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Kelley Bush
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Kelley Bush
2015-06-18 16:07
Good afternoon. My name is Kelley Bush, and I am the head of radon education and awareness under Health Canada's national radon program.
Thank you, Mr. Chair and members of the committee, for inviting me to be here today to discuss radon as a cause of lung cancer and to highlight the work of the Canadian – National Radon Proficiency Program.
Through the ongoing activities of this program, Health Canada is committed to informing Canadians about the health risk of radon, better understanding the methods and technologies available for reducing radon exposure, and giving Canadians the tools to take action to reduce their exposure.
Radon is a colourless, odourless radioactive gas that is formed naturally in the environment. It comes from the breakdown of uranium in soil and rock. When radon is released from the ground in outdoor air, it gets diluted and is not a concern. However, when radon enters an indoor space, such as a home, it can accumulate to high levels and become a serious health risk. Radon naturally breaks down into other radioactive substances called progeny. Radon gas and radon progeny in the air can be breathed into the lungs, where they break down further and emit alpha particles. These alpha particles release small bursts of energy, which are absorbed by the nearby lung tissue and lead to lung cell death or damage. When lung cells are damaged, they have the potential to result in cancer when they reproduce.
The lung cancer risk associated with radon is well recognized internationally. As noted by the World Health Organization, a recent study on indoor radon and lung cancer in North America, Europe, and Asia provided strong evidence that radon causes a substantial number of lung cancers in the general population. It's recognized around the world that radon is the second leading cause of lung cancer after smoking, and that smokers also exposed to high levels of radon have a significantly increased risk of developing lung cancer.
Based on the latest data from Health Canada, 16% of lung cancers are radon-induced, resulting in more than 3,200 deaths in Canada each year. To manage these risks, in 2007 the federal government in collaboration with provinces and territories lowered the federal guideline from 800 to 200 becquerels per cubic metre. Our guideline of 200 becquerels per cubic metre is amongst the lowest radon action levels internationally, and aligns with the World Health Organization's recommended range of 100 to 300 becquerels per cubic metre.
All homes and buildings have some level of radon. It's not a question of “if” you have radon in your house; you do. The only question is how much, and the only way to know is to test. Health Canada recommends that all homeowners test their home and that if the levels are high, above our Canadian guideline, you take action to reduce.
The national radon program was launched in 2007 to support the implementation of the new federal guideline. Funding for this program is provided under the Government of Canada's clean air regulatory agenda. Our national radon program budget is $30.5 million over five years.
Since its creation, the program has had direct and measurable impacts on increasing public awareness, increasing radon testing in homes and public buildings, and reducing radon exposure. This has been accomplished through research to characterize the radon problem in Canada, as well as through measures to protect Canadians by increasing their awareness and giving them tools to take action on radon.
The national radon program includes important research to characterize radon risk in Canada. Two large-scale, cross-Canada residential surveys have been completed, using long-term radon test kits in over 17,000 homes. The surveys have provided us with a much better understanding of radon levels across the country. This data is used by Health Canada and our stakeholder partners to further define radon risk, to effectively target radon outreach, to raise awareness, and to promote action. For example, Public Health Ontario used this data in its radon burden of illness study. The Province of British Columbia used the data to inform its 2014 changes to their provincial building codes, which made radon reduction codes more stringent in radon-prone areas based on the results of our cross-Canada surveys. The CBC used the data to develop a special health investigative report and interactive radon map.
The national radon program also conducts research on radon mitigation, including evaluating the effectiveness of mitigation methods, conducting mitigation action follow-up studies, and analyzing the effects of energy retrofits on radon levels in buildings. For example, in partnership with the National Research Council, the national radon program conducted research on the efficacy of common radon mitigation systems in our beautiful Canadian climatic conditions. It is also working with the Toronto Atmospheric Fund to incorporate radon testing in a study they're doing that looks at community housing retrofits and the impacts on indoor air quality.
This work supports the development of national codes and standards on radon mitigation. The national radon program led changes to the 2010 national building codes. We are currently working on the development of two national mitigation standards, one for existing homes and one for new construction.
The program has developed an extensive outreach program to inform Canadians about the risk from radon and encourage action to reduce exposure. This outreach is conducted through multiple platforms targeting the general public, key stakeholder groups, as well as populations most at risk such as smokers and communities known to have high radon.
Many of the successes we've achieved so far under this program have been accomplished as a result of collaboration and partnership with a broad range of stakeholder partners. Our partners include provincial and municipal governments, non-governmental organizations, health professional organizations, the building industry, the real estate industry, and many more. By working with these stakeholders, the program is able to strengthen the credibility of the messages we're sending out and extend the reach and impact of our outreach efforts. We are very grateful for their ongoing engagement and support.
In November 2013 the New Brunswick Lung Association, the Ontario Lung Association, Summerhill Impact, and Health Canada launched the very first national radon action month. This annual national campaign is promoted through outreach events, website content, social media, public service announcements, and media exposure. It raises awareness about radon and encourages Canadians to take action. In 2014 the campaign grew in the number of stakeholders and organizations that participate in raising awareness. It also included the release of a public service announcement with television personality Mike Holmes, who encouraged all Canadians to test their home for radon.
To give Canadians access to the tools to take action, extensive guidance documents have been developed on radon measurement and mitigation. Heath Canada also supported the development of a Canadian national radon proficiency program, which is a certification program designed to establish guidelines for training professionals in radon services. This program ensures that quality measurement and mitigation services are available to Canadians.
The Ontario College of Family Physicians as well as McMaster University, with the support of Health Canada, have developed an accredited continuing medical education course on radon. This course is designed to help health professionals—a key stakeholder group—answer patients' questions about the health risks of radon and the need to test their homes and reduce their families' exposure.
The national radon program also includes outreach targeted to at-risk populations. For example, Erica already mentioned the three-point home safety checklist that we've supported in partnership with CPCHE. As well, to reach smokers, we have a fact sheet entitled “Radon—Another Reason to Quit”. This is sent out to doctors' offices across Canada to be distributed to patients. Since the distribution of those fact sheets began, the requests from doctors offices have increased quite significantly. It began with about 5,000 fact sheets ordered a month, and we're up to about 30,000 fact sheets ordered a month and delivered across Canada.
In recognition of the significant health risk posed by radon, Health Canada's national radon program continues to undertake a range of activities to increase public awareness of the risk from radon and to provide Canadians with the tools they need to take action. We are pleased to conduct this work in collaboration with many partners across the country.
Thank you for your attention. I look forward to any questions the committee members might have.
Tom Kosatsky
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Tom Kosatsky
2015-06-18 16:43
You know, anyway, that smoking causes lung cancer in smokers. You probably also know that to a degree it causes lung cancer in people who live with smokers. I won't really talk about either of those things, but if you can get to the slide that's marked “Lung Cancer in Lifelong Non-Smokers”, you'll see that there is a new thing that's been described only over the last, about, 10 years, which is lung cancer in lifelong non-smokers, something which, before this committee invited me to speak with you, I didn't know much about. It turns out that it's a whole other disease. It has some similarities to smokers' lung cancer but some very important differences.
The geography is different. It's a huge phenomenon in Asia and in Asians in Canada. It has a female predominance, so there are far more lung cancers in female non-smokers than in male non-smokers. The age distribution is different, so it tends to present itself at a much younger age than smokers' lung cancers do. The cell types, the cancer types are different. The typical small cell squamous lung cancer that you see in smokers, you don't get in non-smokers. You get a whole different cell type and cell shape. The genetics are different, so there is some family relationship. It's not very strong, but there's a very strong genetic relationship based on genetic analysis. You can almost predict who's going to get it, which is a really important thing. Further, it tends to be much more symptomatic at diagnosis than is lung cancer in smokers. The five-year survival, oddly, is better, even though it presents later, for non-smokers' lung cancer than for smokers' lung cancer. In many ways it's a different disease.
Radon-related lung cancer is somewhere intermediate, because, as I'm going to say, most radon-related lung cancers occur in smokers. The question of whether it is more cost-efficient to stop smoking was right on the mark.
The next one is called “Principal risk factors (excluding occupational exposure)”, only because you asked. There are a number of conditions, including radon exposure, that are associated with non-smokers' lung cancer, like the history in your family. It's associated with hormone use in women. It's associated with environmental tobacco smoke. It's associated, to a degree, with air pollution. It's associated with cooking-oil fumes, so indoor cooking over a long period of time. It's associated in Asia and Africa with domestic heating by wood and wood products in the home. Those are also associated with lung cancer. Something that I didn't know much about before is that it's associated with lung infections like tuberculosis and other lung infections over a long period of time. It's also, like so many of the other bad things in life, associated with being poor. Getting lung cancer is associated with being poor, even if you eliminate all the other stuff. To a degree it's mitigated or prevented by a diet high in fruits and vegetables, so eat your leafy greens, eat your fruit, and you're less likely to get lung cancer no matter what else you do.
The next one is an American slide. It has a little American flag, and it looks at the attributable percentage of lung cancer by cause. For active smoking, it's 90%. For radon exposure in the U.S., it is between 9% and 15%, and in Canada it's estimated at 15%. For workplace carcinogen exposure, it's 10%. For air pollution, it's 1% to 2%. That adds up to more than 100% because, as you'll see, some of those causes add to or multiply each other. If you're exposed to radon, don't smoke. If you smoke, don't be exposed to radon.
Non-smokers' lung cancer is a really important cause of lung cancer. It's about number six in terms of all the causes. Radon-related lung cancer—this is U.S. data but for Canada it would be the same—is number eight. How could that be? It could be because smoking and radon exposure are interactive, so one multiplies or adds to the effect of the other. That leads, in any case, to non-smokers' lung cancer being a very bad issue.
Any radon exposure is bad news, not just at over 200. An artificial limit, no matter what it is, is not very useful for lowering the whole population's exposure. It would be better if we were all exposed to less radon rather than picking one area, maybe for convenience, or one level. It may be good for convenience, but it's not a really useful population health measure. For the whole population, it would be better if we were all exposed to less radon. It's a linear relationship. The more radon you're exposed to and the longer you're exposed, the more likely you are to get lung cancer.
The other thing is that, as I was saying, the more you smoke the more it interacts. On the last slide, which I made up using Canadian data, most radon-associated lung cancers occur in smokers. If you've never smoked, as you get up to high levels, like interior B.C. levels, of radon about 36 people out of 1,000 exposed to those levels would get lung cancer. On the other hand if there was no radon exposure and you did smoke, about 100 people would get lung cancer. If you add the two together, you're exposed to a high level of radon and you smoke, 270 people exposed to those two for their whole lives, smoking and radon, will get lung cancer. It's 270 out of 1,000 people; that's tremendous.
How can you lower it? The number one way to lower it is to stop smoking or to never have smoked. The number two way to lower it is to lower your radon exposure, and you'll do that for everybody in the population. The less smoking there is, the less radon there is, the less lung cancer there will be, to the point that as we lower the level of smoking exposure, radon will become a more important cause of lung cancer. But there will be a lot less lung cancer. If we eliminate smoking, there will be less lung cancer in general, but all of these other causes other than smoking will increase in focus. The big issue is the interaction, the doubling, tripling, quadrupling, or really octupling effect, because it's an eight-time effect, of smoking and radon will go away.
What's been the Canadian public health stance on radon? Before the year 2007, it was pretty passive and largely seen as a private issue. Health Canada was helpful. They gave advice when people asked for it. That was at the time of the 800 becquerels per metre cubed, or 800 disintegrations per second per metre cubed level, which is what a becquerel is. Then when the level was lowered a more active stance was taken. Health Canada was involved with large-scale testing across the country to establish a radon profile across the country so that we knew what our levels were likely to be. They were much more active in terms of giving advice, and with this lower guideline, they promoted it and they encouraged “test and remediate”. Test and remediate to me is not the way to go. The way to go is to build it out in the first place.
If you look at this complicated Ontario slide, Ontario looked at levels of radon across the province and how many cases of lung cancer could be saved by doing something for those above 200 becquerels per metre cubed, by adopting 100 becquerels per metre cubed, by adopting 50 becquerels per metre cubed—all of which are attainable—or by going to as low a level possible and getting close to outdoor air levels, which are relatively benign. At 200 becquerels per metre cubed, if every Ontario resident got their house from that point down to outdoor levels, 2% of all the lung cancers in Ontario would be averted. If you got down from current levels above 200, if everybody tested and remediated and they successfully got their house down to background or no radon, it would avert 2% of all lung cancers. If all houses in Ontario with any level of radon in them could get down to outdoor levels, we'd get rid of 13% of all Ontario lung cancer deaths. If there were a way to do it, why not do that? Why not get it down lower?
The next slide looks at the change in levels of radon over time. This is Dutch data. Canada would be the same. Yes, as we've made our buildings tighter, radon levels have increased. This is even more reason to look at the joint effects of building changes on radon.
Sarah Henderson
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Sarah Henderson
2015-06-18 16:55
Good afternoon.
There is a slide deck for me as well. The first page of that slide deck should say, “Radon risk areas and lung cancer mortality trends in British Columbia”. I hope that you all have it. I will try to speak to the slides as I go along for those who don't have them.
I want to start by saying thank you so much for inviting me to be here. It's a real honour.
My title at the BC Centre for Disease Control is senior scientist, and I'm really a research scientist. The mandate of my role is to conduct applied public health research in support of good environmental health policy for the province, and that's how I first became interested in radon in British Columbia.
I'm going to show you some real, hard numbers today that come directly from the population data for British Columbia, and that's a bit different from what everybody else has been talking about so far.
If you move to the first slide, it's just a recap of the current guideline values for radon in Canada. We've heard about the number 200 all day, and any concentration lower than that is below the Health Canada guideline. Then if you measure your home and the concentration is between 200 and 600 becquerels per metre cubed, Health Canada currently recommends that you try to remediate that within the next couple of years, whereas if your measurement if over 600 becquerels per metre cubed, they really recommend that you remediate right away. That is the high-danger area for radon.
We've used these values in British Columbia to sort of break up the province into areas that we consider to be low, moderate, and high radon areas. If you are not seeing this in colour, the darkest areas there are coloured in red, and those are the high radon areas.
We're very lucky right now in British Columbia. We have a database of over 4,000 residential radon measurements, including measurements from Health Canada national surveys as well as from a bunch of surveys that have happened in the province, so we were really able to use the data that we have observed in the province to break things up this way. These geographic regions are called local health areas. They're the smallest health geographic unit that we use in British Columbia. We are able to look at deaths that have occurred in this province at this geographic scale, which is why we've used this geographic scale.
We did something quite simple, but I hope you'll agree, also quite effective. We looked at the province by those regions, and over the course of 25 years we summed up all of the deaths attributed to lung cancer in the low, moderate and high regions, and all deaths attributed to all natural causes, and then we divided the number of lung cancer deaths by the number of deaths from all natural causes, and in general, we expect about 7% of all deaths in B.C. to be attributed to lung cancer, which is probably true for most of Canada.
Slide number 4 shows the hypothetical situation. If there were no lung carcinogens in the world other than radon, we would expect lung cancer to be high and steady in the higher radon areas, somewhat lower and steady over time in the moderate radon areas, and then lower still and steady over time in the low radon areas. That's the framework I want you to think about when we go to this next slide.
When we looked at all deaths in British Columbia, we saw something quite different from what one would expect to see under that hypothetical scenario. The bottom line there shows the low radon areas. You might not be able to see that if you're not looking at it in colour. The middle line, which is just a little bit higher than the bottom line, shows the moderate radon areas. Then that line that is sloping upward over time and is quite distinct from the low and moderate lines is the lung cancer mortality proportion that we see in high radon areas over the past 25 years in British Columbia.
We don't have a lot of data about these people. We're doing this with only administrative data. We don't know whether or not they smoked. We don't know whether or not they lived their entire lives in those high radon areas. There are a whole lot of limitations here that we simply can't speak to.
When we split up these data by the higher and lower smoking regions of the province—we know that smoking rates can be up to 30% in some areas and down to 12% in some areas of B.C.—we still see these same persistent trends. It does seem to be that radon is an important factor here.
Another important distinction, and I think it's probably why I was asked to be here today, is what we see when we look at the trends for men versus women.
To look at men, the low line shown on the slide is the low radon areas, the middle line is the moderate radon areas, and the top line is the high radon areas. There's not as big a difference among those three lines as there was when we were looking at everybody together. In general, the lung cancer rates are going down. That's what we expect as the population stops smoking. When we go ahead and look at women, as shown on the next slide, we see the low and moderate lines towards the bottom there, and then the line for women is just taking off and is quite divergent from the other regions.
We're seeing a pretty big difference with respect to the two sexes here when we split up these data. Speaking anecdotally, it's not very scientific, but those of us who are interested in radon in British Columbia hear so many stories from people who say, “My wife died of lung cancer and she never smoked a day in her life.” This matches up with what we hear anecdotally, although that's not very scientific.
Somebody asked about the burden of radon-related lung cancer in high- and low-risk areas according to the current Health Canada guidelines. On this next slide, what we see is from data published by Jing Chen from Health Canada. There's an estimate of 6% of the housing stock currently being over the 200 becquerels value, and that's related to 28% of lung cancers in Canada, versus 94% of the housing stock being under the guideline value and 72% of all radon-related lung cancers being attributable to homes in that range. The bulk of the burden really remains below what we're currently talking about in terms of the Health Canada guideline.
This very point is something that we've addressed in a new paper. I want to make it clear that this work has not been published yet. It's currently under review, but it's not in the scientific literature and it has not been peer-reviewed. We looked at a bunch of different threshold values. It's really just a line in the sand that we're drawing when we say that 200 is the level or 100 is the level. We took that line in the sand and drew it at 600, 500, 400, 200, 100, and 50 becquerels to see whether or not we could still see a clear distinction between high and low radon areas in B.C. with respect to lung cancer mortality trends when we drew that line in the sand in different places.
Indeed, if you look at the far right-hand side, that top plot shows you lung cancer mortality trends in men and in women at a threshold value of 50 becquerels per metre cubed, and you can see that the trends are still distinct from one another. We still see that sharp increase in lung cancer mortality in women in the high radon areas.
In the final slide, the key message again is that these are very limited administrative data. This is something we've done as a surveillance exercise. It was really an exercise we undertook because a lot of the evidence we use in Canada to build our policy comes from places other than Canada. We're pulling together studies that have happened in Europe, the U.S., and elsewhere. We really wanted to show some hard-hitting data from the Canadian context.
Again, most radon-related lung cancers in Canada happen below the current guideline of 200 becquerels per metre cubed. We see clear temporal trends by radon risk areas of British Columbia. We have not repeated similar analyses elsewhere in Canada, but I wouldn't be surprised to see similar results. The trends that we see at 200 becquerels per metre cubed persist when we drop that threshold to 50 becquerels per metre cubed. This is really supportive of that idea of ALARA, or “as low as reasonably achievable”. As Tom said, the way to pursue ALARA in Canada is really through widespread changes to our national building code to protect the population into the future.
We have estimated that it would take about 75 years to turn over the entire residential building stock in Canada, or most of it, but at the end of that 75 years, you would have a radon-resistant building stock and a population that was well protected.
Finally, there does appear to be a difference between men and women in terms of risk.
Thank you very much for your time.
Sony Perron
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Sony Perron
2015-06-01 15:39
I would like to thank the committee chair and the rest of the committee members for the invitation to appear here today.
I, and other officials at Health Canada, have reviewed the Auditor General's 2015 Report, and we have paid a great deal of attention to his recommendations. We take the findings seriously and are addressing each of them through an action plan. This plan will continue to be refined and defined in collaboration with first nations. Indeed, as you know, we work in cooperation with first nations. This plan can therefore only be completed with an additional commitment by our first nations partners.
The health care system serving first nations is highly complex. Provincial health systems do not directly extend to first nations reserves. To support first nations, Health Canada provides the delivery of a range of effective, sustainable and culturally appropriate programs and services. We work with first nations to increase their control of health services and collaborate with provinces to increase access and promote system integration.
We also support programs that address first nations health priorities in the areas of mental health, chronic disease, maternal and child health, and health benefits providing coverage for prescription drugs, dental care, vision care, mental crisis intervention, and medical supplies and equipment.
Most of the community-based programs have been transferred in varying degrees to over 400 first nation communities. This number does not include British Columbia, where in 2013 Health Canada transferred its role in the design, management, and delivery of first nations health programming in British Columbia to the new First Nations Health Authority.
Health Canada provides funding to first nations to deliver clinical care in 27 remote and isolated communities, again, outside British Columbia. In an additional 53 remote and isolated first nation communities, Health Canada continues to deliver clinical care. The delivery model varies based on the specifics of each province and geographic conditions. The clinical care teams are located in nursing stations, along with community health workers delivering other programs.
Because of the importance of these services, it is imperative that Health Canada ensure that remote communities have access to clinical and client care, that nursing stations are staffed with registered nurses, and that nurses work in a safe environment, have access to physicians to support them, and have access to tools.
Registered nurses and nurse practitioners are predominantly the first point of contact in isolated communities and are highly educated and qualified individuals. To ensure that our nurses are prepared for the unique demands of working in remote stations, a mandatory training requirement has been defined and is now part of the national education policy.
I can report that we currently have an 88% compliance rate on Health Canada's nursing education model for controlled substances in first nations health facilities, while advanced cardiac life support is at 63%, trauma support is at 59%, pediatric advanced life support is at 64%, and immunization is at 61%. The overall compliance rate is at 46% as of the end of April 2015. We still have work to do, and we are doing it while ensuring that we have resources in place to backfill these important positions while incumbents are in training.
Health Canada is committed to ensuring that nurses working in remote first nations communities meet established public service requirements on top of these workers' already robust credentials.
Remote and isolated practice environments sometimes require nurses to respond immediately to life-threatening or emergency situations. Nurses therefore need appropriate mechanisms to perform these important duties.
Clinical practice guidelines assist nurses to address clinical care situations and provide instruction on whether and when consultation with a physician or a nurse practitioner is required. There are arrangements in place for all nursing stations to access physicians when physicians are not located in the community. We also continue to collaborate on region-specific solutions with provinces to advance access to health services and with regulatory bodies to support nurses practising within their scope of practice.
A key challenge is the need for more nurses. Health Canada has implemented a nurse recruitment and retention strategy, which involves a number of initiatives: a nursing recruitment marketing plan, a nursing development program, a student outreach program, and an onboarding program.
Since its February launch, we have received over 500 nursing applications, with 200 of these moving to the next level of screening. As well, the strategy aims to increase the number of nurse practitioners, which will provide greater stability in the clinical teams, assist in meeting training objectives, and enhance the level of services available at the community level.
Nurses and other community health professionals require facilities to conduct their work. Currently, we invest approximately $30 million annually for repairs, renovation, and construction of health facilities, plus an additional $44 million for maintenance and operations. The nursing stations are owned by first nations communities, and we collaborate with them to support their operation.
We work with first nations communities to ensure buildings are inspected and deficiencies are addressed. In response to the audit, we are implementing a more robust tracking system to capture this work. We will also enhance our process in order to use facility condition reports as a tool to better plan maintenance and renovation work with the owners.
In addition, to ensure new nursing stations are built to code, we have updated our requirements for attestations and have communicated the change to facility management staff. The audit rightly noted that the requirements, such as the station as defined currently, did not provide the necessary level of assurance.
Another area reported on was the management of medical transportation; medical transportation that provides coverage to support access to insured health services. Health Canada spends over $300 million on medical transportation per year, and approximately 60% of that is in remote and isolated communities. The main reasons for transportation are emergencies, at 24%, hospital services, at 10%, appointments with general practitioners, at 7%, and dental services, at 5%.
The program provides coverage for transportation to the nearest appropriate professional or facility that takes place when the needed service is not locally available. Our goal is to provide timely coverage for medical transportation to avoid an undue burden for clients and health care professionals. Decisions are based on a national program framework and are made with a solid understanding of the health services available and the transportation options at the regional level.
In response to the audit observations, the program has already modified and disseminated guidelines to resolve discrepancies observed between our practices and the medical transportation framework in terms of the level of documentation required.
Regarding the transportation of children who are not registered, Health Canada has a long practice of allowing coverage for a child up to one year of age to be covered for medical transportation under the registration number of their parents. Health Canada will continue its efforts with partners to inform parents and make available registration material in nursing stations and health centres.
Health Canada and the Assembly of First Nations are undertaking a joint review of the non-insured health benefits program, of which medical transportation is a component, and I am pleased to report that the work is well under way. It will identify strengths, weaknesses, including inefficiencies in administration, and recommendations for action.
Given that the geographic location, the size of the community, and the need to ensure cultural safety influence the range of programs and services funded or provided by Health Canada, comparing one community to the other is not always possible or the best approach. Community health planning, investing in the integration of services with provincial systems, and the development of community programs and capacity have proven to be more effective and more responsive to community needs over time.
As indicated earlier, Health Canada funds a number of community programs aimed at addressing specific needs and working as a complement to the clinical and client care program. These programs are funded to support community health needs and mostly managed by the communities themselves. In response to the audit, we will improve our support to community health planning to enhance integration of the community-based programs and clinical services where these services are delivered by Health Canada. We will also engage with the communities to review the current service delivery model and clinical care resource allocations.
The last area I would like to discuss is coordination among health system jurisdictions.
We work closely with partners to build health service delivery models that take into account community needs.
We have made significant progress with health service integration over the last 10 years. We see examples in various regions where there are more physicians' visits, provincial services are being extended on reserve, and there are more collaborative arrangements between community health services and regional health authorities. Co-management and trilateral tables exist in most regions to formally engage with provincial and first nations partners to advance common practices and resolve systemic issues. We will formally engage these tables in order to make progress on the important issues raised in the report.
Health Canada will continue to collaborate with our partners to develop and implement other models of first nations-led health systems across the country, as we have celebrated in B.C. We have presented an overview of our action plan, which requires further engagement and collaboration with first nation partners. We believe the next update will be more comprehensive as it will benefit from our partners' input.
In closing, we are working on a number of actions in response to the audit, and we will continue to do so.
I would note that I am accompanied today by three senior officials from Health Canada's first nations and Inuit health branch: Valerie Gideon, assistant deputy minister, regional operations; Robin Buckland, executive director, office of primary health care; and Scott Doidge, acting director general, non-insured health benefits.
We would be pleased to answer your questions. Thank you.
Robin Buckland
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Robin Buckland
2015-06-01 16:04
Thanks, Sony.
I am a registered nurse, and I have been for the last 27 years. To become a registered nurse, you have to complete a nursing program. In the vast majority of the country, it's at the baccalaureate level; you have to have a degree in nursing. In Quebec, the entry to practise is actually a diploma, so you can obtain a nursing diploma from the CEGEP in Quebec. Basically, through nursing school, you obtain the core competencies that are required to function as a registered nurse.
Generally speaking, nurses come out of nursing school and they are generalists. They're able to practise in a wide variety of areas.
In remote and isolated locations, there are additional competencies that are required. As the report indicated, they are often the only provider in the community and they are the first point of contact for the patient. They need to be able to respond to what comes in the door. If it's an emergency, a trauma, they need to have the competencies to deal with it. That is why Health Canada has identified advanced cardiac life support, pediatric life support, trauma, and the other courses you'd see listed as our five courses. Those are the key competencies that RNs will require to meet the needs of the community, in addition to so much more.
Valerie Gideon
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Valerie Gideon
2015-06-01 16:27
Very quickly, we have a trilateral table in Ontario with the Ontario Ministry of Health and Long-Term Care. We also have a specific northern table that the northern first nations have asked for, and in that table, which has just started this year, we do anticipate that we're going to be talking quite a bit about clinical and client care and medical transportation and engaging them in terms of our follow-up actions on that plan.
In Manitoba, we've had a committee for several years that was at a more junior officials level. We've now bumped it up to an assistant deputy minister level, with the Province of Manitoba, the Grand Chief of the Assembly of Manitoba Chiefs, and me. As well, we will be using that table to engage first nations in Manitoba with respect to our actions on this report to ensure that we're also monitoring progress and partnership of first nations.
Those are just two examples that are more relevant to this audit, but there are many more across the country. We also have national partnership agreements with the Assembly of First Nations and the Inuit Tapiriit Kanatami, which we signed this year.
Sony Perron
View Sony Perron Profile
Sony Perron
2015-05-12 15:38
Thank you, Mr. Chair, for the opportunity to provide an overview of the programs and services supported by Health Canada in the area of mental health and wellness for first nations and the Inuit.
Health Canada recognizes that addressing mental health and addictions issues are important health priorities for First Nations and Inuit. Consequently, the department is investing more than $300 million this year on a suite of mental wellness programs and services.
Programming includes mental health promotion, addictions and suicide prevention, other crisis response services, treatment and after-care services, and supports to eligible former students of Indian residential schools and their families.
Health Canada is working with partners so that efforts to support individuals, families and communities around mental health care are coordinated and include family support, employment and training, education and social services.
Building on best practices, we know that efforts to support individuals, families and communities should be culturally safe and community-driven. We can find lasting solutions only if we work together with our partners, including First Nations and Inuit organizations and, most importantly, the communities themselves.
Mental health promotion and suicide prevention research emphasizes the need for comprehensive and multi-layered interventions across a continuum of wellness. Interventions at each of the individual, family, and community, and federal, provincial, and territorial levels have been found to be most effective.
We have worked with the Assembly of First Nations and mental wellness leaders to develop the first nations mental wellness continuum framework. Through this process, communities were engaged and brought their ideas to the table.
From these discussions, culture emerged as a foundational component. Community innovation, partnerships across government, collaboration and coordination across sectors, and linkages between programs and services were also identified as being crucial for moving forward.
This framework has been ratified by the Assembly of First Nations' chiefs of assembly and was released by the AFN in January 2015. We are now working with the Inuit Tapiriit Kanatami to develop a mental wellness continuum for the Inuit.
Health Canada is a partner in implementing the first nations mental wellness continuum framework, which calls for integrated models of service delivery that focus on community strengths and indigenous knowledge.
Moving forward, we will look at ways to strengthen the federal mental wellness programming with our partners to meet community-specific needs, such as moving away from siloed program approaches toward more coordinated and effective approaches, and through closer integration between federal, provincial, and territorial programs.
We are also supporting mental wellness teams, which provide specialized treatment to a group of First Nations communities facing mental health issues. These teams seek to increase access to a range of mental wellness services including outreach, assessment, treatment, counselling, case management, referral and aftercare.
Through the National Aboriginal Youth Suicide Prevention Strategy we support screening for depression in schools; education and training for front-line workers to reduce stigma and increase community awareness; referral and intervention training; crisis services; follow-up and support for at-risk youth; and cultural and traditional activities to promote protective factors and to reduce risk factors.
Since 2008, we have supported a range of services to former students of Indian residential school and their families so they may safely address emotional health and wellness issues related to the disclosure of childhood abuse. For example, in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students and their families, and 47,000 professional mental health counselling sessions.
On February 20, 2015, Minister Ambrose announced an investment to prevent, detect, and combat family violence and child abuse. Health Canada's investment will support enhanced access to mental health counselling for first nations victims of violence who are in contact with shelters, and will support the improvement of services to first nations and Inuit victims of violence so that services are better coordinated, more trauma informed, and culturally appropriate.
Thank you for your attention. I am pleased to take your questions afterward.
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.
View Murray Rankin Profile
View Murray Rankin Profile
2015-05-07 15:46
I appreciate that.
As you speak of transparency, that takes me to Vanessa's Law, to which you made reference earlier.
Toronto doctor, Nav Persaud, made an information request to Health Canada to get clinical trials on a pregnancy drug, an anti-nausea drug called Diclectin. He tried that three and a half years ago. He finally got 359 pages, 212 of which were completely redacted or censored.
In March, after Vanessa's Law came in, he resubmitted the request for all of the 359 pages, and so far has been given nothing. I got that as recently as two days ago in a letter. The clinical trial data was something that was to be made available, as I understood it, under Vanessa's Law. His experience has been entirely frustrating.
View Rona Ambrose Profile
I sympathize with his experience.
Under Vanessa's Law, the intention is to make clinical trial information available, but still to some extent—and for legal reasons obviously—protect confidential business information. Our intention under Vanessa's Law—and it's my belief—is that we should be sharing as much as we possibly can.
On that specific one, I think that's still under way, but I know Simon is working on that.
Simon Kennedy
View Simon Kennedy Profile
Simon Kennedy
2015-05-07 15:48
Thanks, Minister.
On this particular case, the original submission was made under the access to information rules. The ministry is obliged to apply the access law, which does require a number of exemptions for business information and so on.
With new authorities under Vanessa's Law, there is this other avenue we can use to make information available where there is a health or safety threat. We've spoken to the researcher in question, and we sent him a fairly detailed letter to explain the process to make an application under Vanessa's Law. That conversation is going on and our hope would be to be able to move through that avenue to deal with the issue.
View David Wilks Profile
Thanks, Chair.
I just have a couple of questions both related to the same topic, one for Health Canada officials and then one to CIHR. They both are with regard to electronic cigarettes. As you know, this committee carried out a study of electronic cigarettes and made a number of recommendations on which the minister is moving forward, including that the Government of Canada establish a new legislative framework for regulating electronic cigarettes and related devices.
Has any of the $26.5 million in planned spending for the tobacco program been identified for developing a legislative framework toward this initiative?
Simon Kennedy
View Simon Kennedy Profile
Simon Kennedy
2015-05-07 17:06
Mr. Chair, on the issue of electronic cigarettes, this is something the department is looking at quite carefully. We're grateful actually for the work of the committee and all of the consultations that were done and the recommendations. We've been examining those quite carefully.
At this point I would say we have not dedicated specific funds to that work because we have policy staff, and analysts and so on, who are busy doing that work, but there hasn't been a necessity of, for example, hiring additional staff or setting up a dedicated office. We have specialists who look at these kinds of issues all the time who are actually doing that work.
Depending on the ultimate decision of the government in terms of how to move forward on this, it's entirely possible we would need to make budget decisions to reallocate resources. But when it comes to the policy development work, and the assessment of the work of this committee, and to develop a government response, that doesn't require the movement of money budgetarily. We're able to handle that within our existing resources.
Simon Kennedy
View Simon Kennedy Profile
Simon Kennedy
2015-05-07 17:07
I want to assure the member there's a lot of work going on to come back with a response.
View Colin Carrie Profile
View Colin Carrie Profile
2015-05-07 17:17
Thank you very much.
I'd like to split my time with Mr. Young. First, I wanted to express my appreciation to Health Canada for all the work you've done over the years for natural health products and the world-class regulatory system.
As you may know, I still work as the minister's...part of the committee for traditional Chinese medicine. With many more Canadians today coming from Asia, looking to have the traditional Chinese medicines they're used to taking, could you explain the work you're doing with traditional Chinese medicine? What approach are you taking with traditional Chinese medicine and what kinds of innovations are you working with to make these products available to Canadians?
Paul Glover
View Paul Glover Profile
Paul Glover
2015-05-07 17:18
Thank you for the member's question.
It is absolutely correct that, increasingly, Canadians are turning to alternatives like traditional Chinese medicine. There are a number of steps the department is taking. First and foremost among them is that, under the leadership of the minister and others, an advisory committee provides advice to the department on an ongoing basis with respect to the regulation of traditional Chinese medicines, the challenges the community has faced in terms of bringing these products into the country, the practice of traditional Chinese medicine, some of the issues related to that, claims around the products, and all of those sorts of things.
We've been working closely with the Chinese government. It has been very generous in providing traditional pharmacopoeias about the different herbs and substances, and how they have traditionally been used in China, to make sure that practitioners making claims about those herbs are in line with their historic use and use patterns so there is an alignment between what is happening in this country, where these herbs come from—the medicines—and how they have long been used. Those are some examples of the range of things we are doing to work closely with that community to make sure that they understand their obligations when bringing these medicines and herbs into the country. We have a quick and efficient way to understand what it is they're proposing and see if that aligns with the traditional uses from their origins.
View Ben Lobb Profile
View Ben Lobb Profile
2015-05-07 17:23
Thank you very much.
This is going to conclude the question and answer portion of our meeting. We have one final task that we need to do. We have to vote on the main estimates. We've received unanimous consent among the three parties. What we're going to be able to do is lump our questions all together in one, and that will save us a little time.
Shall votes 1 and 5 under the Canadian Food Inspection Agency, votes 1 and 5 under the Canadian Institutes of Health Research, votes 1, 5, and 10 under Health, and vote 1 under the Patented Medicine Prices Review Board, less the amount approved in interim supply carry?
Mr. Murray Rankin: Is this a recorded vote?
The Chair: Yes, it's recorded.
Vote 1—Operating expenditures and contributions..........$537,749,431
Vote 5—Capital expenditures..........$25,783,194
(Votes 1 and 5 agreed to: yeas 5; nays 4)
Vote 1—Operating expenditures..........$47,463,563
Vote 5—The grants listed in the Estimates..........$955,287,128
(Votes 1 and 5 agreed to: yeas 5; nays 4)
Vote 1—Operating expenditures..........$1,777,987,439
Vote 5—Capital expenditures..........$28,035,364
Vote 10—The grants listed in the Estimates and contributions..........$1,678,425,178
(Votes 1, 5, and 10 agreed to: yeas 5; nays 4)
Vote 1—Program expenditures..........$9,947,595
(Vote 1 agreed to: yeas 5; nays 4)
View Stéphane Dion Profile
Lib. (QC)
Okay. Thank you.
Madam Cornell, in recommendation number 4 you state the following:
That the federal government recognize those dance organizations working to improve Canadians’ health and well-being by providing access to federal funding at agencies such as Health Canada and Industry Canada.
What do you have in mind here?
Kate Cornell
View Kate Cornell Profile
Kate Cornell
2015-05-04 17:19
There are many dance organizations that are working in schools across Canada, helping those teachers who are afraid to teach dance, to have the benefit of a professional artist in the schools to give them exposure to professional dance. Those dance organizations are helping to keep Canadians healthy.
Because education obviously is a provincial concern, currently these programs come under operating funding from the Canada Council, and possibly from the Department of Canadian Heritage. There is no special funding directed toward these programs.
I can't help but notice that at Industry Canada they have in their Canada 150 program a pillar that is culture, and yet several—I believe that most of their programs are not-for-profits—aren't actually eligible to apply for those programs. It may be examining that.
I'm certainly not an expert in health. But I also wonder, in terms of the incredible benefits Mr. Dalrymple was speaking about with the Sharing Dance program, getting a million Canadians dancing, if there could possibly be some funding there to recognize the health value of dance and the work that's going on at these important dance organizations.
Frank Clegg
View Frank Clegg Profile
Frank Clegg
2015-04-23 15:45
Mr. Chair and committee members, I'd like to thank you for the invitation to speak with you this afternoon and for deciding to invest committee time on Safety Code 6.
When I ran the Canadian operations for Microsoft, I learned that it is critical to focus on process. Today, as a board member for Indigo Books and Music, my role has shifted more towards governance and oversight. In both roles, process is critical to success. Government is the largest corporation of all, so process is of paramount importance. As someone who regularly examines success and failure, I believe I can explain why the Safety Code 6 process is a failure by all metrics and has left Canadians unprotected.
There is a book written by Nassim Taleb called The Black Swan, a focus on very low-probability, high-impact events that aren't supposed to happen. Oil spills, train derailments, and airplane crashes are some of the events in this category. Taleb calls these “black swan” events.
If one decides that all swans are white and refuses evidence of black swans, then one will conclude that all swans are white. Black swans are rare, but they do exist. Unfortunately, experts convinced themselves that these events had zero probability. They did not plan appropriately and people died.
The American Academy of Environmental Medicine is an international organization of physicians and scientists that has predicted, among other things, the rise in multiple chemical sensitivity, which is now protected in many public policies. Regarding the unprecedented increase in wireless devices, the academy forecasts “a widespread public health hazard that the medical system is not yet prepared to address”.
I believe Health Canada's analysis focuses on identifying and counting white swans, while ignoring black swan evidence. Health Canada's representative informed this committee on March 24:
...some of these studies report biological or adverse health effects of RF fields at levels below the limits in Safety Code 6, I want to emphasize that these studies are in the minority and they do not represent the prevailing line of scientific evidence in this area.
In other words, black swans exist.
In your handout—I don't know if you have it, as we put it in for translation—is a document entitled “Analysis of 140 Studies Submitted by Canadians for Safe Technology (C4ST) During the Public Comment Period on Safety Code 6”. A chart in that document shows that Health Canada accepts that there are in fact 36 studies all passing Health Canada's quality criteria showing harm at levels below Safety Code 6.
As a Canadian, I find this confusing. As an executive, I find it inexcusable.
Of the 36 studies Health Canada deemed satisfactory, cancer is linked in six of them. In 13 of them, the brain and/or nervous system is disrupted. In 16 studies, Health Canada admits that biochemical disruption occurs. Finally, seven high-level scientific studies indicate an effect on intellectual development and/or learning behaviour. All of these studies show impacts with radiation below Safety Code 6 limits. How was this black swan evidence evaluated?
In our two-year investigation, C4ST has determined that Health Canada doesn't even have the proper software required to access, summarize, and analyze the large number of relevant studies. If our group of learned and qualified volunteers can uncover 140 studies, how many more are being missed or ignored?
Health Canada references its weight-of-evidence approach. It is unclear how many studies you need to outweigh 36 studies that show harm, especially to children. I just can't fathom why Health Canada is not highlighting these studies and prioritizing their implications. Despite requests to publish the weight-of-evidence criteria as per international standards, Health Canada refuses to do so. Even the recent 2015 rationale document does not provide this critical information.
Health Canada dismisses scientific evidence unless it shows harm where the microwave levels are strong enough to heat your skin. The notion that microwaves are not harmful unless they heat your skin is decades out of date. The core premise of this white swan dates back to Einstein's theory that non-ionizing radiation cannot cause harm, or if it does, it must heat tissue to do that. Albert Einstein passed away the same year Steve Jobs was born. To think that science has not evolved since then is classic white swan thinking. It's part of a process predetermined to fail.
Health Canada says on its website today that there is no chance that Wi-Fi or cellphones can harm you because it has studied all the science, but when pressed under oath, Health Canada officials give a more fulsome answer. In Quebec Superior Court in September 2013, Health Canada senior scientist James McNamee admitted that Health Canada only assesses risk based on the thermal effect, i.e., the heating of tissue.
Unfortunately, Canada has not invested the necessary time nor had the balanced opinion of experts necessary to undertake a proper review. Our research has uncovered that the Health Canada author of Safety Code 6 has published papers demonstrating his bias towards this topic.
In a few hours over three days, this health committee has spent more time speaking with scientific experts who believe there is harm from wireless radiation below Safety Code 6 than all of Health Canada combined. You can't find black swans when you don't talk to the experts who've identified them.
There is a fundamental business rule: you can't manage what you don't measure. It is clear that Health Canada not only doesn't follow that rule but even resists it. A memo obtained under access to information to the Minister of Health in March of 2012 revealed that Health Canada “does not support the recommendation to establish an adverse reaction reporting process specifically for RF exposures”. The memo goes on to state that “consumer complaints...may be directed to...the web-based system...under the...Canada Consumer Product Safety Act”. This is an inadequate solution and, I believe, a missed opportunity.
I refer you to the C4ST fact sheet. I think you have it. I'd like to highlight three examples from that fact sheet: Health Canada's Safety Code 6 is among the countries with the worst guidelines in the world; Canada has fallen behind countries such as France, Taiwan, and Belgium in protecting Canadians; and finally, Health Canada wasted over $100,000 of taxpayers' money, as the Royal Society report is not an independent review.
Health Canada also states that Safety Code 6 is a guideline and that other organizations at the provincial and local levels of government are free to implement lower levels as they see fit; however, that's not the reality of what happens. We have witnessed school boards, power and water utilities, Industry Canada, and manufacturers depending on Health Canada's analysis, and frankly, abdicating to it. They don't perform their own analysis.
Safer solutions exist. There are several situations in Canada regarding cell towers where the proponents have voluntarily offered to restrict radiation exposure, in some cases to thousands of times less than Safety Code 6. There is a solution in Iowa for smart meters that use a wired meter that provides a safer, more secure solution at a lower cost.
Given that our track record in North America is not successful regarding such products as tobacco, asbestos, BPA, thalidomide, DDT, urea-formaldahyde insulation, and many others, use of the precautionary principle of prudent avoidance should be recommended until the science proves beyond reasonable doubt that there is no potential for harm.
For the last three years, science has published a new study every month that shows irreparable harm at levels below Safety Code 6. That is why we're asking the committee to take three decisive steps.
First, conduct a national campaign to educate Canadians about methods to minimize exposure to RF radiation, ban Wi-Fi in day care centres and preschools, and ban the marketing of wireless devices to children.
Second, protect individuals who are sensitive to RF radiation by accommodating them with safer levels of wireless exposure in federal workplaces and federal areas of responsibility.
Third, and finally, create an adverse reporting system for Canadians and a publicly available database to collect improved data regarding potential links between health effects and exposure to RF radiation.
Parallel to the above, recommend that Health Canada conduct a comprehensive systematic review, subject to international standards, regarding the potential harmfulness of RF radiation to human health, with a scientific review panel that is balanced in opinion. It was a textbook case of black swan thinking that has led to this failure of Safety Code 6.
In conclusion, C4ST volunteers found 36 black swans that Health Canada agrees are high quality. How many would be available if Health Canada sincerely looked? Better yet, how many black swans will it take before Health Canada takes serious actions? Thank you very much.
View Christine Moore Profile
We know that provincial health care is paying more and more for infertility treatments. Should we, in your opinion, pay particular attention to this issue if we want to avoid getting an enormous bill later? Often, people try to have a child for a long time before realizing that they have these problems. If someone has been carrying a cell phone in his pocket for 20 years, then it may be difficult to help with related issues later. Should this be of particular concern to us, in your opinion?
Frank Clegg
View Frank Clegg Profile
Frank Clegg
2015-04-23 16:14
One of our recommendations is for Health Canada to raise an awareness campaign. Part of that awareness campaign should be telling young men to keep the phone out of their pants' pockets, because that's where men keep their phones. Young men keep their phones in their pockets. That's why we were calling for a recommendation to have Health Canada educate people to be aware that there is a potential risk and prevent it.
View David Wilks Profile
Thanks, Chair.
Thank you to the witnesses for being here. I'll share my time with Mr. Richards, because he has to leave here after the first hour, I believe.
You perked my interest when you said police officers and radar because I did that for a year and a half.
Professor Miller, you mentioned in your opening remarks that an opportunity to provide greater safety to the public has been missed. You did explain a bit about it, but I wonder if you could articulate a little more on what we've missed and what we could move forward with in respect to recommendations to Health Canada and to the minister.
Anthony Miller
View Anthony Miller Profile
Anthony Miller
2015-04-23 16:15
When I think about Health Canada, I'm not saying this committee has missed. What Health Canada has missed is a proper scientific review of the data that would convince them—and I don't understand why they haven't been convinced—that the limits they have placed in their advisory limits are not sufficiently safe to protect the population. That's why I believe an opportunity to protect the population, and potentially to prevent a major cancer problem in the future, has been missed by Health Canada.
View Hedy Fry Profile
Lib. (BC)
This is like déjà vu. I think you asked a very important question, Dr. Havas. I don't understand. Inherent, for instance, in the medical ethos is to first do no harm, so the primary thing for a physician is the precautionary principle unless you see that the benefits outweigh the risks and you are prepared to do some harm in order to divert worse harm.
I've been listening to this so I called up my son and my daughter-in-law and I said, “Hey, you guys have a wireless baby monitor on my granddaughter's crib. I'm hearing this stuff and I think maybe you should take precautions and get a plug-in monitor or find a way to turn it on only when you need to”.
They said to me, “Oh, for God's sake, that is such a bunch of hokey stuff. The guidelines are clear, blah, blah, blah”, and of course I was almost accused of crying wolf.
If I couldn't convince my children that this is not reasonable and fair.... I think you said that it was 50 years before we got anybody to understand, in spite of evidence, that cigarettes caused cancer; and in the case of acid rain, it was 20 years. Surely to goodness we have learned by now that we shouldn't be taking that long. We need to see the harm that not acting on evidence sooner does.
Given that those blocking this the most are in industry themselves, and the fact that, let's be honest, governments have to balance economic growth and development and progress against harm to the greater good, and given that there is almost this conflict of interest between how governments currently operate and how governments could operate to protect people, how can we convince the public, which is completely addicted to Wi-Fi and to wireless devices, when they don't know anything else?
I'm addicted. I can't put away my stupid BlackBerry, so how do we convince people, because public awareness, obviously, as Frank said, must be a part of the recommendations? How do you put forward a public awareness program that will actually reach people and sink in without people saying, “Oh my God, everybody is being so hysterical about this”?
Frank Clegg
View Frank Clegg Profile
Frank Clegg
2015-04-23 16:25
I would make two comments, Dr. Fry.
I would say that people are smart, and when they have the right information, they act appropriately and they act responsibly, particularly parents with newborns.
What I've heard though, hundreds of times now, is that it must be okay if Health Canada says it's safe. They don't understand that it takes time for this information to be digested. As Dr. Miller said, we are befuddled as to why Health Canada isn't being more active. If the health authority in Canada, which is Health Canada, came out with very clear statements that said there is proof that there could be harm, so we should be careful and take a precautionary approach, I think you would see the majority of Canadians change what they do.
You also made a comment about industry. I have spent my life in industry. We go out and work hard to provide technology that is cheaper, faster, better. That's the way we work.
View Hedy Fry Profile
Lib. (BC)
I do think, however, there's this inherent conflict and problem because Industry Canada should be looking at how we can make sure that industry is progressive, is functioning, and we have economic development going on in the country. But that is not Health Canada's mandate.
View Hedy Fry Profile
Lib. (BC)
Health Canada's mandate is very clear. It is supposed to protect the health and safety of Canadians.
Frank Clegg
View Frank Clegg Profile
Frank Clegg
2015-04-23 16:28
View Hedy Fry Profile
Lib. (BC)
Surely to goodness I think we in this committee here, having heard the things we heard, and having learned—because I'm long in the tooth—from the things we had been fighting against, for such a long time, that cause great harm and eventually everyone.... Now we have seatbelts in legislation, and all of those kinds of things that protect people. It was a long fight.
For me, the idea that we should let Health Canada believe that it has to be true to its own mandate, which is the protection of Canadians, should be the overriding concern of this committee. I can tell you now it's something that I've taken seriously and it's something I'm going to do something about. I've lived through this stuff, as a physician and in all of my years as an environmental advocate, etc., and we have to do better than we currently do now.
I want to thank you for your presentation, actually, because it's clear and it's scientifically based. The evidence you talked about is something that we need to call for, which is a new review. Given that other countries have set the tone, France and Israel, and other countries, I think this committee should hear you very clearly. I know some of us are.
View Cathy McLeod Profile
Thank you.
I'd like to thank the witnesses for their presentations.
Certainly, as I mentioned before, I was on the committee that originally set that process in place in terms of the work done by the Royal Society. Certainly the intention of the committee was to have something that was very solid in terms of its response to that issue.
I understand Canada is also currently very active with the WHO in terms of a massive undertaking. Is maybe that the better place to be really looking at the scientific reviews around this issue?
Could someone speak to the WHO process? It seems sometimes like we have all these different countries that spend a lot of time, money, and energy, and keep reinventing the wheel. What about this international collaboration piece and is that the better mechanism?
Frank Clegg
View Frank Clegg Profile
Frank Clegg
2015-04-23 16:31
I would also add, Ms. McLeod, that as a Canadian I am proud that we're leading the world on some things, like acid rain. I don't want to wait for an international consensus to act. I would be afraid to death that my future grandchildren would have to wait for the WHO to lead what I think is clear evidence today that Health Canada has the mandate, the authority, and the resources to lead the world, or be among the leaders, in fact, not even lead the world, but catch up to some countries. I would really resist relying on a WHO process.
When they did the IARC committee—and you'll hear from the next speaker, that the IARC committee, and Dr. Miller wrote the paper on the cancer section—you had a full body of scientists who had contrarian opinions. That's what I have learned over the last several years now is where good science happens. You have two sides of the debate and they get in a room and debate, as they did in 2011 when they debated among 30 scientists around the world. The WHO committee is not made up of a balance of scientists with opposing views.
Dariusz Leszczynski
View Dariusz Leszczynski Profile
Dariusz Leszczynski
2015-04-23 16:41
Thank you very much.
Thank you for inviting me to this hearing. It's an honour and a pleasure.
My name is Dariusz Leszczynski. I'm currently adjunct professor for biochemistry at the University of Helsinki, in Finland. I have done research in the area of biological and health effects of cellphone-emitted radiation since 1997. I was a member of the expert group of IARC, which in 2011 classified cellphone radiation as a possible human carcinogen.
When scientific evidence is unclear, contradictory, or ambivalent, careful and unbiased interpretation of it is of paramount importance. However, it is often the case that such scientific evidence gives room for a diverse interpretation that may lead to the development of contradictory expert opinions, causing confusion and impairing development of rational recommendations aimed at protecting the general population.
This is the current situation in the area of cellphone- and wireless communication-emitted radiation. Unclear experimental evidence leads to the polarization of the scientific opinions into two extremes: the no-effect opinion and the harmful-effect opinion. Currently scientists do not agree on the matter of biological and health effects of radiation exposures. The term “consensus” might be be misleading for the general public. We should rather speak about “differences in scientific opinion”.
A recent comment by the head of the World Health Organization's EMF project, Dr. Emilie van Deventer, well describes the current situation, and I will quote her comment given for The Daily Princetonian, “There is no consensus, it’s true. There’s a big group and a little group, but it’s still two groups.”
Talking about a big and a small group is a pure speculation because the size of the groups was never examined. From my nearly 19 years of experience in this area of research, I know that the vast majority of the scientists do not openly take a side in the debate.
The interpretation of scientific evidence by committee is of most use for the decision-makers. This is the reason that the development of unbiased opinions by committees are of paramount importance. Opinions of committees are defined by the expert composition. In an ideal committee, experts would not have conflict-of-interest issues and would be independent of any kind of lobbying; only science would matter. Nearly all of the committees dealing with the health effects of radiation emitted by wireless communication devices have a problem of biased expert selection, a potential conflict of interest, and a potential influence by an industrial lobby, which may occur in spite of set-up firewalls.
The majority of the committees consist of scientists having the same expert opinion. Individual committees experts commonly do not reflect all current scientific opinions. This concerns both international committees and national committees. This includes the committee in Canada that provided evidence for Safety Code 6. The composition of the Health Canada expert committee was clearly biased towards the no-effect opinion, and some of the experts are known to advise the telecom industry. This is a serious potential conflict of interest.
The above-mentioned system of firewalls to protect experts from influence of industry doesn't work. Industry sponsors know who receives funding; sponsored scientists know who provides funding. This is especially worrisome when the influential ICNIRP committee is in part funded by the industry through firewalls of the Royal Adelaide Hospital in Australia. The same goes for the EMF project of the WHO. If your experts know very well that the opinions of ICNIRP will be unfavourable for the telecom industry, their sponsorship may end. The firewall is only a gimmick.
Currently, WHO's EMF project is preparing an evaluation of the scientific evidence concerning health effects of radiation emitted by wireless communication devices, the so-called environmental health criteria for RF-EMF. The major problem with the draft document of environmental health criteria is the lack of balanced presentation of the scientific evidence. The environmental health criteria draft was written solely by scientists with a no-effect opinion.
The environmental health criteria document will have a global impact on billions of users of wireless technology and on the multi-trillion dollar business. This is why it is disturbing that preparation of such a document is solely reflecting opinions of ICNIRP, an organization with a firm, single-sided, no-effect opinion. This is a disturbing situation, where one group of scientists was given preferential treatment only because of their close link with the WHO and where other relevant expert opinions were deliberately and arbitrarily excluded without scientific debate.
Recommendations for decision-makers developed by committees, where memberships are consistently biased towards either a no-effect opinion or harmful effect opinion, are not representative of the whole currently available scientific evidence and should be viewed with extreme caution, or outright dismissed, until the proper, unbiased evaluation takes place.
To my knowledge there was only one scientific committee—IARC's working expert group in 2011, of which I was a member—where the full scope of diverse scientific opinions were represented. IARC classification completely disagreed with one-sided opinions of the majority of international and national committees, including Health Canada. Until an unbiased, round table of scientific debate takes place, where all scientific opinions will be duly represented and evaluated, the opinions developed to date by various international and national committees, based on biased expert selections, should be dismissed by decision-makers as insufficient.
According to year 2000 documents of the European Union on the precautionary principle, there are three criteria that need to be fulfilled in order to implement the precautionary principle. All of them are currently fulfilled.
Number one, scientific information is insufficient, inconclusive, or uncertain to make a firm decision. This is exactly what the IARC classification says on cellphone radiation as a possible human carcinogen, group 2B.
Number two, there are indications that the possible effects to human health may be potentially dangerous. Increased risk of brain cancer in long-term, avid users is a dangerous outcome, shown by three replicated epidemiological studies: European INTERPHONE, Swedish Hardell group, and French CERENAT studies.
Number three, the effects are inconsistent with the chosen level of protection. Epidemiological studies showing an increased risk in long-term, avid users were generated in populations using regular cellphones meeting all current safety standards. This means that the current safety standards are insufficient to protect users because the risk of developing cancer increases in long-term, avid users.
Proponents of the precautionary principle need to understand that precaution does not equal prevention of use of wireless technology. Requirements to develop more efficient, less radiation-emitting technology, and further biomedical research on the radiation effects, will create new knowledge through research and will create jobs in the research and technology. Implementation of the precautionary principle will not prevent technological developments. Claims by some that the implementation of the precautionary principle will cause economic stagnation are unfounded.
In the current situation of inadequate review of scientific evidence by groups of scientists with biased selection of members, and until the round table, unbiased review is performed, decision-makers should implement the precautionary principle. The reason is not that the harm was proven beyond doubt, but because the harm is possible and evidence is uncertain and suggesting that harmful health effects are possible. The precautionary principle was developed just for such situations where scientific uncertainty with concomitant indications of possible harm requires society to wait for more scientific evidence. Saying, “Better to be safe than sorry” applies here.
Thank you.
Andrew Adams
View Andrew Adams Profile
Andrew Adams
2015-03-24 15:32
Thank you very much. I have some opening remarks to make.
Chairman and members of the committee, it is my pleasure to be here today to speak on Health Canada Safety Code 6. My name is Andrew Adams, and I am the director of the environmental and radiation health sciences directorate in the healthy environments and consumer safety branch of Health Canada. I am joined today by Dr. James McNamee, the chief of the health effects and assessments division in the consumer and clinical radiation protection bureau and the lead author of Safety Code 6.
Safety Code 6 is Health Canada's guideline for exposure to radio frequency, or RF, electromagnetic energy, the kind of energy given off by cellphones and Wi-Fi, as well as broadcasting and cellphone towers. Safety Code 6 provides human exposure limits in the 3 kilohertz to 300 gigahertz frequency range, and we have provided chart A of the electromagnetic spectrum, just so committee members can situate the frequency range we're talking about.
But Safety Code 6 does not cover exposure to electromagnetic energy in the optical or ionizing radiation portions of the electromagnetic spectrum. Safety Code 6 establishes limits for safe human exposure to RF energy. These limits incorporate large safety margins to protect the health and safety of all Canadians, including those who work near RF sources.
While Safety Code 6 recommends limits for safe human exposure, Health Canada does not regulate the general public's exposure to electromagnetic RF energy.
Industry Canada is the regulator of radiocommunication and broadcasting installations and apparatus in Canada. To ensure that public exposures fall within acceptable guidelines, Industry Canada has developed regulatory standards that require compliance with the human exposure limits outlined in Safety Code 6.
I'd like to talk a little bit about the approach for updates to Safety Code 6. Safety Code 6 is reviewed on a regular basis to verify that the guideline provides protection against all known potentially harmful health effects and that it takes into account recent scientific data from studies carried out worldwide. The most recent update to Safety Code 6 was completed earlier this month. I will describe the process used for that update later in my remarks.
When developing the exposure limits in the revised Safety Code 6, departmental scientists considered all peer-reviewed scientific studies, including those pertaining to both thermal and non-thermal, and employed a weight-of-evidence approach when evaluating possible health risks from exposure to RF energy.
The weight-of-evidence approach takes into account both the quantity of studies on a particular end point and the quality of those studies. Poorly conducted studies receive relatively little weight, while properly conducted studies receive more weight.
Now I'll focus on the recent update of Safety Code 6.
The most recent update to Safety Code 6 was initiated in 2012, with the goal of ensuring that the most up-to-date and credible scientific studies on the potential effects of RF energy on human health were reflected in the code.
Health Canada proposed changes to Safety Code 6 that were based on the latest available scientific evidence, including improved modelling of the interaction of RF fields with the human body, and alignment with exposure limits specified by the International Commission on Non-Ionizing Radiation Protection. These changes were proposed to ensure that wide safety margins were maintained to protect the health and safety of all Canadians, including infants and children.
Some of you may recall that this committee previously conducted a study on the potential health impacts of RF electromagnetic radiation. Among the recommendations included in the committee's December 2010 report was a recommendation that:
Health Canada request that the Council of Canadian Academies or another appropriate independent institution conduct an assessment of the Canadian and international scientific literature regarding the potential health impacts of short and long-term exposure to radiofrequency electromagnetic radiation....
ln response to this recommendation, in 2013, Health Canada contracted the Royal Society of Canada to review the results of emerging research relating to the safety of RF energy on human health, to ensure it was appropriately reflected in the revised Safety Code, through a formalized expert panel process.
I'm sure you know that today we're joined by the chair of the expert panel and one of the members of the expert panel.
The Expert Panel of the Royal Society released their review in March 2014, concluding that in the view of the panel there are no established adverse health effects at exposure levels below the proposed limits.
Among the recommendations made by the expert panel was the suggestion that the proposed reference levels in the draft Safety Code 6 be made slightly more restrictive in some frequency ranges to ensure larger safety margins for all Canadians, including newborn infants and children.
ln the interest of openness and transparency, Health Canada also undertook a 60-day public consultation period for the proposed revisions to Safety Code 6 between May and July 2014. The department invited feedback from interested Canadians and stakeholders.
Comments related to the scientific and technical aspects of Safety Code 6 received by Health Canada during the public consultation period, as well as the recommendations provided by the Royal Society Expert Panel, were taken into consideration when finalizing the revised guideline.
The final version of Safety Code 6 was published on March 13, 2015. Health Canada also published a summary of the feedback received during the public consultation period. Given the scientific basis of the guideline, only feedback of a technical or scientific nature could be considered in the finalization of Safety Code 6; however, the summary of consultation feedback responds to both technical and non-technical comments received from Canadians.
With the recent update, Canadians should be confident that the radiofrequency exposure limits in Safety Code 6 are now among the most stringent science-based limits in the world.
To shift a little bit and talk about the scientific methodology that underlies the revision of Safety Code 6, a large number of submissions received during the public consultation period raised concerns that Health Canada had not considered all of the relevant scientific literature when updating Safety Code 6. ln particular, it has been stated that 140 studies were ignored. I would like to address that criticism here today.
ln updating Safety Code 6, Health Canada made use of existing internationally recognized reviews of the literature along with its own expert review of the relevant scientific literature. Numerous reviews on this issue have been written in recent years by international organizations such as the World Health Organization, the European Commission's Scientific Committee on Emerging Newly identified Health Risks, and ICNIRP. I believe we have provided links to some of these reports for the committee's interest.
While Safety Code 6 references these international reviews, the code is an exposure guideline, not a scientific review article. Accordingly, most individual scientific studies are not referenced in the code. However, this does not mean that Health Canada did not consider all relevant scientific information when deriving the science-based exposure limits in the code. I can assure you we did.
lt should be noted that studies with inappropriate study design or methodology can lead to erroneous results that are scientifically meaningless.
Studies were considered not to be of sufficient quality to inform the recent update if it was not possible to determine the dosage studied, if the study lacked an appropriate control, if experiments within the study were not repeated a sufficient number of times, if no statistical analysis of the results was conducted, or if other improper scientific techniques were used. Of the 140 studies that have been cited, a large number fall into this category.
Other studies were not considered to be within scope. For example, some of these studies looked at exposures to a frequency range outside of the frequency range covered by Safety Code 6 and were therefore not considered relevant.
However, Health Canada did consider all studies that were considered to be both in scope and of sufficient quality for inclusion in our risk assessment. While it is true that some of these studies report biological or adverse health effects of RF fields at levels below the limits in Safety Code 6, I want to emphasize that these studies are in the minority and they do not represent the prevailing line of scientific evidence in this area.
The conclusions reached by Health Canada are consistent with reviews of the scientific evidence by national and international health authorities. Of note, the European Commission's Scientific Committee on Emerging and Newly Identified Health Risks earlier this month released its final opinion on the potential health effects of electromagnetic fields. SCENIHR concluded that there are no evident adverse health effects, provided exposure levels remain below levels recommended by European Union legislation.
Now I'd like to talk a little bit about an international comparison. Members of the committee may be wondering how the limits in Safety Code 6 compare with limits in other parts of the world. I refer you to the chart of radio frequency exposure limits for the general public in different countries. Internationally, a few jurisdictions have applied more restrictive limits for RF field exposures from cell towers; however, there is no scientific evidence to support the need for such restrictive limits. Canada's limits are consistent with, if not more stringent than, the science-based limits used in such other jurisdictions as the European Union, the United States, Japan, Australia, and New Zealand.
In conclusion, the health of Canadians is protected form radio frequency electromagnetic energy when the human exposure limits recommended in Safety Code 6 are respected. Safety Code 6 has always established and maintained a human exposure limit that is far below the threshold for potentially adverse health effects. The health of Canadians was protected under the previous version of Safety Code 6, and recent revisions to the code ensure even greater protection.
Health Canada will continue to monitor the scientific literature on this issue on an ongoing basis. Should new evidence arise that indicates a risk to Canadians at levels below the limits in Safety Code 6, the department would take appropriate action.
Thank you for your time.
Paul Demers
View Paul Demers Profile
Paul Demers
2015-03-24 15:53
Thank you, Mr. Chair and members of the committee, for inviting me here today. I know I've been asked to come here today because I chaired the expert panel of the Royal Society of Canada on Safety Code 6. But I thought I'd start by saying a few other things about my background.
I'm the director of the Occupational Cancer Research Centre, which is based in Cancer Care Ontario, a provincial agency that is also funded by the Ontario Ministry of Labour and the Canadian Cancer Society. I'm also a member of the faculty of the schools of public health of the University of Toronto and the University of British Columbia.
I am an epidemiologist, so I study impacts of different types of health effects upon populations of people, but my primary area of research is on the risk of cancer associated with workplace chemicals, dust, and radiation, although I have done research on a number of other diseases as well as on environmental exposures. However, I want to state that, unlike Dr. Prato, I'm not an expert specifically in the area of electromagnetic fields and have never actually done research on radio frequency radiation.
As you know, at the request of Health Canada the Royal Society convened an extra panel to conduct a review of the 2013 draft of Safety Code 6. I was asked to chair that panel because I had no conflicts of interest and because of my expertise in cancer epidemiology, which was identified as one of the areas for which they wanted expertise on the panel.
I was also asked because of my experience sitting on similar panels for the International Agency for Research on Cancer, the U.S. national toxicology program, the U.S. Institute of Medicine, which is part of the National Academy of Sciences, and the Council of Canadian Academies, the latter two being fairly similar to the Royal Society of Canada in the way they operate.
I should also mention, although you may be aware of this already, that I was the second chair of the panel. The first panel resigned because of a perceived conflict of interest, and I took over as chair of the panel about midway through. But I also want to state that I'm here as individual and am not representing the Royal Society of Canada or any other organization at this point.
The panel was presented with five specific questions, and I'm going to over very briefly our responses to those five questions. Overall, they were all dealing with whether or not there were any established health effects at levels below those recommended by Safety Code 6 and related types of questions.
To answer these questions, we did a review of recently published studies in the area on a wide range of different types of health effects. We also looked at many of the international reviews, which I think have already been mentioned here today. These are conducted on a pretty regular basis by many agencies around the world.
Because we were asked to look in particular at established health effects, we defined an established adverse health effect as something that has been seen consistently or been observed consistently in multiple studies with a strong methodology. So we had a fairly flexible definition, but still it required an effect's being observed in not just a single study.
Before I get into the questions—because I'm actually going to read out the questions we were given—I want to explain two different terms that are used quite a bit in those questions, namely the definition of what basic restrictions are and what reference levels are.
Basic restrictions in Safety Code 6 are things that happen within the body, either heating or induced fields within the bodies, or things like those. Many of the actual limits are set based upon that. Because these are not easily measured, the code also uses reference levels, which are things you can measure outside of the body using a meter. They are much easier for regulatory purposes. You will often see that the questions are phrased in terms of these basic restrictions and reference levels.
Our first question was, do the basic restrictions specified in Safety Code 6 provide adequate protection for both workers and the general population from established adverse health effects of radio frequency fields? Our conclusion was that yes, they provided that protection. Specifically, Safety Code 6 was designed to protect against two kinds of established health effects, thermal effects and peripheral nerve stimulation. The margins of safety, we concluded, appeared to be quite protective. For peripheral nerve stimulation, it was a safety factor of five for the workplace or controlled environments, and a 10-fold factor for uncontrolled environments, which are closer to what you would experience in the general public. For thermal effects, the safety factor was 10-fold for workplaces and 50-fold for the general public.
The second question that we were given was, are there any other established adverse health effects occurring at exposure levels below the basic restrictions on Safety Code 6 that should be considered in revising the code? Our conclusion to that question was no. The panel reviewed the evidence for a wide variety of health effects, including cancer, cognitive and neurologic effects, male and female reproductive effects, development effects, cardiac function, heart rate variability, electromagnetic hypersensitivity, and adverse effects in susceptible areas of the eye. Although research in many of these areas—important research, I think—continues, we were unable to identify any adverse health effects occurring at levels below those allowed by Safety Code 6.
Our third question related specifically to the eye: Is there sufficient scientific evidence upon which to establish separate basic restrictions or recommendations for the eye? We concluded that no there wasn't sufficient evidence. Recent studies do not show adverse health effects in susceptible regions of the eye at exposure levels below those proposed by Safety Code 6 for the head, neck, and trunk. Therefore we recommended that it not contain separate basic restrictions for the eye.
The fourth question was perhaps a bit more complex: Do the reference levels established in Safety Code 6 provide adequate protection against exceeding the basic restrictions? That is, do the levels that are proposed as limits for things you can measure outside the body actually protect against the target health effects the code is trying to prevent within the body? Our conclusion was that for most frequencies, yes, reference levels were adequate, but that there were some regions where compliance with the reference levels may not ensure compliance with the basic restrictions. We recommended that the proposed reference levels in Safety Code 6 be reviewed by Health Canada to make them somewhat more restrictive in some frequency ranges to ensure a larger safety margin for Canadians, including newborn infants and children.
This recommendation took into account recent studies that we call dosimetry studies, at least one of which was published after Health Canada produced the proposed Safety Code 6.
Our fifth question was, should additional precautionary measures be introduced into Safety Code 6 exposure limits? I'll state that although there was a range of opinions on the panel regarding precautionary efforts, overall the panel believed that Safety Code 6 was well-designed to avoid established health effects; we did not have any science-based recommendations for precautionary measures to lower the limits. I'll say that it was for the reasons that I think Dr. Prato explained quite well, which is that we couldn't, at least in looking at the study, say that the evidence tells us that we should lower it it in such a fashion. However, we did recommend a number of other measures that can and should be taken by Health Canada.
I'll read some of them here now.
First was to investigate the problems of individuals with what's called electromagnetic hypersensitivity—it goes by other names as well, IEI-EMF, and things like that—with the aim of understanding their health conditions and finding ways to provide effective treatment.
Second was to develop a procedure for the public to report suspected disease clusters and a protocol for investigating them.
Third was to expand Health Canada's risk communication strategy to address consumer needs for more information around radio frequency radiation.
Fourth was to identify additional practical measures that Canadians can take to reduce their own exposure.
These recommendations are really in response to the public input that we received as part of the panel. We also had a number of different research recommendations. In particular, if one has the chance to read the report, you'll notice that each section on a particular health effect usually ends by basically pointing out that more research is needed on that health effect.
A few of the specific ones are that Health Canada should aggressively pursue research aimed at clarifying the radio frequency radiation cancer issue, which would allow the government to develop protective measures if the risk were substantiated; and that Health Canada should pursue research to expand our current understanding of possible adverse health effects of exposure to radio frequency radiation at levels below those allowed by Safety Code 6.
The response to the panel's report from Health Canada—
Paul Demers
View Paul Demers Profile
Paul Demers
2015-03-24 16:05
I have about two sentences left. Thank you very much.
The response to the panel's report from Health Canada, which is publicly available on the web, is that it would review all the panel's recommendations and would revise the levels in the update to Safety Code 6, which has now been adapted. I am personally not an expert in the measurement of electromagnetic fields, as I mentioned, but Health Canada has reported that our feedback was incorporated. In looking at the new Safety Code 6, you can actually see that changes were made in the frequencies that we had recommended be lowered.
With that, I'll end. I'm sorry if I went over time.
View Christine Moore Profile
Thank you, Mr. Chair.
In December 2010, the Standing Committee on Health published a report entitled “An Examination of the Potential Health Impacts of Radiofrequency Electromagnetic Radiation”. Allow me to summarize the five recommendations I'm interested in.
The first recommendation was to provide funding to the Canadian Institutes of Health Research for studies into this matter.
The second was to conduct an assessment of scientific literature.
The third called for a comprehensive risk awareness program for exposure to electromagnetic radiation.
The fourth involved providing information, including awareness sessions.
The fifth recommendation was to implement a process to receive reports of adverse reactions.
As we know, the government did not respond to that report because of the 2011 federal election. I would like to know which of those five recommendations submitted by the committee over four years ago have been followed, why some of them may not have been implemented, and to what extent certain recommendations were followed.
I would also like to know what the next steps are.
Andrew Adams
View Andrew Adams Profile
Andrew Adams
2015-03-24 16:08
Thank you.
Health Canada did receive the committee's recommendations in 2010. I can give you an overview of what we have done in response to the recommendations.
It could take some time, as there are five recommendations.
The Health Canada website provides some information on the effects of electromagnetic fields and on what Canadians can do to protect themselves. We have information on cellphones and on how Canadians can reduce their exposure to those devices. We also have information on Safety Code 6, as well as on its development and measures to protect the health of Canadians.
I think we have submitted to the committee a list of documents available on the Health Canada website. I should have a copy of it. Perhaps I should be asking you whether you have received the list. I think we have given you documents from the Health Canada website.
View Christine Moore Profile
If I understand correctly, only people who look for the information on your website will be educated. There are no awareness programs for the general population—for instance, warning young people against carrying their cellphones in their pockets, directly against their skin.
James McNamee
View James McNamee Profile
James McNamee
2015-03-24 16:16
Yes. For the past several years—at least two years now—there has been an ongoing effort to assemble a risk assessment at an international level through the WHO's international EMF project. This process is basically a systematic review, wherein all studies are identified. They are assessed for quality according to a variety of required measures; the studies are summarized; and there is a statement of their strengths and weaknesses. Some studies that have very poor methodologies or quality are included in the analysis but are removed from the final decision matrix. But they are actually documented, so that there is a very clear, transparent accountability over which studies have been looked at, which studies have been included for risk analysis, and which studies have been excluded based on quality.
A draft version of that document was posted on the WHO website, I believe in December 2014. The public consultation was, I think, originally for 30 days, but it was extended to 60 days. I believe that period has now ended. The intent is to publish that risk analysis document by 2016.
View Hedy Fry Profile
Lib. (BC)
If there is no database that looks at clusters of new diseases, new cancers, etc., in people who have had extensive cellphone usage, and that is age-related and based on frequency of use, and of course the cumulative effect.... Especially in children, how do you gauge the cumulative effect when it is only in the last three or four years that we have seen people exposing their kids as young as two or three years old to cellphone use, etc. Now, there is obviously no study done on the longitudinal effects of cumulative use, etc., because these kids are still little.
Do you not feel that it is important to have some kind of database that looks at clusters, that is reporting clusters, or that physicians may be asked to look at any kind of possible cause and effect on new cancers among people based on the frequency of their cellphone use, the cumulative effect, and age-related use? Has that been done? Has Health Canada tried to set up such a database or reporting system of some kind?
View Terence Young Profile
View Terence Young Profile
2015-03-24 16:30
I'll tell you why I ask. The two at the bottom are the lowest levels. They are Russia and Switzerland. China and Italy also have extremely low levels. Had they been included, it would have told a significantly different story. In fact, that's 1.2 billion people who are covered by very low levels, well below the levels in Safety Code 6. I was a little disappointed by that.
I want to ask you, on record, why you expect the Canadian public to just take your word for it that you looked at 140 studies presented by a national group based in my riding of Oakville.
“Just trust us. We looked at them.”
Why can't you practise the scientific method and put together a report that says, “We reject this study because it was the wrong frequency. We reject this one because it wasn't repeatable,” or some such thing? That's the scientific method.
Why don't you have enough respect for Canadians to show them why you reject the studies or why you accept them. What is your methodology?
Andrew Adams
View Andrew Adams Profile
Andrew Adams
2015-03-24 16:31
I can assure you, as I did during my opening remarks, that we did look at the 140 studies. Most of those studies had already been looked at when the safety code was updated, but—
View Terence Young Profile
View Terence Young Profile
2015-03-24 16:33
Thank you very much.
I read your Safety Code 6. I've read all those documents, all the links you showed, and I read the latest one. I read about nerve stimulation, excitable tissue, dosimetry, and I read quotes such as that the evidence does “...not provide a credible foundation for making science-based recommendations...”.
Frankly, it doesn't tell me what I need to know and it doesn't tell me what my constituents need to know. No evidence of harm does not mean safe. That's the industry line. They always say there's no evidence of harm. They just repeat it ad nauseam. But it's not their job to keep Canadians safe; it's your job.
Meg Sears
View Meg Sears Profile
Meg Sears
2015-03-24 16:44
Thank you very much, Mr. Chairman and members of the panel. I'm very grateful for this opportunity today.
I apologize for not providing bilingual materials, but I received my invitation just a week ago, so the timing didn't work out to take advantage of your translation services.
My name is Margaret Sears. I am here as someone with some knowledge on the subject matter—a very limited knowledge on the subject matter—but more importantly, as a scientist interested in environmental health as well as methodology in this field.
I am inspired by working with Dr. David Moher's research group here in Ottawa at the Ottawa Hospital. He is among the world's premier methodologists in clinical epidemiology, a highly respected and influential scientist. I also work in environmental health, was funded as a principal investigator for a Canadian Institutes of Health Research project. I'm associated with research institutes at both CHEO and the Ottawa Hospital, and have worked with Canadian medical specialists in environmental health preparing reports for the Canadian Human Rights Commission, the Canadian Transportation Authority, the Alberta Energy Regulator, and others. I have been a guest editor for peer-reviewed medical journals and have co-authored several systematic reviews. That's enough about me.
Regarding Safety Code 6, I made submissions to the Royal Society of Canada and to Health Canada, and Dr. Moher and I also attended a meeting on September 19 with Mr. Adams, Dr. McNamee, and Ms. Bellier.
I also recently responded to the World Health Organization during consultations on their review of health effects of radio frequency radiation. I'll briefly answer one of the questions about that. That consultation document is only partially done. There were no conclusions associated with it, and according to the method section, the literature search ended in 2011, so it's far from complete. So it is nothing that we could be basing anything on at this stage. And it also had no tables of evidence or anything like that in it.
In short, I see major problems with the reporting of these studies, which should reflect on the execution of these reviews. If a review is not well conducted, it is subject to bias and incorrect conclusions.
Last year, the prominent medical journal, The Lancet, published a series of articles on waste in research that was not adequately conducted or reported. It is a big problem, wasting a lot of money on badly conducted and badly reported research.
You have been provided a paper by Rooney et al describing the most recent methodology for systematic reviews in environmental health. The reviews of health and frequencies covered by Safety Code 6 that I have examined, including many of the authoritative reviews relied upon by Health Canada, are lacking salient features of systematic reviews, as summarized in the chart you have been provided. They have also captured but a fraction of the literature, according to what's referenced, with organizations referring to the validity of one another's reviews.
On the other hand, I have a sample of one of the systematic reviews that I co-authored. It's on the relatively narrow topic of dietary supplements and cardiovascular drugs. This is a concern for a much smaller segment of the population than radio frequency radiation that we're all exposed to, but we started from scratch because there was no good review to base it upon, and initially we screened over 33,000 records. There are methods and software established to handle this kind of volume of literature. In a 2012 presentation, it was stated by Pascale Bellier that Health Canada has reviewed 50 years of research. Canadians are waiting to see this evidence because it is not evident to date.
Systematic reviews address specific questions, not really general questions so much, so you have to parse your question to be able to tackle it with really good methodology. They are collaborative. They're transparent. Certainly these processes with Health Canada leave a lot to be desired. Systematic reviews address ingrained biases.
You can only build upon previous reviews that are of high quality. Without previous high-quality reviews to build upon, we have to go back to that 50 years of data. What we have currently is a bit like that telephone game in which messages get mixed up as they're half-heard while they are whispered to one another around the table.
I also believe that there's good reason for concern in this field. Safety Code 6 is said to protect against “established” health effects. What does it take to establish a health effect? Sometimes that hurdle is very high, and there's a somewhat arbitrary bar, because people are.... We'll talk about that in a minute, but keep in mind that every time you hear “established health effects”, there is the question, what does it take to establish a health effect?
I'll give you a couple of examples of research. In the slides that were distributed to you, there is a table with cancer studies. The clearest research originates from Hardell's group in Sweden, comparing phone use between people who had brain tumours and healthy individuals; this is called a case-control study. In Sweden, the background rate of glioma is, I believe, lower than in Canada. We do not properly capture details of brain tumour incidence in Canada, although a database is being set up.
Higher risks, up to fourfold increases, were seen in Sweden with use of wireless phones, both cellphones and cordless phones. The risk of a tumour on the side of the head the phone was held against increases when use begins earlier in life, so children and adolescents are at greater risk, with longer cumulative time on the phone and more years of use. But only part of this information was referenced by the Royal Society of Canada.
The Interphone Study was referenced. This was an enormous study extending over 13 countries, and the diversity of health status and co-exposures really muddied the waters in this study. For example, in some countries, having a phone was a symbol of wealth and was associated with a healthier diet and a cleaner environment. Initial analyses showed that cellphones protect you from cancer, which even the author said was a completely implausible effect, and it was because of this confounding. Further analysis did show higher tumour incidence with phone use.
These two human studies were key in the IARC determination that cellphones possibly cause cancer. But since then, the French CERENAT study was published in 2014. It was not referenced in any of the documents from Health Canada or the Royal Society. It is similar to the Hardell studies. When the analyses were performed in the same manner, the results were basically replicated. So now we have that replication, and such replication is key to becoming an established health effect.
Another concern relating to cancer is women who carry their phones in their bras. Phones are sending signals constantly to keep in touch with a network, even when you're not talking. The first case was reported in 2009, in a keen cell phone user who stored her phone in her bra for 10 years. Cases are piling up of characteristic tumours in young women with no known genetic predisposition. This information also was not taken into account, as far as we know. Maybe it was, but it was certainly not documented that it was taken into account.
Now, if women carry phones in their bras, men carry a lot of phones in their pockets. In Canada, we have some problem with infertility. This is one of many studies showing effects on sperm—there is a graph in your handout. When exposed to typical radiation from phones in pockets, sperm stop swimming, their DNA is damaged, and they die.
What we see in people is backed up by much other research into cells and animals. A lot of the recent research demonstrating potential harm was omitted from reports that supported Safety Code 6, as was discussed previously.
I should say that in the comments regarding the ability to assign a dose to an exposure, what happens in this research is that, if animals are merely exposed to a phone.... With a phone, it's hard to say that the exposure is precisely such and such a number, but it's status quo. But these status quo phone exposure studies are discarded. There's a huge body of evidence that is discarded just because they used a phone instead of something that was more “scientific”.
In summary, I'd offer three recommendations.
First, Health Canada must systematically access, assess, and act upon all the science from scratch. It needs specific tools as well as methodological and library expertise to accomplish this.
Second, we have to open our eyes and collect this environmental health data, both exposures and health outcomes. On that, I would note that the regular compliance data that Industry Canada is accumulating should be made public, so that if a doctor is concerned, he has that data to connect the dots.
We also have to be collecting really good, detailed cancer incidence data. We used to collect that, but it's not available any more. The Public Health Agency of Canada has some data on their website. It used to be reported in small areas, but now it's only reported at the provincial level.
View Murray Rankin Profile
View Murray Rankin Profile
2015-03-24 17:08
In fact, I'll take six minutes, please. I would like to ask if you could interrupt me toward the end so my colleague, Ms. Moore, could ask a very short question.
I want to say thank you to the two witnesses.
I must say that your testimony is very, very disturbing. I'm putting myself in the position of a parent sitting at home hearing what you've said, just after we've heard from Health Canada and Industry Canada assuring us that nothing is wrong.
Recently Health Canada sent a fact sheet to our committee. It was modified less than two weeks ago, on March 13. It would seem to suggest that there's really nothing wrong with Safety Code 6 in protecting Canadians. So I must say it's very, very disturbing.
The first question I have is for Doctor Sears.
If I could summarize, in your words Health Canada must review the science from scratch. They have to make the data more publicly available and they have to collect detailed cancer data because what you used to be able to get is no longer available, except at the provincial level. That's a very disturbing conclusion. The fact that the information is not being made publicly available is equally disturbing.
Can you elaborate a little on that?
Meg Sears
View Meg Sears Profile
Meg Sears
2015-03-24 17:09
There are two issues here.
One issue is that a lot of data that should have been collected is simply not being collected. An independent brain tumour group is starting up a database, but it's not in place yet. In order to detect the oncoming tsunami of brain tumours, should that happen—and it looks as if we may see an increase in brain tumours—we would have to have detailed information about where exactly these tumours are located. There's also an issue with tumours in the salivary gland, and we're not collecting that data at all.
You need to have detailed data on the location and the histology, the actual details—
View Murray Rankin Profile
View Murray Rankin Profile
2015-03-24 17:10
Yes, thank you. You'll appreciate that time is so limited.
Dr. Blank, you started by saying that Health Canada was not measuring the right parameters, that it was focusing on temperature but not looking at the biological parameters. I think you said something to that effect. Health Canada tells us in this fact sheet that I just mentioned that they do. They say:
....Health Canada scientists consider all peer-reviewed scientific studies (which includes thermal, non-thermal, and biological effects)....
They claim they are doing what you say they should be doing.
Martin Blank
View Martin Blank Profile
Martin Blank
2015-03-24 17:11
Well, I don't see that.
They didn't elaborate what the biological effects were and what the non-thermal effects were. The only one they referred to was the...I forget the particular ones they had about non-thermal effects.
The fact is that they didn't refer to the stress response, which I think is the body's first line of defence in connection with a lot of stimuli that are present in nature.
View Murray Rankin Profile
View Murray Rankin Profile
2015-03-24 17:11
If there is a stress protein created, as you've suggested, or that some studies that you and Dr. Goodman refer to suggest, the implication seems to be that the creation of stress proteins is a serious thing.
Does that necessarily follow—?
Martin Blank
View Martin Blank Profile
Martin Blank
2015-03-24 17:11
That's the body's reaction.
You'd never know that because this was not written by biologists. I'm amazed that at the beginning of the report they put in a word for a chemical engineer, another engineer to come on board. They didn't even mention that they need one biologist. They need somebody there who understands what's going on at the level of a cell.
View Murray Rankin Profile
View Murray Rankin Profile
2015-03-24 17:12
Here we have your analysis, which has been very clearly presented by both of you. Toward the end of your recommendation, you refer to Dr. Lerchl, from Bremen, who has in the past not been alive to these concerns, but who has recently been concluding that there is a concern. Yet, as recently as March 13, Health Canada puts out to the Canadian public a fact sheet saying that there are no concerns here.
This is very hard for Canadians to understand. It seems that our regulators are not giving this the attention that this deserves. I say “seems” because I'm not a scientist. I have to rely on what they conclude and what you two are asserting.
Martin Blank
View Martin Blank Profile
Martin Blank
2015-03-24 17:13
Well, we have been carrying this message out. I'm not a shrinking violet, as you can tell from my presentation. I call things the way I see them. I've published a lot of papers. I was president of the Bioelectromagnetics Society. I've organized symposia on the precautionary principle. I've been active in this and I've made the message go out.
My papers have been published as well. The fact that they have been ignored, that's on the other side of the ledger. These guys don't want to hear it. Why? You may inquire into that as well, because that's an interesting question. The fact is that they have ignored it.
I actually pointed it out when I presented at an earlier review, when the draft of the report was being considered. I made a presentation then and said the same thing, more or less, and it just was not mentioned. The fact that they ignored the papers by Dr. Goodman and me.... We've published many papers on this subject, and it's a very important thing, if I may say so. I mean, this is a basic reaction of cells, and especially when you're interested in harm that's coming to cells, this should be mentioned. It should at least get a footnote or get a reference in there that we looked at it.
Mr. Murray Rankin: Thank you.
View Hedy Fry Profile
Lib. (BC)
Dr. Sears gave us protocols of how we should be looking at good research, and so on, and how we should be evaluating it. I noticed that those are not the protocols used for evaluating research by Health Canada when they got their report. They used a totally different set of protocols.
Professor Blank, you are very intriguing, and I think everything you said makes a lot of sense. The body is an electric organism in many ways. The cells respond—
Allan Markin
View Allan Markin Profile
Allan Markin
2015-03-12 15:51
Chair, honourable members of the committee, my name is Allan Markin, and my vision is preventive health care for everyone.
I am the founder and chief accountability officer of the Pure North S’Energy Foundation, Canada’s largest primary prevention-focused not-for-profit organization. I'm accompanied by Dr. Mark Atkinson, a medical doctor and director of quality assurance, and Dr. Samantha Kimball, research director at the Pure North S’Energy Foundation.
At Pure North we empower Canadians to feel better and live longer through the use of simple and effective prevention-focused clinical interventions. These include vitamin D3 and high-quality multivitamin and mineral supplementation, health education, and the safe removal of mercury amalgam fillings. Our preventive program supports the advancement of modern medicine. Our multidisciplinary team of over 100 people includes medical doctors, naturopathic doctors, nurse practitioners, dentists, pharmacists, nurses, and other health care professionals.
Over an eight-to-ten-year period, 40,000 Canadians, including 25,000 vulnerable seniors, homeless, and first nations, have accessed our preventive health program, and have their blood panel taken regularly. Participants in our program experience a significant increase in quality of life and a 20% improvement in physical and mental health. Forty-eight per cent of those with pre-diabetes have experienced a complete reversal in their disease. Emerging evidence demonstrates there's a 17% reduction in the prevalence of metabolic syndrome for every 25 nanomoles per litre of vitamin D3 increase.
Our request is for the Government of Canada to proactively resolve what we call the four injustices, and for all Canadian physicians, medical students, dentists, and allied health professionals to be educated about these injustices.
Injustice number one is that Health Canada has regulated that no supplement in Canada contain more than 1,000 IUs of vitamin D3. Any amount higher than this requires a doctor’s prescription and is regarded a drug. In the U.S.A., a country that has exactly the same recommended daily allowance for vitamin D3 as Canada, people have access to vitamin D3 supplements containing 7,000 IUs of vitamin D3 per tablet. It does not require a prescription, to our knowledge. The FDA has not put a limit on the amount of vitamin D3 in a pill, but Health Canada has. Canadians should have access to vitamin D3 supplements at the same dose as Americans, or higher.
Injustice number two is that the recommended daily allowance for vitamin D3 should be changed to be between 7,000 IUs and 9,000 IUs. Health Canada has been proven to have made a significant mathematical error in their calculation of the RDA for vitamin D3. The Health Canada vitamin D3 RDA for most adults is 600 IUs per day. Using Health Canada data and the correct statistical methodology, Professor Paul Veugelers at the University of Alberta has shown that the IOM vitamin D3 recommendation would have been 9,000 IUs per day if IOM had not made a math error. Another group, led by Dr. Heaney, a vitamin D3 expert from Creighton University in Nebraska, came up with a similar figure of 7,000 IUs based on an analysis of a dataset of 3,600 individuals. Dr. Kimball has published extensively on vitamin D3, including a trial of 14,000 IUs per day in patients with MS. The evidence is clear: vitamin D3 is safe, and the vitamin D3 RDA should be 10 to 15 times higher than the current Health Canada RDA.
Injustice number three is that Canada needs to mandate a complete ban on the use of mercury amalgam fillings in all Canadians, and not just children, pregnant women, and those with impaired kidney function. In Health Canada's report, “The Safety of Dental Amalgam”, they acknowledge that amalgams impair kidney function. Pure North research has found that the safe removal of amalgams results in a significant improvement in kidney and liver function and in self-reported physical and mental health symptoms, such as anger, depression, and anxiety. The World Health Organization acknowledges that mercury is poisonous at any level. The use of mercury amalgam fillings has already been completely banned in Norway, Sweden, and soon Brazil, as well as a partial ban in Denmark. Canada needs to follow suit. Amalgam removal needs to be done safely.
Injustice number four is that Canadian emergency departments have unnecessarily long lineups and waiting times. The Wait Time Alliance’s annual report card states that 27% of Canadians reported waiting more than four hours in an emergency department, as compared with 1% in the Netherlands, for example.
A recent analysis of the data relating to 6,600 of our program participants by the school of public policy at the University of Calgary found that a preventive health program such as Pure North's keeps people out of hospital. Within one year of being on the program, the Pure North participants had 45% fewer nights in hospital and accessed emergency departments 28% less than controls. This happened in less than one year.
The inconvenient truth is that millions of Canadians experience disease and suffer unnecessarily because our health care system has not yet made primary prevention a priority.
In 1943 the Canadian Medical Association called for preventive medicine to become a federal priority.
The World Health Organization report on the impact of chronic disease in Canada predicted that between 2005 and 2015 over two million Canadians, or 400,000 people a year, on average, will die from chronic disease.
Studies have found that if Canadians optimized their intake of vitamin D3, 37,000 premature deaths would be prevented annually, and the economic burden would be reduced by $20 billion per year.
In summary, integration of a proven preventive health program such as Pure North’s prevents premature deaths and saves the government money. An assessment of the economic impact of our program estimated that every dollar invested in the Pure North program provides a return of between 13:1 and 25:1.
The result is that the health care cost curve is bent downwards with real potential cost savings of at least $420 million per year if rolled out to 600,000 Canadians. If Alberta, for example, implemented the Pure North program province-wide, this could free up the equivalent of 1,600 hospital beds every year. This is roughly the same as building two entirely new hospitals.
The provincial governments are also locked into an unfortunate mindset that the health care costs avoided rather than current health care dollars saved are not worth pursuing. Preventing [Technical Difficulty—Editor] chronic disease in the future avoids the size of the increase in budget that we are otherwise headed for. To avoid prevention since it does not reduce the size of the health budget today is nothing more than flawed logic with tragic implications, a sicker population and ever-increasing costs of treating them.
It is our hope that the Standing Committee on Health will attach great importance to these issues and take action to resolve them.
Claudette Dumont-Smith
View Claudette Dumont-Smith Profile
Claudette Dumont-Smith
2015-02-05 12:41
The Native Women's Association had different departments.
One, for example, was health. In April 2012 we had word from Health Canada that all our funding was cut. We couldn't do anything in the health sector for aboriginal women. Eight of our staff were laid off, and we never brought them back on because we were not successful in getting any more funds from Health Canada. That was one major cut.
Other cutbacks were, of course, with the Status of Women funding. During the Sisters in Spirit, the Native Women's Association of Canada was receiving about $1 million, which is public information. It has decreased steadily since then. We're getting much less than we had then, than we had last year. We have even less this year than what we had last year. Again, it has to be in relation to our staff. We have fewer staff in that department as well.
Core funding was decreased, as well, for all NAOs and aboriginal regional organizations across the board last year. In order to get funds to do work in various areas, we had to apply to a $20-million pot with the other four NAOs and all the aboriginal regional organizations across Canada. It was a very competitive process.
We entered the process. We submitted our 10 proposals on February 20, or something like that, of last year, which was the due date of each proposal, and we had word only in October, November, that some of our projects had been funded. Right now we're doing work that has to be completed by March 31. It's one year of work that has to be completed by March 31, in three or four months.
It's very difficult for me and for our staff to work under those conditions. Of course, as my colleague was saying here, it is hard to keep a dedicated staff, where they want to work, where they want to be in the workforce, and where they like their job. But we can't offer stability. That's the situation I, along with all the other NAOs and ROs, am in right now in terms of funding.
View Susan Truppe Profile
What about the funding you receive from Health Canada, or is that not correct? Did you ever receive any funding from Health Canada?
Jenny Wright
View Jenny Wright Profile
Jenny Wright
2015-01-29 11:46
Not really. We don't have Health Canada funding. We get small grants from our local health initiatives. We also run a housing program, which gets provincial funding. That comes from what we call the supportive housing program, which comes out of housing dollars. We have AIDS-supportive housing.
Kendal Weber
View Kendal Weber Profile
Kendal Weber
2014-12-02 9:52
Thank you, Mr. Chair, and members of the Committee.
My name is Kendal Weber and I am the director general of policy, planning and international affairs in the health products and food branch at Health Canada.
Thank you for the opportunity to present Health Canada's perspective on Bill C-21, the red tape reduction act.
As you know, Health Canada's primary mandate is to protect the health and safety of Canadians. We support the government's red tape reduction action plan, including enshrining the one-for-one rule in law to target and control administrative burden on business. Cutting red tape to business fosters growth, competitiveness, job creation, and innovation.
As one of the government's major regulators, Health Canada is committed to reducing regulatory administrative burden to industry, while ensuring that the health and safety of Canadians is not compromised.
Health Canada has an ambitious regulatory modernization agenda and follows good regulatory design principles, including the reduction of unnecessary administrative burden to industry. The good practices required by the one-for-one rule are consistent with departmental approaches to regulatory design.
With respect to reducing administrative burden, it is now a matter of practice within Health Canada that the development of regulations includes an assessment of the cost, alternatives, and consideration of ways to reduce the imposition of administrative burden on regulated parties, particularly small business.
This practice is embedded in the design of our regulations. Stakeholders are consulted throughout the regulatory development process, including on the assessment and costing of administrative burden, as well as identifying alternatives to minimize the burden without compromising on health and safety requirements.
Stakeholder consultations begin early and include publishing regulations in the Canada Gazette, part I. This pre-publication of regulations gives all Canadians a chance to submit their comments about a proposed regulation well before it is made. Bill C-21 would allow for a 24-month reconciliation of administrative burden. This flexibility over two years respects the realities of the timelines involved in introducing new or amended regulations through the Canada Gazette process.
ln implementing the requirements of the one-for-one rule over the past two years, we have recognized that there are opportunities within the 95 regulations which we administer to cut red tape and minimize burden on businesses while continuing to meet our mandate of protecting the health and safety of Canadians. These two objectives of health and safety and administrative burden reduction are not incompatible.
Here is an example of how Health Canada has been able to do just that: reduce administrative burden on business without compromising the health and safety of Canadians.
Pharmacists and their regulatory associations told us that certain requirements under the food and drug regulations were out of step with more modern provincial legislation and were unnecessarily prescriptive, requiring pharmacists to perform functions which could be safely performed by pharmacy technicians. We listened and amended the provisions that regulate prescription drugs. The regulations now allow the transfer of prescriptions by pharmacy technicians, an administrative task that was previously administered solely by pharmacists. This means that community pharmacies and retailers that dispense prescriptions may better utilize the skills of lower-salaried pharmacy technicians, thereby reducing the overall operating and administrative costs of business.
This change alone represents a net annual reduction of almost $15 million in unnecessary administrative burden and does not compromise the health and safety of Canadians. lt was of benefit to everyone, was practical, and made good sense.
As of June 2014, the department has contributed to approximately 70% of government-wide administrative cost reductions.
Health Canada will continue to seek opportunities to reduce unnecessary regulatory burden to industry implementing the one-for-one rule while protecting the health and safety of Canadians.
Furthermore, the department has embedded in its regulatory design a small business lens assessment to consider flexible regulatory options that reduce costs to small businesses.
Thank you for the opportunity to appear before you today on this important issue. I'm happy to answer your questions.
View Ben Lobb Profile
View Ben Lobb Profile
2014-11-20 11:07
Good morning, ladies and gentlemen. Thank you for all being here today.
We're looking at the supplementary estimates (B).
We're happy to have the minister here today and all of her officials. I thank the minister for taking the time out of her schedule today.
Do you have your prepared statement ready, Minister?
View Rona Ambrose Profile
I do.
The Chair: Okay. Thank you very much.
Hon. Rona Ambrose: Thank you, Mr. Chair.
It's great to be here in front of the health committee.
I want to start off by thanking you for all of the good work that you're doing. Thank you for the invitation to discuss supplementary estimates for the health portfolio.
We have a number of officials here that many of you know already: Alain Beaudet, from the Canadian Institutes of Health Research; of course, Bruce Archibald, who's here from CFIA; George Da Pont, our deputy minister from Health Canada; Gregory Taylor, our chief public health officer; and Krista Outhwaite, our newly appointed deputy minister for the Public Health Agency.
I'm going to provide just a short update to committee members on Canada's response to the Ebola outbreak in West Africa, as that I believe would prove helpful to all of you.
As many of you know, this outbreak is the most severe and complex the world has seen in 40 years of combatting the virus. The humanitarian, social, and economic impacts will be felt long after the virus is contained. Canada has been at the forefront of the international response to this outbreak, and has been since April. We are contributing funds, expertise, and equipment. To date we have committed over $65 million in health, humanitarian support, and security interventions. I'm pleased to report to the committee that 57 million dollars' worth of this funding has now been disbursed. This funding has gone to support the United Nations, the World Health Organization, UNICEF, and many others to improve treatment and prevention, improve health capacity, save lives, and support the basics such as nutrition.
Our efforts are directed at bringing an end to this outbreak, treating patients, assuring the availability of essential services, preserving stability, and preventing outbreaks in surrounding countries.
We've also now donated and delivered over 2.5 million dollars' worth of personal protective equipment to West Africa that was requested by the WHO, including 1.5 million pairs of gloves, two million masks, over 480,000 respirators, and over 1,000 beds and blankets. The Public Health Agency also has deployed our mobile laboratory again to Sierra Leone to provide rapid diagnostic support and infection control testing, and we're currently awaiting further direction from the WHO on where our second mobile lab can be deployed.
In addition to Canada's invention of an experimental Ebola vaccine, which is currently undergoing clinical trials, we've generously donated the Canadian Ebola vaccine, in the amount of 800 vials, to the World Health Organization in Geneva. This vaccine is a fine example of Canadian scientific innovation. It's our hope that if found to be safe and effective, it will be used in West Africa to help stop this outbreak.
To support this goal, we've recently launched a Canadian phase one clinical trial for the vaccine, led by the Canadian Immunization Research Network in Halifax at the Canadian Centre for Vaccinology in the IWK Health Centre. This trial will support concurrent trials elsewhere in the world by determining if lower dosages could be just as effective as higher ones, potentially multiplying the amount of doses in each vial. While there has never been a case of Ebola in Canada, we must of course continue to be prepared and take every precaution necessary.
I've now spoken with health ministers from across the country several times and we've held, I think, three meetings. Our chief public health officer is in regular contact with medical officers in provinces and territories, I think now meeting almost twice a week for a number of months. In the event of an Ebola case, the Public Health Agency is ready to support the provinces and territories by deploying our Ebola rapid response teams. These five teams are made up of a team lead, a field epidemiologist, an infection control expert, a biosafety expert, a laboratory expert, a communications expert, and a logistics expert, and they would be deployed immediately to support any local public health systems that would need our support.
Transport Canada is also supporting the Public Health Agency by having planes readily available to deploy at a moment's notice. These planes are also stocked with emergency supplies, including protective equipment, like masks, gloves, and gowns. Our government is also providing additional funding to support Ebola preparedness and response capacity here in Canada to further support the provinces. This includes, of course, the $27.5 million that will be directed towards domestic preparedness. This amount includes just under $25 million to support further research and development of Ebola medical countermeasures. This means more money for research of the Canadian Ebola vaccine and monoclonal antibodies.
Funding has also been set aside to support infection control training and equipment, and to deploy additional quarantine officers at Canadian airports.
We've also launched an online Ebola information campaign designed to help raise public awareness about the disease and its risks, through social media such as Facebook and Twitter. As we combat the disease, we need to fight the stigma around it. Canadians need to know the facts about Ebola, how the virus is transmitted, its symptoms, and any other information that will help them manage their fears of contracting this disease.
Of course, we are making a strong contribution to international efforts abroad and working together to prepare here at home. We are strengthening coordination across the federal, provincial, and territorial governments, and other important agencies, and doing everything possible to protect Canadians and fight the disease.
On a different subject, I'd like to commend and thank all of you for your thoughtful study of Bill C-17, Vanessa's Law. In addition to the many months of consultations—
View Rona Ambrose Profile
In addition to the many months of consultations that we held with Canadians, this committee's careful review of this bill contributed to the successful passage of Vanessa's Law. I feel that we've made very real progress in the last year on improving public health and safety, and nowhere is this more apparent than with the royal assent of Vanessa's Law. Vanessa's Law contains some of the most profound changes to the Food and Drugs Act in more than 50 years. It's truly an historic step in our government's continuous improvements to patient safety, especially over the past several years.
Thanks to the hard work of this committee, and Vanessa's Law, Canadians can have renewed confidence that the medicines they are using are safe. As Minister of Health I now have the powers to recall a drug and take it off store shelves when it's not safe. For the very first time, serious adverse drug reactions and medical device incidents will have to be reported by health care institutions. As well, as you know full well, courts can now impose penalties on drug companies that include up to $5 million per day or jail time for distributing unsafe products. Also, we can compel drug companies to revise labels so that they clearly reflect health risk information, including updates for health warnings for children. We can direct companies to do further testing on a product, including when issues are identified with specific at-risk populations such as children.
Many of these new powers came into effect with the royal assent of Vanessa's Law, and we are moving quickly to put regulations in place to support other powers, such as the requirement for all authorized clinical trials to be registered, and some elements of mandatory adverse reaction reporting for health care institutions.
Canadians need access to information, especially when it comes to their health, and beyond Vanessa's Law we've made great progress in increasing transparency through Health Canada's regulatory transparency and openness framework and action plan. For example, Health Canada has begun to post summaries of drug safety reviews that both patients and medical professionals can use to make informed decisions. Patients can also check the clinical trials database to determine if a clinical trial they are interested in has met regulatory requirements. These concrete initiatives are making more information on departmental decision-making and results available to Canadians in an easy-to-understand format. More can always be done. I have asked my officials to accelerate the implementation of the transparency initiative.
I would also like to congratulate this committee on your report on the serious health risks and harms of marijuana. As this committee noted, smoking marijuana has serious health risks for youth. As many of you know, Health Canada launched an awareness campaign aimed at educating parents on how to talk with their teenage children about the dangers associated with prescription drug abuse and smoking marijuana, in line with recommendations included in your report. Television ads began airing in October focusing on the developing brains and bodies of teenagers and how marijuana use, as well as prescription drug abuse, can cause permanent damage to their development and put educational achievement and long-term mental health at serious risk.
The department developed web and social media content as well on the dangers associated with marijuana and prescription drug abuse in order to encourage parents to get the facts, and tips on how to speak with their children on drug use and abuse. As this committee will know, our government has also committed almost $45 million over five years to expand the national anti-drug strategy to now also include prescription drug abuse. The many dangerous and unpredictable consequences of drug abuse make this a very real and widespread public health issue, and no one feels that more acutely than Canadian families.
Over the past year I've met with health officials, physicians, pharmacists, first nations representatives, law enforcement, addiction specialists and medical associations to discuss how we can collectively tackle prescription drug abuse. I've issued a call for proposals to seek new ways to improve prescribing practices for opioids and other drugs that pose a high risk of abuse or addiction. Additionally, we are now providing funding to build on initiatives to support research on new clinical and community-based interventions for preventing and treating prescription drug abuse.
I'd like now to turn to innovation in health care, Mr. Chair.
As you know, Canadians benefit from a system that provides access to high-quality care and supports good health outcomes, but with Canada's aging population and a growing burden of chronic disease, we know we need to accelerate the pace of change. That's why I launched the advisory panel on health care innovation back in June. It's headed by Dr. David Naylor and this panel has truly hit the ground running.
The panel is consulting broadly across Canada, identifying promising areas for innovation, and determining how the federal government can help accelerate that progress. In fact, the panel is eager to hear from Canadians from across the country in an online consultation that runs until December 5. I anticipate the arrival of the final report by the end of May and I look forward to sharing this information with members of this committee.
Mr. Chair, Canadians expect their federal government to play a major role in sustaining our high-quality health care system. Today, I want to reinforce that our government is at the table and we want to make sure Canadians have the highest level of care.
Once again, thank you for inviting me to be here today to speak with you. My officials and I are pleased to take any questions that you may have.
View Libby Davies Profile
Thank you very much, Chairperson.
Thank you to Minister Ambrose for appearing before our committee today as we deal with the estimates.
Thank you to the officials who will be here.
Minister, I know you're here only for an hour so obviously we want to ask as many questions as possible. I'm glad that you began your comments with an update on the Ebola situation because I do think that has been a very urgent matter and as you know, we've raised it in the House a number of times with you and also with the parliamentary secretary. There have been a lot of concerns about delays from Canada, both in terms of getting equipment and protective gear out the door, and there have certainly been significant concerns around the vaccine. So I'm glad to hear you say today that now $57 million of the federal commitment has actually been disbursed.
I do want to come to a question, though, on the vaccine itself. You're probably aware that the contract with NewLink, which is the company in Iowa that received a contract from the federal government in 2010. That's four years ago, and that contract requires the company to commercialize the made-in-Canada vaccine, and within that contract there are specifics that outline that any parking, shelving, or lack of diligently and aggressively commercializing the vaccine is considered to be a fundamental breach of contract.
The question that I have is whether or not you as the minister, or the federal government, have given notice to NewLink Genetics outlining the concerns that many Canadians have—certainly we have—with the apparent parking of the vaccine development over the last four years, and the lack of urgency this summer to conduct the clinical trials. The contract says that 90 days' notice has to be given for required inactivity to be considered a sufficient cause for termination. Basically we want to know, have you given notice of breach of contract? Have you been seeking alternate sources to ensure that this vaccine is commercialized, given that now we're looking at four years since this contract was initiated?
View Rona Ambrose Profile
First of all, I think we're all very proud that Canadians and Canadian taxpayer money has paid for the research over 10 years to develop this vaccine. As you know, this outbreak has become urgent in the last year. I have absolutely no evidence that there is any lack of urgency around commercializing this vaccine. In fact it's the opposite. I've asked many times. I received very clear reassurances—and I'll be happy to allow Dr. Taylor and Krista Outhwaite to speak to this—that this process is moving at an unprecedented pace.
View Rona Ambrose Profile
The words that have been shared with me are that the international community has been brought to bear to support the rapid commercialization. Let's remember this is an experimental vaccine. We are in phase one clinical trials. We're still testing for safety and efficacy. Let's hope that it is safe and that it is able to be deployed quickly once we do know that it is safe to be used.
View Libby Davies Profile
Minister, I think we all share your concerns about safety, so I want to ask you again. You have no concerns whatsoever that this company has been parking or shelving or has lacked any diligence in terms of aggressively commercializing this very desperately needed vaccine, no concerns with the company whatsoever.
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-20 11:24
I don't think we have concerns with this company. They've been working diligently. Some of the delays have to do with a production process to produce a large amount of vaccine for clinical grade. That took some time. We placed our order with them initially so we would have some vaccine. We just received that batch early this year. I think it was around February, so it took a long time for the production to get going.
As for the clinical trials, I think it's worth remembering that typically this process takes five years or more from the beginning. Prior to this outbreak there had been only 2,500 cases in the world—
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-20 11:24
That's 2010. So it took a long time to get the production facility in place. Once the vaccine was produced and we had some of that early this year, there have been no less than six clinical trials they've engaged with.
They have another manufacturing system on line. They've produced some for this year and there will be some in early March 2015, which could be as many as 100 million doses. We don't know that. We go by vials. We purchased initially 1,400 vials, but with some of the testing in the Canadian clinical trials using a very low dose, as the minister suggested, it could be much longer.
They've invested well over $10 million, and they've leveraged as much as $42 million. million from the U.S. Department of Defense, National Institute of Allergy and Infectious Diseases, etc.
View Libby Davies Profile
Dr. Taylor, perhaps I could just do a quick follow-up to you. As you know, we have the visa ban that was initiated by Canada from affected Ebola countries, and I'd like to ask you as the chief medical health officer for Canada, do you support the visa ban from affected Ebola countries? What evidence supports the decision that was made?
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-20 11:25
The balance we have to take between protecting Canadians and trying to assist and trying to deal with the outbreak is always very difficult to do. It's not an outright ban. It's a pause in issuing new visas. In my understanding there are about 1,700 to 1,800 existing visas that will continue to be valid.
It's very difficult to get exactly the right balance. It's not like it's a border closure; it's a pause in issuing that. My understanding as well is that the—
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-20 11:26
Personally I think it's the appropriate balance to take, and yes, I support a very measured approach like this.
View Rona Ambrose Profile
MP Davies, I think there's been some misinformation. The media, I think, didn't do Canadians a service on this. This is not a travel ban. This is a pause in new applications of visas. Just to put it into context, we get very few visa applications from even the three combined countries—
View Rona Ambrose Profile
Existing visas, and there are about 1,900 of them that are active today from people who have visas from those countries. Many of them are multiple-entry visas. People will continue to be able to travel back and forth from those West African countries, and Canadians can travel in an unlimited way. But we have told Canadians not to travel there unless they need to, unless they're humanitarian workers or it's essential business travel.
We've done the same thing in reverse. In a very practical way we said we'd look at it case by case. If it's essential travel for economic purposes, we're honouring the visas that exist, both single entry and multiple entry, and the Minister of Immigration has the discretion to look at these on a case-by-case basis. It's a cautious, prudent, and practical approach. We're taking the same approach with Canadians.
View Eve Adams Profile
Lib. (ON)
Thanks, Mr. Chair.
Thank you, Madam Minister, for joining us here at the committee today. It's our great pleasure to have you.
I'd like to follow up and ask some additional questions regarding Ebola. I want to thank you for your comments and for focusing on the significant contributions that Canada has made to date.
This is, in our lifetime, one of the most significant health crises that the world is facing. Perhaps you could provide some additional detail on the leadership role that Canada has played in fighting the Ebola outbreak in West Africa.
View Rona Ambrose Profile
Sure, I always appreciate the opportunity to speak about Canada's response to the Ebola outbreak in West Africa. It also allows me to correct some of the misinformation that exists and combat the stigma that we're seeing in some places, especially for returning health care workers.
It's clear that we're in the midst, as you said, of the largest outbreak ever in the four-decade history of this disease, but for all the headlines and the horrifying statistics, there is a great deal of misinformation about Ebola, and that persists. Because the virus has never actually been present in Canada, the facts about what Ebola actually is and how it spreads might not be top of mind for many Canadians. That's why earlier this month we announced that throughout November we're broadcasting a public awareness campaign to communicate the facts on Ebola and combat stigma. This includes the basics on what the virus is, how it spreads, and what people should do to be prepared.
What was of significant concern to me after speaking to the heads of our aid agencies was that many aid workers were returning home to Canada and not being treated like the heros they really are. The head of Doctors Without Borders was particularly concerned about how people in neighbourhoods were reacting to returning doctors, how hospitals were reacting, and even other health care workers were reacting to people who were returning.
The truth is that these people are putting their lives on the line at great personal risk, and the aid agencies are managing their health care workers with very rigorous rest periods and self-isolation. They're taking all the precautions necessary. The Canadian public needs to have the facts on the virus should there be a case of Ebola ever occurring here in Canada, but we also need to make sure that the public is well educated, and as a country we need to be prepared.
In terms of our preparedness, I feel quite reassured about the level of preparedness in the provinces and territories. I speak regularly with my provincial counterparts, and Dr. Taylor speaks almost twice a week with his counterparts. Our provincial colleagues feel very confident about their preparedness or their readiness. The Public Health Agency has now provided updated guidance to provincial and territorial health authorities.
Of course, they are responsible for training their health care workers, but we've really seen them step up to the plate and offer the necessary training to nurses and doctors. What I've said to the heads of the nurses union and nurses association is that if any of their members still feel vulnerable to step up and speak to the people in their organization, make sure that the training is offered and that it's hands-on training, not just a video, and that they feel completely confident putting that equipment on and taking it off. It seems to me from the feedback I've received that this is happening. People are speaking up should they feel they need more training and the provinces are working hard to make sure that training is available.
As I mentioned earlier, the Public Health Agency stands ready with all our expertise. Our five rapid response teams are ready to support the provinces should they have to receive a patient with Ebola. Our teams are ready to deploy at a moment's notice. We've been provided with the aircraft necessary to make sure we're able to get to any point in Canada should we need to do that.
We also have set aside $3 million for the provinces and territories to support them in their preparedness on the community side.
As committee members will appreciate, I want to thank my officials from the Public Health Agency. They've worked very collaboratively with the provinces and territories and with front-line health care workers. At every point that there have been any concerns, they have been invited in to be heard. We've done our very best to respond to everyone, whether it's the provincial-level officials or nursing associations. Even though nurses may not be our jurisdiction we wouldn't even think about not having them at the table. We've worked very hard to make sure everyone is included at every step in the guidelines we've been providing. We've communicated directly with not only the provinces and territories but with many front-line organizations as well so that we can support them directly.
We'll continue to take all steps necessary, and we continue to respond to requests.
Canada's response has been very significant and very effective, and it has been based on requests. As requests come in from the World Health Organization, such as for protective equipment, we'll continue to respond.
View Eve Adams Profile
Lib. (ON)
Thank you.
Let me move on to food safety, Minister. We had some wonderful news this morning as we opened up The Globe and Mail. Canada has tied for first place in food safety, along with Ireland.
It's of paramount concern to ensure that the food we're placing on the table before our families is safe. I can tell you that it's something I'm concerned about as a mom and that my girlfriends are concerned about as they prepare meals for their families.
Could you update us on Canada's food safety system and what the next steps might be?
View Rona Ambrose Profile
I'd be happy to, and I'd like to take this opportunity to congratulate Bruce on the number one position—no pressure on the head of the CFIA, but it's obviously great news. A lot of work has been done at the Canadian Food Inspection Agency over the last few years to continue striving to be the best.
It's obviously wonderful to be recognized. It doesn't mean that we won't stop working very hard, because this is an issue that matters to all of us, as you said. In the last budget, we reinforced our commitment to food safety by investing another $400 million to strengthen our food safety regime. We hope this will give our inspectors and those who work in this area the tools they need to continue to ensure that our food safety system remains the best in the world.
In addition to that, of course, our government has now invested more than half a billion dollars in various safety initiatives since 2008. These also include enhancing food inspection programs and hiring more inspectors. The significant funding being delivered through our economic action plan over five years is further strengthening our food safety system, and it will include resources to hire 200 additional food safety inspectors and staff.
We're also establishing the food safety information network, which is a network among federal, provincial, and territorial food safety partners and laboratories. What it does is it helps better protect Canadians from food safety risks by improving our ability to anticipate, detect, and respond to food safety hazards.
The funding will also—
View Hedy Fry Profile
Lib. (BC)
Thank you very much, Mr. Chair.
I want to thank the minister for the presentation. I've always felt that health is too important for us to play political, partisan games with, so I will start by congratulating the minister on what I consider to be now—in the past, the minister knows how I felt about certain of the Ebola initiatives—a very excellent response, including the vaccine.
The only question I have to ask with regard to that is this—and I'm going to ask the questions, and maybe you can answer afterwards, so that we can get a fulsome answer. Who did you consult with concerning the pause in visas? I know that the World Health Organization and many other public health officials felt that it created a bit of an anxiety in the public when you did that pause because they felt people would believe that travellers could in fact be a risk.
That's the first question I want to ask. Other than that, good work on Ebola, I say to Dr. Taylor and to you.
I also want to bring up the issue of marijuana. As you well know, I felt that the marijuana report.... We had a report that suggested that the study was very flawed, because you cannot look at risks without looking at benefits, and there was very little done to look at benefits.
We felt that much of the contradictory evidence that came from many of our expert witnesses was not reflected in the report. We also felt that there were a couple of pieces, including looking at some studies and some research that would eventually talk about risks and benefits and at long-term and short-term effects of marijuana both on youth and on others, that were very important things to do. That was not accepted as a recommendation. So we feel that the report leaves a lot to be desired.
What I want to ask, though, is very simply this. There are ads out there now, and I know that the minister is asking for more than $5 million to present the ads. Given what we heard in the testimony, that the evidence was not really out there suggesting that the long-term effects of marijuana use are so absolutely awful—we know the short-term effects—who did the minister consult when she put those ads out? Would she tell us who they were, list them, and table the list to the committee at some point in time?
View Hedy Fry Profile
Lib. (BC)
That's the second question.
The third question is about PHAC. Again, while I congratulate you on how well you have responded to Ebola—although we thought there was a bit of foot-dragging at the beginning, now I think the response is good—I wanted to know if you could tell us who you consulted when you created the changes in the chief public health officer's position within Health Canada.
Not that this has anything against Dr. Taylor or Ms. Outhwaite, but I do think that the concept of the chief public health officer having a deputy minister position was one that was studied really well as a result of some of the things that we found after SARS and after H1N1. This all came together with a lot of public health officials coming up with this particular way that Health Canada had existed, and now this change, I think, brings down the chief public health officer's ability to respond quickly to get the resources he needs. Currently that may work if he and Ms. Outhwaite get along really well, but when changes occur.... It shouldn't be personal; it should be objective.
I want to know who the minister consulted with. I have heard from many public health officers across the country that they think this is a bad decision, so I wanted to know who the minister consulted with. Could she table the list of people she consulted, because I do think it's a major problem?
Finally, actually, no, that's it. Those are the questions.
View Rona Ambrose Profile
Do I have time to answer?
The Chair: Yes.
Hon. Rona Ambrose: Okay.
Sure, I'm happy to answer.
Thank you for your compliment on the Ebola response. The Public Health Agency has worked very hard. We have tried, as a government, to.... I shouldn't say try, we've supported them in every possible way with any requests that they've had to make sure that they're able to respond appropriately, and we'll continue to do that.
On marijuana, who did we consult? I held a number of round tables that I'm happy to share with you. Actually, I think we put out a press release after the expert round table we had with researchers and physicians who have studied this issue for many years, addiction specialists. When I asked them, overwhelmingly their message to me was that the evidence is absolutely irrefutable. Of course, the same message has been made publicly by the head of the Canadian Medical Association, that the evidence is irrefutable about the harm of marijuana to youth and the developing brain.
I asked the researchers point-blank, “What can we as a government do? If you had your wish, what would you ask me to do to help you?” They said that we needed a national marijuana smoking cessation campaign, a national one. Kids don't know how harmful marijuana is to their health. Parents think it's the same as what they smoked 30 years ago. They have no clue about how this could harm their kids. We've seen psychosis; we've seen mental health issues.
I said, “Okay, we're going to try to do that”, and we did. We put together an awareness campaign, focused on the impact on the developing brain of youth. Health Canada did a lot of work with researchers to make sure that anything that was said in those campaigns was backed by research, and we can table that and give it to you should you want to see it. We can provide you a briefing. There's no question about the harmful effects of marijuana on the developing brain. The science is irrefutable.
To your point about people wanting to know what the benefits are, if there are any legitimate researchers who would like to do a clinical trial, I haven't met them yet. They haven't come forward to me and said, “We have the funds and the backing of a company or someone who wants to do clinical trials.” There's no evidence right now, and you know that from the recent report of the Canadian Family Physician and from the guidelines that are being given to doctors to prescribe marijuana across this country. We don't have the evidence that it's actually—
View Hedy Fry Profile
Lib. (BC)
Minister, I sat through the committee hearings. The recommendations from many of our experts was that we do research on the benefits and risks of marijuana, the short- and long-term effects of marijuana on the developing brain. There's only one study that said irrefutably that there were very long-term effects.
The idea of saying that the CMA, etc.—and I think that's unfair to them—have decided that you should do this ad, when they refused to do the ad with the Ministry of Health—
View Rona Ambrose Profile
—that the president of the Canadian Medical Association is on the record saying, “especially in youth, the evidence is irrefutable—marijuana is dangerous.”
What I'm telling you is that I think the experts told me loud and clear what we needed to do, so we have a public awareness campaign to support parents who are struggling with trying to help their kids get off marijuana.
View David Wilks Profile
Thank you very much, Mr. Chair.
Thank you, Minister, for being here today.
I'll go down that same road with you, Minister, with regard to Health Canada and their running of a series of TV ads warning children and parents about the serious health risks involving both prescription drug abuse and smoking marijuana.
As MP Fry has indicated, the committee recently concluded our study on the serious health risks and harms of smoking marijuana, in which we recommended that a public awareness campaign be undertaken. During that study we heard from doctors and researchers on the serious and harmful effects associated with marijuana use, especially on teens.
Could I add that in my previous career I did three years of drug work, predominantly on marijuana? I can rest assured that not only with regard to teens, but well beyond that, there are some significant problems and we need to deal with them. So I'm very happy to see that we ran this series of TV ads.
Could you update the committee on how this campaign has been received?
View Rona Ambrose Profile
It's interesting, because someone approached me the other day and said, “I didn't know that marijuana is so much stronger today than it was when I was a kid”. In fact, there are experts who think that we've underestimated, and that it's actually much stronger, but we used very credible researchers, very credible experts, to ensure that what is in these ads is completely defensible. I'd be happy to share any of that information from Health Canada.
I commend Health Canada for doing this. I don't think we've had an anti-marijuana smoking-cessation campaign for a.... Well, I don't even know if we've ever had one in Canada. What we know, I think it's from UNICEF, is that our kids are smoking more pot per capita than anywhere in the world. We know that the experts are saying very clearly that it's harmful to the development of their brains. That's not only in terms of mental health issues, but serious mental health issues such as psychosis and the onset of schizophrenia.
I could give you reams of documents from very credible experts who say the same thing. The former head of the CMA said it's dangerous. The current head of the CMA said, “Any effort to highlight the dangers, harm and potential side effects of consuming marijuana is welcome”. Addiction specialists are struggling, people who are dealing with these kids in their offices are struggling, and rehab specialists are struggling.
Kids are using more and more of this. People are putting it in the form of candy now, and giving it to kids in grade school. I mean, this stuff is more addictive. This is not the pot of the 1960s, and it's really difficult for parents because they're up against the idea that it's normal, that it's like smoking cigarettes, and that it's not as harmful as alcohol. Well, alcohol is harmful; smoking cigarettes is harmful. We have smoking-cessation campaigns for tobacco. We don't want people to drink a lot. We have all kinds of ad campaigns about alcohol abuse, yet somehow we're not supposed to have an ad campaign about kids smoking pot. It's nuts.
I can't believe the reaction of people from a partisan point of view. This is based on science. Parents are struggling with their kids, who are clearly being impacted mentally and physically, and it would be irresponsible for us not to do a public awareness campaign. So I think in the face of accusations where the Liberals are normalizing marijuana so that somehow this is a partisan campaign, this is absolutely ludicrous. It's based on science, it's necessary, and we'll continue with it.
View David Wilks Profile
Thank you very much.
Prior to the marijuana study, we did a study on Vanessa's Law, on which I must congratulate my colleague Terence Young for his admirable work and years of getting it to where it got to. We heard testimony from several witnesses who are experts in the field of drug safety on the need to ensure that Health Canada shares information in an open and transparent manner.
As a former police officer, I know that there are a number of inherent risks present in many drugs, including those that are freely available over the counter. That is why I was very pleased to be part of the committee's deliberations on Vanessa's Law and of amending the legislation to include a greater degree of transparency.
Can you update the committee on what is being done to ensure that drug safety information is being made available to those who need it?
View Rona Ambrose Profile
Sure, but here is just one more thing about marijuana.
It's really important that everyone, as health committee members, remember that marijuana is not an approved drug in this country. It has never gone through any rigorous approvals or scientific clinical trials to show that it is safe to take as a medicine. Let's all remember that. Think about it as health committee members. It's very difficult, because that message is out there, and kids have a sense that somehow it's safe because it's “a medicine”, whereas it has never gone through any approval processes at Health Canada, is not an approved drug, and is not an approved medicine.
Going back to your question about Vanessa's Law, I again commend the committee and all members of Parliament who worked so hard in a multi-party, non-partisan way to make these important improvements.
The legislation, as you know, updates the Food and Drug Act for the first time in 50 years, something which is incredibly important. The sound amendments that were made by the committee..... Again, I want to thank each and every one of you for having been a part of this achievement. You laid it out quite well. Nowhere is confidence and transparency more important than in the decisions made that affect the health and safety of Canadians.
Vanessa's Law will ensure that additional details on Health Canada's drug approval process are made public, concerning both those that receive approval and those that do not, which was, I know, an important point brought to light when the legislation was first tabled. I was happy the committee was able to amend it.
We now have a world-leading regulatory transparency and openness framework and action plan, and I will continue, as I said, to work with Health Canada to further our transparency in the way we approve drugs. I'm very pleased to report that, as of November 5, Health Canada has posted a list of all of its inspections of drug manufacturing plants over the past three years, something that I know Canadians were looking for. I applaud them for their level of transparency.
View Matthew Kellway Profile
Thank you, Mr. Chair.
Thank you, Minister, for coming today and spending some time with us and answering questions. I have two questions for you today. Let me set them both out and leave you to determine how to judge your response times.
The first has to do with the Mental Health Commission of Canada and mental health as an issue that we need to deal with. Of course, Minister, our job in the opposition is always to be critical, but when asked whether I can say something good about the government I always happily refer to the Mental Health Commission of Canada. It's accomplished a great deal in a very short period of time. It's put in place a national strategy, as you know, and has moved beyond that to do a lot more in terms of policy and best practices and training, and so on.
But the issue, Minister, as you know, is not going away. One in five Canadians is living with mental illness and it's costing our economy $50 billion a year, and it's anticipated that those costs are going to rise significantly as we move forward. It's time and the Mental Health Commission of Canada has asked to put in place a renewed mandate to turn their strategy into an action plan and extend the funding to support a new mandate for the Mental Health Commission of Canada. So my first question is this. Will your government do that, extend the mandate of the commission, and of course provide funding to support that mandate?
The second question has to do with food labelling. We know that chronic diseases are the leading cause of death and disability in Canada and are among the most costly but also preventable diseases. We know that part of that equation is an unhealthy diet and that they are in fact a public health risk to Canadians with 60% of adults suffering from obesity and nearly a third of kids. We know that Canadian diets do not meet national recommendations. We also know that your department has put forward some recommendations or proposals with respect to food labelling, but those proposals seem to have some glaring omissions to us.
First is that they continue to give, on the front of food packaging, priority to the marketing claims of the producer as opposed to nutritional information. Second, the labelling doesn't deal with added sugars, and we know that research is showing that excess sugar from added sugars can triple the risk of dying from heart disease. Lastly, we ought to have on those labels standardized serving sizes that actually reflect consumption, so that we don't have to reach for calculators to figure out what it is we're actually taking in.
Have your proposed changes to food labelling gone through, been approved, or are they outstanding? Depending on your answer to that, will you make some further changes to those proposals or why didn't you include these three issues in your proposals?
View Rona Ambrose Profile
Sure. Maybe I can get more specifics from you offline, but standardized serving sizes is one of the things that we're looking at and we went out to consult with Canadians at large and then also to consult with health groups. In the industry we've done focus groups. The consultation is just wrapping up. But by all means, if you have some ideas you want to share with us we're happy to take them. But standardized serving size was something we heard loud and clear about from people. I use the example of one of my staffers who said when she buys two different brands of perogies, one serving size is six and one serving size is two. Trying to figure out the calorie content—and who eats two perogies, nobody does—it's very confusing. When you're buying bread it's by one slice. Normally people eat two.
People want consistent, realistic, relevant serving sizes to what they actually eat, so we've been looking at that and I hope we can make progress on it. Sugars is a big one. We heard that loud and clear from moms—I say moms, because moms apparently do almost all the shopping as we found out through a lot of questions—and they said loud and clear they want to know about added sugar and how much sugar is in the food. So that was one of the things we had on our proposed label change.
In terms of front-of-package labelling, I might ask Bruce to speak a bit to that. But if a company or a manufacturer does make a health claim they do have to come through Health Canada. They have to show evidence of that health claim if that's what you mean. If it's just marketing, different kinds of marketing.... Do you want to be more specific, maybe?
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