HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

• 0905

Thursday, November 26, 1998

[English]

The Chair (Mr. Joseph Volpe (Eglinton—Lawrence, Lib.): Colleagues, gentlemen, ladies, welcome to an unusual sitting of the health committee. We are in Room 253-D, august chambers. Your voices are recorded—and for the first time in a while, so are your visual images.

We welcome to the committee this morning witnesses from Health Canada: David Dodge, Deputy Minister; Robert Lafleur, Senior Assistant Deputy Minister, Corporate Services Branch; Ian Potter, Assistant Deputy Minister, Health Promotion and Programs Branch; Dr. Joe Losos, Assistant Deputy Minister, Health Protection Branch; and Orvel Marquardt, Director General, Departmental Planning and Financial Administration.

Colleagues, as you know, we're here pursuant to Standing Order 81(5) and (6) and its order of reference dated October 29, 1998, consideration of the supplementary estimates (B) for the fiscal year ending March 31, 1999, votes 1b, 5b, 10b, 15b, 20b, and 25b. We're also here pursuant to Standing Order 108(2), consideration of the Health Canada Performance Report for the fiscal year ending March 31, 1998.

I would like to welcome our members from the department, and we'll go immediately to presentations.

Mr. Dodge, my understanding is you'll be speaking first. And since I've already given an indication of who everyone is at the table, and I think some of the members are not unknown to committee members around the table, we'll dispense with further introductions.

We have established a modus operandi in this committee that we'll try to keep presentations by witnesses to no more than five minutes in order to maximize the exchange between witnesses and members. We would really appreciate it if you kept that in mind.

Mr. Dodge.

Mr. David Dodge (Deputy Minister, Health Canada): Thank you very much, Mr. Chairman. It's a real pleasure for me to be here today on behalf of the ministry and on behalf of my minister, Allan Rock, to talk with you about the work the department is doing to promote the health of Canadians.

You've already introduced those of us at the table here, Mr. Chairman, so I'll dispense with that. I'm going to keep my remarks very short, because several weeks ago I met with a number of you on the federal agenda for health. I have copies of the presentation I made to you at that time available for those members who were not there on October 28.

I'll just note there were really five priorities we discussed at that time: how we deal with the risks to health—health protection; how we promote the health of Canadians—so-called promoting population health; how we improve the health of the aboriginal population for whom the department has particular responsibility; how we expand and enhance the use of health information to improve the health of Canadians; and finally, how we modernize what we know as medicare. Those are the five priorities. We had a discussion of those at that time, and we can come back to any of them if you wish.

These priorities reflect the long-term federal commitment to protect and promote the health of Canadians. They also reflect Health Canada's concerted effort to try to manage the resources allocated to it within Treasury Board's framework of results-based management.

• 0910

The departmental performance report demonstrates that we are taking action to respond to the long-term health priorities the government has set. The supplementary estimates allocate funds needed to follow through this year on those commitments the government has made since the original estimates were tabled and moneys needed to respond to changing circumstances.

As we all know, nothing is static in the area of health. That's why our strategies for managing risk to health and promoting population health all need to be targeted, but also need to be flexible. These strategies are developed and implemented in partnership with provincial and territorial governments, with the aboriginal people, and with the health community in a wide range of professional and voluntary organizations. It truly is a partnership of a lot of elements of Canadian society to try to improve the health of Canadians.

I don't have to tell you that Canadians care deeply about health and about their health care system, and they expect all of us to work together. And indeed, that is the aim of those of us in the department, to work with all our partners to try to produce the maximum results.

We're not all the way there yet, but I think the performance report, which you have, demonstrates that Health Canada is taking strides to do so. But a lot more is going to have to be done, and in the coming months we're undoubtedly going to be back here several times to work with you as you consider an increasing number of far-reaching and complex issues, and how the Government of Canada should try to deal with them.

All I can say is we look forward to working with all the members of the committee as we try to work through these issues, and I particularly look forward to this. This is a new committee for me, and I really do look forward to working with you.

Thank you, Mr. Chairman.

The Chair: Thank you, Mr. Dodge.

Did other members of the panel want to add something? Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you, Mr. Chair.

I'd like to start by directing my questions to Dr. Losos, if I might. We've studied natural health products over the last little while at some depth, and one of the things we heard is the enforcement activities were being undertaken with—if I might characterize it this way—less vigour, because of the changes that were envisaged. I've had a number of individuals give me examples where that doesn't seem to be the case, and I want to bring a specific example to you today.

Ross Henderson is a fellow who lives in Winnipeg. Since 1982, under the personal use policy, he's been importing for personal use vitamins, minerals, and supplements. In March of this year he received a shipment of vitamin C. I won't go over all the names, because they are vitamins, and in one case, a mineral. These shipments have been coming to him and have been coming in with no problem. Just this last week, 10 days ago, the identical shipment came to him and was turned back at the border. The reasons given are that these products are classed as drugs in Canada, they're not labelled in accordance with various sections of the food and drug regulations, and no valid drug DIN was on the label. Mr. Henderson has asked me, and I'm doing this for him, to find out what rationale there would be for turning back vitamin C, pantothenic acid, picolinate, and niacinamide at the border, when he's been getting these products for years. So I leave you with that question.

The Chair: Dr. Joe Losos.

Dr. Joe Losos (Assistant Deputy Minister, Health Protection Branch, Health Canada): Thank you, Mr. Chairman.

As the committee has been looking at natural health products, we have certainly tempered our approach to enforcement of a large number of health products out there. That is not the case where a product has been shown to be of higher risk, where we have had, in fact, to move in several times.

• 0915

I'm not personally familiar, Dr. Hill, with Dr. Henderson's case on vitamin C, but certainly this should not be an issue. I will look into it and get back to you promptly on that one.

The Chair: Mr. Hill.

Mr. Grant Hill: The whole idea that the department's enforcement activities were softened doesn't look to be the case. Maybe there is an explanation for this. We've talked about arbitrary, somewhat dictatorial enforcement policies, and this looks to me like a classic example. Surely vitamin C, super B, pantothenic acids, zinc picolinate, and niacinamide are not controversial in any way, shape or form. Would you agree with me?

Dr. Joe Losos: Yes I would, sir.

Mr. Grant Hill: They have been coming to this individual since 1982, maybe 1981. A shipment in March came through with exactly the same constituents, quantity and price from exactly the same source. What is different with this shipment? What could be different?

Dr. Joe Losos: I don't have an answer for you, Dr. Hill. I'd be happy to look into it for you. It shouldn't be a problem. It must be an aberrant situation. I'll be happy to look into it and get back to you.

The Chair: Dr. Losos, in getting back to Mr. Hill, I wonder if you would forward the response through the committee researchers so we would all benefit from the response.

Dr. Joe Losos: Certainly.

The Chair: Thank you.

Mr. Hill.

Mr. Grant Hill: Dr. Losos, you have exactly the same information Ross Henderson has, only you are in charge of the department and the inspection and enforcement activities. He's saying “What is going on? This is bizarre and unusual and impossible to comprehend.” This guy is a Harvard graduate, a PhD, a fellow who works in Canada. He's basically saying he thinks he should be in charge of what vitamins he takes and the HPB has determined that he cannot have this shipment. You have exactly the same information as he, but you're in charge. So I need to have an explanation of how this could happen.

Dr. Joe Losos: The Health Protection Branch is a large organization. We do hundreds and hundreds of health transactions every day. I personally am involved in dozens every week. I would not be involved in every inspector's refusal to allow an importation. As I've said, I'll give this personal attention and give you feedback as to what the problem was.

The Chair: Mr. Jackson.

Mr. Ovid L. Jackson (Bruce—Grey, Lib.): Thank you very much, Mr. Chair.

My question has to do with Canada's drug strategy, on pages 46 and 47 of the performance report. We've had an interdepartmental initiative approved since 1992, and I'm not too sure whether new moneys have been allocated to it. I'm wondering how we're doing with it. It's one of the ways we track systems and make the system more efficient.

I don't know, Mr. Dodge, if you're on top of that.

Mr. David Dodge: I'm not as on top of it as I will be in time. Ian Potter has been working very hard on this, so perhaps he would like to give you an update.

Mr. Ian Potter (Assistant Deputy Minister, Health Promotion and Programs Branch, Health Canada): Thank you very much, Mr. Jackson and Mr. Chair.

Canada's drug strategy was an interdepartmentally funded initiative for which overall funding has terminated. It was a five-year program. The initiative, however, continues.

It contains components in which the federal government works with provincial governments. We provide assistance to provincial governments in the neighbourhood of $14.5 million a year to support them in innovative programs of treatment essentially aimed at women in difficult situations—more innovative and demonstration programs.

We've worked closely with the chiefs of police, the RCMP, and both the social health and law enforcement parts of the provincial governments. We have recently released a document that outlines the activities the federal government has initiated. I would be pleased to provide a copy of that to the chair and through the chair to you.

• 0920

We have been working in a number of different areas to look at drug problems. For example, in British Columbia we have a particular initiative with the Vancouver/Richmond Health Board to deal with the particular problems of injection drug use in that community. We are continuing our work on that strategy to see if we can refine it and more effectively adapt it to the needs of the current problems in drug use. That's moving along quite well in consultation with provinces and other interest groups.

Mr. Ovid Jackson: One concern I've had, Mr. Chairman, and I'm sure you people must have it too, is technology can be very effective when used as a tool, but in my experience officials from different departments or different provinces use different programs and it's very hard to integrate them. That makes for a real challenge. People have to buy into the use in order to make the thing efficient. You can save a lot of dollars that way.

I'm wondering if you have some kind of regime or committee that tries to make sure everybody's using the same thing. It's all well and good to have the information in the machine, but if they can't talk to each other on an efficient basis, the whole thing is lost.

Mr. Ian Potter: Yes, we do. This is an important issue. We support the Canadian Centre on Substance Abuse, which tries to do just that. It's an organization established by an act of Parliament and has representation from across Canada. It provides a repository of best practices, information on drug control and drug issues. It takes a number of initiatives to try to bring together organizations and provinces so there are more effective programs and treatments available.

The Chair: Mr. Jackson, is that it?

Mr. Ovid Jackson: Yes. Thank you.

The Chair: Mr. McTeague.

Mr. Dan McTeague (Pickering—Ajax—Uxbridge, Lib.): Thank you, Mr. Chairman.

Welcome, Mr. Dodge and others.

I have a number of questions, but given the time perhaps it would be best if I try to zero in on one or two.

Recently, in the election in Quebec, we heard a rather chilling story from an expert panel to the effect that the cost of drugs, pharmaceuticals and medicines in that province are such that many people are in a position today where they can no longer afford to provide themselves with the necessities to maintain a certain standard of living. I'm wondering if your department has had an opportunity to review those findings and perhaps provide some recommendations as to overall policy of drug care.

Mr. David Dodge: That's a very far-ranging question, and I'm not going to try to deal with it all. But let me give the answer in two or three parts.

First, as you're well aware, through the PMPRB we really track and watch closely the prices of patented drugs that are sold here in Canada vis-à-vis other countries. Over the past few years we have observed that the prices of these drugs in Canada, relative to comparable countries, have come down.

So there has been some very real success over the past few years, not necessarily in controlling the absolute cost of these medicines, but in controlling them in respect to the prices at which they're sold in other countries. That's formally part of our job, and we do that part of our job.

The second issue you raised is much more difficult and wide-ranging. As you know, insured services cover only doctor services and services provided in a hospital, with a little bit of help for long-term care. In the 1960s when we adopted medicare, those insured services were roughly 75% or a little bit more of the total cost of medical care in the country because so much was done in the hospitals and by doctors.

• 0925

Over the past thirty years what has been happening, very appropriately, is as medical technologies have advanced, a lot of the care that formerly had to be given in hospitals, because techniques and surgery were very invasive, could be dealt with outside by either therapeutics or by much less invasive surgery, which meant people could recover at home rather than in the hospitals.

That gives rise to a very real problem because now insurance services under the Canada Health Act probably only account for about half of total medical costs, so we collectively have a very real question about how, as we move into the 21st century, we really ought to be dealing with it.

Mr. Dan McTeague: I would like to ask a more specific question, since you raised the question of the PMPRB. Some of us here have made submissions to that board. In that context we have detected a lack of consistency with their methodology and their reference-based pricing. The comparison to other nations may give us a sense of comfort, but it becomes rather important when, on further scrutiny and study, it's very subjective and the pricing is highly questionable.

I guess what I'm really asking, and I'd like to try to get an answer from you or some of your colleagues, is if the price of drugs is rising to the extent that it is making it impossible for ordinary Canadians or provincial governments to cover, and people are choosing alternatives that often make them twice as sick or have terrible health consequences, particularly as relating to institutionalization or putting these people in the hospital, is there not some kind of decision making that could occur within your department to include, as part of the health strategy, the importance of drugs and recognize, notwithstanding what PMPRB's wonderful wishful thinking world would be, that the price of drugs for many people is unattainable?

I give the example of insulin. Last week a number of members of Parliament were visited by people who had diabetes. I was quite surprised to see that a company like Eli Lilly, which of course has one of the patents on a product I thought was invented here in Canada, continues to raise the price of this product at a rate that's well in excess of inflation, yet the PMPRB says nothing about it.

Will the Department of Health begin to examine the high costs of drugs as part and parcel of an overall health strategy?

Mr. David Dodge: I never quite know what the word “examine” means here. I said there were three points. The third issue, which we are working on really quite hard in conjunction with a number of provincial agencies, is the area of cost-effectiveness of drugs. This is a real concern to provinces because they put the drugs on the formulary for various provincial plans. We have gone at this in a rather piecemeal way historically in Canada.

I was in Alberta a couple of weeks ago talking to the group out there that work on this issue to see if we can get a much more concerted effort to look at the cost-effectiveness of these drugs within the public sector. It's very important that it be done within the public sector so we get the best information we can on the cost-effectiveness of various drugs.

The issue you raised is a more difficult issue because it goes beyond that. It goes to the issue of to what extent we ought to cover drugs as an insured service. At the moment they are not covered. It is an extraordinarily important issue for us to face as we go forward for the reasons I gave because they are going to constitute a larger fraction of the total costs.

• 0930

That's not so much an issue for the department. We could provide Parliament with the information on this. This is a really very major decision as to whether we want to expand the scope of insurance services as they're set out in the Canada Health Act.

The Chair: Mr. Dodge, thank you.

Mr. McTeague, if you wish to pursue this I'll come back to you.

Mr. Dan McTeague: Thank you.

The Chair: Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Mr. Chairperson.

I'd like to begin by referring to the performance report and asking specifically what amount of money is now being spent on the Health Protection Branch. I'm having trouble finding it in this report, because I see we no longer use the name Health Protection Branch. So my first question is whether in fact the Health Protection Branch is now what is called the “management of risk to health by service”.

Mr. David Dodge: We tried to do this presentation in the new format with business lines. I appreciate that may be slightly confusing, but I'll turn to Bob Lafleur and Orvel Marquardt, who can give you the precise numbers.

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Health Canada): Essentially, when we talk about the risk management business line we're talking about the Health Protection Branch. There are some activities outside of the branch managed by other branches, but the bulk of it is the Health Protection Branch. The resources available to the branch this year in terms of its budget are $234 million. There was additionally in the budget, as essentially a pass-through amount, $30 million that was conveyed to the Canadian Blood Services and Héma-Québec for the support of the setting up of the agencies.

Basically, the working budget is $234 million.

Ms. Judy Wasylycia-Leis: Is that before or after the money collected through cost recovery on drug approval process?

Mr. Robert Lafleur: That's after. Within that is about $40 million of cost recovery.

Ms. Judy Wasylycia-Leis: So it strikes me that given this, there has been a significant drop in the budget for the Health Protection Branch going back five years, or certainly going back several years. How do you account for that? I know we've had the closure of the drug research bureau. I have raised that every chance I get. I'm wondering what else accounts for the drop.

Mr. Robert Lafleur: Five years is a long time, and a lot has happened with respect to that particular business line and the branch's resources related to it. There have been increases and decreases. There is about $30 million of resources that were transferred out of the branch to other organizations in the public service. The services provided through those resources are still being provided, but they're not being provided by the Health Protection Branch. For example, the Canadian Food Inspection Agency, which was an effort by the government to integrate the activities related to the tracking of foods and the inspection of foods, resulted in a portion of the staff and the resources of the Health Protection Branch being transferred to that agency along with all the support that is required.

In addition, there were some sunsetting programs that the government had approved in the late 1980s and early 1990s—in the case of this business line, about $20 million of programs that were intended to sunset after their period of approval, five years usually. For example, the Green Plan, which was a program that affected a number of departments, and in our case a number of branches, was removed. There were also some investments during that time. During the time of program review the department decided to cut its resources more than what the government had set as its target in order to reinvest in the Health Protection Branch, particularly in the surveillance activities of the branch. So in the middle of all this government cutting there was a reinvestment, and since then there was additional investment again in that area. And the very latest one, which is particularly important, is $125 million over five years that the government has approved for blood surveillance regulation and so on.

So there have been a lot of changes, as you can see. It's difficult therefore to compare. But the branch certainly has not had an important reduction in its resources for the work it has to do.

This is not to say that there isn't a further need for resources. There are other things that need to be done, and we are working on that. There is a process of transition to strengthen the branch for the new millenium. It's a very open process, with public consultation across the country, and it's an important core activity of Health Canada.

• 0935

Ms. Judy Wasylycia-Leis: If I could just think a moment—

The Chair: I know you're just getting warmed up, but we'll give you ample time to pursue this. Let me just go to the others on the list.

Ms. Judy Wasylycia-Leis: Okay. Put me back on the list.

The Chair: No problem.

Ms. Judy Wasylycia-Leis: How much time do we have as a committee with the witnesses?

The Chair: We'll go as long as they can stay.

Ms. Judy Wasylycia-Leis: Okay.

The Chair: Grant.

Mr. Grant Hill: Thank you, Mr. Chair.

I'd like to come back to the issue of enforcement. Just to show that the enforcement problem is not a unique or an aberrant problem, I have another product and I brought the product here today. This product is an herbal sweetener called stevia. It comes from a plant the leaves of which are very sweet. I had an opportunity to take a little bit of the leaf and grind it up in my fingers and taste it. In fact, in this particular format it's in a form of a very small tablet. It's an extract of stevia. If you taste it, it tastes just like sugar.

This product is unavailable in Canada. What happened with it is an inspector, without announcing herself or her employ, came into a vitamin shop in Victoria and said she wanted to have this product. It comes also in a packet, which is much more like sugar. And when given this she then identified herself and said this product was not proper in Canada. When asked why, she said it was because it was not approved as a food additive.

So here we have a product— And I invite any of the committee members to look at this. I've actually given this to the parliamentary secretary, and her report to me was frankly incorrect. It is banned. I'd like to have a logical explanation from the Health Protection Branch as to why a food additive like this would not be allowed. It doesn't make any sense.

Dr. Joe Losos: Dr. Hill, the additives to food are very closely controlled under the Food and Drugs Act, and there is a long history of that occurring. Food additives are becoming a large part of the industry—supplementation with vitamins, for example. The industry would argue that adding calcium to foods as a food additive is a good public health manoeuvre. However, calcium in large amounts has health effects. Food additives are very closely controlled under the Food and Drugs Act, which is an act of Parliament.

There's no question that the Food and Drugs Act has limitations, especially in the area of natural health products and in the explosion of technologies today. That's why we have this transition process to try to look at these acts with the input of the various players in Canada from the public health industry and elsewhere and the general public to redesign these acts. If the act is inappropriate with a product like that—and I'll be happy again, Dr. Hill, to look into this product specifically for you and for the committee—the real issue here is can the Food and Drugs Act handle situations like this? And my answer to you is that it cannot.

Justice Krever suggested that the drugs side of the Food and Drugs Act is unintelligible. There are very many deficiencies of the food side of the Food and Drugs Act as well, and that's why it has to be redesigned.

But I will look specifically into this additive.

Mr. Grant Hill: Your statement that the Food and Drugs Act is in fact unintelligible is correct, but your original comment to me was that the department was being relaxed in terms of their enforcement activities. Without any difficulty, I could bring you a host of other examples that this is not so.

Really, the request of the public—and I'm trying to represent this request—is that the department stop these arbitrary, unintelligent activities and let this process we have undergone take place. It just doesn't seem to be consistent with your earlier statement.

• 0940

I brought a vitamin shipment from the U.S. for personal importation purposes. I brought in what is surely not a food additive but is really just a sweetener. It's an herbal sweetener.

It looks like there are other forces brought to bear here, and I would suggest that the other forces are market forces. There are companies that would find this product to be a threat to their products.

Your comment that this is an unintelligible act is one that I think many Canadians would agree with.

How much longer do I have, Mr. Chair?

The Chair: You have about 15 seconds. Do you want to consume it all or do you want an answer?

Mr. Grant Hill: I was rambling there, making a statement, so it really didn't require a response. I think my response is there.

The Chair: Since you're flashing a copy of the committee report, I wonder whether Dr. Losos and others have had a chance to go through the committee report. I know it's really only fresh off the press.

Dr. Joe Losos: Yes, Mr. Chairman, we've gone through it in detail, and I've created a working team within the branch—that is not within therapeutics, it's within the branch—to analyse this for the minister and get back to the committee within the timeframe that is required.

Mr. Chairman, if I can take five seconds, I would say that Dr. Hill's point is a very good one. It's difficult for the inspectors. I will look into this product, I promise you, but it's really difficult for inspectors to interpret labels, claims, and the act at the same time, which was written in the 1950s, when these products are on the market.

Certainly with the hundreds of transactions a day, there may be inappropriate actions taking place, and I'll look into that. But the difficulty is really the structural and legislative one as far as the explosion of technologies, the importation of these products, and how do we handle them given the limitations Parliament gave us in 1950 with the act.

The Chair: Then I guess we can look forward to getting a report a little later on as to just where you're going in that direction. Maybe we can be more incisive in our questions when we get a sense of how far down the road you are on that.

Okay, let me go to—

Ms. Elinor Caplan (Thornhill, Lib.): If I could, since my name was raised, and Dr. Hill did bring that product to my attention— The information I gave him, I understand, was accurate, that no application had been made by that product to make it legal in Canada, and that was the reason the product was unavailable in Canada.

The Chair: Mr. McTeague, we're back to you.

Mr. Dan McTeague: Thank you. I didn't think we'd get back so quickly. This is really interesting.

The Chair: We can go to somebody else and then come back.

Mr. Dan McTeague: Okay, I—

The Chair: Just a second. I've only got you on the list in the order you've raised your hands. I realized that after I put you down, there were others. So if you want to wait—

Mr. Dan McTeague: No, I'll defer to the other members.

The Chair: Okay. Then it's Lynn Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Mr. Chairman.

I wanted to talk a little bit about initiatives for children, and perhaps, Mr. Dodge, you can help me out on this.

The supplementary estimates indicate a renewal of the CAPC program, the prenatal program, and the aboriginal headstart program, and I happen to think they're great programs. I wonder if you could tell the committee what the separate funding allocation was for each of those programs ending March 31, 1998.

Mr. David Dodge: These are the allocations for last year?

Mr. Lynn Myers: Yes.

Mr. Ian Potter: I can provide those to the committee. If you give me a moment, I might be able to find them.

Mr. Lynn Myers: While you're looking, my next question is, do you also have them extended for March 31, 1999?

Perhaps I can go on. Mr. Dodge, have you had an opportunity to review those programs, and if so, do you see any examples that stand out in terms of excellence and things that we should be looking at by way of models? What's your overall impression, is really what I'm trying to get at here.

Mr. David Dodge: Impressions are always a little dangerous to try to focus on, but let me step back one step.

• 0945

I've spent a bit of time working with the CIAR's population health program over the years, and one has to be impressed with the growing evidence of the real importance for health and social development in the early childhood years, starting from conception and going until the age of three or four. If you look historically at where the focus has been federally and provincially, it's been on children once they get to school age rather than on those early years. It's through programs such as CAPC that we have come over the last few years to try to do some really interesting and valuable work to try to improve the health of very young children, and hence improve their chances at life.

Similarly, the prenatal nutrition program—I think a better name for it would be the prenatal health program—despite the relatively small amount of resources devoted to it, from what I can see, produces extraordinarily important results.

These programs are hard to deliver. It's the ones down there on the ground in the community that really work. These involve the engagement of individuals in the community, including mothers, fathers, and members of the local community. That's the real strength of the way these programs work.

But that means they develop slowly. You have to gain experience, and what works in one community doesn't work in another.

It's undoubtedly true that if we want to have a healthier population over the course of the next quarter or half century, then the place to begin is right at the beginning of life, and a few dollars devoted at the beginning of life often can save many dollars later on in terms of direct health care costs. But perhaps even more important is that it provides all individuals with an equal opportunity when starting out in life.

Mr. Lynn Myers: Mr. Chairman, I'm happy to hear Mr. Dodge say that.

It seems to me that what you say is correct. I've heard it said that a dollar today will save seven dollars later. It certainly makes a lot of sense to me, and it seems like you're confirming that somewhat.

What should we be doing in addition to what we already are doing? It seems to me we should be augmenting these very successful programs. I'd like to hear your comment on that.

Mr. David Dodge: Certainly my sense of the evidence and literature would say that this is probably the place of highest return to invest our dollars. It's also probably one of the most difficult, for the reasons I mentioned. It really does involve getting down to try to deal with the problems at the very local level.

The structure that has been evolving as we worked under the CAPC program or under the prenatal nutrition program is a very interesting one. It's not one that's sort of normal, because it really involves partnerships. It's sort of messy. It doesn't look exactly the same in one place as it does in another place.

That doesn't mean it's bad. It simply means that the developments are likely to be a little bit slower in coming than they are in programs where essentially we're just writing cheques. We're pretty experienced at being able to write cheques. Delivering right on the ground and doing so with particular problems is much more difficult.

But I might ask Ian Potter to comment, because he's actually responsible for running these programs.

Mr. Ian Potter: Yes, I'll give you the precise answers to your question with respect to the allocation of dollars.

In general, there was an increase in expenditures on CAPC and CPN, the Canada prenatal nutrition program, of $33.3 million per year starting in the 1998-99 budget. Between those two programs, we spend approximately $80 million. This year's expenditures for CAPC are $62 million. For prenatal nutrition, we are spending $14.5 million. I'd like to mention we also have an aboriginal head start program, which has run for a while off reserve, that is spending approximately $22 million. The government has just launched an additional program for aboriginal head start on reserve at the range of about $25 million per year.

• 0950

I think these programs are quite successful. They involve working with communities in extensive partnerships. I have brought for the committee—and I could provide through the clerk of the committee—this information, which is essentially information on where those projects are in Canada. We have many different projects right across the country. The feedback we have now is only at the beginning, but it indicates these are being quite successful.

We have launched a fairly rigorous evaluation program to look at the impact of that program on the developmental outcomes of children. We're using the national longitudinal survey of children as a control group, so there is a national longitudinal survey that surveys children year after year. We're going to be comparing the results of those children to the children who go through the programs. So we'll be able to provide some fairly concrete scientific impact. Right now we have a lot of general findings, from the activities we have and from others, that do indicate there is that kind of a payback of $7 saved for $1 invested. So I can provide this information to the committee.

The Chair: We'd be happy to receive it. If you have enough for the committee at the end of the session, we can distribute it then. Otherwise, as per usual procedures, just make them available through the researcher. Thank you.

Mr. Lynn Myers: I have one small question.

The Chair: I'll come back to you. We're well over time. I'll come back to you as well.

Madam Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you, Mr. Chairperson.

Further to my first round of questioning, I'd like to specifically zero in on the Food Directorate. I know that back in 1993, five years ago, the budget for the Food Directorate was over $60 million. The actual budget for 1997-98 listed in the performance report is $33.5 million. So that's a cut in half. Surely there is more to account for that difference than the movement of inspectors into the Canadian Food Inspection Agency.

On top of that, it's my understanding the director general of the Food Directorate has actually told the food scientists there will only be $22.5 million available. So my question is, where's the other $10 million going, and can you account for this tremendous drop in expenditure in this area? What capacity do we have left to do meaningful research in the food area when over the last five years there has been an exponential growth in new products that are causing very serious worry and concern among Canadians?

The Chair: Mr. Lafleur.

Mr. Robert Lafleur: Yes, Mr. Chairman. The bulk of the reduction is attributable to the transfers to the Canadian Food Inspection Agency. But also, as part of the overall effort of the department to reduce its expenditures as part of program review, there was a reduction of some millions of dollars in the Food Directorate that was intended to take place, but in fact essentially did not take place because the minister put a moratorium on the reductions at the time we started reconsidering how we would approach the future requirements of the branch and of the Food Directorate.

Essentially, there has been very little reduction in the actual moneys available to the Food Directorate. But as I said in my earlier comment, that's not to say there are sufficient funds there. The requirements will be considered as part of this transition process as we build up the strength of the Health Protection Branch.

Ms. Judy Wasylycia-Leis: Can you account for why scientists in the food research bureau were told their budget will actually be reduced to $22.5 million, as opposed to the $33.5 million listed in your performance report?

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Mr. Robert Lafleur: I don't know why they would have been told that. In terms of the actual appropriations, there was a reduction, as I mentioned. But in terms of the moneys available to the branch there was not, because we made available moneys from elsewhere in the department to ensure there wasn't a reduction in the activities and resources available to the scientists.

Ms. Judy Wasylycia-Leis: Just on that, Mr. Chair, I think it would be useful for our committee to actually get some details about expenditures at the bureau on food research over the last number of years. What's the current spending? With the moratorium put in place, are all those food labs that were shut down and had equipment destroyed in fact up and running? Are all those scientists who were working very diligently on food research projects back on the job doing the work Canadians think they're doing?

I wanted to ask a specific question around this whole area of who's doing the research, because in fact my sense from the HPB transition meetings and from David Dodge himself is that there's a move in the department to rely more and more on outside scientific information and external forces for fundamental research, as opposed to ensuring a strong capacity within the department.

I think it's important today because it's the anniversary of the Krever report. Krever clearly recommended that we in the Health Protection Branch needed a strong internal scientific capacity, a strong laboratory capacity, to ensure there was no conflict of interest and Canadians could be guaranteed that products were as safe as possible.

So my question is, in the spirit of Krever, why is this department—why is this government—moving toward an off-loading of the research function to external agencies? Why did we shut down the drug research lab? Why have there been cuts to the food research lab? Is there a move now, then, to return to a strong function within government for research and scientific investigation?

The Chair: There are a couple of implied questions there that relate to government policy. But I'm sure, Mr. Dodge, you'll find your way to addressing the issues as they relate to departmental processes and procedures instead.

Mr. David Dodge: Thank you, Mr. Chairman. I'll start off, and then I'd like Dr. Losos to follow up.

I think the heart of the honourable member's question is don't we need really strong, publicly funded research work in the area of foods, independent of commercial interests? That I think is a really, really important question. And the answer to that is yes, and we will need more over time.

The question, then, that comes to Joe as the manager of the branch or to me as the manager of the department is how best to secure that and how to ensure that we in Canada really can do the first-class work that needs to be done. Is trying to do all of this within the walls, if you will, of a government agency the right way to go about it?

I think the answer is that what we have historically failed to do as well as we should have is to build the network of all of the public research that is going on and to support this network in a good way. It is important that the work done in universities, where researchers are doing things subject to peer review, be adequately funded, and that there be really good interaction between the work that goes on there and what goes on in the Health Protection Branch itself.

Secondly, it's really important that there be good, strong, peer-reviewed scientific work taking place within the branch so that scientists within the branch are indeed on the cutting edge. It will be critical, as we march forward—because we're dealing with new problems all the time—to develop this network of publicly supported research that is absolutely independent of commercial influence to enable the regulators within the branch to do their work.

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Joe, you have to manage this on a day-to-day basis, so you can probably give the honourable member a more detailed answer than I did.

Dr. Joe Losos: Yes, thank you, Mr. Dodge.

I think Ms. Wasylycia-Leis' question is really an excellent one. The Health Protection Branch needs a really, really strong, vibrant, competitive science base that's peer-reviewed, respected by everyone in Canada and internationally, and second to none, because very often we're the first ones in on the wire when it comes to health problems. Someone has to be in charge, and legislation or jurisdictions aside, very often that's us.

At the same time as we have to build up and strengthen our internal capacity, we have to use the very many bright Canadian minds out there in the various networks to help us do our job. As two examples, I'll give you the network of excellence that's taking shape on novel foods.

Your report on natural health products said research had to be done. We would, of course, have to tap into and use machinery like that—making sure there's no conflict of interest and that the public safety is maintained—use networks like those, which the public is paying for in other fora. Also in the area of nutrition, for example, we would need to and should tap into the various and sizeable capacities of the University of Toronto, the University of Guelph, the University of Saskatoon's capacity in biotechnology and the like.

So to echo Mr. Dodge's statement, we need both. But let there be no confusion that the branch itself needs an absolutely first-class, aggressive scientific capacity.

The Chair: Thank you.

The chair acknowledges Mr. Nault.

Mr. Robert D. Nault (Kenora—Rainy River, Lib.): Thank you, Mr. Chairman.

I want to focus my two questions in the time I have on aboriginal health. I just wanted to read the statement you made on page 31 of your performance report:

Serious health inequalities persist in the aboriginal population. For example, the rates of diabetes, tuberculosis, suicide, and smoking are much higher than for the Canadian population at large. With the first nations' and Inuit birth rates twice that of the Canadian average, population growth is expected to drive up costs.

Mr. Chairman, I wanted to let Mr. Dodge know that as a representative of 51 first nations in northern Ontario, presently in MSB I have a 26% vacancy rate in nurses in the nursing stations. Now, for a number of years when I wrote letters to Health Canada and asked when can we expect to get more nurses, the answer I got from the regional director was that there was no money in the regional budget, so we'd have to live with what we had. Now they've changed gears on me and are saying we can't get nurses because there's a shortage.

I'd like to ask a very specific question, and seeing as you're close to both Mr. Martin and Mr. Rock, maybe you can have a little influence. Before we transfer all our moneys to the provinces, I would hope you would make it very clear to both ministers that one of our major priorities—because of our fiduciary responsibility—is to put money back into aboriginal health, where there's a grave need, based on your own comments.

The other issue I would like to have raised here, Mr. Chairman, is that for a number of years we've had a suicide crisis in first nations five to six times the national average. And at this point, even though I've been here for ten years asking, there still is no mental health program in MSB dealing with first nation people.

I'd like to know why that is and whether we'll see something of that nature when we have a health budget coming forward, as has been told us by the people in cabinet and communicated to everyone across the country. I'd like to know whether we can see the poorest of the poor in Canada dealt with as it relates to mental health, as well.

Those are my two questions, Mr. Chairman, in the time I have.

The Chair: Mr. Dodge, did you want to give it a shot?

Mr. David Dodge: I'm not really sure it's appropriate to take on the second question. That really will have to go to Mr. Martin or Mr. Rock.

With respect to the first question, on the provision of services to first nations, in a very real sense, just as in the provision of services by provinces to the rest of us, we are struggling with both of the problems you mentioned. One is that budgets are growing much less rapidly than they were in the 1970s and the 1980s. Secondly, a relatively recent phenomenon, although not unexpected, is that we have a general problem that is going to get worse over the next few years with respect to nursing. As you know, there is a cycle to nursing. We're just now entering that part of the cycle when we have a real shortage.

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So both of the answers that you had received are indeed accurate. The dollar problem, which is there for all health services, not just aboriginal health services, is compounded now with a true labour market problem in terms of the shortage of nursing personnel.

The Chair: Mr. Nault.

Mr. Robert Nault: Well, Mr. Chairman, it's well known—at least it is in my riding, which contains 51 first nations that I represent—that almost 70% of the aboriginal population is under 25 years old. We have a severe suicide crisis. In those communities, we find the worst health of all Canadians. I'm trying to get a sense of whether or not the people who run this department see this to be a crisis as strongly as I do. If you're going to be supplementing the budgets of health care for the provinces, we would also be very much wise to see aboriginal health as a priority by making sure that MSB has the resources financially to deal with that particular issue. It's not going to go away.

We all know there's a diabetes crisis as well. Those of us who have lived with it close to the ground know what the cost of it is to the health care system if we don't deal with it early on, in a preventive way. It is now getting to the point where 40% to 50%—and sometimes 70%—of the population of first nations communities is at risk of getting diabetes, or already has diabetes. That's an unbelievable statistic, and it's one we can't hide from. I want to get some information as to whether the managers of this department and this health care system—for which we have fiduciary responsibility—are going to deal with it before we end up having to cart people away and cut their legs or arms off as we go along in the next number of years.

I'm not trying to put the more political spin on this, but I'm very concerned that we don't seem to see it as a priority in Health Canada. That's not to suggest that the other issues are not important, because they are, but I see this as the most important issue confronting Health Canada today.

The Chair: I don't know how much of a question was there, but go ahead.

Mr. David Dodge: I have three quick responses.

First of all, in a sense, Health Canada's Medical Services Branch is like a provincial health jurisdiction for these roughly 550,000 people. It's a jurisdiction perhaps comparable to that of New Brunswick—it's a little bit smaller in size—in terms of what it's going to deal with. Obviously, because of the rather poor health status of those individuals with whom it is dealing, it faces very difficult problems.

As we talk about improvements to the health care system as a whole, we do have to remember that this part of it is actually the federal jurisdiction that is exactly equivalent to the provincial, and it ought to be treated in the same way. Whether or not it's done in exactly the same way is a different issue because of the more severe problems of this particular population.

The second point I'd like to make is that Medical Services Branch is the sort of repair shop that picks up the problems after they've occurred. The real problem with this particular population is that, with rather poor nutrition, difficult living conditions, often substandard water and so on, the social and economic conditions in which they are living leads to extraordinarily poor health conditions.

• 1010

From the point of view of the department that is responsible for the repair shop, then, it seems that our focus should be to stop people from having to come into the repair shop, because once people are in the repair shop, it's really too late. That goes to such things as the aboriginal head start initiative and so on, of which we are really very strong proponents, and which we actively support in terms of our staff out there in the field.

The Chair: Ms. Minna.

Ms. Maria Minna (Beaches—East York, Lib.): Thank you, Mr. Chairman. I have about three questions to ask.

Most of these questions deal with the Health Protection Branch, although you're guided under the MRH. The first one has to do with best practices. The job of the Health Protection Branch, as I understand it, is to look at protecting Canadians' health, at ensuring that Canadians get the best health care system, and at minimizing risk to their health. I look at breast and other cancers. There was an article in the media recently that talked about the differences between Ontario and B.C., and the outcomes of cancers—especially including breast cancers—which I found quite astounding.

Does the department and this particular branch look at best practices? Is there any evaluation being done? Are you looking at services across the country to see where best practices are performed, so that there could somehow be some dialogue with the differences provinces in terms of improving the outcomes of services?

Dr. Joe Losos: The Health Protection Branch is involved in cancer in a number of ways. We have extensive surveillance programs with the provinces, with the cancer institutes, with the cancer care organizations, with the Canadian Cancer Society and various others, and even that is being augmented. With Statistics Canada, we would be largely the source of information for things like disparities between parts of the country, various at-risk groups, etc.

We're also involved in regulation of the various therapies—both pharmaceutical and chemotherapies—as well as being involved when the machines are bought, the diagnostic equipment, as far as mammography and the like are concerned. We're not the whole spectrum of cancer programs in the department, though—and Ian Potter can expand on that for you some more.

Ms. Maria Minna: Before he does that, I'd just add to that. I just want to make sure you know what I'm looking for. I understand that we make sure we have the right equipment and all of that other stuff. What I'm looking for, though, is whether Health Canada is looking to do any evaluation of best practices of delivery of services. Will it produce a report card, an accountability process of some kind, so that we we can be more proactive about something when we look across the country and see that it is really working well in one place while there are women or people dying in another. Is anything of that nature happening, or are you looking to do anything like that?

Dr. Joe Losos: Yes, we are doing that, and Ian will address the report card in a second. However, with all of those players that I mentioned earlier—the National Cancer Institute of Canada, the Canadian Cancer Society, the various registries, and the cancer care organizations of the provinces—in the Laboratory Centre for Disease Control in my branch, the Health Protection Branch, we have set up the coordinator and secretariat for Canadian Coalition on Cancer Research.

As I travel internationally, I speak to people about this, because it's an avant-garde system globally for monitoring exactly the type of thing you're talking about. It takes in everything from stages of cancer—cancers have various stages, from stage one, which is less aggressive, to higher stages, where perhaps it's been invasive—cross-referenced or correlated with the various types of therapies, the types of risk factors and the like. That will be a very rich database in terms of mining the types of information for a policy like the one you're alluding to, the kind that would appear in the type of report card I would ask Ian to comment on.

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Mr. Ian Potter: Mr. Chairman, if I could address the honourable member's question, the government supports those kinds of initiatives through a comprehensive initiative that we have in supporting breast cancer. It includes support to research, improved practice, and improved screening and prevention efforts.

The department supports a steering committee for clinical practice guidelines, and it is chaired by Dr. Mark Levine. It has sixteen delegates, who represent constituencies and different groups across Canada. That steering committee has produced what we call clinical practice guidelines. Those guidelines are a review of all of the different treatments, different regimes and identification of those that have scientific merit and are the most efficacious. The group has produced ten existing guidelines on care and on particular aspects of treatment. The committee has updated seven new guidelines in the last few months, and at the moment it is working to consider better ways of dissemination. We have provided those clinical practice guidelines in a form that is available to physicians, and we have a common-language form for patients. The latter would basically explain in lay language what those guidelines should be.

So it is an important area, work is continuing, and we do feel it's an issue that needs to be addressed. It requires the collaboration of the medical profession, the College of Physicians and Surgeons, and the various different colleges, and it also requires the support of provincial governments. That's the reason why we have created this steering committee for clinical practice guidelines.

The Chair: Ms. Minna, you have approximately fifteen seconds.

Ms. Maria Minna: I guess I'll go to my other two questions later, then. Quickly, though, B.C. follows certain guidelines with respect to breast practices, which is why the province has good outcomes. Do other provinces have similar guidelines in place, and are we monitoring them to try to encourage others to follow through? We're looking at lives, so that's my question specifically.

Mr. Ian Potter: These guidelines are national guidelines for national application. The application of those guidelines is the choice of physicians and the choice of the professional bodies that govern them.

Ms. Maria Minna: Monitoring those across the country?

Mr. Ian Potter: There is some monitoring of their application, but that's generally left to provincial governments and to the professional colleges that establish the standards of practice for physicians.

Ms. Maria Minna: Then there's no accountability.

The Chair: Mr. Hill, you wanted back in.

Mr. Grant Hill: Yes, thank you.

Just to finish off the issue of the natural health products, Dr. Losos, you said very plainly that the Food and Drugs Act is archaic, unintelligible and difficult to understand, that those individuals at the enforcement end have difficulty, and that the department is trying to soften its enforcement activity. Have you actually sent out a specific directive that the enforcement people could read? If you have, I'd like to have a copy of it.

Dr. Joe Losos: Dr. Hill, I will get you that. And we've also had training courses, orientation courses, and sensitivity courses for the inspectors in this field and in other fields as well, so I will get you a package on how we deal with our inspection practices.

The Chair: Always through the chair.

Dr. Joe Losos: Yes, always through the chair.

The Chair: Thank you.

Mr. Grant Hill: I would like to switch to a different topic, that topic being rBST, the milk-modifying hormone. The department has been studying this particular product for nine years. The minister has said over and over again that it won't be approved unless it's safe. Nine years is a long time to study an issue. Can you give me some sense of why it has taken so long, and some sense of where we are with it?

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Dr. Joe Losos: There are three reasons, Dr. Hill. The first is that the science the company has submitted to us keeps changing. A submission was given to us in or around 1990. As new evidence becomes available, we either ask the company for that evidence or they submit it, and that restarts some of the engine as far as having to evaluate the health and safety. Health and safety is the bottom line here. There is no other role for us in rBST.

Secondly, the technology has really exploded. What is known now on insulin growth factors is certainly very different from what was known eight or nine years ago. That's why, when I came in as assistant deputy minister, I asked specifically for an intensive briefing by our scientists as to everything they knew and everything they did not know about rBST. I specifically asked for that famous gap analysis the media is talking about. That was my baby; that was my child. I wanted to know exactly what the gaps were, because the technology had changed so much. I'm not an immunologist, but in my mind, they needed to answer a number of questions. That's why I struck those expert panels of the Royal College of Physicians and Surgeons of Canada and the Veterinary Medical Association.

The third factor is that this is not an easy decision to make. It has been a point of international debate and discussion for many years, and it's still unsettled. The codex system of the World Health Organization and the World Trade Organization is unclear as to how things will go. Europe has a moratorium. The States licensed it in 1993 but with conditions, and they're continuing to do post-marketing surveillance. That's not a stable environment in which I can make an easy decision one way or the other. I've run science organizations here and internationally for many years, and I've never seen a black-and-white answer, and this is certainly not one. So nothing is going to be approved by the Health Protection Branch in the department unless we're really sure this thing is safe.

Mr. Grant Hill: I'd like to know the department's position on the labelling of genetically engineered product. This is one of the first that would and could affect our society. It's a similar issue to the one of the public wanting to know and to make decisions for themselves. They don't want to have big daddy making decisions for them when it is not black and white. So to my mind, labelling of genetically engineered product, either BST-free or BST-modified, makes sense from the public perspective. Where does the department come down on the issue of labelling of genetically engineered foods?

Dr. Joe Losos: Dr. Hill, I personally am a great believer in labelling. If I do nothing else in the branch while I'm with it, I will have opened the gates of the branch as far as transparency and participation of stakeholders and the public. That's a huge part of the transition, as you know.

We have a project underway to look at labelling not only of biotechnology, technologically engineered products, but also of food in general. In the United States it has been shown to be a powerful public health tool in the hands of the individual homemaker or people in the home in order to make decisions on the nutritional content and advantages of certain foods. We would like to move to a much more modern day, interactive labelling scheme in general, as well as for biotechnology, with this initiative.

Food safety is our number one priority. We know we have to strengthen it, and I personally want to strengthen it. When things are really breaking, we need a vibrant program. So food safety is number one, and labelling is a very important part of that.

The Chair: Thank you.

Mr. McTeague.

Mr. Dan McTeague: Thank you.

It looks as if you're going to be facing quite a few different questions, and I want to shift gears a little bit. I've been advised here that PMPRB will be appearing before this committee, so I'll save questions on that for further down the road.

Mr. Dodge, I wanted to know if within your department last year a joint study by the Ministry of Environment and yourselves concluded that the sulphur content in gasoline is killing people. Quite frankly, the numbers that were provided were the impetus for a recent decision by the Minister of Environment. I'm wondering if the panel that looked into this at least from the health side of things has had an opportunity to subject itself to peer review and to have its findings put under closer scrutiny, since we've made a rather important decision as far as public policy is concerned.

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Mr. David Dodge: As you know, this debate on the science was a rather public one, and that debate is going to continue.

As to specific reviews since the panel reported, I'll have to turn to Dr. Losos.

The Chair: Dr. Losos.

Dr. Joe Losos: The report of the panel itself was not peer reviewed. It was felt by Environment Canada and Health Canada that it was up to the pristine experts available to us to reach that conclusion. However, much of the data the panel used to make its decision came from Health Canada and its networks and was peer reviewed. So the basis on which the panel made the decision certainly was peer reviewed, and we have supplemented that panel's deliberations with a continuation of the work.

Canada is blessed with a health care system with an incredibly deep database. Correlated with Environment Canada's capacity with regard to changes in the weather patterns, we've been able to track over a number of years the hospitalizations and, through sophisticated epidemiological techniques, to isolate sulphur and sulphur particles as a risk factor or non-risk factor in a wide variety of areas, such as cardiovascular problems, the 15% or 20% of kids who now have asthma, and other people at risk. Subsequent to that expert panel, our data was again peer reviewed and published, and it shows the correlations even stronger than the panel thought several years ago.

Mr. Dan McTeague: Dr. Losos, are you familiar with the CanTox study that in many respects repudiates the findings of the health and environmental expert panel, as well as the position taken by one of those experts, I believe from the health side, Dr. Frederick Lipfiert, which was to the effect that as one of the three members of the expert panel, he found his initial views may have been a little hasty?

Dr. Joe Losos: Yes, sir. We have actually met with the CanTox group, and we had quite a detailed discussion on what they did or did not find scientifically. They didn't convince us they had any evidence that repudiated what we had done. Dr. Lipfiert himself has worked on our various expert panels and attests to and has been part of the peer review of some of the data we've used. So we weren't convinced by CanTox.

Mr. Dan McTeague: My final question, Mr. Chairman, deals very specifically with the amount of investment and time put into this issue. My understanding is that south of the border there's a far more extensive and exhaustive process. California has met the standard we are currently seeking, and they have had that standard for some two to three years now. If this is such an important issue, and notwithstanding the fact you've claimed here that it was not subjected to a peer review per se, I wonder if your panel has had an opportunity to review evidence coming from the United States or if in fact there are people within the scientific community who are of equal weight and importance in terms of their own background who might question the findings you have made with very limited resources, apparently.

The Chair: Please be brief in your answer, Dr. Losos.

Dr. Joe Losos: Yes, sir.

When the Health Protection Branch does an evaluation on anything, we look at everything globally as far as the availability of data or science is concerned. The United States envies us to a large degree, because of the richness of the databases with which we work. So I would suggest that our data is as strong or perhaps even stronger than much of the U.S. data.

With regard to lead in gasoline, the science is stronger than it was.

Mr. Dan McTeague: Thank you.

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The Chair: Mr. Jackson.

Mr. Ovid Jackson: Thank you very much, Mr. Chairman. I want to go back to the future of this department and talk about wellness versus sickness.

I am particularly interested in your investment ensuring the CAPC, the parental nutritional program, and of course the aboriginal head start program. Within a little while aboriginals are going to be in the majority in two provinces, and I think we need to pay a lot of attention to that population.

Mr. Chairman, we are compared a lot with the United States. When you look at the gross domestic products of the world, they are at about 47%. The Japanese are about 12%, Europeans are about 31%, including Germany, and Canada is 2%. One of the things that happens with the United States that makes them do well is they rob the world of their young and their brightest—including us, by the way. I'm hoping maybe we'll use a Trojan horse technique here whereby they use a lot of bright Canucks and then we control them in that way. That's probably the only way we can do it.

I'm famous for telling stories, and I'm going to make my point by telling a story of how during the Civil War some natives attacked a train and they got a strongbox full of gold and on the safe it had a combination lock. They took it up in the hills and they tried to whack it with a tomahawk to open it but they couldn't get it opened. They tried some dynamite, but that didn't work, so they threw it over the side and it rolled down a large hill. The only thing that came off was one wheel; the bullion was still secured in it. In two weeks' time, a cavalry officer came and he had the combination. He dialled it, and it opened and out came the bullion.

I believe that every child born in this world, every Canadian child, men and women, have great treasures in their minds. We have to feed them and clothe them. We have to give them the good start. I believe that lifestyle is very important. I believe we have a lot of indications about when the brain is wired and when certain interventions should be made to correct things. I believe that is the best thing we can do as a country.

Mr. Dodge, I hear you are very efficient. I hope you can get some more moneys put into this, because notwithstanding what you alluded to, that it's a long-term policy, and it takes a little while before it comes on stream. Politicians like to think in the short term. I would want it to be known when I leave this place that one of the things I did best is that the country is better because we're looking after our children.

My point here, Mr. Chairman, is to make sure that when Mr. Dodge and his colleagues are looking at this health care budget they do a lot of reinvestment in these programs.

You have the longitutinal studies. I think the rest of the world is moving ahead on this, including the United States. They're looking at best practices, the scientific impact of some of these studies, and the use of the statistics as the kids move through the system. I hope we can have some more reinvestment in this.

Thank you.

The Chair: Mr. Jackson, I enjoyed your intervention, but you haven't left much time for response by our witnesses.

Do you have a brief comment?

Mr. David Dodge: Mr. Chair, this folows a little bit on Mr. Myers' question earlier, and we didn't hear from Dr. Losos from the Health Protection Branch, which is also engaged in this. Maybe we could just have one minute for him to say what their involvement is.

The Chair: He's prepped, so now he can sally forth again. Go ahead.

Dr. Joe Losos: Thank you, Mr. Chairman.

I would certainly agree that what Mr. Myers said and what Mr. Jackson said is vital, and the data are certainly accumulating. At the same time, I think it's really important to remember that the Health Protection Branch has to remain very active with the provinces in vigilant systems and early warning systems. And we are doing so. While we're shifting the paradigm, if you will, we have very extensive perinatal surveillance programs on what happens in and around birthing in Canada, on high-risk groups and the general population, on kids' cancer surveillance, and on abuse of children. The surveillance of environmental toxins and what they might do to kids is also going on, as well as the myriad of regulations on children's products, nutritional labelling, consumer products that you've heard of recently, and educational standards.

So the department really has a wide view of the well-being and the health and safety of kids. I thought I would give you that information as well.

The Chair: Thank you.

I'm going to go to Madam Picard, who hasn't had a turn yet.

[Translation]

Ms. Pauline Picard (Drummond, BQ): Thank you. I have a question for the Assistant Deputy Minister, Mr. Potter, who is from the Health Promotion and Programs Branch.

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We are told that Health Canada contributes $2 million to health promotion. These contributions are given to individuals and organizations to support health promotion projects in the areas of community health, resources, training and development, and research. I would like to know how much money Health Canada contributes to mental health. I have been asked these questions by organizations in Quebec and by certain agencies in other provinces. I have done some research and found nothing. What is Health Canada's contribution to mental health and, if there are programs, please provide me with a breakdown.

[English]

Mr. Ian Potter: If I could respond, Mr. Chairman, Health Canada works in two areas with respect to mental health. One is we coordinate an intergovernmental group that looks at mental health services across the country. This is a federal-provincial-territorial group that tries to exchange best practices and ensures that people know what's happening in the various jurisdictions.

In addition, we have a group that deals with mental health promotion, and we have been working on a number of different initiatives related to that. Most recently, we have, in conjunction with groups, unveiled a new promotional activity, or product, at the Canadian Mental Health Association's annual meeting. It's an attempt to deal with depression and suicide in youth. It's a product that has been developed in consultation with young people on the street. We created what's an interactive CD. It's a tool or an instrument that can be used in different settings, youth groups and clinical settings, that allows young people to explore their feelings and to deal with the kind of broad angst they might have. It also is effective in identifying depression. We've done that.

We've also started a youth network. This is a kind of Internet system where young people can tune in, can chat, and can access counselling or expert advice. Those are two examples of the kinds of things we do with respect to mental health.

I think that mental health, as well, is affected by the other major initiative we support. Physical activity we know is linked to people's sense of well-being. Nutrition, as well, is linked to that. So we have projects that promote those two activities and they do contribute to the mental health of individuals.

[Translation]

Ms. Pauline Picard: For instance, does Health Canada make a contribution to schizophrenia research?

[English]

Mr. Ian Potter: The research initiative would fall under the responsibility of the Medical Research Council of Canada. I could get information for the honourable member. I don't know exactly what they are doing at this moment.

Ms. Elinor Caplan: Drug approvals for any of the illness-related, new breakthrough drugs, that sort of thing.

Dr. Joe Losos: Yes, absolutely.

The Chair: I'll go back to Mr. Myers.

Mr. Lynn Myers: Thank you, Mr. Chairman.

I want to comment—Mr. Jackson also was interested in CAPC and perinatal programs and such—on one of the things you said, Mr. Dodge and Mr. Potter, which was, and I want to reinforce and emphasize this, that the inherent goodness of those programs is because of the flexibility built in and the ability of communities and grassroots people to really get involved and tailor it to their circumstances and what they think is best. I wanted to re-emphasize that, because it really is the strength of the program.

• 1040

Also, Dr. Losos, in terms of an answer you gave to Mr. Hill with respect to bovine growth hormone and other issues, I thought you said it very well. It certainly gave me great comfort to know that safety is paramount when it comes to what Health Canada is involved in and what they need to do on behalf of all Canadians. That's exactly what Canadians want to hear. So I think we need to maintain that kind of thinking on that track, and I know you'll do so.

I wanted Mr. Dodge to go to the Canada Health Act. I was interested in the performance report. I think I saw two references with respect to compliance and enforcement, if you will. I wonder if you could talk a little bit about that working group that has been put together—at least I understand it has been put together—and the kinds of things you're doing to ensure there is compliance surrounding the Canada Health Act.

Mr. David Dodge: In terms of the strict compliance aspect, I can't give you the details. As you know, we have two activities at the moment—one is with respect to Alberta and the other is with respect to Nova Scotia—where we are actively withholding some moneys because of non-compliance with the act. That's number one. Number two is that we do have a federal-provincial working group.

The objective here is to make the act work. We don't want to be in there enforcing after the fact; we want to make the act work before the fact. So we have a federal-provincial working group of assistant deputy ministers who work on that.

Number three goes back in some ways to the issue that was raised earlier. The margins of the act are really important and very difficult to deal with. So 15 years ago, if somebody was in the hospital for a gallbladder operation, they were probably there for the better part of two weeks. Then they were in some sort of nursing home care or whatever for another three or four weeks. Also, the drugs that were necessary to deal with that were all part and parcel of it.

Today, that person is very often in and out of the hospital in 24 hours. The drug treatment carries on for three, four, or five weeks, but it's not covered technically under the Canada Health Act. That's because the nature of the system when the act was written was rather different from what it is today. How we collectively are going to come to grips with that issue is a real challenge.

All of us in this room are lucky. Under the health insurance plans either for the public service or members of Parliament, that's taken care of. That's true for actually a fairly large percentage of the Canadian population.

But this is probably not the case about 20% to 25% of the time. That's a very real worry. It's a very real worry to the provinces for the elderly in particular. Most provinces have some sort of drug scheme—some are more complete than others—with respect to the elderly in terms of just how much should be covered, how much is not covered, and so on.

That's a real issue—this goes along with home care, which is the alternative way to provide those care services that used to be provided in hospitals—that we are collectively going to have to come back to and struggle with, because the nature of the health care system in the 21st century is rather different from what it was in the 1960s, when our structure was essentially put in place.

The Chair: Thank you very much.

We'll go back to Judy Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Mr. Chairperson, assuming this is probably my last opportunity, I've got two areas to cover, which is the Health Protection Branch again and the tobacco control initiative. So I'll ask all my questions at once.

The first question has to do with HPB and the fact that what you said this morning does not seem to fit certainly with perceptions of Canadians, and perhaps not even with reality.

• 1045

I would make three observations I've picked up from Canadians over the last year. One, HPB no longer has the resources or independence to regulate in a fair and balanced way. Two, there is a real mess in the Health Protection Branch, causing a loss of public confidence in this department. That mess comes partly from the fact that you have two criminal investigations going on, you have scientists who have taken the unlikely step of going to the Public Service Staff Relations Board, you have sworn testimony before the Senate committee about intimidation and threats, and you have examples of the pharmaceutical industry influencing the drug approval process. The third observation I would make is there clearly is a shift in the whole department, as is symbolically stated by this new-fangled title of the branch, the Management of Risks to Health Bureau, as opposed to the Health Protection Branch.

In fact you and others have stated to folks that regulation is the old way to deal with health protection, that risk management is the new way. You've said risk preferences among Canadians may be different. You have opened up a whole new direction and in fact are implementing that new direction. I need to hear from you about what that new direction is and why you're taking it.

Secondly, for the tobacco control initiative you list $5 million in the supplementary estimates for this year. I want to ask where the rest of the money is. We know there was a promise of $100 million that should have been up and running shortly after the election. You've only spent about 2% of that; you're now asking for $5 million. Have you been given directions to put in place programs that start spending $20 million a year on education and prevention of smoking among young people? What are your plans? The parliamentary secretary said at a previous committee there are consultations going on actively on this issue. I have yet to determine those consultations are actually taking place. What is your process for expending the $100 million?

The Chair: Judy, you would have been a great singer; you did all of that in one breath. You would have a great voice.

Without belittling what the member has asked, please go ahead, even though there isn't a lot of time left in the period.

Mr. David Dodge: I'll start off, Mr. Chairman.

First of all, let there be absolutely no question, the Health Protection Branch is independent. Its job is to protect the health and safety of Canadians; it has no other job but that. That has not changed. The resources have remained roughly constant in dollar terms. They've gone up and down a little bit, but as we move forward and look out to 1999 and the year 2000, certainly they are back at the level they were in 1993-94 and 1994-95. They have not been added to. One would hope as we move into the future, having corrected the problems we were in with respect to the deficit, additional resources will indeed be added as needed.

I would go to the issue of the so-called mess in the HPB. There have been a large number of allegations. Those allegations are as yet unsubstantiated. There are processes in place, very important processes, to try to get at the bottom of them. I can assure the honourable member that I'm every bit as interested in getting to the bottom of these allegations as she is and as the Canadian public is, because the Canadian public must have confidence in the work of the Health Protection Branch. All of our interest is in getting to the bottom of those allegations.

The processes must run their course, and some go more quickly than others. But a process such as a grievance is an absolutely normal process. The grievance process is a fundamental part of employee relations, not just in the Government of Canada, but for any good employer. As the honourable member will appreciate, until that has run its course it would be inappropriate for me, as part of that process, to comment on it.

The other investigations are moving as quickly as possible. I had hoped by today the information commissioner would have had his report to me; it will probably be next week now. But that has moved as quickly as possible. It really is important that we get to the bottom of these, and I want to assure the committee that we are doing our very best to find out which allegations have substance to them and which don't.

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Finally, with respect to the so-called shift in the department, the goal remains exactly the same. The goal is to protect the health and safety of Canadians. But the 21st century is different and does have different problems from what we had in the 1950s and 1960s or earlier, when most of the legislation we operate under was written. We also have a number of new tools available to deal with this.

At the same time, there are huge challenges out there. We mentioned genetically engineered products earlier. There's a whole new wave of these coming at us. We have that challenge.

There is also the fact that Canadians individually are not only more conscious of health issues than they probably were 30 or 40 years ago, but they're extraordinarily more capable of making decisions on their own part, provided the information is made available to them. We also have the tools to provide the information that were not available even as recently as a decade ago.

So it's really important that we move forward and look at the problems we have coming down the road at us and try to deal with them. If that represents a shift, it represents a shift in the way one operates to make the constant goal, which is the health and safety of Canadians. But because the world's changing, we have to change the way we do it.

We will be back to this committee—you'll probably get absolutely sick of seeing us—because we will have to go back to a number of pieces of legislation you have asked us to administer to try to get them into shape to deal with the problems of the 21st century.

The Chair: I'm going to interrupt you for a moment, if you don't mind.

I have four other requests for interventions. That would take us at least 15 minutes beyond 11 o'clock. I know when you were contacted we were going to try to have you out of here by 11 o'clock. Can you stay another 10 or 15 minutes?

Mr. David Dodge: We'll stay as long as you need us, Mr. Chairman.

The Chair: Maintenance is going to kick us out of here shortly after we finish, anyway.

I will ask you to finish answering the question from Ms. Wasylycia-Leis regarding tobacco, and then I'll go to the rest of the questions.

Mr. David Dodge: I'll start and then ask Ian Potter who runs the program to continue.

The second $50 million tranche of the $100 million you alluded to has only just been approved. The programming for that is now being completed. It will be directed entirely at young people and a little bit toward dealing with pregnant moms as well, as part of the CPNP program. I'll let Ian talk about it because we are just now tooling up to get ready to go on that second $50 million.

Mr. Ian Potter: Thank you very much, Mr. Dodge.

As Mr. Dodge said, the commitment of the government was $100 million over five years. The allocation is to legislation and regulation, enforcement, research and public education. Of the $100 million, $50 million is allocated to public education and smoking cessation initiatives. In the interest of designing a program that's most efficacious and efficient, we have deferred some of the spending for this year into later years.

We are in the process now of working with different partners who are interested in this area. These are provincial governments, interest groups, children's organizations, public health organizations and agencies like the Canadian Cancer Society and the Heart and Stroke Foundation.

• 1055

So the public education programs the federal government invests in are the most effective. There are many organizations involved in this, as you are well aware. Therefore it was our intent to try not to duplicate or do things in an incoherent manner, but to try to make sure provinces and organizations that are interested in this have a more comprehensive plan. We are spending our time doing that at the moment. We have met with committees in fairly large forums and smaller forums to work out the best approach.

As Mr. Dodge indicated, the focus of the tobacco education component is protection, prevention, cessation, best practices, building capacity with those organizations that are working in this area, and providing education to the public in general. Our main targets are with respect to youth.

Our basic objective is to try to prevent young people from starting. The evidence shows that the addiction is strongest if people begin smoking before age 19. People are starting to smoke at 10, 11 or 12. When they start that young there is a physiological as well as a mental addiction that takes place. If we can defer that and prevent more children from starting to smoke, we know in the long run we will reduce the number of people who smoke and are addicted. So a lot of our attention is there.

In the last year we have had an initiative with MuchMusic and Cineplex Odeon. Maybe you have seen the ads. These ads were designed by young people. We had a competition and asked for their best advice. We had 10,000 or 14,000 different responses. We picked the best and produced some information. We want to work with young people and involve them in the messaging, because we aren't going to get the messages right. They're going to tell us how to communicate.

The other area we're working on is maternal smoking, an incredibly important area. It affects the birth weight and the development of the infant.

We're also working on educating retailers. We're spending time educating the people who do the enforcement so when they visit a retailer or a small corner store they can also provide the educational messages as to why those retailers should be concerned about the health of the young people in their community and how they can become active participants in the prevention program as well.

The Chair: Thanks, Mr. Potter. You could have been a politician. I notice you have the same sort of indifference to the clock as the rest of us.

My colleague, Madam Minna, is going to hit the ground running, so be prepared.

Ms. Maria Minna: Thank you, Mr. Chairman.

When we talk about the area of prevention and preventing risks, I want to discuss a little bit the area of tampons and dioxins. I've been doing quite a bit of work in this area for the last year, talking with a number of people who are experts in the field and with some people who have major concerns in Toronto. These people feel the product still has far too high a level of dioxins within it, in terms of causing health problems for women.

Some products on the market now are pure cotton, or at least Tampax claims they're pure cotton. So there's dispute in the community as to whether that's true or not.

In terms of the research and the approvals, do we accept the research done by companies like Tampax, or do we do research ourselves? Is there any research Health Canada does specifically, in addition to accepting the protocols and whatever else the company gives, to ensure the level of dioxin in those products is not harmful?

The information I have so far is that Health Canada does not do its own research and we accept the protocols. But while the research provided by the companies claims there are no health risks, a lot of independent research in the U.S. and in other parts of Canada show that in fact there are.

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Given that this is a product that 51% of the population are exposed to for a good part of their lives at some point, and that over a long period of use this can affect one's health, I would like to know what the protocol is and what happens.

The Chair: Dr. Losos.

Dr. Joe Losos: Mr. Chair, we have done a lot of work on dioxins in paper and absorptive products. These usually have been packaging materials such as milk cartons and the like. I don't know offhand about dioxins in tampons, but I will find out and then get that to the chair.

Do we accept research by companies? Yes, we do accept research by companies. But we demand of them a standard that's nationally and internationally promulgated. As far as the research is concerned, we demand that protocols are to be followed to the letter. We also audit them on those protocols. If we're not satisfied with it, we ask them for more information and put them through the hoops again.

When there's a specific problem, we generate either expert groups or do research investigations, if you will. We will gear up a capacity to look at everything from dioxins to a pharmaceutical to a vaccine to a public health risk. So we do, in fact, gear up. I will reallocate within the branch on an emergency basis as need be.

At the same time, we have to maintain vigilant systems and act on data. When a company has to produce the evidence for putting a product on the market, we put them through the hoops. But the studies are usually limited to a number of thousands of individuals, whatever the scientific methodology will allow.

Once a product is out in the general market, a huge amount of experience of course occurs. Then there can be a variation. So post-marketing surveillance is a very active process in the branch now. We will monitor products, remove products from sale, remove licences, and demand more information. There's a wide variety of regulatory tools that we'll use over and above the voluntary tools that we would have with companies when it comes to risk.

I will specifically look into this and get you information on dioxins in these products.

Ms. Maria Minna: To just conclude, Mr. Chairman, this is a product that basically goes into the body of people. It's very important to me and to a lot of women. I would like to be able to work closely or meet with someone because I would really like to discuss the information I have.

My sense is that there isn't enough protection. In the larger population, I'm not sure what kind of monitoring we've done to see what the results could be. It's an area that I have a great deal of interest in. Given the level of cancer and what have you, I think it's important to take a look at what these products are doing and what could be done further to improve health for women.

Dr. Joe Losos: We'd be happy to set that up.

Ms. Maria Minna: Thank you.

The Chair: Thank you very much.

Mr. Hill.

Mr. Grant Hill: Dr. Losos' comment on rBST and the issue of bio-modified foods and drugs and whatnot was that he favours labelling. I'd like to be a little bit more specific than that. Would he recommend that rBST, if it's approved for Canada, be labelled as either rBST-modified milk or rBST-free milk?

Dr. Joe Losos: Dr. Hill, I personally favour labelling, but it isn't as simple as that. It can't be my opinion; there are regulations of Parliament under the Food and Drugs Act and the Canadian Food Inspection Agency Act as far as labelling is concerned. I think we need to work that through if ever this product is approved.

What I was alluding to specifically was the use of labelling of food in general as a public health information tool for individuals to better their health. I'm certainly a great believer in that. I think the public is ready for it. It's been proven in the United States. It certainly would work.

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As a generic statement, I would favour the consumer knowing what is in any product, and if rBST or biotechnology happens to be an issue of concern, then my personal opinion is it should be labelled. However, I'll have to take that through the regulatory framework that is provided for the Health Protection Branch to see if we can do that.

Mr. Grant Hill: I'd like to redirect the same question to Mr. Dodge, who is the head of the department. Would he personally favour labelling of these products so the public could make the decision?

Mr. David Dodge: As I said earlier, Mr. Chairman, I think provision of information and labelling is a very important way information gets provided. It is something we have to work much harder on as we move into the 21st century than we perhaps did 20 or 30 years ago. Yes, labelling is extraordinarily important. I think I'll just add one comment here.

There are two classes of problem we have to deal with. One is the second-party risk, when a company sells you or me a product. This is really a transaction between the producer and you or me, and at that stage information is an extraordinarily powerful tool, because we can, in a sense, deal with it. There is a much bigger problem, however, when we move to a third-party risk. This is where something is happening. And in some sense rBST is that. It's a drug that goes into animals, and as consumers of the product of that, we can't be absolutely sure it's not having an impact on us, just as we talked about sulphur in gasoline earlier. I buy the gas from the gas company, but it's you who walks down the street who ends up with the problem.

When dealing with third-party risk issues the more classical use of the regulatory tools is really more appropriate, because information in and of itself won't do the job. The legislation under which we work doesn't really distinguish between second-party and third-party risks. It's something we're going to have to come back to this committee with, because it really is quite an important distinction to think about how we deal with health risks under these two rather different circumstances.

Mr. Grant Hill: Okay, that's quite helpful. You mentioned activities against Alberta and Nova Scotia under the Canada Health Act. Could you be specific about what the department is reducing funds in those two areas for now?

Mr. David Dodge: I will have to get back to you through the chairman. We produce a report every month precisely on that, and I will send the committee, through the chairman, our most recent monthly report. They are relatively small amounts and they're highly specific in most cases.

Mr. Grant Hill: Thank you.

[Translation]

The Chairman: Ms. Picard.

Ms. Pauline Picard: I have a question for Mr. Potter. The Performance Report talks about health promotion on page 16 in the English version. It reads:

Implement overall health promotion and disease prevention programs, based on a life-stages approach.

Our population is ageing. Many elderly people are going to suffer from arthritis. I would like to know which promotion and prevention programs will help these people who are going to be suffering from arthritis.

I have another question. We are told that a contribution of $2 million is made to individuals and organizations to support promotion projects. What are these organizations, and how much money have they each received? Could the committee members obtain this list?

[English]

The Chair: We'll probably get the last part of that answer addressed quickly.

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Mr. Ian Potter: I would have to ask my colleagues who manage the financial things to identify precisely what those amounts are and what they're for, and we'll provide that to the committee through the chair.

With respect to aging and the issues of arthritis and other diseases, the honourable member has raised some very important questions. We have an active group dealing with aging and seniors' issues, and within that there are groups working with other colleagues outside in the health professions and with the provinces to look at particular ailments that affect the elderly, such as arthritis. Our initiatives basically are around things like best practices. Working with the physicians organizations, we look at what the best practices are in terms of treatments.

Information to patients is another area we deal with, so we are working with respect to a system that will provide public information to Canadians on issues such as how to deal with their arthritis. We work with the Canadian Arthritis Society to do those things, and we are working with them right now at trying to get their information accessible to all Canadians.

We are also looking at the broader question of the impact of aging, and I'm happy to say we have two very well recognized Canadians chairing an international year of older persons group. They are the Honourable Flora MacDonald and Don Harron, who are co-chairs of a broad Canadian-wide organization. The United Nations has identified 1999 as the international year of older persons, and as part of that we are emphasizing research into aging. We're emphasizing programs of prevention, so as the population ages those people who are elderly can maintain their health, and improved medical treatment and care for those people. You'll see much more activity on that front as 1999 begins and we put more emphasis on that and provide more public information on what's happening.

The Chair: Madame Caplan, I know you've been very patient in this marathon session and you probably want to ask a question yourself. If you don't, I have another member who really would like to do that as well.

Ms. Elinor Caplan: All members go first and I'll have the last word, how's that?

The Chair: Is that okay with you, Judy?

Ms. Judy Wasylycia-Leis: Yes, I think the parliamentary secretary should have the last word. Could you just let me slip in two quick questions?

The Chair: Judy, the word quick is spelled “quick”.

Ms. Judy Wasylycia-Leis: Are you saying it's a contradiction in terms?

The first question follows from Marie's question about toxicity in tampons and it pertains to the loss of the Bureau of Drug Research. When that shut down in the summer of 1997—it only amounted to I think about a $2 million expenditure—we lost the only reproductive toxicologist in the department, and that hurts our ability to further research the kind of issue Marie is raising. My question about the bureau is, when that was announced the minister indicated—and it was reinforced by department officials at committee—that function would be picked up by the drug industries themselves, by universities, and by external agencies. We have heard no specific reference to any program delivered to us in terms of what's been set up to pick up that slack. Who's got the money, where did it go, and who's performing the function?

The second question has to do with the smoking issue. I appreciate the answer from Ian Potter, but in fact he should know that the red book in 1997 said clearly that there would be $100 million for programs to prevent smoking among young people and help them to stop. It was not meant to deal with enforcement, research, and other functions that should be considered line items in the department on a regular basis. This was a new announcement, a new initiative. What you're telling us is that $100 million is now going into 100 different areas to cover off basic functions of the department. Why is that money—and it's not enough to begin with—not being devoted solely to the issue of smoking prevention and education among young people?

The Chair: Judy, I now understand what you mean by quick. You just went into third gear as you were asking the question, but it didn't really mean you were going to make it brief.

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Ms. Judy Wasylycia-Leis: That was only a minute, wasn't it?

The Chair: You almost made it under a minute. You were going for a record there. It only went for two minutes.

I think the question on the red book would probably be better addressed by the parliamentary secretary, although I'm not going to suggest to Mr. Dodge and his colleagues that they not attempt to answer some of these questions. But certainly that first question is worthy of an answer.

Dr. Joe Losos: Ms. Wasylycia-Leis, the toxicology on something like dioxins would be done in two areas of the branch, which are still certainly very strong. We have two large areas of toxicology in the foods program and in the environmental health program, where a toxin such as dioxin can very easily be studied irrespective of what vehicle it happens to have, tampons, food, or whatever.

What happened with the Bureau of Drug Research? If the toxicology programs or other laboratory programs within the EHD couldn't handle it, we could go to the faculties of pharmacy and the network of toxicologists across the country. There's a strong association, and we can do contract work there. Much of the capacity of the Bureau of Drug Research was, in fact, shifted to a higher priority in the area of pharmaceuticals and biologicals for the next century. Two-thirds of that scientific staff has been reabsorbed into the Bureau of Biologics in the Office of Science within therapeutics, and they are part of the strengthening of those programs.

For tobacco, I'll turn it back to my colleague.

Mr. Ian Potter: I can respond that the intent of all of those initiatives is a reduction in the use of tobacco. It's not only public education that will make a difference. We believe the control of advertising does make a difference. We believe the control of the distribution of the product to young people, which requires legislation, regulation, and enforcement so that there are no sales to people under 19, is an important contribution in terms of reducing the use of tobacco by young people. So we see legislation, regulation, enforcement, and public education working together as part of a strategy to reduce tobacco use primarily by young people.

The Chair: Mr. Potter, thank you very much.

That is reminiscent of a new word in the English language my researcher just reminded me of—that is, a “multi-pronged” approach to the problem. Mr. Hill and Madam Picard will remember that we went through that for quite some time.

Anyway, thank you very much.

Ms. Caplan, to you falls the onerous responsibility of respecting the clock. I don't know if you can manage this. But because you've been so patient, we are going to ask you to finish within five minutes, and that includes responses as well. Do you think you can handle that?

Ms. Elinor Caplan: I think we can handle that.

The Chair: Great.

Ms. Elinor Caplan: Thank you very much, Mr. Chair.

I wanted to start by saying how important I think this session has been in terms of both the important and serious questions that have been asked and how forthcoming the department has been with the answers they have given.

I think most Canadians are just beginning to really understand the federal role in this changing world, as we approach the next millennium. We will have lots of opportunities appropriately at this committee to hear from the department as to how Health Canada is going to respond in order to make sure that the health and safety of Canadians is a continued priority and to respond appropriately in these changing times, as we enter the new millennium.

I think the expectation of Canadians is that when they walk into a store to buy a product, they expect that someone out there—they may not even know who—has made sure it is safe. Therefore, when Health Canada comes out with warnings, when Health Canada does not approve products, when Health Canada talks about its important role in ensuring the health and safety of Canadians and letting them know how we do that, whether it is through legislation and then the enforcement of that legislation, through the important role of surveillance, or the research capacity, whether it's internal or external—

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The other thing we heard this morning was Health Canada's role in bringing all of the interests of the stakeholders together from across this country. I thought that was a very important part of the discussion this morning.

What was also interesting to me, particularly with my background and understanding of the provincial role, is I think that anyone who was watching this morning's hearings may wonder whether the federal government has a role in the delivery of services. We know we don't, except in aboriginal health issues. The provinces, as everyone should know, are the ones that deliver services. That doesn't mean the federal government doesn't have a role in the development of guidelines and best practices and dissemination of that information.

I want to pick up on the theme from my colleague, Ms. Minna. I think that just as everyone, when they walk into a store to buy a product, wants to have confidence that Health Canada has inspected it and approved it, and they can have some assurance it's safe and of good quality, that it has a health claim on it and that some evidence has been provided to support the claim, when people look to the federal government they're also expecting greater accountability. I think it was a very important issue that was raised, because what I heard this morning is we have a long way to go on this issue.

We have new tools, information technology and so forth, that will allow for greater accountability as we enter the next millennium. But I have one question I was going to ask a response to, and it had to do with the transition process, which is such an important part of the performance report. There are some cynics who have been suggesting that as a result of the consultation and discussion under transitions, progress is going to be delayed, particularly in the area of work.

We've heard about natural health products, which is something this committee worked very hard on for a year, but there are other things as well. The question I'd like to have answered for the committee and the public watching is whether the transitions process is one in which we are going to have to wait until it's all over before we see change. Could you explain how that is going to work, Deputy Minister?

Mr. David Dodge: The answer to that is no. In fact, as the committee is aware, with respect to the Bureau of Biologics, we are now making an investment in building a bureau that can indeed cope with the problems that are coming down the road at us. Over the next five years, we'll be investing about $125 million in building that. That was step one.

Step two is what we are working on extraordinarily hard right at the moment in respect of the food side of the house. We would expect that by next spring we will be making some significant investments there.

The third area where we have more work to deal with than we can cope with is on the environmental health side. That will be the next one on the list. That's the staged approach of trying to deal with one problem at a time, figure out how you're going to deal with it, go get the money and then move ahead.

But the chapeau really is this process of trying to figure out how the branch ought to operate in the 21st century. That's going to involve, as I've said before, you people a lot, because our view at the moment is that the legislative tools we've been given are really not adequate to deal with the 21st century problems we have to deal with.

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What we would hope to do is late in the spring to be in a position to put out a second round of working papers that would provide the framework that we think, as a department, is a legislative framework that would be appropriate for the 21st century, an operational framework that would be appropriate in all of the areas. And then here in this committee we will have to have really quite significant discussion before we in turn come back with some specific ideas on the legislative side of things.

The short answer to the parliamentary secretary's question is we are not waiting. We are moving piece by piece. We have moved in the Bureau of Biologics. That's where the blood stuff is. We are about to move on some of the food. We had been waiting for the report of this committee before trying to finalize our plans in that regard, but now we have it and we will be moving quickly. Then the next one will be some of the environmental health areas, where we really have some work to do.

The Chair: Thank you very much, Mr. Dodge, Dr. Losos, Mr. Potter, Mr. Lafleur, and Mr. Marquardt. We didn't get a chance to engage you in the thrust and parry of exchanges, but your presence was appreciated here nonetheless.

As I said a moment or two ago, half in jest, it was a marathon session, and we gave a little bit more leeway to members in order to give them an opportunity to ask questions that would, on occasion, deviate from our initial intent. But I'm pleased on behalf of all committee members that you stayed patiently to address each and every one of our concerns. So on behalf of all committee members, thank you very much.

We are adjourned at the call of the chair.