Good morning, Mr. Chair, and all members of the committee. It's a pleasure for me to be here. This will be my second appearance before a committee to discuss the main estimates that we'll be discussing this morning. I see this as a second opportunity to again discuss some of the good work being done in the health portfolio. As some of you may be aware, I appeared before committee in March for two hours.
It's good to see some familiar faces and some new ones as well. I would like to offer my congratulations to all of you on your recent election success. In addition to being a voice for your constituents here in Ottawa, you also have an opportunity to work in the national interest of the committee.
I want to start off by introducing the officials who are here with me today. We have Glenda Yeates, deputy minister for the Department of Health; Jamie Tibbetts, chief financial officer, Department of Health; Dr. David Butler-Jones, chief public health officer of the Public Health Agency of Canada; James Libbey, chief financial officer of the Public Health Agency of Canada; Dr. Alain Beaudet, president, and James Roberge, chief financial officer, both of the Canadian Institutes of Health Research.
For those of you who are new, I would like to give you a sense of some of the major priorities of the health portfolio. The federal health portfolio covers a lot of ground, with organizations playing leadership roles in health care, regulatory oversight, first nations and Inuit health, public health, and research. All of these activities feed into our clear mission and goal, which is to work together to maintain and improve the health of Canadians, and that's a goal I know each and every one of us here shares.
As you know, Budget 2011 renewed funding for important programs, including the chemicals management plan. Budget 2011 also allocated up to $100 million to help establish the Canadian Brain Research Fund to support the very best Canadian neuroscience and to accelerate discoveries to improve the health and quality of life for Canadians who suffer from brain disorders.
I would like to reflect on some of the accomplishments during the last session of Parliament. We saw some important change in the way we protect the health of Canadians and the way in which we help them maintain and improve their health. Most notable was the Canada Consumer Product Safety Act, which was passed during the last session and comes into force today. It replaces the 40-year-old legislation that had proven to be no longer effective in regulating the marketplace of today. This legislation will also give us, for example, the ability to recall dangerous products and track their path through the marketplace. The new act is full of common-sense changes that Canadians expect and deserve.
As well, on June 9 I tabled three new proposed tobacco labelling regulations for consideration by the House of Commons, as required under the Tobacco Act. Among the proposed changes are new requirements for cigarettes and little cigar packages, including 16 new health warning messages than would be even larger and more noticeable than what we currently have in Canada. The Government of Canada is also committed to increasing awareness of the health hazards associated with tobacco use and the benefits of quitting.
We have also invested in innovative projects that aim to counter some of the factors that contribute to mental health problems, especially among children and youth. I recently announced $27 million in funding for programs for those at higher risk of developing a mental health problem because of their socio-economic circumstances and living conditions. Those funds will support programs over the next five years that focus on children, youth, and families in diverse communities, including rural, northern, and those of low socio-economic status.
From the public health perspective, we continue to apply the lessons learned from H1N1 to ensure emergency preparedness. While it's important to be able to respond to significant health challenges like H1N1, I personally believe it's important that we work proactively to prevent disease and injury, which is why health promotion is important.
Last year my federal and provincial colleagues and I adopted a declaration on prevention and promotion, showing our commitment to work together on initiatives that would curb childhood obesity. I believe this is a critical step in helping Canadians live longer and healthier lives.
As we look towards the future, there is no shortage of daunting challenges. If we are to bring about positive change to health services for aboriginal people in Canada, they must be based on innovative partnerships between all levels of government, including first nations. Such innovative partnerships form the basis of a tripartite initiative currently under way in British Columbia, where we are working with B.C. first nations and the British Columbia government on the development of a new first nations health governance structure. Our shared vision would see first nations plan and deliver health services and programs that are better integrated with the British Columbia health system.
We are also proposing changes to the marijuana medical access program. Those changes would help eliminate some of the hazards that have developed under the program in the last decade. We are proposing changes that would shift production away from individuals in their homes to licensed producers who could be better regulated by our inspectors. I believe that our proposed changes strike an important balance between patient access and strengthening public safety.
Health Canada is both a leader and a partner in helping to ensure that Canadians have access to quality health services. Through the Canada health transfer administered by Finance Canada, the federal government provides long-term, predictable funding to support provincial and territorial health systems. Canada health transfers in 2011-12 will amount to $27 billion and will grow to an all-time high of $30 billion by 2013-14.
Cooperation with the provinces and the territories has produced some tangible results across many of the priority areas in the 2004 accord. For example, in the area of wait times, the Canadian Institute for Health Information has reported that at least eight out of ten Canadian patients are receiving priority procedures within medically acceptable wait times.
I have also asked the Senate Standing Committee on Social Affairs, Science and Technology to resume its review of the accord. I know that the committee's findings will help guide us as the time for renewal gets closer.
Our government is committed to working collaboratively with the provinces and the territories to ensure that the health care system is sustainable and that there is accountability for results. At this time, jurisdictions are reviewing results achieved against the accord commitments. It will be very important for this evaluation to occur in order to have an understanding, based on evidence, of where progress was made and where there may still be work to do.
In the meantime, we will maintain the 6% escalator for the Canada health transfer and will work to renew the health accord while respecting provincial and territorial jurisdictions in health care.
Our government is not waiting for the conclusion of the health accord to improve health services to Canadians. There are measures we can take today to address the health needs of Canadians, such as continuing to help improve access for Canadians to medical professionals.
Strengthening health care with more physicians for Canadians is a priority for our government. That is why I recently announced federal funding to support more than 100 family medicine residents to receive training and to provide medical services for work in rural and remote communities across Canada.
While we are improving access to health care professionals or increasing their numbers, we are working closely with the provinces and the territories to accomplish this goal.
Mr. Chair and members of the committee, I hope you have found this overview of where we've been and where we're going helpful. If you have any questions, I would be pleased to answer your questions this morning.
Thank you.
:
Thank you very much, Mr. Chair.
And thank you, Minister Aglukkaq and members from the department, for being here with us this morning.
As a member of Parliament from Saskatchewan, I want to extend a special welcome to both Glenda Yeates and Dr. David Butler-Jones, both individuals who have served Saskatchewan very well in the past and are now serving our country in very similar capacities. It's good to see you here again.
Despite the comments of the chair, we here on the government side of the table are very pleased to have you here at committee today to give us the opportunity to have a dialogue with you and health officials.
As a newly appointed member to the health committee, I am very much looking forward to learning more about many of the initiatives you and the department have begun to put in place. I am very interested in the plans and priorities as reflected in the estimates and in the budgets going forward.
Today the new Canada Consumer Product Safety Act is coming into force. I'm wondering, Minister, if you could tell us how this act will better protect the health and safety of Canadians from hazardous consumer products.
:
Thank you, and I appreciate your comments and feedback.
It actually took four attempts in the House before we were able to pass the consumer product safety legislation in December in the Senate.
As parents we make the assumption that when we walk into a store, products on the shelves are safe. Going into this role, as a mother, learning that we have 40-year-old legislation that does not protect children from harmful products, as an example, was a concern to me. The act we introduced and passed will give the government stronger and more.... This is modern legislation. The previous legislation was 40 years old.
Now, for the first time, we have the power to recall unsafe products from the market or off the shelves. The Canada Consumer Product Safety Act also increases industry's responsibility regarding the safety of the products they sell in Canada. It requires the industry to report incidents to Health Canada so we have a better monitoring system across the country. And it's in the interest of industry, in my view, to ensure that the products they do sell are safe as well, so they'll be working with us closely.
My department, in the last year, has been communicating with retailers and industries across the country to educate them on the new legislation. And I'm very pleased to be able to say that the legislation comes into force today.
Thank you.
Since our government came into force, as I stated before, we introduced the Mental Health Commission, the first of its kind in Canada, to address and improve the quality of life of Canadians dealing with mental health challenges.
In Budget 2007 we committed $130 million to create the commission, which will be going forward with recommendations on areas to address, by 2012, in partnership with researchers in provinces and territories that deliver health care. An additional $110 million was provided to the commission in 2008 for research projects for homelessness and mental health.
But we also recognize that there is an area for youth where we need to start addressing early diagnosis of youth with mental illness and start putting in place better support systems for their families, school teachers, and whatnot. So this is early diagnosis and working with children with mental health problems throughout their lives, as opposed to when they're homeless or incarcerated or when they get into trouble. We're trying to focus on the prevention aspect of it, which is why I was so proud to announce the $27 million of mental health projects our government has invested, which will deal with children's needs and youth needs. The focus is on children between the ages of six and twelve, and we're working with parents, school teachers, health care providers, and community partners in terms of how we will deliver these programs across the country. Basically that will build on the recommendations that will be coming forward through the Mental Health Commission that we are establishing in Canada, so this is a significant investment.
First of all, I would like to take a few seconds to thank the minister for being here with us this morning, since I had no time to do so in the 30 seconds I was given earlier. We appreciate it.
My question is about Vancouver; that's where we were yesterday. A recent study published in the British medical journal The Lancet has showed that the Vancouver supervised injection site was giving good results and was making real progress possible. It works, since there was a 35% drop in overdose cases for people with drug addiction problems in the Downtown Eastside. I was in this neighbourhood this past weekend. It is shocking and brutal to see.
A recent study from Quebec has also showed that a similar site in Montreal, which is unfortunately now closed, had not caused any disturbance in the area. So these sites are not under attack for security reasons.
If these methods are working and they are an effective weapon against substance abuse, making it possible to avoid senseless deaths, why does the minister or the federal government insist on wanting to close Insite in Vancouver?
:
In terms of innovation, I've been on the health portfolio for about six or seven years, provincially and now federally. I have seen a lot of changes in the provincial jurisdiction, a shifting to focus more on areas of better integration and prevention. I've always stated that equally important to treating people when they get ill is preventing them from getting ill in the first place.
When you consider the health indicators of the Canadian population, you will note very quickly that many of them are preventable. When it comes to illnesses associated with obesity, cancer rates associated with tobacco use, the lack of physical activity, and injury prevention, there are a number of startling statistics in Canada.
The shifting we're doing is the first of its kind. In September, for the first time, we signed a declaration on keeping Canadians healthy. That was signed with the provinces and territories. We committed to work together to combat the issue of obesity. There are other areas within our portfolio over which we have direct control, such as consumer product safety legislation and tobacco legislation. We're looking at prevention, illicit drug use by our children, and addressing mental health. These are programs designed to keep people healthier as well as to support individuals who require support, the more vulnerable. That is quite exciting.
Another area that is innovative would be the tripartite agreement discussions we are having in British Columbia. British Columbia first nations, the province, and the federal government have been working for four or five years on how to better integrate health care services for the first nations people within the province. The work we are doing with the British Columbia first nations is innovative. It integrates first nations to be part of finding solutions. They are at the table in terms of providing better programs in their communities.
It is an exciting time to be discussing some of those initiatives. I think they are changing how we deliver health care, in less of a silo environment, how we better integrate all residents in each jurisdiction to provide health care services, as opposed to first nations having certain services and that type of thing. It doesn't work, and we know that. The work has been--
I'd just point out that, yes, our government had to make some cuts in the nineties because we inherited this $42 billion Conservative deficit and we were in a state of crisis. But having balanced the books, don't forget it was the Liberal government that initiated the 10-year health accord, where funds would grow at 6% per year for 10 years from 2004 to 2014.
Let me move to a different subject, which is the topic of funding for first nations and Inuit health care. I have two concerns. If one looks at the estimates on pages 163 and 164, in the current year we're getting less information than we did in the previous year. Under first nations and Inuit health care, for 2010-11 there were 10 categories of spending that were revealed in the estimates. In the more recent years, 2011-12, there are only three categories. So you've amalgamated a whole bunch of smaller amounts into a much smaller number of categories, thereby providing less information.
I have two questions. One, why do you think it's appropriate to give so much less information to Canadians and to this committee? Second, I note that the total expenditures are very similar for each of the two years, whereas the Assembly of First Nations has estimated a nearly 10% increase in the number of first nations people eligible for non-insured health benefits. So you have expenditures that are nearly flat, and the demand or need in terms of population growth is rising very quickly.
I guess I have two questions. Why collapse the information, and why are expenditures not nearly keeping pace with the population growth of aboriginal and Inuit people?
:
I believe the non-insured health benefits on the items will be reflected in the supplementary budget piece.
On the question around the issue of less information, as a former territorial health minister, and looking at community-based programs, I'll give you one example of a community that had to apply 15 times for programs.
The community wanted to deliver programs to pregnant women to deal with obesity, tobacco, FASD, and diabetes. The way the program was designed before was disease-specific, so the community group of volunteers had to apply five times to be able to deliver to a pregnant lady prenatal programs on FASD, diabetes, and whatnot.
So the clustering of the programs means they are better aligned to address the need for a broader delivery of programs at the community level, as opposed to spending their entire time and resources reporting 10 or 15 times to deliver programs. That's the explanation around that.
:
Thank you for your question.
This is an area that jurisdictions have been working on for some time. I was the territorial health minister when we started dealing with how we can address some of the issues around wait times.
I can say that the latest data from the Canadian Institute for Health Information and the provinces and the territories shows that we have had some decrease in wait times across the country. Our government, as I stated before, will continue to provide to the provinces and the territories as they adopt innovative approaches to delivering on and addressing wait times. At the same time, we will continue to provide the provinces and territories with the 6% escalator, which they will use to allocate to areas of need.
We continue to work with the provinces and territories on a health accord. As I stated before, the health accord has three more years left. A lot of work has gone into addressing wait times, as an example, as a priority area. But in order to see the true reflection of what we were able to achieve within the 10 years, we need to let the course run itself. Within the wait-time reports across the country, we are seeing significant reductions, and we'll continue to work on that.
In addition, our government has made significant investments in prevention, such as the prevention of hip injury, as an example, and in a number of other areas, which will mitigate some of the pressures we see within the hospitals around wait times.
As you know, globally we're dealing with an aging population. But where I come from, in Nunavut, it's the complete opposite. In Nunavut, we have more young people today, as opposed to other jurisdictions. So there will be some differences in provincial areas of work.
Our government is supporting areas to deal with our aging population, around injury prevention, as an example, and seniors in aging friendly communities. We've also encouraged communities to design programs for active and health living for aging. We have the Canadian prevention program for seniors--the name escapes me at the moment. But we're putting programs in place to address the healthy aging of our population.
Our government continues to also make significant investments in the area of research to support Alzheimer's care--the brain funding we announced--and dementia programs.
There are a number of significant investments we've made that way. As well, through the Canadian Institutes of Health Research, through the leadership of Dr. Beaudet, Canada is leading in coordinating Alzheimer's research internationally, as an example. The results, again, will help us identify programs we can make investments in.
Thank you.
:
Thank you for that question.
Our government recognizes the impact of neurological illnesses on Canadians, which is why we have acted to support brain research and will continue to do so.
Our government has also provided funding for a four-year study of persons with neurological diseases, and the national population health study will also bring together the Public Health Agency of Canada and the neurological health charities of Canada. The first annual progress meeting was held this past year in March.
We also have heard a lot about CCSVI and MS. I was pleased to support the development of the ongoing national MS monitoring system, which will provide those with MS, health care providers, and Canadians with a better understanding of the disease patterns and the use of treatments.
We also established a scientific expert working group in monitoring and analyzing results of the seven MS Society sponsored studies already under way both in Canada and the United States. If the expert advisory committee advises in favour of clinical trials, our government, working with the MS Society in the provinces and the territories, will ensure that we fund the programs.
In terms of research into neurological illnesses, including Alzheimer's disease, as I stated before, Canada is taking the leadership role internationally. I was recently joined by the honourable Minister of State for Seniors to announce important investments in the area of more than 40 Alzheimer's research projects across the country. CIHR will contribute to that as well, through a research strategy to address Alzheimer's disease on an international global scale.
Building on this effort, Budget 2011 includes significant funding to establish that Canada bring a research fund in support of the very best Canadian neuroscientists. That's in Budget 2011 to go forward as well.
:
Thank you very much, Mr. Chair.
I'm very happy to speak to this important issue. I think there are two issues: one is the amount of money, and the second is how it's displayed and shown in the estimates.
I'll start with the first question on the amount of money. The biggest change you will see in the estimates is because of the non-insured health benefits. They are supplementary benefits that we offer through Health Canada to first nations individuals. The largest components of that are for prescription and non-prescription drugs, and medical transportation for dental and optometric support, for example.
As the member notes, these are demand-driven programs, so as the population increases you will expect to see an increase in the amount. In fact, every year or two, depending, we look at the demand and the estimates and come up with a final estimate as to what we think the actual draw on the program will be. We're in the process of that as well. We typically get a base budget, and then we get money in the supplementary estimates that reflects the actual demand. But there's no change in the benefit levels for those programs for 2011-12. We expect to see--perhaps before this committee--the supplementary amounts in the supplementary estimates that will come in the fall.
The second part of the question was about the categories. I recognize that in these estimates there are changes that go in a couple of directions. The first one I will point the members to is on page 162. You can see that we previously portrayed the first nations and Inuit health programs--if you look at 2010-11--as $2.2 billion. They were portrayed there as one number. In a sense, this year, if we look again to page 161, we're showing that amount in three categories for 2011-12 . So there is the supplementary health benefits category that I mentioned--the sort of insurance program that is demand driven; primary health care--the second one--that tends to be our services for everything from public health immunization programs to emergency nursing services in remote communities; and then there's infrastructure support, which is support for the actual running of the services.
Rather than just showing the $2.2 billion, we have tried to give parliamentarians a better sense there by showing it in these three components. But as the member noted, on page 164 we're showing the transfer payments in these three big categories, because we think that better reflects the three particular program lines. But as the minister noted, we are taking the authorities down from what used to be 10 different authorities that ran these programs to three. That is very much in keeping with our desire to not essentially hamstring first nations communities in delivering the programs, because when we say it's precisely under this authority, we sometimes limit their ability to move the money where it's needed.
We are basically saying that if something is under the authority of primary care services, they have some ability, within all of the accountability frameworks we have in place, to move that money within that envelope. So we are reducing the authorities in that way.
:
Thank you for the important question on the topic of sodium.
We've had a working group, as members may be aware, that did some work and presented governments, essentially, with a report. As the minister noted, this was considered at the FPT ministers of health meeting last September. Governments collectively--federal, provincial, and territorial ministers of health--supported further work on this strategy. They endorsed the reduction of the target by 2016 from the current 3,400 grams to 2,300 grams.
They have endorsed that particular target. As FPT officials, they've sent us away to actually do work, saying, “Give us the strategies and give us the best research as to how we will achieve that.”
That work is going on within our base budget. We don't have a specific targeted line item in these estimates that reflects this, but we certainly are trying to integrate it with our other food work, because we realize that it's about the entire diet that the population eats, and sodium is clearly one key component.
But we're integrating that work. We're working with our provincial and territorial colleagues on an integrated strategy. So that work is very much going on, but the member is quite correct: there's not a line item in the budget. But I can assure the committee that it's going on.
:
Thank you very much for the question.
I want to reassure the committee members, Mr. Chair, that we are talking about a timing and a budget process on both of these questions. I would not want first nations people listening to this committee to be concerned that in fact there had been a reduction in the programs as outlined. This is a timing question. Some figures get reflected in the main estimates and some get reflected in the supplementary estimates. As I said, there is no change in the program, no change in this current year in any of the programs that are being cited. Again, I would not want anyone listening or following these proceedings to take what is essentially a budget mechanism issue with government budgeting about timing to think in any way that the programs had been reduced, because that's simply not the case.
Again, the situation on the environmental risk, as mentioned, is the same situation where these estimates...when we compare them to main estimates last year, we were at the end of the sunsetting programs for environmental assessment. Those have been reviewed, as was announced in Budget 2011, and the government has committed $200 million for the renewal of those programs on a go-forward basis over a number of years. The majority of it comes to Health Canada, but we work in close partnership with Environment Canada and some other departments, so that money will be allocated. I can assure the committee that we will see that budget figure reflected in individual departmental supplementary estimates.
:
Thanks very much for the question.
This is primarily for the information of members who haven't sat at the health committee. Every portfolio is structured a little bit differently. In some portfolios, agencies, the financing is done by the lead department, etc. In our health portfolio we actually have separate accountabilities. We're a departmental structured entity, so for the budget items, etc., that are part of the Public Health Agency, I'm the accounting officer related to them. For CIHR it's Dr. Beaudet. That's just for your information as background.
On the mental health piece, I'll start and then Glenda will pick up with the first nations piece.
On the $27 million that was announced, there are two aspects. One is that obviously health services are provincial, and we work very closely as a portfolio with our provincial and territorial partners around how, as a country, we can address issues collectively where that makes sense, particularly on public health issues. The $27 million, though, is specifically focused, as you identified, in terms of low socio-economic status in rural and northern communities, aboriginal communities. We'll address issues such as bullying, change in law, substance abuse, and suicide and look at really strengthening how we can, through some strategic investments and supports, actually promote and support so that people have the kind of living situation that makes them less likely to have mental health challenges later on.
:
Thank you very much, Mr. Chair. I'm happy to speak to this important area.
I can absolutely understand the challenges that the mains to mains comparison gives in this circumstance, because we are obviously not at the time when we have the supplementary estimates. But with specific reference to the area the member raises, in terms of pesticide safety, they are also part of the department that is a recipient of the chemicals management plan, for example. Again, as that funding came to the end of its sunset, as it was reviewed and evaluated, the money came out of the main estimates. But then, of course, the government announced in the budget that the government intends to renew the chemicals management plan and some of the other environmental health agenda items. The government announced the $200 million funding in the budget, and that will then only appear, as budgeted initiatives do, in supplementary estimates. I just wanted to make it clear that also applies.
Thank you for the question, because it might not have been clear that the chemicals management plan affects several parts of the department, but it includes our pesticide area as well. Similarly, the reduction that was mentioned in the environmental area as well is this chemicals management plan being renewed. So I just want to mention that, again, with the budget announcement we will see those moneys be allocated to the departments and come back in the supplementary estimates.
But I appreciate that for members of the committee, at this point in time, what looks like a reduction would raise concern, and I would just want to reassure members that once we see the supplementary estimates you will see those funds get reflected back into the department's budget.
:
Thank you for the question.
[English]
CADTH, the Canadian Agency for Drugs and Technologies in Health. I believe the member is referring to that line. And I'm very pleased, Mr. Chair, to be able to speak to that agency. As its name implies, it's a joint federally, provincially, territorially supported agency.
There was a sense a number of years ago, when I was the provincial health deputy, that there were economies of scale, looking at some of these new technologies one time, to gather the expertise and then share that among the provinces and territories. They do drug assessments. They do medical device assessments and other things.
One of the challenges we faced in the last number of years was a shortage of medical isotopes. What we learned through that period was that there are a number of ways, through good information sharing and working together.... Provinces coped with that shortage and actually worked very hard--positions on the front line.... We did a good deal of coordination as well to try to effectively make sure that patients were not harmed as different kinds of responses, different isotopes in some cases and different procedures in others, were used during that situation.
As part of this, we have given a grant, an increase, of $3 million to CADTH over two years--some of it is reflected in this year's budget--to do some follow-up work on isotopes, to make sure we learn the lessons, in a sense, that we're looking forward to the new technologies: what do we understand from what we learned in that experience, and how do we share those lessons? Some parts of the country did things differently from others. Who had the best outcomes? Can we understand that? And also, to work internationally, do a piece of research essentially on what is our best way going forward.
Again, we felt it was a positive experience. We wanted to make sure we learned the lessons and assessed that experience. That's why there's an increase in the CADTH budget.