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View Rona Ambrose Profile
Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, Vanessa's Law. Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
Vanessa's Law, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in Vanessa's Law, we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
Sabine Luning
View Sabine Luning Profile
Sabine Luning
2012-03-28 15:35
The mining sectors of countries like Mali and Burkina Faso have undergone substantial changes over the last 20 years. Burkina Faso has made a shift from dominant state intervention to a sector giving ample room to private companies.
In this process of liberalization, tasks of the state, NGOs, and private corporations have been redefined. I think that a marriage of the public-private partnerships between CIDA, NGOs, and Canadian mining companies has to be assessed in relation to the institutional setting in which the mining operations and development initiatives are taking place.
I fully agree with Professor Bebbington, who made a statement in your committee on February 29 that the link between mining and development cannot be determined on the basis of individual projects. Exploration and large-scale mining operations in countries such as Burkina Faso trigger complex processes of social change. Whether these social processes can be seen to help or hinder development is a major issue. This question is at the heart of the debate about whether resource endowment is a curse or a blessing for developing countries.
Even researchers collaborating closely with the International Council on Mining and Metals, the ICMM, emphasize that structural arrangements are crucial to preventing developing countries from getting trapped in the resource curse. Dr. Dan Haglund, working for Oxford Policy Management, portrays the situation for a country like Burkina Faso this way: “In Burkina Faso, the mining sector accounted for 2% of exports in 2005, but by 2010 its share had risen to 41%.”
This resource dependence is, of course, a challenge, and may generate wealth, but it is also risky. A rapid surge of revenue can only lead to development if, first, state institutions have sufficient capacity and discipline, and second, if mining can be connected to other economic activities so as to trigger multiplier effects. This would prevent, say, Dutch disease and real exchange rate problems.
In this situation, development is foremost a matter of institutional development, and this entails proper strengthening of state structures and strategies for spinoff into other sectors of the economy. These requirements force us to think about partnerships and mining companies in relation to two issues: first, institutional development and division of responsibilities, and second, the relationship between mining and economic development.
I'll talk about institutional development and division of responsibilities first.
The current trend in foreign direct investment in mining in developing countries has changed the relations and tasks of corporations and host states. As owners of subsoil resources, states are the authorizing instance. The state organizes access and monitors mining—ideally, that is. A report by Dr. John Ruggie called “Protect, Respect and Remedy: a Framework for Business and Human Rights” makes a convincing case that many developing states have weak governance structures. They often lack capacity to regulate and survey the corporations they host. There is a governance gap between the weakness of states and the impact of strong economic forces and global actors that has to be accommodated in the country.
In many cases, reinforcing these structures is far from simple and is hindered by political cultures marked by corruption and patrimonialism. In a recent report on the political economy of the mining sector in Burkina Faso, Oxford Policy Management again gives a rather gloomy image of the political elite of Burkina Faso. The mining sector is linked by control, co-option, and corruption into the hegemonic government, a category into which the World Bank labels this situation in Burkina.
I think the current discussion in Canada on public-private partnerships should pay special attention to how these initiatives affect the relation with, and the position of, the host state. If we agree that development is institutional development, then capacity-building for the host state should remain high on the agenda. In my view this could require, first of all, a clear division of tasks and responsibilities.
In particular, in countries such as Burkina Faso, in which the history of large-scale mining is still young, governance capacity-building should be centre stage.
However, mining companies that have to be authorized and monitored by that same state cannot do this. Support for institutional capacity-building should be organized in bilateral public-public partnering. In this light we have to ask whether the current forms of partnering between CIDA, NGOs such as Plan Canada, and mining companies do not risk being counterproductive. If institutional development is the central goal, these partnerships may blur boundaries, responsibilities, and identities even further.
So far I've argued that mining companies should keep a distance from responsibilities assigned to public authorities of the host state. In what follows I will emphasize that such a distance should be matched by the closest possible commitment to their responsibility in and for the local setting in which they operate.
Now I'll turn to my second point, which is the relationship between mining and economic development. Here I will turn to the partnerships in Burkina Faso and in Canada.
The partnership of CIDA, Plan Canada, and IAMGOLD in Burkina Faso and the public-private partnership in Ghana deserve to be elaborated upon, but for time reasons I will confine myself just to the latter.
In Ghana, CIDA works together with World University Service of Canada and Rio Tinto Alcan in a project to train community members to strengthen governance structures. In the meantime, however, the Rio Tinto Alcan mine associated with this project was sold to a Chinese company. In a question and answer leaflet given out by the World University Service of Canada, it is argued that this situation proves the partnership's integrity. It states that Rio Tinto is no longer working in Ghana and does not stand to profit financially from its support to this project. However, this situation implies that the current partnership is disconnected from responsibilities directly linked to the mining operation, which is now in new hands.
This broadening of involvement—
Sabine Luning
View Sabine Luning Profile
Sabine Luning
2012-03-28 15:53
It's not so much in terms of sequencing as it is in levels, I think. I would absolutely, if mining is to contribute to development, insist upon my second point: first of all, mitigation. Before we start talking about development, we have to ensure that companies are organized in such a way that they can prevent damage, right? I think on that level, that is the first step to be taken.
I think the second issue, also alluded to by Professor Bebbington, is that we should look into the fact that the streams of money that come into the country—and in a country like Burkina, quite massively now—are organized by state organizations in such a way that they set up proper public institutions and benefit the population.
In that respect, strong regulation of mining companies to control them in their activities, with a strong framework and control on the host country on the other hand, would make sure that the revenues coming in, which are quite massive, can enter into the public domain properly.
Kenneth V. Georgetti
View Kenneth V. Georgetti Profile
Kenneth V. Georgetti
2012-02-27 15:39
Thank you very much.
By way of opening comment, let me say that the Canadian Labour Congress has a long history of working with trade unions and non-governmental organizations throughout the world. We've managed projects in over 30 countries, many of which were funded by CIDA, the Canadian International Development Agency.
The CLC does not agree with the government that partnering with the private sector to fund foreign-aid projects is the best way to improve the lives of the world's poor. It's unconscionable that our government wants to achieve this by making Canadian profit-driven extractive, agriculture, manufacturing, tourism, and other companies collaborators to foreign aid.
Already some $531 million in 2009 and $336 million in 2010 were spent by CIDA on NGOs and others doing so-called private sector development to support the likes of micro-credit, credit union capacity-building, value-chain developments, and support for small and medium-sized businesses. We have concerns about the facts that these often exceed expenditures of many of CIDA's other categories. In 2010, spending on education, health, environment, and governance were all declining relative to 2009, while private sector development increased. We don't know about 2011 because last year the government stopped reporting its spending on this.
Now CIDA is funding NGOs to implement corporate social responsibility projects--CSR--projects with contributing companies such as Rio Tinto Alcan, IAMGOLD, and Barrick Gold, whose clear mandate is to maximize profits for their shareholders—that's what they do. CIDA is poised to continue along this vein.
Please understand, we don't object to Canadian investments abroad for the purposes of making profit; that's what they do. However, trade unions from throughout the world are involved with multinational companies, and we know how their self-interest can conflict with the public interest. This is what we're worried about. Regrettably, NGOs with good reputation and credibility are being drawn into collaborating, no matter how laudable the results of their work might be. The approach will certainly ease Canadian investors' access to local resources and soothe the waters with communities that have already suffered or would oppose mining and other operations. The whole approach will also invariably reduce their costs of doing business. But a point of contention is about enabling companies to protect their profits back in Canada, companies that are already reaping tremendous benefits from tax breaks right here at home.
We worry about the impacts of Canadian companies competing among themselves and others within a developing country context. Yet Canadian taxpayers have been led to believe that funding these corporate social responsibility projects in connection to large corporations will somehow yield some form of company accountability or corporate responsibility. We don't believe that. We think it's nonsense, frankly. The CSR projects do not in any way implement company accountability principles as understood by the international community dealing with these issues. We're worried that these projects will serve instead to gloss over local conflicts that have already emerged or will arise as a result of any investment project.
The government is well aware of the degree of opposition to Canadian company projects in quite a number of countries. In 2005 this awareness led to a ground-breaking parliamentary report calling for strong norms to deal with corporate misbehaviour, such as environment and human rights violations, which are now on the rise. Instead, the government created a weak-kneed extractive sector CSR counsellor, who's already proved to be ineffective in handling a number of recent complaints, leaving a total vacuum for available tools to ensure company accountability.
The CIDA corporate social responsibility projects cannot be a substitute for corporate accountability. Moreover, it's very misleading to suggest that these CSR projects will do much, if anything, to reduce poverty.
Business leaders have already appeared before this committee, but their testimony raises a number of questions. They may be justified in saying that specific projects would benefit training, work experience, or could result in economic effects for jobs and improved incomes. It's what they're not saying that we think is a problem. Their statements have to be measured against a more complete picture of costs and benefits, both positive and negative. They have to be seen in light of social and environmental costs beyond the lifetime of those projects compared to other scenarios that could yield better scenarios.
Evidence submitted by MiningWatch to this committee convinces me that company operations do far more in the long term to exacerbate income gaps than to reduce poverty. The committee cannot turn a blind eye to these realities. At the core of any analysis about poverty is the question of jobs.
I remind this committee that Canada joined the G-20 and other countries last year to support a decent work agenda put forward by the International Labour Organization. So where's the analysis to show the impacts of company operations on full-time and part-time jobs that will be created or lost, and what is the quality of those jobs, and what are the conditions of the work environment and the human rights in the workplace? What about the livelihood issues for community well-being? What other scenarios for investment or for CIDA expenditures would create more jobs than the paltry few that have been talked about here? I repeat, where is the analysis on all of this?
Witnesses have also argued that company operations contribute to the tax base and thus strengthen the autonomy of local and national governments. There is strong evidence to show that company activities do quite the opposite, and we've provided that to the committee in our formal brief.
In many countries, the very presence of extractive companies in rural areas also jeopardizes the integrity of indigenous communities. I would like to suggest that the committee follow up by encouraging our government to perform an analysis of both the negative and positive impacts of these company operations before venturing further on CSR exercises that blindly support or justify them. The government should also report annually to Parliament detailing the full picture of all aspects of private sector funding.
You should follow through with the commitments to implement the 2011 Busan high-level forum, which emphasizes the importance of ensuring strong country ownership of development, accountability, and of course transparency through a new global partnership for effective development.
You should establish a Canadian legal framework for private sector accountability based on internationally agreed ILO standards, the Organisation for Economic Cooperation and Development guidelines on multinational enterprises, and the United Nations guiding principles on business and human rights.
The government should be guided by the outcomes of the Canadian Westray mining disaster in instituting criminal penalties for egregious activities abroad.
These corporate accountability measurements are important for stemming any drive to lower the occupational and other standards due to competition.
Lastly, we'd like to say that you should promote the G-20 commitments to implement the ILO decent work agenda as a direct means for eradicating poverty in the world.
Thank you.
John Sullivan
View John Sullivan Profile
John Sullivan
2012-02-13 15:33
Thank you very much. I really appreciate the invitation to be here. I'm thrilled that your committee is holding these hearings and looking into the subject, as you might expect. It's our life blood, so we're thrilled that you're doing this.
By way of background, I should mention that the Center for International Private Enterprise is an affiliate of the United States Chamber of Commerce. As you may know, the U.S. Chamber is one of the largest associations of private sector business. Our centre is funded by the U.S. government principally through the National Endowment for Democracy, which I will return to in a moment.
As we saw recently at the High-Level Forum on Aid Effectiveness in Busan, South Korea, it is becoming generally accepted that the private sector needs to be at the centre of development. It drives economic growth, job creation, innovation, and opportunity. However—and this also came out to some extent at the private sector forum that was held at the Busan meeting—many of the international development initiatives that are going on, including many of the ones of the U.S. government, really focus more on individual entrepreneurs rather than the institutional reforms needed to remove barriers to doing business and create the kind of enabling environment that drives entrepreneurship.
You have already heard from Hernando de Soto. He was here testifying before you. Hernando was our very first project in 1984. We helped him get started, and we continue to work with him. We just finished up a project working with Hernando in the indigenous regions of Peru, but we've also worked with him in Egypt and a number of other places. I wholeheartedly endorse what he's saying, which is very similar to my message.
I'd like to tell you what somebody said who taught both Hernando and me a great deal about this, and that's the Nobel Laureate, Douglass North. Doug has summarized the entire history of economic growth and development in one sentence. Now forgive me; it's a very long sentence. It should be.
Doug said that economic growth is about going from personal exchange, to where you can only do business with people you know, are related to, have some personal tie to, and therefore can trust, to being able to do business with strangers, and to get from here to here you have to put in place a whole set of institutions, and that's the enabling environment: a court system that will enforce contracts; property rights that can be enforced—as Hernando was talking about to a great extent; and bankruptcy.
A whole range of institutions needs to be in place, yet all too often in our development programs we focus more on trying to teach entrepreneurship. That's very important. We do it ourselves in Afghanistan, Peru, and elsewhere. But if you're just teaching entrepreneurship, you're not putting in place the institutions.
What you really need is the kind of institutional environment that Canada, the United States, and much of western Europe have. Yet in much of the developing world, as we see, corruption, red tape, favouritism, the lack of a voice, and the ability to affect policy and decisions really constrain the entrepreneurial sector.
Reducing poverty comes down to the policy reforms that expand access to opportunity and instill confidence in these market institutions. As Doug says, ultimately the rule of law binds a lot of this together in different ways, but for much of the world that has meant fully functioning democratic institutions creating that rule of law.
As I mentioned, we're an affiliate of the U.S. Chamber of Commerce, so you won't be surprised that our method of working is to partner with business associations, think tanks, sometimes with chambers of commerce, and other civil society organizations in the developing countries to build their capacity to affect law and regulation in public policy in areas like anti-corruption, advocacy, the management and strengthening of business associations, and corporate governance, which is incredibly important but, as we found out ourselves the hard way, is missing in so many of the developing countries.
Until the early 2000s, when the coalition that we were part of helped create it, there were no words for corporate governance in the Arabic language. It took two years to get that translated, and now we have an official seal issued by an Islamic institute with a stamp with the translation on it, and the translated words are now being used throughout the Middle East. That's a game changer.
Why do we do this? Well, because we found that these barriers to entrepreneurship are really what is keeping the majority of the population in so many countries trapped in that informal sector that Hernando talked about.
We've also found that top-down reforms tend not to work. We found something we called the reality gap. When fly-in experts come to a country, help create these institutions or write the laws, they then get translated into the local languages and passed by Parliament. They sit there like a hovercraft on water, never really touching it. We've actually measured the reality gap in some countries. It's the gap between what the law says on paper and what the real practices are. Unless you get the local business associations and private sector engaged, you can't see that gap; it just isn't visible to you.
One of the things that came out of the Busan meeting was a recommitment to public-private dialogue. In the joint statement between the public sector and the private sector that was issued during the Busan forum, they committed to five principles, and I'd like to just end by mentioning those: an inclusive dialogue for building a policy environment that is conducive to sustainable development—and by policy dialogue I mean dialogue, a two-way conversation between the public and the private sector; collective action, strengthening the associations and other CSO-NGO operations; sustainability, so that we know these institutions will stay in place; transparency; and finally, accountability for results.
I could give you lots of examples of programs that drive this kind of reform. My personal favourite is something that a coalition of Pakistani groups did, with which we were involved, where we changed the law. It was called the Trade Organizations Ordinance, basically the law on associations. Beginning in 2006, for the first time women can now form and be on the boards of trade associations in Pakistan. They have seven of their own, they're building more, and all of a sudden they have much more of a voice. Without voice, one doesn't get to accountability, one doesn't get these policy reforms, and there is no room for the private sector to move in and participate.
Thank you very much.
Toby Sanger
View Toby Sanger Profile
Toby Sanger
2011-10-17 17:16
One of the major sources of savings is simply the lower costs of financing through public procurement and financing--i.e., not P3s. Over the 30 or 40 years that these might be amortized those 100 or 200 basis points can be a really substantial amount. Unfortunately, a lot of the value-for-money studies that are done by provincial governments really obfuscate the information. They present just a few pages of information. It's really not transparent. Unfortunately, that lack of transparency about the costing is endemic to P3 projects as well, because the public just does not have access to that information, which is often protected by commercial confidentiality and thousands of pages of legal contracts.
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