Thank you, Madam Chair. I'd like to thank you for introducing my officials.
Good afternoon, everyone. It's a pleasure to be back.
Today I am here to discuss supplementary estimates (B) for the health portfolio. For that reason, joining me are officials from Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research. As well, each deputy head has brought along their financial officials. If you have any specific or detailed questions, they'll be able to answer them.
Madam Chair, I would like to give you a quick overview of the 2011-12 supplementary estimates (B) before we go into the discussions.
On the Health Canada side, supplementary (B) provides $330 million in new spending for 2011-12. That increase raises the total budget to $3.8 billion for the current fiscal year.
The major increases include $218 million to provide health benefits for pharmacy and dental services and to continue nursing services in remote and isolated first nations communities through the first nations and Inuit health branch; $64 million for the chemicals management plan; and $26 million for the clean air regulatory agenda.
With respect to the other parts of the portfolio, the Public Health Agency of Canada received a net increase of $31 million, increasing the Public Health Agency of Canada's total budget to $675 million for the current fiscal year.
The major increases include $16 million for the short-term replenishment of the national antiviral stockpile; $8 million to secure Canada's pandemic influenza vaccine supply; and $2 million to renew funding for the genomics research and development initiatives. These increases for various health portfolios programs all help to maintain and protect the health of Canadians.
Since my last appearance at this committee, I have had the opportunity to travel from coast to coast to coast, and to talk to Canadians about a broad range of health concerns. While I've been on the road making health announcements, I've also had the privilege of seeing first-hand some of the great work being done by medical professionals and researchers at labs, in hospitals, and at the community level.
Here are some of the main priority files that have been progressing over the past several months.
We are working to reduce the impact of non-communicable diseases, or chronic diseases. I was very pleased to attend the United Nations in September and sign off a political declaration on non-communicable diseases. I sat among health ministers and leaders in health care from all over the world. We acknowledged the direct impact of chronic diseases on social and economic development, and we made national and international commitments for their prevention and control.
Here at home, chronic diseases have been a priority for our government as well. Most of you will recall that last year Canada's ministers of health signed a declaration on prevention and health promotion. It sets out guiding principles, including the need for more emphasis to be placed on the promotion of health, with the aim of preventing or delaying chronic diseases, disabilities, and injuries.
I am particularly interested in the prevention aspect. There are many ways to encourage our population to be instrumental in their own healthy living lifestyles. That means getting back to basics of regular exercise, healthy eating, and making informed lifestyle changes.
I'd like to thank you, as the committee, for the important work you're doing for prevention. I think it's an essential part of making the health care system more effective and more sustainable in the long run. On behalf of Canadians, thank you again for your committee's hard work in this area.
When it comes to prevention, you can't get much more ahead of the game than by dealing with childhood obesity. That is one of our main priorities. Again, in September 2010, the federal, provincial, and territorial ministers of health agreed to a framework through which we could make childhood obesity a collective priority. It will allow us to coordinate our work with many sectors of Canadian society and support healthier weight among children and youth.
As a first step in implementing the framework, FPT partners brought together a diverse group of more than a thousand citizens and stakeholders to identify ways in which we can create the conditions that will help achieve healthy weights. I'll be discussing this further with my provincial and territorial counterparts when we meet in Halifax this Friday.
An all-too-common chronic disease is diabetes. Approximately two million Canadians have already been diagnosed with diabetes and many more are unaware that they have the disease. Type 2 diabetes is the most common type, accounting for between 90% to 95% of all cases.
With Type 2 diabetes, the sooner it is detected, the fewer the complications. Also, it can often be prevented or delayed by adopting a healthier lifestyle, but first, Canadians have to be aware of their risk of developing Type 2 diabetes.
Last week I was in Toronto, where I announced that Shoppers Drug Mart will be making our CANRISK survey available through pharmacies across the country. By putting this helpful tool in people's hands and having pharmacists on hand to discuss the results with them, I believe there is a huge potential to help people make informed decisions that will help them to avoid developing Type 2 diabetes.
We're also investing $6 million through the Canadian diabetes strategy to fund 37 new community-based projects across the country. This funding will address screening, early detection, and management of diabetes, as well as the prevention of secondary complications from the disease. By giving Canadians information they need, we can help them make healthier choices so they can live longer and healthier lives.
An ever-present health concern is the use of tobacco. It is still associated with the deaths of almost 37,000 Canadians every year. To get more people thinking about its negative health effects, we have changed tobacco labelling regulations so that in the coming months smokers will begin to see much bigger health warning labels on the tobacco packages.
We have unveiled new graphic images that will cover 75% of the package so they cannot be ignored. One of those images is of a dying Barb Tarbox, who wanted to discourage others from suffering like she did and offered her image for use in this context. It was a powerful experience for me to announce the new label with Barb's widower, Pat, and her daughter Mackenzie, who shared very honestly with students the pain she experienced by losing her mother to cancer. We are grateful for the work that was done with her family and for their support in this campaign.
We want to get the attention of smokers with those images and we also want to help them quit. That is why we worked with the provinces and the territories to create a quit line that all Canadians can access. The phone number and web address will be on the new packaging so that all Canadians can get help, no matter where they live.
In 2010 smoking among teens aged 15 years to 17 years was 9%. This is the lowest rate we've ever recorded for this age group, which is critical in our fight against smoking. We are encouraged to see overall smoking rates at historic lows, and we will keep up the fight.
A month ago, I was pleased to represent the Government of Canada in signing the B.C. Tripartite Framework Agreement on First Nation Health Governance, along with the Province of British Columbia, the B.C. First Nations Health Society, and the B.C. First Nations Health Council. This agreement is the first of its kind for first nations health in Canada. It promotes a more integrated model of health service delivery for British Columbia first nations, and it creates a health governance structure that will more effectively respond to first nations needs.
A British Columbia First Nations Health Authority is at the heart of the new structure. Through this authority, programs and services will be designed, delivered, and managed by first nations for first nations, and in ways that best meet first nations needs.
I am proud of the work we are doing in collaboration with first nations. We know that this hands-on approach will better meet the needs of first nations in British Columbia.
To have the best health care system in the world, the patients must always come first. We are working to make sure that it is also true when it comes to research. This summer, at the annual meeting of the Canadian Medical Association, I announced a new national strategy to better integrate health, research, and health care. We want to be sure that research doesn't just stop at the lab. We want it to translate into better treatments in clinics, hospitals, and doctors' offices throughout Canada. This new approach will foster research that will help health care providers compare the results of different treatment options and determine the best course of action for patients. Putting the needs of patients first will bring meaningful changes to our health care system.
One of the ways we can put patients first relates to making sure that there are safe drugs available on the market. One of the many duties of the health portfolio is to conduct a thorough review of drugs to ensure that they are safe before patients can use them.
Health Canada scientists can be asked to review more than 4,000 drug submissions in any given year. This obviously is a significant number of reviews, and it poses a challenge to the organization. Earlier this year we updated Health Canada's user fees. This has allowed the department to progress reviews more efficiently and effectively.
We also have taken action to address the global issue of drug shortages. This summer I wrote to drug companies and asked that they take action to develop a system that provides patients and health care providers with the information they need about possible drug shortages so that they can make informed decisions about treatment plans.
I told these companies that if they did not come up with an approach that accomplished this goal, then as minister I would be prepared to take action and regulate a solution.
I'm pleased to report that the response was positive. In the near future, Canadians will be able to log on to a public website to see if there are drug shortage issues that affect them. This is in addition to existing communication channels that industry and Health Canada have with the medical community.
In conclusion, as you can see, a great deal has been accomplished and work continues on several fronts. As I mentioned earlier, this week I will be meeting with my provincial and territorial counterparts, and we'll begin talking about what should replace the 2004 health accord.
As you know, our government has committed to increase total health transfers by 6% beyond 2014. Our government has committed to working with the provinces and the territories to reach a new agreement that provides accountability, meaning better results for patients.
I would like to thank the members of this committee for their time. I am prepared to answer any questions you may have.
Thank you very much, Chairperson.
To the minister, thank you for coming today and for your presentation. You've presented some information, but I have to say from hearing you and reading through your brief, I think there are several major issues facing our health care system that are not being addressed by the federal government. I'd like to focus on that by asking you some questions.
You've spoken a little about one of the issues, which is the shortage of drugs. I noted in the House today that you said you're very happy there's now a plan; you asked these drug companies to come up with something. I would point out that this was all done behind closed doors.
We wanted to study this at the health committee. There's been no discussion here. There's been no public disclosure. I think it's very obvious that a pledge to post information is just that: it's just providing information. It doesn't actually resolve the problem of the drug shortages themselves. As I'm sure you're aware, a number of medical journals, academics, and health professionals seriously question why these shortages exist. It's very interesting that the shortages seem to be mostly among the older generic drugs—some of which have been around for 50 years—forcing people to pay more.
I'm very perplexed that your government's response, your response, to this is basically to say, well, post the information. That's not resolving the question, Minister. We'd like to know what you intend to do to ensure that these shortages, which put people in jeopardy, don't continue to exist. I think this is very much related to the whole question of affordable drugs and accessibility.
As you know, in the 2004 health accord, a commitment was made for a universal prescription drug coverage plan. We can go as far back as 1964 to 1997 to 2002—the Romanow commission, the 2004 accord—and when we look at the reality of what's going on, we can see again that the federal government has taken no action in addressing this critical issue.
So these two things are related. I find it very problematic that we've seen nothing from you or the government to address what is now the biggest cost in our health care system, and that's the cost of prescription drugs, and now we've got shortages as well.
I'd like you to respond to that and say why nothing has been done and what is intended to be done, to address these two issues.
Thank you very much, Madam Chair.
Everybody seems to be on the issue of drugs, so I'm going to stick with that at the moment, because that's of very great importance to me. As you well know, in the 2003 first ministers meeting, one of the priorities was that drugs are safe, effective, and accessible to patients in a timely and cost-effective manner. I want to deal with some of these.
First I want to deal with the safety and effectiveness of drugs. I think that talks about post-market surveillance or what we call pharmaco-vigilance. When a drug is out there and people are using it, we need to look at what the adverse reactions are. Is it effective? Is it doing what it says it would do?
I would like the minister to answer the question based on that, in terms of her own report, which says in some instances this is not happening. The Health Council of Canada says it's not happening because the Department of Health lacks the regulatory mechanisms and it needs funding for research into effectiveness of drugs, etc. There's a funding issue here, and there is a regulatory issue, which the Department of Health doesn't have the ability to do. I'd like her comment on that, which is what the Health Council talked about.
Second, a part of the accessibility of drugs within the 2004 accord was about getting a task force together of all levels of government, with the federal government and a province co-chairing it, to be able to look at accessibility and affordability of drugs. I'd like the minister to tell me what exactly happened to that task force because I'm told it no longer exists. Yet it was a priority for the 2004 health accord and had funding in it for that.
The third piece, of course, that I wanted to ask about is what everyone is asking about, which is the shortage of drugs. It is an international issue. We know that it goes deep. It's raw materials that are not available in some instances. Certain companies are not producing the drugs. Why aren't they? Ms. Block asked the question of whether or not President Obama asked the FDA to look into this. He also asked his justice department to do an investigation of the industry itself to see whether there was anything going on in the industry that may or may not be leading to the shortages. I notice that the minister said she has an agreement with the industry--and I've read her website. This agreement is interesting in that it is actually a voluntary agreement. It just talks about informing people if there's going to be a drug that, after 20 days, is not going to be available. That doesn't tell us if the drug will be there. People need it. What are we going to do about getting the actual drug to people who need it? It's not about telling us it's not there. We know it's not there. How do we get the drug?
Those are the three questions I'd like the minister to answer.
This is quite funny. It's really nice, actually, to get some questions for a change, because it has been pretty quiet in the House of late.
In terms of the response to the drug, I said to the industry this spring that I would regulate if necessary, but you don't approach everything with an iron fist. You go forward and you try to work through the process of getting the people and the parties involved to resolve the matter.
If I'm not satisfied and if we have to regulate, then that's always an option, but you don't go from a problem to regulation; you work through the process of identifying where the problem is occurring. That's exactly what we're doing.
I'm very pleased with the response from the industry. For the very first time in this country, the industry has come together to resolve a matter, and we should be proud of that as Canadians, in that we're moving forward and working with the partners that are involved and that are an integral part of the health care system delivery.
On the second point, on the issue of the national pharmaceutical plan, I was the health minister for Nunavut when that agreement was struck. I was also finance minister when health transfers were cut. In terms of the committee that was established, the problem with coming up with a national plan is that jurisdictions all have to agree on what that plan is. If you don't have an agreement, you can't have a plan, so it fell apart.
Jurisdictions themselves have worked to determine how they can better manage their pharmaceutical programs. And they have. They've done great work in terms of dealing with catastrophic drugs. The transfers to the jurisdictions continue to grow every year, and each jurisdiction will make the determination of how they will spend that money based on their population's health care needs.
Our role here is to support them and work with them, which we've done. On this recent issue on drug shortages, I'm again going to sit down with the provincial and territorial ministers on Friday and discuss how we can move forward in ensuring that it doesn't occur in Canada.
Our government understands the burden that chronic diseases place on the health care system in Canada. It is committed to reducing that impact. We are striving to create conditions for healthier aging by preventing or delaying the onset of chronic diseases and preventing complications when they occur.
This is really achieved through a number of investments in a number of areas, such as research, surveillance, and better understanding of the factors associated with aging. We launched the population health study on neurological disease, which looks at neurological diseases such as Alzheimer's disease, dementia, and Parkinson's—again in partnership with the Canadian Institutes of Health Research. They have taken it a step further and are collaborating with the international community, which is doing similar research activity, again, to deal with providing better support to our aging population.
In addition to filling that gap, our government has been working with a range of partners to provide information for healthy aging initiatives with seniors' ministries in the provinces and territories. As well, in September 2010, the provinces and territories endorsed a declaration on prevention and promotion. Again, that's a collaboration with the jurisdictions.
In addition to that, in September of this year, I attended a conference on non-communicable diseases at the UN in New York, and I signed the UN declaration on preventing and controlling chronic diseases. This important declaration addresses the growing threat of chronic diseases around the world, and the countries have agreed that they must take effective action to reduce that. That's why we have taken the action to reduce tobacco use, promote healthy living, and to deal with obesity as well as a number of initiatives. It fits right under that umbrella declaration.
We have taken significant steps in that. The UN agreement basically complements what we have signed in Canada—the declaration with health ministries on prevention and dealing with preventable illnesses before they come into our health care system.
Thank you for that question.
Dr. Chan was in the House today. A year or two ago she said that the next global epidemic would be obesity. I think some of the illnesses we're seeing in our system today directly relate to the lack of activity and obesity. When you're dealing with diabetes, heart disease, and knee and hip replacement surgery, they all relate to obesity.
Canada has made important gains in how we can encourage Canadians to be more physically active, particularly our young people. Our government believes that physical activity is a shared responsibility with the provinces and territories and a number of stakeholders, such as municipalities, with parks and walking trails; the school systems; and parents. What can we do to provide information to parents so they can make informed decisions on the importance of physical activity or eating healthy food?
Our government also said we would invest in the fitness tax credit for Canadians to promote physical activity, recognizing that we need to start with this generation. All the statistics today indicate that our children will not live to be our age--and it's this generation--based on obesity. We need to start tackling that issue.
I believe our government has made significant investments. The commitment in the declaration we signed in Newfoundland last year with the Public Health Agency of Canada is the first agreement in Canada on keeping our people healthy. As opposed to saying, “Here's more money for when you fall ill”, it shifts the thinking to, “Here's what we can do to keep our children healthy”.
I am very encouraged when I hear someone say, “It's not up to you as my doctor to keep me healthy; it's up to me as an individual, but here's what you can do to help me”--shifting some of that kind of conversation. So how do we support that? I believe the commitments made by the provinces and territories in the initiatives they're now undertaking within their own jurisdictions are very encouraging.
On the second part, I told you we signed a declaration at the UN with global health ministers on what we need to do to deal with chronic diseases, and many of them stem from obesity, as an example.
I think we can be proud of our record in working to shift that thinking, and working with jurisdictions that are doing things to keep you out of the hospital in the first place. So it's quite encouraging.
This week in Halifax we'll be able to update Canadians on where we're heading with the work we did over the summer.
Thank you, Madam Chair.
Thank you for the question.
The value of indicators and information is critical.
Those things are very important if we want to have an idea of the progress made since the 2004 accord.
Tremendous importance has been placed on data. Both the Canadian Institute for Health Information and the Health Council of Canada put out information from time to time about progress that's been made on the accord, and about progress in the health system generally.
It was mentioned by the honourable member that we have made considerable progress in some focused areas, for example, wait times. I think the data is much better than it was. It was a big focus area under the accord. It's very difficult and it has been very difficult to get comparable data. But the last report from CIHI commented on the fact that we are now getting much more comparable data, and we can actually see the progress that's been made.
Health human resources was mentioned by the honourable member. Again, CIHI most recently put out—and regularly puts out—the progress we're making on numbers of physicians, for example, and the nursing workforce. We've expanded the number of health professions that we are tracking to other critical professions, such as physiotherapists, occupational therapists, and pharmacists, for example. So we are continuing to expand the role of information that we have.
We have data on some areas of the accord, for example, home care. We have some information about how much home care is available across the country, but it's not an area where, at the moment, we have comparable indicators.
Individual jurisdictions, as was mentioned, report to their citizens. I would say that, relative to the past, we have much better data, but it continues to be an area where we would like to do better. As the minister mentioned, it's one of the reasons accountability is a discussion for this week's meeting, but it will be a discussion on an ongoing basis.
As I talk to my colleagues across the country, there's certainly an understanding that we need to have more data and better data. I would like to say I think we're making significant progress, but we would certainly want to continue that progress and have increasingly better data to manage and to measure, and be transparent to Canadians about the system.