Interventions in Committee
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View Rona Ambrose Profile
Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, Vanessa's Law. Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
Vanessa's Law, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in Vanessa's Law, we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 16:51
Mr. Chair and members of the committee, thank you for giving me an opportunity to discuss with you the amendment to the Public Health Agency of Canada Act—which is presented in Bill C-43—and my role as Chief Public Health Officer of the Public Health Agency of Canada.
As you know, that amendment aims to redefine the role of the chief public health officer so that it would focus exclusively on the public health needs of Canadians. This amendment also aims to create a position of president of the Public Health Agency of Canada, who would be in charge of managing the agency.
I strongly support this amendment. My unique journey has allowed me to gain a lot of experience and come to this conclusion.
I started my medical career as an M.D. in a private small city practice. As a family physician I experienced the challenges of holding two jobs much like the position of chief public health officer. On one hand I was helping patients improve their health and essentially managing a business on the other, often causing tension between the two.
In the 20 years since, I've held progressive leadership positions in the federal government, specializing in public health, and I've watched the agency grow from a branch of Health Canada to a global leader in public health. Today with an ebola epidemic in the public spotlight, we're reminded why the country needs its leading public health professional to focus exclusively on one major task: public health.
Since the agency's inception, the competencies and experiences to lead national public health issues have grown, as have the skills needed to manage a growing public sector organization. The Public Health Agency of Canada now has over 2,000 employees across the country. It's annual operating budget is over $600 million.
For years now it's been clear to me and my colleagues that the CPHO role must evolve and complement that growth in a way that makes sense. Division 20 of this bill will allow my position to focus on moving Canada forward in public health issues, providing advice directly to the Minister of Health and to Canadians, collaborating with all partners and interacting with multiple key players including the Canadian public. At the same time, a dedicated agency president will provide focused strategic management and corporate leadership for a world-leading, vibrant and strong organization.
The president, as deputy head of the agency, will assume some of the management responsibilities currently assigned to the CPHO including accountabilities for finance, audit, evaluation, staffing, official languages, and access to information and privacy. These are all important functions requiring the attention of a senior leader.
The changes proposed do not diminish the role of the chief public health officer, they enhance it. In essence, they associate internal management and capacity issues with a dedicated agency head and direction on public health issues with the CPHO. It makes good management sense and good public health sense to make these changes.
It's a structure that works well for many provinces and territories, and for countries, including the United Kingdom and Australia. In fact, we've been moving this way as an agency for some time now and have, in fact, adopted this type of management structure since 2012. At that time we began to separate out the roles and responsibilities of the CPHO on an interim basis. My appointment as CPHO on September 24th of this year—the date of the agency's 10th anniversary—reflected the first step needed to move public health forward in Canada.
The next step will ensure we have the right people in the right positions focused on the right tasks for Canadians. I'm very proud of the agency's maturation. The agency has become a world leader in public health, and just as its profile of importance has grown, so have public expectations of our work. We need to enhance our public health connections globally.
After 10 years and many high-profile public health success stories, the agency and the position of chief public health officer are no longer young. We now need to adapt and advance in a way that makes good management and public health sense.
Mr. Chair, committee members, for these reasons I strongly support division 20 of Bill C-43 before you today that will amend the Public Health Agency of Canada Act.
The associate deputy minister and I believe these changes are the right thing to do for the health of Canadians. I thank you for inviting me today.
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:31
When I'm speaking to Canadians, I'm speaking on behalf of the Public Health Agency. Part of the role of the CPHO has always been speaking to Canadians and that will continue. There's also an annual report, the CPHO report, that goes directly to parliamentarians.
View Murray Rankin Profile
View Murray Rankin Profile
2014-11-19 17:31
I'm familiar with the annual report but this section changes now, and only contemplates speaking and giving advice to the minister. I wasn't sure, do you have a communications protocol or something to confirm your ability to speak independently to the media?
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:31
It's advice I give to the minister that goes to the president, the cabinet, and the Prime Minister. Speaking to Canadians is continually a clear role that happens, and as I say, I'm speaking on behalf of the entire agency and oftentimes on behalf of the entire government.
When I'm speaking on behalf of the government, I confer within the agency and confer that we're having the right message consistent with other departments, for example.
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:32
No, nothing changes that. I will still be the spokesperson for public health for the federal government.
View Mike Allen Profile
Yes, I would, Chair.
I want to follow up with Mr. Taylor with a question specifically referencing your remarks where you said:
...we've been moving this way as an agency for some time now and have, in fact, adopted this type of management structure since 2012. At that time we began to separate out the roles and responsibilities of the CPHO on an interim basis.
Can you comment about the conflict during that two-year period? It sounds to me as if you've been doing some of the administration and everything else. What percentage of your time has been allocated to what we'll call the back-office things, as opposed to the things we really want you to do?
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:46
During that period of time, which was precipitated by David Butler-Jones' stroke and his stepping down, Krista Outhwaite continued as the acting deputy head and I was the deputy chief public health officer. So we separated the role and I focused on the content of the CPHO role and she focused on management. In essence we've been functioning like this for the last two and a half years, which I think has been very effective. I think I've been able to focus on a number of issues as the deputy chief public health officer, H5N1, etc., as we've been moving forward.
All this does in the current situation is stratify and formalize that role of the new CPHO.
Sylvain Segard
View Sylvain Segard Profile
Sylvain Segard
2014-11-05 17:38
That is correct. The measure simply separates the authority for management and moves that over to the new president's function, whereas the CPHO will continue to have the same responsibilities and ability to advise directly the minister or Canadians on all matters related to public health.
Steven Sternthal
View Steven Sternthal Profile
Steven Sternthal
2014-06-03 8:53
Good morning.
Thank you, Mr. Chair and members of the committee, for the opportunity to contribute to your deliberations on Bill C-442.
I am pleased to be here today to address the work under way in the Public Health Agency of Canada to reduce Lyme disease across the country.
I'll begin by addressing the agency's role and how it applies to Lyme disease.
The agency aims to promote better overall health of Canadians by preventing and controlling infectious diseases. We undertake primary public health functions, such as health promotion, surveillance, and risk assessment. These inform evidence-based approaches to prevent and control the spread of infectious diseases.
As part of its public health leadership role, the agency coordinates the national surveillance on Lyme disease as one of the most rapidly emerging infectious diseases in North America. I know that was part of your deliberations late last week.
The spread of Lyme disease is driven, in part, by climate change, as the tick vector spreads northwards from endemic areas of the United States. Moving into Canada, it is impacting our most densely populated regions. Based on the lessons learned in the United States, we anticipate the disease will affect over 10,000 Canadians per year by the 2020s.
To date, we have seen cases increase from 128, in 2009, when Lyme disease became a nationally notifiable disease, to an estimate of over 500, in 2013. That's a fourfold increase in just over five years.
However, this national snapshot only reflects a portion of all cases in Canada. This is because some people do not seek treatment for milder symptoms. Others do seek medical help, but may be misdiagnosed because their doctors are not always aware of the range of symptoms, or even that Lyme disease is in Canada. Agency risk models estimate the true number of infections to be at least three times higher than what has been reported today.
To support physicians in diagnosing Lyme disease, laboratory diagnostic testing is available across Canada in various public health laboratories. Like the United States, we use a two-tier test that must be requisitioned by a physician: the ELISA, to screen; and the western blot, to confirm Lyme disease.
The following are just a few facts about the testing in Canada.
Last year, almost 40,000 ELISA tests were administered by provincial and national laboratories. Of this total, approximately 3,000 tested positive or inconclusive, and were sent on to have essentially the second part of the screening and testing, the western blot, for confirmation of Lyme disease, by either our National Microbiology Laboratory in Winnipeg, or by public health laboratories in Ontario and British Columbia.
Following a thorough review of this surveillance information, available domestic and international research, stakeholder views, and existing public health messaging on this important topic, the agency has put in place an action plan to prevent and control Lyme disease in Canada. The action plan identifies three pillars for concrete action: engagement, education, and awareness; surveillance, prevention, and control; and research and diagnosis.
The first pillar includes a comprehensive public awareness plan that focuses on educating health care professionals and the public about Lyme disease.
Raising awareness among health professionals is one of our main goals: informing them that Lyme disease is here, educating them on symptoms, and encouraging them to properly diagnose and report cases.
This year, we have already reached an estimated 200,000 health professionals with awareness posters published in medical journals beginning in March. We have also presented to clinicians at a variety of venues across Canada in recent months.
We are also using every means available to get the message out to the general public. From social media, to Google AdWords, to partnering with organizations like The Weather Network, we are telling Canadians that Lyme disease is here, how to recognize it, and how to protect themselves from it. These public messages will continue throughout the summer period, which really is the Lyme disease season in Canada.
The agency has also worked with provincial and territorial public health authorities, as part of the Pan-Canadian Public Health Network, to develop a coordinated, vector-borne disease communications strategy, and public awareness tools targeting Lyme disease.
We hope that by the end of this year's tick season Lyme disease will be a household term.
I would now like to address the second pillar, which focuses on innovative ways to conduct surveillance and encourage preventive behaviour.
Efforts made in Lyme disease surveillance are starting to show some results. This year the majority of provinces are providing detailed case information, which will help identify new areas where Lyme disease is endemic and assist provinces in tailoring their preventive strategies.
The information will also provide a clear picture of the signs and symptoms of Lyme disease, information that is key for clinicians to properly diagnose it.
The final pillar focuses on increasing lab capacity, testing new diagnostic methods and carrying out research to generate new insights into effective diagnosis and treatment.
Under this pillar the agency is increasing testing capacity and quality by using state-of-the-art laboratory equipment. We recognize the challenges with current testing, particularly around detecting early Lyme disease, as the human body takes some time to develop antibodies to the bacteria.
The agency is committed to improving diagnostic testing. New methods are being evaluated and any that outperform current methods, the two-step method, will of course be adopted.
In the meantime we continue to recommend doctors diagnose patients on the basis of a full, wholesome, clinical assessment.
We recognize that laboratory technologies have evolved and will continue to do so in the future. The agency's national microbiology laboratory, in collaboration with the Canadian Public Health Laboratory Network and other stakeholders, will be updating our laboratory diagnostic guidelines in the near future.
However in doing so the agency faces a challenge. We can update the guidelines to reflect the current available evidence, but new evidence is needed to inform new diagnostic and new treatment methods. Therefore the agency is committed to continuing to work with medical professionals, patient advocacy groups such as the Canadian Lyme Disease Foundation and the Canadian Institutes of Health Research, and my colleagues on the video conference today to identify and address research gaps.
In closing, I would like to restate that the goal of the agency is to mitigate the impact of Lyme disease on Canadians. Through our collective efforts, Canadians will become more aware of the disease, how to recognize its symptoms, and the benefits from early treatment.
Together, we can reduce the severity of Lyme disease in Canada.
Thank you for your attention.
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