Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, . Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in , we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
When Finance Minister Jim Flaherty renewed our commitment to the provinces and territories at the end of the health accord, he renewed, for the next 10 years, record-level funding. Of course, that includes an escalator of 6% up to 2016, and after that a 3% escalator for the provinces. That means that by the end of the decade that amount will reach $40 billion annually. That's a 70% increase in federal transfers, just for health care, since 2006.
That is very important to the provinces and territories because it has allowed them to plan their own budgets in a much more predictable way, and it's probably the area in which they are struggling the most when they think about the impact on other parts of their own provincial budgets. Let's remember that health care takes up a great deal of the federal budget, but it takes a great deal, if not 50%, of most provincial budgets, so they are struggling with figuring out ways to curb costs at the provincial level, because otherwise they're going to have to look at the impact it has on other services.
I think one of the things we should think about is the latest information out of the Canadian Institute of Health Information. Since the year 2000 health spending by provinces and territories grew by less than 5%, and since 2010, spending by provinces grew by less than 3%. So if you think about that and the amount of increase and the escalator we're applying to the funding we give to provinces and territories every year, that means that for the next three years, with a 6% escalator, our transfer increases are projected to continue to rise at more than double the rate of health spending increases by the provinces. We are well in line with providing them with the appropriate amount necessary.
However, I think the other part of the discussion has to be around money, because while health transfers are at record levels, the truth is that provinces are trying to find ways to curb their costs, because if you look 20 years out and if we continue down the track we're on, it would basically take up the entire budget of every province, and that's completely unsustainable.
That's why we're focused on innovation. That's why we're focused on working on the recommendations that come out of the panel in June, with the provinces and territories, to look at what we can do to innovate our health care system. If we don't do that, I think we're letting Canadians down, because we invest heavily per capita in health care, but we don't have the best health care system in the world. I like to brag about this health care system, but there are areas in which we can improve, and I think only through innovation will that happen.
We are making those investments in innovation and we'll continue to have that conversation with the provinces about supporting them in areas, such as the strategic patient-oriented research partnership we have with the provinces, and other investments we made recently in the budget.
This is a good time to have this conversation because we have money on the table for the next 10 years in health care. Let's talk about the smart way to spend it, and the best way to get the best possible outcomes for Canadians. I think that's what our government is focused on now with the provinces, and I think it will benefit the health care system.
I want to thank the minister for coming today. I'm going to ask the minister a series of questions. I'm looking for short answers because I have quite a few questions I want to ask you.
With regard to innovation, I notice that the CIHR has been cut. It's a decrease of $4.5 million from the estimates to date in 2014-15 and knowing that the Naylor report on innovation is coming out, how would the CIHR deal with this if you don't increase the budget for CIHR to fund further research into innovation of the health care system?
The second piece is that we know that currently the agencies that are doing research are having to find a fairly large amount of money, $8.5 million, for these groups that don't have anywhere to raise the money to be able to do that little transition for three months each year for the last two years. This cut means they're going to have to.... Nobody knows what they're going to do because there's no way to be able to get that transition money from CIHR, because CIHR is going to have to be cutting certain things. That's about CIHR.
I also wondered why.... For instance, we looked at the fact that the budget for first nations and Inuit primary health care has been cut by a fairly large amount, $45 million, from 2014-15, and $59 million.... That's going to leave us with a real shortfall at a time when we see that the Auditor General has been talking about the quality of care and outcomes and the number of nurses and the ability to deliver care in the north and to Inuit and first nations populations.
We see the increase in infectious diseases, in obesity, in type 2 diabetes. We see rickets in the north, which I only learned about in medical school as a historical fact. Nobody has seen rickets here for, I don't know, almost a century, and we're seeing this in the north. The nutrition is no longer good. We're seeing overcrowding. We're watching tuberculosis increasing. We're watching this kind of falling happening, and I know the minister will say that this cut has come about because of the sunsetting of the water and waste water action plan.
Since February of this year we've had 139 drinking water advisories in first nations communities, so the water isn't safe and it's getting worse. In three months we've had 139 advisories. Why are we cutting such essential programs for a group of Canadians who have the worst health outcomes in the world as seen in the last UNICEF report that was done here?
There is one last piece I wanted to ask you about as well because I think that's all I'll fit, so I'm putting these three on the table. One of them has to do with the CFIA. It's receiving $107 million less than it did in 2013-14. We're also seeing that there is a plan in your planning and priorities for 2015-16 for 271 full-time employees to be eliminated for the meat and poultry subprogram of the food safety enhancement program.
We also know that we're hearing about E. coli in beef and we want to know how many meat inspectors were employed in 2013, 2014, and 2015. Were any positions left unfilled? Have the number and frequency of inspections been cut back at any plant, and if so, which plant and why? How many times a year are general sanitation inspections done at ready-to-eat food plants, like Maple Leaf Foods or raw food plants, such as beef and poultry, etc.
Why would there be a cut in something that is so essential and which has had really bad outcomes for the last three years?
The minister said in the House that she would get inspectors to inspect inspectors because of the bad results that have been happening. What is the quality and the level of the training of the inspectors there? Do they have any requirements for their training if they allow such huge problems to occur?
I'm going to leave those three questions on the table and I'm hoping to get every piece of them answered. That's why I was so specific.
There have been no cuts to CIHR. In fact, there are increases. I'll leave it to Michel Perron in the second hour to elaborate on all of those.
To aboriginal health there have been no cuts whatsoever. Anything in the estimates that shows a decrease is because those we're sunsetting. We've approved and renewed those, so you'll see them come back. There are no cuts to aboriginal health.
There are no cuts to CFIA. In fact, there was $400 million extra in the budget last year. I'll let Bruce explain to you the specifics around that.
In terms of aboriginal health, I want to say how committed our government is to the $2.5 billion we invest every single year and the 24-7 access to essential nursing services we have in 80 communities.
Let's remember, no matter where you are, if you're an aboriginal Canadian we will provide emergency evacuation for something as simple as a regular appointment, no matter where someone is. If they live in an area where there are no roads, we will provide emergency evacuation transportation to get people to a hospital, to a doctor, to wherever they need to make sure they have access to care. We spend over $200 million a year just on evacuation and transportation for medical purposes for aboriginal Canadians.
Of course, we have coverage, whether it's medical transport, dental care, or prescription drugs. We provide a very comprehensive care for aboriginal Canadians on first nations when it comes to health care. We've now increased our support for aboriginal health by 31% since 2006. We will continue to work with all of our aboriginal partners in the now 734 health facilities across Canada that are on aboriginal first nations that we support.
Sure. Thank you, and I want to congratulate you on your private member's bill, on your personal recovery, and on your advocacy of that in supporting those who are working so hard to live drug free.
Obviously, as health minister, I'm very concerned about the impacts of marijuana smoking on kids in Canada, and you know, from the committee study that you did, the severe health impacts. Marijuana is an illegal drug for a reason. It's illegal because it's very harmful and it does have serious health effects on youth. This committee heard that loud and clear, and when I had an opportunity to bring together health stakeholders from the mental health and addictions field, they talked about their concerns around the proliferation of marijuana and how many young people were exposed to it who didn't know enough about how this could harm them. I asked, “What is the one thing I could do to help you in the work that you do?” They said, “We want a smoking cessation campaign, a national campaign.”
What we committed to doing was an ad campaign so that we could get to parents and kids, get that information to them. That's what we did, and we targeted the issue of marijuana and prescription drug abuse. It was very effective because a lot of parents said, “You're kidding. I didn't know that this stuff that's out on the streets is something like 500 times stronger than it was when I was a kid”, and there are all of these health impacts, whether it's the early onset of psychosis or schizophrenia, obviously decreased IQ, and many of the things that you heard from the committee study.
We know that especially in youth the evidence is irrefutable, so we have to get that information out there. I would quote the current Canadian Medical Association president who said, “Any effort to highlight the dangers, harm and potential side effects of consuming marijuana is welcome”.
We'll continue to do that.
What do I think of 's idea of legalizing marijuana? I don't like it. I've seen what's happening in Vancouver where pot dispensaries are selling pot to kids, well, to a 15-year-old the other day who ended up very sick and overdosed. I think making a harmful drug more accessible and normalizing it by selling it in storefronts is a very bad idea. I don't know how, as health minister, I could think in any other way. This has a serious health impact on young people. I think parents need to educate themselves and think very clearly about what kind of city they want to live in, and make that known to those who are making these decisions. I think it's irresponsible.
We clearly have heard from communities and parents across Canada that home grow ops pose a public health issue, but more so a public safety issue, so we have fought to shut those down. We've passed regulations to shut down home grow ops. Of course, we're now fighting the courts because the courts have put an injunction in place, and we'll continue to fight that in court. We don't think home grow ops are a good idea. We've heard from the police, from the firefighters, and from parents in neighbourhoods that they don't want marijuana grow ops in their neighbourhoods, and we'll continue to fight that fight.
We know that a UNICEF report a few years ago said that Canadian youth were the number one users of marijuana in the world per capita, and that was very concerning. We have really made an effort in schools and in other ways to reach out to young people in our ad campaign. I was very pleased about a recent report that, according to the Canadian Centre on Substance Abuse, there is a decrease, from what I understand, in the number of kids using marijuana, so that's a good thing. The strategy is working. This idea that, if we make it legal, somehow kids will use less, makes absolutely no sense to me. I think we have to keep warning kids about the dangers of it and parents as well so that they have that conversation with their kids and keep it away from them.
Okay. Thank you, Mr. Chair.
I'd like to talk about the Canadian Food Inspection Agency. In April, a slew of articles came out about the shortage of inspectors.
Minister, you told us that the funding had not been reduced but, in fact, raised slightly. In your presentation, you mentioned that a secure Web platform would be used to share information. That's a positive measure. But does the government also intend to hire more inspectors?
According to Bob Kingston, the president of the Agriculture Union, which represents federal inspectors, the government is really cutting corners when it comes to food safety. More and more, the responsibility for food inspection is falling on companies. In Montreal and throughout Quebec, a minimum of 45 inspectors are needed, but there are only 30. Overall, 10 inspectors are lacking when it comes to satisfying the required minimum number of inspectors at a number of meat-processing plants. Has any money been set aside to hire new inspectors? This is, after all, an issue that has a tremendous impact on Canadians.
My understanding is that meat intended for export to the U.S. is inspected on a daily basis, while meat for Canadian consumption is inspected just three times a week.
I'd like to know the reason for the double standard. Why, under the budget, is meat for Canadian consumption subject to less inspection than that intended for U.S. consumption?
Are there plans in the budget to do away with that double standard?
Sir, I'd be happy to. In fact, I am a very enthusiastic supporter of what's happening in British Columbia, and I believe very strongly that this is the policy answer for other first nations, provincial governments, and Health Canada for the delivery of health care to first nations. It's progressive, it's groundbreaking, it's integrated, and it is doing fantastic things in terms of empowering the first nations members to not only be accountable for their own health but actually be involved in the creation of their own health programs.
The transfer happened, of course, in late 2013, where British Columbia first nations now have responsibility for their own health services. Health Canada still provides the funding, and Health Canada in no way has left the table. Health Canada is there every step of the way, working with the First Nations Health Authority and the provincial government to integrate the services at the provincial level.
But what this means now is that when the Province of British Columbia speaks about health, it says it has seven health authorities, and it includes the First Nations Health Authority in all of its plans as a government when it comes to first nations health. The funding is in no way offloaded. We still are providing the funding, but it's a really transformative, fantastic way to integrate health services in a way that empowers first nations communities and integrates them into what is really the health service delivery model of the province.
We're hoping to have conversations. I've spoken to all of my health minister colleagues across the country. We are hoping to sit down soon with Saskatchewan to discuss the same model. We have been encouraged by Manitoba, but we haven't had conversations with them yet, We've discussed this with first nations in Alberta.
It's a big undertaking, but British Columbia, the first nations in British Columbia, and Grand Chief Doug Kelly have proven that it can be done. We're at the one-year anniversary, and we're seeing some very good, positive results. I met with the committee and the health authority on Monday, and I'm just absolutely thrilled to see the enthusiasm at the community level to take charge of their own health. It's really excellent.
We hope that other provinces will also be interested in talking to us about this same model.
I'd be delighted, Mr. Chair. That's an excellent question.
Having just been there, I want to start by saying that the interventions are working. As you've seen, the numbers have gone down consistently. Clearly, if there's not another case by Saturday, Liberia will be declared Ebola-free. Sierra Leone's numbers are going down significantly; Guinea still has some. The interventions and the support, which from Canada I am proud to say with $110 million, our vaccine, our labs on the ground, our Canadian Forces, are making a difference.
I must say, from being on the ground in West Africa, I came back very proud to be a Canadian. It was truly a collaborative mission. I went with some staff from DFATD, as well as the CEO of the Canadian Red Cross, and the CEO of the Canadian Médecins Sans Frontières, or Doctors Without Borders. I was supported by our ambassador on the ground, and our high commissioner on the ground and staff. It was really an excellent mission. It left an indelible impression on me, I must say. You can read about it, you can see the pictures, but it's not the same as being there in person.
I was struck with the question of poverty. I was taken by one of my staff to a slum in Freetown where they had just lifted a quarantine. It was a household-based quarantine for one case. That included 50 to 60 people because they define that as the number of people using one toilet. It was right out of the movies in terms of standing beside a clinic and seeing somebody cooking two feet in front of me, then urine being dumped in the alleyway two feet beyond that.
Clearly, what was striking was the basic public health needs of these people. The needs of clean water and latrines are simply not being met. In Guinea, in that country, what was striking there was the sense of chaos. It was a lot of moving pieces, a lot going on at the same time. I'm left with a vision of goats being transported in a little car and the goats were on the roof racks of the car, just hanging on and barely falling off.
I did see our forces at Freetown. Our forces were working directly with our U.K. colleagues. It was a spectacular experience. They felt like one team and were very proud of what they're doing. I had a chance to speak to some of the young men and women and doctors and nurses who were working there and very proud.
I must say—and I use this word—I “tripped” over Canadians. When we arrived at one of the Ebola treatment centres a nurse who was working there and who I was unaware was from Nova Scotia, took us on the tour. That was one of the MSF treatment centres. Another treatment centre was run by the Red Cross, the French Red Cross. A doctor from B.C. took us on the tour.
Canada has a very high reputation in that country. I think the key message leaving is that it's not over yet. The numbers are going down, but as you probably saw in Liberia, it popped up because it now seems that it's transmitted by sex through intercourse. Seemingly, you can apparently have the virus for up to...it's looking like four to five months potentially, and that's what we think was the case in the one individual in Liberia. So it's not over yet, and long after Ebola is done the public health needs will remain quite high in those countries. There's been some interesting modelling suggesting that because the infrastructure has disappeared and kids weren't getting immunizations, perhaps measles will actually kill more children than Ebola did during the outbreak. That's not to mention, of course, that these countries have some of the highest rates of malaria in the world.
Clearly, it's not over. Clearly, they're going to need the international community's help. Clearly, Canada still has a lot to offer, I think, and I must come back to the fundamental issue of clean water. Sanitation is sorely needed in those countries.
Thank you very much for the question.
I think there are a number of positive things the agency is proud of. Over the last number of years there have been significant investments in the area of food safety, launches of enhanced oversight programs to deal with fresh fruits and vegetables, the creation of inspection verification teams that ensure the high level of integrity within our system, and the adoption of a science-based approach to how we conduct our work and do our evaluations.
As the minister mentioned, we were very pleased to find that the report from the Conference Board of Canada, ranking us against the 17 other OECD countries, placed us in the number one position. There are always opportunities for improvement. We're always looking for ways to continue to strengthen our systems. As the minister mentioned, there was a significant investment to ensure that various food safety laboratories across the country, provincial and federal, are linked together so we can have real-time data sharing.
I know this committee primarily deals on the health space, but I do want to mention a very successful management of outbreak of avian influenza in Canada that occurred at the end of the last calender year. We've had some cases show up again in Ontario this year. Through good cooperation with the provinces and the excellent biosecurity programs that the government has invested in, as well as good cooperation with various producer groups, if you look at that particular challenge, it's had much greater success in Canada than our colleagues in the U.S. have had. In fact, they've sent in folks from the U.S.A. to look at our systems, to understand them and see how we can help them improve their own system. I think there has been a lot of things to talk about.
The final comment is in terms of our staff. Every year the Government of Canada does a public employee survey. We had participation in excess of 82%, which is the highest of any large federal department or agency. Around 90% of our staff indicated that they were proud of the work that they did at CFIA, and 95% said they were prepared to go the extra mile. To me, those are all indicators of a strong staff that does excellent work every day.
Thank you for the opportunity to talk about them.