Good afternoon. Welcome to meeting number 108 of the health committee. Today we are going to be studying diabetes strategies in Canada and abroad.
I want to take the opportunity to welcome Terry Beech and Peter Fragiskatos, who have joined our committee members today.
We have some excellent witnesses with us. From the Public Health Agency of Canada, we have Gerry Gallagher, executive director of the centre for chronic disease prevention and health equity, health promotion and chronic disease prevention branch; and Jennette Toews, chief, centre for surveillance and applied research, health promotion and chronic disease prevention branch.
Along with them we have Alfred Aziz, chief, nutrition regulations and standards division, Department of Health; and Valerie Gideon, senior assistant deputy minister, first nations and Inuit health branch, Department of Indigenous Services Canada.
The Public Health Agency of Canada and the Department of Indigenous Services will each have seven minutes to present to the committee.
We'll begin with Gerry Gallagher.
Thank you for the opportunity, Madam Chair, to address the standing committee with regard to the Public Health Agency of Canada's role in addressing diabetes and other chronic diseases in Canada.
Our role is threefold: to obtain data to better understand the patterns and trends related to chronic diseases; to gather, generate, and share evidence to inform policies and programs; and to design, test, and scale up innovative interventions to prevent chronic disease. We do this in collaboration with partners from within and outside the health sector.
Diabetes, as you know, is a chronic condition that affects Canadians of all ages. Each year, close to 200,000 Canadians are newly diagnosed with diabetes, and approximately 90% of those have type 2. Currently, about three million Canadians are living with diagnosed diabetes, and with the growth and aging of the Canadian population, the number of Canadians living with diabetes is expected to continue to increase in the coming years.
Some Canadians are at increased risk of diabetes, such as first nations, Métis peoples, and immigrants. There are higher rates of diabetes among Canadians with lower incomes and education. For example, if the prevalence of diabetes among adults who have not completed high school were as low as that of university graduates, we would see 180,500 fewer cases of diabetes in Canada.
Diabetes and many other chronic diseases, such as cancer, cardiovascular disease, and chronic respiratory diseases, are largely preventable. Scientific evidence demonstrates that by eating healthier, increasing physical activity, not smoking, and moderating alcohol use, the onset of many chronic diseases can be prevented or delayed. That is why the Public Health Agency of Canada takes an integrated approach to promote healthy living and prevent chronic disease.
Through our health surveillance function, we are able to better understand the impact of chronic diseases and risk and protective factors. For instance, in collaboration with all provinces and territories, we conduct national surveillance of diabetes and 20 other chronic conditions to support the planning and evaluation of related policies and programs.
The Pan-Canadian Health Inequalities Reporting Initiative includes new insights into how diabetes impacts different groups of Canadians in different contexts. Products include an interactive online data pool and a narrative report on key health inequalities in Canada. This initiative is a partnership between the Public Health Agency of Canada, the provinces and territories, Statistics Canada, the Canadian Institute for Health Information and the First Nations Information Governance Centre.
We recognize that innovative solutions and partnerships with health and other sectors are needed to better address the complex challenges of chronic disease prevention. The Canadian Task Force on Preventive Health Care develops evidence-based clinical practice guidelines to support Canadian primary care providers. The Task Force published recommendations on screening for type 2 diabetes in 2012. The Public Health Agency of Canada funds and provides scientific support to this independent arms-length body.
To help Canadians understand their risk factors and motivate them to make lifestyle changes to prevent diabetes, the Public Health Agency of Canada has developed CANRISK. It is a questionnaire that provides an individual risk score and guidance on how to reduce risk for diabetes. CANRISK is accessible to Canadians through partnerships with Diabetes Canada as well as with Shoppers Drug Mart, Pharmasave, Rexall, Loblaws and others.
Since its launch in 2013, our multisectoral partnerships approach to promote healthy living and prevent chronic disease has invested $73 million and leveraged another $57 million in non-government sources to support innovative interventions that address the common risk factors that underlie major chronic diseases, including diabetes.
For example, Play for Prevention is a Right to Play and Maple Leaf Sports Entertainment Foundation project, which uses an activity-based approach to youth empowerment to address diabetes prevention in urban indigenous peoples. Trained community mentors plan and lead events that have engaged over 1,000 children and youth in 16 cities across Ontario, Alberta, and British Columbia in helping active lifestyle programming.
The healthy weights initiative is a culturally adapted community-specific partnership with Alliance Wellness and Rehabilitation Inc., the YMCA, and the University of Saskatchewan. It is an evidence-based program for adults, which includes physical activity support, nutrition education, and social supports. It has demonstrated significant improvements to address unhealthy weights and encourage a healthier lifestyle.
In addition, budget 2018 proposed to provide an additional $25 million over five years, starting in 2018-19, for Participaction to increase participation in daily physical activity among Canadians.
The Public Health Agency of Canada works closely with Government of Canada partners such as Health Canada and Indigenous Services Canada.
Scientific research has established again and again that poor diet is a primary risk factor for these conditions. This is why Health Canada launched the comprehensive Healthy Eating Strategy in October 2016. This is made up of complementary mutually-reinforcing initiatives which will make it easier for Canadians to make healthier choices for themselves and for their families. The strategy includes important mandate commitments to promote public health by restricting the marketing of unhealthy foods to children, eliminating trans fat and reducing salt, and improving labelling on packaged foods, including front-of-pack labelling initiatives.
The Public Health Agency of Canada also collaborates with federal, provincial and territorial partners. For example, since the endorsement by ministers of the Declaration on Prevention and Promotion in 2010, we have partnered on initiatives to promote healthy weights and curb childhood obesity.
We are now working towards a common vision and collaborative approaches to support Canadians to move more and sit less.
In addition, we collaborate globally, contributing to and learning from the global evidence base, as a World Health Organization collaborating centre on non-communicable disease policy.
In closing, I want to thank the Standing Committee on Health for examining diabetes strategies in Canada and abroad. Through data, evidence, tools, innovation, and partnerships, the Public Health Agency of Canada is advancing our collective efforts to prevent diabetes and other chronic conditions among Canadians.
We'd be pleased to answer any questions you may have and look forward to reading your report.
I'd like to start by acknowledging that we're on unceded Algonquin territory today. As a member of the Micmac Nation of Gesgapegiag First Nation in the region of Quebec, I am pleased to have been asked to speak to you today about diabetes and other chronic diseases among indigenous peoples across Canada.
I'll begin by sharing some statistics with you on the prevalence of diabetes among indigenous peoples. Diabetes rates are three to four times higher among first nations than among the general Canadian population and all indigenous peoples are at increased risk of developing diabetes. Results from the last three cycles of the first nations regional health survey indicate that the prevalence of diabetes among first nations adults has remained steady, at approximately 19% to 20% over the past 14 years.
To help reduce the prevalence of type 2 diabetes, Indigenous Services Canada provides funding of $44.5 million annually for the aboriginal diabetes initiative to support community-based health promotion and disease prevention services in over 400 first nations and Inuit communities. First nations communities in British Columbia also receive these services, through support from the B.C. First Nations Health Authority, which took over our regional health-specific operations in 2013.
Indigenous Services Canada recognizes that food security is a critical issue for indigenous peoples and that it significantly impacts the health and well-being of individuals, families, and communities. As part of nutrition north Canada, Indigenous Services Canada and the Public Health Agency of Canada fund and support culturally appropriate community-based nutrition education activities in 111 eligible first nations and Inuit communities. Budget 2017 announced $828.2 million over five years to address key long-standing program gaps and improve health outcomes for first nations and Inuit, in areas such as primary care, home and community care, mental wellness, and many other areas.
As a concrete example, in fall 2017, the Government of Canada provided $19 million over four years to support first nation-led basic foot care services in all Manitoba first nations communities. In partnership with regional leadership councils, the first nations' basic food care program was developed to help clients in 63 Manitoba first nations communities to maintain their health and lower their risks from diabetes-related foot complications.
One significant advancement in the management of chronic disease prevention more generally is the development of a specific framework for indigenous peoples related to the prevention of chronic disease. The framework provides broad direction and identifies opportunities to improve access for individuals, families, and communities to appropriate, culturally relevant services and supports based on their needs at any point along the health continuum.
This framework was mirrored by Inuit Tapiriit Kanatami, which developed a specific framework to address the specific needs of Inuit in Canada.
Indigenous Services Canada has many mechanisms in place to ensure the engagement of partners. For example, engagement protocols were developed with the Assembly of First Nations and the Inuit Tapiriit Kanatami to advance a culture of respect, transparency and reciprocal accountability in support of the First Nations and Inuit Health Strategic Plan. These have been valuable tools for building and maintaining relationships.
There are also partnership tables with first nations and Inuit in every region to support joint planning and priority setting. These tables include bilateral tables, as well as trilateral tables with provincial and territorial governments.
Indigenous Services Canada values a collaborative approach with external indigenous and other organizations to advance health initiatives for first nations and Inuit. For example, in Saskatchewan we've partnered with the Dieticians of Canada on a six-month pilot project for the operation of a dietician call centre, which will provide free access to trusted food and nutrition advice via telephone or email to all first nations communities in Saskatchewan, including more isolated and remote communities.
Through our non-insured health benefits program, a number of diabetes treatment supports are offered.
First, a total of 12 diabetes medications to date are covered, with additional medications pending decision, and are aligned with the Canadian Agency for Drugs and Technologies in Health's recommendations and other public drug plans.
Blood glucose test strips are an open benefit under the NIHB program. As well, a range of medical supplies and equipment is available to support clients facing complications from diabetes, such as wound-care supplies, mobility devices, and prosthetic devices.
Lastly, the non-insured health benefits program provides medical transportation coverage, including accommodations and meals, so that clients can access health services not available to them in the community where they live.
Indigenous Services Canada is working collaboratively with provinces, territories, other federal departments, and with indigenous partners to ensure that data linkages are supported where possible and that health survey data are available to inform health care planning.
More specifically, over the past 17 years, the first nations information governance centre's regional health survey has provided national, on-reserve, and Yukon first nations' prevalence rates of health status and lifestyle risk behaviours.
Through budget 2018, the federal government announced $82 million over 10 years, with $6 million per year ongoing, for the co-creation of a permanent Inuit health survey.
In summary, Indigenous Services Canada is committed to reducing the prevalence of type 2 diabetes and related complications in first nations and Inuit communities across Canada.
While progress has been made, we are committed to continuing to work in partnership with indigenous peoples to address diabetes and its risk factors.
Thank you. Wela'lin.
I will humbly say that in the past, the chronic disease prevention framework that was developed with the first nations—now the Inuit have their own, really, and copies of that could be provided to the committee—essentially was a program-by-program approach in communities and health care systems. People would get lost if they weren't caught by one program or another, so this is about creating a continuum of services along a lifespan, with culture as the foundation. Indigenous people certainly share that aspect of it.
It's also about looking at that connection to the social determinants of health. For instance, if a mom is pregnant and gets a prenatal visit, there is also education provided to her about healthy living for herself; planning for the family to have healthy nutrition; preparing for baby to come; continuing that follow-up when baby comes; and, making sure she's attending public health sessions with respect to healthy living and doing it within that context. Then, when her child goes to an aboriginal head start program, there's nutrition education in the program, so that when they're at the preschool level, kids are informed about what types of healthy foods are available to them and how they should seek out the connection to oral health. There's a connection between nutrition and oral health as well; we have the children's oral health initiative.
Really, it's not so much a diabetes strategy. People have moved away from one disease-specific or illness-specific western medical model of strategy development and more into this holistic framework approach. We have one for mental wellness. It's the same concept with chronic disease.
Perhaps I can start and then turn to Alfred.
On the first question about performance measures, we have strengthened our approach to performance measures. We look across our programming from an integrated perspective. A performance measurement framework is in place. It looks at behavioural changes for project participants. It also looks at social and physical environments to support those behavioural changes. We have moved away from awareness only to looking for concrete and measurable health outcomes, and are now starting to look at physiological measures for some of our project programming.
That's the approach. I'm happy to share with you the performance measurement framework that we use for our integrated chronic disease program.
On the second question around inequalities, I spoke earlier about our role in understanding the portrait of health inequalities in Canada, as well as the narrative and the contextual considerations related to that. We've done a lot of work over the last five years related to that. The data tool is one part of that initiative.
The narrative report is a much richer part of the storytelling, in terms of the interaction between broader contextual factors—culture, tradition, interaction—and a lot of other considerations, such as income and education, to name a few, that look at the determinants of health and interaction with actual health behaviours, health status, and health outcomes. That's another role that we play.
As far as the broader work on acting on those determinants is concerned, we are taking steps with our programs to move further upstream. We know that Peel is a leader in this area in terms of looking at builds in social environments, to have the spaces and places where folks make the healthy choice and easier choice, whether that means access to walkability or to affordable food choices within their community.
I do not have an answer for this, but I would like to build on what Ms. Gallagher mentioned regarding Health Canada's role with respect to diabetes.
As I mentioned earlier, Health Canada is responsible for regulating food and health products.
Specifically with diabetes, we regulate medications and drugs that are approved for the treatment of diabetes. We also have a role in providing Canadians with information about food, health, and nutrition so that they can make informed decisions about their health.
In 2016, Health Canada launched the healthy eating strategy. It was put in place to improve the food environment so that the healthier choice becomes the easier choice for Canadians.
We're working along four different themes. We are improving nutrition information through improving Canada's food guide, as well as improving food labels and providing information on the front of the package. We're also building a team around protecting vulnerable subpopulations, including restricting the marketing of unhealthy food and beverages for children, so that they are set up for a better start in life and are prevented from developing these chronic diseases, like diabetes, later in life.
With respect to food security, nutrition north Canada was put in place, and indigenous services are working on that now.
In terms of food security under the food policy for Canada, that is under the leadership of the Department of Agriculture and the Minister of Agriculture.
Thank you. Good afternoon, bonjour
We thank you for the opportunity to address the Standing Committee on Health. We would like to acknowledge that we are visitors here today on the traditional unceded territories of the Algonquin people.
We are here today to address the Standing Committee on Health to advocate on behalf of the National Aboriginal Diabetes Association, also known as NADA, and all those working with, or who are affected by, diabetes to ensure that this pandemic affecting indigenous peoples in Canada is recognized as a top national health priority.
Type 2, type 1, and gestational diabetes are on the rise, and the complications, such as amputation, blindness, and heart disease, are devastating our communities. According to the Truth and Reconciliation Commission call to action 19, aboriginal health is a direct result of government policies, including residential schools, and it is only through change that the health gap between indigenous and non-indigenous peoples can be closed.
According to a recent study, approximately eight in 10 indigenous young adults will develop type 2 diabetes in their lifetime, compared with five in 10 in the general Canadian population. In fact, diabetes is three to five times higher now in the indigenous population and the onset of this debilitating illness is around the forties, while the rest of society tends to be affected later in life. Alarmingly, diabetes among indigenous peoples is no longer an adult condition, as children as young as five are diagnosed with type 2 diabetes. This disease was almost unknown in the aboriginal communities prior to the 1950s.
There are a number of complex factors contributing to the higher rates of diabetes in the indigenous population. The impact of diabetes varies also between regions and communities, and is highest among the first nations and lowest among the Inuit populations. However, the rates of diabetes are on the rise among the Inuit as well. The causes are rooted in the abrupt and forced socio-cultural changes to our traditional ways over the past several decades.
The first nations regional health survey, referred to as FNRHS, released in 2015-16, provides some of the available data in support of the recommendations that NADA brings forward today. Like many studies on aboriginal Canadians, this does not represent all first nations and does not reflect any Métis or Inuit in the data. The prevalence of diabetes among first nations in this study was an alarming 20% in females and 18% in males. One in 10 children had a mother diagnosed with gestational diabetes, which is diabetes during pregnancy. Seventeen per cent of women were pregnant when first diagnosed with diabetes and 83% of them were told they had diabetes outside of pregnancy. More than half of the first nations adults with diabetes have experienced at least one major complication. Over 25% had complications with neuropathy, retinopathy, and circulation; 21% had complications with lower limbs; and 2.4% of cases resulted in amputation.
Since the Truth and Reconciliation Commission final report released in 2015, our non-indigenous partners are just now realizing the devastating proportion of those affected by diabetes and the severity of complications of diabetes in our communities. However, together with our partners, community-based organizations, and individuals, NADA has been aware of the escalating and devastating impact of diabetes in our communities for over two decades.
Since its inception, NADA has created and implemented a wide range of clinical, health promotion, and support activities aimed at reducing the incidence and prevalence of diabetes and improving the health status of indigenous peoples, families, and communities across the nation. NADA has continually advocated for expansion of our capacity to deliver culturally appropriate and uninterrupted programming through education, prevention, and treatment strategies, as well as research initiatives.
Our second recommendation is to prioritize food sovereignty.
NADA supports culturally competent and safe environments for living, learning, and working, with a focus on promoting healthy environments, for example in food security and mental health. A key priority area in addressing the diabetes pandemic is food sovereignty. It is imperative to recognize that the root causes of the current state of diabetes among indigenous peoples include colonized food systems; reserve systems; erosion of harvesting, trapping, fishing, and hunting rights; erosion of land bases; and access to clean water.
NADA recommends continued and open discussions with government departments and other sectors in identifying cross-sectoral approaches to creating healthy environments through policy and guideline development. We reference the TRC's call to action 18:
|| We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools...
As is our tradition, I want to tell a brief story. I have a couple of interesting documents. The document is from the Indian Office in Brantford, dated August 6, 1920. It's a request to pay $100 to support Norman General, a Six Nation Indian who was going to the Olympic Games in Antwerp, Belgium. The cheque would be payable to the Bank of Toronto in Brantford. In this reference, they “beg to state that General in training” and that the requested amount of money...“is a nice thing to have the Six Nations represented at a meeting of this sort”. Subsequently, this was paid by the Indian trust fund of the Department of Indian Affairs to send Norman General to the Olympics. Norman General led a very long and healthy life as an Olympic runner and did very well at the Olympics. His niece, Helen Dockstader, went to the residential school in Brantford known as the “mush hole”, from the age of three to the age of 15. She passed away from the effects of diabetes, as did most of her children, including her eldest son Andy Baird, my uncle. He was also a runner, but did not make it to the Olympics due to double amputation. We emphasize the direct result of residential schools on indigenous health.
The third recommendation is to provide access to appropriate care and treatment options and to traditional healers and medicines. Despite minimal funding, over the last 20 years, NADA has provided a platform for networking and sharing of traditional and new knowledge and skills, as well as for developing and distributing tools, resources, and services for diabetes management and prevention among aboriginal diabetes initiative and community diabetes prevention workers, health care professionals, and indigenous communities. NADA requests support from the government in building collaborative relationships with non-indigenous health care and industry sectors to establish comprehensive approaches for incorporating traditional healers and medicines, through best-practice sharing of the collective skills and knowledge. Open and respectful collaboration between the communities and external health care teams and authorities encourages trust and promotes continuity and consistency of diabetes care for community members.
I wish to thank the committee for the invitation to speak and to provide a pediatric perspective on diabetes in Canada.
I'm a pediatric endocrinologist and researcher at the CHU Sainte-Justine and co-director of a cardiovascular disease risk prevention program at Sainte-Justine called CIRCUIT.
Obesity is the number one risk factor for type 2 diabetes in children. Ninety-five per cent of children diagnosed with type 2 diabetes in Canada are obese. The prevalence of obesity in Canadian children has tripled over the last three decades. This is particularly alarming given the adverse consequences of obesity on type 2 diabetes and cardiovascular disease. This is compounded by the fact that obese children tend to become obese adults, with the substantial consequent morbidity and mortality associated with adult obesity.
Adolescent overweight is a predictor of mortality in adulthood regardless of adult weight and is in fact a stronger risk factor than adult overweight, underscoring the urgency to intervene early. Childhood obesity is a multifactorial condition. Lifestyle factors, such as low physical activity, sedentary behaviours, and poor nutrition, play an important role in its development and its maintenance.
Research tells us that higher physical activity levels and less screen time can lower the risk of type 2 diabetes in children, yet only 7% of children in Canada reach the recommended guidelines for levels of physical activity daily, whilst 45% exceed screen time recommendations. What's more, the level of physical activity is even lower among teenagers and children with obesity.
Sugar-sweetened beverage consumption is associated with prediabetes and obesity, and yet it still accounts for 2% to 18% of total caloric intake among children in Canada. Increasing fruit and vegetable intake may reduce the risk of type 2 diabetes, yet their consumption is inadequate or insufficient in Canadian children and adolescents.
Limiting saturated fat intake may also be beneficial to preventing diabetes in childhood, yet the highest consumers of fast food in Canada are adolescents. Clearly there is room to improve Canadian children's lifestyle habits.
Several countries have seen their rates of pediatric type 2 diabetes increase over the past years, mirroring the increase in obesity rates. While the actual prevalence of type 2 diabetes in Canadian children remains uncertain, hospital-based prevalence estimates have increased parallel to the increased prevalence in obesity. Moreover, prediabetic conditions are on the rise in youth, particularly obese youth. In fact more than a quarter of obese youth have been reported to have prediabetes. This is very, very significant given that obesity was traditionally an adult-onset disease with late-life complications. You can imagine when I'm treating a 14-year-old who has type 2 diabetes what that means in terms of eventual mortality and morbidity for that young person.
Importantly, type 2 diabetes appears to be much more aggressive in children than it is in adults. Indeed, among newly diagnosed youth with type 2 diabetes, 6% already have kidney complications at diagnosis; 13% already display eye complications at diagnosis; 4.5% have abnormal cholesterol levels at diagnosis; and 11.6% have high blood pressure at diagnosis. In addition, it appears that youth with type 2 diabetes require a rapid intensification of treatment, so they rapidly fail on a single oral medication and often require the use of insulin injections for treatment.
Recent evidence suggests that individuals diagnosed with type 2 diabetes at a young age are victims of cardiovascular disease events early on in life and that they will lose about 15 years of life expectancy on average.
The economic consequences of pediatric type 2 diabetes have been poorly documented, but understanding the economic burden of obesity is imperative given that it is the main cause of type 2 diabetes among children. At the national level, direct costs of overweight and obesity are estimated to be between $3.9 billion and $6 billion, which represents 4% of the total health care budget. This figure does not even take into account indirect costs.
The true cure for type 2 diabetes is probably to identify at-risk individuals and avoid deterioration through preventive strategies targeting childhood obesity and its associated lifestyle determinants. There is extensive evidence supporting the fact that lifestyle intensification and interventions in adults delay or possibly entirely prevent the transition from prediabetes to overt type 2 diabetes. While the evidence remains limited, similar findings in children have been demonstrated by my group and others.
Childhood represents a critical time frame in which to intervene to prevent and treat obesity by enhancing the adoption of healthy lifestyle habits and ultimately preventing type 2 diabetes and later cardiovascular disease in these vulnerable youth.
In addition to the increasing rates of childhood type 2 diabetes, recent reports show evidence of worldwide increases in the incidences of type 1 diabetes mellitus, particularly among children less than five years of age. Since 1990, the global incidence of type 1 diabetes has increased by 2.8% each year among youth less than 15 years of age, and Canada has not been spared by this increase.
Type 1 diabetes accounts for 90% of child and youth diabetes and is also among the most prevalent childhood chronic diseases in Canada. In 2010, the estimated economic burden of diabetes in Canada was $12.2 billion and projected to increase by another $4.7 billion by 2020.
The early onset of type 1 diabetes is particularly worrisome given its strong association with a marked increased risk of cardiovascular disease. In fact, individuals with type 1 diabetes are 10 times more likely to die of heart disease than their healthy peers.
While heart attacks and strokes occur in adulthood, atherosclerosis begins in childhood. This is well documented. Atherosclerosis in individuals with type 1 diabetes appears to be more aggressive. It occurs earlier; it is more diffuse; and it leads to higher death rates, cardiac failure, and shorter survival than in the general population.
Childhood represents a pivotal time period to prevent obesity and consequently type 2 diabetes but also the deleterious consequences, namely cardiovascular disease, of both type 1 and type 2 diabetes.
Recommendations emanating from this committee need to address the specific needs of children and adolescents. I humbly propose five recommendations to be considered by the committee.
The first is to provide access across Canada to proven, evidence-based, multidisciplinary programs to ensure the treatment of obesity, such as the CIRCUIT program at CHU Sainte-Justine. Children and adolescents will also benefit from access to proven, community-based obesity and cardiovascular disease prevention programs that target youth and are tailored to the community's needs.
Second, we should be favouring healthy lifestyle habits early in life and integrating them into preschool and school curriculums. As an example, mandatory daily physical education courses should be implemented in schools.
Third, treatment programs for the management of children with type 1 and type 2 diabetes should be tailored to their needs—in particular, those of vulnerable communities, such as first nations, which was clearly pointed out by the previously speakers.
Fourth, funding of high-quality research in the fields of pediatric obesity, type 1 diabetes, and type 2 diabetes is urgently needed in order to enhance our understanding of what the best strategies are for prevention and treatment to ultimately optimize the care of affected children and adolescents who will become the next generation of adults.
Finally, I think it's important that we implement educational efforts to sensitize families and primary health care providers to the early symptoms of diabetes for early screening and diagnosis among children and adolescents.
I wish to thank you for your time and for allowing me to give a voice to children and adolescents with diabetes, and I welcome any questions you may have.
That's a very good question. I'm going to answer it in two ways.
Certainly there are technologies of interest for the treatment of type 1 diabetes in particular. I know the committee discussed the difference between type 1 and type 2 at the last session, but I'll just refresh everyone's memory.
Type 1 diabetes requires insulin administration via injections or an insulin pump, with a regular and routine blood glucose measurement. Currently there's no harmonized process across Canada for accessibility to pumps. Some provinces allow people to have access to pumps no matter what their age.
For example, in Quebec, if you're under 18 you have access to government coverage for a pump, but if you're over 18 you don't. If I have patients who are diagnosed at 17 and a half, I have six months to try to have them learn about type 1 diabetes, how to manage it, and then consider the pump. Because I know that after that, they won't be admissible for coverage. For the first year of the pump, that certainly means $10,000 of expenses.
In a similar vein, there are some very new technologies for monitoring blood glucose in a continuous fashion. Traditionally, we use a finger poke to check our blood sugar. There are devices now that can monitor it 240 times in a day without your having to poke yourself 240 times a day, which is obviously impossible. These technologies have a really significant impact on my management of my patients. That's not covered. It may be covered by some private insurance, but not universally.
Obviously, insulin is covered for children across Canada. That's fantastic. Access to insulin is not equal across the world. We're privileged in that sense. I think we do have some work to do to make some of the newer technologies for individuals with type 1 diabetes more accessible in a universal fashion.
I think, Dr. Coutinho, that these were your words.
If not, maybe they were yours, Ms. Baird.
You called diabetes “a systemic disease at pandemic levels”. That's a pretty jarring description of where we're at in 2018.
We just had some senior federal civil servants here. I was asking them about the degree of progress that we've made since the 2013 Auditor General's report, which I will say is scathing. It's just an across-the-board comprehensive indictment of the failure of the diabetes program at Health Canada at that time.
At that time in 2013, the AG's report called for Health Canada to commit to properly measuring outcomes of the aboriginal diabetes initiative. Health Canada agreed to enhance performance measures to assess the impact of the ADI, to use those enhanced performance measures to assess and advance the diabetes activities funded, and to provide increased support to regions to use data for health status reporting. In response to that report, Health Canada committed to doing all of that by the end of 2013.
Have you seen major changes or progress in the past five years since those better performance measures and enhanced programming commitments were made by Health Canada?