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Dariusz Leszczynski
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Dariusz Leszczynski
2015-04-23 16:41
Thank you very much.
Thank you for inviting me to this hearing. It's an honour and a pleasure.
My name is Dariusz Leszczynski. I'm currently adjunct professor for biochemistry at the University of Helsinki, in Finland. I have done research in the area of biological and health effects of cellphone-emitted radiation since 1997. I was a member of the expert group of IARC, which in 2011 classified cellphone radiation as a possible human carcinogen.
When scientific evidence is unclear, contradictory, or ambivalent, careful and unbiased interpretation of it is of paramount importance. However, it is often the case that such scientific evidence gives room for a diverse interpretation that may lead to the development of contradictory expert opinions, causing confusion and impairing development of rational recommendations aimed at protecting the general population.
This is the current situation in the area of cellphone- and wireless communication-emitted radiation. Unclear experimental evidence leads to the polarization of the scientific opinions into two extremes: the no-effect opinion and the harmful-effect opinion. Currently scientists do not agree on the matter of biological and health effects of radiation exposures. The term “consensus” might be be misleading for the general public. We should rather speak about “differences in scientific opinion”.
A recent comment by the head of the World Health Organization's EMF project, Dr. Emilie van Deventer, well describes the current situation, and I will quote her comment given for The Daily Princetonian, “There is no consensus, it’s true. There’s a big group and a little group, but it’s still two groups.”
Talking about a big and a small group is a pure speculation because the size of the groups was never examined. From my nearly 19 years of experience in this area of research, I know that the vast majority of the scientists do not openly take a side in the debate.
The interpretation of scientific evidence by committee is of most use for the decision-makers. This is the reason that the development of unbiased opinions by committees are of paramount importance. Opinions of committees are defined by the expert composition. In an ideal committee, experts would not have conflict-of-interest issues and would be independent of any kind of lobbying; only science would matter. Nearly all of the committees dealing with the health effects of radiation emitted by wireless communication devices have a problem of biased expert selection, a potential conflict of interest, and a potential influence by an industrial lobby, which may occur in spite of set-up firewalls.
The majority of the committees consist of scientists having the same expert opinion. Individual committees experts commonly do not reflect all current scientific opinions. This concerns both international committees and national committees. This includes the committee in Canada that provided evidence for Safety Code 6. The composition of the Health Canada expert committee was clearly biased towards the no-effect opinion, and some of the experts are known to advise the telecom industry. This is a serious potential conflict of interest.
The above-mentioned system of firewalls to protect experts from influence of industry doesn't work. Industry sponsors know who receives funding; sponsored scientists know who provides funding. This is especially worrisome when the influential ICNIRP committee is in part funded by the industry through firewalls of the Royal Adelaide Hospital in Australia. The same goes for the EMF project of the WHO. If your experts know very well that the opinions of ICNIRP will be unfavourable for the telecom industry, their sponsorship may end. The firewall is only a gimmick.
Currently, WHO's EMF project is preparing an evaluation of the scientific evidence concerning health effects of radiation emitted by wireless communication devices, the so-called environmental health criteria for RF-EMF. The major problem with the draft document of environmental health criteria is the lack of balanced presentation of the scientific evidence. The environmental health criteria draft was written solely by scientists with a no-effect opinion.
The environmental health criteria document will have a global impact on billions of users of wireless technology and on the multi-trillion dollar business. This is why it is disturbing that preparation of such a document is solely reflecting opinions of ICNIRP, an organization with a firm, single-sided, no-effect opinion. This is a disturbing situation, where one group of scientists was given preferential treatment only because of their close link with the WHO and where other relevant expert opinions were deliberately and arbitrarily excluded without scientific debate.
Recommendations for decision-makers developed by committees, where memberships are consistently biased towards either a no-effect opinion or harmful effect opinion, are not representative of the whole currently available scientific evidence and should be viewed with extreme caution, or outright dismissed, until the proper, unbiased evaluation takes place.
To my knowledge there was only one scientific committee—IARC's working expert group in 2011, of which I was a member—where the full scope of diverse scientific opinions were represented. IARC classification completely disagreed with one-sided opinions of the majority of international and national committees, including Health Canada. Until an unbiased, round table of scientific debate takes place, where all scientific opinions will be duly represented and evaluated, the opinions developed to date by various international and national committees, based on biased expert selections, should be dismissed by decision-makers as insufficient.
According to year 2000 documents of the European Union on the precautionary principle, there are three criteria that need to be fulfilled in order to implement the precautionary principle. All of them are currently fulfilled.
Number one, scientific information is insufficient, inconclusive, or uncertain to make a firm decision. This is exactly what the IARC classification says on cellphone radiation as a possible human carcinogen, group 2B.
Number two, there are indications that the possible effects to human health may be potentially dangerous. Increased risk of brain cancer in long-term, avid users is a dangerous outcome, shown by three replicated epidemiological studies: European INTERPHONE, Swedish Hardell group, and French CERENAT studies.
Number three, the effects are inconsistent with the chosen level of protection. Epidemiological studies showing an increased risk in long-term, avid users were generated in populations using regular cellphones meeting all current safety standards. This means that the current safety standards are insufficient to protect users because the risk of developing cancer increases in long-term, avid users.
Proponents of the precautionary principle need to understand that precaution does not equal prevention of use of wireless technology. Requirements to develop more efficient, less radiation-emitting technology, and further biomedical research on the radiation effects, will create new knowledge through research and will create jobs in the research and technology. Implementation of the precautionary principle will not prevent technological developments. Claims by some that the implementation of the precautionary principle will cause economic stagnation are unfounded.
In the current situation of inadequate review of scientific evidence by groups of scientists with biased selection of members, and until the round table, unbiased review is performed, decision-makers should implement the precautionary principle. The reason is not that the harm was proven beyond doubt, but because the harm is possible and evidence is uncertain and suggesting that harmful health effects are possible. The precautionary principle was developed just for such situations where scientific uncertainty with concomitant indications of possible harm requires society to wait for more scientific evidence. Saying, “Better to be safe than sorry” applies here.
Thank you.
View Hélène Laverdière Profile
NDP (QC)
I think this is key.
Mr. Morley, I did not get a chance to ask what your opinion is on the need to help build public health systems. Do you have any comments on that?
David Morley
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David Morley
2015-04-23 12:31
You had mentioned Ethiopia and I think in the health system in Ethiopia, which is one that UNICEF and the Government of Canada and the Government of Ethiopia have worked on a lot, they have been training and equipping community health workers who go out around the country. There are two things I think in the kind of big picture that we see where this works. Three years ago in the Horn of Africa there was a famine. There was a famine in Somalia and there wasn't in Ethiopia. Why? Ethiopia had that grassroots.... It is the same climate, they're next to each other, but the health system in Ethiopia worked. Two months ago when Bill Gates was here I was part of a small meeting with the minister and some other NGO people. His comment was about Ethiopia—he didn't know that you were going to say this—but Bill Gates said that if Ebola had hit Ethiopia there would have only been one case because they have a strong health system that's out into the communities.
Helen Scott
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Helen Scott
2015-03-31 11:19
Thank you, both of you. Those were excellent. It's tough shoes to follow such eloquent speakers, but I want to start just by saying thank you to all of you. I know of your work and of your leadership and your roles. I'm very grateful, as a Canadian mom, for your focus and your energy. I've had a chance to travel and work with some of you more closely and I'm very, very grateful for how hard you work.
I'm privileged to have the opportunity right now in my career to coordinate the efforts of the Canadian Network for Maternal, Newborn and Child Health. This is a partnership of over 80 Canadian organizations focused on maternal, newborn, and child health. My colleagues here at the table sit within the network, so we speak from a common voice in many ways. Our organizations work in over 1,000 regions around the world to improve the lives of women, their newborns, and their children. We were officially created in 2012, shortly after the launch of the Muskoka initiative.
We have three key objectives.
The first is we know that we need to do a better job of being accountable in measuring results. We focus on working with our partners to make sure that we're doing the best possible job of measuring our impact and our outcomes and really tracking where the investment dollars are going, so that we know whether we're doing the best possible job we can with the limited resources that we have.
Our second key objective is to exchange knowledge. We're focusing on measuring results. We're looking to see what the best way to address these causes is, and we're taking that information and making sure that we share it with each other. There's no one in the network who doesn't know that they need to have vitamin A capsules in their implementation programs. I'm not sure five to ten years ago if that was the case.
Our third component is to engage stakeholders. We know that we can't do this alone. We know that through the network, the increased collaboration across sectors has shown itself to be very effective and efficient, so we look to engage more Canadians to join us in this effort. In addition, our experts look for opportunities to advise and inform the Canadian government in their investments.
On that note, I just want to say Canada got it right in 2010 when maternal, newborn, and child health was prioritized. Given the tremendous progress today and what work remains, we know that it's imperative to women and children around the world that this effort continue. We know that improving maternal, newborn, and child health—and Joel has articulated this so well—is foundational to economic growth, to political stability and human security, and it's a critical component of child protection.
I know that you've heard from many of our partners in the past meetings here at the standing committee. I think one of the key messages that they've shared with you is there's no silver bullet on child protection. It's going to require a multi-sectoral and multi-faceted approach. Even though I'm going to speak about one element of that approach, focusing on health, I recognize that this is just one component, albeit a critical one, of the many necessary systems and structures that afford children the opportunity to survive and thrive. I think you had Peter Singer here a few weeks ago. Peter has coined a term that I love, and which I think needs to go in the dictionary, “thrival”. It's not good enough that children survive birth and survive their first five years, they need to thrive. I think that's what we're all focusing on. We're starting to see progress. The mortality rates are dropping around the world. We're starting to see this progress and now is the time that we really need to focus on making sure that these children thrive.
The efforts to improve global health rank among the greatest development achievements. Canada has played such an important role in shaping and supporting global initiatives that have made a significant impact, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Global Alliance for Vaccines and Immunisation, which vaccinates millions of children year, the Micronutrient Initiative which is another great example, and of course the Muskoka initiative. Launched at the G8 summit in 2010, the Muskoka initiative has contributed to substantial progress in improving the health of women, newborns, and children, including—and I think this builds nicely on what Joel just said—through galvanizing international support and commitments.
For example, Canada was a key leader in galvanizing support for the United Nations Secretary-General's global strategy for women's and children's health, which we call the global strategy. A recently published report on the global strategy highlighted it as the fastest-growing public health partnership in history, with 2.4 million women's and children's lives saved since 2010.
I want to stop for a minute. I'm a statistician by training and we throw around these big numbers and they don't mean very much to us. So just think of a child in your life who you love, and then think of 2.4 million children who are loved and whose lives have been saved since 2010. I mean this is phenomenal. This is something that we should be celebrating. It points to the fact that we know what to do, but we just need to dig in and get this work done.
Here we are in 2015. The world is at a critical juncture to achieving lasting progress in maternal, newborn and child health. To do so, political and financial commitments must be mobilized following Canada's leadership and our footsteps with the announcement of $3.5 billion in May 2014, just a few months ago.
The newly formed Department of Foreign Affairs, Trade and Development provides Canada with the unique opportunity to harness our foreign policy and trade tools to better achieve our development agenda. The multi-sectoral reach of the Canadian network positions us to make unparalleled progress on the ground. We're working with the academics, Canadian universities, Canadian NGOs, Canadian health professional associations, and with doctors, midwives, nurses, and surgeons who are working on the ground.
Together the Government of Canada and the 80 partner organizations of this network will bring a new level of rigour and commitment to seeing our shared aspirations achieved for mothers and children around the world.
Through increased global leadership, the international community can empower women and support increased resilience by strengthening health care systems, fighting infectious diseases, improving sexual reproductive, maternal, newborn, and child health, and ensuring that the unfinished business of the health-related millennium development goals are not lost in the transition to the sustainable development goals that we launch later this year.
We're proposing that Canada make the following commitments, and I should say Canada is so committed. This is a reiteration of some of the work that's already happening. We need to renew commitments and encourage the rest of the world to renew their commitments made under Muskoka and the global strategy for women's and children's health, such as through A Promise Renewed, the every newborn action plan, and Family Planning 2020, and make sure these commitments are met.
We need to welcome and support the renewed global strategy for women's and children's health to be launched in September 2015. We're calling it global strategy 2.0. We need to support the ambitious but achievable goal of ending preventable deaths by 2030 in the post-2015 negotiations and agree to tackle inequality by focusing on those groups that are furthest left behind. I think Caroline spoke so nicely to that.
We need to provide financial and non-financial resources to deliver the post-2015 framework and support countries to raise and spend greater domestic resources on universal public services, including the newly established global financing facility in support of every woman, every child program that will be launched at the financing for development conference in Addis Ababa in July 2015.
We need to deliver an ambitious commitment on aid expenditure in support of increased domestic resource mobilization and align the ODA for the health and rights of women and children, including through the global finance facility.
I want to mention accountability. We need to continue Canada's leadership role in accountability. We need to broaden and strengthen our established global leadership by championing simplified, harmonized maternal, newborn and child health accountability frameworks. Enhanced community basic accountability mechanisms and increased efforts to produce reliable disaggregated vital statistics are critical to strengthening health services delivery.
Vital statistics in civil registration is so boring. It's hard to make it sound interesting. It's critical because when you know a child is born, and when they're registered, that child counts. That child is counted. We can track services, we can track delivery, and we can track the children. That's critical in child protection. It encompasses all of the work that we try to do.
The last point I want to make is that—and I say this a bit humbly because I'm so fortunate to have this opportunity—I see how effective we can be when we work together and when we stop creating silos, have our universities working over here, our NGOs working over here, and we come together. I would stress that we bring together organizations across sectors with different expertise to facilitate their collaboration, especially in country, where, just using Canada as an example, different organizations are working in country and they really need to be collaborating. This is imperative for increased success.
We need to enhance and capitalize on partnerships between governments, civil society, local communities, health care professionals, academic and research institutions, multilateral organizations, global funds that exist, and the foundations. The media is critical as is the private sector in coming along on this journey.
Addressing the rights and needs of women and children is key to creating sustainable change and development. The last five years of the global strategy for women and children's health and the Muskoka initiative launched in Canada, with the hard work of many of you, has shown that well-planned coordinated interventions can achieve results and save lives. Now we need to focus on making sure those children thrive and those women thrive.
The year 2015 is the time to build on this achievement, to renew commitments and support strong strategies that will end preventable maternal, newborn, and child deaths, ensure that those women and children and survive, and improve overall health.
Thank you.
Paul Demers
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Paul Demers
2015-03-24 15:53
Thank you, Mr. Chair and members of the committee, for inviting me here today. I know I've been asked to come here today because I chaired the expert panel of the Royal Society of Canada on Safety Code 6. But I thought I'd start by saying a few other things about my background.
I'm the director of the Occupational Cancer Research Centre, which is based in Cancer Care Ontario, a provincial agency that is also funded by the Ontario Ministry of Labour and the Canadian Cancer Society. I'm also a member of the faculty of the schools of public health of the University of Toronto and the University of British Columbia.
I am an epidemiologist, so I study impacts of different types of health effects upon populations of people, but my primary area of research is on the risk of cancer associated with workplace chemicals, dust, and radiation, although I have done research on a number of other diseases as well as on environmental exposures. However, I want to state that, unlike Dr. Prato, I'm not an expert specifically in the area of electromagnetic fields and have never actually done research on radio frequency radiation.
As you know, at the request of Health Canada the Royal Society convened an extra panel to conduct a review of the 2013 draft of Safety Code 6. I was asked to chair that panel because I had no conflicts of interest and because of my expertise in cancer epidemiology, which was identified as one of the areas for which they wanted expertise on the panel.
I was also asked because of my experience sitting on similar panels for the International Agency for Research on Cancer, the U.S. national toxicology program, the U.S. Institute of Medicine, which is part of the National Academy of Sciences, and the Council of Canadian Academies, the latter two being fairly similar to the Royal Society of Canada in the way they operate.
I should also mention, although you may be aware of this already, that I was the second chair of the panel. The first panel resigned because of a perceived conflict of interest, and I took over as chair of the panel about midway through. But I also want to state that I'm here as individual and am not representing the Royal Society of Canada or any other organization at this point.
The panel was presented with five specific questions, and I'm going to over very briefly our responses to those five questions. Overall, they were all dealing with whether or not there were any established health effects at levels below those recommended by Safety Code 6 and related types of questions.
To answer these questions, we did a review of recently published studies in the area on a wide range of different types of health effects. We also looked at many of the international reviews, which I think have already been mentioned here today. These are conducted on a pretty regular basis by many agencies around the world.
Because we were asked to look in particular at established health effects, we defined an established adverse health effect as something that has been seen consistently or been observed consistently in multiple studies with a strong methodology. So we had a fairly flexible definition, but still it required an effect's being observed in not just a single study.
Before I get into the questions—because I'm actually going to read out the questions we were given—I want to explain two different terms that are used quite a bit in those questions, namely the definition of what basic restrictions are and what reference levels are.
Basic restrictions in Safety Code 6 are things that happen within the body, either heating or induced fields within the bodies, or things like those. Many of the actual limits are set based upon that. Because these are not easily measured, the code also uses reference levels, which are things you can measure outside of the body using a meter. They are much easier for regulatory purposes. You will often see that the questions are phrased in terms of these basic restrictions and reference levels.
Our first question was, do the basic restrictions specified in Safety Code 6 provide adequate protection for both workers and the general population from established adverse health effects of radio frequency fields? Our conclusion was that yes, they provided that protection. Specifically, Safety Code 6 was designed to protect against two kinds of established health effects, thermal effects and peripheral nerve stimulation. The margins of safety, we concluded, appeared to be quite protective. For peripheral nerve stimulation, it was a safety factor of five for the workplace or controlled environments, and a 10-fold factor for uncontrolled environments, which are closer to what you would experience in the general public. For thermal effects, the safety factor was 10-fold for workplaces and 50-fold for the general public.
The second question that we were given was, are there any other established adverse health effects occurring at exposure levels below the basic restrictions on Safety Code 6 that should be considered in revising the code? Our conclusion to that question was no. The panel reviewed the evidence for a wide variety of health effects, including cancer, cognitive and neurologic effects, male and female reproductive effects, development effects, cardiac function, heart rate variability, electromagnetic hypersensitivity, and adverse effects in susceptible areas of the eye. Although research in many of these areas—important research, I think—continues, we were unable to identify any adverse health effects occurring at levels below those allowed by Safety Code 6.
Our third question related specifically to the eye: Is there sufficient scientific evidence upon which to establish separate basic restrictions or recommendations for the eye? We concluded that no there wasn't sufficient evidence. Recent studies do not show adverse health effects in susceptible regions of the eye at exposure levels below those proposed by Safety Code 6 for the head, neck, and trunk. Therefore we recommended that it not contain separate basic restrictions for the eye.
The fourth question was perhaps a bit more complex: Do the reference levels established in Safety Code 6 provide adequate protection against exceeding the basic restrictions? That is, do the levels that are proposed as limits for things you can measure outside the body actually protect against the target health effects the code is trying to prevent within the body? Our conclusion was that for most frequencies, yes, reference levels were adequate, but that there were some regions where compliance with the reference levels may not ensure compliance with the basic restrictions. We recommended that the proposed reference levels in Safety Code 6 be reviewed by Health Canada to make them somewhat more restrictive in some frequency ranges to ensure a larger safety margin for Canadians, including newborn infants and children.
This recommendation took into account recent studies that we call dosimetry studies, at least one of which was published after Health Canada produced the proposed Safety Code 6.
Our fifth question was, should additional precautionary measures be introduced into Safety Code 6 exposure limits? I'll state that although there was a range of opinions on the panel regarding precautionary efforts, overall the panel believed that Safety Code 6 was well-designed to avoid established health effects; we did not have any science-based recommendations for precautionary measures to lower the limits. I'll say that it was for the reasons that I think Dr. Prato explained quite well, which is that we couldn't, at least in looking at the study, say that the evidence tells us that we should lower it it in such a fashion. However, we did recommend a number of other measures that can and should be taken by Health Canada.
I'll read some of them here now.
First was to investigate the problems of individuals with what's called electromagnetic hypersensitivity—it goes by other names as well, IEI-EMF, and things like that—with the aim of understanding their health conditions and finding ways to provide effective treatment.
Second was to develop a procedure for the public to report suspected disease clusters and a protocol for investigating them.
Third was to expand Health Canada's risk communication strategy to address consumer needs for more information around radio frequency radiation.
Fourth was to identify additional practical measures that Canadians can take to reduce their own exposure.
These recommendations are really in response to the public input that we received as part of the panel. We also had a number of different research recommendations. In particular, if one has the chance to read the report, you'll notice that each section on a particular health effect usually ends by basically pointing out that more research is needed on that health effect.
A few of the specific ones are that Health Canada should aggressively pursue research aimed at clarifying the radio frequency radiation cancer issue, which would allow the government to develop protective measures if the risk were substantiated; and that Health Canada should pursue research to expand our current understanding of possible adverse health effects of exposure to radio frequency radiation at levels below those allowed by Safety Code 6.
The response to the panel's report from Health Canada—
Robert Strang
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Robert Strang
2014-12-04 11:49
Good morning to the committee. Thank you for the opportunity to speak today on electronic nicotine delivery systems, ENDS. I'll explain that term in a second.
I'm speaking in my role as the chief public health officer and chief medical officer of health for the Nova Scotia Department of Health and Wellness, as well as the recent past chair of the Council of Chief Medical Officers of Health.
For the committee, CCMOH consists of all the chief MOHs from the 13 provinces and territories, the national chief public health officer, senior officials from Health Canada, the first nations and Inuit health branch, Correctional Services Canada, Customs and Immigration Canada, and the Department of National Defence. As such, it represents senior government public health officials in Canada.
In 2013 the FPT deputy ministers of health asked CCMOH to provide their advice regarding the regulations on e-cigarettes. Today I'm going to speak to the position statement, which I know has been circulated to committee, that was developed by the provincial and territorial chief MOHs in response to that request. That position statement does represent the current consensus of FPT chief MOHs on the issue of electronic nicotine delivery systems.
To give a bit of background, e-cigarettes were developed in their current form in the early 2000s and have gained substantial market penetration globally. They are rapidly evolving as a product line, and alternative nicotine delivery systems are now appearing. That's the reason the language I will use today in our position statement is on the larger construct of ENDS and does not just use the term e-cigarettes.
It's important to acknowledge that some ENDS can also be sold for use with non nicotine-containing e-juice. There is also growing evidence that ENDS are increasingly being used for other substances, often illegal drugs such as marijuana.
The current legal status of e-cigarettes in Canada is such that electronic cigarettes with nicotine or that make health claims are regulated by the federal Food and Drugs Act, which means that they have to be authorized by Health Canada to be imported, advertised, or sold in Canada. To date, Health Canada has not given market authorization to any such products. E-cigarettes that don't have nicotine and don't make any health claims are regulated by the federal Canada Consumer Product Safety Act, which requires companies to ensure that the products they manufacture are safe.
Some points to make are that any assessment of policy options on ENDS must account for the need to acknowledge that we've made great strides in tobacco control in Canada with the greatest success being in the significant reduction in smoking rates for youth aged 15 to 19 years. But as new products such as ENDS emerge, it's important that we don't lose ground, particularly with the huge smoking segment.
Despite the current federal regulations, ENDS and e-juice-containing nicotine containers are readily available for purchase in all provinces and territories, both in stores and on the Internet. We can't ignore that reality. The lack of any regulations regarding product testing and labelling makes it extremely difficult to differentiate between those that contain nicotine and those that do not. There are also significant concerns around quality control and product safety.
We do also have to acknowledge that there has been a significant increase in the use of e-cigarettes, including by youth, since 2010.
The next point is that ENDS do present both risks and benefits at both the individual level and the population level, but there is no definitive scientific evidence in any of these areas at this time. However, waiting for more definitive evidence before taking action runs the very real risk of increasing overall and youth smoking rates, so essentially we can't wait to take some form of action.
To inform the development of the position statement, CCMOH held a virtual symposium in June 2014 to which we also invited members of the FPT Pan-Canadian Public Health Network Council, and the FPT Tobacco Control Liaison Committee. A summary of that symposium is an appendix to the position statement that was distributed to the committee. I won't take time to walk through that today.
The PT chief MOHs, in the summer of 2014, held follow-up discussions to discuss the information we had heard at the virtual symposium and developed our common position statement. That position statement was received by both the FPT deputy ministers and the ministers of health in August and September respectively in 2014.
Just to go through our position statement, this position statement is based on our collective expertise and experience in public health. The information was provided to us by five experts during the virtual symposium, as well as informed by discussions that we had among ourselves and by other discussions on ENDS products that many of us have been involved in.
We feel that given the current state of knowledge on ENDS, this position is an appropriate balance of allowing accessibility to these products as potential aids for cessation or reduction of tobacco use for existing tobacco users, while minimizing their potential to develop nicotine dependence and new tobacco users, as well as decrease the motivation for quitting for existing tobacco users.
I do need to clarify that our definition of ENDS in our policy includes both the devices as well as any accompanying e-juice containers. Our recommendations apply to all ENDS whether they contain nicotine or not.
Our recommendations that we made to provincial and territorial governments were to amend or develop legislation or regulations to first, make it illegal to sell ENDS to minors; second, make the point of sale display, advertising and promotion of ENDS illegal; and third, make it illegal to use ENDS in locations where tobacco smoking is currently prohibited.
Since we developed this position statement, Nova Scotia has passed legislation which brings all three of those recommendations into force as of May 31, 2015. Ontario currently has similar legislation in the legislative process.
For the federal government, our recommendation is, for the longer term, to develop a provincial-territorial engagement strategy to work together along with tobacco control experts to develop a new regulatory framework for ENDS.
We acknowledge that these products don't fit neatly as either a pharmaceutical or as a cessation product and ultimately we need a whole new regulatory approach to these products. However, given the time this process would require and the need for urgent regulatory action, we recommend in the short-term that ENDS should be considered as equivalent to cigarettes and regulated as such under existing federal legislation and regulations. That would mean advertising restrictions that are currently in place for tobacco products would apply to ENDS, that the standard labelling requirements that are required for tobacco products would apply for ENDS, and that the smoke-free requirements for federal workplaces and other federally controlled environments such as airports and airplanes would also apply to ENDS. We're also recommending that youth-oriented e-juice flavours should be banned.
I want to thank you for the opportunity to present today. I welcome any questions.
Steven Hoffman
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Steven Hoffman
2014-11-24 15:34
Mr. Chair and committee members, thank you for inviting me to make submissions about Bill C-43 concerning changes to the Public Health Agency of Canada Act.
By way of background, I'm an assistant professor of law and director of the global strategy lab at the University of Ottawa. My research focuses on global health governance and institutional design.
Based on my research, it's clear that our chief public health officer needs an independent voice and the ability to speak scientific truth to members of the public and to those in power. This bill, in splitting the chief public health officer's role in two—one part technical, one part administrative—removes the little independence this position once offered. This bill achieves this effect by demoting the chief public health officer from his current deputy minister rank, by removing his direct line to the minister, by making him subservient to a bureaucratic agency president, and by eliminating reimbursement for his public activities.
Any loss of independence matters because it erodes the trust that we can all place in our chief public health officer of Canada. In reviewing this bill, it seems to me that we've forgotten the harsh lessons of SARS. It was just 11 years ago, in 2003, when the World Health Organization slapped Toronto with a travel advisory, costing that city $2 billion and 28,000 jobs. That's a lot of money and a lot of jobs. This loss was not because of the number of SARS cases. Singapore had a similar number. The loss was because the federal government did not have a trusted public health leader who could effectively coordinate with the provinces and communicate the outbreak status with other countries.
SARS shone a light on the hurdles that Canada's version of federalism places before effective pandemic responses. Significant changes followed, including the creation of the Public Health Agency of Canada and its chief public health officer. The big idea behind all of this was that we needed to build trust. Provinces and their public health departments needed a guarantee that the federal government's public health pronouncements were based on scientific principles, rather than political talking points. Unfortunately, this guarantee was never realized. The chief public health officer was made an officer of government instead of an officer of Parliament, thereby preventing him from exercising full independence, as our Auditor General or Privacy Commissioner would have. Let there be no doubt about this: in my mind that was a mistake.
But this bill takes us even further away from where we need to be. At least the original legislation gave the chief public health officer some independent powers to speak and be reimbursed for those public activities. This encouraged the provinces to buy into a nationally directed system. The removal of these limited independent powers is not helpful. On this basis, demotion and politicization of the chief public health officer is undoubtedly a wrong-headed move. With an Ebola outbreak raging in West Africa, it seems that this isn't the right time to be weakening our national public health infrastructure. This change would make us less prepared for Ebola and other diseases like it.
I understand that last week this committee heard contradicting testimony from the new chief public health officer. I understand he said that shrugging off managerial oversight of the agency would free him to focus on providing scientific advice. He might win back some of his time, but I think we all need to ask this question. After his demotion, will anybody be listening to him? Will his bureaucratic boss even allow him to speak?
Ultimately, if this change really must go forward, I would suggest two very small revisions that would lessen its harm.
The first is to add a provision granting scientific independence to the chief public health officer and legislatively allowing him to speak without political interference.
The second is to just drop section 258 that would remove the reimbursement for the chief public health officer in performing his public duties.
These two small changes would ensure that the chief public health officer could serve that interprovincial coordination function that was shown to be so important in SARS, and ultimately be trusted by all Canadians.
I would have suggested a third small revision, to maintain the chief public health officer's deputy minister rank, which is important for him to access federal decision-making tables, but I think I'm already pushing my luck by suggesting any changes at all.
Just to conclude, in coming here today my only hope is that we won't need another SARS or Ebola in Canada to make us realize the harm that the proposed changes would cause. I implore you to do whatever you can to minimize the bill's damage. We would all be less safe with these proposed changes, and we're all going to suffer the consequences if the committee allows them to pass.
Thank you.
Ian Culbert
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Ian Culbert
2014-11-24 15:39
Thank you, Mr. Chair and committee members, for the invitation to present to you today.
I would like to be clear, first and foremost, that my comments and those contained in our written brief are not intended as a reflection upon any current or former employees of the Public Health Agency of Canada. We have only the greatest respect for all of them.
It is the position of the Canadian Public Health Association that the chief public health officer should continue to be the deputy head of the Public Health Agency of Canada and continue to operate at the deputy minister level. As such, we recommend to this committee that the amendments to the Public Health Agency of Canada Act proposed in Bill C-43 be withdrawn and that the consequential amendment to the Financial Administration Act also be withdrawn.
While we agree that there should be a division of roles and responsibilities between the administrative and professional sides of the agency, we feel strongly that the titular head of the agency must be a public health professional. The current structure was established based on the recommendations of the Naylor committee after the 2003 SARS outbreak. That committee was very specific in its recommendation that the agency should be headed by the CPHO and that the CPHO report directly to the federal Minister of Health. The Naylor committee reviewed the organizational structures in place for a number of different jurisdictions and felt that its recommendations represented the best option for Canada's national public health body.
In 2010 the position of executive vice-president and chief operating officer was created to provide administrative support to the CPHO. This change formally split the administrative and professional responsibilities of the CPHO while leaving the CPHO as the deputy head of the agency. Since that time that structure has served the agency and Canadians well.
Our concerns for the proposed amendments are as follows.
First, while the CPHO has the responsibility to promote and protect the health of Canadians, in the proposed structure the position would retain responsibility but have no authority to mobilize resources.
Second, the country's public health priorities must take precedence over bureaucratic priorities, but this does not preclude the executive vice-president and chief operating officer from being responsible for day-to-day operational and administrative duties.
Third, it is essential that the CPHO work closely with fellow deputy ministers at the federal and provincial/territorial levels. Under the current structure the CPHO has a seat at those tables by right of his or her position. Under the proposed amendments the CPHO could only be invited to those discussions, and only as an adviser so that he or she would not be taking part in the decision-making process.
At the end of the day, rank matters and these amendments will essentially strip the position of CPHO of its current rank.
Our final and possibly most troubling concern is that the new model would give both the CPHO and the president of the agency direct access to the minister. In the unfortunate situation where agreement cannot be reached between the CPHO and the president, the minister could be faced with contradictory policy advice and left in the role of arbiter. This model is not considered good practice in a modern bureaucracy and should be avoided.
During a public health emergency such as a pandemic of H1N1 or Ebola, the importance of evidence-based advice from the CPHO is clear. This advice, however, is important at all times as Canadians are increasingly concerned about the sustainability of their publicly funded health care system. Public health has at its foundation the protection and improvement of health and well-being of Canadians and, as such, its policies, programs, and initiatives are focused on keeping people out of hospitals and doctors' offices. If the CPHO does not have the necessary authority to direct agency staff and marshal its resources, his or her advice may not be worth the paper on which it is written.
The structure of the agency with the CPHO at its helm has been effective for the first decade of its existence, and there is no clear evidence that the proposed changes are needed.
Thank you.
Véronique Lalande
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Véronique Lalande
2014-11-24 15:43
Mr. Chair, members of the committee, for more than two years now, Initiative citoyenne de vigilance du Port de Québec has made it its mission to compile and distribute information on the environmental impacts of industrial activities at Quebec City's port. This is not a battle we chose; it was dropped on us, literally. What we did choose, however, was to come together as ordinary citizens to assert our most basic right: the right to raise our families in an environment where our health and quality of life are not at risk on a daily basis because one of our neighbours is unable to behave responsibly.
Today, we have more than 450 members, as well as 1,000 supporters, who are also involved in a variety of grassroots movements right across the country. We are united in our pursuit of one goal: requiring port authorities to dutifully respect their mandate of running a profitable operation while respecting the environment and surrounding communities. In response to all those who have all too often argued that ports, and thus the problem, are under federal jurisdiction, I have said time and time again what a tremendous step forward that would be, were it only true. The fact of the matter is that ports seem to be less and less under federal jurisdiction and more and more under self-control.
No doubt when Parliament created independent federal agencies to manage port sites and operations, its intention was to improve their management. Clearly, the powerful lobbies of the marine industry, and related mining and oil and gas industries have repeatedly argued that fewer restrictions and more authority are essential to develop a marine industry that will ultimately benefit all.
Although we do not deny that ports generate economic benefits, a number of studies have downplayed those benefits, especially when it comes to handling and bulk storage activities. It is also troubling to note that the costs to the community are never taken into account when the real benefit is being worked out. In my community, this particular legal framework has led to major environmental lapses, lapses that are still happening as we speak.
In Canada, the average amount of nickel in the ambient air is approximately 1 nanogram per cubic metre of air, and 2 nanograms is the level considered safe. In Limoilou, however, residents have, for years, been exposed to levels hovering around 52 nanograms, with event-driven peaks of 1,670 nanograms. Regardless, no one has been able to do anything about it, or wanted to.
Although we have worked tirelessly in the past few years to bring to light an environmental disgrace, measurable progress remains less than stellar. I should point out that, as we speak, the port facilities are emitting fugitive particulate made up of an assortment of toxic substances. These contaminants are emitted into the environment, affecting people's health and significantly diminishing the quality of life of thousands.
The level of nickel in the ambient air in my neighbourhood is always well above the threshold considered safe. Quebec City's port authority still refuses to acknowledge or assume its responsibilities, even though a major project to expand the Beauport terminal is about to get under way. Despite being the project proponent, the Quebec City port authority will be in charge of defining the criteria and environmental studies, overseeing the evaluation process and eventually issuing the necessary permits. Nevertheless, over the past two years, the ministers responsible have continued to tell us that the Quebec City port authority has complete authority, that it has the situation under control and that they have total confidence in the members of the port authority's administration.
Like many communities around the country, we, as residents, have lost almost all trust in our port authority. Rightfully, we are calling on the government to tighten up the framework governing all port authorities to put an end to these lapses once and for all. And yet, the amendments to the Canada Marine Act currently being considered are intended to increase, yet again, the powers held by port authorities.
In conclusion, I must remind you that the first duty of elected representatives is, as I see it, to protect society's most vulnerable and ensure that everyone has the right to live in a safe environment. I urge you to consider the message that rewarding a delinquent industry with more powers would send to thousands of men, women and children who live close to port facilities and lack the industry's resources to plead their case. You would be telling them that, regardless of the consequences, it is acceptable to exclude certain industries from the proper legislative regime, favouring a specific regulatory framework for the sake of the bottom line. You would be telling them that it is absolutely fine for an organization to regulate itself, overseeing the enforcement of the very laws that are supposed to govern it. Not only that, but you would be telling them that ports are entities outside space and time, devoid of any ties to the communities they call home, and therefore, it is appropriate for the Canada Marine Act to be the only applicable legislation.
I humbly ask that you reconsider the proposed amendments in favour of measures that would subject Canada's 18 port authorities to stricter control, transparency and accountability.
Thank you.
Joel Kettner
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Joel Kettner
2014-11-24 16:04
Hello, Mr. Chairman, and thank you.
I'll very briefly say thank you for the opportunity to present at this hearing. I'm going to speak as an individual, although I'm affiliated with the university and with other organizations that I won't take the time to describe at this moment. I'm going to speak mostly from my experience as a provincial chief public health officer in Manitoba, which I was for 12 years, and from my work in public health in general.
I'm going to approach the changes proposed to the Public Health Agency of Canada Act from the perspective of how I think they might have impacts on the effectiveness of the chief public health officer in particular, but more broadly on the ability of the Public Health Agency of Canada to fulfill its roles and mission. I think many important points have been raised by previous witnesses, and I look forward to the question and answer period, where we can go into more of those in some detail.
I believe there are pros and cons in these changes, so I'm going to go through what I think are the most important ones, and I'm going to frame it on what I'm going to call “six functions” of the chief public health officer. I will look at each one and how they may be affected by the way the act is written now, and with the changes that have been proposed.
The first function is that of adviser to the minister, and of course in this case it's the Minister of Health. The old act specified that the role was to assist the minister and to be “the lead health professional” within the Government of Canada. I believe that has not changed. Specifically, there is now a clause that says the role is to advise the minister and in addition the president—this is the new role—of the Public Health Agency and that it should be “on a scientific basis”. I think it could be a good thing to have made that more clear, because that is the role of the chief public health officer with respect to government, particularly through the minister to the government.
The second function is that of communicator to the public, a very important role that others have spoken about, because the act allows the chief public health officer to prepare and publish a report on any issue related to public health. That has not changed. I do not believe that the ability of the chief public health officer to communicate to the public freely and without direction by the minister—or now by the president of the agency, as proposed—should be changed. I certainly hope that it isn't changed. I'm also hopeful that the interpretation of “reports” is broad, and that includes all communications to the public and to anyone else that the chief public health officer feels he or she needs to communicate with.
With regard to the leadership of the agency itself, I think there are many models that exist across this country in the provinces and also around the world and, frankly, I'm not sure which is the best. However, I don't think this model that's being proposed necessarily diminishes the ability of the chief public health officer to continue to provide advice to government and also to influence the leadership and decisions in a collaborative way with the lead administrator, who has the deputy head status. As I think was pointed out, if the two of them can't figure it out together, they must have it resolved by the minister. That's actually the way it goes in public health departments of governments anyway, because in the act, as is the case in most provinces, it is the minister who is really responsible for government public health practice. That's I think mostly as it should be, because the political decisions that are most important in public health need to be made by elected officials and their governments.
As far as collaborating with other chief public health officers goes, I think that being a deputy minister potentially could be—and has been—a difficulty there, because other chief public health officers are not at that level. The ability to be equal collaborators and then bring advice through the conference of deputy ministers to the ministers in a collaborative way can be limited by having one of them designated as a deputy minister. Also, my observation and experience, without reference to individuals, is that being at the deputy minister level makes it even more difficult to speak freely and independently to the public.
Finally, I would like to just say this about the act itself. Where it needs most strengthening, or at least most use, is to recognize that regulations can be brought in to collect and analyze data across the country that so far has not been used. The agency itself has not had the power to coordinate and collect information, when needed, on a national basis to deal with a national issue.
I'll make one last point around the capacity of the chief public health officer within the agency. Whether this is written into the law or just understood as policy, I think it's very important for there to be a strong office for the chief public health officer, with a deputy chief officer and a staff including research assistants, communications people, and others who can ensure that those functions of the chief public health officer are preserved, no matter what.
View Scott Brison Profile
Lib. (NS)
Thanks to each of you for your interventions today.
You may be wondering in fact why we're talking about public health as part of a budget implementation act. If it makes you feel any better, we're wondering about the same question.
Mr. Cullen mentioned the challenge we have with budget implementation acts that are so massive in terms of the material covered. I think there is a consensus among the members on this side of the table that we would prefer to see measures related strictly to the fiscal framework of government and budgets as part of this. It would enable members of Parliament with even greater expertise than ours to engage directly with experts such as you on issues that are of great importance in terms of public policy but are not issues with which we necessarily have a great depth of experience, such as the area of public health.
That being the case, Mr. Hoffman, have you considered these changes to the governance over the chief public health officer's role in the broader sense of what some have called the muzzling of scientific voices within this government, not just in this instance but more broadly within government departments and agencies?
Steven Hoffman
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Steven Hoffman
2014-11-24 16:26
Certainly that's what many of my colleagues have been talking about. Whatever the motivations for this bill and these changes are, concerns about that situation are deepened. We have a situation here in which the chief public health officer will no longer be able to exercise the same level of independence he once had. So in some respects whether the intention is to muzzle, the effect is that the chief public health officer as the chief public health scientist will no longer be able to speak.
My comments were really to highlight the fact that the demotion means he is less likely to be heard when he does speak. Of course now he reports to a bureaucratic agency president, which means that even if he wants to speak, he might not be allowed to. That's a big problem when we have a federal model in which not only does the federal government receive advice from the chief public health officer—of course that's an important part of it—but also our provinces need to have trust in him. The provinces have the majority of health responsibilities in Canada, and if they can't trust that the chief public health officer is basing his advice and public statements on scientific principles rather than political talking points, that's a big problem.
View Scott Brison Profile
Lib. (NS)
Mr. Culbert, Mr. Hoffman talked about the potential politicization of the role. Do you think there is a risk of that for the future in terms of some of the changes we're making to the role? Will there be a heightened risk of politicization around issues in the future?
Ian Culbert
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Ian Culbert
2014-11-24 16:28
At the end of the day the CPHO was and will continue to be a civil servant, so there are challenges around that. In our form of government, politicians have the final say, and ministers have the final say on decisions. So to say that a position will become more or less politicized, you're talking about shades of grey, I would say.
When the Naylor committee made its recommendation, as Mr. Hoffman said, one of the options was to create a parliamentary officer, like the Parliamentary Budget Officer. But then once again you have a great spokesperson who is independent but lacks the ability to do anything. They could criticize or support or encourage, but they don't have the authority to actually make something happen.
There is no ideal situation, but the Naylor commission recommendation, and what we've been working with for the past 10 years with a public health professional as the deputy head of the agency with the appropriate bureaucratic support, is what we feel is the best solution if not a perfect solution.
View Scott Brison Profile
Lib. (NS)
How does the governance structure proposed in this legislation for the chief public health officer compare with that of governing chief public health officers in other countries, for instance, in the United States? What would you say is the delta between how it's structured there and what is being proposed here?
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