Interventions in Committee
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Kelley Bush
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Kelley Bush
2015-06-18 16:07
Good afternoon. My name is Kelley Bush, and I am the head of radon education and awareness under Health Canada's national radon program.
Thank you, Mr. Chair and members of the committee, for inviting me to be here today to discuss radon as a cause of lung cancer and to highlight the work of the Canadian – National Radon Proficiency Program.
Through the ongoing activities of this program, Health Canada is committed to informing Canadians about the health risk of radon, better understanding the methods and technologies available for reducing radon exposure, and giving Canadians the tools to take action to reduce their exposure.
Radon is a colourless, odourless radioactive gas that is formed naturally in the environment. It comes from the breakdown of uranium in soil and rock. When radon is released from the ground in outdoor air, it gets diluted and is not a concern. However, when radon enters an indoor space, such as a home, it can accumulate to high levels and become a serious health risk. Radon naturally breaks down into other radioactive substances called progeny. Radon gas and radon progeny in the air can be breathed into the lungs, where they break down further and emit alpha particles. These alpha particles release small bursts of energy, which are absorbed by the nearby lung tissue and lead to lung cell death or damage. When lung cells are damaged, they have the potential to result in cancer when they reproduce.
The lung cancer risk associated with radon is well recognized internationally. As noted by the World Health Organization, a recent study on indoor radon and lung cancer in North America, Europe, and Asia provided strong evidence that radon causes a substantial number of lung cancers in the general population. It's recognized around the world that radon is the second leading cause of lung cancer after smoking, and that smokers also exposed to high levels of radon have a significantly increased risk of developing lung cancer.
Based on the latest data from Health Canada, 16% of lung cancers are radon-induced, resulting in more than 3,200 deaths in Canada each year. To manage these risks, in 2007 the federal government in collaboration with provinces and territories lowered the federal guideline from 800 to 200 becquerels per cubic metre. Our guideline of 200 becquerels per cubic metre is amongst the lowest radon action levels internationally, and aligns with the World Health Organization's recommended range of 100 to 300 becquerels per cubic metre.
All homes and buildings have some level of radon. It's not a question of “if” you have radon in your house; you do. The only question is how much, and the only way to know is to test. Health Canada recommends that all homeowners test their home and that if the levels are high, above our Canadian guideline, you take action to reduce.
The national radon program was launched in 2007 to support the implementation of the new federal guideline. Funding for this program is provided under the Government of Canada's clean air regulatory agenda. Our national radon program budget is $30.5 million over five years.
Since its creation, the program has had direct and measurable impacts on increasing public awareness, increasing radon testing in homes and public buildings, and reducing radon exposure. This has been accomplished through research to characterize the radon problem in Canada, as well as through measures to protect Canadians by increasing their awareness and giving them tools to take action on radon.
The national radon program includes important research to characterize radon risk in Canada. Two large-scale, cross-Canada residential surveys have been completed, using long-term radon test kits in over 17,000 homes. The surveys have provided us with a much better understanding of radon levels across the country. This data is used by Health Canada and our stakeholder partners to further define radon risk, to effectively target radon outreach, to raise awareness, and to promote action. For example, Public Health Ontario used this data in its radon burden of illness study. The Province of British Columbia used the data to inform its 2014 changes to their provincial building codes, which made radon reduction codes more stringent in radon-prone areas based on the results of our cross-Canada surveys. The CBC used the data to develop a special health investigative report and interactive radon map.
The national radon program also conducts research on radon mitigation, including evaluating the effectiveness of mitigation methods, conducting mitigation action follow-up studies, and analyzing the effects of energy retrofits on radon levels in buildings. For example, in partnership with the National Research Council, the national radon program conducted research on the efficacy of common radon mitigation systems in our beautiful Canadian climatic conditions. It is also working with the Toronto Atmospheric Fund to incorporate radon testing in a study they're doing that looks at community housing retrofits and the impacts on indoor air quality.
This work supports the development of national codes and standards on radon mitigation. The national radon program led changes to the 2010 national building codes. We are currently working on the development of two national mitigation standards, one for existing homes and one for new construction.
The program has developed an extensive outreach program to inform Canadians about the risk from radon and encourage action to reduce exposure. This outreach is conducted through multiple platforms targeting the general public, key stakeholder groups, as well as populations most at risk such as smokers and communities known to have high radon.
Many of the successes we've achieved so far under this program have been accomplished as a result of collaboration and partnership with a broad range of stakeholder partners. Our partners include provincial and municipal governments, non-governmental organizations, health professional organizations, the building industry, the real estate industry, and many more. By working with these stakeholders, the program is able to strengthen the credibility of the messages we're sending out and extend the reach and impact of our outreach efforts. We are very grateful for their ongoing engagement and support.
In November 2013 the New Brunswick Lung Association, the Ontario Lung Association, Summerhill Impact, and Health Canada launched the very first national radon action month. This annual national campaign is promoted through outreach events, website content, social media, public service announcements, and media exposure. It raises awareness about radon and encourages Canadians to take action. In 2014 the campaign grew in the number of stakeholders and organizations that participate in raising awareness. It also included the release of a public service announcement with television personality Mike Holmes, who encouraged all Canadians to test their home for radon.
To give Canadians access to the tools to take action, extensive guidance documents have been developed on radon measurement and mitigation. Heath Canada also supported the development of a Canadian national radon proficiency program, which is a certification program designed to establish guidelines for training professionals in radon services. This program ensures that quality measurement and mitigation services are available to Canadians.
The Ontario College of Family Physicians as well as McMaster University, with the support of Health Canada, have developed an accredited continuing medical education course on radon. This course is designed to help health professionals—a key stakeholder group—answer patients' questions about the health risks of radon and the need to test their homes and reduce their families' exposure.
The national radon program also includes outreach targeted to at-risk populations. For example, Erica already mentioned the three-point home safety checklist that we've supported in partnership with CPCHE. As well, to reach smokers, we have a fact sheet entitled “Radon—Another Reason to Quit”. This is sent out to doctors' offices across Canada to be distributed to patients. Since the distribution of those fact sheets began, the requests from doctors offices have increased quite significantly. It began with about 5,000 fact sheets ordered a month, and we're up to about 30,000 fact sheets ordered a month and delivered across Canada.
In recognition of the significant health risk posed by radon, Health Canada's national radon program continues to undertake a range of activities to increase public awareness of the risk from radon and to provide Canadians with the tools they need to take action. We are pleased to conduct this work in collaboration with many partners across the country.
Thank you for your attention. I look forward to any questions the committee members might have.
Sony Perron
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Sony Perron
2015-06-01 15:39
I would like to thank the committee chair and the rest of the committee members for the invitation to appear here today.
I, and other officials at Health Canada, have reviewed the Auditor General's 2015 Report, and we have paid a great deal of attention to his recommendations. We take the findings seriously and are addressing each of them through an action plan. This plan will continue to be refined and defined in collaboration with first nations. Indeed, as you know, we work in cooperation with first nations. This plan can therefore only be completed with an additional commitment by our first nations partners.
The health care system serving first nations is highly complex. Provincial health systems do not directly extend to first nations reserves. To support first nations, Health Canada provides the delivery of a range of effective, sustainable and culturally appropriate programs and services. We work with first nations to increase their control of health services and collaborate with provinces to increase access and promote system integration.
We also support programs that address first nations health priorities in the areas of mental health, chronic disease, maternal and child health, and health benefits providing coverage for prescription drugs, dental care, vision care, mental crisis intervention, and medical supplies and equipment.
Most of the community-based programs have been transferred in varying degrees to over 400 first nation communities. This number does not include British Columbia, where in 2013 Health Canada transferred its role in the design, management, and delivery of first nations health programming in British Columbia to the new First Nations Health Authority.
Health Canada provides funding to first nations to deliver clinical care in 27 remote and isolated communities, again, outside British Columbia. In an additional 53 remote and isolated first nation communities, Health Canada continues to deliver clinical care. The delivery model varies based on the specifics of each province and geographic conditions. The clinical care teams are located in nursing stations, along with community health workers delivering other programs.
Because of the importance of these services, it is imperative that Health Canada ensure that remote communities have access to clinical and client care, that nursing stations are staffed with registered nurses, and that nurses work in a safe environment, have access to physicians to support them, and have access to tools.
Registered nurses and nurse practitioners are predominantly the first point of contact in isolated communities and are highly educated and qualified individuals. To ensure that our nurses are prepared for the unique demands of working in remote stations, a mandatory training requirement has been defined and is now part of the national education policy.
I can report that we currently have an 88% compliance rate on Health Canada's nursing education model for controlled substances in first nations health facilities, while advanced cardiac life support is at 63%, trauma support is at 59%, pediatric advanced life support is at 64%, and immunization is at 61%. The overall compliance rate is at 46% as of the end of April 2015. We still have work to do, and we are doing it while ensuring that we have resources in place to backfill these important positions while incumbents are in training.
Health Canada is committed to ensuring that nurses working in remote first nations communities meet established public service requirements on top of these workers' already robust credentials.
Remote and isolated practice environments sometimes require nurses to respond immediately to life-threatening or emergency situations. Nurses therefore need appropriate mechanisms to perform these important duties.
Clinical practice guidelines assist nurses to address clinical care situations and provide instruction on whether and when consultation with a physician or a nurse practitioner is required. There are arrangements in place for all nursing stations to access physicians when physicians are not located in the community. We also continue to collaborate on region-specific solutions with provinces to advance access to health services and with regulatory bodies to support nurses practising within their scope of practice.
A key challenge is the need for more nurses. Health Canada has implemented a nurse recruitment and retention strategy, which involves a number of initiatives: a nursing recruitment marketing plan, a nursing development program, a student outreach program, and an onboarding program.
Since its February launch, we have received over 500 nursing applications, with 200 of these moving to the next level of screening. As well, the strategy aims to increase the number of nurse practitioners, which will provide greater stability in the clinical teams, assist in meeting training objectives, and enhance the level of services available at the community level.
Nurses and other community health professionals require facilities to conduct their work. Currently, we invest approximately $30 million annually for repairs, renovation, and construction of health facilities, plus an additional $44 million for maintenance and operations. The nursing stations are owned by first nations communities, and we collaborate with them to support their operation.
We work with first nations communities to ensure buildings are inspected and deficiencies are addressed. In response to the audit, we are implementing a more robust tracking system to capture this work. We will also enhance our process in order to use facility condition reports as a tool to better plan maintenance and renovation work with the owners.
In addition, to ensure new nursing stations are built to code, we have updated our requirements for attestations and have communicated the change to facility management staff. The audit rightly noted that the requirements, such as the station as defined currently, did not provide the necessary level of assurance.
Another area reported on was the management of medical transportation; medical transportation that provides coverage to support access to insured health services. Health Canada spends over $300 million on medical transportation per year, and approximately 60% of that is in remote and isolated communities. The main reasons for transportation are emergencies, at 24%, hospital services, at 10%, appointments with general practitioners, at 7%, and dental services, at 5%.
The program provides coverage for transportation to the nearest appropriate professional or facility that takes place when the needed service is not locally available. Our goal is to provide timely coverage for medical transportation to avoid an undue burden for clients and health care professionals. Decisions are based on a national program framework and are made with a solid understanding of the health services available and the transportation options at the regional level.
In response to the audit observations, the program has already modified and disseminated guidelines to resolve discrepancies observed between our practices and the medical transportation framework in terms of the level of documentation required.
Regarding the transportation of children who are not registered, Health Canada has a long practice of allowing coverage for a child up to one year of age to be covered for medical transportation under the registration number of their parents. Health Canada will continue its efforts with partners to inform parents and make available registration material in nursing stations and health centres.
Health Canada and the Assembly of First Nations are undertaking a joint review of the non-insured health benefits program, of which medical transportation is a component, and I am pleased to report that the work is well under way. It will identify strengths, weaknesses, including inefficiencies in administration, and recommendations for action.
Given that the geographic location, the size of the community, and the need to ensure cultural safety influence the range of programs and services funded or provided by Health Canada, comparing one community to the other is not always possible or the best approach. Community health planning, investing in the integration of services with provincial systems, and the development of community programs and capacity have proven to be more effective and more responsive to community needs over time.
As indicated earlier, Health Canada funds a number of community programs aimed at addressing specific needs and working as a complement to the clinical and client care program. These programs are funded to support community health needs and mostly managed by the communities themselves. In response to the audit, we will improve our support to community health planning to enhance integration of the community-based programs and clinical services where these services are delivered by Health Canada. We will also engage with the communities to review the current service delivery model and clinical care resource allocations.
The last area I would like to discuss is coordination among health system jurisdictions.
We work closely with partners to build health service delivery models that take into account community needs.
We have made significant progress with health service integration over the last 10 years. We see examples in various regions where there are more physicians' visits, provincial services are being extended on reserve, and there are more collaborative arrangements between community health services and regional health authorities. Co-management and trilateral tables exist in most regions to formally engage with provincial and first nations partners to advance common practices and resolve systemic issues. We will formally engage these tables in order to make progress on the important issues raised in the report.
Health Canada will continue to collaborate with our partners to develop and implement other models of first nations-led health systems across the country, as we have celebrated in B.C. We have presented an overview of our action plan, which requires further engagement and collaboration with first nation partners. We believe the next update will be more comprehensive as it will benefit from our partners' input.
In closing, we are working on a number of actions in response to the audit, and we will continue to do so.
I would note that I am accompanied today by three senior officials from Health Canada's first nations and Inuit health branch: Valerie Gideon, assistant deputy minister, regional operations; Robin Buckland, executive director, office of primary health care; and Scott Doidge, acting director general, non-insured health benefits.
We would be pleased to answer your questions. Thank you.
Sony Perron
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Sony Perron
2015-06-01 16:50
Thank you.
One of the things we have done for almost 15 years now is we have invested in health human resources not only to attract people from the south to working in first nation communities, but also to increase the number of aboriginal health workers. This has been an important investment for the branch. While most of them may not come to work in the first nations and Inuit health branch, in the end they may decide to go to work for the provinces or for the first nation communities themselves, which is great. Having more health workers who have an aboriginal background is one element of the strategy, because we do have employees who come from first nation communities working in first nation communities. We are really proud of that, because the cultural dimension of the health services is very important.
Something all of you are probably aware of is that we have a lot of people who, when they go to the south to visit a hospital or see a physician, are a bit nervous about that contact, because they are not used to it. We are trying to bring the cultural appropriateness of the service into the community, thinking that this will also create a more resilient and stable workforce there. It's very important to invest there.
In terms of better informing the nurses, if you have not done so, I invite all of you to go to the Health Canada website to see the video and information we have displayed there since February of this year in terms of what it is like to be a nurse in a first nation community. We do this to try to attract more workers to Health Canada, but we also use that to bring those people who prefer to work for first nation communities there. It's an aggressive marketing campaign to show what it is like to work there. There are also advantages for people who like to live closer to nature, work in small teams, and face challenges. There is value. We are also trying to amplify the positive side of this. There is not only the negative.
I think working in this environment might also bring a lot of satisfaction for the health worker. In fact, we see that when we meet with our staff who are in these locations, they are very dedicated, highly professional, and highly conscientious people, and they like their work. Some will go there for a while because.... The bad side of that—and we're trying to be very transparent with that—is that there is a lot of overtime. For people working in these communities, if there is someone who is sick at night and the nursing station is not open, they will go there and be on overtime. Sometimes there are really long shifts and it's really intense at times in the community. Some people are attracted to that. We are trying to profile this, as well.
Robin, I don't know if you want to add something about the onboarding or the training action we do to prepare nurses to go to work in the communities.
View Isabelle Morin Profile
Since we only have five minutes, my questions will be short.
Ms. Schroeder, I am very interested in the mental health of seniors. The numbers you gave us are very troubling. Many seniors tell me about the obstacles they are facing. You talked at length about shame, which we often hear about. It is not always easy for children to realize that their parents have mental health problems. They wonder how to meet with responders and how to help their parents.
Your approach is much more centred on cooperation. You mentioned a few practical examples. If you know of any model initiatives on awareness, prevention and reducing the stigma, could you tell us about them? What could we do? What are the model initiatives? What is the role of the Mental Health Commission of Canada in sharing these initiatives?
You also talked about housing, which I think is very important. I sometimes receive people at my office who tell me that they have trouble finding housing. This is a challenge first, because they are seniors and, second, because they have mental health problems. It is very difficult for them to find housing. Do you have solutions to suggest to us?
Bonnie Schroeder
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Bonnie Schroeder
2015-05-28 16:06
Merci. I'm going to respond in English.
You raised three points. You asked about family caregivers, collaborative initiatives, and housing. Let's start with caregivers.
We know that, in the recent Mental Health Commission data indicators report, it was reported that 16% of caregivers report distress caring for someone receiving publicly funded home care. We know that number jumps for people caring for someone with depression, end of life, dementia, and aggressive behaviours. It increases exponentially. I do think we need to talk about not only caring for a senior regarding mental health, but we need to also think about the mental health of family caregivers. I think it's very important, and I will get into more of that in the written brief.
That being said, we know there's the emotional toll. We also know working caregivers really are struggling to juggle both work and care, and we're pleased with the federal government, through the Employment and Social Development Canada, for bringing in the employers for caregivers plan and working with businesses to bring this to the forefront, recognizing cost to bottom line, recruitment, turnover, and the like. I think it is a very important population that we need to address.
You talked about collaborative initiatives we've developed. We have our guidelines around stigma, which I think is really key. We developed anti-stigma training for providers, including a video, with the support of the Mental Health Commission of Canada, and the video was recently released. I will highlight two initiatives in our network. The Canadian Mental Health Association in Ontario adapted and piloted and evaluated a community-based mental health promotion program called Living Life to the Full. It found significant clinical improvement in mood, well-being, and quality-of-life indicators for this program, and we think it shows some real promising practice to protect and promote the mental wellness of seniors.
The other one is the Fountain of Health program, in Nova Scotia, which looks at seniors' mental health promotion along five domains: mental health, physical activity, positive thinking, and I forget the other two, but it's a great community-based initiative. So those would be three.
With regard to housing, care in home is critical, I think, and sometimes seniors cannot live independently in their own home. Where do they need to go if they're living with both physical and mental health problems? Long-term care is, again, a struggle to get into, and the statistics that Dr. Cohen mentioned are key. We see a much higher acuity and complexity in long-term care. So what are other options? Assisted living, retirement homes, and home care are options to support seniors living independently in their own homes.
Robert Thibeau
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Robert Thibeau
2015-05-27 18:33
Good evening.
Once again, it's a great pleasure for me to appear in front of this committee to speak to you on behalf of the Aboriginal Veterans Autochtones and its partner organization the Congress of Aboriginal Peoples veterans, as well as the first nations veterans of Canada.
I've been asked by this committee to comment specifically on division 17 of part 3 of Bill C-59, which amends the Canadian Forces Members and Veterans Re-establishment and Compensation Act to:
(a) add a purpose statement to that Act; (b) improve the transition process of the Canadian Forces members and veterans to civilian life...; (c) establish the retirement income security benefit to provide eligible veterans and their survivors with a continued financial benefit after the age of 65 years; (d) establish the critical injury benefit to provide eligible Canadian Forces members and veterans with lump-sum compensation for severe, sudden and traumatic injuries or acute diseases that are service related, regardless of whether they result in a permanent disability; and (e) establish the family caregiver relief benefit to provide eligible veterans who require a high level on ongoing care from an informal caregiver with an annual grant to recognize that caregiver's support.
The Aboriginal Veterans Autochtones believes that this portion of Bill C-59 as it deals with veterans requires us to examine it more closely as to the substance of what will be contained in that bill and what that actually encompasses. We feel that there needs to be a substantive commitment and positive action to prove to veterans, the veterans community and their families that this government and this nation does care for those they have sent into harm's way.
I will now briefly acknowledge the details of division 17 of part 3 and offer our words on these.
Aboriginal Veterans Autochtones and its partners are in full agreement that this looks like a step in the right direction for the Government of Canada and Veterans Affairs Canada. Transitioning of Canadian Armed Forces members and veterans and the services that have been mentioned in broad terms must include a sound and effective communication plan. There cannot be any misunderstanding as to what services are available and the benefits prescribed through Veterans Affairs. Therefore, effective communication is the key.
An issue previously brought forward to this committee by the Aboriginal Veterans Autochtones was this very issue of effective communication to rural and remote communities of aboriginals, including first nations, Métis, and the Inuit. We must consider veterans living in remote areas and develop ways to remove barriers due to location and possibly a lack of technology and to improve outreach to those veterans.
The retirement income security benefit and its establishment cannot be commented on fully at this time as we require to see the content of the proposal. We can only hope that whatever will be proposed will be acceptable to meet the needs of those veterans and families requiring this assistance and that we will not struggle later on to obtain the services for veterans or survivors.
The establishment of the critical injury benefit is another positive step forward to respond to the needs of those who suffer severe and/or traumatic injuries related to their service. Again, we must ensure that the content of this will meet the needs of the affected veterans.
During a recent trip that I took with 28 veterans of the Italian campaign—heros of Canada—I heard horrific stories of battles fought, friends lost, and pain endured. I was humbled to be included with these individuals. The stories I heard were stories that had never been talked about. They were stories of tragic events, happy occasions, and remembrance of good old friends. It certainly gave me a better understanding and an appreciation of the need to ensure that veterans are properly looked after due to their personal contributions, their personal sacrifices, and their abilities to move forward.
I was informed by some of these outstanding veterans of suicides of friends, of alcohol abuse, and of family problems suffered by returning veterans.
I also heard of how some were able to tackle the demons and to become successful in whatever they decided to do. There are two comments that stand out in my mind that were shared by these veterans with me.
The first one is that we had a number of aboriginals who were in our units. They were all good soldiers and we lost more than a few of them. It is too bad they were not looked after when they returned home.
Two, if it was not for the Afghanistan veterans, we veterans would not have gotten the benefits that were denied to us long ago. We can certainly see the similarities between what earlier veterans had gone through in the past and what our current veterans are going through today. Today's veterans have also suffered deeply, both physically and mentally, from recent conflicts.
Today's veterans are forced to rely on the dedicated and steadfast efforts of caregivers who in some cases are spouses, who gave up careers, took a reduction in income, and faced financial hardships, and which for some, led to a strain on relationships and a breakdown in relationships. These caregivers ensure the best of care is given. They are the ones who assist the injured while leading to the ultimate survival of the heros. No one could ever take for granted these what I term front-line defenders of our injured.
Compensation to caregivers who sacrifice everything in order to provide much in the therapeutic recovery of our veterans should not be undermined, and they must be recognized for their selfless contributions. If there is a need to continue support beyond age 65, then this should never be questioned, as we are talking about individuals who have given a great deal of themselves for the freedoms enjoyed by other Canadians.
We must also remember that as a country, Canada has sent these soldiers, sailors, air men and women to places of turmoil, conflict, and outright horror. That being the case, we should never accept the shirking of the responsibility we have for looking after injured Canadian Forces members and veterans.
In closing, I echo the comments made by both the Veterans Ombudsman and the Royal Canadian Legion. The new Veterans Charter and the enhanced Veterans Charter are considered living documents. This means that as a living document it requires review and adjustment in order for it to meet the needs of its recipients. As I have stated before, the new Veterans Charter was introduced in the House and all parties accepted it, as did the Canadian Armed Forces and a vast majority of the veterans groups. The new Veterans Charter has a number of issues and problems, but it is the job of our politicians to look to and listen to organizations that are providing good advice and offering solutions to the problems associated with veterans.
ADA stands behind the Royal Canadian Legion and the ombudsman for their tireless efforts to move forward on behalf of all veterans. ADA has always taken the stance that we will support only those organizations or groups that are for positive movement forward on veterans issues.
A final thought from one of my partner organizations is that veterans should probably be the labour force at Veterans Affairs Canada and also appointees to the Veterans Review and Appeal Board.
On behalf of myself, my partner organizations, and all Canadian veterans, I offer sincere thanks for allowing me to attend this committee.
Joseph Burke
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Joseph Burke
2015-05-27 18:46
We approve of the wording amendments for the earnings loss benefit in clause 208, and the addition (c). We also applaud the extension of the earnings loss benefit past the age of 65.
Our previous concern was that the earnings loss benefit be set at 100% of previous military net income. It is retained in the act at 75%, which represents a loss of 25% of income for the veteran. It is our opinion that this retention of 75% of previous military net income does not meet the test of fairness. We have concerns that the spousal benefit, with the retention of the 75% of previous military net income, will also not meet the test of fairness for survivors.
We applaud the powers given to the minister to waive application if it is deemed that a disability exists in proposed section 40.5.
I will turn now to critical injury benefit, disability award, a death benefit clothing allowance, and a detention benefit.
Regarding critical injury benefit, in proposed subsection 44.1(1), our interpretation of “or developed an acute disease” means physiological diseases. We request that the committee support an amendment to the proposed subsection to change the wording to read “or developed a physiological disease or psychological disorder”, thus using proper medical terminology.
We applaud the family caregiver relief provision in proposed subsection 65.1(1). However, we are appalled that there were no provisions in the bill for a caregivers monthly benefit. In our previous submission to this committee, we suggested a monthly benefit of a minimum of $1,600 net income after taxes, and CPP deduction compensation for all their caregiving activities in the daily care for their disabled veteran.
We are further extremely disappointed that there is no provision for a child support benefit. In our previous submission to the committee, we suggested a child support benefit based on the Ontario courts schedule as an example of the support needed per child.
View Sylvain Chicoine Profile
Thank you, Mr. Chair.
I'd also like to thank the witnesses for joining us this evening and answering our questions.
Ms. Migneault, we understand that you are a bit disappointed with the amount of the caregiver relief benefit. A question came to mind. Would you have preferred to have the benefit included in the veterans independence program, which you do not qualify for either? It's meant for activities such as housekeeping and yard maintenance, in order to give caregivers a break.
If the benefit had been included in the veterans independence program, would it have been helpful to you, given that you also have fairly young children at home?
Jenifer Migneault
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Jenifer Migneault
2015-05-27 19:02
The measure would have actually enabled me to keep working longer. One of the problems I encountered was case managers telling me that I was there to do the work and take over. That's the argument they would use to deny my husband services.
That said, another problem is the form that the benefit has been given. Something I would like everyone to understand is that, in the context of my relationship and family reality, my fatigue needs to be taken into account. I can't be separated from my position as a member of a couple. There are no if's, and's or but's about it; I am well when my husband is well.
Jenifer Migneault
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Jenifer Migneault
2015-05-27 19:05
Initiatives already exist, such as Wounded Warriors Canada and Can Praxis. It's necessary to address—
caregiver fatigue as a couple, as a family, and with also an input of education—just tools that I will bring back home to make a difference. Don't forget that PTSD is a process; we cannot solve this overnight.
Jenifer Migneault
View Jenifer Migneault Profile
Jenifer Migneault
2015-05-27 19:08
It would be as needed.
I know I look devastated. Honestly I am, but I was much worse five, six, seven years ago. It's a process. So if I needed it, honestly, for two weeks a year until I didn't need it as much, why not?
You must provide us with the help that we need when we need it, not when the system decides that this is the number of sessions we can have, for instance, with a psychologist.
Debbie Lowther
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Debbie Lowther
2015-05-26 18:53
Well, thank you, first of all, for asking VETS Canada to attend this evening and asking me to speak on behalf of the organization.
VETS Canada is an organization whose mission is to assist homeless, at-risk, and in-crisis veterans of the military and the RCMP. My husband, who is a veteran, and I founded the organization in 2010 after he stumbled across a veteran whom he had served with who was homeless in Halifax.
During the past five years we've had the privilege of helping over 500 veterans across the country. We've expanded from Halifax right to the west coast. In June of last year we were awarded a contract with Veterans Affairs as service providers in the field of outreach to homeless, at-risk, and in-crisis veterans. In the past five years, as I said, we've had the opportunity and the privilege to assist over 500 veterans.
One thing we've noticed is that every veteran's story is different. Every veteran's set of circumstances is different. There's no cookie-cutter solution to helping any one of them. One common denominator we see in our work is that the men and women we've assisted have not made a successful transition from their life of service to their civilian life.
A great deal of effort and rigorous training goes into preparing the men and women to serve their country, and we feel it would be wonderful if they were given the same amount of training and preparedness on the other end, when their career is coming to an end, particularly for those who are being medically released, as it is unexpected.
The reason we're here today is to discuss division 17 of Bill C-59. It's the opinion of VETS Canada that the retirement income security benefit, the critical injury benefit, and the caregiver's benefit are all positive first steps. We do support that they be passed; however, we have some concerns about whether or not they will be the end of the road. It's our hope and our wish that they remain just that, first steps. There is a lot of improvement there.
We feel that the retirement income security benefit could be higher than the 70%. We would like to see the critical injury benefit be more inclusive of those men and women who suffer with OSIs, as these injuries, generally, do not immediately present themselves.
Something that would be nice to see included in the caregiver's benefit would be training for caregivers—and I'll take off my VETS Canada hat and put on my caregiver hat for a moment. My husband had PTSD, and when I was his caregiver—and I still at times am his caregiver—I didn't know if I was doing the right thing. Caregivers need training. They could be doing more harm than good, so it would be nice to see training for caregivers included in that caregivers benefit. Along with the amount of the benefit itself, it would be nice to see it revert to something a little closer to the attendance allowance.
In summary, as I said, VETS Canada does support the passage of Bill C-59, but it is our hope that it remains just first steps and that there's room for improvement. We like to say: Is it better than what was on the table yesterday? Yes. Is there room for improvement? Yes.
Thank you.
Perry Gray
View Perry Gray Profile
Perry Gray
2015-05-26 19:51
Thank you, Mr. Chair and committee members.
Like many public announcements, these new programs seem to offer more financial support for the veterans community. Closer examination of each one can raise a host of potential problems.
The one question that this committee can ask VAC about any new financial policy is, how generous will VAC be? VAC has a reputation for being as stingy as Ebenezer Scrooge or Scrooge McDuck. As of 2014, only 227 clients had received 100% of the new Veterans Charter lump sum, out of 46,760 recipients. The CIB lump sum of $70,000 will be offered on a limited basis and, like the NVC lump sum, is based on a percentage calculated by assessing the severity of disabilities. Initial estimates suggest that hundreds rather than thousands will receive CIB.
The FCRB is expected to provide relief to approximately 350 spouses or caregivers by 2020. Why is this estimated number of caregivers so small? I would think that many primary caregivers would like to take a break, considering the fact that many of them did not expect to have to work for 24 hours a day, seven days a week, because of veterans' disabilities. In fact, the FCRB could reduce the number of divorces caused by caregiver burnout.
The RISB may benefit about 261 clients over the first five years of the program. In my opinion, the RISB also has a poorly justified limit. In addition, it will be 70% of pre-65 income. There are two concerns that I shall highlight. Why is there any decrease in a veteran's financial support because of a change in age? Is it assumed that veterans need less support after the age of 65? Based on the studies of VAC's own Gerontological Advisory Council, veterans are able to enjoy long life but only if they have good support.
In 2006, Greg Thompson, the incumbent minister, provided information on the veterans independence program for this very committee. He stated that 86,000 war service veterans did not receive VIP. He did not offer an explanation about why they did not receive support and added that providing them with VIP might never happen. He did acknowledge that that home care is better than institutional care, and the council also acknowledged that veterans were likely to live longer if they remained in their own homes.
VAC is also aware that most of the health care given to Canadians occurs when we are babies and then in the last months of our lives. This suggests to me that, rather than less money, veterans will need more money to maintain an independent lifestyle, which will likely include support during activities that elderly and disabled people find difficult or impossible.
It should also be noted that the age of 65 will stop being a benchmark by 2023 for old age security. Will VAC also raise the age of eligibility for the RISB? I think that using age as a factor contradicts the spirit of Canadian human rights. Pension Act benefits are awarded in recognition of the sacrifices made by veterans, as are other benefits provided by VAC. Decreasing these based on age is discrimination. Nobody improves with age, unlike wine.
In summary, these three programs are expected to benefit a very small number of the estimated 205,000 clients and their families. The RISB may also result in financial hardships at a time in life when clients may need to pay for more support. Why is VAC developing programs if only a few will benefit?
Thus, VAC seems to be advertising a lot but delivering only a little.
Thank you.
Michael Blais
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Michael Blais
2015-05-26 19:55
Thank you.
Good evening. My name is Michael Blais. I'm the president and founder of the Canadian Veterans Advocacy. Thank you for inviting me to attend committee tonight to speak to Bill C-59 and the creation of new programs designed to improve the quality of life for disabled veterans.
It is very gratifying to me to note that several of the primary issues that I found at the Canadian Veterans Advocacy in 2010 have been addressed recently. While there is a certain degree of scepticism within the veterans community I serve as to the timing of these announcements and the looming election, I am hopeful that the government is acting in good faith and that there will be merit in these discussions.
I understand there is only so much we can do with the limited time available to us. To that end, I'd like to focus on the shortcomings that I believe can be resolved at this time, if the government is acting in good faith, to ensure the proposals that have been brought forward will be inclusive to all veterans, not only those who have experienced physical trauma.
Critical injury benefit: I believe this is a positive development. However, what is very troubling to me is the fact that many who have sustained mental wounds will be excluded, due to the immediate prerequisite within the proposal. This exclusion is detrimental to our collective objective to eliminate stigma, to ensure that those who have sustained mental wounds are assured that the pervasive health insidious stigma does not relegate the seriousness of their sacrifice, as this does, to a lower state of recognition. There must be equality in acknowledgement of all serious wounds, physical or mental.
I would respectfully remind the committee members that mental wounds are just as lethal as physical wounds. We must acknowledge the grim fact that more of Canada's sons and daughters have died as a consequence of suicide than the nation's sacrifice during the war on terror. Without effective intervention, this number will only rise. Furthermore, we must be cognizant that these intensely tragic numbers speak only to one segment of the issue, as Veterans Affairs Canada does not track suicides within the veteran community. These numbers may be exponentially higher.
We know now that mental wounds, when incurred during an operational period, are often not recognized or acknowledged by the individual until returning home and the cycle of despair begins to ravage the mind, adversely affecting self and the family unit. We also understand that many of our heroes suppress acknowledging the seriousness of the wound, fearful of stigma and career-ending ramifications, until the mental discord appears and finally the treatment is brought forward.
We must consider all serious national sacrifice equally. It should matter not whether you have sustained a physical or a mental wound. Should it not qualify for the prerequisites of the CIB because a mental wound is bereft of the need for immediate hospitalization? Amendments can be made to respect the national sacrifice of those who have sustained mental wounds as a consequence of their service, so that they, too, will be included in this compensatory proposal.
In regard to caregivers, this too is a positive step forward, aligning the NVC provisions with that of the Pension Act and providing annual respite for primary caregivers who have been consigned to a lifetime of caring for seriously disabled veterans.
Once again, however, caregivers who are caring for veterans who have sustained serious mental wounds have virtually been excluded. Spouses who care for their husbands 24/7, fearing the spectre of suicide on a daily basis, are not accorded the opportunity for dedicated respite while knowing their loved ones are cared for.
There must be equality and recognition that the impact that a mental wound bears upon the caregiver is extraordinary, that the threat of the wound manifesting catastrophically is clear and present long after a physical wound has been determined non-life threatening. I would encourage you to recognize the travail that caregivers of those with mental wounds are experiencing. Amend the legislation to include the plight of families who are dealing with mental wounds.
Regarding the retirement income supplementary benefit, this has been the cornerstone principle of the CVA since conception, that is, the plight of our disabled veterans when reaching aged 65. I repeat, it's for disabled veterans, ladies and gentlemen. The foundation of the RISB, a comparative to the average Canadian's post-retirement income at 70% of 75%, negates the disabled veteran's quotient completely. We're not speaking of ordinary Canadians; we're speaking of disabled veterans who are bereft of a lifetime of opportunity to prepare for retirement. Disabled veterans do not retire from being disabled. Indeed, as they grow older, they require additional help.
We believe there should be no reduction and that the 70% of 75% equation does not respect the needs of a disabled veteran. The RISB should ensure the quality of life provisions to which they have been accorded, the foundation of VAC's mandate, are maintained at 75%. We also find it disingenuous to include a permanent impairment allowance—an award that recognizes the fact that seriously disabled veterans require financial support to cope with their wounds in addition to the 75% ELB or SISIP provision—into the harmonization of these income prerequisites. Once again, these are seriously impaired veterans. To negate the PIA mandate through a RISB clawback formula—despite the fact they are still seriously disabled and have already sustained a significant physical reduction—when reaching age 65 will consign them to lives of near poverty.
We also have grave concerns about the proposals to give 50% of 70% of prior earnings to dependants should the veteran pass prior to the spouse. We find this is grotesquely insufficient. There must be equality in recognition of national sacrifice. A serious life-altering wound must be treated with the same level of respect, regardless of whether it's physical or mental in nature.
I have come here today to attempt to convince you to fulfill this obligation, this sacred obligation to the valiant who have sustained serious mental wounds and to their families who have offered such profound sacrifice on behalf of this magnificent nation.
Thank you.
Janet Currie
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Janet Currie
2015-05-26 16:32
Thank you very much for asking me to submit to you today. As the chair said, I'm presenting for the Psychiatric Medication Awareness Group, which is a web-based information support group for people on psychiatric drugs. I'm also the co-chair of the Canadian Women's Health Network, and have contributed to many Health Canada regulatory hearings, and was a member of the expert advisory panel on the vigilance of health products for five years.
I'm going to bring to the session today my background in working with families, parents, and children in tapering them safely off psychiatric drugs. These are people who have faced a myriad of side effects related to psychiatric drugs, which have increased their mental health and emotional problems. I'll be discussing gaps and barriers in the mental health strategy and proposing some best practices.
I want to talk first about the context in which our mental health services are delivered, and this is really a unique and unprecedented context.
First of all, we have very high stated prevalence rates of mental illness and high diagnostics in many areas of mental health, and these rates are continuing to rise. I think in Canada now we consider that 20% of Canadians may be exposed to a mental illness, and in some cases the rates are much higher. The World Health Organization is now saying that depression will be the major cause of disability globally by 2020. Thirty years ago, depression was considered to affect a very small number of people and to be self limiting.
So in terms of statistics, what does this manifest itself in? We have 6% of boys from 6 to 14 taking psycho-stimulants. We have a quarter of our seniors in our care homes taking antipsychotics, even though they do not have a diagnosis of schizophrenia. We have 20% to 25% of women in middle age and older taking antidepressants. We have a tenfold increase in the number of children who are being prescribed antipsychotics, which are very potent drugs not approved for this group. And we have large numbers of people taking benzodiazepines—15% to 25% in some cases. I was very disturbed to learn that Canada is the third-largest user of antidepressants among 22 comparable OECD countries.
So what does this mean in terms of the individual and their mental health? All psychoactive drugs have side effects. They are very potent drugs that affect the structure of the brain and the neurotransmitters that are the chemical in the brain. All of the drugs can either exacerbate or create new mental health problems or new kinds of emotional problems for the user.
For example, someone taking a tranquillizer like Ativan, which is a very commonly prescribed drug, will eventually become depressed if they take it long enough, and then they will go back to their doctor and say they are depressed, and their doctor will either increase the dosage of benzodiazepines or prescribe an antidepressant to deal with the depression, which is a side effect of the tranquillizer. This kind of pattern is called the prescription cascade, and anyone who's on a psychoactive drug for long enough is going to be taking other drugs to deal with the side effects of the drug they are already taking.
It's the same for antidepressants. Someone on antidepressants may become agitated and develop akathisia, which is a form of restlessness. They may have agitated depression, and so they may be put on a tranquillizer, or they might be put on an antipsychotic to deal with those symptoms.
The point I am making is that we need to take adverse drug reactions from psychiatric drugs very seriously. These drugs not only cause impacts on the sense of mental well-being of patients, but they also cause physical effects. For example, tranquillizers cause dizziness and falls that lead to hip fractures. Antidepressants can lead to suicide or suicide ideation and sexual dysfunction. Antipsychotics can lead to cognitive impairments, memory loss, and issues like that, as well as a predisposition to diabetes and stroke. So we really need to take these things seriously.
I think the other thing that we need to recognize is that if a person stays on a psychoactive or psychiatric drug for a long period of time, their brain is going to adapt to it and they're going to become addicted. I know that's a strong word that we don't like to use in relation to the drugs we prescribe. But it actually is the same mechanism as addiction. When a person tries to reduce their dose or change their dose, they may be affected by an upsurge of symptoms that can be really very unpleasant, including increased anxiety and increased agitation, to the point of hallucinations and irrational violent behaviour. I think in the media we're seeing stories of people engaging in very frightening homicidal or suicidal acts that are associated with prescription drugs. We feel that prescription drugs are definitely a contributor in these cases.
So what do we need to do about it? We need to reassess the degree to which we're prescribing psychiatric drugs. A recent study in the United States is showing that the rate of prescription of psychiatric drugs to children has grown by about 31% in the last decade, yet the children who are prescribed these drugs are ones who are considered to have really moderate issues, whereas children with very severe issues are falling through the cracks. So I think we really need to reassess the degree to which we are prescribing psychiatric drugs. In order to do that we need to provide more supports in the community to families, to women who are pregnant and who are having post-partum difficulties, to young people, to teenagers, to seniors, so that they can address their sense of isolation and find cognitive help that's accessible and reasonable in terms of access. I think a central place to provide these services for families is in the schools, where in the past there were school counsellors and groups that would help parents deal with their family issues and their children.
I also think that we need to really assess people's use of drugs and the impacts these may be having on mental health. We talk about dealing with polypharmacy, but I think anyone who comes in to a health provider with a mental health symptom needs to be assessed in terms of the drugs they are taking. It is not only psychiatric drugs that cause mental health symptoms. There are also common cardiac drugs, antibiotics, the corticosteroids, smoking cessation drugs, and acne treatments. All of these can be associated with mental health issues that the person or physician don't associate with the drug. I would say, too, that we really need physicians and health care providers who are skilled not only in assessing the side effects or the adverse drug reactions caused by psychiatric drugs, but also physicians who understand how to taper the use of these drugs, how to design tapers, how to support people, how to understand what a person is going through on a taper. I've done tapers for dozens of people. It's an arduous job, but it's really miraculous the degree to which people can recover their health. However, it needs skilled health care providers to provide that kind of service.
Finally, I would say that when we consider mental health in general, we need to consider it as a gender issue. Two-thirds of the people who are diagnosed with mental health issues and who receive prescription drugs are women. Women are subject to many stressors related to their role in society and the expectations placed on them. I think we really need to build that back into our assessment of the most effective mental health treatment.
Thank you.
View Ben Lobb Profile
View Ben Lobb Profile
2015-03-12 15:30
Good afternoon, ladies and gentlemen. Thank you for attending our committee.
We're continuing our study.
We have a number of guests today who are appearing by video conference. I think that while the technology is up and running, we better hear your testimony first.
First is the Cline Medical Centre, and John Cline.
Go ahead, sir.
John C. Cline
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John C. Cline
2015-03-12 15:31
Good afternoon.
Thank you to the chair of the committee and to my MP, Dr. James Lunney, for inviting me to present.
As you know, there's an urgent need for health care reform in Canada. I believe the solution is to introduce and implement functional medicine in health care professions' curricula and practices throughout Canada.
Functional medicine addresses the underlying causes of disease using a systems-oriented approach and engages both patient and practitioner in a therapeutic partnership.
You have the cover page of “21st Century Medicine”, which is a white paper published a couple of years ago on how functional medicine could take our health care forward.
Functional medicine offers a powerful new operating system and clinical model for assessment, treatment, and prevention of chronic disease. It incorporates the latest in genetic science, systems biology, and the understanding of how environmental and lifestyle factors influence the emergence and progression of disease. It enables physicians and other health professionals to practise proactive, predictive, and personalized medicine.
The slide with the picture of the three-legged stool illustrates the importance of the three components of functional medicine: the patient’s complete story, looking at modifiable lifestyle factors, and a systems biology matrix framework.
The next slide goes over the seven organizing systems where core clinical imbalances are developed, such as, assimilation, defence and repair, energy, and biotransformation.
On the next slide the three core tools are the matrix, the timeline, and a GoTo It heuristic. What this provides the practitioner is a way of critical thinking when presented with complex cases.
The next slide is the functional medicine matrix, with a column “The Patient’s Story Retold” on the left, with antecedents, triggering events, and mediators. On the bottom is a section detailing fundamental lifestyle factors. In the centre is the mental, emotional, and spiritual components of the person, surrounded by the core clinical imbalances.
The next slide looks at the timeline from preconception to current concerns.
Then there is the GoTo It heuristic that helps the practitioner gather, organize, retell the story, and initiate a care plan.
The next slide is a picture of a dense jungle. That's how we often feel when we have these complex cases sitting before us and have to sort all of this out.
We know there are many famous detectives in the world, such as Detective Adrian Monk, Inspector Clouseau, Sherlock Holmes, and then the most famous of all, the medical detective, “Dr. Fxn L. MeD”.
I'll end this presentation with a case study of a woman with severe pain and gasping. This is a woman I met a few years ago. She is a 45-year-old businesswoman who had just got her M.B.A. She had a one-year history of episodic vomiting, diarrhea, abdominal pain, non-throbbing headaches, night sweats, red eyes, and severe muscle and joint pain, especially in the wrists and ankles. She also had intermittent shortness of breath with gasping episodes. You can see what I mean about being in a jungle and having to sort all this out. She had had several ER admissions, and most of her symptoms cleared up within several months.
She had evidence of fluid in her lungs at one of those admissions. Her joints were transiently swollen, and her C-reactive protein level was extremely high, at 211. That's the best marker we have for inflammatory disorder.
She had seen five specialists, including a rheumatologist, who thought she had inflammatory arthritis of unknown origin. She'd seen an ophthalmologist, as well as an allergist, and nobody came up with a diagnosis.
When I was taking her history, there was a key question I asked her: Did anything unusual happen to her just before becoming ill each time? She said, “Yes, one to two days before becoming ill, I sprayed my trees and shrubs with malathion”, which is a potent pesticide and herbicide. Examining her, I found her blood pressure was low, her skin was dry, her finger tips were cracked, the membranes of her nose were quite swollen, and her wrists and ankles were warm to touch.
Her lab work showed that she had iron deficiency anaemia, her C-reactive protein inflammatory marker had come down to 38 and it should be under 5, and her vitamin D level was quite low. I also ordered genomic studies to see how she was designed for detoxification and I found that in her phase I detoxification pathways, two of them had genetic mutations. Then in her phase II pathways, she had a complete absence of the most important pathway for getting metals and chemicals out of the system, called glutathione. This is specific to liver and kidneys.
I went on line to the Agency for Toxic Substances and Disease Registry and found the toxicologic profile for malathion and discovered that it is metabolized through the glutathione pathway, the pathway she was missing, and she had every symptom described in that profile.
The therapeutic intervention was to change her diet and put her on a medical food product to support her detox, probiotics, pharmaceutical-grade fish oil, a good dose of vitamin D, high dose of curcumin, which comes from the spice turmeric, the most potent anti-inflammatory compound on earth, and oral glutathione, and I told her to avoid further exposure to chemicals.
The outcomes at the four-week follow-up showed that her wrist and ankle pain and swelling had improved by 95%. Her arm muscles had regained strength. Her night sweats and GI symptoms had all resolved. Her sinuses were clearer than they had been in year. She had only occasional headaches now, and she was back to work.
The second-last page is cost comparisons. We look at the conventional approach and we see she had had numerous trips to the ER, eight days in hospital, five specialist consults, numerous blood tests and imaging studies, numerous medications, and no diagnosis, with prolonged disability. In the functional medicine approach, she had no ER visits, only two office visits, no specialists, and few blood tests. I had ordered the genomic study on detoxification and comprehensive stool study and arrived at the correct diagnosis. She experienced rapid recovery, was back to work in a month, and regained a thriving life.
I do believe that the answer to our health care problem in Canada is the introduction and implementation of functional medicine in the health care profession's curricula and practice throughout Canada.
Thank you very much.
Janice Wright
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Janice Wright
2015-03-12 15:40
Thank you for this opportunity.
As mentioned, my name is Janice Wright. I'm a medical doctor and the CMO of InspireHealth. We are a non-profit charity in Vancouver, British Columbia.
I'd like to talk today about bringing health into health care by using the example of our cancer care model. For us the most innovative thing that we could introduce into our health care system is the support of health.
I'll give a little bit of background on InspireHealth. We're a not-for profit. We were founded 18 years ago by two medical doctors. We are still to this day physician led. We provide a team approach to cancer care. We are grateful to be partially funded by the B.C. Ministry of Health. We work with local and national cancer foundations and would welcome a stronger opportunity to work with the national cancer strategy. I'd like to move right into talking about our current situation in health care.
We view this health care system as being actually more a disease treatment system, or as some people call it, a sick care system, rather than a health care system. Part of the reason for this is that as physicians, we're trained almost exclusively to diagnose and treat disease. Very little time in medical school is dedicated to learning to support our own or our patients' health.
As we all know, money alone will not save the health care system. The focus of our current system is on how to diagnose and treat disease, and few resources are given to prevention. In fact, as physicians and other allied health care providers, we are left to mop up when patients, who perhaps haven't learned how to take care of themselves properly or optimally, develop significant and chronic diseases.
Have we asked ourselves as physicians, as patients, as decision-makers, how we can work to turn off the tap, how we can work more towards prevention?
Our health care system currently does not effectively teach or model health. Medical students and residents, as I mentioned, don't learn how to support their own health let alone their patients' health. We learn how to diagnose and treat disease. Many doctors, as we know, are stressed and burned out and not in the position to model health for their patients.
Turning to our slides, in the disease treatment model, using cancer as an example from our practice, you'll see the tumour with standard therapy, such as surgery, chemotherapy, and radiation targeting the cancer, targeting the tumour, and the physician is the expert and advises the patient on what to do for their health.
In a fuller health care model, those standard therapies are still important. The surgery and chemo and radiation are still targeting the T—for tumour—in this next slide. However, you'll see all of these other ways that the patient...but also allied health care providers including physicians can support the patient to actually feel well, and perhaps to even have a better outcome than they would have with just standard cancer therapies alone.
I'd like to also point out—on the right-hand side of this slide—that the patient is in the driver's seat here. In fact, sometimes at InspireHealth we call them a participant. The patient is having conversations with their physician, their allied health care providers, and we are all having conversations with one another.
It is absolutely essential that patients become empowered, that they take responsibility, that they become engaged in their own health. Physician engagement in health care is equally important. Again, it's essential that physicians learn how to take care of themselves so that they can model this and support patients along the way, working as guides, as educators, as supporters, in addition to being diagnosticians and people who treat. This leads to a very powerful relationship, the physician-patient partnership, where they work together on shared decision-making and work to support the patient's good health.
You might be surprised to hear that actually many of our cancer patients who are working with a life-threatening illness tell us they've never felt better in their lives.
I'd like to also touch on two health care assumptions that I believe are quite prevalent.
One is that health is simply the absence of a diagnosable disease. Patients are sent the message from our current system that they need to be diagnosably sick before they go in to talk to a health care provider about their health.
There is a commercial on TV right now—I'm sure there have been many in the past, and there will be more in the future—that is quite compelling. I won't mention the name of the company. However, a gentleman who appears to be 20 to 25 pounds overweight runs into his home gleefully to eat foods that are highly processed, high-fat foods spread all across the dining-room table. The important part of this commercial is that he has a pill to take for his heartburn. Now, perhaps he doesn't have a diagnosable illness. He may consider himself to be healthy, and just needs to run to the drugstore for his next dose of a pill that might suppress his reflux. But this gentlemen being 24 pounds overweight, as we all know, is at higher risk for developing diabetes, cardiovascular disease, high blood pressure, and other illnesses.
Health is much, much more than the absence of a diagnosable disease.
The other assumption I'd like to touch on today is that people already know how to take care of their own health. I don't actually think that's true in many cases. In fact, as I mentioned, as physicians we don't necessarily know how to optimally take care of our health, or our patients' health either.
I'd like to show you this chart on the slide that reads “Deaths from Heart Disease”. I'd like to give you the example of cardiovascular disease.
Prior to the 1970s and healthy heart programs becoming de rigueur, patients were coming through the emergency room with an acute cardiac event and being told by their physicians that there was nothing that could be done for them. In fact, they were advised not to exercise because it would put them at higher risk for damaging their heart muscle and would lead to another cardiac event or death. Patients were labelled “cardiac cripples”. They were told that diet does not make a difference.
Thanks to some research, mostly that came out of the U.S., there was a change such that now healthy heart programs are recommended to every patient that has a cardiac event. Patients are up and walking and exercising the day after they have either cardiac surgery or an angioplasty. It's very, very powerful medicine. It shows that until that time, we as physicians didn't even know what was best for our patients' health. It's important that we recognize that we don't all necessarily know how to take care of our health and there is much to learn beyond just diagnosing disease.
I'd like to tell you a bit about InspireHealth's model of care. Again, we work exclusively at this time, mandated by the B.C. Ministry of Health, with cancer patients, adults living with cancer and their families. I'll highlight that in a moment.
We believe that we have an innovative program. We are research based. We support the health of cancer patients, but we also support the health of their families. The families come in and learn how to eat healthily through our cooking classes and other programs. They learn how to reduce stress in their lives, not just acutely but long term. They work towards restorative sleep and healthy nutrition. They learn to exercise. They take the programs home with them, or they participate in our exercise or other movement classes. They are provided with emotional and spiritual support.
One of the most important things is that with these group programs, they end up supporting one another. It's in a supportive environment. We provide patient-centred care, a team approach with allied health professionals including nutritionists, counsellors, and exercise therapists. We provide not only in-person programs but also virtual programs that we've now taken across Canada.
I mentioned that we were research based. I want to provide two examples. I won't go into the details, although I'm happy to provide references if you are interested. One shows that physical activity can actually help to prevent cancer in these particular cancers, and the other shows that physical activity can actually help breast cancer patients survive.
Coming to my conclusions, we believe at InspireHealth that the greatest innovation is to bring health into health care. One of the solutions, and a very important one in our eyes, is to actually educate physicians through formal modules on how to take care of their own health and how to support others in their health, so that physicians become educators. They become guides and supports in addition to diagnosticians. They are providing patient-centred care where the patient is in the driver's seat and this powerful relationship between doctor and patient, or other health care provider and patient, is strongly supporting health.
I cannot say enough about group programs. These have been instigated in certain cases across Canada, and I cannot say enough about them. I actually wonder whether we support our patients more greatly or they support one another more greatly. They've been there, and they can support one another in the lifestyle changes they're making that help them feel well and are potentially changing the course of their disease. A team approach is very important, where physicians learn to work not just in a multidisciplinary setting behind closed doors or siloed, but actually alongside one another toward the greatest health for all.
Our model of care is applicable Canada-wide. We've taken it in a virtual way across Canada to date. It is something that we would be happy to be consultants on, to help support the entire spectrum of health across Canada, not only for chronic disease, but for the whole spectrum, including prevention.
Our virtual programs, as I mentioned, have been supporting patients in underserviced areas already, and for patients across the country who don't have access to our services in person. We forge strategic partnerships across Canada with cancer agencies and foundations, and as mentioned, we would welcome the opportunity to work more strongly with the national cancer strategy.
We are very honoured that we are being studied by an international research institute at the moment. It's a four-year study. They have received a sizable research grant to study our model of care. They are doing an observational study, looking at survival outcomes and quality of life. We would also look forward to an economic analysis after that.
I welcome any questions. Thank you.
Allan Markin
View Allan Markin Profile
Allan Markin
2015-03-12 15:51
Chair, honourable members of the committee, my name is Allan Markin, and my vision is preventive health care for everyone.
I am the founder and chief accountability officer of the Pure North S’Energy Foundation, Canada’s largest primary prevention-focused not-for-profit organization. I'm accompanied by Dr. Mark Atkinson, a medical doctor and director of quality assurance, and Dr. Samantha Kimball, research director at the Pure North S’Energy Foundation.
At Pure North we empower Canadians to feel better and live longer through the use of simple and effective prevention-focused clinical interventions. These include vitamin D3 and high-quality multivitamin and mineral supplementation, health education, and the safe removal of mercury amalgam fillings. Our preventive program supports the advancement of modern medicine. Our multidisciplinary team of over 100 people includes medical doctors, naturopathic doctors, nurse practitioners, dentists, pharmacists, nurses, and other health care professionals.
Over an eight-to-ten-year period, 40,000 Canadians, including 25,000 vulnerable seniors, homeless, and first nations, have accessed our preventive health program, and have their blood panel taken regularly. Participants in our program experience a significant increase in quality of life and a 20% improvement in physical and mental health. Forty-eight per cent of those with pre-diabetes have experienced a complete reversal in their disease. Emerging evidence demonstrates there's a 17% reduction in the prevalence of metabolic syndrome for every 25 nanomoles per litre of vitamin D3 increase.
Our request is for the Government of Canada to proactively resolve what we call the four injustices, and for all Canadian physicians, medical students, dentists, and allied health professionals to be educated about these injustices.
Injustice number one is that Health Canada has regulated that no supplement in Canada contain more than 1,000 IUs of vitamin D3. Any amount higher than this requires a doctor’s prescription and is regarded a drug. In the U.S.A., a country that has exactly the same recommended daily allowance for vitamin D3 as Canada, people have access to vitamin D3 supplements containing 7,000 IUs of vitamin D3 per tablet. It does not require a prescription, to our knowledge. The FDA has not put a limit on the amount of vitamin D3 in a pill, but Health Canada has. Canadians should have access to vitamin D3 supplements at the same dose as Americans, or higher.
Injustice number two is that the recommended daily allowance for vitamin D3 should be changed to be between 7,000 IUs and 9,000 IUs. Health Canada has been proven to have made a significant mathematical error in their calculation of the RDA for vitamin D3. The Health Canada vitamin D3 RDA for most adults is 600 IUs per day. Using Health Canada data and the correct statistical methodology, Professor Paul Veugelers at the University of Alberta has shown that the IOM vitamin D3 recommendation would have been 9,000 IUs per day if IOM had not made a math error. Another group, led by Dr. Heaney, a vitamin D3 expert from Creighton University in Nebraska, came up with a similar figure of 7,000 IUs based on an analysis of a dataset of 3,600 individuals. Dr. Kimball has published extensively on vitamin D3, including a trial of 14,000 IUs per day in patients with MS. The evidence is clear: vitamin D3 is safe, and the vitamin D3 RDA should be 10 to 15 times higher than the current Health Canada RDA.
Injustice number three is that Canada needs to mandate a complete ban on the use of mercury amalgam fillings in all Canadians, and not just children, pregnant women, and those with impaired kidney function. In Health Canada's report, “The Safety of Dental Amalgam”, they acknowledge that amalgams impair kidney function. Pure North research has found that the safe removal of amalgams results in a significant improvement in kidney and liver function and in self-reported physical and mental health symptoms, such as anger, depression, and anxiety. The World Health Organization acknowledges that mercury is poisonous at any level. The use of mercury amalgam fillings has already been completely banned in Norway, Sweden, and soon Brazil, as well as a partial ban in Denmark. Canada needs to follow suit. Amalgam removal needs to be done safely.
Injustice number four is that Canadian emergency departments have unnecessarily long lineups and waiting times. The Wait Time Alliance’s annual report card states that 27% of Canadians reported waiting more than four hours in an emergency department, as compared with 1% in the Netherlands, for example.
A recent analysis of the data relating to 6,600 of our program participants by the school of public policy at the University of Calgary found that a preventive health program such as Pure North's keeps people out of hospital. Within one year of being on the program, the Pure North participants had 45% fewer nights in hospital and accessed emergency departments 28% less than controls. This happened in less than one year.
The inconvenient truth is that millions of Canadians experience disease and suffer unnecessarily because our health care system has not yet made primary prevention a priority.
In 1943 the Canadian Medical Association called for preventive medicine to become a federal priority.
The World Health Organization report on the impact of chronic disease in Canada predicted that between 2005 and 2015 over two million Canadians, or 400,000 people a year, on average, will die from chronic disease.
Studies have found that if Canadians optimized their intake of vitamin D3, 37,000 premature deaths would be prevented annually, and the economic burden would be reduced by $20 billion per year.
In summary, integration of a proven preventive health program such as Pure North’s prevents premature deaths and saves the government money. An assessment of the economic impact of our program estimated that every dollar invested in the Pure North program provides a return of between 13:1 and 25:1.
The result is that the health care cost curve is bent downwards with real potential cost savings of at least $420 million per year if rolled out to 600,000 Canadians. If Alberta, for example, implemented the Pure North program province-wide, this could free up the equivalent of 1,600 hospital beds every year. This is roughly the same as building two entirely new hospitals.
The provincial governments are also locked into an unfortunate mindset that the health care costs avoided rather than current health care dollars saved are not worth pursuing. Preventing [Technical Difficulty—Editor] chronic disease in the future avoids the size of the increase in budget that we are otherwise headed for. To avoid prevention since it does not reduce the size of the health budget today is nothing more than flawed logic with tragic implications, a sicker population and ever-increasing costs of treating them.
It is our hope that the Standing Committee on Health will attach great importance to these issues and take action to resolve them.
Emmanuelle Hébert
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Emmanuelle Hébert
2015-03-12 15:58
Thank you, Mr. Chair and committee members, for the opportunity to appear today to contribute to the study of best practices and federal barriers related to scope of practice and skills training of healthcare professionals.
My name is Emmanuelle Hébert, President of the Canadian Association of Midwives, registered midwife and professor at the Université du Québec à Trois-Rivières.
The Canadian Association of Midwives is the national organization representing midwives and the profession of midwifery in Canada. The association's mission is to provide leadership and advocacy for midwifery as a regulated, publicly founded and vital part of the primary maternity care system in all Canadian jurisdictions.
The Canadian Association of Midwives also works to support the interests and objectives of 13 provincial and territorial midwifery associations, as well as the National Aboriginal Council of Midwives. There are currently just over 1,300 practising midwives in Canada.
Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, birth and the post-partum period. They are often the first point of entry to maternity services, and are fully responsible for clinical decisions and the management of care within their scope of practice. Models of care vary across the country, but are based on the principles of continuity of care provider, informed choice, and the choice of birth place which includes hospitals, birth centres and homes.
Midwives regularly interact with a wide variety of health care professionals and social services workers in order to provide optimal care for clients. These include obstetricians and gynecologists, family physicians, pediatricians, nurses, radiologists, psychiatrists, paramedics, social workers, pharmacists, dieticians, and many more.
Collaboration and consultation with other health care providers is integral to the scope and practice of midwifery. Midwives, together with physicians and nurses, are actively exploring collaborative models of care and multidisciplinary practice to help address shortages of care providers and ensure women's access to maternity services, particularly in rural and remote communities.
Let's talk about midwifery training. The midwifery education program is a four-year direct entry baccalaureate program in midwifery. Seven Canadian universities in five provinces offer the midwifery education program. There are also three community-based midwifery education programs located in first nations and Inuit communities that specifically address the needs of aboriginal peoples.
Three bridging programs also exist in Canada, designed to help internationally educated midwives learn how to use their skills in a Canadian context; one in British Columbia, one in Ontario and one in Quebec. All students graduating from the midwifery baccalaureate programs take the Canadian midwifery registration examination which demonstrates that they have the core competencies and meet a common standard for entry level competency in all Canadian jurisdictions. All midwifery education programs are based on the same standards of education to train midwives as autonomous primary health care providers able to practise in all provinces and territories.
In jurisdictions where midwives work to their full scope, midwifery practice includes epidural monitoring, induction for post-term pregnancy and augmentation of labour by pharmacological means, prescription or fitting of contraceptives, well women and well baby care beyond the six-week post-partum period, and other aspects of primary care.
Scopes of practice reviews to amend drug schedules and expand on the authorized acts that midwives may perform have been completed. The objective is to harmonize high standards of midwifery care across Canada, reduce barriers to interprofessional collaboration and keep pace with a changing maternity and newborn care environment.
In every jurisdiction where midwifery is regulated, the provincial and territorial colleges are responsible for registering competent, qualified midwives and establishing, monitoring and upholding standards of practice.
The Canadian Midwifery Regulators Consortium is a body that groups together the provincial and territorial regulatory bodies. It has identified competencies that are common across all jurisdictions, covering antepartum care, care during labour and birth, postpartum care of the woman, care of the newborn and young infant, breast feeding, well woman care, education and counseling, and professional, interprofessional and legal issues.
Regulatory authorities further specify advanced competencies that midwives with the necessary training and certification may perform in certain situations or practice settings. In some rural or remote communities for example, midwives work to an expanded scope and provide a broader range of services to meet the needs of the population. Definitions of advanced—versus entry-level—competencies vary according to the regulatory framework in each province and territory.
In June 2017, Canada will host the world's Triennial Global Midwifery Congress in Toronto. Over 4,000 midwives and maternity care providers from around the globe will be in Canada. This will be a unique opportunity for us to show the world Canada's contributions and to highlight what we do within our own borders to provide fair and equitable maternity care to all of the population.
In order to optimize that visibility in Canada, the Canadian Association of Midwives believes that we should ensure that federal mechanisms are in place to allow communities to hire midwives to deliver maternity and newborn care services. Midwifery is not listed as a recognized profession under the Health Services Occupational Group Structure within the Treasury Board of Canada. This lack of an occupational classification has been identified as a barrier to midwives being hired by communities under federal jurisdiction for service delivery.
Maternal and child health statistics in aboriginal communities fall well below that of the rest of Canada. As the rest of Canada's fertility rates decline, the fertility rates of first nations and Inuit peoples increase. This is in the midst of a severe shortage of maternity and newborn health care providers.
These communities are already underserved and will feel the effects of this crisis disproportionately in the coming years. It is therefore crucial that birth care be brought back to communities and that access to midwifery care services in all aboriginal communities be provided.
Since April 2013, the Government of Canada has been providing student loan forgiveness to eligible family doctors, residents in family medicine, nurse practitioners, and nurses who work in rural or remote communities. Including midwives in this incentive program would increase the outflow of maternity care providers to rural and remote communities.
In New Brunswick, Prince Edward Island, Newfoundland and Labrador and in the Yukon, the profession of midwifery is still not regulated. CAM is working with its provincial and territorial partners and stakeholders to support the regulation of the profession in all jurisdictions.
As stated in the prestigious and well-respected Lancet series published in June 2014, midwifery plays an essential and unique role in ensuring safe, quality and cost effective care to women and babies here and around the world.
Thank you for the opportunity to appear before the committee. I look forward to any questions you may have.
Thank you very much.
View Christine Moore Profile
Thank you, Mr. Chair.
When I was a student, there was a focus on clinical assessment. It was said that questions accounted for 70% of that assessment. You had to take the time to assess the patient well and this was done through questions alone. The physical and visual examination, where the patient is touched, made up 20% of the assessment. Additional tests such as blood tests or X-rays made up the remaining 10%.
One often gets the impression now that the opposite happens when you go to a hospital emergency ward to see a doctor. There they ask you questions during one or two minutes, you are examined for a minute or two, and then you are sent for a multiple series of tests, blood tests, lab tests, X-rays, and so on.
Dr. Cline, can you tell me what you think of that? Perhaps the same problem exists in traditional medicine, where physicians take less and less time to question a patient and carry out an in-depth clinical exam. If a physician took the time to question the patient, he or she could have a better idea of what is going on.
John C. Cline
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John C. Cline
2015-03-12 16:12
Thank you for the question.
This is absolutely true. Sir William Osler, the famous Canadian physician, said to his medical students a century ago that if you listen carefully enough to your patient they will tell you what the problem is. For the case I presented, it took me one and a half hours to take that history and to do a careful physical examination.
When I teach residents in functional medicine, I'm surprised at their lack of physical exam skills. A large part of my teaching is on helping residents to sharpen up their history-taking skills and physical exams skills.
The power of the functional medicine matrix is that it forces you to think outside of your comfort zone and it forces you to be thorough in your critical thinking of these complex cases. It also helps us to hone in on what the patient has deemed most important. We teach our functional medicine residents to retell the patient's story back to them, and that's a very powerful therapeutic encounter.
The history and physical exam is still a cornerstone and should be the foundation on which you build other tests.
View Christine Moore Profile
Ms. Hébert, my question to you is in the same vein as the previous one.
In your opinion, is the success midwives have in their relationship with patients attributable to the fact that they take much more time to talk to them and assess them properly so as to target their needs? This could be why many patients report preferring their experience with a midwife to the ones they have had with traditional medicine.
Emmanuelle Hébert
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Emmanuelle Hébert
2015-03-12 16:12
It is certainly true that the time spent with each woman is very important. In fact, the relationship is at the very core of the midwifery profession. In order to support a woman well in her labour and delivery, it is very important that the midwife develop a relationship with her. Also, the woman must be placed at the centre of the decision-making, so there is really a partnership that develops, which is very important.
View Christine Moore Profile
Is the building of such a relationship a part of the training provided to midwives? Is the training limited to teaching midwives the biological aspect of maternal health, or does it also focus on the relationship with the patient and the assessment of her needs? Does the training allow midwives to acquire communication and helping relationship skills, or is it mostly focused on the biological aspect?
Emmanuelle Hébert
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Emmanuelle Hébert
2015-03-12 16:13
A large part of the training is focused on the relationship, the helping relationship, and communication. The students who do a baccalaureate in midwifery practice have several semesters of practical training and are trained individually by midwives. The midwife becomes a role model for the students. This is an important and integral part of the midwifery practice curriculums. It is really very important to us.
View Christine Moore Profile
My question is addressed to the two witnesses who have not spoken yet.
Do you find that the success of your preventive approach is due to the additional time you devote to patients and to the fact that as compared to more traditional systems, you are much more aware of their needs?
Mark Atkinson
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Mark Atkinson
2015-03-12 16:15
I'd welcome the opportunity to speak to that.
There are a number of factors here. The first thing is that when people come into a preventive health program, there are a number of health professionals who are working with them, from the receptionist, to the phlebotomist, to the nurse, to the doctor. We're wrapping around individuals so they know we are here to support them. That can....[Technical Difficulty—Editor]
The second thing is the time we spend with them. We are getting to know them, their context, and the way they live their life. That matters.
The other big thing in prevention is our focus on the solution rather than the problem. We are much more interested in not what's wrong, but what's right, what needs to change, and what their goal or aspiration is for their health. That combination is very effective.
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