HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Monday, December 8, 1997

• 1617

[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): I'll call the meeting to order. This is the tenth meeting of the Standing Committee on Health, and it's Monday, December 8, 1997.

With us today we have today the Honourable Allan Rock, Minister of Health. We're glad he had the time to be with us to give his comments on the estimates, and he has three people with him. Mr. Rock, maybe you could introduce them to the members sitting at the table.

The Honourable Allan Rock (Minister of Health, Lib.): I'd be delighted to, Madam Chair.

First, let me say hello. Thank you for having invited me. I know it's my responsibility, but it's also a welcome opportunity to appear before colleagues of the House with whom I will have the privilege of working on matters relating to health during the coming period. I know that, to a great degree, the members of the committee and I share objectives in common. I very much look forward to our collaboration. As I've done directly, both with colleagues from my own party and with representatives of others, I offer and commit the cooperation and openness of the department and officials, and we pledge to do everything possible to assist colleagues in their work in the House and in this committee.

I am pleased to have representatives of the department with me this afternoon.

[Translation]

I would like to introduce the Deputy Minister, Ms. Michèle Jean; the Associate Deputy Minister, Mr. Alan Nymark, Mr. Robert Lafleur, Senior Assistant Deputy Minister, Corporate Services Branch; Mr. André Juneau, Assistant Deputy Minister, Policy and Consultation Branch;

[English]

Dr. Joe Losos, assistant deputy minister with the Health Protection Branch; Mr. Ian Potter, assistant deputy minister in the Health Promotion and Programs Branch; Mr. Orvel Marquardt, who is the director general of the Departmental Planning and Financial Administration Directorate; and

[Translation]

Mr. Guy Bujold, Director General, Intergovernmental Affairs.

• 1620

[English]

The Chair: Mr. Rock, there was some concern about how long you would speak. We have an hour and a half, and we're just hoping you don't quite use up the hour and a half. All the members have questions to ask you, so if you could just keep your comments down.... We're not going to say five minutes, like we to do to everybody else, but it's just so they have time to ask some questions.

Mr. Allan Rock: I'll be respectful of time constraints. My purpose really is just to introduce myself in this capacity, and to touch briefly on some of the priorities of the department.

[Translation]

I would like to mention very briefly the priorities of the Department of Health.

The first is obviously to ensure the future of the health insurance system, because Canadians are afraid that their family members may not be able to obtain the quality service they will need in the future. I think that Canadians deserve to know that a one-tier public system will continue to provide them with high- quality health care. We have already taken an important step in announcing an increase in the Canada Health and Social Transfer.

The minimum cash contribution is increased to $12.5 billion instead of $11 billion. In fact, this afternoon, the Minister of Finance tabled in the House of Commons an amendment to ensure an increase in the minimum level for this year and the next five years. As a result, over a four-year period the provinces will receive a further $4.8 billion, which they will be able to use to meet the healthcare requirement of Canadians.

[English]

What I could do is touch upon some of the specific files we're concerned with at the moment in keeping with that first, most important priority. The first is to see to the improvement and modernization of medicare.

The Health Transition Fund, which was announced last February, Madam Chair, will enable us to spend some $150 million over the next two years in pursuit of four priority areas with the provinces: reform of primary care; a better integration of health services; exploring prospects for pan-Canadian home care; and a pan-Canadian pharmacare enterprise. In pursuit of some of those priorities, we will be co-hosting three national conferences during the coming months with provincial ministers, and they will be dedicated to exploring home care, pharmacare and pan-Canadian information systems respectively.

I should touch as well upon the Health Protection Branch and the regulatory responsibilities of the department. Quite apart from medicare issues, we are looking to fortify and improve the already strong capacity of the department in connection with public health and safety. The bottom line of this government—and my bottom line as minister—is the safety of the public and their health.

As you know, the Health Protection Branch carries out its responsibilities of assessing, monitoring and responding to public health needs, including risks to the safety of food, drugs and medical devices. Program review entails some reductions of resources for the Health Protection Branch. In recent months, I imposed a moratorium on some of those reductions, Madam Chair. In fact, I have reinstated projects that had been stopped altogether, and I have appointed an arm's-length science advisory board to provide me with independent advice from knowledgeable people on the question of whether or not we have within the department sufficient science to meet and fulfil our responsibilities. That science advisory board will soon be at work for that purpose.

In terms of specific files, I'm grateful that the committee is undertaking the work of looking at the best way to deal with herbal remedies. I know you have already received a technical briefing from officials at Health Canada. I think the task there is straightforward, although its achievement may not be simple. I cancelled plans to put certain regulations in place—they had first been intended for July of this year, and then for January of next—which would have imposed a more elaborate regime for licensing of those who wanted to import or sell herbal or natural remedies.

• 1625

It seems to me that this committee and the parliamentary process is best able to examine fully and responsibly the best way to achieve what I think should be our objective—that is, the proper balance between freedom of access by mature Canadians to natural products, and that degree of regulation that is necessary and desirable to prevent abuse, to weed out people who might be fraudulent or dishonest, or who might try to sell impure or dangerous products.

I look forward to receiving the report and recommendations of this committee on that important subject.

[Translation]

I would also like to talk about the blood supply. Since my appointment as Minister of Health last June, I have worked closely with my provincial and territorial colleagues and also with healthcare consumers in order to set up a new blood system.

We are seeking to set up an integrated system with clear traditional requirements and a degree of transparency which will gain the trust of Canadians. In my department, we have enhanced our ability to regulate blood and blood products more effectively through improved monitoring of diseases and the setting up of an advisory committee of experts to help us regulate blood products.

[English]

With the receipt of the Krever report, we have now additional and detailed guidance on issues relating to both governance and regulation of blood and blood products. In the months to come, I'll be working with provincial and territorial partners to take on board the important recommendations Mr. Justice Krever has made.

I should mention two other things before I conclude and invite questions, Madam Chair. The first has to do with aboriginal health, and the second with children.

On the subject of aboriginal health, members of the committee will be aware of the special responsibilities the Minister of Health has in relation to aboriginal and first nations persons living on reserve. We are, in effect, in the place of a provincial government in relation to the rest of the country. We have the responsibility of delivering health services, which we do to a total cost of about $1 billion every year.

The plight of aboriginal persons in this country insofar as health is concerned is not good. Their health difficulties reflect the challenging social and economic circumstances in which they find themselves. Notwithstanding that, we work hard, through the Medical Services Branch—Paul Cochrane, who heads that branch, is here this afternoon—in order to fulfil our responsibilities to the aboriginal persons in that regard.

We will be working to put into place the aboriginal head start program, which we undertook to do, and to create an aboriginal health institute, so that we might better understand some of the unique health challenges facing the aboriginal population.

Let me close by mentioning the subject of children, not because it's least important—in fact, it's one of the most important responsibilities I bear.

As a result of my office, Madam Chair, I am responsible for the national children's agenda. I am the chair of that initiative. I work closely with my colleague Pierre Pettigrew, the Minister of Human Resources Development, and also with provincial ministers who share that responsibility.

In the course of the coming months I expect we will be working together to define the contents of the national children's agenda, to express it in concrete, achievable objectives. We will work methodically until we address together the issues and challenges that face Canadian children, whose circumstances should reflect the riches of the nation, but whose condition too often instead shows the prevalence of poverty, and as a result, opportunities for those children are limited.

[Translation]

I fully appreciate that committee members will have their own questions they wish to ask. Therefore, I will conclude here and thank you for your attention. I will be very pleased to answer any questions you may have.

[English]

The Chair: Thank you very much. That's pretty impressive.

Mr. Hill.

• 1630

Mr. Grant Hill (Macleod, Ref.): Thanks, Madam Chair, and thanks to the minister for being here.

I'll try to keep my questions brief and I ask that the answers be brief as well.

About smoking and sponsorship, to begin with, does the minister accept that there is a connection between youths beginning to smoke and exciting advertising at events like car races and white-water kayaking?

Mr. Allan Rock: I don't know if it's as simple as cause and effect. I know you want me to keep my answer brief, but I don't think a yes or no is appropriate for a question like that.

There's no doubt that when tobacco companies associate themselves with glamorous events it's in an effort to legitimize themselves and make their products look like normal products, like everything else, and we should discourage it. That's why sponsorship is discouraged and limited by the legislation that we've already adopted and will be limited and discouraged by any amendment that we bring forward.

Mr. Grant Hill: In my view, the weakening of the bill that was promised by another health minister, and which you're following up on, is a grave error. And I'm going to give four reasons why I think it's such a mistake.

The Canadian Medical Association, the Canadian Dental Association, and the Canadian Nurses Association all stand vigorously opposed to this reduction.

Belgium and France have both found the wherewithal and strength to withstand the pressure and they have said no.

On November 16, The Lancet, a pre-eminent medical journal from Britain, had very fresh data showing that the second strongest reason for young men to start smoking is the watching of Formula 1. This was so important that the researcher did not continue the study for five years, but immediately reported it. That's unheard of in research.

Finally, and this maybe has a little political spin, the government in Britain received a huge amount of money from Formula 1 and had huge political problems.

And to my mind, there is a political component to this. Your government looks weak. This looks like a U-turn, like a reverse on a very important issue.

For those reasons, may I have a comment from you, please, as to why you're going down a route that surely is weakening this bill?

Mr. Allan Rock: First, I think the context is important. For decades, we in Canada have had the strongest and most far-reaching regulation of advertising, sponsorship and promotion by tobacco companies. Whether it's in terms of labelling or advertising or the regulation of tobacco itself, we've gone farther and faster than virtually any other country in the world. We've set the standard in many respects.

Two years ago, our Supreme Court of Canada struck down that far-reaching legislation, saying in fact that it went too far because it virtually denied commercial free speech. We went back to the drawing board and we prepared the Tobacco Act, which was adopted this spring and which puts in place at present measures the Europeans last week were only talking about phasing in over the next nine years. We are ahead of them in every material respect: advertising, labelling, promotion and sponsorship. We are ahead of them.

So I think that to say this is a U-turn or to say that we're substantially weakening the national thrust or the pan-Canadian position doesn't do justice to the strides we've made in the legislation.

Let me also say that

[Translation]

the deputy minister was in Geneva a few months ago at an international meeting, and representatives of about 40 countries asked for a copy of our bill because they saw that it was the best way of reducing smoking. We have sent copies of our bill to 45 or 47 countries around the world.

[English]

We're very proud of it.

Dr. Hill, let me just finish quickly by saying—

[Translation]

Mr. Grant Hill: Thirty seconds.

Mr. Allan Rock: I myself have a daughter twelve years of age and twin boys ten years of age, and I am very sensitive to the fact that they are now at the most vulnerable age for tobacco companies. It is very important to discourage smoking among young people. We have adopted legislation against smoking, and over the next five years we intend to spend $100 million as part of an integrated strategy to be implemented across the country in order to encourage young people not to start smoking.

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[English]

It's not just the act, not just the regulations, but that effort.

If by creating that exception for Formula 1 sponsorship we to a limited extent permit that to continue, as other countries of the world are doing—because it's an event that's broadcast by television throughout the world in any event, no matter what we do in Canada—perhaps that's not the most gleaming feature of our initiative, but it has to be seen in that broader context and I urge you to do so.

[Translation]

Mr. Grant Hill: The problem is most acute in the province of Quebec. We have seen a staggering rise in the number of young people smoking, an increase from 19 to 38% between 1991 and 1996. That is not very, very encouraging.

Mr. Allan Rock: I agree. Part of the problem is due to the fact that we reduced cigarette taxes a few years ago because of smuggling. As you know because you were there, the Minister of Finance said this afternoon in answer to your question: "Yes, I would like to further increase taxes on cigarettes".

This is an important factor in the decision of young people to smoke or not to smoke. However, we need the consent of the provinces to do this. I hope that we will manage to get that consent, because it is very important in the fight against smoking to tax cigarettes at such a level that young people are discouraged from buying them.

[English]

The Chair: Thank you.

[Translation]

Mr. Allan Rock: Smoking among young men and women is a very serious problem in Alberta, not only in Quebec.

[English]

The Chair: Sorry, to Mr. Hill's advantage I forgot to mention the time.

Mr. Ménard, who's not a regular member of this committee, would like to speak now, I presume in place of Madame Picard. Do I have the committee's indulgence?

Okay, Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): May I ask more than one question, Madam Chair?

[English]

The Chair: You have five minutes.

[Translation]

Mr. Réal Ménard: You will no doubt not be surprised that I should ask a question about the National AIDS Strategy. As you know, a subcommittee reviewed the overall Strategy for three years. There are three major recommendations about which I would like to obtain your opinion, since when you made your announcement in Toronto you remained relatively silent about this point, whereas it is well known that you are not naturally a silent person. Therefore, I will give you the opportunity to express your position on this question.

As regards the licencing of drugs, there is, as you know, a very specific report which argues that the drug licencing system in Canada is not very competitive, and a committee was set up at the deputy minister level to review the whole question. I would be grateful if you could give us an update on the issue.

Second, as you know, Canada is the only industrialized country with a clinical trials network which does not have its own budget, with the result that clinical trials conducted in Canada are paid for by pharmaceutical companies. That is not always in the interest of the people affected.

A recommendation was made on this subject. As you know, the Canadian Clinical Trials Network has a budget of $2.9 million, which is in fact controlled by pharmaceutical companies. Do you share my concern and consider that it would be desirable for your government, as part of the reallocation of resources, to give a larger budget to the Canadian Network so that trials might be assessed by the Network rather than by pharmaceutical companies?

Third, you appreciate the importance community groups place on the fight against AIDS. You yourself pointed this out at your press conference in Toronto. The main support program for community groups is the AIDS Community Action Program, known as ACAP.

This program is divided into specific services and support services. Community groups have asked for more money to be given to the operating program. Do you intend to accede to their request? I'll begin with these three questions, and I also have two others.

Mr. Allan Rock: First, in answer to your question about community groups, as you know, I have met a number of national and local groups to discuss the third phase of the strategy to combat AIDS and HIV.

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A few days ago in Toronto, I announced funding of the third phase of this strategy and our objectives, which include helping community groups in the fight against AIDS and in the treatment of AIDS victims.

We have not yet decided on the specific allocation of the $42 million which will be given each year over the next five years. However, it is clear that we must respect the role of community groups. We will do so in the way the money is spent.

Mr. Réal Ménard: Therefore, you basically support the request or those groups asking for more money to do their work. That is what I understand.

Mr. Allan Rock: Yes, and we are currently holding discussions with the groups concerned about the specific amounts needed to do that.

Mr. Réal Ménard: What do you think of the Canadian Network?

Mr. Allan Rock: We discussed the funding of a Canadian network so as to test drugs here in Canada, and not rely on the decisions of international companies which comprise the networks in the United States, Europe and elsewhere. I am sure we can make progress on that issue. I'm not sure that I can announce details at present, but we are working with pharmaceutical companies and a group from Vancouver involved in this area in order to improve the situation.

I will be very pleased to ask someone from the department to provide more details at an informal meeting with you, if you wish.

Mr. Réal Ménard: Thank you. Perhaps Ms. Jean?

Mr. Allan Rock: Yes, perhaps. She is fully aware of all these developments.

[English]

The Chair: Your time is really up.

[Translation]

Mr. Réal Ménard: Madam Chair, you know me. So we really have to ensure that the licencing process, which is not very competitive compared with the system in the United States... Before a drug is licenced, there are four stages. Some witnesses have even suggested that the process be combined with that used by the FDA in the United States. I know that you have a task force in your department studying this issue. It might be useful to discuss this together.

Mr. Allan Rock: In order to coordinate the work of both governments when approving pharmaceutical products?

Mr. Réal Ménard: So as to speed up the process. We are told that it is a matter of resources. There are 300 people working at the FDA whereas I'm told that you don't have quite 25. Therefore, there is a problem of resources, but drugs must be licenced more quickly. Essentially, it's for the study of monographs that resources are needed.

Mr. Allan Rock: That's correct. Our two authorities already share information, and we have also set targets to reduce the time the Department of Health needs to approve drugs.

Mr. Réal Ménard: On average, how much time does it take?

[English]

The Chair: Excuse me, your time is up. We've gone well over. If you want to, you can ask another question when we come around.

Mr. McTeague.

Mr. Dan McTeague (Pickering—Ajax—Uxbridge, Lib.): Thank you. That woke me up as well, Madam Chair, and in very good time.

Mr. Minister, I want to thank you very much for coming to this committee. I'm sure you're going to find a diversity of questions here. It's almost as if every member has his or her own special interest in dealing with the whole question of health. I don't know how you're going to keep it all together, but let me try.

I have two very brief questions, and I'm sure it won't take you five minutes to answer.

The Patented Medicine Prices Review Board is currently under investigation. There is an internal audit by the Auditor General. It is very clear that your statements on the question of pharmacare have a lot to do with the recognition of rising drug prices in this country. I wonder if you could give me an illustration of what you think the future of the PMPRB ought to be, given that drug care is an important part of our health care system and the question of affordability seems to be very much compromised. There are obviously questions about methodology, and I'll let the Auditor General respond to those concerns, which have been raised before.

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My second question deals with the Health Protection Branch and a decision earlier this summer to shut down the Drugs Directorate. I'm wondering what assurance you can give to the committee that the question of safety will remain paramount, notwithstanding the fact that there are a number of scientists who I understand have been redirected.

I seem to recall a letter a number of scientists provided your department concerning the future of the Health Protection Branch and in particular the question of safety as it affects our ability to make decisions on the question of drugs that are at arm's length from the cost-recovery initiatives of the pharmaceutical industry.

I realize that's a very loaded question, but I think it deserves to be aired. I certainly would like to hear your opinion in order to have that answered.

Mr. Allan Rock: Let me take those in order, Madam Chair.

First, the Patented Medicine Prices Review Board, or PMPRB, is an important board that performs an essential function, which is to say it watches carefully and compares the prices of pharmaceuticals that are patented against an international standard. So while intellectual innovation is rewarded and may be exploited for commercial benefit, it's done in a way that doesn't subject the health system in Canada to inordinate costs. It keeps us in line with an international standard that's appropriate.

The PMPRB, under the leadership of Dr. Elgie, has made a real contribution. Its periodic reports detail its findings and the steps it has taken to track and sometimes keep drug prices within the standards it has set.

The question arises whether the PMPRB can be strengthened and improved in the role it performs. As you know, the Standing Committee on Industry of the House in the early part of this year, along with some of the membership of the Standing Committee on Health, looked at that whole question and came up with some observations and recommendations.

Minister Manley and I are engaged now in looking at those recommendations and in specific possible steps that might be taken to enforce the role of the PMPRB and make it even more effective. We hope to be in a position in the not-too-distant future to announce what we'd like to do in that regard, and bring it here to have the views of this committee if steps are proposed that affect legislation.

In terms of the Health Protection Branch, I don't recognize your reference to shutting down the Drugs Directorate. I know in the summertime we made an announcement that closed some research labs that affected the setting of standards for food safety that then went off to the inspectors in the Food Inspection Agency.

I emphasize two things. First of all, in answer to your question about safety, I repeat and I emphasize that the safety of Canadians is the bottom line for me and the department. That is what we are there for, and we are determined to fulfil that responsibility.

We imposed a freeze on further cuts. We rolled back some of the decisions to close those labs and in fact reopened them. We have the scientists back at work on the very projects that were stopped, as they relate to food safety and researching certain subjects in relation to food.

As I mentioned in the opening, Mr. McTeague, we also went outside the department and persuaded about 15 scientists from the Science Advisory Board—most of whom have world reputations and some of whom come from outside Canada—under the leadership of Dr. Roberta Bondar, who will serve as chair, to look critically at the science component in the Department of Health so we don't have to take my word for it or the word of a member of the committee for it. We might disagree as to whether we have enough scientists or the right kinds of scientists.

As I've said, let's put this question in the hands of those who understand science, who have no axe to grind, who are independent of me and the government. Let's have them look critically at what we're doing, and if they recommend we increase the strength of our scientific complement in this element or that of the Health Protection Branch in order to fulfil our function, we'll have that recommendation before us.

The last thing I'll say on that point is the Health Protection Branch itself is in the process of renewal. It's about to publish a consultation document that will ask for public and sectoral input into how it should do its job. It's a three-year transition that will see the Health Protection Branch modernized and strengthened to do its difficult job in a modern and complex world.

We're determined to get it right, to fulfil the responsibility and to respect our first duty, which is the safety of Canadians.

The Chair: Thank you, Mr. Rock.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you.

• 1650

Let me start with three questions on different areas. First, I'll follow up on Dan McTeague's question on the Health Protection Branch, and specifically the drug research bureau, since it was under your ministry that the drug research bureau was shut down completely. I believe it was a cost in the budget of only about $2 billion.

From all of the study I've done on the issue, it seems to me that in fact the drug research bureau provided a valuable role in terms of assessing the impact of a drug once it hit the market and was able to determine the impact between drugs, between drugs and foods, and between drugs and environmental issues.

As I understand it, as one example, by the closure of that bureau we lost the only reproductive toxicologist in the country in terms of an independent force being able to assess the interaction of drugs in terms of pregnancy or whatever.

Mr. Allan Rock: Food research?

Ms. Judy Wasylycia-Leis: No, I'm talking about the drug research lab that was shut down.

Would you agree to at least review the impact of that closure, include it your overall assessment that is under way now with your committee of scientists, and make a commitment to reinvest in that area since it is a fairly insignificant, small amount of money in the overall scheme of things, with a great deal of benefit, in my estimation, for the Canadian population? That's question one.

Two, on the question of patented medicines, many recommendations were made at that industry committee last spring, some of which did not appear in the final industry report. One that has been raised over and over again is with respect to getting rid of the notice of compliance linkage regulations.

Are you prepared to ensure that those regulations are repealed as quickly as possible? It doesn't take legislation, it's an order in council. Will you give us assurances that this is on your agenda and will be done quickly?

The third question relates to your press conference today. Obviously we're disappointed with the announcement, or reannouncement, of the election promise and the Speech from the Throne promise. It doesn't take into account that under your formula, cash transfers for health care will decline in real terms. All you've done is slowed down the rate of decline.

Will you, leading up to the next budget, be fighting to increase the cash floor for cash transfers to the provinces for health care and put in place a formula that takes into account growth in the economy as well as growth in the population?

Mr. Allan Rock: Let me respond in order.

The first question had to do with drugs research. The Drugs Directorate is still there. It is alive and well. The one thing affected by the change was some basic research that was stopped. It was felt that basic research is not the appropriate role of the Department of Health, but research related to the regulatory function is continuing. In fact, it's going to be strengthened.

In answer to your question of whether I will reconsider, let me say that I think there were good reasons why the government withdrew from basic research. I think there's a strong argument that this isn't the role of government.

Let me also hasten to add that the very science advisory board of which I spoke will be looking at the role of the Health Protection Branch. We'll have every opportunity to say that we ought to get back in the business of basic research, if that's their view, and we'll have to assess that recommendation.

I'm not afraid of such a discussion. I welcome it. Let's talk about it. If there's a serious, informed mind out there—a scientist, say—who looks at our mandate, studies what scientists we have, and feels that we should have a basic research capacity in our Drugs Directorate, well, let's hear from them, and we'll talk about it.

On the second subject, the NOC regulations, I know that was a subject of discussion before the industry committee. Let me say that Minister Manley and I are at work now examining the recommendations of that committee. One of the recommendations was to look again at the regulations, to talk with stakeholders and see how people feel about it.

I've done that. I've met with all the interested parties since I became minister in June. I've met with Minister Manley. John Manley and I very much share a common view on this. We have to find a way to reconcile valid industrial objectives with health priorities. We're going to do that.

I think in the months ahead we'll be announcing how we see that being achieved. I hope to be in a position to respond specifically to your question before too long.

• 1655

On the last subject you raised, which is the Canada health and social transfer, you mentioned that you're disappointed at today's announcement. I know that you're a strong proponent of medicare, and I don't understand why you'd be disappointed that we're announcing today we're devoting $143 million of additional cash to the provinces this year for health and medicare. I don't know why you'd be disappointed that we're increasing by $1.5 billion the amount that will be transferred in cash next year. I don't understand—

Ms. Judy Wasylycia-Leis: But you're going to cut next year.

Mr. Allan Rock: I don't know why you'd be disappointed that over the next four years we're increasing by $4.8 billion the amount of money we're giving the provinces for health.

Ms. Judy Wasylycia-Leis: That's what it is now.

Mr. Allan Rock: Right now we're transferring a total of about $25 billion in cash and tax points to the provinces for health and social services. That will rise between now and 2002 to $28 billion.

You ask me whether we're prepared to commit further money. I remind you this is a government that has undertaken already, in relation to the so-called fiscal dividend or surplus, to devote fully one half to reinvesting in social programs where it's needed—we've also said health is a priority—and the other half to tax reductions for those who need it most and reducing the debt.

There have been a dozen polls in the last few months that purport to test the views of Canadians. It's interesting that those polls read together.... Some of them are inconsistent, but if you do the best you can to reconcile them, I think you find broad support for that approach. Whatever surplus we have we shouldn't throw away. We're not going back to the old days of a program for every problem and throwing money at problems the way it was done in earlier years. Rather, we have to be smart about it. We must keep in mind the need to reduce the debt and to reduce taxes for those who are paying too much, and also we must focus on refurbishing and reinforcing our important social programs, health first among them. Of course I can say that this will be among our priorities; it's what we got elected on. That will be our approach.

The Chair: Mr. Thompson.

Mr. Greg Thompson (Charlotte, PC): Thank you, Madam Chair.

Mr. Minister, it's nice to have you with us.

My question is in regard to the smoking issue as well. It seems to me that the health minister is the weakest link in the chain when it comes to cabinet decisions. I believe that in the testimony you've provided to the committee you've indicated you're a great believer in the tax incentive, in tax increases that decrease the amount of smoking incurred by Canadians, especially young Canadians. You recognize a correlation between a tax increase and the number of Canadians, especially young Canadians, who would indeed smoke, if I'm correct. Is that correct, Minister?

Mr. Allan Rock: Kids are very price-sensitive, no question about it.

Mr. Greg Thompson: Mister Minister, going back to the point I'm making, if your primary concern is the health and welfare of all Canadians, which I sincerely believe it is, it appears as if the battle is always lost in cabinet by yourself or previous ministers.

My belief is that the slippery slope they put you and the department on, especially early in 1994, when instead of addressing a smuggling problem, for goodness sake, they decided to abandon the health and welfare of Canadians, especially young Canadians, and said okay, tax reduction.... Immediately most of us, including yourself, would assume that there are going to be younger smokers coming on board. It's a huge problem.

I go back, Mr. Minister, to my point. Are you willing to take that battle to cabinet and see some regressive measures in terms of tax disincentives, if you wish, in terms of smoking? In other words, are you going to support an increase in the taxing on cigarettes to decrease the number of people who are smoking?

I ask that because obviously the battle is going to be fought between you and the Minister of Justice and the Solicitor General. I believe that if there is a smuggling problem it has to be addressed by the appropriate department, and it's not the Department of Health. I suggest that it has to be enforcement on the smuggling side.

It really frightens me to believe that previous ministers, and I hope you won't be included, have abandoned the fight on smuggling and thrown the rest of us to the wolves—that is, young Canadians and those people who may take up smoking or may continue smoking.

• 1700

Mr. Minister, I won't hog all the time. I hope you can respond in a favourable manner.

Mr. Allan Rock: I can respond very directly. My battle is not in cabinet, sir. In fact, I was on the platform with the Minister of Finance this afternoon and he was asked this very question. He said he would be delighted to increase taxes on cigarettes, but we require the consent of the provinces, and so far we don't have that unanimous consent.

So my fight is not in cabinet. And let me make clear....

Shall I not respond to your question?

Mr. Greg Thompson: No, sir, because every time, whether it's the Krever inquiry—it's smoking now, and what was the other one you're waiting for, the pharmacare program—it's always, always consult with the provinces. You're laying the blame on the back of the provinces, whereas as a minister you have a constitutional right and power to act with federal taxation. That is simply a lame duck argument, that you have to wait for the provinces to come on board.

Mr. Allan Rock: If we ran the country as you suggest it wouldn't last very long.

Mr. Greg Thompson: I'll tell you, it will last a lot longer than if we have millions of Canadians, thousands of Canadians, dying from lung cancer. Not many of us will be left. I suggest my course is the right course.

The Chair: Mr. Thompson, could you let him answer the question?

Mr. Greg Thompson: Okay, Madam Chair. I promised I wouldn't beat up on the minister, and I don't want to be accused of that, certainly.

Go ahead, sir.

Mr. Allan Rock: I don't take it that way at all. I know you feel strongly about this, and I share your views.

I will just tell you that we have an agreement with the provinces whereby any such increase will be done by consent, and I don't think we interfere with that lightly.

Let me also say there's nobody in the country who wants to get my kids to start smoking cigarettes. I don't think anybody wants to see an increase in the incidence of smoking, apart, perhaps, from some who might gain by it financially.

Let me just stress this, Mr. Thompson. There is a point of intersection between the level of taxation and the creation of a serious enforcement problem with smuggling. It's easy for you to say the Justice Department and the Solicitor General can go out and stop smuggling. We have hundreds of millions of border crossings every year. We have 3,000 miles of undefended border across which boats and trucks and cars can slip in darkness without being detected.

And don't try to tell me the way to stop a kid from smoking is by making these contraband cigarettes more easily available in the streets. It's not.

So let's do what works; let's do what is smart. Let's do it with the consent of the provinces, so it's done in an integrated fashion, consistent with our agreements. I believe we can—

Mr. Greg Thompson: I believe you're abdicating your responsibility to act decisively and swiftly, whether it's on hepatitis C victims—

The Chair: Thank you very much. Time is up.

Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

Thank you for attending today, Mr. Minister. I think it's very important.

I have three questions. The first relates to MAI. We had testimony last week, conflicting views, on whether or not it was good or bad as it affects health care. I wonder if you could give your assurance that in fact it will not in any way compromise health care in Canada. I think it's important that we hear that.

Secondly, home care is a really important area, and I wondered about the health services adjustment fund, which in the 1997 budget earmarked $150 million, and whether or not pilot projects for home care were being funded out of that fund. As a supplementary question, what do you see as the role of Health Canada in home care?

The third question is you alluded to polls Canadians respond to on a number of issues, and there was one about health care in today's media. It seems to me Canadians are very much looking for a vision for health care as we move into the 21st century. I know time is limited, but I wonder if you could begin to articulate a vision for health care as we move into the new millennium.

Mr. Allan Rock: First of all, on the subject of the Multilateral Agreement on Investment, I was delighted to see this committee took the initiative of convening hearings on that subject over a couple of days and you heard such a wide range of witnesses. I commend you for that, because as it relates to health and other social programs domestically questions arise which must be faced squarely.

I can tell you that as Minister of Health I am very mindful of my responsibility to ensure any international or multilateral agreement we enter into does not undermine or threaten one of our most precious social assets; and I know the Minister of International Trade feels exactly the same way and just as strongly. The conclusion I've reached, based on briefings I've had, based on questions I've asked and information I've received, is that any such agreement as proposed at present.... We have to remember it's now in the negotiation stage, so there is a long way to go before any agreement is reached. Nothing in any of the proposals now under discussion would undermine Canada's capacity to maintain, and indeed strengthen, our own domestic health policy and medicare program or continue to strengthen and administer publicly financed, single-payer health systems throughout the country. So I don't see any threat to medicare from the MAI.

• 1705

I bear in mind as well—I urge you to remember this—that when the Canada-United States Free Trade Agreement and NAFTA were under discussion, there were also allegations that these would bring medicare to an end. These were to undermine our capacity and independence to maintain medicare. Of course that didn't come to pass. The allegations and accusations were wildly distorted and didn't bear any relation to the facts.

I think we should continue to monitor this. I think we should have reports periodically on the state of negotiations. You should call upon me to repeat my assurances from time to time. We should monitor it, because health care and medicare are too important to let any such possibility arise. I can just give you my view, but based on what I know to date, it's not threatened by the MAI.

On home care, the role of the federal government, in my view, is to show leadership in identifying the need for a consistently high standard of community care for Canadians throughout the country.

It seems to me that the Canada Health Act, which was written in the early 1980s and put into force in 1984, represents a snapshot of the health care system at that time. It was a system that focused on institutions and services furnished by doctors. It ensured health care only as long as it was provided in the hospital or by a physician, in keeping with the provincial insurance plan.

That snapshot has remained static, but the reality of health care and its delivery have changed as the years have gone by. We now find a trend toward fewer hospital beds and more community and home care. I think there has been a 15% reduction in hospital beds over the last five years. There's about the same percentage increase in care going on in the community and at home.

Indeed, I read a statistic a few weeks ago or a couple of months ago now that was really impressive to me. One in five Canadian women between the ages of 35 and 55 is looking after someone in the home either chronically ill or disabled, and half of those women are also working outside the home. Many of them have children they are caring for as well.

These women are reporting difficulties with their own health as a result of the burden they're carrying. To use the too often used term “offloading”, we have to ask: Has the system disproportionately offloaded responsibility onto women for care from the hospitals to the communities to the homes? That's with the effect that we have to take a look at whether comprehensiveness of care in the national insurance plan is still properly defined in the current context. I think those are questions worth examining.

We are convening a national conference on home care in early March that will bring together not only provincial, federal, and territorial governments, but also a vast range of people who are interested in and knowledgeable about these issues to look at the following questions.

First, how can we define home or community care? What should it include?

Second, once we have it defined, how should it be financed if it's going to be insured publicly? Should all of it be insured, or just part of it? Should there be a role for private insurance? Should there be some system of co-payment or deductible?

Third, what's the respective role of the federal and provincial governments in furnishing or paying for these services?

Fourth, how could we establish and superimpose a pan-Canadian system upon what's already in place in the provinces to varying degrees that might establish a standard level of service and care with those who are properly trained to provide it?

Those questions will be examined in the course of the coming months, particularly at the conference, but beyond the conference as well. I think the questions are well worth considering, because I believe that many services that are so-called medically necessary are being furnished now but are not being insured, because they're not being furnished by physicians or they're being furnished outside of the hospital context. But they are medically necessary nonetheless, and we have to look at the question of whether Canadians are being properly served as things stand.

The Chair: Thank you, Minister.

Mr. Allan Rock: I haven't had a chance to answer your last question. Perhaps later on, or under difference circumstances, I would be able to.

The Chair: Mr. Vellacott, are you yielding your time to Mr. Hill?

Mr. Maurice Vellacott: Yes.

Mr. Grant Hill: I'm just back for a little touch on tobacco, a quick one.

• 1710

When Mr. Dingwall was the minister he said that he would respect the international standard on race cars. You have chosen an international standard I disagree with. I would prefer you chose the international standard of France or Belgium or the WHO, who say that sponsorship should be completely gone. I make that as a statement rather than a question. The international standard gives you a way out, by the way.

You brought up the Canada Health Act. I wanted to go over three specific breakdowns in the Canada Health Act for your consideration.

On accessibility, the figures are arguable, but the figures I'm using are that over 170,000 people in Canada are on waiting lists today. There's no qualifier in the Canada Health Act to say when accessibility has broken down. There should be.

On portability, vacationing Canadians are promised a payment if they get ill. There are provinces who are not making those payments. That breaks the Canada Health Act in a very specific legalistic way, something I'd think you'd be interested in. Quebeckers travelling outside their province are not paid what the province in which they get sick allows them. They don't have portability.

On universality, many provinces are covering different things. That does not give a universal program. A test-tube baby is one example. Facility fees are also being overlooked in some provinces. In my view, the Canada Health Act is coming apart at the seams. You've said it was basically an act that came out in the 1980s. That's true. I would like to have a commentary, if you will, on the selective enforcement of the Canada Health Act.

Mr. Allan Rock: All right. First of all, while the Canada Health Act was a snapshot of the medical system or the health system of the early 1980s, which focused on hospitals, I think the principles of medicare and the principles of the Canada Health Act are timeless. I think their application may have to be changed to meet the changing circumstances, such as the shift from hospitals to community. But the principles remain every bit as valuable and valid as they were in 1982. I'm here to defend them and to say they won't change as long as we're in office.

You mentioned accessibility in the context of the people on waiting lists. You used a number; I don't know where it comes from. There are various numbers, depending who you ask. I hope you're not using the Fraser Institute numbers, because that was a survey that used methodology that is highly suspect, and is, as usual, more ideological than statistical. But let's take the fact that there are people on waiting lists.

A lot of work is being done by some serious-minded people around the country on waiting lists in terms of what they mean, how they're compiled, and what we can do about them. I can't claim to be an expert on it, Dr. Hill. I've been in this job for less than six months, so I don't pretend that I'm an expert. But let me tell you what I have learned, because I have spent considerable time over the last six months talking to people who do know. I have had roundtable discussions with experts on health care, on health policy, in various parts of the country.

Some of the things I've been made aware of are that some of these lists are for people who are awaiting elective procedures, with no degree of urgency. Some of these lists are appropriate. You should have waiting lists for some elective, non-urgent care where you're allocating services rationally.

Some of them result from mismanagement in the sense that you'll have a waiting list at facility A while facility B has no waiting list, and no one has thought to share the resources in a way that's more effective. Still others reflect decisions on the part of the provincial governments in terms of where they're going to allocate their dollars, whether it's to this diagnostic machine or that.

For example, there are some jurisdictions in Canada that have budgetary surpluses, so money can't be the problem, that indeed are calling conventions to discuss how they're going to deal with their surplus, and that have not invested in certain diagnostic machines, the deployment of which might indeed reduce some of those lists.

So the mere fact that there are lists I don't think should be taken as a starting point or the first premise for a syllogism that leads to a conclusion about the Canada Health Act being outdated. Sometimes it goes to management skills; sometimes it goes to reliability of information; sometimes it goes to decisions about investment.

But let me say this, Dr. Hill, on accessibility: We are at the moment investing with the provinces in a really crash effort to create a nationwide information system that will link the all too often isolated information systems that are in place at present, so that we can share information nationally about the management of waiting lists, determine best practices, and try to get some of them reduced where there shouldn't be lists.

• 1715

On portability, the “snow birds” issue is before the court. It comes down to an interpretation of the statute and the obligations of provinces. It is a matter that is under appeal. I think we've intervened in the appeal, and our point of view will be stressed in the courtroom.

On universality, it's true to say that provinces exercise their own power to decide what's listed and unlisted, in different ways. It's true to say that in one province some things are in and in other provinces other things are out. But for the most part, those are at the margins, and the truly medically necessary services are covered in a consistent way throughout the country.

To the extent to which there is inconsistency, in September of this year in Fredericton we created with the other health ministers five working groups, at least one of which is devoted to determining how we can get a standard protocol for deciding what's in and what's out so that we pick even those things that are at the margins.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Minister.

[Translation]

Mr. Drouin.

Mr. Claude Drouin (Beauce, Lib.): Thank you, Mr. Minister, for coming to meet with us this afternoon.

My question deals with food safety. In the budget speech of 1996 reference was made to changes to the food inspection system, and I'll be grateful if you could provide us with details on the way the food safety system is being changed. How is the new system different from the old one, and what were the reasons for setting up a single food inspection system?

Mr. Allan Rock: The system was changed because there were three or four provincial and federal levels within it. It was changed to make it more efficient, to move things along. We created the Canadian agency, which is unique and has 4,000 people working solely on ensuring the safety of food in Canada. This agency reports to the Minister of Agriculture. The Department of Health is not directly responsible for the Agency, but to the best of my knowledge they are working at the present time to increase its efficiency. It's less expensive and more efficient.

The deputy minister informs me that the Department of Health is responsible for standards, policy and research, but the operations of the agency are the responsibility of the Minister, Mr. Vanclief.

Mr. Claude Drouin: Thank you.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

[Translation]

Mr. Dumas.

Mr. Maurice Dumas (Argenteuil—Papineau, BQ): I congratulated you earlier, Mr. Minister, on your excellent French. I wouldn't want you to consider that my three questions are the brickbats which follow the bouquets.

Mr. Allan Rock: I prefer bouquets.

Mr. Maurice Dumas: In the fight against AIDS, is it to be hoped that one day marijuana may be decriminalized if used for therapeutic purposes? I think you have been challenged to answer that question.

My second question concerns the amendments to the anti-tobacco legislation. Will they apply to the sponsorship of sports and cultural events, and will you undertake the meet the Ralliement pour la liberté de commandite before tabling those amendments?

My third question concerns Bill C-14, specifically the control of materials coming into contact with water. Do you still maintain that you have the support of the Quebec government for Bill C-14?

Mr. Allan Rock: Is Bill C-14 about drinking water?

Mr. Maurice Dumas: Yes.

Mr. Allan Rock: Thank you for the bouquet. You are very kind.

As regards Bill C-14 in answer to questions by Bloc members, I have tried in the House of Commons to clearly explain the position of the federal government. Drinking water is clearly a provincial responsibility.

• 1720

However, we have developed legislation on drinking water material, not drinking water as such, but for example imports and sales of materials used to transport or treat drinking water. Filters used to put drinking water on the table are a material affected by this bill.

We have been in consultation with provincial governments for years with a view to developing such standards and approaches. Therefore, I am sure that our bill does not infringe on provincial areas of responsibility, and that we are acting fully within federal jurisdiction.

Mr. Maurice Dumas: Mr. Minister, as regards C-14, it is always a fear that the federal government might put its foot in the door and at some point go further and open the door completely.

I must tell you that at its meeting of November 29 and 30 last, the National Council of the Parti québécois including the Premier, Mr. Bouchard, adopted a unanimous resolution opposing Bill C-14.

Mr. Allan Rock: They may have changed their position, because previously it was considered a matter of health policy whereas now it is a political issue. That is unfortunate, because I think we have done something to improve the situation with C-14.

As regards the anti-tobacco legislation, I have met with Max Beck and the Ralliement pour la liberté de commandite, as well as people from Juste pour rire, the Circuit Trois-Rivières, and representatives from Montreal, Toronto and Vancouver Jazz Festivals, and people from the fireworks displays. I met them during the summer and explained that I would try to find an approach which would protect their interests, but I am the Minister of Health, and my priority must be health. We are considering an amendment to meet the commitment of last April, but I must also promote the health objectives of the anti-tobacco bill.

The have not ruled anything out. At the present time, we are considering a wide range of possible amendments to the anti-tobacco legislation which would enable us to meet our commitment, including initiatives to protect other people. I can assure you, Mr. Dumas, that my priority will be to meet the government's commitments and health priorities. Therefore, it is certain that we are working on the issue and I hope that we will be able to propose an amendment soon.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Minister.

Mr. Szabo.

[Translation]

Mr. Réal Ménard: What do you think of marijuana?

[English]

The Vice-Chair (Ms. Elinor Caplan): Excuse me. It's Mr. Szabo's turn.

Mr. Paul Szabo (Mississauga South, Lib.): Welcome, Minister.

I want to make a quick point. I hope that fetal alcohol syndrome remains on Health Canada's agenda. It is an issue I've followed, and I think it's quite important.

I did want to thank you for mentioning children and investing in children. Last November the National Forum on Health issued its report. The issue of investing in children was a very significant portion of it, and it was very clear that it wasn't just a health department issue. It touched upon HRD, taxation, etc., that very clearly you're going to have to be working.... My question for you, though, has to do with targeting, or health strategy, the health department's role in terms of investing in children.

Last April a research report on the development of the human brain was actually announced in the White House. They said that the foundations for rational thinking, problem solving, and general reasoning are all established by age one. This kind of ties in with the Dr. Fraser Mustard stuff on the formative years. It means that the vital period of influencing children's ability to learn and to cope and to be healthy physically and mentally as well as socially—that this is a prime time for us to be investing in children.

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Let me further complicate it by the fact that as you well know, family breakdown in Canada is a very serious problem as well, and that the breakdowns are prevalently occurring during the first five years of marriage.

When you put all this together, I want to know, in terms of your overall health strategy, whether you feel there is a role for Health Canada to play in terms of assisting families, not simply by giving money to the lowest-income-earners you can find, but in fact recognizing that poverty is only an exacerbating factor, not a causal factor of poor outcomes of children, and that we somehow have to get down to where the high-risk elements are of childhood outcomes so that we do in fact serve the health needs of our children.

Mr. Allan Rock: Mr. Szabo, your interest in these issues, particularly early intervention, is well known, and I'm delighted to have a chance to speak to you about it. The fact is that the national children's agenda, in my mind, should focus on early intervention and readiness to learn.

In the Speech from the Throne we undertook to use readiness to learn as a benchmark by which to gauge our success. I think it's a wise benchmark to choose, because I think it includes a variety of other factors—from proper nutrition, to nurturing, to familial care—that are implicit. If you get a child who comes to kindergarten or grade one with emotional stability, with brain development, with social adjustment such that they can sit down and start learning, then I think you can say that child has the building blocks in place for a successful life. Readiness to learn can be something that discloses symptoms of underlying problems. So I think it's a good benchmark.

We haven't got a lot of time. Let me come to one point that I think is central. I think one of the most effective things that government does is the community action program for children. It's not much heralded—in fact, it's very little known—but it's remarkably successful. It is a two-key system, as they call it, between the federal and provincial governments. We set aside money—which we have just increased to the tune of $100 million over the next three years—which we devote to community projects that focus on children. We don't spend a nickel unless the province agrees that it's properly spent and they contribute. So both of us spend on the same project; we both agree it meets our criteria.

These are community plans, so we're not forcing anything on people. This is something they do for themselves—thousands and thousands of volunteer hours every month. I've visited a variety of them.

[Translation]

I visited the Dispensaire diététique in Montreal, which I think has been there for 123 years.

[English]

In Toronto, I visited the George Hull Centre for Children and Families in my own riding of Etobicoke Centre. I visited in Oshawa a program that helps young single mothers cope with the sometimes overwhelming adjustment of having a little baby to look after.

These programs take a variety of forms. I can tell you that in 500 communities throughout the country there are 750 of these projects that touch the lives of 30,000 Canadian children a week. Relying to a very great degree on volunteer efforts by parents and others, they help single mothers in distress. They give them a break. They give them education on how to look after their kids. They help kids socialize with others. They give them a place to go, maybe to get a hot meal or to get some assistance in learning to read. They help in very many varieties of ways.

If we were to focus on that kind of programming—build on it, invest more in it—I think we could go long way toward achieving some of the goals I know are very close to your heart, and it would produce healthier children in the long run.

My time is up.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Minister.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you. Again, let me try to do three or four issues. I'm assuming this is probably my last chance to raise a number of issues.

Mr. Minister, you did not answer my question about the fact that your announcement today does not address the fact that your government still took $6.8 billion out of the cash transfer payments for health and education and social programs. We're still dealing with the fact today. This is causing the problem Mr. Hill mentioned in terms of waiting lists. It is causing this huge agenda of privatization in this country. My question remains: Where are you going to look at ensuring a formula that is meaningful in terms of health care needs and that is based on growth in the economy?

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Number two, you did a disservice to the drug research bureau by simply suggesting that this is basic research, as if it's some airy-fairy scientific nonsense, when in fact the issue is very much related to thalidomide. The same type of issue could face us today. You've taken away the capacity in our government for independent research in terms of drugs that meet standards that are on paper. They get into the marketplace and they could run into problems in terms of mixing with other drugs or foods or if they do not take into account particular situations like pregnancy.

Number three, I don't know if you're aware of all of this, but certainly everything we're hearing is that there's an agenda of deregulation and privatization going on in the Health Protection Branch. There's a copy of a paper circulating now called Keeping Faith With Canadians, which talks about finding further ways to privatize and save moneys and to reduce the liability of the department. That's still very much alive and well and very much a concern in terms of Canadians' health and safety being first and foremost in terms of government policy.

Related to that is your capacity to respond to the Krever report, which calls for tough regulations, stopping the privatization agenda and the farming out to third-party labs, and the reduction in liability. It's talking about the opposite of what your department is now doing.

My final point is on the whole drug pricing policy. Your government flip-flopped on the 20-year patent protection. Then you kept in place the Mulroney proposal for these linkage regulations that add another two, three, perhaps even five years of patent protection to these multinational big brand name companies. When are we going to see some balance in the drug pricing policy? When are we going to see some leadership when it comes to financing and standards with respect to cash transfers? When are we going to see a reversal in the agenda from deregulation and privatization? When are we going to see Canadians' health and safety put first?

Mr. Allan Rock: On the first point, which is cash transfers, the National Forum on Health spent over two years looking at the state of the health care system in Canada. It was comprised, I might say, of people with expertise in their field. It concluded that there is in fact sufficient money in health care in Canada by governments; it's an issue of managing and of using it wisely and properly. To suggest that merely increasing the cash transfers is going to solve the problems in the health care system I think is quite wrong.

You said flatly that the reduced cash transfers have caused waiting lists and they've caused the increase in privatization. I think that's plain wrong. The reality is that waiting lists and privatization occur in provinces that have budget surpluses. Surely if those provincial ministers of health and provincial premiers felt there was a need to invest more of their money in order to save medicare, they'd do it.

Manitoba has what they call a rainy day fund of almost $600 million. Surely they'd devote some of that spare cash if they felt that money alone was the answer to the problems. Alberta had a two-day conference on how to spend their budget surplus. Surely if the problem with privatization or waiting lists in Alberta is money, the provincial government has the money to resolve that problem. I don't think it's as simple as that.

I think it's a question of management. It's a question of understanding what's needed. I don't think one can simply say that changes in the transfers to provinces have caused these problems.

In any event, as we said months ago, the era of cuts, from our perspective, is over. We've increased the amount we're transferring to the provinces on CHST by $4.8 billion over the four years to come, and we hope they'll devote those dollars to health.

On the so-called agenda for privatizing, I really don't know what my learned friend is talking about. I've been at pains to stress since my arrival in this department that the agenda we'll work from is a government agenda, not an agenda of someone who is or may have been in the Health Protection Branch. It's a government-wide agenda. Frankly, it's shared by Dr. Lozos, who is the director of that branch. It's shared by the people and the professionals in that branch with whom I work and whom I respect so much. That agenda is the protection of the health and safety of Canadians; that is our objective.

You speak of privatizing. I just announced last week when the Krever report was handed to me that we're going to be devoting an additional $13 million per year to the regulation function in the bureau of biologics and radiopharmaceuticals to ensure the safety of the new blood system. That's virtually doubling the amount of money that's there right now.

• 1735

I announced the creation of a blood safety council, chaired by a distinguished hematologist and populated by people who know what they are talking about, to oversee our implementation of the Krever recommendations.

I'm not talking about privatizing. We are talking about acting for the public good in the department.

As to patent protection, let me just say the regulations do not add three or five years of protection to patents, and they are under review. That's all I would say.

The Vice-Chair (Ms. Elinor Caplan): Dr. Bennett.

Mrs. Carolyn Bennett (St. Paul's, Lib.): In looking at the main estimates, I was just a little worried that the MRC didn't seem to make it to the list here. As you know, we have a demoralized medical research community, which is looking south of the border for where they can get stable funding. I was hoping maybe for Christmas we could ask Santa for more for the MRC.

Mr. Allan Rock: The MRC wouldn't be found in our estimates. It's not in the estimates, but it's included in what is called the health portfolio because I answer to Parliament for it. The total budget is shown as $237.6 million for this fiscal year, but that is a 13% decrease since 1994.

Let me say, Dr. Bennett, and to all my colleagues here, no matter what the party, because I think health is a non-partisan issue, and certainly medical research is, I have met with Dr. Friesen a number of times. I've met with people he has introduced me to, people who are very knowledgeable about the state of health research in Canada. I've met with researchers around the country, who have implored me to recognize the importance of this as a priority. I've spoken to young physicians, brilliant young physicians, who have explained that they find it necessary to leave the country because they can't get access to research dollars here. I've assured them we take our responsibilities as government very seriously. That's what the Canadian fund for innovation is all about, to put in place the hardware to enable research to be carried on. That's what John Manley's agenda of the knowledge economy is all about: to encourage and permit research, development, innovation.

About the Medical Research Council itself, I think it's fair to say the case they make for increased funding has been heard, is respected, is impressive. As Minister of Health, I've spoken with my colleagues in cabinet about that priority. I don't think it's something Santa Claus can do, but you know, I think in the fullness of time it will become evident that the government understands and acknowledges the importance of health research.

Mrs. Carolyn Bennett: It's great for jobs.

Mr. Allan Rock: Yes, it's good for jobs. It's good for health too.

The Vice-Chair (Ms. Elinor Caplan): Mr. Thompson.

Mr. Greg Thompson: Thank you, Madam Chair.

Minister, let's pick it up where we left off. I support you fully—

The Vice-Chair (Ms. Elinor Caplan): Mr. Thompson, I'm going to caution you. If your question is a long one, as it was last time, I'm going to give the minister extra time to answer.

Mr. Greg Thompson: I would say I would be in favour of staying later to continue this discussion. But Madam Chair, I'll behave myself if the minister does.

Minister, I share your thoughts. Health care and the welfare of Canadians are not a political issue. It's one we are all concerned about. That's why I'm trying to hold your feet to the fire, as long as we agree on that.

There are three issues I've approached you on either in the House or here at committee, one of them being the Krever inquiry and the hepatitis C victims, ranging from 12,000 up, depending on what number we prefer to believe. The other issue, of course, is the pharmacare issue. Then there is the issue we mentioned today, the smoking issue.

To go back to what I was mentioning, your fall-back position on this always is “I have to consult with the provinces”. We know decisions can't be made in isolation, but when you do get, for example, into Saskatoon in January to meet with the health ministers and one of the things you are going to be talking about is the pharmacare program, what exactly will your bargaining position be? Are you going to use the carrot or the stick in negotiations with the provinces?

The leadership issue is what I'm getting at. Since you are our national health minister, and with the constitutional powers you do have to drive these issues, I'm looking for that leadership from you in Saskatoon.

• 1740

Mr. Allan Rock: The federal government has an important role of leadership in so many areas in this country. Health is perhaps first among them. Let me give you an example. I don't quite understand the nature of the concern.

On blood, two years ago the system was in a complete mess. Public confidence was at an all-time low. Right in the middle of a long royal commission that looked like it was going to go longer, the federal Minister of Health said this is too important to wait. He convened a meeting of the provincial ministers of health, and they started on a process of renewing the blood agency.

By the time I arrived on the scene, most of the heavy lifting had been done. I went to two meetings of ministers over the summer. The federal government—not me personally, but the federal government—demonstrated real leadership on that issue. We got to the point where, by the time the Krever report was released two weeks ago, we already had decided on important principles of the governance of the new system and negotiated and agreed on a memorandum of understanding as to the powers of the new agency, how it's run, how it's financed, and how it will operate.

When you read Mr. Justice Krever's recommendations on governance, you find that the majority of them have already been satisfied. That's the nature of federal leadership in health. That's the kind of leadership—

Mr. Greg Thompson: Mr. Minister, I asked about compensation.

The Vice-Chair (Ms. Elinor Caplan): Mr. Thompson, you are out of order. Thank you.

Who is going to have the last question? Mr. McTeague.

Mr. Dan McTeague: Madam Chair, I need thirty seconds.

Mr. Minister, I want to find out.... I'm sorry about the repartee there; I assure you it will be a little more civil. On the look-back and trace-back program that was recommended in the interim report of the Krever inquiry—and I realize there has been far more to it with respect to hepatitis C—is there any initiative you believe you can undertake to begin to warn people who may not know they are passing on this very dangerous disease?

Mr. Allan Rock: Hepatitis C?

Mr. Dan McTeague: Hepatitis C.

Mr. Allan Rock: I think British Columbia has a look-back; Nova Scotia has a look-back.

It's not transmissible except by certain means. If you're sharing a needle, it's transmissible, but it's not sexually transmissible for the most part. It's transmissible through blood.

I think the question of whether there should be look-back programs is one for the provincial ministers to decide. Some of them have decided to do that and to communicate directly with people who have had transfusions.

On the subject of compensation, I don't want this member to think I'm avoiding his question, because nothing about it intimidates me at all, and I want to make that clear. But I think it would be dumb for a federal government to go out and grapple with this issue first without talking to provincial ministers, because I think the interest of victims is better served by a coordinated response. I think it would be irresponsible for the federal government to act without talking to provincial partners.

If someone takes a different view, that's too bad. That's my view. So I'm going to talk to provincial ministers about it and see if we can develop a coordinated response. If we can't, that's a different matter.

I think federal leadership isn't always standing on a soapbox and bleating. Sometimes federal leadership is sitting down quietly and coordinating. It has worked on the development of a new blood governance system, it's worked in a number of other areas, and I expect it will work here.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Minister.

One minute remains until the appointed hour. Mr. Vellacott, could keep your question short so the minister can answer briefly?

Mr. Maurice Vellacott (Wanuskewin, Ref.): Is it all within the minute?

The Vice-Chair (Ms. Elinor Caplan): All within the minute.

Mr. Grant Hill: We didn't exactly start on time.

Mr. Maurice Vellacott: My question, Minister Rock, is in respect to your commitment to the basic principle of democracy and accountability for this committee in respect to the spending of health dollars. As you know, the main estimates have already been reported back to the House, deemed adopted without amendments. My question basically is on the matter of health dollars for which you as finance minister are accountable, the issue of accountability.

You're a very articulate person; I commend you for that today, and other responses as well. On this matter of accountability, was it insincerity in regard to that, or was it because of cowardice that you did not appear before the committee on the spending estimates?

Mr. Allan Rock: Is that the whole list, or do I have a choice of another reason?

• 1745

Some hon. members: Oh, oh!

Mr. Maurice Vellacott: Well, you can—

The Vice-Chair (Ms. Elinor Caplan): Mr. Vellacott, you've placed your question.

Minister.

Mr. Allan Rock: It's not really a question, but let me tell you that I'm here to respond to anything you want to raise about the way the Department of Health proposes to spend the public funds allocated to it by the Parliament of Canada. If you have a question about anything we're doing as evidenced by the estimates, I'd be pleased to deal with it on its merits. Do you have a question about how we're spending the money?

Mr. Maurice Vellacott: I had a question in respect to why you did not appear before, as opposed to now, when we now have no opportunity in respect to the spending estimates. It's after the fact.

Mr. Allan Rock: Ordinarily, ministers appear in the first part of the year, when the estimates are tabled after the budget. Of course we had an election that intervened this time. This is the first convenient day for you and me to be here since the composition of this committee was finalized, so I'm presenting myself to answer for the way this minister and this department propose to spend these public funds. If you have some difficulty with the way we propose to spend them, please raise it with me and I'll respond.

Mr. Maurice Vellacott: It's the issue of accountability.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Mr. Vellacott. Your time is up.

Ms. Judy Wasylycia-Leis: I have a point of order.

The Vice-Chair (Ms. Elinor Caplan): You have a point of order? What is your point of order?

Ms. Judy Wasylycia-Leis: It's a point of information.

The Vice-Chair (Ms. Elinor Caplan): No, I'm sorry, there's no such thing as a point of information.

Ms. Judy Wasylycia-Leis: It's a point of order, then.

The Vice-Chair (Ms. Elinor Caplan): I suspect it's not a real point of order.

Ms. Judy Wasylycia-Leis: It is a point of order, actually. I wanted to clarify that I was wrong. I checked the records in terms of the average length added to—

The Vice-Chair (Ms. Elinor Caplan): What is your point of order?

Ms. Judy Wasylycia-Leis: —patent legislation.

The Vice-Chair (Ms. Elinor Caplan): You're out of order. That's not a point of order.

Ms. Judy Wasylycia-Leis: I just wanted to clarify for the minister that he's right, that it is two to three years and not three to five years. I wanted the record to show that I have checked the facts. But I would still at some point like an answer to the question of whether it's acceptable to have two to three years added to the twenty-year patent protection already in place.

The Vice-Chair (Ms. Elinor Caplan): Ms. Wasylycia-Leis, that's not a point of order. If the minister wants to respond to what you've stated, he'll have to do it privately.

An hon. member: Madam Chair, that's allowing additional questions—

The Vice-Chair (Ms. Elinor Caplan): Just a minute. Are you going to let me to finish? I said that if the minister wants to respond, he'll have to do it privately, because our time with him is now up.

Minister, thank you very much for coming to the committee.

Mr. Allan Rock: Thank you, Madam Chair.

The Vice-Chair (Ms. Elinor Caplan): We appreciate the opportunity to have some time with you.

We do have two items of business before the committee that have to be dealt with. What I would like to know is whether we are ready to proceed on the motion we have received from Ms. Wasylycia-Leis.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you, Madam Chair.

Pursuant to the 48-hour provision that I understand is the rule adopted by the committee, I tabled this motion with the committee last week, and I'll just move it very quickly.

I move that the committee report to the House of Commons its recommendation that the Minister of International Trade and his MAI negotiators seek to replace the current insufficient draft reservation for health and social services with a complete exemption for government-sponsored health and social services.

Mr. Dan McTeague: Is that “exception” or “exemption”?

The Vice-Chair (Ms. Elinor Caplan): “Exception”.

Mr. Dan McTeague: Thank you.

The Vice-Chair (Ms. Elinor Caplan): The terminology in the draft before us uses the word “exception”.

(Motion negatived)

• 1750

The Vice-Chair (Ms. Elinor Caplan): The next item before us is the consideration of the budget request for travel funds for the committee. As I understand it, this is a request for the funds to be set aside and allocated so the committee can do the travelling as required. There are insufficient funds in the budget right now. This is a place-holder. There's no requirement that the funds be spent nor a requirement that the committee actually travel, but if we don't make the request of the Board of Internal Economy, then we will not be able to have the resources should we wish to travel.

The motion suggested is that the committee apply to the budget subcommittee for a budget of $144,733 to travel in February during the committee's consultation on natural health products.

Is there a mover for that motion? Mr. Myers.

Is there a seconder for that motion? Mr. Drouin.

Is there any discussion on the motion? Dr. Hill.

Mr. Grant Hill: It's a backwards way to do things. We're setting aside funds when we have no clue what we're doing. In private life none of us would do this. This is not the way to go.

The Vice-Chair (Ms. Elinor Caplan): Thank you, Dr. Hill. The only thing I would point out to the committee is there's no requirement that the committee use all of these funds. It's, as I said, a place-holder. I believe it was a decision of the subcommittee to recommend this approach.

Is there any further discussion on the motion? Madame Picard.

[Translation]

Ms. Pauline Picard (Drummond, BQ): I heard that it wasn't the subcommittee which took that decision, but rather the steering committee. Therefore, I think that the steering committee...

[English]

The Vice-Chair (Ms. Elinor Caplan): My mistake; I meant steering committee.

[Translation]

Ms. Pauline Picard: I see. Excuse me. Therefore, we delegated powers to the steering committee. If we can't accept the decision of the steering committee, I don't see why we should waste our time and energy making decisions within that committee. I think we have to ask for the $144,000. The money has not yet been distributed.

[English]

The Vice-Chair (Ms. Elinor Caplan): It's $144,733.

[Translation]

Ms. Pauline Picard: I see. That's what I said, Madam Chair.

[English]

The Vice-Chair (Ms. Elinor Caplan): Excuse me. You are correct. There's a typo in the English. The correct amount is $114,733. That makes a very large difference.

[Translation]

Ms. Pauline Picard: I think we won't have to spend all that money. However, according to our plan, it is essential that a decision be taken on that subject. We took that decision in the steering committee, and I think the decision should be adopted by the full committee.

At the steering committee, I indicated that staggering amounts of money were being spent to visit outdoor sports centres and go around the world. The Standing Committee on Health, since 1993— this is my second term—has not undertaken any extravagant trips. We use our travel points as members when we want to travel. I think we need information for the study we are undertaking. It is not enough to make comparisons with video conference systems because in some cases it could prove to be more expensive than actually travelling to the place in question. Therefore, I approve the amount and think that all opposition parties should do likewise.

Thank you.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Ms. Picard.

[English]

Is there any further debate? Then I'll call the question on the motion regarding the steering committee's recommendation to request $114,733 so the committee can travel if it so chooses.

(Motion agreed to)

The Vice-Chair (Ms. Elinor Caplan): I see that we have completed the agenda for today. I want to thank all the members.

The meeting is adjourned.