Welcome to the health committee. It's a pleasure to see everybody again this morning, and a special pleasure to have our guests here.
Pursuant to Standing Order 81(5), we have supplementary estimates (B) 2010-11: votes 1b, 5b, 10b, 20b, 25b, and 40b under Health, referred to the committee on Thursday, November 4, 2010.
We have our witnesses with us. From the Department of Health, we have Glenda Yeates, deputy minister, and Germain Tremblay, chief financial officer. Welcome.
From the Public Health Agency of Canada, we have Dr. David Butler-Jones, chief public health officer, and James Libbey, chief financial officer.
We are expecting, from the Canadian Institutes of Health Research, Alain Beaudet, president, and James Roberge, chief financial officer.
We will begin now, because we need to get our meeting on the way. I'm sure Mr. Beaudet will be joining us in a timely manner.
We'll begin with the Public Health Agency of Canada. Dr. David Butler-Jones.
But the drugs are all legal, just prednisone and things like that.
The Chair: Continue. We have faith in you.
Dr. David Butler-Jones: Thank you.
With me today is Jim Libbey, chief financial officer for the Public Health Agency. I appreciate the opportunity to speak to the supplementary estimates (B) for 2010-11 as they pertain to the agency.
Our commitment to chronic disease prevention and control is among our highest priorities for the coming year and this year.
Chronic diseases, such as cancer, heart disease and diabetes, remain the greatest cause of death and disability in Canada.
It is remarkable that much of this is preventable. It demonstrates an ever-increasing need for Canadians to focus on their own health. And it underscores the necessity of collaboration between governments at all levels, their partners, communities, and individuals to help prevent these diseases and to increase awareness and understanding.
In September the Minister of Health announced a landmark declaration on prevention and promotion, including Canada's first intergovernmental framework for curbing childhood obesity.
The declaration is a visionary public statement of our intent. Governments across this country are working together on these crucial issues. We are providing the foundation for much of our future work.
This fiscal year $685.6 million has been allocated to the agency. As I noted in June, we are devoting over $115 million this year to efforts surrounding chronic disease.
That includes efforts to increase capacity and knowledge in prevention and control of diseases, such as HIV and AIDS.
It also helps us gather and analyze data on the rates, trends, and patterns of injuries and disease in Canada. As an update since June, the agency will also be transferring funds worth approximately $4.3 million this fiscal year, much of which will complement those initiatives. For example, $600,000 dollars will be transferred to the Canadian Institutes for Health Research to support intervention research and knowledge translation to address chronic disease prevention.
There is one other major item I would like to mention before I close.
Breast cancer, as members know, is the most common cancer among Canadian women.
Hundreds of Canadians are newly diagnosed with breast cancer each week. It is imperative that the government continue to support cancer prevention, control, and research, and to do its part to reduce the burden of cancer in Canada.
For these reasons, I am pleased to report that, through a permanent transfer of $3 million to the Canadian Institutes for Health Research, the agency is helping to fund targeted breast cancer research.
I am confident this funding will go a long way towards improved survival rates, and improved prevention and quality of life for those suffering from breast cancer.
This represents our single biggest transfer for these estimates. I have only touched the surface of the agency's priorities this year. The H1N1 pandemic, for example, which lasted into this year, solidified our place, we believe, as global leaders in responding to infectious disease outbreaks.
2010 saw the agency continue to build on the lessons learned from H1N1, focusing efforts on continued collaboration with all partners. These efforts will strengthen our preparedness for future pandemics and outbreaks.
Madam Chair, these supplementary estimates show that the Public Health Agency's vision remains constant and relevant to healthy Canadians and communities in a healthier world. All of Canada, we believe, will benefit from our efforts.
Thank you for your time. I will be happy to answer questions later.
Thank you very much. Good morning, Madam Chair and members of the committee. It is a pleasure to be here today to discuss the supplementary estimates (B) and how these funds will be used to help Canadians improve their health.
The funds we will be discussing today will be used for a variety of important programs, many of which have been in place for years and have been proven effective.
Health Canada is seeking a net funding increase of $48.1 million in the following areas: aboriginal health programs, Nutrition North program, tobacco litigation, and medical isotopes.
Most of the increases are strategic investments for us that were announced in budget 2010. Much of this additional funding will allow Health Canada to continue to provide support to Canada's aboriginal people by delivering valuable programs, some of which are provided in partnership with the Department of Indian Affairs and Northern Development.
With respect to the first nations health programs, $32.8 million is being sought for the Indian residential schools resolution health support program. As committee members may be aware, this program provides emotional and cultural health support services as well as professional counselling to former students and their families throughout all phases of the Indian residential schools settlement agreement. Some services are provided directly through local aboriginal organizations, and others are provided by psychologists and social workers who have experience working with aboriginal people.
This investment ensures that Health Canada can fulfill its commitment to provide culturally appropriate mental health and emotional support services to residential school survivors and their families.
Another notable item is $5.5 million for additional health programs in the areas of maternal child health, mental health and addictions, and community capacity for two Innu communities in Labrador.
Additional funds are also required to help in the transition from the outdated Food Mail program to the new Nutrition North Canada program.
Nutrition North Canada will support improvements to ensure that northerners benefit from improved and increased access to nutritious food throughout the year. Nutrition North will also support improvements such as education initiatives intended to increase awareness of healthy eating while developing skills for selecting and preparing healthy products from stores along with traditional or country foods. Health Canada is allocating $1.5 million this fiscal year and $2.9 million for 2011-12 for nutrition and education initiatives.
Among our additional investments in these supplementary estimates is the provision of $10.3 million to support the defence of the Government of Canada in ongoing tobacco litigation.Three million dollars over two years is also being sought to support non-reactor-based production of medical isotopes, to look to optimize the use of the existing supply, and to support the development of new medical imaging technologies that do not use isotopes.
In closing, the resources requested through the supplementary estimates (B) will be used to help Canadians maintain and improve their health in these very specific areas.
Thank you for your time, and I look forward to answering any questions the committee may have.
Thank you, Madam Chair.
Members of the committee, as president of the Canadian Institutes of Health Research it's a privilege for me to offer you a report card on the supplementary estimates (B) and use this opportunity to discuss how CIHR has employed its budgetary allocation to ensure fulfilling our mandate to improve through research the health of Canadians and the health care system.
As you know, an additional, recurrent amount of $16 million has been allocated to the CIHR budget for 2010-2011 so that we can continue our cutting edge research dedicated to improving the health of Canadians.
Four million of these dollars have been targeted to CIHR's open operating grant program. As its title implies, this program is an open call for research proposals, with no restrictions on areas of research or maximum level of requested funds. All proposals are subjected to the highest international standards of peer review to ensure excellence.
This increase in funding brings total plan spending in this program to more than $400 million.
Though CIHR currently supports more than 4,000 multiyear research projects under the program, the demand continues to increase and we are able to fund only a small portion of the proposals that have cleared the bar that our criteria of excellence have set very high and that have been recommended for funding by our committees of experts.
Six million dollars has been allocated to advance the strategy on patient-oriented research. This strategy is a nation-wide coalition aimed at improving health outcomes and service delivery by enhancing the clinical application and economic impact of health innovations and by providing health care professionals and policy-makers with information on how to deliver high-quality care and services in a cost-effective manner.
In collaboration with the provinces, we aim to improve the clinical research environment and infrastructure, set up mechanisms to better train and mentor health professionals engaged in clinical research, and strengthen organizational, regulatory, and financial support for clinical studies.
Five million dollars are dedicated to international research collaboration on Alzheimer's disease and other age-related dementias. As members know from recent debates in the House, like many other nations, Canada's aging population is facing an upcoming tide in the numbers of persons who will be afflicted by Alzheimer's disease and dementia.
The good news is that Canada is already investing in this field and has built an excellent track record and a reputation for high-impact, collaborative health research.
These new funds have allowed us to build on our leadership in the area of Alzheimer's disease and related dementias by establishing an international network for cooperation that will allow us to increase our research capacity and to expand our horizons in the area. Already, cooperative projects have begun with France, the United Kingdom, Germany and the United States.
Working closely with the Alzheimer Society of Canada, we have launched funding opportunities focused on the early diagnosis and early treatment of the disease. The long-term objective is to delay by five years the onset of symptoms.
Finally, of the $16 million, $1 million has been allocated to operating requirements to address the significant increase in applications for open operating grants and to address the new patient-oriented research and Alzheimer's strategies.
The supplementary estimates (B) also include CIHR's access to $10 billion in funding over two years from the isotope supply initiative to support research to develop and demonstrate new technologies, to optimize the use of medical isotopes and alternative medical imaging technologies, and to establish a clinical trial network to test new isotopic and non-isotopic tools.
It also includes funding for the Canada Excellence Research Chairs, a program that supports the development of a world-class workforce, which is crucial to the innovation process. It positions Canada as a magnet for the world's top researchers and graduate students and promotes the development and application of leading-edge knowledge. Six Canada Excellence Research Chairs were awarded in health and related life sciences and technologies. Total funding for CIHR for the eight years amounts to $60 million.
The supplementary estimates (B) also reflect CIHR's funding for the Banting post-doctoral fellowships program to offer new, prestigious fellowships at an internationally competitive level of funding to attract and retain top-tier post-doctoral talent from Canada and abroad.
Total funding for CIHR is $1.5 million in 2010-11 and $3.4 million in 2011-12 and ongoing.
I will certainly be pleased to answer any questions.
Merci beaucoup, madame la présidente.
Thank you very much, all of you, for being here.
My questions are essentially three brief questions, and they may be directed, I believe, to Ms. Yeates.
First, in terms of the mass media expenditure for tobacco control, we have figures going back many years, even back to 2006-07, in terms of Health Canada spending money in that area. We have no figures for 2007-08, 2008-09, or 2009-10, and none projected in 2010-11. Can you tell us why?
Can you give us some details in writing, without disclosing solicitor-client issues?
Ms. Glenda Yeates: I'd be happy to do so.
Hon. Ujjal Dosanjh: On my last question, if I may, there has been a lot of publicity surrounding the abandonment of the expanded warnings on cigarette packages, after doing six or seven years of research and work. My understanding is that the provinces were all expecting the federal government to do this, and suddenly in tobacco control it's only about contraband. They don't have to be mutually exclusive. Contraband is obviously very important to deal with.
Why was this abandoned at this late stage, when everybody was expecting it?
The Chair: There you go.
Mr. Luc Malo: So I will keep all my political questions for December 2, and I will just ask you some questions of a technical nature this morning.
In the past, as you know, I have had questions because we have seen votes added to the health portfolio in order to deal with some backlogs, with natural health products specifically.
The backlog is still there and a new vote has not yet been passed. Some users and producers are worried that the regulations on natural health products will go into effect in their entirety in March 2011.
Is it in fact the Department of Health's intention to put the regulations in effect in their entirety in March 2011? Can you just give us some figures on the applications that still have to be processed?
Thank you for your question. I think I will answer in English because there are a lot of figures and I want to make sure I get the figures right.
As you mentioned, we have had a backlog in the natural health products area, and we have been working diligently on that.
Maybe I'll start by outlining that we have currently issued over 25,000 natural health product licences, which means there are now over 33,000 products on the market. This is more than the number for over-the-counter drugs.
On how we are addressing the backlog, there has been something of a change in how we're dealing with it, partly because of consultations with stakeholders. We have a new set of regulations that are altering how we deal with this. So we're dealing with the backlog in a different way now, but it's a way that I think stakeholders, including NAPRA, the pharmaceutical association, have found to be quite useful.
Under this regime we have mechanisms that we call the UPLAR--“unprocessed product licence application regulations”. They came into force on August 4. These regulations give us the mechanism to temporarily authorize the sale of certain unlicensed NHPs. So once we've been able to assure ourselves that these natural health products meet key safety criteria--and we can at the same time, if we need to, put conditions on their sale--we can allow them into the market. This gives us the ability to move them forward.
We have currently completed 87% of what would have been considered the backlog under the previous regime. We are on target to continue to move these forward, but we now have a slightly different mechanism of counting because we've changed our mechanism. We think the new regulations give us the ability to move things through and deal more expeditiously with natural health products.
I would like to talk to you about another backlog. Let me read the warning posted on the Health Canada website. This is what it says:
|| Health Canada is currently experiencing a temporary delay in processing applications for an authorization to possess and/or a licence to produce marihuana for medical purposes, due to a sharp rise in the number of applications received in recent months.
|| To address the situation, Health Canada has implemented a strategy that is improving the efficiency of its review and authorization process and will restore standard processing times of 8 to 10 weeks.
|| As part of our strategy, our officials have reviewed all operational policies and procedures and implemented several key process changes in order to improve efficiencies and speed up these processes.
|| We anticipate that the number of applications being processed will increase as we progress with the implementation of our strategy. The Department is making efforts to restore normal processing times by the end of this year.
Now, I see no additional funds to implement or support that strategy. So I gather that you do not need additional funds.
I have two questions. Why was there a sharp rise in the number of applications in recent months?
But you must be aware that, for marihuana, if people do not have their authorization, they can be prosecuted. So, the issue of health aside, there is another problem. What is the strategy you have put in place?
Thank you for the question.
It is the case that we have noticed an increase, and we are not entirely sure why that is the case. Perhaps there is a growing awareness of the program. Perhaps there is a growing comfort with physicians in terms of recommending that their patients with various conditions access medical marijuana. I don't think we precisely know the reasons for the increase in demand, but we are certainly seeing the increases that have been ongoing and in fact are accelerating at this point.
That has meant, as is noted in the item on the website, that we are in fact not meeting the benchmarks that we set ourselves internally, because we realize this is an important benchmark to meet for individuals.
The member is absolutely correct. We are not requesting additional funding, but to our own reallocation we need to put and train more individuals, so they can respond to the increase in the demand. That is what we have done.
Our strategy has been to allocate and train additional individuals. We've also introduced a very tight tracking system to understand. We track now weekly. I see these numbers, and the branch sees them even more frequently to actually see how many we are getting in each week, how many we are processing, and if we are on track to clear the backlog.
One of the challenges for us is that we try to project what will come in the following week, so we train staff. There are certain challenges in terms of you can't just add anyone on a given day. There's a certain process of training to make sure that people can provide the steps.
That's the strategy we have put in place, and we're working through that.
I have several areas.
Correct me if I'm wrong, but a few years ago there was a plan to build a non-profit HIV vaccine manufacturing facility. I think earlier this year you decided not to go ahead with it, thereby saving $88 million, something of that nature. Are you transferring that money to the community-based HIV projects? Are you transferring it there?
As I recall, $26 million of that $88 million was taken from the community-based HIV projects. I remember that quite a large number of organizations in the Toronto area that I represent had difficulty because there was a cutback.
I assume some of that funding will be going back to restore or make sure that some of these non-profit organizations would be able to get their AIDS community-based funding. How much is being allocated in that area? How much is committed and how much has been spent so far this year?
Thank you very much for the question.
There is a real sense among all deputy ministers that a crucial part of our role is to ensure financial integrity for the department.
I'm pleased to tell the committee that Health Canada has a strong financial management control framework in place. We have a strong internal control division that monitors the effectiveness of our internal controls. As other departments do, we have a departmental audit committee with outside members who are very helpful in advising the deputy on the strength and the completeness of our internal controls.
The Treasury Board Secretariat has a management accountability framework, and they assess every department on the strength of their financial accountability. They've given Health Canada good marks for our financial stewardship and financial management. Very much, there are other Treasury Board policy recommendations, and when we compare ours against those policy requirements, we do well.
We have a strong internal audit function. It's obviously very helpful when external auditors come and look at our programs, but we want to have a strong internal audit function as well, and that is functioning well, as I said, with a number of regular, scheduled audits looking at the highest-risk areas coming through our audit committee. When we do find areas where we think we can improve and where improvement is called for, we take strong action there.
I would note that the Office of the Auditor General, in their audit procedures on our transactions in the latest fiscal year, 2009-10, found no significant new issues for the department; therefore, there was nothing that warranted the issuance of a management letter. That is an important milestone, certainly, for me as the chief accounting officer, but committee members would also find this to be a real vote of confidence in the control mechanisms.
I wouldn't want to leave the committee with the sense that we are resting on our laurels. This is such a critical area for public trust that we want to always continue to push forward and make sure we are continuing to improve our practices, but I feel we have good practices at the moment and we will work to make them even better.
I would add that in departments across government, clearly deputies have a responsibility for the best use of resources and matching our responsibilities to the capacities that we have.
In public health, the focus on prevention has always been a good investment, but it has not always been the most invested area. In a sense we have duct-taped and binder-twined, and that actually occasionally works, but the point is that whatever resources we have must be focused on the areas that can make the most difference.
Glenda mentioned the calibre of both the internal audit processes and the external audit committees. For example, on our audit committee for the agency we have a former provincial auditor general, a former federal comptroller general, a former CEO, a head of health regions, and a deputy minister. From past lives they bring tremendous expertise not only in the fiscal and financial aspects but also in the links to whether we are spending money in the ways that will deliver to Canadians the best things we can do.
I'll leave it at that. Thank you.
I now live in Ottawa. The irony of listeria was that I was on the phone every day, all day, but I happened to be in Manitoba at the time, so it was not on television. The image was that I wasn't as involved as in fact I indeed was, and once I got to Ottawa they stopped broadcasting them live.
The point is that what we saw on H1N1 was part of the reflection of the importance of a consistent, visible presence. Whether it's me or whoever is not so much the point; Canadians need to hear, they need to hear directly, and they need to see that the political part of the organization, meaning the deputy, and the chief public health officer, in this case, are working closely, are transparent, and are clear in their messaging. At the end of the day people need to know what we know, what we do not know, what we are doing to find out, what we are doing to address it, and what they themselves can do to reduce their risk.
On H1N1, we've applied many of those lessons and will continue to do so. We actually have a risk communications framework and a number of things in place. We are working with not just other departments; we are also, as you saw during H1N1, working very closely with provinces, territories, the WHO, and others to make sure we all have the information and are able to share that information publicly.
I understand that. Thank you.
Dr. Beaudet, I'm going to ask about the Multiple Sclerosis Society of Canada, which called on the government to provide $10 million for research into CCSVI and MS. Mr. Savoie, president of the MS Society of Canada, said:
||The safety and health of people living with MS is our primary concern. The Government...can play a leadership role in addressing the needs of Canadians living with MS by funding research, including clinical trials in CCSVI and MS. Doing so will both advance research and provide safeguards to those seeking treatment.
I am wondering if that $10 million has been appropriated to the budget of CIHR and earmarked for CCSVI research. I asked about it in the spring. I know we talked about the $16 million. I want to know, please, if $10 million is earmarked for this.
Well, we're certainly hoping it's going to mitigate. Obviously we're funding a lot of research to understand causes of the disease and to treat it at its roots. We realize this can take time, so in parallel we're really focusing research efforts on early diagnosis, early biomarkers, early imaging markers, which would allow us to treat the disease before substantial neuro-degeneration has occurred.
We believe that if the clinical trials on Alzheimer's disease have not been successful so far, it's because they were carried out on patients who were in stages of the disease that were too far advanced. We believe if we can diagnosis the disease earlier and carry out clinical trials earlier, we will see drugs that allow us to delay the onset of the disease.
Our objective is fairly modest; it is to delay the onset of the disease by five years. But we're talking about huge, huge impacts, both economic and social, if we succeed in doing that.
I'll perhaps start with that, Madam Chair.
My background, as I think I've mentioned before at the committee, is as a provincial deputy minister. This process is a little bit different from the provincial process as well, but essentially departments build most of their A-base, the known expenditures that they will have year to year, into the regular budget process, and that's what gets tabled early in the year. But then as we go through, for example, in a budget, we would often be involved with the budget discussions. For example, one of the items in our supplementary estimates this year is to recognize increased demands for programs under the Indian residential school support program. That would have become apparent to us, that the base we had in the budget we didn't feel was going to be sufficient to meet the demands we were seeing, and that's a requirement, that we'd be able to provide those supports for everyone who comes forward. So with that, we would have gone with the revision, essentially, to say that we are seeing greater numbers, and if that then is approved in the budget, then we hear often in a budget announcement a number of those programs, and indeed most of the ones that I mentioned in my opening remarks were things you would have heard as part of the budget. Then the process for regularizing and finalizing the details and getting them before Parliament occurs later in the year through the Treasury Board process in here.
Essentially it's a staged process, partly because of a difference between what things are fundamentally in an A-base that we can deal with at one point in time versus other things that arise later either because they're new or because we have revised estimates, for example.
I read an article, and I will perhaps brag slightly about my own community. In this community, because we were talking about chronic disease, Kamloops has one of three of what they call a strategic alliance, and it is a partnership between the health authority and the city where they've trained people who are specialists in exercising and supporting exercise for chronic disease. Again, there are only three across the country. I think they are probably doing amazing work.
If you're not affiliated with a university, how does that ever connect through? If you have some things that are happening that are absolutely fantastic, how does it ever connect through to the CIHR process or the Public Health Agency of Canada's process if it's sort of not formalized, not connected with the university, in terms of you saying “Wow, those are great ideas, let's do a more formal evaluation”? How are we going to not only formally evaluate but look at embedding and ensuring that knowledge?
HIV/AIDS awareness week is coming up next week. Could you table for the committee some of the initiatives that are currently under way? I think it would be helpful.
I had another question for Ms. Yeates on a topic that I believe Mr. Malo touched upon in regard to the natural health products directorate. As a chiropractor in my previous life, prior to becoming an MP, I know that it's an important issue for many people within my network.
You mentioned that with the new regulations, 87% of the backlog has been completed. How many applications do you currently have within the directorate, and how quickly do you see those being processed? The delay in getting them approved has been a huge area of concern for many stakeholders.
There are actually a number of areas we're involved with, in close contact with departments across government not only here but also with our colleagues in other countries.
In terms of the laboratory, the genetic sequencing or genome sequencing of the cholera bacteria is actually something that we did, which helps to identify exactly the potential sources, etc. So we're very much involved in that, working jointly with the CDC in the U.S. on that.
There has not been a request for assistance, in the sense of a team of epidemiologists and others going down, but if we are asked, we are available to go.
Thank you very much for the question.
Yes, Health Canada partners in a number of ways with Environment Canada and others on the environmental file, because there's often a concern on both the environmental and human health sides. Environment tends to be the lead department, but we are very much, we think, an important partner in a number of environmental activities. Certainly one of the ones that's in these estimates is something that's very specific to air quality.
There is a need for additional research to support the development and refinement of an indicator that would help us measure the connection between air quality and health, because I think that understanding which conditions are linked in the epidemiological research to which air quality indices or air quality findings is critical to taking action. So the research function of a new health air indicator we think is quite important. It would allow us to track changes over time in air pollution levels, for example, and to see what links those might have to the health of Canadians.
So there is actually $240,000 in supplementary estimates (B) for the expansion of this indicator to include other pollutants. It's an ongoing piece of work that we are doing. Currently, we have an air quality indicator for ozone and for particulate matter, but we are working to expand that as part of our overall clean air agenda in terms of the work we do with Environment Canada under the chemicals management plan and the work we do on the environmental and health files generally.
It's really about your excellent northern health initiative for accessible and nutritious food.
Have you considered rolling that out to other parts of Canada that need access to healthy nutritious meals, and especially to children, given that boys are now 16 pounds heavier than they were 20 years ago and girls 11 or 12 pounds heavier? That's substantial. So access to nutritious, affordable, local food is really important.
Is there any movement on this, or are there any learnings from your food mail program on this? Is it community-based? Maybe you could describe it somewhat.
Thank you for that question.
I'll speak to the Nutrition North program, specifically. In answer to the broader question of the consideration, when health ministers met this past September, there was a real joint coming together on the issues. There was a declaration on prevention and promotion and a focus on childhood obesity and a specific initiative in terms of a framework on childhood obesity.
Now, we have been tasked with coming forward with strategies and with collectively bringing back to the ministers of provinces and territories and the federal government strategies and options. One of the things they particularly asked us to look at, for example, is the marketing of unhealthy foods to children.
Ministers are seized of the issue. I think everyone realizes that this is all levels of government. Everyone is working together at the health minister level. So there may be further things there.
It's early days, so I don't think we're at that stage. But certainly the partners are looking to understand best practices. I know that some jurisdictions do some of those programs now, and others may wish to learn from them and work on them.
To make the link to Nutrition North, which is obviously a program that is within the Government of Canada's remit and focus, there was a real sense that we should be focusing on this program to try to improve the availability of nutritious food. Our colleague department, INAC, is actually the lead on this program. On moving the subsidies, we had to make some choices about trying to focus the resources on healthy foods. We had an expert panel that looked at, for example, removing food that had high levels of salt or sugar and focusing the supports on other foods.
The Health Canada portion I think is quite important, because in addition to simply making foods available, I think all the best research has told us that it's also about making sure that people have the understanding and the skills, in terms of how to prepare these foods, that might lead people to choose them.
The money in supplementaries is for us to actually work with communities and work with the existing programs to try to build nutrition supports for communities. It may be cooking classes. It may be displays right in retail establishments. It may be community freezers.
Well, there are both. We provide a lot of money, actually, to support those things. But it's not just a federal issue. It is about different levels of government working together and different agencies working together.
In my life as a local medical officer, one of the things we found was that kids were recognized as coming to school hungry, and parents' groups and teachers wanted to come together and put together a program, such as a muffin program or whatever. What I observed is that there were all these regulatory things, and by the time they worked through all the regulations and having kitchens and all this, they ran out of energy. So what we did was bring the inspectors, the nurses, and the schools together and said “Okay, how can we make this easy so that all the energy of the volunteers and the parents can go into actually delivering the program?”
There are a number of things to do. From the agency's perspective, in addition to the kinds of programs we fund, one of the things that's really key, which goes back to, in a way, a previous question, is how you get that information out there. We have the Canadian best practices portal and the chronic disease portal. We're very much focused on evaluations and understanding what works and what doesn't. It is why my annual report is not just a list of the problems but has ways in which communities and organizations can actually address them.
We're seized with the idea that every public health nurse in this country, every inspector, every nurse, and every nutritionist should not have to rediscover what's been learned and what is a good program in Kamloops or whatever.
That is a strong focus. We've reinstituted the preventive practices group. We've done a number of things that I think over the next few years will help so that practitioners, whether they're teachers or public health workers or whatever, have access to the tools that will assist them in actually getting the work done, as opposed to waiting for somebody to get something to happen.
Perhaps I'll just start, in terms of the agency's role in this, and then Glenda could speak to the extensive programs that have developed for first nations communities.
This is a huge challenge, obviously. And unfortunately for kids born with fetal alcohol, it is a life challenge; it's not just an event. Some of the things that were recognized were awareness, understanding, guidelines, standards in terms of diagnosis, and what are appropriate therapies and approaches, etc.
A lot of our resources have been focused on ensuring that practitioners, physicians, and others have the tools they need to actually address that. Then we're also seeing the development in the provinces, who actually deliver these services, at not only an increased understanding but an increased focus on how best to do that. Our job is to make sure they have the best tools possible to both understand the condition but also to address it.
Madam Chair, perhaps I could speak specifically to our efforts as part of our participation in the Inuit health branch. As David has mentioned, all jurisdictions—provinces, territories, and the federal government—are very much aware of the challenge. So we, as part of the first nations and Inuit health branch, have some specific focus here as well.
We invest $16 million annually, as part of an FASD prevention program. We're working on trying to improve awareness. We've done some public opinion research, which tells us that we are actually increasing the awareness in our first nations communities of some of the challenges.
We are working to develop actual support programs that give us culturally appropriate and evidence-based prevention, and early intervention programs. So we're working with some mentoring projects, for example, in certain areas to provide women who are pregnant with some supports. We're also supporting community coordinator positions to increase access for families to multidisciplinary teams in certain areas.
We're continuing to work with communities. Again, much like other issues, this isn't something the Government of Canada can do for people. It is working with communities, providing them with the support, the knowledge, the information, and the assistance to deal with what is obviously a very challenging and important issue.
Thank you very much, Madam Chair.
I notice that my colleague mentions all the briefing notes and research documents that have been written by Health Canada about the implementation of new tobacco health warnings. This could be quite voluminous, and there may be issues regarding cabinet confidence.
We do have a system, access to information, and I would think it might be a better option for the member to consider putting this through ATIP, as they would take the cabinet confidence issue into account. So I'd like to make that recommendation on that second point.
Does anybody else want to discuss that point? There are a few things I'd like to talk about.
Again, I would just point out that my colleague did request information going all the way back to 2004. The Federal Accountability Act and the details and the checks and balances we put in didn't come into effect until 2006, I think, or later.
You were the Minister of Health back in 2004. Maybe the quickest thing to do, if you really want that information, is to go into your own schedule. For the time between 2004 and 2006, when we didn't have the Office of the Commissioner of Lobbying or the ability to look at these different things, I don't even know if that information would be available through ATIP and all these other offices. But you might have that yourself, and that would be the quickest way to get that to us for the time from 2004 to 2006.
Madam Chair, with the committee there are ways of getting this through. And he's asked to have it within seven days. This request really resembles an order paper question, and we know that other colleagues around the table have asked for these before. There are reasons we allow 45 days for responses to order paper questions. Because of the volume of what he's asking for here, I would suggest as well that seven working days is unreasonable. For the part between 2004 and 2006, he might be able to pull that out of his old schedule. But he's asking for a lot of information here.
Even in the next question--“All the written and verbal input”--he's talking about verbal input--“the government has received related to the implementation of new tobacco warning labels” as the next point. How does one even provide verbal input in a written form? If somebody is just talking back and forth, how do you provide that in a written form?
And then it indicates any and all deliberations that the government has undertaken regarding the implementation of new tobacco warnings. Again, this is more cabinet confidence. And if you put it through ATIP, they will take all of this into account.
I think, Madam Chair, there is a reason you can put this as an order paper question and give a reasonable amount of time to get the responses to this. This is incredibly unusual.
Ms. Chow, stop laughing. Let's come back to order here.
We will now move that motion. The motion is on the floor.
The motion was that Mr. Dosanjh bring forward those documents. But now we learn that in committee a member cannot be compelled to do that. The House can compel him, but the committee cannot.
So we have that clarified, right? Good.
So that motion cannot go forward, Dr. Carrie.
We'll go in camera on healthy living.
So we can cite the committee business you're talking about, Monsieur Malo.
Monsieur Malo: Voila. Absolument.
The Chair: Monsieur Malo, we've got you. Good.
Some hon. members: Hear, hear!
The Chair: It's pretty bad when the committee applauds when I actually get it--it's sad actually.
So we'll proceed that way.
For the life of me, I don't know how these people are going to get all these documents in, even in nine days. I might be wrong, but how do we proceed if they cannot do that? We'll deal with it when they come; that's all we can do.
Now we're going to talk about injury prevention. I would like Karin to go....
If you want to prevent your injury, Mr. Dosanjh.... No, I'm just teasing.
We have to pay attention to this. We have to clarify what we're going to be studying on injury prevention. We've talked about childhood and adults, so we need some input from the committee.