Mr. Chairman, thank you very much.
Good afternoon, everyone. On behalf of the Asthma Society of Canada, I wanted to thank the legislative committee for allowing us to speak with you regarding , Canada's Clean Air Act.
We also welcome the opportunity to briefly speak to you on the new national respiratory care strategy for the Asthma Society of Canada, which concentrates on asthma, associated allergies, and chronic obstructive pulmonary disease, otherwise known as COPD, which will be positively impacted by this bill.
First, the national strategy focuses on defining several priority tactics that aim to substantially increase the number of patients who have full control of their disease, as well as to empower patients to access the care that they require and identify the steps required to prevent both asthma and COPD. The recently renewed mission in supporting Canadians with asthma, associated allergies, and COPD is designed to achieve a managed life through the funding of respiratory disease prevention; the delivery of accredited, relevant breathing tests; the delivery of patient-centred asthma, allergy, and COPD self-management education; and advocacy efforts to ensure that the essential respiratory health programs are delivered in every province.
Everyone needs to fully understand that asthma prevalence has increased dramatically in western countries in the last 25 years. It has been estimated that both allergies and asthma affect 30% to 35% of the Canadian population. Chronic obstructive pulmonary disease is a disease that is similar in many ways to asthma; it has been generally estimated that approximately 714,000 Canadians are currently diagnosed with COPD, but it is also estimated that more than 50% of the patients are undiagnosed, which suggests there might in fact be over 1.4 million Canadians suffering from COPD.
Asthma prevalence is increasing worldwide and is generally more common in western English-speaking countries and less common in developing countries. Moreover, there is considerable evidence that asthma and COPD exact a heavy economic and social burden. The costs of loss of productivity and medical spending are clearly underestimated for COPD and asthma, and these are generally perceived as more serious conditions.
The Asthma Society of Canada is very much in support of , given the improved environmental impact it will provide for the health of Canadians. In particular, the Asthma Society of Canada recognizes the intent of the bill to provide mandatory regulations with national targets, which will be a vast improvement over the current situation. As the bill states, the purpose “is to promote the reduction of air pollution and to promote air quality in order to protect the environment and the health of all Canadians, especially that of the more vulnerable members of society”.
In June 2006 the Asthma Society of Canada completed a new special research initiative that clearly demonstrates how polluted air negatively impacts on the respiratory health of Canadians. Breathe Free in Canada outlines the scientific connection between air pollution and increased respiratory exacerbations for Canadians affected with asthma and chronic obstructive pulmonary disease.
Poor outdoor air quality affects more than individuals with respiratory disease. Indeed, the greatest burden of disease occurs with mild effects because of the large base of the population affected. Improvements in air quality can have dramatic effects on the rates of respiratory tract symptoms on a national scale.
Thus, regulatory proposals contained in help deal with the realities of those affected by poor air quality. From the perspective of the Asthma Society, this bill helps recognize that the time has come for a respiratory care revolution in our country. In addition, this bill will help allow patients the right to breathe more freely and easily.
Supplementary to these discussions with the bill, the Asthma Society is currently working with the Minister of the Environment and undertaking discussions regarding outdoor air quality initiatives. One of those is the Breathe Free Canada program, which will support organizations that have taken concrete action in implementing operational processes that demonstrate a clear reduction in air pollutants. The ASC officially recognizes Canadian firms that are able to demonstrate environmental initiatives while allowing Canadians to breathe more freely. That particular program was unveiled back in October 2006 with Robert Kennedy Jr. at a special event we held in Toronto.
Secondly, air quality indexes only tell part of the story and need to be expanded to deal with patients suffering from asthma, allergies, and COPD. The ASC has developed the breathing score program, which will assign grade levels to the air quality index and pollen index on a daily basis and forecast periodically. There will be specific recommendations for people with asthma, allergies, and COPD in regard to the air quality of the day, and it will be a comprehensive tool that will be clinically proven to help manage asthma, allergies, and COPD. The ASC proposes to make a grading system applicable to people with asthma, allergies, and COPD and make recommendations per each grade level for each disease.
The ASC also recognizes the indoor air quality aspects of Bill with the asthma friendly certification program. This program has been established to help Canadians with asthma and associated allergies identify suitable products in the retail environment. All products with an asthma friendly® certification mark have been independently tested by standards approved by the Asthma Society of Canada. This program will advertise and be marketed by the ASC and therefore create consumer demand for asthma-certified products. This program is currently already up and running and in retail stores in Canada.
The Asthma Society of Canada welcomes the opportunity to explore other possibilities and wishes to reiterate our support for Bill C-30 in that it will help strengthen the need to be more conscious about the air we breathe. We strongly urge committee members to support this important initiative and to move forth with the proposed mandatory regulations necessary for better indoor and outdoor air quality for all Canadians.
Thank you, Mr. Chairman.
Honourable Chair and honourable members of the legislative committee that is reviewing Bill , thank you for the opportunity to be able to speak on this important issue.
Before I start the formal part of my presentation, you are probably all looking at your materials and no doubt have found the straw. I would like all the members to please take out the straw, put it in your mouth, pinch your nose, and breathe for about 30 seconds.
The purpose of that, ladies and gentlemen, is to let you know what asthmatics or a person suffering from severe allergies or chronic obstructive pulmonary disease feel like when they are undergoing an exacerbation. The motto of the Lung Association is, “When you can't breathe, nothing else matters”.
If there is nothing else in my brief that you remember at the end of the day, I am starting off with what a patient feels like. You have gone through a small test. I will start and end with the words “When you can't breathe, nothing else matters”, and I hope that will position a picture of what it is like for citizens throughout Canada.
The Lung Association commends the federal government for increasing awareness and promoting action on air pollution through the tabling of the Clean Air Act. We also commend all parties for participating in this committee to develop the very best legislation for reducing air pollution and greenhouse gases.
The Canadian Lung Association is Canada's oldest health charity, representing and assisting Canadians who suffer from lung disease. Every 20 minutes, one Canadian dies from lung disease, 2.5 million Canadians have asthma, and the rate in children is four times higher than it was 20 years ago. By 2020, chronic obstructive pulmonary disease will be the third leading cause of death in Canada.
More people will die this year from lung cancer than from any other type of cancer, including breast, prostate, and colon cancer combined. Approximately six million Canadians suffer from lung disease at an estimated cost to the economy of over $15 billion. This includes the direct cost to the health care system, as well as the estimated cost of lost work time and degraded productivity.
The Lung Association has a particular interest in air quality since air pollution exacerbates many respiratory conditions, causing lost work or school days, emergency room visits, hospital stays, and even mortality. Health Canada has estimated that 5,900 people die each year in the eight Canadian cities involved in a recent study. The Ontario Medical Association estimated that in Ontario alone the total yearly costs of death, pain, suffering, lost work, doctor's office visits, emergency room visits, and hospital stays are a staggering $7.8 billion.
General comments. The Lung Association clearly asserts that the guiding principles of a Clean Air Act component of CEPA should be the protection of human health, especially the health of the vulnerable population, such as the young, the elderly, those with pre-existing diseases that make them more susceptible to environmental toxins, and certainly socially vulnerable groups such as the lower socio-economic group categories and first nations.
The Lung Association recognizes the important connection between climate change and air pollution, from causal, impact, and solutions viewpoints--on the connection between climate change, air pollution, and respiratory health. With respect to the Lung Association mission to improve respiratory health, these connections are particularly important in justifying actions to reduce the use of fossil fuels. Caution must be exercised when replacing fossil fuels with alternative energy sources, and careful consideration should be given to the impact on both air quality and greenhouse gas emissions. For instance, the use of biomass as an energy source is problematic from the perspective of respiratory disease, because combustion of biomass produces high levels of air pollution.
Under our recommended amendments to , in our paragraph 1.1 regarding CEPA's overarching considerations, CEPA 1999 is currently under review, and both the House of Commons and Senate committees have received many recommendations for the improvement of this bill. These recommendations include aspects relevant to clean air and greenhouse gases.
The final recommendations, through and the CEPA review process, should be amalgamated so as not to lose the excellent recommendations that have already been tabled in that review process.
Although the Lung Association has advocated for many years that we must link actions on air quality and climate change, each topic must have its own and equal priority within the bill. While some of the remedial actions for each problem will dovetail, they should stand distinct within the bill, because air pollution and greenhouse gases are interrelated but distinct problems, each requiring its own set of solutions.
Related legislation and international agreements will be focused on either air quality or climate change, but not necessarily on both problems. Thus it is recommended that the amended bill clearly separate air pollutants from greenhouse gases. However, the actions resulting from the bill must ensure that remedial measures on air pollution do not increase greenhouse gases and vice versa. Co-benefit analyses of proposed actions should be conducted.
In our paragraph 1.2.1, under the title “National Air Quality Objectives”, our recommendation regarding proposed section 103.07 is that the word “objectives” should be changed to “standards” and should mean a legally enforceable level.
In 1.2.3, Canada's air quality standard should be set as equal to or lower than the most health protective standards existing internationally. Recognition must be given to the fact that air quality standards cannot be met only by reducing emissions per vehicle or by an intensity basis from industries and power sources. Emissions must also be reduced by efficiency measures—for example, efforts to support a reduction in kilometres driven by vehicles.
In 1.3.1, regulations to eliminate or reduce emissions should be mandatory for all substances on the CEPA toxic list. Wording to this effect should be explicit in , using words such as “will” instead of “may” when indicating regulation.
In 1.3.2, it is also recommended that the bill explicitly stipulate that regulations should aim to reduce emissions to a level equal to or below the level achieved by the most stringent international examples. For certain emissions, such as vehicle emissions, aligning with the United States is a reasonable initial goal. For other emissions, such as those from coal-fired power plants, aligning with other jurisdictions that are leaders in reducing emissions in this area should be the objective.
In 1.3.3, mandatory timelines should be specified in the bill, such that regulations are in place for substances on the toxic list, within the timelines already advised by many groups through the CEPA review process.
In 1.4, regarding the separation of air pollution and greenhouse gases from the CEPA toxic list, removes these substances from the list and places them in a separate new designation. There is no substantive rationale or benefit in doing this, and there exists a reasonable risk. The federal government has a well-established jurisdictional and historical authority to regulate substances that cross borders, including provincial borders. If those substances cause identifiable risk to Canadians, removing the word “toxic” from the air pollution and greenhouse gas list may make the regulation of these substances vulnerable to provincial or industrial court challenges.
In 1.4.1, it is strongly recommended that the bill use the CEPA toxic list for air pollutants and greenhouse gases in a manner similar to that existing in CEPA 1999. The Clean Air Act component of CEPA should focus action on the air pollutants and greenhouse gas subset of this list and assign new terminology to the air pollutants, referring to them as “hazardous air pollutants”, thus explicitly designating them as dangerous to human health.
In part 1.5 we list our amendments to greenhouse gas provisions.
First, the most contributory greenhouse gases should be included in the CEPA toxic list, which would thus trigger the duty and authority of the ministers of environment and health.
In the interests of reducing or mitigating the threat to human health, including respiratory health, posed by global climate change, the provisions of Bill C-30 must ensure that Canada achieves early and aggressive reductions in greenhouse gas emissions. From this perspective, the targets and timelines specified by the Kyoto accord should be viewed as a starting point for action.
The Lung Association strongly recommends that the federal government pursue measures that will accomplish actual emission reductions over the use of monitoring mechanisms to meet the Kyoto targets. The rationale for this stance is that emission reductions mitigate both greenhouse gases and air pollutants released locally in Canadian communities. Thus emission reductions will improve the health of Canadians as well as reduce the threat of global climate impacts. Priority should therefore be given to measures that achieve reductions and emissions in Canada, complemented by expenditures that would produce actual greenhouse gas reductions in other areas of the world.
Although Bill C-30 does not specify the targets and timelines for reducing greenhouse gases, action arising from the act must recognize the urgent need to achieve even greater reductions in the near term, in the interest of mitigating potential harmful effects on the respiratory health of Canadians.
With the goal of achieving early actual reductions in air pollution and greenhouse gases, it is recommended that all targets be for fixed caps on emissions rather than intensity-based, and that the timelines be tightened considerably.
Under 1.5.4. we list some actions regarding greenhouse gases that should be triggered by the provisions in Bill C-30.
First, in terms of short-term goals, Canada must make every effort to meet the target of reducing its greenhouse gases to 6% below 1990 levels by 2012. If this is not possible with action emission reductions in Canada, the federal government should complement its domestic efforts through financial expenditures on projects that will achieve reductions elsewhere in the world, and set a target date--for example, of 2015--to meet actual emission reductions to 6% below 1990 levels.
With regard to mid-term goals, stringent mid-term targets could be drawn from other leading jurisdictions or international examples. Canada's continued participation in UNFCCC should provide a guideline for those incremental targets. Once again, with a view to protecting the respiratory health of Canadians, the Lung Association recommends that the federal government embrace aggressive goals that will result in early real reductions in both air pollution and greenhouse gases.
In terms of long-term goals, Canada must develop five-year incremental targets to achieve a reduction to 80% below 1990 levels by 2050.
Moving to indoor air quality, the Lung Association is very supportive of the inclusion of indoor air exposures as being equally important to outdoor air exposures, requiring the attention of government, industry, and the public. Standards related to indoor exposure should be set at a level that's protective of the health of vulnerable populations.
The wording in the bill of proposed section 103.09 should be reassessed to ensure that it covers exposure to such substances as radon, which has natural, not anthropogenic, sources. While radon cannot be regulated, activities such as housing construction can be regulated to reduce exposures.
The government is to be congratulated on its recent action to produce radon guidelines that reduce radon from 800 Bq/m3 to 200 Bq/m3.
With regard to accountability, Bill C-30 mentions briefly that emissions will be monitored and reported. It is essential that the act designate clear responsibility for compliance: specific details of when, where, and how monitoring will be conducted; specific reporting deadlines; and the requirement for active public engagement in this process. Actions arising from the act must specify fiscal support to relevant government departments and to jurisdictions as needed.
Due to the time, I'm going to bypass some of these parts, Mr. Chair, but I think it's important to stress that this brief was done and reviewed in consultation with a wide range of experts, including the following: Dr. Monica Campbell, Toronto Public Health; Dr. Paul Hasselback, medical consultant; Dr. Michael Brauer, professor of medical epidemiology at the University of British Columbia; Mr. Bruce Dudley, vice-president of the Delphi Group; Dr. Scott Giffin, Medical Officer of Health, New Brunswick; Dr. Tom Kosatsky, Santé publique de Montréal; and Dr. Menn Biagtan, British Columbia Lung Association.
As I said at the start, thank you very much. This committee, in my mind, has one of the most important challenges facing Parliament today: to come together and produce something for all Canadians, something that we need, that being action on climate change and action on cleaning up the air.
I will close by simply saying what I started with. Gentlemen, ladies, members of Parliament, when you can't breathe, nothing else matters. Please remember that.
Thank you very much.
Thank you very much, Mr. Chair and members of the committee.
Good afternoon. My name is Stephen Samis. I'm director of health policy for the Heart and Stroke Foundation of Canada. I'm also chair of the Chronic Disease Prevention Alliance of Canada, although I'm here today in my capacity with the Heart and Stroke Foundation of Canada.
The Heart and Stroke Foundation of Canada, a volunteer-based health charity, leads in eliminating heart disease and stroke and reduces their impact through the advancement of research, its application, the promotion of healthy living, and advocacy. It was our fiftieth anniversary this year, and in our fifty years, just to note, we've funded about $1 billion in research in this country.
Today I would like to stress the importance of addressing the cardiovascular health effects brought about by air pollution and, by extension, climate change. By reducing air pollution, we can help significantly reduce the burden of death and disability stemming from cardiovascular diseases. The Heart and Stroke Foundation of Canada applauds the efforts by the federal government to address the health and economic burden posed by air pollution and climate change.
As you are no doubt aware, cardiovascular disease inflicts a terrible toll upon Canadians as the leading cause of death in our country. In total, approximately 72,000 Canadians die of heart disease and stroke annually, representing 32% of all deaths. Cardiovascular disease is also the leading cause of both hospitalizations and drug prescriptions, and is responsible for about $18.5 billion dollars annually in direct and indirect costs.
There is strong evidence to support the assertion that air pollution has a serious effect on cardiovascular disease and health. For example, Dr. Stephen Van Eeden, associate professor with the Faculty of Medicine at the University of British Columbia and a Heart and Stroke Foundation-funded researcher, has been conducting studies on how air pollution contributes to heart disease. Air pollution causes an inflammatory process in the lungs that activates blood vessels and ultimately leads to atherosclerosis, which causes plaque to build up in the arteries, increasing risk of heart attack and stroke.
A study by the air health effects division of Health Canada in 2004 estimated conservatively that 6,000 excess deaths in Canada occur each year due to air pollution. That includes both the short- and long-term exposure to air pollution. The American Heart Association estimates that long-term exposure to fine particulate matter in major U.S. cities causes 60,000 deaths each year in the United States. And a study on 65,000 post-menopausal women between 1994 and 1998 in 36 U.S. metropolitan areas was published in the New England Journal of Medicine. That study concluded that long-term exposure to fine particulate air pollution was directly associated with the incidence of cardiovascular disease and death among these women in the study.
High levels of pollution have also been associated with acute myocardial infarctions. In other words, pollution not only contributes to the development of underlying cardiovascular disease and other health problems over the long term; it has also been shown to lead to increases in the number of acute myocardial infarctions—or heart attacks—whenever pollution levels are particularly high.
Given the above evidence and the clear links between air pollution and cardiovascular disease, the Heart and Stroke Foundation of Canada is pleased that is proposing to take a concerted approach to reducing air pollution in Canada. The foundation seeks to impress upon this legislative committee the immediate and ongoing effects of air pollution, specifically of fine particulate matter, on cardiovascular health.
In addition, the foundation would like to make several general recommendations to the committee. First, the Heart and Stroke Foundation of Canada would like to express its support for the amendments that make specific reference to health as affected by pollution. The requirement for the Minister of Health to conduct studies on the role of pollution in health is viewed very positively, as is the clause that recognizes that air pollutants and greenhouse gases represent risks to both health and the environment.
Second, it should be stressed that unlike climate change, which is a problem of mainly long-term scope, the effects of air pollution on health are immediate and costly. As a result, the Heart and Stroke Foundation of Canada supports the recommendation of the Canadian Lung Association, that the bill clearly separate air pollutants from greenhouse gases.
Third, the Heart and Stroke Foundation recommends the adoption of achievable and significant short-, medium-, and long-term goals to reduce air pollution.
Fourth, the Heart and Stoke Foundation supports several of the Canadian Lung Association's recommendations, specifically the following: targets for fixed caps on emissions, rather than intensity-based targets, with the timelines for these to be outlined and tightened as much as possible; that the federal government embrace aggressive goals that will result in early real reductions in both air pollutants and greenhouse gases, and that these goals be tailored to each separately; and with respect to accountability, that the bill designate clear responsibility for compliance and specify the details of when, where, and how monitoring will be conducted. The bill should specify reporting deadlines and the requirement for public engagement in the process.
Fifth, while not addressed specifically in , the Heart and Stroke Foundation would like to point out the importance of built environments with respect to pollution, climate change, and health. The topic of the built environment is one in which the foundation has been deeply involved and very active lately. Briefly, built environments that emphasize active transportation and public transit use have the potential to create extremely positive effects for both health and the environment simultaneously. For example, a recent study conducted in King County, Washington, which includes the city of Seattle, found that a 5% increase in the walkability of neighbourhoods was associated with a 6.5% decrease in driving and a 5.5% decrease in pollution. These relationships are inextricably linked. In short, reducing auto dependency helps to promote physical activity and, ultimately, reduced air pollution.
In sum, improvements to the built environment and increased federal funding for infrastructure that promotes healthy, active living will decrease air pollution and prevent deaths in Canada. Among the actions the federal government could take to address air pollution are enhancing federal investments in intra- and inter-city transportation—for example, providing funding for emissions-reduced public transit systems in our cities and for improved inter-city passenger rail service, particularly in busy corridors such as the Windsor–Quebec City corridor and Calgary–Edmonton.
In conclusion, the Heart and Stroke Foundation of Canada would like to stress the importance of taking a broad view with respect to and of giving serious consideration to the health effects of air pollution, both short- and long-term. The regulations proposed in Bill C-30 have the potential to not only reduce air pollution in the interests of climate change, but also to have significant positive effects on the health of Canadians, including their cardiovascular health, and particularly those Canadians living in our largest metropolitan areas.