I will be very brief, Mr. Chair.
Mr. Chair, members of the committee, it is a pleasure to be here to discuss supplementary estimates (C) for the budget year that's soon coming to a close.
This year was an eventful one in terms of health legislation, health research and health promotion. The minister will discuss these subjects more closely when she appears before the committee later this month.
As you know, the department I represent delivers a number of critical programs and services to Canadians, and does so based on its mission of helping Canadians to maintain and improve their health.
I'm now going to turn my attention directly to supplementary estimates (C).
For Health Canada, these estimates represent a net decrease of $818,000 in the 2010-11 supplementary estimates (C), which reduces our total budget from $3.756 billion to $3.755 billion for the current fiscal year.
I'm not going to go through every one of the major items contributing to this decrease, but they include a transfer of $706,000 to Indian Affairs and Northern Development.
These funds are destined to support self-governing Yukon first nations as they assume direct responsibility for the delivery of certain health programs and services. Funding will support them to administer health promotion programming related to diabetes, youth suicide prevention, the anti-drug strategy, and maternal and child health. These are services that previously had been funded and provided directly by Health Canada, and they'll now be provided by the self-governing first nations. This is in keeping with our general policy of transferring relevant departmental funding following the finalization of self-governing agreements.
The other significant transfer for us is the transfer of $200,000 to the Canadian Institutes of Health Research. This was proposed to be transferred to CIHR to help establish a research chair for autism.
Both of those transfers are fulfilling commitments made in recent years to making long-term improvements to health care.
With respect to autism, the transferred funds will be used to establish a research chair to focus research on this condition.
With reference to the Yukon first nations programs, this too is a part of a long-term commitment to give first nations greater control over the delivery of their own health services. This is based on the sound principle that first nations have the best understanding of the needs of their communities.
Mr. Chair, members of the committee, I hope this gives everyone a better snapshot of Health Canada's supplementary estimates (C).
Thank you for this opportunity. We will be pleased to answer any questions you might have.
I would like to thank the committee for this opportunity to provide an update on supplementary estimates (C) as they pertain to the Public Health Agency of Canada.
With me today is James Libbey, chief financial officer, and Dr. Rainer Engelhardt, who is here as it related to the second topic, antimicrobial resistance.
As the current fiscal year comes to a close, the agency actually has no additional funding to request under these estimates.
However, as my colleagues in the health portfolio are proceeding this morning, before I respond to committee questions I would like to provide the context in which this activity is taking place.
Mr. Chair, generally speaking, Canadians are healthier today than they have ever been.
Life expectancy in Canada has increased by more than two years in the last decade alone, and by more than 30 years since the early 20th century. Most Canadians today consider themselves to be in very good or excellent health.
Advances in treatment and medical science, while crucial, are not the only reason, and may be only a small reason, for the improvements we've seen. Canada has a remarkably strong history of action and partnership in health promotion and disease prevention, from the early colonial period to the 1986 Ottawa Charter for Health Promotion to the Declaration on Prevention and Promotion by Canada's Ministers of Health and Health Promotion/Healthy Living in 2010.
Since the formation of the agency six years ago, Canada has solidified its place as a global leader in public health.
Each year, at the agency, we are able to build on the sound policy, surveillance and science we generate, and on successful programs that directly help Canadians.
The main reason we need to keep building on this success is that improvements in health aren't shared equally among all Canadians. In many cases, health inequalities between Canadians are growing. Not all health trends are improving, and not all Canadians are benefiting to the same degree. Some groups in Canada experience lower life expectancy, as well as higher rates of infant mortality, injury, disease, and addiction.
The Public Health Agency plays a key role in the effort to narrow these gaps through partnership, advocacy, enabling, and mitigating when needed, but while government efforts are central, public health is, at its heart, local. Health promotion and disease prevention need to reach Canadians at home, in their communities, and at work. We need the partnership that all levels of government, health professionals, the corporate world, and community organizations can provide.
This is the idea behind so much of what we do at the agency, and each year our resources are devoted accordingly. This week, for example, Canada's ministers of health launched Our Health Our Future: A National Dialogue on Healthy Weights.
The dialogue is a key step in identifying actions to curb childhood obesity, a significant health concern in this country, and to promote healthy weights.
It's about engagement and discussion because, as in many public health issues, everyone plays a role. Everyone can commit to action on curbing childhood obesity. As Canada deals with an increasingly less active and more obese and overweight population, tied closely to escalating levels of chronic disease, I expect this will be a continued priority moving into the next fiscal year.
Of the $684.6 million allocated to the agency, over $182 million was dedicated to health promotion. These funds are helping to support activities like the dialogue I just mentioned, updating the physical activity guidelines, and building on our accomplishments through successful community-based programs, including those for vulnerable populations. This year $116 million was devoted to the disease prevention agenda.
These funds continue to enhance Canada's ability to prevent and manage diseases and injuries, and they are helping us continue to gather and analyze data on the traits, trends, and patterns of injuries in Canada. They are helping, for example, to increase awareness of risks such as lung disease and to increase capacity and knowledge on prevention and control of a broad range of chronic diseases, including diabetes, heart disease, cancer, and neurological diseases.
Under these supplementary estimates, the agency will be transferring approximately $1.9 million to other government departments for public health activities that help us reach these goals. For example, $1 million will be transferred to the Canadian Institutes of Health Research to support the need for enhanced research in population health interventions and the reduction of health inequalities, particularly in the realm of obesity and mental health.
An additional $800,000 will be transferred to CIHR for research on HIV and AIDS co-infections and other co-morbidities, which will help us understand how a spectrum of chronic diseases interact.
We are focusing our efforts where they are needed most.
We continue working to increase public health capacity and enhancing our national and international collaborations. We continue to strengthen surveillance and increase capability in assessing the health of the population.
We remain the government-wide lead on efforts to study and address determinants of health. We continue to work closely with all our partners to ensure that the government's responses to national outbreaks, including food-borne diseases and pandemics, are watertight, efficient, and well coordinated.
Before I close, I would like to highlight one additional area that you've requested in which the agency collaborates closely.
The Government of Canada as a whole has committed significant resources to tracking antibiotic use and resistance. The agency leads national surveillance systems that track antibiotic resistance and antibiotic use in health care, in community settings, and in the food supply.
The agency will also be working with Health Canada, CFIA, and Agriculture on the development of a coordinated approach to AMR, antimicrobial resistance, in Canada. This will include working closely with the health portfolio, provincial and territorial partners, as well as many other stakeholders to help control the spread of AMR in Canada.
Collaboration will always be our watchword. I believe these estimates reflect that priority. I appreciate your time and I am happy to answer any questions.
I would like to thank the committee for this opportunity to discuss the transfers to the Canadian Institutes of Health Research under supplementary estimates (C).
As you have seen, CIHR's grants vote will increase by $10.67 million with approval of the 2010-11 supplementary estimates (C). This increase will bring CIHR's reference levels for the 2010-11 fiscal year to $1.026 billion.
I would like to highlight the potential impact of a few of these transfers on health outcomes and commercialization of health discoveries.
The largest transfer is $9.36 million for the Centres of Excellence for Commercialization and Research. This investment is being used to fund two centres of excellence: the Centre for Commercialization of Regenerative Medicine located in Toronto, and the Centre for Imaging Technology Commercialization located in London.
Regenerative medicine and medical imaging are two areas at the forefront of discovery in health research. They are also two areas in which Canada is world-renowned for its scientific expertise. These two new centres therefore represent exciting opportunities for future breakthrough discoveries with impact on the health of Canadians and the strength of our life sciences industry.
CIHR's transfers, as you just heard, also include a transfer of $1 million from the Public Health Agency of Canada for population health intervention research. With this investment, CIHR and PHAC have succeeded in attracting other partners, including the Canadian Institute for Health Information, the Heart and Stroke Foundation of Canada, the New Brunswick Health Research Foundation, and the Ontario Ministry of Health and Long-Term Care. Together with these partners, CIHR will fund seven major research projects in the area of mental health promotion and the prevention and reduction of obesity, two major priority areas for the health of Canadians.
For CIHR this is but one of many of these very Canadian examples where government investment serves as a catalyst for the engagement of other partners so as to increase the coherence of research funding and maximize its potential for impact.
A third transfer of $800,000 from the Public Health Agency will go to major projects on HIV and AIDS co-infections and other co-morbidities, as you have heard. This research will provide the evidence needed for future programs and policies to prevent or control HIV and AIDS co-infections and other co-morbidities.
Finally, CIHR is transferring out the amount of $700,000 to the International Development Research Centre for an international research initiative on adaptation to climate change. This investment will support multinational research teams to advance a fuller understanding of climate and related stressors on vulnerable populations, resources, and ecosystem health in Canada and in low income and middle income countries.
The purposes of having this knowledge are: to shape policies and practices that help people and vulnerable segments to adapt to climate change; to train highly qualified staff; and, finally, to establish networks that will enhance the ability of governments, of the private sector and of civil society to adapt to climate change and to reduce its effects.
I would like to thank you for your support of CIHR's endeavours and for health research in general.
I'm pleased to take any questions that you may have.
Mr. Chair, the member raises a very important question. It's been one that has been flagged in the media, and indeed by the Canadian Pharmacists Association, as was mentioned.
This has been brought to our attention by the Canadian Pharmacists Association and others. As we all know, drugs are manufactured by industry. There are a number of changes, at all times, taking place in the industry supply chain, whether they are on the wholesale side or the retail side. When this issue comes forward, we typically try to work with partners to understand the nature of the issue.
Currently we've been discussing this with a number of provinces. We've been in contact with provinces and territories which, as you know, are responsible for not only delivering hospital services but also significant drug programs. In addition, we are preparing a letter. I think the minister will be writing a letter to the major drug manufacturers to explore with them what they are experiencing.
We are following up with stakeholders. We don't at this time have a full understanding of what these drug shortages might be and where they might be occurring. We have anecdotal information. We're working with CADTH, the Canadian Agency for Drugs and Technologies in Health, to understand if we can get a better picture of the situation.
Those are the steps we're taking at the moment, Mr. Chair.
Mr. Chair, I'm pleased to answer this very important question.
The Canadian Partnership Against Cancer has been a real success story in Canada. There is often a question about whether there's a need for a pan-Canadian organization over and above the delivery that occurs in individual provinces and territories. In a sense the Canadian Partnership Against Cancer has shown us what can happen when we do that function well.
The partnership has done a number of things. It's been doing seven large-scale initiatives to combat the common risk factors of cancer and other chronic diseases. I think there's often a worry that we'll look disease by disease, but I think the cancer partnership has been very clear that it is about some of the common risk factors for cancer and other diseases.
They've taken a collaborative approach. They've offered support for some individual provinces that may not have had colorectal screening programs, for example. They've been able to be a best practices or a sharing organization in that way.
A very important thing, and I speak here from some experience with the data information collection world, is cancer stage data has always been something we've striven to have in Canada. When you're trying to analyze cancer and what works and which interventions are most effective, understanding what stage a cancer is at is critical. It isn't data we've had collected before and that's because a fair bit of work has to be done on standardizing the format, standardizing the definitions. The Canadian Partnership Against Cancer has made major strides in this area, and I think this is going to be critical for the future.
They've done some very good public reporting work on cancer system performance. We always want to understand which practices perform best and how we are doing. They've had a pan-Canadian initiative on the management of pain and other symptoms for cancer patients, some very critical and fundamental issues that affect individual Canadians. I think at this point they're looking at some work on understanding the causes of cancer.
It's been a very successful partnership thus far.
Thank you to everyone for coming here today.
Since we only have one question, I wanted to raise an issue that is important to many of my constituents in Brampton—Springdale. As you may or may not know, in Brampton, we've built one of the largest and newest hospitals in the country. We have seen a tremendous number of challenges at that hospital, in terms of the wait times and in terms of the services that have been received. The hospital has done a great job in trying to work with the community to rectify these.
Most recently, there was a woman who had the wrong leg amputated. It is a serious, serious issue. Even though the delivery is supposed to be provincial, we wrote to the Minister of Health requesting that she visit the hospital to see it first hand and to get an insight on how severe the challenges are. We were quite astonished to receive her response that she did not have time. I would ask the deputy minister, who I know is very passionate about health care and about delivery, to ensure the message is passed on that there are some serious challenges out there.
My colleague, Dr. , spoke about the 2014 health care agreement. You stated that there is no formal discussion going on at this point, only through the Senate. I find that very alarming. We are three years away and I can tell you that every Canadian across the country is very concerned and worried.
The question I have actually is on another important public health issue in regard to organic chicken. We had a variety of stakeholders before us at our last meeting. They sounded a bit of an alarm in terms of what's going on in the industry. I wanted to ask Dr. Butler-Jones about organic chicken, which people assume is very safe. They were saying there are not the same monitoring mechanisms for people who sell organic chicken that there are for chicken sold off the market. They were saying that only 97% of the producers are actually in compliance with the protocols that have been established by the Public Health Agency. What happens to the other 3%? What's going on with the producers of organic chicken?
Can I generalize the question a bit? It is an issue as it relates to some of our assumptions that getting something at the farm gate or whatever somehow has to be healthier because it's more natural. At the same time, it doesn't have the same level of oversight. It's not so much the oversight of testing and inspection, but the processes in place to minimize the risk of infections and transmission.
If you look at the food supply system generally, in order to get disease, several things actually have to happen. There must be a pathogen in place, a bacteria, a virus or whatever. Food must have come in contact with a human, because it's not cooked right, it's not stored right, or there's cross-contamination, etc.
The reality is that animals carry a number of diseases, some of which can potentially infect humans. All the measures in the health system in commercial operations are there to minimize that risk, and then, at the end of the day as a consumer, we have to make sure we cook the meat appropriately. There are numbers involved. As Paul was saying, there's very close collaboration among ourselves, CFIA, and Health Canada to make sure that all the parts of the system are in fact working in the same direction, and then with provincial authorities, because again, in many of these areas, the provinces actually have authority.
My first concern is people should not make assumptions that because something is called “natural” or “organic” that somehow it is more healthy. It's like the debate about special bottled water, which often has more pathogens and more stuff in it than our tap water. These generalizations are not helpful for health.
I think it's absolutely essential in getting the best advice, in getting that kind of information, to not make assumptions and actually to understand the sources of the food and the risks, and the things we can do to mitigate that risk. That would be the Public Health approach, not just in terms of organic chickens, but more broadly, whether it's cheese or other things as well.
Yes, and it's multiple. When you put it all together, the relationship between pathogens in animals and humans is very complex. Some don't pass over; a number do. That's partly what we're concerned about.
Part of the reason for inspections by CFIA is to make sure that no sick animal gets into the food system. They make sure they're fundamentally healthy so we don't have situations where there are abscesses in the meat, or infection directly in the meat that could be transferred.
On the other hand, there are infections that come from fecal material, like E. coli, that get on the carcasses, on the meat, and potentially cross-contaminate, or something like listeria, which is in the environment and gets in through the food-processing system. There are various testing methods to minimize that impact.
In general, if you're eating a healthy animal, as opposed to road kill or something you picked up in the forest, it's not going to be through the meat. The animal is healthy. If you cook it well or cook it properly, you're going to kill off any bacteria or viruses on the surface. Generally, healthy meat won't have bacteria or viruses in the meat itself. That's one of our key assurances, as long as we don't cross-contaminate.
It will be difficult to answer in a minute but I'll do my best.
It's important to realize that globally, Canada is doing extremely well in health research generally. We're doing very well according to all the available indicators, particularly the bibliometric indicators, the number of publications, the number of publications per dollar invested, and most importantly, the impact of those publications in terms of how often those papers are actually read by the international community.
There are certain areas where we truly excel. It's difficult because I don't want to forget any, but in terms of these indicators, we're very strong in neuroscience research and neuroscience mental health. We're really top of the charts in pain research, one of the top countries in the world.
We are performing extremely well in terms of the quality of clinical research. Our papers, our publications, our studies in clinical research have had, and are having, a huge impact worldwide. They have changed the way certain diseases are treated worldwide. The problem is that we are losing ground. The quantity is not there and we're having more and more difficulty attracting health professionals into research. That's a very important issue. We want to maintain leadership in that area.
I'd add cancer research, regenerative medicine, and infection and immunity as areas where we're doing extremely well. By and large it is a sector of science Canada can be proud of and we're really in the top tier.