Interventions in Committee
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View Ben Lobb Profile
View Ben Lobb Profile
2013-11-25 15:30
Good afternoon, ladies and gentlemen. Welcome to our health committee, meeting number six.
This afternoon we are honoured to have the Minister of Health here, Minister Ambrose. She's agreed to be here for an hour to go over the supplementary estimates. She has some of her colleagues from the department here as well.
Minister, you have some opening comments, and then you know the routine as far as questions and answers go. After the minister is done, we'll suspend for two minutes, and then we'll continue with our questions and answers from other people within the department. The last ten minutes we'll allocate to voting on the estimates.
Thanks, everybody, for being here. And thank you to the clerk for arranging to pull a few strings to get this large meeting room, so we can fit everybody in.
Without any further ado, Minister Ambrose, it's your time.
View Rona Ambrose Profile
Thank you, Mr. Chair and members of the committee. Thank you for the invitation to discuss supplementary estimates (B) for the health portfolio.
I'd also like to congratulate you, Mr. Chair. I know you have taken over this position recently. Thank you for that. I wanted to say a big thank you to Joy Smith, who I know chaired this committee with great success for quite a long time. I know you'll be working hard to build on her strong record.
I have with me some members of a couple of departments. Of course, we have the deputy minister of Health Canada, George Da Pont; our associate deputy minister from the Public Health Agency of Canada, Krista Outhwaite; and Dr. Bruce Archibald from the Canadian Food Inspection Agency. Thérèse Roy is here as well, the CFO from the Canadian Institutes of Health Research, on behalf of Dr. Alain Beaudet.
I've also brought with me today, for interest's sake, something we just announced recently. I'll allow the clerk to pass it out. It's our new healthy and safe food for Canadians framework. This is the culmination of a lot of work, bringing CFIA under the health portfolio, as you know.
I understand also that the committee is undertaking a very important study on the growing problem of prescription drug abuse. I'd like to thank you for this work and say to you that after the meetings I've had with provinces and territories, this is not only an emerging issue, I think it's a pressing issue. I very much look forward to reviewing the report.
Do you need me to say I'm tabling this?
View Rona Ambrose Profile
As you know, members, in the recent Speech from the Throne, our government committed to expanding the national anti-drug strategy to address this very issue of prescription drug abuse. And I know that your work here at committee will provide much needed information on this important topic.
This is my first appearance before the committee as Minister of Health, so I would like to take a few moments to discuss how I will be approaching my role in general, before getting into some priority areas.
As evidenced in budget 2013 and also reiterated in the recent Speech from the Throne, health is a key priority for the government. In my opinion, one of the keys to success is finding new and better ways of working together. I can assure the committee that fostering partnerships and building relationships with the provinces and territories, with medical associations and health professionals, will be fundamental tenets of my time as health minister. This is noteworthy because we know there is nothing more important than good health.
Federally, we play a vital role when it comes to promoting healthy living, preventing chronic diseases, protecting Canadians from harm, innovating through research, and providing leadership on national health issues. But of course we can't do any of this alone. We all have a role to play when it comes to improving the health of Canadians.
A key achievement of our government has been to increase health transfers to the provinces and territories to unprecedented levels. Our record funding will reach $40 billion by the end of the decade, providing stability and predictability to the system. These transfer dollars support the provinces and territories in addressing the health concerns of their residents and allow all jurisdictions to focus on innovative solutions to their health care needs. As the new federal health minister, I take that responsibility very seriously, and I'm committed to each aspect of the portfolio. However, today I'd like an opportunity to highlight four key areas of interest before getting into the details of the portfolio's supplementary estimates. These include addressing family violence, fostering innovation in health care, working with partners on healthy living and injury prevention, and providing Canadians with healthy and safe food.
As I have in the past, I will continue to shine a spotlight on family violence, an important issue, and encourage Canadians to be part of the solution. Family violence, as you know, can wreak physical and emotional havoc on individuals, families, and communities. Violence in any form reverberates across our society, and of course across the economy as well. According to Justice Canada, spousal violence alone costs society at least $7.4 billion annually. Of that, approximately $6 billion was spent on medical treatment and psychological services alone.
From my perspective, family violence is a health matter—just as much as a criminal one.
To help address it, as you know, we have the federal family violence initiative that connects the work of 15 federal departments and agencies. The Public Health Agency of Canada is leading this work to make sure this initiative is focused on priorities that make a difference to Canadians.
Another focal point I'd like to touch on centres around innovation, technology, and research, all of which are obviously linked. At the federal-provincial-territorial health ministers meeting in early October in Toronto, I was very encouraged to hear from my colleagues that they've expressed their desire to make health care innovation our top priority in working together. It was also obviously well received at the annual meeting of the Canadian Medical Association as a priority for physicians. Federally, our government supports research and innovation through a range of initiatives. Most notably, of course, is the fact that we are the single largest investor in Canadian health innovation.
On any given day, thousands of federally funded research projects are under way involving more than 13,000 Canadian researchers. These researchers are developing cutting-edge technologies designed to help improve our health care system. We will continue to invest in research and innovation so that together with the provinces and territories we can continue to improve the quality, accessibility, and sustainability of our system so that it's there for Canadians when and where they need it.
On another note, ensuring that Canadian children and youth get the healthiest start in life is a key priority for our government. One in three children in Canada right now are overweight or obese. On average, only 12% of Canadian children take part in enough physical activity on a daily basis. These are truly alarming statistics. In the recent Speech from the Throne, our government committed to working with our provincial and territorial counterparts, as well as the private and not-for-profit sector, to support Canadian children and youth in leading healthy active lifestyles.
Awareness and momentum are growing. We are seeing strong leadership across the country to work towards the common objective.
Through the Public Health Agency of Canada, we are now mobilizing with groups like Canadian Tire, Right to Play, Maple Leaf Sports and Entertainment, Air Miles, and the YMCA. By leveraging our resources and theirs and ideas across sectors, we're laying a foundation for sustainable change.
Another area of interest and focus that I have, and the department is working on, revolves around injury prevention, a topic of such importance that it was also specifically highlighted in the recent Speech from the Throne. Unfortunately, preventable injury is the leading cause of death for Canadians aged 1 to 44 years. Often considered accidents, preventable injuries are far more common than people think, and of course all are most often predictable and most often preventable. Preventable injury is also a concern from a health equity perspective.
An injury can happen to anyone at any time, but children, youth, seniors, aboriginal people, and those of low socio-economic status carry a higher burden of injury than other Canadians. By working together and leveraging our resources, we can reduce the number of preventable injuries in this country and make a real, tangible difference in the lives of Canadians. Going forward, we will continue to build on new partnerships, raise awareness about injury prevention, and give Canadians the tools they need to live safer, healthier lives.
I also want to touch upon the issue of healthy and safe food for Canadians and why this is such a focus for our government. As committee members know, Canadians are fortunate to have a world-class food safety system. But that said, we must always be looking for ways to improve it.
Earlier this fall our government moved the Canadian Food Inspection Agency into the broader health portfolio. This decision takes the three federal authorities responsible for food safety—the CFIA, the Public Health Agency of Canada, and Health Canada—and places them under one umbrella. We did this because food safety is not only a top priority for our government, but we do feel that by better connecting these three entities, we are improving the way we manage food safety, as well as regulating, sharing information, and communicating with Canadians about food safety.
One of the accomplishments stemming from that reorganization was the recent release of the document I just shared with you: the healthy and safe foods for Canadians framework. This framework outlines the portfolio's work on food safety as it pertains to three key pillars: promotion, prevention, and protection. With this in place, Canadians can have greater confidence in the food they buy and eat.
We're also improving food recall warnings by making important information easier to understand and more accessible by tapping into such things as social media. Whether it's Facebook, Twitter, or other tools, we are also trying to provide Canadians with essential, easy to understand information whenever and wherever they need it.
Now, under the healthy and safe foods for Canadians framework, we have all the researchers, inspectors, scientists, and public health officers working together with a common goal.
As outlined in the recent Speech from the Throne, we will continue and we are committed to strengthening Canada's food inspection regimes and ensuring that our food safety and recall system remains one of the best in the world.
As l've mentioned, with respect to this appearance, the agency is seeking an additional $39.9 million to further enhance its ability to maintain increased frequency of food inspections in meat processing establishments, improve online service delivery, and fund inspection verification teams.
To conclude, Mr. Chair, l'm proud of the vital role our government plays in health care in this country.
As Minister of Health, l'm committed to investing in health promotion by working with provinces, territories, and other partners, of course, on delivery of high-quality, cost-effective health care, by promoting innovation and health research, and by providing federal leadership on the areas that matter a great deal to Canadians.
Once again, thank you for inviting me to speak with you today.
My officials and I are pleased to take any questions you may have.
Thank you.
View Libby Davies Profile
Thank you very much, Chairperson. Maybe you could give me a heads up when I have about three minutes left.
First of all, thank you, Minister Ambrose, for appearing before the committee today, your first appearance as health minister. Welcome. It's a pleasure to see you.
I listened very carefully to your presentation and noted that an issue you actually didn't address, which I think is a very serious concern for Canadians, is the question of drug safety. In actual fact, Health Canada doesn't have the power to recall prescription medications. To us, that's another example on a long list of drug safety issues that have plagued your department for years. You're obviously a newcomer to it, but this is definitely not a new issue.
We've had numerous Health Canada warnings about safety and effectiveness for birth control, antibiotic, and blood pressure medications, but the concern is that there isn't actually a recall provision that exists. In addition, Health Canada doesn't follow up on adverse drug reaction reports, even when they're filed by family members when people feel that someone has died or have had a terrible reaction to a drug. There's been a lot of coverage about this issue. Some of the media have done extensive research on it, and it certainly does seem to be a major shortcoming.
My question, therefore, is when will Health Canada upgrade its drug safety protocols to ensure that medications Canadians are taking are safe, and that unsafe medications can be removed from the market immediately?
I do have one other question for you as well.
View Rona Ambrose Profile
I will try to be quick then.
I appreciate that, and I understand the concerns that Canadian families have experienced over adverse drug reactions. Of course, you probably know one of our members of Parliament is here, elected for that very reason, and we work closely with him on this issue.
We introduced in our Speech from the Throne a commitment to moving forward with patient safety legislation. I can't get into the details of the legislation, but I want to reassure you that we are working closely with multiple stakeholders, including patient safety advocates, to ensure that we do get this right. We'll have a chance as well for that legislation to come before committee.
I have also recently asked Health Canada to begin to publish more transparently their drug reviews. I think that's important information that regular Canadians should have access to. Some of it is difficult to understand, but I don't think that should be a reason to not make it available to Canadians, and of course to researchers and physicians who would like to have that level of information. I hope to see a template from Health Canada soon on what that would look like, so we can ensure that we do publish that data more transparently when it comes to drug reviews. Of course, when it comes to adverse drug reactions, that's something we also hope to address in the patient safety legislation.
View Libby Davies Profile
We certainly look forward to seeing that information, because there's no question that when you analyze this issue, we're lagging far behind the drug safety measures in, for example, the U.S. and Europe.
I'd now like to ask you a second question concerning your recent decision to intervene and, in effect, ignore the experts in your own department who had given approval under the special access program for the SALOME trial in Vancouver. One of the things that really bothered me about this is that both you as minister and your office publicly said on a number of occasions that the SAP is for rare diseases or terminal illnesses. According to your own website, “...practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable.” Now, that's clearly within the realm of what the SALOME trial was about.
It was also very disturbing that you repeatedly referred to illicit drugs, when in actual fact, diacetylmorphine is actually a clinically produced medication. I'm aware that Health Canada, before coming to its decision under SAP, sought the advice of Michael Lester, an independent expert who has specialized in opiate dependence treatment for nearly 20 years. In fact, in a recent report in 2013 that he did for Health Canada, he called prescription heroin “a promising treatment of last resort” for this population, noting that there is no other next step for people who have failed multiple treatment attempts with methadone.
It is all very disturbing that this intervention was made at a political level, particularly in light of the information I've given you. So I guess my question is, why have you allowed politics to trump evidence-based medicine when the process was in place? Clearly, a decision was made based on expert evaluation, and as a result, because of your political intervention, I would say that people's lives are at risk and a very vulnerable population is left hanging out there with basically a political decision made by yourself. Maybe you can answer for that.
View Rona Ambrose Profile
First of all, in regard to the SALOME trial, these requests under the SAP are not, as you know, the SALOME trial. The SALOME trial is separate. That research is ongoing and was actually approved by our government.
In terms of the physicians who made this request, you should know that in the past when a request like this was made, it was denied. Under the special access program, as you know, Health Canada can approve emergency access to certain medicines for Canadians with rare diseases or terminal illnesses. The intent of that program was not—
View Libby Davies Profile
That's actually not the case. It's life-threatening conditions.
View Rona Ambrose Profile
I appreciate that. I know you quoted one person with 20 years' experience in the addictions world. I'll quote another.
View Rona Ambrose Profile
I've read it.
I'll also quote another addiction specialist, who's been researching in this field for 20 years, who says, “Heroin treatment is unsafe and...does not address the treatment needs....”
For this very small, vulnerable group of people I support treatment, I support intervention, and I support recovery programs. We know that these kinds of addictive drugs are very dangerous. I believe that drug treatment should be focused on ending drug use, not on maintaining drug use, and supporting these people to recover and lead a drug-free life.
As well, you also know, as do many physicians, that there are safe alternatives available to giving heroin to someone who's addicted to heroin. If I had a request to give cocaine to someone addicted to cocaine through the special access program, or LSD.... I could go through the whole list—that is the list of substances that we have now disallowed under the special access program. But I can tell you, as far as I know, we've never received any requests for that. In the past, any request for this substance was denied.
View Eve Adams Profile
Lib. (ON)
Thank you.
Thank you very much, Minister, for joining us here today to review the supplementary estimates with our committee.
As you kindly noted, our committee is currently undertaking a study of prescription drug abuse. In the last few weeks, we've heard quite a bit of testimony about the scope of this problem and some of the challenges that lie ahead in addressing this very serious issue.
Our Conservative government has a very strong, proven track record when it comes to illicit drug use, addressing that through our national anti-drug strategy. I'm hoping that through the study we'll be able to look at some promising strategies on how we can best address prescription drug abuse.
Would you be kind enough to comment on what our government has done to date as it relates to prescription drug abuse and where you think the future lies in addressing this issue?
View Rona Ambrose Profile
Thank you very much for the question. I'm very encouraged that the committee is engaged on this issue, because I think it is a very serious one.
As you've probably seen from some of the statistics, Canada is now, I think, number two in the world in prescription drug abuse. While a lot of the work lies at the provincial level, we're working cooperatively with the provinces and territories on what we can do together to address this problem. We have levers, obviously, at the federal level as well.
The abuse of certain prescription drugs I think represents a very serious health and safety issue in Canada, and one that we committed to addressing, as you know, in the Speech from the Throne. I, myself, and probably many people in this room, have seen and heard the heartbreaking stories of people who have become addicted to prescription drugs, starting with a prescription they needed for back pain, and it has literally ruined their lives. Unfortunately, we haven't had enough focus on this area, given its seriousness. I know it's a growing problem, and we are working very diligently with the provinces and territories to address it.
We do have to cooperate with them, obviously. We've committed in the Speech from the Throne to expanding our national anti-drug strategy to include prescription drug abuse, and not just illicit drug abuse, which I think is important. This action will help build on the work we've already done to tighten such things as licensing rules around drugs such as OxyContin to prevent their being illegally distributed. These include tightened controls on companies that produce drugs like OxyContin to ensure that proper care is taken when they're manufactured, but also when they are distributed.
In terms of our own policy levers within Health Canada, we've also used our public drug plan, which is run by Health Canada. We now have maximum monthly and daily drug limits, we monitor the use of certain drugs to address potential misuse, and we also have real-time warning messages to pharmacists at the point of sale when we see issues.
On top of the good and very helpful and cooperative work that we're doing with partners, I also encourage provinces, territories, and medical professionals to develop their own complementary strategies, and some of them are doing this. We all have a responsibility to fight this issue.
This includes sharing of information that demonstrates that we know—obviously I don't know the extent of the issue—that there is some evidence that some people are doctor shopping and that doctors are prescribing too much. Too much ends up in someone's medicine cabinet and sits there for months. Unfortunately, sometimes kids get their hands on it, take it to school, and sell it. We really need to raise more awareness around this.
But there also have to be measures in place to make sure that doctors are also accountable for some of the misuse. If information is known about this happening, then Health Canada needs to be informed, and if we are informed, then we can take the necessary steps to stop these irresponsible practices.
There are obviously a number of stakeholders involved here. We are working with all of them. We very recently met with a number of them to bring them together in what will be, when we move forward, the first time that all of these stakeholders will be addressing this issue together. I think that's a really good first step, and there will be great information coming out of this committee to build on that work.
View Eve Adams Profile
Lib. (ON)
Thank you.
Let me move to innovation. You noted in your opening comments that our federal government is the nation's largest investor of research and innovation in the country. That is a very proud legacy to have. I'm particularly focused on the results of those types of investments. Perhaps you could highlight for us some of the outstanding results that you've seen to date.
View Rona Ambrose Profile
The Canadian Institutes of Health Research is really an amazing research organization, and the support they're giving to Canadian researchers across the country is phenomenal.
In my short time as health minister I've had an opportunity to see that. I'm sure you've heard on this committee from many of those innovative health researchers. It's close to 13,000 presently, and at times it has been higher. So whether it's investing in research in diabetes, personalized medicine, aboriginal health, mental health—of course, the list goes on. We've invested recently $100 million in Brain Canada for neuroscience, and we've also created the pathways to health equity for aboriginal peoples.
We have recently, not that long ago, launched the strategy for patient-oriented research, which is a great initiative, working closely with the provinces and territories, which sees additional money going to the territories to support their particular specific innovation priorities. So it's a great opportunity for the federal government to use our research capacity to support the provinces in the areas where they need help, making sure patients are getting the right kind of treatment at the right time. It also focuses on including patients in the research itself, which has been obviously welcomed by patients' advocates. I think it really helps bridge the gap between research evidence and health care practice, which has been very well received across the country. We just launched the first initiative of this kind in Alberta, and there are a number more that will follow.
Obviously, Canada has been a leader on research on HIV. Whether it's new ways to prevent chronic diseases...our support has been providing the resources needed for that work as well.
The deputy wants me to tell you that we've also invested $2.1 billion today for electronic health records. Obviously that's a huge issue for the provinces and territories because they're delivering health services on the ground, and that is a huge undertaking that has seen great success. We know that there have been a lot of challenges in different jurisdictions on electronic records, but Infoway has an impeccable record, not only from the Auditor General, but recently they just won an international award for project management. So we're glad to see the $2 billion investment actually helping people, helping those who deliver health services on the ground do it better and in a more sustainable way.
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