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Kathleen Cooper
View Kathleen Cooper Profile
Kathleen Cooper
2015-06-18 15:48
First of all, to tell you about the Canadian Environmental Law Association, we're a non-profit public interest organization specializing in environmental law. We're also a legal aid clinic within Ontario. We provide legal representation to low-income individuals and vulnerable communities.
Then we have law reform priorities, and in setting our strategic priorities, one of those is environment and human health. In deciding within that large topic how to set priorities, we take a population health approach, the same as Health Canada, the Public Health Agency of Canada, and public health agencies everywhere do. You set priorities by focusing on issues where large numbers of people are potentially or directly affected or where you have serious outcomes.
You can't get much more serious than a known carcinogen where there's strong science. Radon, as I'm sure you're going to hear later as well, is in a class by itself compared to most other environmental carcinogens. That's why we've focused on radon.
I'm going to speak today to a report we prepared last year, “Radon in Indoor Air: A Review of Policy and Law in Canada”. I believe you've been circulated the media release that was issued the day we released the report. That's all I was able to have translated given the time pressure of meeting with you today.
We canvassed policy and law across Canada at the federal and provincial levels and looked at jurisdictions and roles. We focused on public buildings and building codes, looked at other relevant provincial policy and law and the associated common law, and made a number of recommendations, but I'll focus today on just the recommendations we made with respect to the federal government.
Overall, our findings were that Canadians need better legal protection from radon. We found a patchwork of inconsistent and mostly unenforceable guidance.
For the federal government, we found that really important leadership has occurred, and Kelley Bush from Health Canada will provide some details on that for you today, although we definitely made recommendations for more that can be done. At the provincial and territorial level, where actually most jurisdiction lies, we found a wide range of laws that need to be updated or that contain gaps or ambiguities. There's very limited case law, which points to the need for improving a law or for law reform. I won't get into detail on what's been done at the federal level on radon, although the report does, because Kelley will be doing that for you later on.
Just in summary, under the national radon program there has been very valuable research, testing, and mapping of high -radon areas. The guideline for indoor radon was updated in 2007. The national building code was updated with respect to radon provisions, there's a certification program for radon mitigators, and there has been a national campaign to urge the testing by Canadians of their homes. It's recommended that every home in Canada be tested.
We recommended, to build on that important work, that there really is a logical next step here. Through the work of the Green Budget Coalition this past year, we recommended a tax credit for radon remediation. We recommended that the Income Tax Act add a tax credit for radon mitigation of up to $3,000 for individual Canadians, so long as it's done by a certified expert under the national program. That was not included in the budget, although we think it's still a very good idea. We had some very positive response from the federal officials we spoke to about it.
We also recommended that there be clearer messaging about radon, and that we use words like “radiation” and “radioactivity” because they are accurate and are what people understand more in terms of the risks of radiation and radon. We also recommended that there be better data sharing nationally between the federal government and the provinces and territories in terms of the testing that's done, along with the sharing of information that's paid for nationally, and that information be available publicly.
In terms of recommendations for federal action as well, we note that the David Suzuki Foundation report that came out just last month says the World Health Organization has recommended a lower level of 100 for indoor radon. Currently, our federal level is 200 becquerels per cubic metre. We definitely supported that recommendation and recommend that the federal government reduce the indoor radon guideline to 100.
The other two areas I want to touch on that are relevant to your investigation here have to do with the Canada Labour Code and the need to update it as well, and also the need for improving the uptake across Canada of the naturally occurring radioactive materials guidelines, the NORM guidelines. I'm going to speak to those two areas now.
Under the Canada Labour Code, there is the only legally enforceable limit for radon in Canada that's broadly applicable, but it's only for federally regulated workplaces and it remains at an outdated level of 800 becquerels per cubic metre. We think it should be brought down to the federal reference level of 200 becquerels per cubic metre to begin with, and we think that level should come down to 100 becquerels per cubic metre. On the updating of that level, apparently what was going to happen in 2015 now sounds like it's going to happen in 2016, so it would be great if your committee recommended speeding up that process.
In terms of the NORM guidelines, these are guidelines that were prepared by a federal-provincial-territorial committee. We interviewed occupational health and safety inspectors across Canada and found a lot of confusion and uncertainty about workplace radon rules or whether the NORM guidelines apply. In fact, they apply to every workplace in Canada. In any indoor space that is a workplace, including the room in which you are sitting, those guidelines apply.
However, it's a reactive, complaint-driven system. Inspectors get few or no complaints because there is a lack of awareness, so they don't take enforcement action. Also, some inspectors didn't think that radon was an occupational health and safety issue at all. They said that enforcement action was unlikely because the only agreed-upon levels for radiation are those for radiation-exposed workers. That is just not accurate, so we've made recommendations in response to that situation.
Turning to the recommendations we made with respect to the Canada Labour Code, as I've mentioned, it should be brought up to date swiftly. It's out of date by many years and still at that level of 800 becquerels per cubic metre.
With respect to radon, we recommended that the federal-provincial-territorial radiation protection committee, which deals with far more than radon—it deals with a whole manner of radiation exposure issues—convene a task force for occupational health and safety inspectors across the country so that there is clarity and there is a more generalized consistent application of those NORM guidelines to ensure worker health and safety. The consequences of that inconsistent application are that you're going to have uneven worker protection across the country and the possibility that people are overexposed, both in the workplace and in their homes, if they happen to be unlucky enough to have high radon levels in both of those indoor locations where they live and work. Related to that, we made a range of recommendations about provincial labour codes, which I won't get into.
In another area of occupational exposure, with respect to radon mitigators, we also recommended that CAREX Canada, who you're going to hear from later today, undertake, with the Canadian national radon proficiency program, research and dosimetry monitoring for radon mitigators so that we can make sure their workplaces are safe as well.
Just to recap on the findings in this report and to recommend to you to take up some of these recommendations in your deliberations on this topic, we found a need for greater legal requirements rather than guidance in this area for several reasons, including the need to underscore the seriousness of the problem and to support public outreach messages by the federal government and by other organizations who you're going to hear from today, including the Canadian Partnership for Children's Health and Environment.
Also, there's a need for legal requirements to require testing in public buildings and to ensure public access to that information. As well, there's the need to correct that inconsistent response among both the public health and the occupational health and safety inspectors and to provide them with tools to take action with respect to radon. As I mentioned, we found limited to no case law under either statutes or common law. We also found that improving the law or law reform is a better remedy than costly and situation-specific litigation to resolve radon problems.
Then, as I mentioned, there's a need for specific federal government action, including updating that federal guideline and putting in place a tax credit to help Canadians undertake radon mitigation when they have high levels, updating that Canada Labour Code, and ensuring the NORM guidelines are applied.
We've calculated the health care savings from prevented lung cancer deaths. If all homes in Canada were mitigated to the level of 200 becquerels per cubic metre, you'd see more than $17 million a year in savings through prevented lung cancer deaths. It likely would be double that if you were to reduce the level to 100 becquerels per cubic metre. Then, of course, anyone who works in cancer will tell you that the indirect costs are five times higher than the direct costs, so a lot of savings are possible there, along with the avoidance of the pain and suffering associated with lung cancer.
Tom Kosatsky
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Tom Kosatsky
2015-06-18 16:43
You know, anyway, that smoking causes lung cancer in smokers. You probably also know that to a degree it causes lung cancer in people who live with smokers. I won't really talk about either of those things, but if you can get to the slide that's marked “Lung Cancer in Lifelong Non-Smokers”, you'll see that there is a new thing that's been described only over the last, about, 10 years, which is lung cancer in lifelong non-smokers, something which, before this committee invited me to speak with you, I didn't know much about. It turns out that it's a whole other disease. It has some similarities to smokers' lung cancer but some very important differences.
The geography is different. It's a huge phenomenon in Asia and in Asians in Canada. It has a female predominance, so there are far more lung cancers in female non-smokers than in male non-smokers. The age distribution is different, so it tends to present itself at a much younger age than smokers' lung cancers do. The cell types, the cancer types are different. The typical small cell squamous lung cancer that you see in smokers, you don't get in non-smokers. You get a whole different cell type and cell shape. The genetics are different, so there is some family relationship. It's not very strong, but there's a very strong genetic relationship based on genetic analysis. You can almost predict who's going to get it, which is a really important thing. Further, it tends to be much more symptomatic at diagnosis than is lung cancer in smokers. The five-year survival, oddly, is better, even though it presents later, for non-smokers' lung cancer than for smokers' lung cancer. In many ways it's a different disease.
Radon-related lung cancer is somewhere intermediate, because, as I'm going to say, most radon-related lung cancers occur in smokers. The question of whether it is more cost-efficient to stop smoking was right on the mark.
The next one is called “Principal risk factors (excluding occupational exposure)”, only because you asked. There are a number of conditions, including radon exposure, that are associated with non-smokers' lung cancer, like the history in your family. It's associated with hormone use in women. It's associated with environmental tobacco smoke. It's associated, to a degree, with air pollution. It's associated with cooking-oil fumes, so indoor cooking over a long period of time. It's associated in Asia and Africa with domestic heating by wood and wood products in the home. Those are also associated with lung cancer. Something that I didn't know much about before is that it's associated with lung infections like tuberculosis and other lung infections over a long period of time. It's also, like so many of the other bad things in life, associated with being poor. Getting lung cancer is associated with being poor, even if you eliminate all the other stuff. To a degree it's mitigated or prevented by a diet high in fruits and vegetables, so eat your leafy greens, eat your fruit, and you're less likely to get lung cancer no matter what else you do.
The next one is an American slide. It has a little American flag, and it looks at the attributable percentage of lung cancer by cause. For active smoking, it's 90%. For radon exposure in the U.S., it is between 9% and 15%, and in Canada it's estimated at 15%. For workplace carcinogen exposure, it's 10%. For air pollution, it's 1% to 2%. That adds up to more than 100% because, as you'll see, some of those causes add to or multiply each other. If you're exposed to radon, don't smoke. If you smoke, don't be exposed to radon.
Non-smokers' lung cancer is a really important cause of lung cancer. It's about number six in terms of all the causes. Radon-related lung cancer—this is U.S. data but for Canada it would be the same—is number eight. How could that be? It could be because smoking and radon exposure are interactive, so one multiplies or adds to the effect of the other. That leads, in any case, to non-smokers' lung cancer being a very bad issue.
Any radon exposure is bad news, not just at over 200. An artificial limit, no matter what it is, is not very useful for lowering the whole population's exposure. It would be better if we were all exposed to less radon rather than picking one area, maybe for convenience, or one level. It may be good for convenience, but it's not a really useful population health measure. For the whole population, it would be better if we were all exposed to less radon. It's a linear relationship. The more radon you're exposed to and the longer you're exposed, the more likely you are to get lung cancer.
The other thing is that, as I was saying, the more you smoke the more it interacts. On the last slide, which I made up using Canadian data, most radon-associated lung cancers occur in smokers. If you've never smoked, as you get up to high levels, like interior B.C. levels, of radon about 36 people out of 1,000 exposed to those levels would get lung cancer. On the other hand if there was no radon exposure and you did smoke, about 100 people would get lung cancer. If you add the two together, you're exposed to a high level of radon and you smoke, 270 people exposed to those two for their whole lives, smoking and radon, will get lung cancer. It's 270 out of 1,000 people; that's tremendous.
How can you lower it? The number one way to lower it is to stop smoking or to never have smoked. The number two way to lower it is to lower your radon exposure, and you'll do that for everybody in the population. The less smoking there is, the less radon there is, the less lung cancer there will be, to the point that as we lower the level of smoking exposure, radon will become a more important cause of lung cancer. But there will be a lot less lung cancer. If we eliminate smoking, there will be less lung cancer in general, but all of these other causes other than smoking will increase in focus. The big issue is the interaction, the doubling, tripling, quadrupling, or really octupling effect, because it's an eight-time effect, of smoking and radon will go away.
What's been the Canadian public health stance on radon? Before the year 2007, it was pretty passive and largely seen as a private issue. Health Canada was helpful. They gave advice when people asked for it. That was at the time of the 800 becquerels per metre cubed, or 800 disintegrations per second per metre cubed level, which is what a becquerel is. Then when the level was lowered a more active stance was taken. Health Canada was involved with large-scale testing across the country to establish a radon profile across the country so that we knew what our levels were likely to be. They were much more active in terms of giving advice, and with this lower guideline, they promoted it and they encouraged “test and remediate”. Test and remediate to me is not the way to go. The way to go is to build it out in the first place.
If you look at this complicated Ontario slide, Ontario looked at levels of radon across the province and how many cases of lung cancer could be saved by doing something for those above 200 becquerels per metre cubed, by adopting 100 becquerels per metre cubed, by adopting 50 becquerels per metre cubed—all of which are attainable—or by going to as low a level possible and getting close to outdoor air levels, which are relatively benign. At 200 becquerels per metre cubed, if every Ontario resident got their house from that point down to outdoor levels, 2% of all the lung cancers in Ontario would be averted. If you got down from current levels above 200, if everybody tested and remediated and they successfully got their house down to background or no radon, it would avert 2% of all lung cancers. If all houses in Ontario with any level of radon in them could get down to outdoor levels, we'd get rid of 13% of all Ontario lung cancer deaths. If there were a way to do it, why not do that? Why not get it down lower?
The next slide looks at the change in levels of radon over time. This is Dutch data. Canada would be the same. Yes, as we've made our buildings tighter, radon levels have increased. This is even more reason to look at the joint effects of building changes on radon.
Anne-Marie Nicol
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Anne-Marie Nicol
2015-06-18 17:06
You should also have a slide deck from me. It says “Radon and Lung Cancer” on it. I recognize I am the very last person, and I appreciate your persistence. Luckily many people have also spoken to a number of the points that I wish to discuss, so I will go very quickly over the first few slides.
I am an assistant professor at Simon Fraser University in British Columbia. I also work at the National Collaborating Centre with Tom and Sarah, and I also run CAREX Canada, which is the carcinogen surveillance system funded by the Canadian Partnership Against Cancer. I am here because we prioritized Canadians' exposure to environmental carcinogens and the leading causes of cancer-related deaths from environmental exposures, and radon gas was by far the most significant carcinogen. I admit that when I started my research at CAREX, I had never heard of radon gas either. When I went back into the literature, I realized that over time Canada has actually played a very important role in understanding radon and lung cancer.
The data from many of the studies that were done on uranium miners, at Eldorado and even here in Ontario, has been used to determine the relationship between exposure and lung cancer. We've actually been on the forefront of this issue but very much in an academic context rather than in a public health context.
We've already discussed the fact that the WHO notes that this is a significant carcinogen. I would also like to point out that agencies around the world are coming to the conclusion that radon is more dangerous than they had previously thought. In 1993 we had a certain understanding about the relationship between radon gas and lung cancer. That's doubled. The slope that Tom was talking about used to go like this and now it goes like this. Radon is now known to be much more dangerous than we had originally thought. The reason for that is that radon is actually an alpha-particle emitter.
We are a uranium-rich country. Uranium is in the soil and as it breaks down there is a point at which it becomes a gas. That means it becomes movable within the soil. That gas itself gives off alpha radiation, which is a very dangerous form of radiation that can damage DNA. On the next slide you'll see both direct and indirect damage to DNA. This information is compliments of Dr. Aaron Goodarzi. We actually have a Canada research chair studying this at the moment in Alberta.
The next slide, on radiation and DNA damage, shows that alpha radiation is powerful. It doesn't penetrate very far, so if it hits our skin, it doesn't do as much damage as it does if it gets into our lungs. Our lungs are very sensitive. The lining of our lungs is sensitive and when the cells in them are irradiated, they get damaged. Alpha particles are very destructive. The damage is akin to having a cannon go through DNA. That kind of damage is hard to repair, and as a result the probability of genetic mutations and cancer goes up.
The next slide is on strategies for reducing risk. Just to recap, the kind of damage done by the radiation emitted from radon is significant. The damage is difficult for the body to repair once radon is in the lungs.
The next slide is on education and priority setting. Radon does exist across the country. People have developed radon-potential maps. This one is compliments of Radon Environmental where they've looked at where uranium exists and where the potential for higher-breakdown products is, although we do recognize that every home is different. Also there's a map of the United States to show that we are not alone in this and that the states that are on the border have a similar kind of radon profile to that found in Canada. We know that under our current Canadian strategies, we need to educate not just the public but ourselves. Most public health professionals have never heard of radon. When we do work out in public health units, environmental health inspectors, public health inspectors, and medical health officers are still unaware that radon is dangerous. Many bureaucrats and ministries of health are unaware that radon is dangerous.
Also health researchers are only really beginning to do work in this area across the country. In order to have building codes changed, people need to know why you're changing them. We need testing and remediation training. People need to understand why they're actually doing this kind of work.
Kelley Bush alluded to the fact that they've been tracking awareness among the population. This is done by Statistics Canada. The next slide shows a representative Canadian sample. It's been done since 2007 actually, but these are results for 2009 onward. You can see that about 10% of the population were aware of radon. That's gone up to about 30%. This is the number of people who know what radon is and can accurately describe it. We're still at around 30% of the population who know that radon can cause lung cancer.
Health Canada does recommend that everybody test their homes. The next slide, which is also using data collected by Statistics Canada, clearly shows that very few people have tested their homes. Less than 10% of Canadians across the country have tested their homes. We have had a radon awareness program since 2007, so why aren't people testing? We don't have regulatory requirements, as Kathleen Cooper stated earlier. People need to be aware and motivated to change. It's up to the consumer. We have left it up to the consumer to test their own home.
I believe things like denial, the invisible nature of the gas, and people simply being unaware contribute to this. Test kits are still not that readily available across the country. You can phone and ask where you can find them, but they're not always there. In rural regions it's much harder for people to get access to test kits. People then fear the downstream costs of remediating—i.e., I don't want to go in there because I don't know how much it's going to cost me to fix my basement. In some cases the costs can be somewhat considerable, depending on the structure of the home.
Turning to the next slide, I believe to reduce the lung cancer risk from radon gas we need more leadership. The government can legitimate this as a risk. It's something that people don't know about, and we need to take a stronger role in getting people more engaged in this topic. It's not just Health Canada; it's all levels of government—ministries of health, provinces, municipalities. We need to be training people in the trades so they know what they're doing when they're building those radon-resistant homes, and why. Why is that pipe important? Why is that fan important? Again, we need to build radon out, going forward.
Other countries have shown that providing financial assistance works. People will energy-retrofit their home because they get a rebate, but the energy retrofit does increase radon levels. There is clear evidence that this exists. The tighter your home, the more the radon gas remains in your home. In Manitoba they're doing research to look at that at the moment. In Manitoba, though, you can also now get a rebate through Manitoba Hydro to do radon remediation. Some parts of the country are starting, but we need to be offering some kind of incentive for citizens to do this.
I would also like to put in a plug for workplace exposure, because I do study workplace exposure and radon. There are places in the country where people work underground, or in basements and even ground-level buildings, where radon levels are high. Some of these are federal government workers. We need more testing and remediation for workplaces.
That's it. Thank you.
View Wladyslaw Lizon Profile
CPC (ON)
Yes, very short, Mr. Chair, because we were talking about an awareness campaign. Speaking for my constituents, the majority of them have no idea that we have radon and no idea about statistics.
When I go to a doctor's office, I see brochures about doing the PSA test or about checking my heart. I've never seen a brochure about checking my home for radon. Do you have any comments on that?
Tom Kosatsky
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Tom Kosatsky
2015-06-18 17:25
Both Health Canada and the BCCDC have encouraged doctors—those of us in British Columbia and Health Canada across the country—and have had awareness campaigns for physicians. We have issued pamphlets to physicians and have put it in the medical literature. Doctors can help with this, especially if their patients are smokers or live in high radon areas. They can do a lot to encourage people to do something to protect themselves from lung cancer. We could all do more, but we wouldn't need to do more if we'd build it out in the first place.
Jürgen Rehm
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Jürgen Rehm
2015-05-26 16:41
Thanks a lot for allowing me to present the point of view of the Centre for Addiction and Mental Health, the largest hospital for psychiatric illnesses.
I would like to start with a definition of “addiction” since we were asked to talk about addiction. Usually this term comprises substance use disorders, but also more recently it has been expanded to gambling and gaming disorders. For example, the DSM-5 and the current proceedings of the ICD-11 will also include something to that degree.
If you look into those addictions, and we take the full spectrum of addictions, we have to say that alcohol use disorders are the most prevalent of the addictions. There is a question mark here with tobacco use disorders, because they're usually not assessed in general population surveys like the CCHS. If you go into how many people are actually concerned with addictions, alcohol again is also the highest. About 1 in 20 men in Canada—and that's of all age groups—would have alcohol use disorders, and it's 1.7% for females.
The second most important addiction would be cannabis use disorders, and all other drug addictions would be about half of cannabis, at about 0.7%. Again, the usual prevalence is higher for men compared to women by a factor of 2:1 for most of those addictions.
In terms of harm, we do have a lot of disorders resulting from the legal substances that are associated with far more [Inaudible—Editor] in terms of mortality and morbidity, but also disability, than the illegal substances, and all of those addictions have a pattern of high comorbidity with other mental disorders. This means we usually have comorbidities with mood disorders. About one in five people with addictions would also have a concurrent mood disorder, and if you go into generalized anxiety disorders, it's about one in ten. Mood disorders, of course, would be what we would normally call depression, and they include a whole number of psychiatrically defined depressions.
Now to your questions with regard to the mental health strategy and how addictions are treated, addictions overall are covered by the mental health strategy, and there are a lot of very important things to be said about them. But if you look into the practice and if you look into the national policies and the strategic approaches, we see that a lot has been regulated by the national anti-drug strategy of the Government of Canada, and that leads to a conflict of objectives and a conflict of different overarching approaches.
When we look at the national anti-drug strategy we welcome the recent addition of non-medical use of prescription opioids and non-medical use of other drugs as a good step. Part of that, as you heard in the first submission, of course is a result of addictions having been caused in part by the medical system.
The two most costly substances from both a health and economic standpoint, however, are tobacco and alcohol, and these remain completely outside the strategy. I would just mention again that gambling and gaming, although lesser in scope and money, are also outside of and not covered by the national anti-drug strategy.
Overall we would like stress that all addictions and substance use disorders should be a health issue, and substance use should be dealt with by a public health approach. That means we should have a four-pillar approach for illicit drugs, prevention, harm reduction, treatment, and enforcement. The same is true for legal drugs.
We also have to state that the current approach to illegal drugs in Canada is overly enforcement focused. That means that if we look into the balance between a four-pillar approach and the current Canadian approach, we have an emphasis on enforcement, both in terms of money spent and the overall efforts of society. We would like to add to this a harm reduction approach, which is currently missing altogether. The more Canada can shift its overall approach into the public health sphere, the better our chances are for reducing the overall harm.
For the first point, I would like to summarize that addictions in Canada should be addressed through a public health approach, more or less in the way we have seen it in the mental health strategy. If we go into this public health approach, we would have to change some of the things in the national anti-drug strategy, but it would be rewarded by better strategies for tackling addictions and reducing the harm related to addictions.
For the second part of my submission, I would like to look at the stigmatization issue. You've asked specifically about stigmatization for addictions, and unfortunately addictions are very stigmatized in our society. We are not alone in the world. Addiction issues are the most stigmatized mental disorders in all high-income countries, in North America, Europe, and Japan.
From surveys, we know that while the overall stigma associated with mental health has been reduced over the past decades, for addictions this is unfortunately not the case. People with addictions are seen as unpredictable and dangerous. The overall causal attributions that are made see them as not being morally intact and as responsible for their own addictions. This, of course, makes a problem not only for the people afflicted with addictions, but also for the health care system in total because it is leading to the lowest treatment rates of all mental disorders.
While the treatment rates of mental disorders are still below the treatment rates of somatic disorders, among the mental disorders, addictions stand out. For example, in people with alcohol use disorders, only one out of ten in Ontario would get adequate treatment, and would be treated.
Contributing to that is our tendency to see the world in black and white, usually as dichotomous people with having or not having a disease, and not as a continuum. The problem of this dichotomous approach, of not seeing addictions as heavy use over time, as one end of a continuum—which we all share—is leading to these people being more stigmatized and more outside of our society. As a result, they do not seek treatment because they do not want to open themselves up to admitting that they're addicted. That leads to problems in the whole health care system, both in primary health care and in specialist health care.
Stigma interferes with a seamless continuum of treatment, and this is part of what is currently plaguing addictions.
I will remain here. I have 10 minutes, and I have used the 10 minutes, and I would like to just summarize.
All addictions should be seen as a public health problem and should be dealt with from a public health perspective. Stigmatization is one of the major barriers not only for mental health in general but also for addiction specifically.
Thanks a lot.
View Rona Ambrose Profile
CPC (AB)
Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, Vanessa's Law. Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
Vanessa's Law, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in Vanessa's Law, we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
John Dalrymple
View John Dalrymple Profile
John Dalrymple
2015-05-04 15:47
Thank you very much. I really appreciate being here. I'm here representing Canada's National Ballet School. Our major funder is the Department of Canadian Heritage, so we're very happy to be at this table today.
The ballet school has been around for 55 years. We're basically committed to the idea of demonstrating the relevance of dance to every individual in Canada. Dance improves quality of life, it improves health, it has emotional and cognitive benefits, whether you're watching it or doing it. Our principal role in that process, and it has been this way since the founding of the organization, has been to train Olympic-calibre young people to become the great performers and stars of tomorrow, and that remains a steadfast principle of the school.
Something that has been significant for us as we've been moving forward thinking about the future of our art form and the future of our organization is how do we demonstrate that relevance more broadly? Typically, you have a small population of individuals who have been exposed to dance at a young age, and those are the people we're relying on to become the audiences of tomorrow, so we wonder about the rest of the young people in Canada, and what about the rest of the aging populations in Canada for whom dance can also be a significant benefit?
We started a program called Sharing Dance, and that's really what I want to talk about in my presentation today. Sharing Dance is an umbrella program that has three streams. Stream number one is designed for young people. What it really does is to support school teachers in the public school system across the country, delivering the curriculum that is already in the physical education curriculum, and it's related to dance. When I was a kid—and it's still the same in many schools today—you did lane square dancing for three gym classes, and that was about it for your exposure to dance. The reason is because there are very few dance specialists in your average public school. It is part of a larger physical education curriculum, so we feel we have a role to play in helping teachers bring more dance into the classroom.
Our second stream deals with aging populations. There are brain issues that come with aging that are dramatically impacted by regular activities related to specialized dancing, specifically a Dancing With Parkinson's program that we've been running at the school.
The third stream is something called Sharing Dance Day, which is an opportunity to give a very accessible fun dance routine to the whole community that both of these streams can participate in, and anyone else who is involved. Once a year we have a multi-generational celebration of dance in Canada, and as we build towards 2017 our goal is to have a million Canadians involved in this program over the course of the 150th birthday year.
Sharing Dance addresses major social issues. I think that's an important thing for any art style or any arts sector to look to do. It's not enough to say fund the arts for arts' sake. We really need to look at what some of the broader issues are in society. Childhood obesity and a lack of physical activity are major priorities for most Canadians. There's a lack of resources for arts, dance, and even physical education activities in most public schools. They're all on the decline. The emotional health of our young people is something people are concerned about. Then the issues that come with aging, as we have a baby-boom aging population, is another priority for Canadians. We believe that efforts to get dance in the community can impact all of these things positively.
For the remainder of my presentation, I thought I would tie what I have to say to the points that were given to me in the outline for this appearance.
To start with, you were looking for feedback on how dance can define and express various aspects of Canadian culture. We know from the programs we deliver in the school systems, that some students can't express themselves in English as they would like. The good thing about dance is the way that it's inclusive, so it lets them experience a more level playing field with their classmates. That applies as well to students who have significant physical challenges or mobility issues.
Kids have an interest in dance, often from their cultural background, and giving kids more opportunities to dance in the classroom allows them to tap into that. Dance really celebrates our differences, but also highlights our sameness at the same time, because while the styles of dance may be different from different cultures, we all tell the story the same way.
Another question we wanted to address was how young Canadians, in nurturing and developing their physical and musical skills, can benefit from dance. You were looking for information on the health benefits of dance specifically. Well, dance is an excellent form of physical activity. There probably isn't another art form that has the same level or quality of physical activity connected to it. In fact, there have been studies done at the Arizona State University, as well as the National Cancer Institute in the United States, showing that the metabolic equivalent intensity levels of dance as delivered in a classroom context often exceed the vast majority of any other typical source of classroom activities, including playing hockey, basketball, baseball. So we're looking at an activity that has all the emotional and cognitive benefits that come with an art form but, in fact, have superior physical benefits to those we've been traditionally relying on in the school system. Those mental and emotional benefits are incredibly significant.
We acknowledge that kids today are dealing with a great number of complex stresses, and having the ability to foster social skills and emotional well-being through a creative activity is something that's really important. Also, having that specialty so we can give that back to the community is significant for us as a large arts organization.
The last piece I'd like to say about that is that about 15% of Canadian kids get access to dance through recreational activities their parents pay for. But that means 85% of kids are getting access to formal dance activities only through the school system. So we think this is a huge opportunity to really make an impact.
In terms of the impact on local economies, really, in a nutshell, we're looking at building the audiences of tomorrow. There's no way you can expect somebody to really care about dance performed at the most avant-garde, creative, or high ballet Olympic level if they've never been exposed to it as a child. It's fundamental and there's tons of research to demonstrate that.
So we feel that investments to get dance activities to kids are huge for the future of our art form. We are also looking at programs through which we can identify specific kids with real leadership ability and provide immersion experiences for them.
In terms of how the government supports dance in Canada, as I mentioned, 10% to 15% of Canadian youth are in formal programs. As the largest dance training organization, we recruit from that small slice of actually engaged dancers every year to join our professional ballet program. So, there are really untold numbers of kinesthetically gifted youth, with the potential to have amazing dance careers, who are yet to be discovered because they haven't been exposed to the art form yet. The great thing about it is that while this might help us find more Olympic-calibre amazing dance artists in Canada, this creates an opportunity for all Canadian youth to enjoy these benefits.
In terms of encouraging our dancers to stay in Canada, I think if you go back to the argument of building a really strong audience for tomorrow, then there will be more artists who stay in Canada. Many dancers go to Europe because their work is valued there more often than it is valued here. I think funding in these programs to demonstrate the relevance of dance more broadly will make that value emerge here in Canada.
Finally, we're looking for information on how we can assist dancers who are recareering. Also, as the organization that runs the largest teacher training program for professional ballet teachers as well as recreational teachers in Canada, we know that the opportunity to expose more youth to dance will actually build and support a larger recreational dance community, providing more teaching opportunities and more jobs for dancers as they recareer.
I'm happy to answer any questions, and thank you again for the time.
View Stéphane Dion Profile
Lib. (QC)
Thank you, Mr. Chair.
Thank you, Mr. Dalrymple.
Ms. Bowring, Mr. Lemay and Mr. Hunter, I would like to thank you for providing us with a very good overview of the situation.
However, if I used my seven minutes to ask you to describe the film, what kind of presentation you would have made, all three of you, five or 10 years ago? What has changed? Where would we be in five or 10 years from now if we continued to apply today's policies? It would be very helpful for the committee to hear what you have to say about the situation historically and as it is now.
Mr. Lemay could start.
John Dalrymple
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John Dalrymple
2015-05-04 16:15
I would follow up on the digital piece. I think that's usually significant. I see it as an opportunity for this sector. We know that people who visit a website to watch cultural content online are twice as likely to buy a ticket for it later. So in terms of that audience development piece, the digital thing is essential. For young people it's even more pronounced. We're immigrants in the digital world, but they are the natives. We need to make sure that we're investing and providing quality content and programming in that digital sphere, because that's where we will find the young people, and the scalability that comes with that is significant. It's one thing to get bums in seats of a certain sized house, but it's another thing to actually think about delivering programs to thousands or millions of people. You can do that with digital technology.
The public health element is something that wasn't well recognized or talked about five years ago either. We at the National Ballet School are getting a significant amount of interest from potential funders and partners who would never have thought of partnering with us, like Canadian Sport for Life and the Public Health Agency, all because of the really strong arguments we can make for dance as something that's good for emotional, mental, and physical health.
The last piece is accessibility. We need to look at dance as a physical art form, but there are ways we can create quality dance activities for anybody, regardless of their state of health or physical mobility. These issues are more significant now than they were five years ago.
Anthony Miller
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Anthony Miller
2015-04-23 15:34
Mr. Chair, members of the committee, thank you very much for giving me the opportunity to present on Health Canada's review of the evidence for Safety Code 6, which I believe has led to unsafe conclusions.
I am a physician and epidemiologist specializing in cancer etiology, prevention, and screening. I have performed research on ionizing radiation and cancer, electromagnetic fields and cancer, and other aspects of cancer causation. I have served on many committees assessing the carcinogenicity of various exposures, including working groups of the International Agency for Research on Cancer, commonly known as IARC, of which Canada is a member. I was the first Canadian member of their scientific council.
I was a visiting senior scientist in the monographs program in IARC in September 2011 until January 2012, where as part of my duties I reviewed the scientific literature that was used by a working group to designate radio frequency fields as a class 2B carcinogen, that is, a possible carcinogen. I was also one of the peer reviewers invited by the Royal Society of Canada to review the draft report of the Royal Society panel on Safety Code 6.
I have a number of concerns over the documents that have recently been released by Health Canada on Safety Code 6 and the document called “Rationale”. What Health Canada has said in its latest iteration of Safety Code 6 is that it should be distinguished from some municipal and national guidelines that are based on socio-political considerations. I find that a strange statement because it seems to provide no room for emerging evidence on health hazards, which surely should be considered if the safety of humans is the objective.
Since the IARC review, which identified radio frequency fields as a possible human carcinogen, there had been a number of studies that have been reported. In my view—and that of a number of colleagues who've written a couple of papers with me on this issue, one of whom will present to you next week—these studies, we believe, reinforce the evidence that radio frequency fields are not just a possible human carcinogen but a probable human carcinogen, putting it in the category 2A. It would be impossible to ignore such a hazard in regulatory approaches.
One of the most important was a study in France, a large case-controlled study, which found a doubling of risk of glioma, the most malignant form of brain tumour, after two years of exposure to cellphones. After five years it was five times the risk. They also identified the fact that in those who lived in urban environments, where there are probably a number of other carcinogens that could impact upon brain tumours, the risk was even higher.
That brings us back to Safety Code 6 and the document that Health Canada contracted to produce a review of the evidence. This was the document produced by the Royal Society panel. I feel that panel was conflicted. As you probably know, the chair changed and the panel had insufficient expertise in epidemiology. My friend, Paul Demers, was called in to be chair of that panel. I believe he presented to you fairly recently. I feel he was put in an impossible situation.
If you read that document carefully, it says that the panel did not have adequate time to do a full review of the data, they therefore relied on reviews of other people and they did not do a detailed evaluation of the studies. That led them, I believe, to false conclusions.
It's important to recognize that there are no safe levels of exposure to human carcinogens. Although risk increases with increasing intensity of exposure, and for many carcinogens, such as tobacco smoke, even more with increasing duration of exposure, the only way to avoid the carcinogenic risk is to avoid exposure altogether. This is why we tend to ban carcinogens from the environment. Asbestos is one particular example of why much effort is taken to get people, particularly young people, not to smoke. Further, we now recognize that people vary in their genetic makeup, and that certain genes can make some people more susceptible than others to the effect of carcinogens. It is those who are susceptible that safety codes should be designed to protect.
As an epidemiologist who has done a great deal of work on breast cancer, one of the most concerning factors that have come to light is a series of case reports, starting with some reports from California and recently with the identification of a similar case in Saskatchewan. In all, there are now seven case reports of women who developed unusual breast cancers in the exact position where they kept cellphones in their bras. These are unusual tumours. They're multifocal, which means they occur in several places. They seem to mirror where the cellphone was being kept. The radiation from the cellphone seems to have increased in these women the risk, which they presumably already had, of developing breast cancer. They were all relatively young women. This is a most unusual occurrence that must concern us greatly.
We have brain cancers and parotid gland tumours, which are tumours of the salivary gland. There have been several instances of people who have developed this. In Israel recently a study identified increasing risk of these cancers, particularly with increasing exposure.
Given the long natural history of cancer and the fact that human populations have not been exposed for a sufficient length of time to exclude a carcinogenic effect, it is in my view extremely important to adopt a precautionary approach to the exposure of humans, particularly children, to radio frequency fields. We should note that an individual, if appropriately informed, can reduce their exposure to radio frequency fields from devices that use Wi-Fi, but in the case of cell towers and smart meters, the exposure they receive is outside their control. Then, with the people who manufacture these devices and those who promote Wi-Fi in all sorts of instances, we're reaching a situation where homes are being saturated with radio frequency fields.
It will be very difficult to prove conclusively an effect. Spread over a large population, if the normal occurrence is relatively rare—and it is relatively rare for brain tumours to occur—even if you double the risk, triple the risk, or even quadruple the risk, it will be difficult to identify that precisely. We need to do these studies.
In the meantime, to avoid a potential epidemic of cancer caused by radio frequency fields from Wi-Fi and other devices, we should strengthen the codes that are meant to protect the public. In my view, Health Canada has not done an adequate job. Safety Code 6, in its current iteration, needs to be re-revised.
I thank you, Mr. Chairman.
Frank Clegg
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Frank Clegg
2015-04-23 15:45
Mr. Chair and committee members, I'd like to thank you for the invitation to speak with you this afternoon and for deciding to invest committee time on Safety Code 6.
When I ran the Canadian operations for Microsoft, I learned that it is critical to focus on process. Today, as a board member for Indigo Books and Music, my role has shifted more towards governance and oversight. In both roles, process is critical to success. Government is the largest corporation of all, so process is of paramount importance. As someone who regularly examines success and failure, I believe I can explain why the Safety Code 6 process is a failure by all metrics and has left Canadians unprotected.
There is a book written by Nassim Taleb called The Black Swan, a focus on very low-probability, high-impact events that aren't supposed to happen. Oil spills, train derailments, and airplane crashes are some of the events in this category. Taleb calls these “black swan” events.
If one decides that all swans are white and refuses evidence of black swans, then one will conclude that all swans are white. Black swans are rare, but they do exist. Unfortunately, experts convinced themselves that these events had zero probability. They did not plan appropriately and people died.
The American Academy of Environmental Medicine is an international organization of physicians and scientists that has predicted, among other things, the rise in multiple chemical sensitivity, which is now protected in many public policies. Regarding the unprecedented increase in wireless devices, the academy forecasts “a widespread public health hazard that the medical system is not yet prepared to address”.
I believe Health Canada's analysis focuses on identifying and counting white swans, while ignoring black swan evidence. Health Canada's representative informed this committee on March 24:
...some of these studies report biological or adverse health effects of RF fields at levels below the limits in Safety Code 6, I want to emphasize that these studies are in the minority and they do not represent the prevailing line of scientific evidence in this area.
In other words, black swans exist.
In your handout—I don't know if you have it, as we put it in for translation—is a document entitled “Analysis of 140 Studies Submitted by Canadians for Safe Technology (C4ST) During the Public Comment Period on Safety Code 6”. A chart in that document shows that Health Canada accepts that there are in fact 36 studies all passing Health Canada's quality criteria showing harm at levels below Safety Code 6.
As a Canadian, I find this confusing. As an executive, I find it inexcusable.
Of the 36 studies Health Canada deemed satisfactory, cancer is linked in six of them. In 13 of them, the brain and/or nervous system is disrupted. In 16 studies, Health Canada admits that biochemical disruption occurs. Finally, seven high-level scientific studies indicate an effect on intellectual development and/or learning behaviour. All of these studies show impacts with radiation below Safety Code 6 limits. How was this black swan evidence evaluated?
In our two-year investigation, C4ST has determined that Health Canada doesn't even have the proper software required to access, summarize, and analyze the large number of relevant studies. If our group of learned and qualified volunteers can uncover 140 studies, how many more are being missed or ignored?
Health Canada references its weight-of-evidence approach. It is unclear how many studies you need to outweigh 36 studies that show harm, especially to children. I just can't fathom why Health Canada is not highlighting these studies and prioritizing their implications. Despite requests to publish the weight-of-evidence criteria as per international standards, Health Canada refuses to do so. Even the recent 2015 rationale document does not provide this critical information.
Health Canada dismisses scientific evidence unless it shows harm where the microwave levels are strong enough to heat your skin. The notion that microwaves are not harmful unless they heat your skin is decades out of date. The core premise of this white swan dates back to Einstein's theory that non-ionizing radiation cannot cause harm, or if it does, it must heat tissue to do that. Albert Einstein passed away the same year Steve Jobs was born. To think that science has not evolved since then is classic white swan thinking. It's part of a process predetermined to fail.
Health Canada says on its website today that there is no chance that Wi-Fi or cellphones can harm you because it has studied all the science, but when pressed under oath, Health Canada officials give a more fulsome answer. In Quebec Superior Court in September 2013, Health Canada senior scientist James McNamee admitted that Health Canada only assesses risk based on the thermal effect, i.e., the heating of tissue.
Unfortunately, Canada has not invested the necessary time nor had the balanced opinion of experts necessary to undertake a proper review. Our research has uncovered that the Health Canada author of Safety Code 6 has published papers demonstrating his bias towards this topic.
In a few hours over three days, this health committee has spent more time speaking with scientific experts who believe there is harm from wireless radiation below Safety Code 6 than all of Health Canada combined. You can't find black swans when you don't talk to the experts who've identified them.
There is a fundamental business rule: you can't manage what you don't measure. It is clear that Health Canada not only doesn't follow that rule but even resists it. A memo obtained under access to information to the Minister of Health in March of 2012 revealed that Health Canada “does not support the recommendation to establish an adverse reaction reporting process specifically for RF exposures”. The memo goes on to state that “consumer complaints...may be directed to...the web-based system...under the...Canada Consumer Product Safety Act”. This is an inadequate solution and, I believe, a missed opportunity.
I refer you to the C4ST fact sheet. I think you have it. I'd like to highlight three examples from that fact sheet: Health Canada's Safety Code 6 is among the countries with the worst guidelines in the world; Canada has fallen behind countries such as France, Taiwan, and Belgium in protecting Canadians; and finally, Health Canada wasted over $100,000 of taxpayers' money, as the Royal Society report is not an independent review.
Health Canada also states that Safety Code 6 is a guideline and that other organizations at the provincial and local levels of government are free to implement lower levels as they see fit; however, that's not the reality of what happens. We have witnessed school boards, power and water utilities, Industry Canada, and manufacturers depending on Health Canada's analysis, and frankly, abdicating to it. They don't perform their own analysis.
Safer solutions exist. There are several situations in Canada regarding cell towers where the proponents have voluntarily offered to restrict radiation exposure, in some cases to thousands of times less than Safety Code 6. There is a solution in Iowa for smart meters that use a wired meter that provides a safer, more secure solution at a lower cost.
Given that our track record in North America is not successful regarding such products as tobacco, asbestos, BPA, thalidomide, DDT, urea-formaldahyde insulation, and many others, use of the precautionary principle of prudent avoidance should be recommended until the science proves beyond reasonable doubt that there is no potential for harm.
For the last three years, science has published a new study every month that shows irreparable harm at levels below Safety Code 6. That is why we're asking the committee to take three decisive steps.
First, conduct a national campaign to educate Canadians about methods to minimize exposure to RF radiation, ban Wi-Fi in day care centres and preschools, and ban the marketing of wireless devices to children.
Second, protect individuals who are sensitive to RF radiation by accommodating them with safer levels of wireless exposure in federal workplaces and federal areas of responsibility.
Third, and finally, create an adverse reporting system for Canadians and a publicly available database to collect improved data regarding potential links between health effects and exposure to RF radiation.
Parallel to the above, recommend that Health Canada conduct a comprehensive systematic review, subject to international standards, regarding the potential harmfulness of RF radiation to human health, with a scientific review panel that is balanced in opinion. It was a textbook case of black swan thinking that has led to this failure of Safety Code 6.
In conclusion, C4ST volunteers found 36 black swans that Health Canada agrees are high quality. How many would be available if Health Canada sincerely looked? Better yet, how many black swans will it take before Health Canada takes serious actions? Thank you very much.
Magda Havas
View Magda Havas Profile
Magda Havas
2015-04-23 15:55
Thank you very much for the invitation to address you today. My name is Dr. Magda Havas and I'm an associate professor of environmental and resource studies at Trent University in Peterborough, Ontario.
For the past 25 years I have been teaching university students about the biological effects of electromagnetic fields and electromagnetic radiation, which are collectively referred to as “electrosmog”. It is my belief that electrosmog is the emerging public health issue, due largely but not entirely to the rapid proliferation of wireless technology. Concern among health care practitioners and the public is growing as chronic illness increases and health care costs rise.
Since 2000 I have been invited to give more than 300 lectures at medical conferences, at universities, to congressional and Senate staff in the United States, and to community groups concerned with Wi-Fi in schools and antennas in their neighbourhoods. In 2002 Charles Caccia invited me to present to the environment committee of the House of Commons. In 2010 I appeared before the HESA committee to discuss the very same issue we are discussing today. In 2013 we presented to the Canadian Medical Association and the Royal College of Physicians and Surgeons about the harmful effects of electrosmog and the need for public protection.
I began my career as an environmental toxicologist in the mid-1970s, and the emerging issue at that time was acid rain. I was one of the scientists who studied the damage that acid rain does to forests and lakes. My peer-reviewed, published research and that of other scientists helped bring in clean air legislation, referred to as the acid rain accord, signed into international law by Prime Minister Mulroney and President Bush in 1991. This accord guaranteed cleaner air and a healthier environment for millions of Canadians and Americans, and protected our aquatic and terrestrial ecosystems.
We need similar steps to be taken for electrosmog legislation. That accord was due to the work of the Canadian Coalition on Acid Rain, federal and provincial ministers of the environment like Charles Caccia and Jim Bradley, and a large number of scientific studies from eastern North America and north-central Europe. The accord came 15 years after my studies on the effects of acid rain began. We were able to get clean air legislation because members of Parliament based their policy decisions on the science and not on misinformation provided by industry representatives.
At that time, acid rain was not taken seriously. Industry scientists repeatedly claimed that acid rain did not exist or was natural, and was not responsible for the loss of fish and the death of trees. This denial of a problem is common in health and environmental issues that have financial consequences for those generating the pollution. We have seen it with asbestos, DDT, lead, cigarettes, and now electrosmog.
Today I find myself in a situation similar to the one I was in with acid rain. We have industry scientists who repeatedly claim that electromagnetic pollution does not cause cancer or adverse effects on health. These wireless industries are able to hide behind Health Canada's Safety Code 6, which affords more protection to them than to the public.
Schools that have installed Wi-Fi, the telecommunications industry that installs antennas on hospitals and in residential communities, and provincial and municipal governments that do not have expertise in this area, all hide behind Health Canada's Safety Code 6, with the false perception that they are being protected. What they don't realize is that this guideline was designed to protect military personnel from heating of tissue averaged over a six-minute period. It was not intended to protect the infant in the crib lying next to a wireless baby monitor that emits microwave radiation for 12 hours a day.
The science that I teach dates back to the 1940s, when U.S. Navy labs documented illness among radar equipment operators. Back then it was called microwave illness. Today it is called electrohypersensitivity. Radar operators were made sick by the same frequencies later used for the microwave oven, which originally was called the radar range. The same frequencies are now used in Wi-Fi devices. We wouldn't want to live near a radar installation, yet we generate radar frequencies in our home with our wireless technology.
Symptoms of electrohypersensitivity include headaches, chronic pain, chronic fatigue, sleeping problems, difficulty concentrating, poor short-term memory, mood disorders including depression and anxiety, dizziness, nausea, and tinnitus. As many as 3% of the population, one million Canadians, have EHS symptoms that are so severe they are unable to function in our modern world.
Another 35%, 10 million Canadians, have mild to moderate symptoms. These symptoms resemble aging and I refer to electrohypersensitivity as rapid aging syndrome.
My research shows that radio frequency radiation from a cordless phone at levels well below 1% of Safety Code 6 causes an irregular or rapid heart rate in those who are sensitive. This is called tachycardia. In a few individuals, their heart rate increases from 60 beats per minute to 100 beats per minute while they're lying down on a bed without knowing whether the device is turned on or off. The tachycardia is often associated with anxiety. The feeling is that they are experiencing a heart attack.
Dr. Stephen Sinatra, an American cardiologist, believes that minor heart abnormalities, one of which is called Wolff-Parkinson-White syndrome, affects one in 700 children. Combined with exercise and exposure to microwave radiation, such as Wi-Fi or nearby cellphone antennas, this creates the perfect storm that could result in cardiac arrest.
The population in Ottawa elementary schools, with approximately 143,000 students, may have as many as 200 students who are at risk because of this particular heart effect if they have Wi-Fi in their school environment. In the early studies with radar operators, doctors recommended that workers be screened for heart irregularities before working with microwave radiation. Perhaps students should be screened before attending Wi-Fi-equipped schools.
As part of my research, I am trying to find biomarkers for electrohypersensitivity so that doctors can be better equipped to diagnose the environmental illness. So far we have found several—heart rate, heart rate variability, blood viscosity, sugar among diabetics, and muscular coordination problems with people who have multiple sclerosis. More biomarkers are needed. Unlike epidemiological studies that document an association between an agent and an outcome, our studies demonstrate a cause and effect relationship.
Experts who testify at hearings such as this have general or specific backgrounds in science or medicine. Those with a general background and no experience with their patients, or through their own research, are likely to provide misleading information. The reason for this is that we are going through a paradigm shift in our understanding of the relationship between electromagnetic energy and how the human body works.
We now recognize that our cells and organs communicate with each other using electromagnetic impulses rather than just chemical messengers. Any signal that interferes with that communication may adversely affect the health of individuals. The effects are a function of not only intensity, but also frequency modulation waveform.
What you see in front of you, in the bottom slide, is a picture of my blood under the microscope. The cells around.... A few are connected. Most of them are free. This looks like fairly healthy blood.
After I use a computer for 50 minutes, I get the blood you see in the top left-hand corner. The blood cells are sticking together. Ten minutes after using a cordless phone, my blood becomes very sticky, very viscous, and it doesn't distribute the oxygen in my body the way it should. This is one of the symptoms of electrohypersensitivity.
Doctors are not taught in medical schools about electrosmog, as it is a relatively recent problem, nor are they taught how to diagnose electrohypersensitivity. For them, this illness does not exist. When doctors can't identify an illness they often assume it is psychological. I have spoken to psychiatrists who tell me that they are regularly sent patients who have physiological problems and not psychological ones. Some of these people are electrically hypersensitive.
Industry scientists often refer to studies that report that subjects who claim to have EHS are unable to subjectively determine whether a device is on or off. They falsely conclude that this means the person is not electrically hypersensitive. The flawed assumption here is that perception is not necessary for a physiological action to occur and that reactions occur immediately. Neither are true.
We can be outside on a sunny day when the sun is not visible or hot and still get a sunburn. We do not perceive ultraviolet radiation. The sunburn develops over time. Sensitivity to the sun varies among individuals, as does electrohypersensitivity. Indeed, sensitivity to the sun is a good analogy for EHS. The longer you are exposed, the more severe the sunburn.
If you look at the 20 years it took for acid rain and the 50 years it took to address tobacco, the outlook for wireless technology is bleak. That's because it's not one culprit. There are many things in our environment that generate electrosmog.
The bottom line is that levels of microwave radiation are currently well above background levels and continue to increase as more wireless devices are brought to market. These levels, despite being below Safety Code 6, are adversely affecting human health. We can wait another five years, or we can take steps in the right direction to reduce our exposure. If we err, we should err on the side of caution.
I have a quick demonstration if you give me half a minute.
View David Wilks Profile
CPC (BC)
Thanks, Chair.
Thank you to the witnesses for being here. I'll share my time with Mr. Richards, because he has to leave here after the first hour, I believe.
You perked my interest when you said police officers and radar because I did that for a year and a half.
Professor Miller, you mentioned in your opening remarks that an opportunity to provide greater safety to the public has been missed. You did explain a bit about it, but I wonder if you could articulate a little more on what we've missed and what we could move forward with in respect to recommendations to Health Canada and to the minister.
Anthony Miller
View Anthony Miller Profile
Anthony Miller
2015-04-23 16:15
When I think about Health Canada, I'm not saying this committee has missed. What Health Canada has missed is a proper scientific review of the data that would convince them—and I don't understand why they haven't been convinced—that the limits they have placed in their advisory limits are not sufficiently safe to protect the population. That's why I believe an opportunity to protect the population, and potentially to prevent a major cancer problem in the future, has been missed by Health Canada.
Dariusz Leszczynski
View Dariusz Leszczynski Profile
Dariusz Leszczynski
2015-04-23 16:41
Thank you very much.
Thank you for inviting me to this hearing. It's an honour and a pleasure.
My name is Dariusz Leszczynski. I'm currently adjunct professor for biochemistry at the University of Helsinki, in Finland. I have done research in the area of biological and health effects of cellphone-emitted radiation since 1997. I was a member of the expert group of IARC, which in 2011 classified cellphone radiation as a possible human carcinogen.
When scientific evidence is unclear, contradictory, or ambivalent, careful and unbiased interpretation of it is of paramount importance. However, it is often the case that such scientific evidence gives room for a diverse interpretation that may lead to the development of contradictory expert opinions, causing confusion and impairing development of rational recommendations aimed at protecting the general population.
This is the current situation in the area of cellphone- and wireless communication-emitted radiation. Unclear experimental evidence leads to the polarization of the scientific opinions into two extremes: the no-effect opinion and the harmful-effect opinion. Currently scientists do not agree on the matter of biological and health effects of radiation exposures. The term “consensus” might be be misleading for the general public. We should rather speak about “differences in scientific opinion”.
A recent comment by the head of the World Health Organization's EMF project, Dr. Emilie van Deventer, well describes the current situation, and I will quote her comment given for The Daily Princetonian, “There is no consensus, it’s true. There’s a big group and a little group, but it’s still two groups.”
Talking about a big and a small group is a pure speculation because the size of the groups was never examined. From my nearly 19 years of experience in this area of research, I know that the vast majority of the scientists do not openly take a side in the debate.
The interpretation of scientific evidence by committee is of most use for the decision-makers. This is the reason that the development of unbiased opinions by committees are of paramount importance. Opinions of committees are defined by the expert composition. In an ideal committee, experts would not have conflict-of-interest issues and would be independent of any kind of lobbying; only science would matter. Nearly all of the committees dealing with the health effects of radiation emitted by wireless communication devices have a problem of biased expert selection, a potential conflict of interest, and a potential influence by an industrial lobby, which may occur in spite of set-up firewalls.
The majority of the committees consist of scientists having the same expert opinion. Individual committees experts commonly do not reflect all current scientific opinions. This concerns both international committees and national committees. This includes the committee in Canada that provided evidence for Safety Code 6. The composition of the Health Canada expert committee was clearly biased towards the no-effect opinion, and some of the experts are known to advise the telecom industry. This is a serious potential conflict of interest.
The above-mentioned system of firewalls to protect experts from influence of industry doesn't work. Industry sponsors know who receives funding; sponsored scientists know who provides funding. This is especially worrisome when the influential ICNIRP committee is in part funded by the industry through firewalls of the Royal Adelaide Hospital in Australia. The same goes for the EMF project of the WHO. If your experts know very well that the opinions of ICNIRP will be unfavourable for the telecom industry, their sponsorship may end. The firewall is only a gimmick.
Currently, WHO's EMF project is preparing an evaluation of the scientific evidence concerning health effects of radiation emitted by wireless communication devices, the so-called environmental health criteria for RF-EMF. The major problem with the draft document of environmental health criteria is the lack of balanced presentation of the scientific evidence. The environmental health criteria draft was written solely by scientists with a no-effect opinion.
The environmental health criteria document will have a global impact on billions of users of wireless technology and on the multi-trillion dollar business. This is why it is disturbing that preparation of such a document is solely reflecting opinions of ICNIRP, an organization with a firm, single-sided, no-effect opinion. This is a disturbing situation, where one group of scientists was given preferential treatment only because of their close link with the WHO and where other relevant expert opinions were deliberately and arbitrarily excluded without scientific debate.
Recommendations for decision-makers developed by committees, where memberships are consistently biased towards either a no-effect opinion or harmful effect opinion, are not representative of the whole currently available scientific evidence and should be viewed with extreme caution, or outright dismissed, until the proper, unbiased evaluation takes place.
To my knowledge there was only one scientific committee—IARC's working expert group in 2011, of which I was a member—where the full scope of diverse scientific opinions were represented. IARC classification completely disagreed with one-sided opinions of the majority of international and national committees, including Health Canada. Until an unbiased, round table of scientific debate takes place, where all scientific opinions will be duly represented and evaluated, the opinions developed to date by various international and national committees, based on biased expert selections, should be dismissed by decision-makers as insufficient.
According to year 2000 documents of the European Union on the precautionary principle, there are three criteria that need to be fulfilled in order to implement the precautionary principle. All of them are currently fulfilled.
Number one, scientific information is insufficient, inconclusive, or uncertain to make a firm decision. This is exactly what the IARC classification says on cellphone radiation as a possible human carcinogen, group 2B.
Number two, there are indications that the possible effects to human health may be potentially dangerous. Increased risk of brain cancer in long-term, avid users is a dangerous outcome, shown by three replicated epidemiological studies: European INTERPHONE, Swedish Hardell group, and French CERENAT studies.
Number three, the effects are inconsistent with the chosen level of protection. Epidemiological studies showing an increased risk in long-term, avid users were generated in populations using regular cellphones meeting all current safety standards. This means that the current safety standards are insufficient to protect users because the risk of developing cancer increases in long-term, avid users.
Proponents of the precautionary principle need to understand that precaution does not equal prevention of use of wireless technology. Requirements to develop more efficient, less radiation-emitting technology, and further biomedical research on the radiation effects, will create new knowledge through research and will create jobs in the research and technology. Implementation of the precautionary principle will not prevent technological developments. Claims by some that the implementation of the precautionary principle will cause economic stagnation are unfounded.
In the current situation of inadequate review of scientific evidence by groups of scientists with biased selection of members, and until the round table, unbiased review is performed, decision-makers should implement the precautionary principle. The reason is not that the harm was proven beyond doubt, but because the harm is possible and evidence is uncertain and suggesting that harmful health effects are possible. The precautionary principle was developed just for such situations where scientific uncertainty with concomitant indications of possible harm requires society to wait for more scientific evidence. Saying, “Better to be safe than sorry” applies here.
Thank you.
View Hélène Laverdière Profile
NDP (QC)
I think this is key.
Mr. Morley, I did not get a chance to ask what your opinion is on the need to help build public health systems. Do you have any comments on that?
David Morley
View David Morley Profile
David Morley
2015-04-23 12:31
You had mentioned Ethiopia and I think in the health system in Ethiopia, which is one that UNICEF and the Government of Canada and the Government of Ethiopia have worked on a lot, they have been training and equipping community health workers who go out around the country. There are two things I think in the kind of big picture that we see where this works. Three years ago in the Horn of Africa there was a famine. There was a famine in Somalia and there wasn't in Ethiopia. Why? Ethiopia had that grassroots.... It is the same climate, they're next to each other, but the health system in Ethiopia worked. Two months ago when Bill Gates was here I was part of a small meeting with the minister and some other NGO people. His comment was about Ethiopia—he didn't know that you were going to say this—but Bill Gates said that if Ebola had hit Ethiopia there would have only been one case because they have a strong health system that's out into the communities.
Helen Scott
View Helen Scott Profile
Helen Scott
2015-03-31 11:19
Thank you, both of you. Those were excellent. It's tough shoes to follow such eloquent speakers, but I want to start just by saying thank you to all of you. I know of your work and of your leadership and your roles. I'm very grateful, as a Canadian mom, for your focus and your energy. I've had a chance to travel and work with some of you more closely and I'm very, very grateful for how hard you work.
I'm privileged to have the opportunity right now in my career to coordinate the efforts of the Canadian Network for Maternal, Newborn and Child Health. This is a partnership of over 80 Canadian organizations focused on maternal, newborn, and child health. My colleagues here at the table sit within the network, so we speak from a common voice in many ways. Our organizations work in over 1,000 regions around the world to improve the lives of women, their newborns, and their children. We were officially created in 2012, shortly after the launch of the Muskoka initiative.
We have three key objectives.
The first is we know that we need to do a better job of being accountable in measuring results. We focus on working with our partners to make sure that we're doing the best possible job of measuring our impact and our outcomes and really tracking where the investment dollars are going, so that we know whether we're doing the best possible job we can with the limited resources that we have.
Our second key objective is to exchange knowledge. We're focusing on measuring results. We're looking to see what the best way to address these causes is, and we're taking that information and making sure that we share it with each other. There's no one in the network who doesn't know that they need to have vitamin A capsules in their implementation programs. I'm not sure five to ten years ago if that was the case.
Our third component is to engage stakeholders. We know that we can't do this alone. We know that through the network, the increased collaboration across sectors has shown itself to be very effective and efficient, so we look to engage more Canadians to join us in this effort. In addition, our experts look for opportunities to advise and inform the Canadian government in their investments.
On that note, I just want to say Canada got it right in 2010 when maternal, newborn, and child health was prioritized. Given the tremendous progress today and what work remains, we know that it's imperative to women and children around the world that this effort continue. We know that improving maternal, newborn, and child health—and Joel has articulated this so well—is foundational to economic growth, to political stability and human security, and it's a critical component of child protection.
I know that you've heard from many of our partners in the past meetings here at the standing committee. I think one of the key messages that they've shared with you is there's no silver bullet on child protection. It's going to require a multi-sectoral and multi-faceted approach. Even though I'm going to speak about one element of that approach, focusing on health, I recognize that this is just one component, albeit a critical one, of the many necessary systems and structures that afford children the opportunity to survive and thrive. I think you had Peter Singer here a few weeks ago. Peter has coined a term that I love, and which I think needs to go in the dictionary, “thrival”. It's not good enough that children survive birth and survive their first five years, they need to thrive. I think that's what we're all focusing on. We're starting to see progress. The mortality rates are dropping around the world. We're starting to see this progress and now is the time that we really need to focus on making sure that these children thrive.
The efforts to improve global health rank among the greatest development achievements. Canada has played such an important role in shaping and supporting global initiatives that have made a significant impact, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Global Alliance for Vaccines and Immunisation, which vaccinates millions of children year, the Micronutrient Initiative which is another great example, and of course the Muskoka initiative. Launched at the G8 summit in 2010, the Muskoka initiative has contributed to substantial progress in improving the health of women, newborns, and children, including—and I think this builds nicely on what Joel just said—through galvanizing international support and commitments.
For example, Canada was a key leader in galvanizing support for the United Nations Secretary-General's global strategy for women's and children's health, which we call the global strategy. A recently published report on the global strategy highlighted it as the fastest-growing public health partnership in history, with 2.4 million women's and children's lives saved since 2010.
I want to stop for a minute. I'm a statistician by training and we throw around these big numbers and they don't mean very much to us. So just think of a child in your life who you love, and then think of 2.4 million children who are loved and whose lives have been saved since 2010. I mean this is phenomenal. This is something that we should be celebrating. It points to the fact that we know what to do, but we just need to dig in and get this work done.
Here we are in 2015. The world is at a critical juncture to achieving lasting progress in maternal, newborn and child health. To do so, political and financial commitments must be mobilized following Canada's leadership and our footsteps with the announcement of $3.5 billion in May 2014, just a few months ago.
The newly formed Department of Foreign Affairs, Trade and Development provides Canada with the unique opportunity to harness our foreign policy and trade tools to better achieve our development agenda. The multi-sectoral reach of the Canadian network positions us to make unparalleled progress on the ground. We're working with the academics, Canadian universities, Canadian NGOs, Canadian health professional associations, and with doctors, midwives, nurses, and surgeons who are working on the ground.
Together the Government of Canada and the 80 partner organizations of this network will bring a new level of rigour and commitment to seeing our shared aspirations achieved for mothers and children around the world.
Through increased global leadership, the international community can empower women and support increased resilience by strengthening health care systems, fighting infectious diseases, improving sexual reproductive, maternal, newborn, and child health, and ensuring that the unfinished business of the health-related millennium development goals are not lost in the transition to the sustainable development goals that we launch later this year.
We're proposing that Canada make the following commitments, and I should say Canada is so committed. This is a reiteration of some of the work that's already happening. We need to renew commitments and encourage the rest of the world to renew their commitments made under Muskoka and the global strategy for women's and children's health, such as through A Promise Renewed, the every newborn action plan, and Family Planning 2020, and make sure these commitments are met.
We need to welcome and support the renewed global strategy for women's and children's health to be launched in September 2015. We're calling it global strategy 2.0. We need to support the ambitious but achievable goal of ending preventable deaths by 2030 in the post-2015 negotiations and agree to tackle inequality by focusing on those groups that are furthest left behind. I think Caroline spoke so nicely to that.
We need to provide financial and non-financial resources to deliver the post-2015 framework and support countries to raise and spend greater domestic resources on universal public services, including the newly established global financing facility in support of every woman, every child program that will be launched at the financing for development conference in Addis Ababa in July 2015.
We need to deliver an ambitious commitment on aid expenditure in support of increased domestic resource mobilization and align the ODA for the health and rights of women and children, including through the global finance facility.
I want to mention accountability. We need to continue Canada's leadership role in accountability. We need to broaden and strengthen our established global leadership by championing simplified, harmonized maternal, newborn and child health accountability frameworks. Enhanced community basic accountability mechanisms and increased efforts to produce reliable disaggregated vital statistics are critical to strengthening health services delivery.
Vital statistics in civil registration is so boring. It's hard to make it sound interesting. It's critical because when you know a child is born, and when they're registered, that child counts. That child is counted. We can track services, we can track delivery, and we can track the children. That's critical in child protection. It encompasses all of the work that we try to do.
The last point I want to make is that—and I say this a bit humbly because I'm so fortunate to have this opportunity—I see how effective we can be when we work together and when we stop creating silos, have our universities working over here, our NGOs working over here, and we come together. I would stress that we bring together organizations across sectors with different expertise to facilitate their collaboration, especially in country, where, just using Canada as an example, different organizations are working in country and they really need to be collaborating. This is imperative for increased success.
We need to enhance and capitalize on partnerships between governments, civil society, local communities, health care professionals, academic and research institutions, multilateral organizations, global funds that exist, and the foundations. The media is critical as is the private sector in coming along on this journey.
Addressing the rights and needs of women and children is key to creating sustainable change and development. The last five years of the global strategy for women and children's health and the Muskoka initiative launched in Canada, with the hard work of many of you, has shown that well-planned coordinated interventions can achieve results and save lives. Now we need to focus on making sure those children thrive and those women thrive.
The year 2015 is the time to build on this achievement, to renew commitments and support strong strategies that will end preventable maternal, newborn, and child deaths, ensure that those women and children and survive, and improve overall health.
Thank you.
Paul Demers
View Paul Demers Profile
Paul Demers
2015-03-24 15:53
Thank you, Mr. Chair and members of the committee, for inviting me here today. I know I've been asked to come here today because I chaired the expert panel of the Royal Society of Canada on Safety Code 6. But I thought I'd start by saying a few other things about my background.
I'm the director of the Occupational Cancer Research Centre, which is based in Cancer Care Ontario, a provincial agency that is also funded by the Ontario Ministry of Labour and the Canadian Cancer Society. I'm also a member of the faculty of the schools of public health of the University of Toronto and the University of British Columbia.
I am an epidemiologist, so I study impacts of different types of health effects upon populations of people, but my primary area of research is on the risk of cancer associated with workplace chemicals, dust, and radiation, although I have done research on a number of other diseases as well as on environmental exposures. However, I want to state that, unlike Dr. Prato, I'm not an expert specifically in the area of electromagnetic fields and have never actually done research on radio frequency radiation.
As you know, at the request of Health Canada the Royal Society convened an extra panel to conduct a review of the 2013 draft of Safety Code 6. I was asked to chair that panel because I had no conflicts of interest and because of my expertise in cancer epidemiology, which was identified as one of the areas for which they wanted expertise on the panel.
I was also asked because of my experience sitting on similar panels for the International Agency for Research on Cancer, the U.S. national toxicology program, the U.S. Institute of Medicine, which is part of the National Academy of Sciences, and the Council of Canadian Academies, the latter two being fairly similar to the Royal Society of Canada in the way they operate.
I should also mention, although you may be aware of this already, that I was the second chair of the panel. The first panel resigned because of a perceived conflict of interest, and I took over as chair of the panel about midway through. But I also want to state that I'm here as individual and am not representing the Royal Society of Canada or any other organization at this point.
The panel was presented with five specific questions, and I'm going to over very briefly our responses to those five questions. Overall, they were all dealing with whether or not there were any established health effects at levels below those recommended by Safety Code 6 and related types of questions.
To answer these questions, we did a review of recently published studies in the area on a wide range of different types of health effects. We also looked at many of the international reviews, which I think have already been mentioned here today. These are conducted on a pretty regular basis by many agencies around the world.
Because we were asked to look in particular at established health effects, we defined an established adverse health effect as something that has been seen consistently or been observed consistently in multiple studies with a strong methodology. So we had a fairly flexible definition, but still it required an effect's being observed in not just a single study.
Before I get into the questions—because I'm actually going to read out the questions we were given—I want to explain two different terms that are used quite a bit in those questions, namely the definition of what basic restrictions are and what reference levels are.
Basic restrictions in Safety Code 6 are things that happen within the body, either heating or induced fields within the bodies, or things like those. Many of the actual limits are set based upon that. Because these are not easily measured, the code also uses reference levels, which are things you can measure outside of the body using a meter. They are much easier for regulatory purposes. You will often see that the questions are phrased in terms of these basic restrictions and reference levels.
Our first question was, do the basic restrictions specified in Safety Code 6 provide adequate protection for both workers and the general population from established adverse health effects of radio frequency fields? Our conclusion was that yes, they provided that protection. Specifically, Safety Code 6 was designed to protect against two kinds of established health effects, thermal effects and peripheral nerve stimulation. The margins of safety, we concluded, appeared to be quite protective. For peripheral nerve stimulation, it was a safety factor of five for the workplace or controlled environments, and a 10-fold factor for uncontrolled environments, which are closer to what you would experience in the general public. For thermal effects, the safety factor was 10-fold for workplaces and 50-fold for the general public.
The second question that we were given was, are there any other established adverse health effects occurring at exposure levels below the basic restrictions on Safety Code 6 that should be considered in revising the code? Our conclusion to that question was no. The panel reviewed the evidence for a wide variety of health effects, including cancer, cognitive and neurologic effects, male and female reproductive effects, development effects, cardiac function, heart rate variability, electromagnetic hypersensitivity, and adverse effects in susceptible areas of the eye. Although research in many of these areas—important research, I think—continues, we were unable to identify any adverse health effects occurring at levels below those allowed by Safety Code 6.
Our third question related specifically to the eye: Is there sufficient scientific evidence upon which to establish separate basic restrictions or recommendations for the eye? We concluded that no there wasn't sufficient evidence. Recent studies do not show adverse health effects in susceptible regions of the eye at exposure levels below those proposed by Safety Code 6 for the head, neck, and trunk. Therefore we recommended that it not contain separate basic restrictions for the eye.
The fourth question was perhaps a bit more complex: Do the reference levels established in Safety Code 6 provide adequate protection against exceeding the basic restrictions? That is, do the levels that are proposed as limits for things you can measure outside the body actually protect against the target health effects the code is trying to prevent within the body? Our conclusion was that for most frequencies, yes, reference levels were adequate, but that there were some regions where compliance with the reference levels may not ensure compliance with the basic restrictions. We recommended that the proposed reference levels in Safety Code 6 be reviewed by Health Canada to make them somewhat more restrictive in some frequency ranges to ensure a larger safety margin for Canadians, including newborn infants and children.
This recommendation took into account recent studies that we call dosimetry studies, at least one of which was published after Health Canada produced the proposed Safety Code 6.
Our fifth question was, should additional precautionary measures be introduced into Safety Code 6 exposure limits? I'll state that although there was a range of opinions on the panel regarding precautionary efforts, overall the panel believed that Safety Code 6 was well-designed to avoid established health effects; we did not have any science-based recommendations for precautionary measures to lower the limits. I'll say that it was for the reasons that I think Dr. Prato explained quite well, which is that we couldn't, at least in looking at the study, say that the evidence tells us that we should lower it it in such a fashion. However, we did recommend a number of other measures that can and should be taken by Health Canada.
I'll read some of them here now.
First was to investigate the problems of individuals with what's called electromagnetic hypersensitivity—it goes by other names as well, IEI-EMF, and things like that—with the aim of understanding their health conditions and finding ways to provide effective treatment.
Second was to develop a procedure for the public to report suspected disease clusters and a protocol for investigating them.
Third was to expand Health Canada's risk communication strategy to address consumer needs for more information around radio frequency radiation.
Fourth was to identify additional practical measures that Canadians can take to reduce their own exposure.
These recommendations are really in response to the public input that we received as part of the panel. We also had a number of different research recommendations. In particular, if one has the chance to read the report, you'll notice that each section on a particular health effect usually ends by basically pointing out that more research is needed on that health effect.
A few of the specific ones are that Health Canada should aggressively pursue research aimed at clarifying the radio frequency radiation cancer issue, which would allow the government to develop protective measures if the risk were substantiated; and that Health Canada should pursue research to expand our current understanding of possible adverse health effects of exposure to radio frequency radiation at levels below those allowed by Safety Code 6.
The response to the panel's report from Health Canada—
Robert Strang
View Robert Strang Profile
Robert Strang
2014-12-04 11:49
Good morning to the committee. Thank you for the opportunity to speak today on electronic nicotine delivery systems, ENDS. I'll explain that term in a second.
I'm speaking in my role as the chief public health officer and chief medical officer of health for the Nova Scotia Department of Health and Wellness, as well as the recent past chair of the Council of Chief Medical Officers of Health.
For the committee, CCMOH consists of all the chief MOHs from the 13 provinces and territories, the national chief public health officer, senior officials from Health Canada, the first nations and Inuit health branch, Correctional Services Canada, Customs and Immigration Canada, and the Department of National Defence. As such, it represents senior government public health officials in Canada.
In 2013 the FPT deputy ministers of health asked CCMOH to provide their advice regarding the regulations on e-cigarettes. Today I'm going to speak to the position statement, which I know has been circulated to committee, that was developed by the provincial and territorial chief MOHs in response to that request. That position statement does represent the current consensus of FPT chief MOHs on the issue of electronic nicotine delivery systems.
To give a bit of background, e-cigarettes were developed in their current form in the early 2000s and have gained substantial market penetration globally. They are rapidly evolving as a product line, and alternative nicotine delivery systems are now appearing. That's the reason the language I will use today in our position statement is on the larger construct of ENDS and does not just use the term e-cigarettes.
It's important to acknowledge that some ENDS can also be sold for use with non nicotine-containing e-juice. There is also growing evidence that ENDS are increasingly being used for other substances, often illegal drugs such as marijuana.
The current legal status of e-cigarettes in Canada is such that electronic cigarettes with nicotine or that make health claims are regulated by the federal Food and Drugs Act, which means that they have to be authorized by Health Canada to be imported, advertised, or sold in Canada. To date, Health Canada has not given market authorization to any such products. E-cigarettes that don't have nicotine and don't make any health claims are regulated by the federal Canada Consumer Product Safety Act, which requires companies to ensure that the products they manufacture are safe.
Some points to make are that any assessment of policy options on ENDS must account for the need to acknowledge that we've made great strides in tobacco control in Canada with the greatest success being in the significant reduction in smoking rates for youth aged 15 to 19 years. But as new products such as ENDS emerge, it's important that we don't lose ground, particularly with the huge smoking segment.
Despite the current federal regulations, ENDS and e-juice-containing nicotine containers are readily available for purchase in all provinces and territories, both in stores and on the Internet. We can't ignore that reality. The lack of any regulations regarding product testing and labelling makes it extremely difficult to differentiate between those that contain nicotine and those that do not. There are also significant concerns around quality control and product safety.
We do also have to acknowledge that there has been a significant increase in the use of e-cigarettes, including by youth, since 2010.
The next point is that ENDS do present both risks and benefits at both the individual level and the population level, but there is no definitive scientific evidence in any of these areas at this time. However, waiting for more definitive evidence before taking action runs the very real risk of increasing overall and youth smoking rates, so essentially we can't wait to take some form of action.
To inform the development of the position statement, CCMOH held a virtual symposium in June 2014 to which we also invited members of the FPT Pan-Canadian Public Health Network Council, and the FPT Tobacco Control Liaison Committee. A summary of that symposium is an appendix to the position statement that was distributed to the committee. I won't take time to walk through that today.
The PT chief MOHs, in the summer of 2014, held follow-up discussions to discuss the information we had heard at the virtual symposium and developed our common position statement. That position statement was received by both the FPT deputy ministers and the ministers of health in August and September respectively in 2014.
Just to go through our position statement, this position statement is based on our collective expertise and experience in public health. The information was provided to us by five experts during the virtual symposium, as well as informed by discussions that we had among ourselves and by other discussions on ENDS products that many of us have been involved in.
We feel that given the current state of knowledge on ENDS, this position is an appropriate balance of allowing accessibility to these products as potential aids for cessation or reduction of tobacco use for existing tobacco users, while minimizing their potential to develop nicotine dependence and new tobacco users, as well as decrease the motivation for quitting for existing tobacco users.
I do need to clarify that our definition of ENDS in our policy includes both the devices as well as any accompanying e-juice containers. Our recommendations apply to all ENDS whether they contain nicotine or not.
Our recommendations that we made to provincial and territorial governments were to amend or develop legislation or regulations to first, make it illegal to sell ENDS to minors; second, make the point of sale display, advertising and promotion of ENDS illegal; and third, make it illegal to use ENDS in locations where tobacco smoking is currently prohibited.
Since we developed this position statement, Nova Scotia has passed legislation which brings all three of those recommendations into force as of May 31, 2015. Ontario currently has similar legislation in the legislative process.
For the federal government, our recommendation is, for the longer term, to develop a provincial-territorial engagement strategy to work together along with tobacco control experts to develop a new regulatory framework for ENDS.
We acknowledge that these products don't fit neatly as either a pharmaceutical or as a cessation product and ultimately we need a whole new regulatory approach to these products. However, given the time this process would require and the need for urgent regulatory action, we recommend in the short-term that ENDS should be considered as equivalent to cigarettes and regulated as such under existing federal legislation and regulations. That would mean advertising restrictions that are currently in place for tobacco products would apply to ENDS, that the standard labelling requirements that are required for tobacco products would apply for ENDS, and that the smoke-free requirements for federal workplaces and other federally controlled environments such as airports and airplanes would also apply to ENDS. We're also recommending that youth-oriented e-juice flavours should be banned.
I want to thank you for the opportunity to present today. I welcome any questions.
Steven Hoffman
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Steven Hoffman
2014-11-24 15:34
Mr. Chair and committee members, thank you for inviting me to make submissions about Bill C-43 concerning changes to the Public Health Agency of Canada Act.
By way of background, I'm an assistant professor of law and director of the global strategy lab at the University of Ottawa. My research focuses on global health governance and institutional design.
Based on my research, it's clear that our chief public health officer needs an independent voice and the ability to speak scientific truth to members of the public and to those in power. This bill, in splitting the chief public health officer's role in two—one part technical, one part administrative—removes the little independence this position once offered. This bill achieves this effect by demoting the chief public health officer from his current deputy minister rank, by removing his direct line to the minister, by making him subservient to a bureaucratic agency president, and by eliminating reimbursement for his public activities.
Any loss of independence matters because it erodes the trust that we can all place in our chief public health officer of Canada. In reviewing this bill, it seems to me that we've forgotten the harsh lessons of SARS. It was just 11 years ago, in 2003, when the World Health Organization slapped Toronto with a travel advisory, costing that city $2 billion and 28,000 jobs. That's a lot of money and a lot of jobs. This loss was not because of the number of SARS cases. Singapore had a similar number. The loss was because the federal government did not have a trusted public health leader who could effectively coordinate with the provinces and communicate the outbreak status with other countries.
SARS shone a light on the hurdles that Canada's version of federalism places before effective pandemic responses. Significant changes followed, including the creation of the Public Health Agency of Canada and its chief public health officer. The big idea behind all of this was that we needed to build trust. Provinces and their public health departments needed a guarantee that the federal government's public health pronouncements were based on scientific principles, rather than political talking points. Unfortunately, this guarantee was never realized. The chief public health officer was made an officer of government instead of an officer of Parliament, thereby preventing him from exercising full independence, as our Auditor General or Privacy Commissioner would have. Let there be no doubt about this: in my mind that was a mistake.
But this bill takes us even further away from where we need to be. At least the original legislation gave the chief public health officer some independent powers to speak and be reimbursed for those public activities. This encouraged the provinces to buy into a nationally directed system. The removal of these limited independent powers is not helpful. On this basis, demotion and politicization of the chief public health officer is undoubtedly a wrong-headed move. With an Ebola outbreak raging in West Africa, it seems that this isn't the right time to be weakening our national public health infrastructure. This change would make us less prepared for Ebola and other diseases like it.
I understand that last week this committee heard contradicting testimony from the new chief public health officer. I understand he said that shrugging off managerial oversight of the agency would free him to focus on providing scientific advice. He might win back some of his time, but I think we all need to ask this question. After his demotion, will anybody be listening to him? Will his bureaucratic boss even allow him to speak?
Ultimately, if this change really must go forward, I would suggest two very small revisions that would lessen its harm.
The first is to add a provision granting scientific independence to the chief public health officer and legislatively allowing him to speak without political interference.
The second is to just drop section 258 that would remove the reimbursement for the chief public health officer in performing his public duties.
These two small changes would ensure that the chief public health officer could serve that interprovincial coordination function that was shown to be so important in SARS, and ultimately be trusted by all Canadians.
I would have suggested a third small revision, to maintain the chief public health officer's deputy minister rank, which is important for him to access federal decision-making tables, but I think I'm already pushing my luck by suggesting any changes at all.
Just to conclude, in coming here today my only hope is that we won't need another SARS or Ebola in Canada to make us realize the harm that the proposed changes would cause. I implore you to do whatever you can to minimize the bill's damage. We would all be less safe with these proposed changes, and we're all going to suffer the consequences if the committee allows them to pass.
Thank you.
Ian Culbert
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Ian Culbert
2014-11-24 15:39
Thank you, Mr. Chair and committee members, for the invitation to present to you today.
I would like to be clear, first and foremost, that my comments and those contained in our written brief are not intended as a reflection upon any current or former employees of the Public Health Agency of Canada. We have only the greatest respect for all of them.
It is the position of the Canadian Public Health Association that the chief public health officer should continue to be the deputy head of the Public Health Agency of Canada and continue to operate at the deputy minister level. As such, we recommend to this committee that the amendments to the Public Health Agency of Canada Act proposed in Bill C-43 be withdrawn and that the consequential amendment to the Financial Administration Act also be withdrawn.
While we agree that there should be a division of roles and responsibilities between the administrative and professional sides of the agency, we feel strongly that the titular head of the agency must be a public health professional. The current structure was established based on the recommendations of the Naylor committee after the 2003 SARS outbreak. That committee was very specific in its recommendation that the agency should be headed by the CPHO and that the CPHO report directly to the federal Minister of Health. The Naylor committee reviewed the organizational structures in place for a number of different jurisdictions and felt that its recommendations represented the best option for Canada's national public health body.
In 2010 the position of executive vice-president and chief operating officer was created to provide administrative support to the CPHO. This change formally split the administrative and professional responsibilities of the CPHO while leaving the CPHO as the deputy head of the agency. Since that time that structure has served the agency and Canadians well.
Our concerns for the proposed amendments are as follows.
First, while the CPHO has the responsibility to promote and protect the health of Canadians, in the proposed structure the position would retain responsibility but have no authority to mobilize resources.
Second, the country's public health priorities must take precedence over bureaucratic priorities, but this does not preclude the executive vice-president and chief operating officer from being responsible for day-to-day operational and administrative duties.
Third, it is essential that the CPHO work closely with fellow deputy ministers at the federal and provincial/territorial levels. Under the current structure the CPHO has a seat at those tables by right of his or her position. Under the proposed amendments the CPHO could only be invited to those discussions, and only as an adviser so that he or she would not be taking part in the decision-making process.
At the end of the day, rank matters and these amendments will essentially strip the position of CPHO of its current rank.
Our final and possibly most troubling concern is that the new model would give both the CPHO and the president of the agency direct access to the minister. In the unfortunate situation where agreement cannot be reached between the CPHO and the president, the minister could be faced with contradictory policy advice and left in the role of arbiter. This model is not considered good practice in a modern bureaucracy and should be avoided.
During a public health emergency such as a pandemic of H1N1 or Ebola, the importance of evidence-based advice from the CPHO is clear. This advice, however, is important at all times as Canadians are increasingly concerned about the sustainability of their publicly funded health care system. Public health has at its foundation the protection and improvement of health and well-being of Canadians and, as such, its policies, programs, and initiatives are focused on keeping people out of hospitals and doctors' offices. If the CPHO does not have the necessary authority to direct agency staff and marshal its resources, his or her advice may not be worth the paper on which it is written.
The structure of the agency with the CPHO at its helm has been effective for the first decade of its existence, and there is no clear evidence that the proposed changes are needed.
Thank you.
Véronique Lalande
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Véronique Lalande
2014-11-24 15:43
Mr. Chair, members of the committee, for more than two years now, Initiative citoyenne de vigilance du Port de Québec has made it its mission to compile and distribute information on the environmental impacts of industrial activities at Quebec City's port. This is not a battle we chose; it was dropped on us, literally. What we did choose, however, was to come together as ordinary citizens to assert our most basic right: the right to raise our families in an environment where our health and quality of life are not at risk on a daily basis because one of our neighbours is unable to behave responsibly.
Today, we have more than 450 members, as well as 1,000 supporters, who are also involved in a variety of grassroots movements right across the country. We are united in our pursuit of one goal: requiring port authorities to dutifully respect their mandate of running a profitable operation while respecting the environment and surrounding communities. In response to all those who have all too often argued that ports, and thus the problem, are under federal jurisdiction, I have said time and time again what a tremendous step forward that would be, were it only true. The fact of the matter is that ports seem to be less and less under federal jurisdiction and more and more under self-control.
No doubt when Parliament created independent federal agencies to manage port sites and operations, its intention was to improve their management. Clearly, the powerful lobbies of the marine industry, and related mining and oil and gas industries have repeatedly argued that fewer restrictions and more authority are essential to develop a marine industry that will ultimately benefit all.
Although we do not deny that ports generate economic benefits, a number of studies have downplayed those benefits, especially when it comes to handling and bulk storage activities. It is also troubling to note that the costs to the community are never taken into account when the real benefit is being worked out. In my community, this particular legal framework has led to major environmental lapses, lapses that are still happening as we speak.
In Canada, the average amount of nickel in the ambient air is approximately 1 nanogram per cubic metre of air, and 2 nanograms is the level considered safe. In Limoilou, however, residents have, for years, been exposed to levels hovering around 52 nanograms, with event-driven peaks of 1,670 nanograms. Regardless, no one has been able to do anything about it, or wanted to.
Although we have worked tirelessly in the past few years to bring to light an environmental disgrace, measurable progress remains less than stellar. I should point out that, as we speak, the port facilities are emitting fugitive particulate made up of an assortment of toxic substances. These contaminants are emitted into the environment, affecting people's health and significantly diminishing the quality of life of thousands.
The level of nickel in the ambient air in my neighbourhood is always well above the threshold considered safe. Quebec City's port authority still refuses to acknowledge or assume its responsibilities, even though a major project to expand the Beauport terminal is about to get under way. Despite being the project proponent, the Quebec City port authority will be in charge of defining the criteria and environmental studies, overseeing the evaluation process and eventually issuing the necessary permits. Nevertheless, over the past two years, the ministers responsible have continued to tell us that the Quebec City port authority has complete authority, that it has the situation under control and that they have total confidence in the members of the port authority's administration.
Like many communities around the country, we, as residents, have lost almost all trust in our port authority. Rightfully, we are calling on the government to tighten up the framework governing all port authorities to put an end to these lapses once and for all. And yet, the amendments to the Canada Marine Act currently being considered are intended to increase, yet again, the powers held by port authorities.
In conclusion, I must remind you that the first duty of elected representatives is, as I see it, to protect society's most vulnerable and ensure that everyone has the right to live in a safe environment. I urge you to consider the message that rewarding a delinquent industry with more powers would send to thousands of men, women and children who live close to port facilities and lack the industry's resources to plead their case. You would be telling them that, regardless of the consequences, it is acceptable to exclude certain industries from the proper legislative regime, favouring a specific regulatory framework for the sake of the bottom line. You would be telling them that it is absolutely fine for an organization to regulate itself, overseeing the enforcement of the very laws that are supposed to govern it. Not only that, but you would be telling them that ports are entities outside space and time, devoid of any ties to the communities they call home, and therefore, it is appropriate for the Canada Marine Act to be the only applicable legislation.
I humbly ask that you reconsider the proposed amendments in favour of measures that would subject Canada's 18 port authorities to stricter control, transparency and accountability.
Thank you.
Joel Kettner
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Joel Kettner
2014-11-24 16:04
Hello, Mr. Chairman, and thank you.
I'll very briefly say thank you for the opportunity to present at this hearing. I'm going to speak as an individual, although I'm affiliated with the university and with other organizations that I won't take the time to describe at this moment. I'm going to speak mostly from my experience as a provincial chief public health officer in Manitoba, which I was for 12 years, and from my work in public health in general.
I'm going to approach the changes proposed to the Public Health Agency of Canada Act from the perspective of how I think they might have impacts on the effectiveness of the chief public health officer in particular, but more broadly on the ability of the Public Health Agency of Canada to fulfill its roles and mission. I think many important points have been raised by previous witnesses, and I look forward to the question and answer period, where we can go into more of those in some detail.
I believe there are pros and cons in these changes, so I'm going to go through what I think are the most important ones, and I'm going to frame it on what I'm going to call “six functions” of the chief public health officer. I will look at each one and how they may be affected by the way the act is written now, and with the changes that have been proposed.
The first function is that of adviser to the minister, and of course in this case it's the Minister of Health. The old act specified that the role was to assist the minister and to be “the lead health professional” within the Government of Canada. I believe that has not changed. Specifically, there is now a clause that says the role is to advise the minister and in addition the president—this is the new role—of the Public Health Agency and that it should be “on a scientific basis”. I think it could be a good thing to have made that more clear, because that is the role of the chief public health officer with respect to government, particularly through the minister to the government.
The second function is that of communicator to the public, a very important role that others have spoken about, because the act allows the chief public health officer to prepare and publish a report on any issue related to public health. That has not changed. I do not believe that the ability of the chief public health officer to communicate to the public freely and without direction by the minister—or now by the president of the agency, as proposed—should be changed. I certainly hope that it isn't changed. I'm also hopeful that the interpretation of “reports” is broad, and that includes all communications to the public and to anyone else that the chief public health officer feels he or she needs to communicate with.
With regard to the leadership of the agency itself, I think there are many models that exist across this country in the provinces and also around the world and, frankly, I'm not sure which is the best. However, I don't think this model that's being proposed necessarily diminishes the ability of the chief public health officer to continue to provide advice to government and also to influence the leadership and decisions in a collaborative way with the lead administrator, who has the deputy head status. As I think was pointed out, if the two of them can't figure it out together, they must have it resolved by the minister. That's actually the way it goes in public health departments of governments anyway, because in the act, as is the case in most provinces, it is the minister who is really responsible for government public health practice. That's I think mostly as it should be, because the political decisions that are most important in public health need to be made by elected officials and their governments.
As far as collaborating with other chief public health officers goes, I think that being a deputy minister potentially could be—and has been—a difficulty there, because other chief public health officers are not at that level. The ability to be equal collaborators and then bring advice through the conference of deputy ministers to the ministers in a collaborative way can be limited by having one of them designated as a deputy minister. Also, my observation and experience, without reference to individuals, is that being at the deputy minister level makes it even more difficult to speak freely and independently to the public.
Finally, I would like to just say this about the act itself. Where it needs most strengthening, or at least most use, is to recognize that regulations can be brought in to collect and analyze data across the country that so far has not been used. The agency itself has not had the power to coordinate and collect information, when needed, on a national basis to deal with a national issue.
I'll make one last point around the capacity of the chief public health officer within the agency. Whether this is written into the law or just understood as policy, I think it's very important for there to be a strong office for the chief public health officer, with a deputy chief officer and a staff including research assistants, communications people, and others who can ensure that those functions of the chief public health officer are preserved, no matter what.
View Scott Brison Profile
Lib. (NS)
Thanks to each of you for your interventions today.
You may be wondering in fact why we're talking about public health as part of a budget implementation act. If it makes you feel any better, we're wondering about the same question.
Mr. Cullen mentioned the challenge we have with budget implementation acts that are so massive in terms of the material covered. I think there is a consensus among the members on this side of the table that we would prefer to see measures related strictly to the fiscal framework of government and budgets as part of this. It would enable members of Parliament with even greater expertise than ours to engage directly with experts such as you on issues that are of great importance in terms of public policy but are not issues with which we necessarily have a great depth of experience, such as the area of public health.
That being the case, Mr. Hoffman, have you considered these changes to the governance over the chief public health officer's role in the broader sense of what some have called the muzzling of scientific voices within this government, not just in this instance but more broadly within government departments and agencies?
Steven Hoffman
View Steven Hoffman Profile
Steven Hoffman
2014-11-24 16:26
Certainly that's what many of my colleagues have been talking about. Whatever the motivations for this bill and these changes are, concerns about that situation are deepened. We have a situation here in which the chief public health officer will no longer be able to exercise the same level of independence he once had. So in some respects whether the intention is to muzzle, the effect is that the chief public health officer as the chief public health scientist will no longer be able to speak.
My comments were really to highlight the fact that the demotion means he is less likely to be heard when he does speak. Of course now he reports to a bureaucratic agency president, which means that even if he wants to speak, he might not be allowed to. That's a big problem when we have a federal model in which not only does the federal government receive advice from the chief public health officer—of course that's an important part of it—but also our provinces need to have trust in him. The provinces have the majority of health responsibilities in Canada, and if they can't trust that the chief public health officer is basing his advice and public statements on scientific principles rather than political talking points, that's a big problem.
View Scott Brison Profile
Lib. (NS)
Mr. Culbert, Mr. Hoffman talked about the potential politicization of the role. Do you think there is a risk of that for the future in terms of some of the changes we're making to the role? Will there be a heightened risk of politicization around issues in the future?
Ian Culbert
View Ian Culbert Profile
Ian Culbert
2014-11-24 16:28
At the end of the day the CPHO was and will continue to be a civil servant, so there are challenges around that. In our form of government, politicians have the final say, and ministers have the final say on decisions. So to say that a position will become more or less politicized, you're talking about shades of grey, I would say.
When the Naylor committee made its recommendation, as Mr. Hoffman said, one of the options was to create a parliamentary officer, like the Parliamentary Budget Officer. But then once again you have a great spokesperson who is independent but lacks the ability to do anything. They could criticize or support or encourage, but they don't have the authority to actually make something happen.
There is no ideal situation, but the Naylor commission recommendation, and what we've been working with for the past 10 years with a public health professional as the deputy head of the agency with the appropriate bureaucratic support, is what we feel is the best solution if not a perfect solution.
View Scott Brison Profile
Lib. (NS)
How does the governance structure proposed in this legislation for the chief public health officer compare with that of governing chief public health officers in other countries, for instance, in the United States? What would you say is the delta between how it's structured there and what is being proposed here?
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