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Suzy McDonald
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Suzy McDonald
2019-06-18 11:47
I did hear the question. Thank you very much.
I don't have the breakdown by province, but I can talk to you a little bit about how it works. I'll just note that this is the Canada health transfer for which the main estimates has over $40 billion estimated.
Essentially, this program grows in line with a growth track. We do a three-year moving average on the gross domestic product, with funding to increase by a guaranteed amount of 3% every year. For 2019-20, that growth is 4.6%, which is in line with that growth track.
This funding is flexible. It goes to the provinces and territories. It's block funding; they can use it as they want, although we do have conditions associated with it, and it is allocated on a per capita basis.
In addition to this amount—and it might be what you're referring to as well—there is funding that is provided through Health Canada that in a previous year came through Finance Canada's budget as a one-time payment, but the funding for home care services and mental health services is included in Health Canada's budgeting process.
Greg Carreau
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Greg Carreau
2019-06-06 8:56
Thank you, Madam Chair and members of the committee.
Good morning. My name is Greg Carreau and I'm the director of the water and air quality bureau at Health Canada.
I would like to begin by acknowledging that the land on which we are meeting today is on the traditional and unceded territory of the Algonquin nation.
I welcome the opportunity to discuss Health Canada's role in protecting Canadians from environmental risks to health. I will speak to the department's activities and expertise related to mercury and contaminated sites, first in general, and then as it relates to Grassy Narrows. Health Canada works closely with Environment and Climate Change Canada to protect the health of Canadians from environmental contaminants such as mercury through our chemicals management plan. This work is accomplished under the Canadian Environmental Protection Act, 1999, which provides the authority for the federal government to take action to address harmful chemicals.
Mercury poses a host of human health risks. The health risks of mercury depend on its chemical form, route of exposure and the level of exposure. Mercury in its organic form, methylmercury, bioaccumulates up the food chain—for example, in fish—and is absorbed through the digestive tract and distributed throughout the body. It readily enters the brain, where it may remain for long periods of time. In pregnant women, it can cross the placenta and into the fetus.
A child's developing nervous system is particularly sensitive to mercury. Effects can include a decrease in IQ, delays in walking and talking, blindness and seizures. In adults, extreme exposure can lead to personality changes, changes in vision, deafness, loss of muscle coordination and sensation, intellectual impairment and even death. Cardiovascular, renal and carcinogenic effects have also been observed.
The federal government has taken action to reduce levels of mercury and risks to health. A wide range of regulatory and non-regulatory initiatives have effectively reduced mercury emissions in Canada. Since the 1970s, domestic sources of mercury emissions have been reduced by approximately 90%. Global efforts are also important, and Canada ratified the Minamata Convention on Mercury in 2017, a global treaty to reduce mercury emissions and exposures.
Today, methylmercury exposure in Canadians is often linked to eating fish. Health Canada establishes standards for the amount of mercury permitted in retail fish. To further reduce exposure, Health Canada provides advice to Canadians on the consumption of certain types of fish known to contain higher levels of mercury.
Health Canada has undertaken research to evaluate the levels of mercury in Canadians. The Canadian health measures survey collects information from Canadians about their health and includes measurements of chemicals in blood and urine. Results found that over 99% of Canadians sampled had levels of mercury below the established methylmercury blood guidance levels. When levels of methylmercury in blood are below the guidance value, no negative health effects are expected.
Regarding the health risks of contaminated sites, Health Canada participates in the federal contaminated sites action plan. Health Canada's role is to provide expert advice, guidance, training and tools on the assessment and mitigation of health risks. The historical source of the mercury contamination that impacts Grassy Narrows First Nation has not been part of the federal contaminated sites action plan.
Health Canada has had historical involvement in evaluating the human health impacts of mercury contamination in the river system of the English and Wabigoon rivers. Beginning in the 1970s, Health Canada has been investigating the impacts of mercury on the residents of the Grassy Narrows and Whitedog communities. This work was carried out by Health Canada's first nations and Inuit health branch, which was transferred to Indigenous Services Canada in 2017. My colleague from Indigenous Services Canada described these activities earlier.
The residents of Grassy Narrows First Nation have been exposed to elevated levels of mercury resulting from past industrial practices. Health Canada is committed to continuing to work with partners to address the health risk posed by mercury, including our scientific expertise and any future collaborative action with Grassy Narrows First Nation.
I wish to thank the committee for the opportunity to appear today.
View Kevin Waugh Profile
Thank you.
Thank you to all of you for coming here today.
Dr. Wong, you said there was still poisoning going on in the community.
Mr. Carreau, in your remarks, you noted that mercury poses a host of human health risks, including for the brain and pregnant women. It can cross the placenta into the fetus.
Health Canada refused to reveal the names of 150 residents who were identified at birth. The umbilical cord blood of babies was tested for 22 years, from 1970 to 1992, and 357 infants on reserve had testing data that sat somewhere. Some of it was, they said, in bank boxes in Thunder Bay and Ottawa. The information was slow and at times never even passed on.
If we're still having issues today, has this improved situation improved at Health Canada and your departments?
Tom Wong
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Tom Wong
2019-06-06 9:29
Perhaps I'll ask Jennifer Mercer, the director of the program, to speak to that.
What you described was something in the past. However, the department has spent a lot of time working with ethicists at the research ethics board and the community and has poured in additional resources in order to hand search all of the historical documents from the past 40 years and provide those to the communities in boxes, literally.
I'll turn to Jennifer Mercer for the details.
Jennifer Mercer
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Jennifer Mercer
2019-06-06 9:30
You're right. There's over 50 years of historical data in approximately 100 banker boxes. This data is owned by the individuals who were tested. This personal medical information has been released to the individuals who were tested. If you have an individual who, for example, was born to a mother whose cord blood was tested at the time of birth, the cord blood data was released to the mother.
Throughout the past 50 years, we've had ongoing requests from community members to get access to their personal medical information. I've been in the position for about two years, and I've had 40 or 50 individuals who have asked for their personal medical information. That information has been released upon request to the individual, or, depending on how they sign the consent, to the person with whom they want to share the information, such as a researcher or a physician. It is an individual's personal medical information.
That said, since, I think, the mid-1970s, upon request by researchers who had the support of the community, we have been releasing this data, and this data has been going to the researchers in a de-identifiable format. That means it doesn't have a date of birth or a name. You cannot identify who the individual is, but we have been releasing that data when requested.
We need to make sure that we protect individuals' personal medical information, and we have to respect the Privacy Act. If we released data without the appropriate measures in place, we'd be not in keeping with the Privacy Act.
View Bill Casey Profile
Lib. (NS)
Welcome, everybody, to meeting number 148.
We are going to have a little chaos today with the votes and everything. I managed to meet with the minister on the way in and I asked if she would forgo her opening statement to allow for more questions. She said to table the statement. I appreciate that very much.
However, before going to questions, we'd like to invite the minister to say some opening words.
Simon Kennedy
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Simon Kennedy
2019-05-28 16:43
I realize there is limited time so I won't run on, but there are essentially two different kinds of activities that we conduct with regard to medical cannabis.
Tolga Yalkin
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Tolga Yalkin
2019-05-27 12:09
Certainly, Mr. Chair. I'm Director General of Consumer Product Safety at Health Canada.
David Lee
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David Lee
2019-05-06 16:13
Thank you, Mr. Chair.
Subdivision C would amend the Food and Drugs Act to optimize patient safety, but to enable innovation.
Clause 164 would introduce a more organized way to determine classification. Right now, products can fall under more than one definition, such as a food and a drug, or a device and a drug. This would help increase transparency and cause the minister to consult. It would also reduce, especially for innovative smaller businesses, the uncertainties when you have to choose which pathway to take.
Clause 166 would introduce measures to modernize our clinical trial structure. Many advanced ways of conducting clinical trials are being developed. This will be especially good for physician-led research for our children with cancers. It would also include new abilities for clinical trials in foods such as infant formulas and hospital-given foods, for example, through a feeding tube. Right now, companies have to do those clinical trials in other countries because they're not enabled here.
Clause 169 and on would introduce a new pathway for advanced therapeutic products. This is very important because science and technology is really multiplying the developments that we're starting to see, a lot of in-hospital manufacturing of devices that can be embedded with cells. This is for a regulator to be very agile, and look after the safety but make sure we can tailor the requirements through what this pathway is intended to do.
Perhaps I can pass the floor to my colleague to go over the inspection measures.
Greg Loyst
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Greg Loyst
2019-05-06 16:15
Thanks for the opportunity to provide a brief overview of clauses 170 and 171, which deal in particular with the powers of inspection.
We work in an increasingly complex world, and technology is evolving at unprecedented speed, but our powers of inspection have not kept up with the pace of those developments.
The proposed amendments would clarify some of the powers conferred by the act and grant inspectors modern powers to enforce it, which would make it possible to adopt more flexible and adaptable approaches.
The proposed amendments are really intended to help us better protect the health and safety of Canadians. These are in keeping with powers that you would find in other modern federal legislation, including many of those acts that are administered within the health portfolio.
What I'll do is quickly run through some of the highlights of the authorities that we're seeking.
The proposed amendments would allow inspectors to order a person to provide an inspector with any document, information or sample specified by the inspector. This could be done without the inspector being on site. They would add electronic data to the list of records or documents that could be examined, by giving the inspector the ability to reproduce this electronic data or use a computer system or a means of telecommunication at the place being inspected. They would allow things like the inspectors taking photographs or making recordings and sketches during an inspection. An inspector would be able to examine, test or take samples of anything in the place being inspected, or remove anything from the place being inspected for those purposes.
Inspectors would be able to cause a person to identify themselves to the satisfaction of the inspector in the place being inspected. The inspector would be able to order a person to move or stop a conveyance for the purpose of inspecting that conveyance, or if a conveyance is blocking access to products in a warehouse, for example, to move that conveyance so that the inspector could get at it.
It would also allow an authority to pass through or over private property. This would not include a dwelling house. The sanctity of the home would remain. The only two ways we could get into a home would be with a warrant or with the consent of an owner, but this would allow us to pass over private property to execute our functions.
I'd also like to mention that in clauses 173 to 175 you'll find the offence provisions. What's important to note is that where there is a duty created by these new authorities, it would fit within the existing infrastructure of the offences that are currently in the act, so there is no increase to penalties or offences. In those clauses we've really just aligned the provisions that we're seeking here with the existing infrastructure of the penalties.
That's it.
Tolga Yalkin
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Tolga Yalkin
2019-05-06 16:40
Good afternoon, ladies and gentlemen.
To give you some context, Canadian law requires businesses to disclose on their labels the ingredients used in chemical products sold for use in the workplace.
That said, some companies consider their formulas trade secrets, and accordingly, they can file a claim to exempt a chemical product from the requirement to disclose its ingredients on the label.
When a company makes such an application to Health Canada, we review the other information that a company plans on providing a worker on the chemical product in question, including the hazard symbols, the precautionary statements and the first aid treatment in the case of exposure. We review that information obviously to make sure that it is sufficient and accurate to keep workers safe.
The proposed measures, although not radical, would make minor improvements to our process for considering the claims businesses make that their chemical formulas not be disclosed.
The first is removing the requirement that Health Canada be the guarantor of the information they do plan on providing workers on their chemical products as required by the law.
The second is replacing the Canada Gazette process for publishing individual product notifications with an online system. I want to stress that this is not about eliminating the gazetting process for new regulations. That would remain. Rather, it's about individual product notifications. That we are still gazetting these, I think, is really a reflection of the fact that the act in question was conceived of over 40 years ago, a time in which gazetting was really the only way to communicate to companies such notifications.
Other similar notifications you might be interested to know about, as well, for which Health Canada is responsible, such as relating to natural health product licences, drug sale authorizations and novel food safety assessments, for example, are not gazetted but are presented online.
The third is eliminating a heavy and cumbersome appeal process and leaving any disputes to be dealt with by way of judicial review.
The fourth is providing for more graduated sanctions for non-compliance.
The fifth is providing the Minister of Health with the authority under a very narrow set of circumstances to disclose chemical formulas where there is a serious or imminent danger to human health or safety.
That concludes my remarks, Chair, and I'm happy to take any questions.
Jason Flint
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Jason Flint
2019-05-06 16:54
Mr. Chair, clauses 217 to 219 propose changes to improve efficiency and remove some duplication in the Pest Control Products Act.
Just as a background, pesticides in Canada are regulated by Health Canada to protect health and the environment. Products undergo a pre-market scientific risk assessment before being authorized. Once registered, products are subject to cyclical re-evaluations. They're also subject to special reviews if new information comes to light about a registered product.
The issue revolves around the Pest Control Products Act, which requires a special review to be conducted every time another OECD member country removes all uses of a pest control product for health or environmental reasons. The way this is written, it can result in multiple reviews of the same issue having to be conducted, often at the same time.
The amendment proposed would allow Health Canada to combine multiple reviews into one special review, or to examine the issue as part of an ongoing special review or re-evaluation, provided it could be incorporated early enough in the review process to allow for a scientific assessment and consultation on the decision, or in some cases, not to conduct a review at all, if the basis of the foreign decision had already been considered previously by Health Canada and there was no new information.
In summary, this should provide some savings for both government and industry, if we can remove the requirement to do these duplicate special reviews.
Remington Nevin
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Remington Nevin
2019-05-01 15:47
Thank you, Mr. Chair, and thank you, members of the committee, for inviting me here today.
I'm Dr. Remington Nevin, and I'm the executive director of the Quinism Foundation, which is a Vermont-based non-profit organization. Our mission is to support and promote education and research on the medical condition known as chronic quinoline encephalopathy, otherwise known as neuropsychiatric quinism. This is the medical condition caused by poisoning of the central nervous system by mefloquine and related quinoline anti-malarials.
I last provided evidence to this committee in December 2016 in the form of a written brief on the topic of mefloquine, and in that brief I commented in part on what were then the recent changes to the Canadian mefloquine product monograph updated in August of that year. The monograph was subsequently updated again in, I believe, September 2017, following the publication of both the Canadian Forces surgeon general report on mefloquine and the Health Canada report on mefloquine. It is the language from this most recent update that I will refer to in my testimony today.
The current Canadian mefloquine product monograph now warns physicians and other prescribers, in bold typeface, that:
Patients should be advised to consult a healthcare professional if any neurological and/or psychiatric symptoms occur during the prophylactic use of mefloquine
—for the prevention of malaria—
as healthcare professionals may have to discontinue mefloquine and prescribe an alternative medicine for the prevention of malaria.
The monograph further clarifies, in a boxed warning, that not only may mefloquine have to be discontinued, but that “mefloquine should be discontinued” and an alternative medication substituted if psychiatric or neurologic symptoms occur during prophylactic use.
The updated monograph then also makes clear that:
Psychiatric symptoms ranging from anxiety, paranoia...and depression to hallucinations and psychotic behavior...can occur with mefloquine use. Symptoms may occur early in the course of mefloquine use and on occasion...these symptoms have been reported to continue long after mefloquine has been stopped.
The monograph then also makes clear that:
In a small number of patients it has been reported that dizziness or vertigo and loss of balance may continue for months or years after discontinuation of mefloquine, and in some cases vestibular damage may be permanent.
There are several important points being made in this approved labelling, which has been approved by Health Canada and, therefore, presumably are being agreed to by Health Canada.
The first point being made is that there is an acknowledgement by Health Canada and the product's manufacturer that in some cases there are long-term psychiatric and neurologic symptoms that result from mefloquine use. The assumption in the labelling is that there is a likelihood of these symptoms being causal, meaning caused by the drug, and not merely associated with its use. To be clear, this causality is really not disputed by experts. There is broad consensus among international drug regulators on this fact. There's good evidence from the medical and scientific literature and from the accumulated pharmacovigilance data—meaning the adverse-event reports—that symptoms such as insomnia, abnormal dreams, nightmares, anxiety, depression and cognitive dysfunction, among other psychiatric symptoms, for example, can continue for years after use of the drug. That's the first point.
The second point being made by this updated language is that there's also tacit acknowledgement by Health Canada and the drug's manufacturer that to reduce the risk of these long-term symptoms, mefloquine should be discontinued at the onset of any psychiatric or neurologic symptom. This is made clear by the additional language in the monograph, that:
During prophylactic use, if signs of acute anxiety, depression, restlessness or confusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must be discontinued and an alternative medication should be substituted.
It should be clear, given the other language in the monograph, as well as international drug labelling, that these specific symptoms—the acute anxiety, depression, restlessness or confusion—should be considered illustrative and not exclusive. For example, the European drug labelling makes clear that abnormal dreams, nightmares and insomnia should also require the drug's discontinuation. I believe this is clear from the Canadian product monograph language as well.
For the purposes of this committee’s mandate, these two points have profound implications for the care of Canadian veterans, tens of thousands of whom since the 1990s have been exposed to mefloquine, in most cases without the benefit of these enhanced warnings.
One obvious and profound implication is that for those Canadian veterans who were ordered to take mefloquine prior to these warnings appearing in the product monograph, and who were therefore not told to discontinue the drug at the onset of any psychiatric symptoms, there is an increased risk that they experienced the “more serious event” that these psychiatric symptoms are considered prodromal to. To be clear, this more serious event is in fact the development of the long-term psychiatric and neurologic symptoms that in some cases can contribute to disability.
This then raises the question: what is being done systematically by Veterans Affairs Canada and others to identify those veterans who did in fact develop these long-term psychiatric and neurologic symptoms as a result of their use of mefloquine? The answer appears to be nothing. As a result, in a recent letter to the former Minister of Veterans Affairs, we called upon VAC to implement a program to screen veterans for a history of symptomatic mefloquine exposure, meaning those veterans who not only recall having taken mefloquine but who recall having experienced those symptoms that are specifically listed as being prodromal to the more serious event, which we understand is a euphemism for the development of disability from the drug’s use.
Unfortunately, what we received in reply from the current minister was a very unsatisfying response, which suggests to us that VAC is not taking this issue seriously. I'd be happy to share this response for the record on request.
As we noted in our original letter to the veterans affairs minister, we believe that screening veterans “for symptomatic mefloquine exposure is a necessary first step to raising clinicians’ awareness of the prevalence of mefloquine poisoning among the recent Canadian veteran population”. We also believe that screening will permit VAC to more accurately and validly “estimate the total number of veterans exposed to mefloquine” and “how incomplete prescribing documentation may be”. We also believe that this will permit VAC to estimate “how many veterans may be suffering disability who may become eligible for disability compensation” as a result. As we noted in our original letter, our organization would be pleased to work with VAC to help implement such screening in this population.
That concludes my prepared testimony. I would be very pleased to answer any questions the committee members may have. Thank you.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2019-02-07 9:48
Thank you very much.
My question is for Brian and MEDEC.
In December, Health Canada released its action plan on medical devices. It had three principal focuses. In part, it came out of the concerns that some media had with complications from some devices.
First—and you've commented on it—is improving how medical devices get to market. Your presentation really hit on that, and the advice that you've given appears to be heard well by Health Canada.
There are two other areas, though. One was strengthening monitoring, and following up that would include increasing inspection and enforcement by Health Canada regulators. The second was improving information to Canadians. Right now, if there's an incident with an existing licensed piece of equipment, it requires an FOI request to get that information released. Health Canada is looking at, I believe, creating a database of information so that Canadians can more readily access it.
Could you comment on those latter two areas of focus by Health Canada to improve safety for Canadians?
Brian Lewis
View Brian Lewis Profile
Brian Lewis
2019-02-07 9:49
I'll start on it, then Diana will finish.
What we found with Health Canada, with everything that was identified when the International Consortium of Investigative Journalists was looking at this, is that 80% of the work that the consortium was indicating needed to be done, Health Canada had already started. They were well ahead in the process, realizing that there was a need there for all the things you're talking about.
Diana, you have some of the specifics.
Diana Johnson
View Diana Johnson Profile
Diana Johnson
2019-02-07 9:50
To your point about the surgical database, that went online just at the end of last month, which was actually much sooner than predicted in the action plan. It had quoted December of this year for that to be available.
We know that Health Canada had been working on that database for a number of years and we're really pleased to see that it managed to get brought forward as a result. So that's already in play.
With regard to the inspections, that is a concern, based on what we said earlier. The number of audits, especially for small businesses, can be very stifling because you're using the same resources that you would be using for your innovative product development as well.
We don't know any of the details that are being proposed yet with regard to that. We don't know whether it's more to increase foreign inspections, which is a good thing, or whether it's to increase local inspections, which we're already having a lot of. There is a grey area where we don't know what the plan is as yet.
Abby Hoffman
View Abby Hoffman Profile
Abby Hoffman
2019-01-31 15:28
Thank you.
Good afternoon. Thank you for the opportunity to appear in front of you on this important issue.
I want to begin by acknowledging that the land we are meeting on today is the traditional and unceded territory of the Algonquin nation.
I, like everyone else, have been very concerned about the reports we've all heard of indigenous women being coerced into undergoing sterilization procedures. It is unacceptable that this could happen to any woman anywhere in Canada's health care system. Forced or coerced sterilization is a serious violation of human rights and medical ethics. It's a form of gender-based violence and evidence of a broader need to eliminate racism and discriminatory practices that may exist within our health system.
Unfortunately, there is a documented history of compulsory sterilization in Canada linked to a broader eugenics movement in the 1900s. Institutionalization, regulation of marriage and sterilization were social controls in place in some parts of the country. While these practices were codified in law in some provinces, we know that sterilization without appropriate consent occurred in other parts of the country as well. Women with intellectual disabilities and marginalized, racialized and indigenous women were often the victims. Several well-known academics, including Dr. Karen Stote and Dr. Erika Dyck, have documented this history in detail.
Recent media reports of indigenous women undergoing coerced sterilization procedures suggest that these injustices may have occurred long after laws allowing forced sterilization were repealed. The scope of the issue has not been documented comprehensively, aside from the work of now Senator Boyer and Dr. Judith Bartlett.
It's the responsibility of all players in the health system to ensure that patients have access to health services that are free from bias and discrimination. The Government of Canada takes this obligation seriously. We know that indigenous women, along with other vulnerable women impacted by poverty, mental health, addiction issues and so on, also struggle with bias and safety in the system.
Just as an example, in 2016 Women's College Hospital, following a period of study of over six years, released a report entitled “A Thousand Voices for Women's Health”. It documented how women from diverse communities feel they were treated, and expressed their expectation for services that are responsive to and respectful of individual identities, cultures, and social circumstances, and that are non-judgmental.
We know that in Canada no one level of government has exclusive jurisdiction over health care. It's a complex system of shared jurisdiction, where both the federal government and the provinces and territories have important responsibilities. The federal government, for its part, has important roles to play in ensuring the health and safety of Canadians, making financial contributions to the Canadian health care system through the CHT and setting national standards for health care through the Canada Health Act. Provincial and territorial governments have the primary responsibility, of course, for day-to-day management, organization and delivery of health care services. Each jurisdiction has created its own health care system, but based on common principles.
As part of their responsibilities to administer and deliver health care services, each province and territory has laid out, through statute, its frameworks for oversight of health care professionals by self-regulating bodies. These bodies are responsible for reviewing and responding to complaints against health care professionals under their authority, and for disciplinary action when warranted.
Provinces and territories also have the authority to regulate matters related to a patient's consent for medical treatment. The concept of informed consent has evolved over time. It's complex. The processes for making decisions on treatments that were once almost entirely the domain of providers have shifted over time to greater consideration of the views of patients. Informed consent today is about ensuring that the patient has the information and the capacity to make an informed decision based on the advice and counsel of their health practitioner.
Informed consent means that a patient has received information about the nature of the treatment that's proposed, the expected benefits, risks and side effects, alternative courses of action, and the likely consequences of not receiving treatment. But the consent also has to be valid. For the consent to be valid, the consenting individual must have the capacity to make an informed judgment and to provide their consent voluntarily.
Studies involving women consenting to gynecological procedures show that patients frequently describe feeling compelled to sign a consent form despite their preference not to undertake a procedure. ln a study by Hall, Prochazka and Fink, published in the Canadian Medical Association Journal in 2012, 30% of women consenting to surgery reported that they did not think they had a choice about signing the consent form, and 88% of the respondents perceived the form as strictly administrative. This suggests there are some significant shortcomings in practitioner communication with patients on matters of consent and that how and when consent is obtained from women is important.
All jurisdictions have a role in ensuring that health care services are delivered in a manner that is free from discrimination, no matter where those services are delivered, and no matter who provides the service. The federal government can and does play an important role as catalyst for health care system improvements and for supporting collaboration among multiple players and stakeholders on critical issues.
In just a minute, my colleague from lndigenous Services Canada will elaborate on a number of areas, but I want to speak briefly to our plans specific to improving cultural safety.
Our plan is consistent with the government's overall commitment to advancing reconciliation with indigenous peoples and implementing the Truth and Reconciliation Commission's calls to action. Specifically, calls to action 23 and 24 ask all orders of government to support “cultural competency training for all healthcare professionals” and the calls directed to medical and nursing schools ask them to require that all students have “training in intercultural competency, conflict resolution, human rights, and anti-racism”.
On December 11, 2018, the Minister of Health and the then minister of indigenous services wrote to provincial and territorial ministers and to health professional organizations, among others, seeking their collaboration on and participation in a federal-provincial-territorial working group. Health Canada is taking a leadership role and will partner with provinces, territories and health organizations to take actions that we hope will lead to a significant cultural shift in the Canadian health system; that is, a shift to a system that supports efforts to prevent discriminatory practices and increases access to culturally safe health services for indigenous peoples.
This March, Health Canada will convene provincial and territorial partners to begin discussing areas for collaboration on measures to increase cultural safety in the health care system. This group will work closely with indigenous partners, women and health professional organizations. We expect the federal-provincial-territorial group to build on the good work already under way across the country and to identify opportunities for action in areas such as awareness raising and training.
By way of example, in British Columbia, which is among the most advanced jurisdictions in the country, extensive cultural safety training has already been delivered to providers, administrators and policy-makers throughout the province. Health authorities, institutions, provider organizations and so on in other parts of the country have other initiatives under way as well.
We will collaborate with indigenous partners and governments at the national and regional level and with professional colleges and health organizations. Fortunately, there are opportunities to learn from the experiences of groups who've championed the objective of non-discrimination for some time, such as, for example, the First Nations Health Authority in British Columbia, which has a vision of hard-wiring the concepts of cultural safety and cultural humility into the delivery of health care services.
We know that improving health outcomes, increasing access to culturally appropriate health services and programs and addressing the social determinants of health are high priorities for indigenous leaders and communities across the country.
I believe that the work we are undertaking will increase the level of cultural safety within the health care system, lead to improvements in the quality of service and contribute to reconciliation.
I thank you for the opportunity to make these short remarks. Following my colleague's remarks, I would be pleased to attempt to answer your questions. Thank you.
View Ginette Petitpas Taylor Profile
Lib. (NB)
Thank you very much, Mr. Chair.
Good morning, everyone, and thank you so much for inviting me to the Standing Committee on Health.
It's truly important for me to be here today to discuss with you the supplementary estimates (A) for the year 2018-19. I always welcome this opportunity to highlight some of the priorities and to discuss our efforts to keep Canadians healthy and safe. As always, I'm grateful to the committee members for your contributions to discussions, and I look forward to answering your questions.
Before I begin, I would also like to thank my officials who are accompanying me today.
They are Mr. Simon Kennedy, deputy minister of health; Dr. Siddika Mithani, president of the Public Health Agency of Canada; Dr. Theresa Tam, chief public health officer and from the Public Health Agency of Canada; Monsieur Michel Perron, vice-president of external affairs and business development at the Canadian Institutes of Health Research; and last but not least, Mr. Paul Glover, the president of the Canadian Food Inspection Agency.
They are masters in their fields and I am always happy when they accompany me at committee here. Also, I may turn to them for details with respect to some of the questions.
First, I would like to speak to Health Canada's authorities. Through the supplementary estimates (A), we are asking for an increase of $33.5 million. This would raise Health Canada's total authorities to just under $2.4 billion. This increase in funding would allow us to deliver on key priorities of the Government of Canada. I will describe these for you now, starting with opioids.
As Minister of Health, the first file that I was briefed on as Canada's health minister was the opioid crisis.
Since 2016 this crisis has claimed the lives of over 8,000 Canadians. This is a national tragedy that must be stopped, and it's why our government has taken action to save lives and to turn the tide on this national public health crisis.
So far we have restored harm reduction to the core of our approach and opened more than 25 supervised consumption sites. We have implemented the emergency treatment fund through budget 2018, and we are working to reduce stigma, which is a barrier to health and social services for people who use drugs, through public education.
Nevertheless, the opioid crisis continues to take lives and devastate communities. We must do more, and we will do more. These enhanced efforts include Health Canada's substance use and addictions program, which provides more than $28 million annually to support initiatives that work to prevent, treat and reduce all forms of harm from problematic substance use.
As a part of these estimates, this program has realigned $7.3 million to help address the opioid crisis.
Let's turn now to cannabis.
To support the legalization and regulation of cannabis, Health Canada received an additional $500,000 for operating expenditures from the central advertising fund as a part of these estimates for the cannabis pre-legalization advertising campaign.
This funding is a part of our government's significant investment of $108.5 million over six years to support cannabis public education, awareness and surveillance activities. We know that it's essential to invest in public education efforts surrounding the health and safety facts of cannabis, specifically targeting youth, in advance of the Cannabis Act coming into force.
These campaigns began long before legalization. They're intended to give Canadians, especially youth, the honest facts about cannabis, and to put them in a position to make informed, responsible and healthy choices. While healthy choices are the most important part of maintaining good health, environmental factors also have an impact.
Now let's turn to the new impact assessment and regulatory processes.
As you know, our government is renewing the federal impact assessment and regulatory system. The enhanced system will better protect Canadians' health, as well as our environment, fish and waterways. It will also rebuild public trust in how decisions about resource development are made.
This system will apply to all projects that are subject to federal assessment, such as mines, dams, pipelines and marine terminals.
Health Canada is the key federal department positioned to provide expertise on human health impacts of projects like these.
As such, we are requesting $5 million to help transition to the new impact assessment and regulatory processes.
Let's turn now to pay administration. I would now like to turn to an important administrative issue.
As you know, the Phoenix pay system continues to pose challenges for the public service, including employees of Health Canada and its portfolio organizations. For this reason, we are requesting $1.3 million in additional funds to address the issues in pay administration and to help ensure that our employees are paid properly and on time.
I will now speak in more detail about our portfolio organizations, their priorities and their specific requests for funding.
The Public Health Agency of Canada, PHAC, is asking for a net increase of $6.7 million to its authorities. This would bring the total authorities for 2018-2019 to $687.2 million.
This increase includes nearly $5.5 million to support the Aboriginal Head Start in Urban and Northern Communities Program.
This program funds indigenous community-based organizations in urban and northern areas to develop programs that promote healthy development of indigenous preschool children.
The increase we are requesting also includes $1 million to support PHAC's childhood vaccination campaign. This advertising campaign will raise awareness of the importance, safety and effectiveness of vaccination.
As a part of the health portfolio, the Canadian Food Inspection Agency, also known as CFIA, works to uphold a strong and reliable food-safety system.
The supplementary estimates we are presenting today reflect an increase of $9.4 million for CFIA for specific time-limited activities, bringing its total authorities for 2018-2019 to $762 million.
The specific time-limited activities include funding for the Canadian Food Safety Information Network. This network will strengthen Canada's ability to detect and respond to food hazards by connecting and coordinating food safety and public health authorities.
The Canadian Institutes of Health Research, or CIHR, is Canada's health research investment agency. It provides $1 million per year to support Canada's health scientists.
Through these supplementary estimates, CIHR is seeking an increase of $0.4 million, for a total of approximately $1.1 billion in available authorities. This increase will support the creation of new scientific knowledge—knowledge that will lead to improved health, more effective health services and products, and a stronger Canadian health care system.
In conclusion, Health Canada, and indeed all five organizations in the health portfolio, is committed to spending funds responsibly, efficiently and effectively. The work I have outlined today will be instrumental in helping us achieve our mandate to protect the health and safety of all Canadians.
Thank you for this opportunity to speak about our work and to explain our budgetary priorities.
I am now pleased to take your questions.
View Sonia Sidhu Profile
Lib. (ON)
Thank you, Mr. Chair.
Thank you, Minister, and all the officials, for being here today.
My first question is to the minister.
Minister, as you know, I introduced a motion to the committee to study diabetes and its impact on the health of Canadians. Part of the study was around what the government can do to help those living with diabetes, as well as how we can prevent it.
I know that healthy eating is part of diabetes prevention, and thank you for taking a great initiative on that.
I would like to know what our government is doing to help Canadians understand the risk factors and to motivate them to make lifestyle changes to prevent chronic diseases such as diabetes. Also, are you aware of Diabetes Canada's 360° strategy? What are your thoughts on that?
View Ginette Petitpas Taylor Profile
Lib. (NB)
Thank you very much, Ms. Sidhu, for the question. I want to take this opportunity to thank you for the leadership that you've shown with respect to the area of diabetes and also for the work that you've done on the all-party caucus on diabetes, and thank you for bringing forward the motion to ensure that the HESA committee could study this very important issue.
We certainly recognize that many Canadians live with diabetes, either type 1 or type 2 diabetes, and we certainly recognize that there are many contributing risk factors as to why people live with diabetes. Our government is deeply concerned with this area, and that's why we've made significant investments there.
I was very pleased that in budget 2016-17, an investment of $47 million was made in the area of diabetes research. We've also been able to partner with the JDRF, and we were able to collaboratively invest $30 million in the research component of type 1 diabetes. We still have some work to do with respect to that investment, but the money continues to roll out.
Also, I have to say that I was very pleased that over the past several months, I've been able to meet with officials from Diabetes Canada, and they've been able to provide me with a snapshot of the good work that is being done.
I was very pleased to hear about the Diabetes 360° program that they have brought forward. Just a few weeks ago—and I think I saw many of you there that day—they had their mobile unit here on the Hill, and many of us were able to stop in. I think that several members of the health committee were there, as I'm looking around the table. Many of you had your health checks and had your report cards that looked at the risk factors associated with diabetes. Again, we certainly are pleased with the work that Diabetes Canada is doing.
Finally, I think that as a government, we've certainly done a lot of work in addressing the risk factors for diabetes. We recognize that diabetes is a serious, chronic disease, and, as I indicated at the very beginning, we recognize that it affects millions of people and that investments made at the front end can certainly prevent people from living with and suffering from diabetes.
More work needs to be done in the area of research with respect to treatment and prevention. I know that as health minister, I'm extremely pleased with the investments that we've made and the strategies that we've brought forward, such as the healthy eating strategy and the tobacco strategy. We certainly recognize that education also needs to be done to ensure that Canadians are aware of the risk factors associated with diabetes.
View Sonia Sidhu Profile
Lib. (ON)
Thank you.
Canada's health care system is a source of pride and a defining value for Canadians, and our government has been working collaboratively with provinces and territories to improve access to home care and mental health services for Canadians. Budget 2017 provided, as you said, $11 billion in new funding over 10 years to provinces and territories.
In August 2017, provinces and territories endorsed a common statement of principles of shared health priorities that set out pan-Canadian objectives for home care and mental health funding. Could you provide the committee with an update on the ongoing work with the provinces and territories to ensure that this funding meets the needs of Canadians?
I'm also a great advocate for national pharmacare. Can you give us an update on ongoing work on that? When Canadians living with diseases cannot afford their medical supplies and equipment, something has to change. Please give us an update on ongoing work on that.
View Ginette Petitpas Taylor Profile
Lib. (NB)
With respect to investments made in additional funding for mental health care and home care, to give you a snapshot as to where we're at, in budget 2017, as you've indicated, we were pleased that we saw an investment of $11 billion in those two areas. We've certainly heard from Canadians that the areas of home care and mental health were two priority areas, and I was extremely pleased that in budget 2017, targeted investments were made in those two areas.
As a result, over the past year and a half we've been in negotiations with the provinces and territories to finalize the bilateral agreements with provinces and territories. At this point in time, I'm pleased to announce that nine provinces and territories have finalized and have signed their agreements, and as for the other remaining four provinces, we are almost at the end of the negotiations, and either by the end of this year or in early 2019 those negotiations, those bilaterals, will be completed, and the monies will be flowing.
I also have to say that even before the bilateral agreements have been signed, money has been going to provinces and territories. We certainly want to make sure that people have access to the funding that's required, but those bilateral agreements are really key, because we want to make sure that the money is going where it's supposed to be going.
As per your question with respect to pharmacare—I think there was that component as well—as you're all aware, in budget 2018 we announced the creation of an advisory council on the implementation of a national pharmacare program. Work continues to be under way with respect to that. We are very pleased that Dr. Eric Hoskins and a group of fine Canadians have agreed to sit on this committee, and they've been having a national conversation with Canadians with respect to what a national pharmacare program can look like. I look forward to receiving the report in the spring of 2019 with some recommendations of possible options as we move forward. We recognize that the work that's been done in this area by the advisory council is key, and I truly look forward to receiving the report with recommended options and a path to move forward.
View Marilyn Gladu Profile
Thank you, Chair.
Thank you to the minister for being here today and to all of the departmental representatives as well.
I want to start by thanking the minister personally. I see she tabled in the House of Commons the framework on palliative care, of which I am passionately a fan. I see that all of the elements that we heard in consultations across the country were captured, and I look forward to working with her to see us accelerate palliative care for all Canadians. Thank you for that.
My first question has to do with thalidomide. In budget 2018, there was an intent to resolve the remaining claims in the thalidomide area. Could you give us an update as to whether those claims are resolved?
View Ginette Petitpas Taylor Profile
Lib. (NB)
Thank you very much, Ms. Gladu, for your question.
Once again, congratulations on your private member's bill. We were extremely pleased that we were able to table the bill. I look forward to seeing the progression of the work that needs to be done and that will be done with respect to an action plan. I'm looking forward to continuing to work with you on that.
With respect to your question on thalidomide survivors, soon after I was named Minister of Health, I was privileged to meet with many thalidomide survivors in Ottawa, one of whom was Fiona Sampson. I also had the privilege of meeting with TVAC, which is the Thalidomide Victims Association of Canada.
These individuals shared with me the challenges they face, day in and day out as they age, in living with thalidomide. We also heard from some individuals who were concerned because they had not been identified as part of the compensation program.
I was extremely pleased that budget 2018 committed to addressing concerns regarding thalidomide survivors. Within the very near future—within the coming months—we will be announcing steps to move forward with respect to this program.
I certainly want to make sure—and I stress to the committee—that individuals who are thalidomide victims or who feel they are possible victims will have another opportunity to apply for this program. As I've indicated, within the coming months we'll be able to do a formal announcement. I look forward to being able to share that information with all of you.
View Marilyn Gladu Profile
That's very good.
I see that we are expecting the Hoskins report in the spring of 2019. Will the report be made public before the election?
View Ginette Petitpas Taylor Profile
Lib. (NB)
First and foremost, with respect to the report, we have to recognize that Dr. Hoskins and his group of officials have been working diligently in having a conversation with all Canadians from coast to coast to coast. I haven't had an update with respect to the work that's been done thus far, but I do follow through with the secretariat, and they're telling me that they're hard at work.
With respect to the report's findings, I absolutely feel that the report will be made public. I'm not sure of the exact date of the tabling of the report or of our making the report public, but like many of you, I look forward to seeing the findings of that report, as we certainly recognize that it will be a key pillar as we move forward in the decision on what a potential pharmacare program could look like for Canadians.
View Marilyn Gladu Profile
That's very good.
My next question has to do with the competitiveness of Canadians and with some of the things that have been introduced by Health Canada. I would like to offer some examples.
One is pesticides that Canadian producers will not be able to use anymore that don't necessarily have replacements. When we receive food from other countries that do use those same pesticides, that disadvantages us. Also, the front-of-pack labelling will be something that Canadian businesses and industries will have the expense of putting in place, but there are many exemptions given to materials coming from other countries so that they don't need to have that.
Could you make a comment on why, when we put these programs in place, we're punishing Canadian businesses, as opposed to making these requirements for all?
View Ginette Petitpas Taylor Profile
Lib. (NB)
First and foremost, protecting the health and safety of Canadians is my number one priority as Canada's health minister.
There are two components to your question there. Perhaps I'll start off with the second component of your question with respect to the front-of-pack labelling.
We recognize, as I indicated earlier, that the issue of chronic disease is on the rise in this country. We recognize that we spend approximately $28 billion to $30 billion in addressing chronic disease. Our eating habits, either healthy or unhealthy, as well as our sedentary lifestyle, certainly contribute to that.
When it comes to front-of-pack labelling, we want to make sure that we make the healthy choice the easier choice for Canadians. That's why we're moving forward with this initiative of front-of-pack labelling. As you're probably aware, it's to make sure that Canadians are aware that the foods they purchase may be high in sugars, fat or salt.
View Marilyn Gladu Profile
Sure. I'm familiar with the program, but will all other countries have to put on Canadian front-of-pack labelling in order to sell products in Canada?
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