[Recorded by Electronic Apparatus]
Thursday, May 4, 1995
.0906 
[English]
The Chairman: Good morning, everyone. I call this meeting to order.
We welcome our witnesses from the Department of Health, including the assistant deputy minister, Kay Stanley.
Welcome, Kay.
Ms Kay Stanley (Assistant Deputy Minister, Health Programs and Services Branch, Health Canada): Good morning, Mr. Chairman.
The Chairman: How are you?
Ms Stanley: I'm well. I'm a little concerned about that clock behind you, though, because when I looked at it, I thought either I'm in the wrong time zone or....
The Chairman: You just gave me a beautiful opening. When the crowd from Health comes, we measure the time in days, so don't worry about it.
Ms Stanley: Are you ready for me?
The Chairman: Yes, indeed, we are. We'd like you to introduce your colleagues and then give us as brief an opening statement as possible, because we have some questions we'd like to put to you.
Ms Stanley: I'm sure you do.
I thank the committee for this opportunity on behalf of my colleagues.
When I realized that it looks like Health Canada is not an equal opportunity employer, I was glad Mr. Marquardt from the finance department is joining us, because there are a few men in senior positions in my branch, but the directors general are certainly of one gender here.
May I introduce Dr. Mary Ellen Jeans, director general of the Research Program Policy and Planning Directorate. Dr. Jeans came to Health Canada in 1992 on an executive interchange. She's from McGill University, where she served as director of the school of nursing and the associate dean of the faculty of medicine.
I also have with me Catherine Lane. Catherine came to Health Canada in 1992. She certainly has extensive experience in managing government operations and programs both nationally and regionally. She never fails to remind me that she hails from Saskatchewan; she is the westerner on the management team. She is the director general of the Population Health and Issues Directorate.
Diane Kirkpatrick is the director general of the Healthy Living and Disease Prevention Directorate. She has been with Health Canada for over twenty years and served as the director of the Bureau of Chemical Safety in the Health Protection Branch. She's migrated to the Health Programs and Services Branch from the Health Protection Branch, which is a good and healthy thing to have happen.
I'm pleased to appear today as you begin your 1995 assessment of Health Canada's main estimates.
[Translation]
I welcome this opportunity to inform you about the business of my branch and to answer questions.
[English]
Given that the Health Programs and Services Branch is the smallest program branch in the department, with 2.9% of the departmental budget and 9.1% of the human resources, the committee's interest is most appreciated.
Although small when compared with the Health Protection Branch or the Medical Services Branch, the Health Programs and Services Branch plays a key role in Health Canada's mandate of helping Canadians maintain and improve their health.
Our work is centred on health promotion and disease prevention. Our activities support the department's four core businesses: population health strategies, health care system support and renewal, health services to first nations, and the management of health risks. We have distinct responsibilities with respect to the core businesses.
.0910
[Translation]
I want to provide you with a clear picture of what the branch is doing toward the achievement of Health Canada's objectives in the key business areas, why we are doing it and how it impacts on Canadians. In a time of fiscal restraints, the Committee members will want to be sure that our business activities are well managed, cost-efficient and above all, effective in meeting the health need of our clients, the people of Canada. Il will touch upon each of these elements as I describe our branch operations in the next few minutes.
[English]
I'd like to begin with the concept that lies at the very heart of our business, which is health promotion. Health promotion is based on a broad vision of health, one that emphasizes the physical, social, and economic well-being of all Canadians.
Health promotion recognizes that the key to wellness is enabling people to take control of their own health. It's a simple idea, but one with tremendous implications for the future of our health care system. It is fundamental to the achievement of health care renewal.
Health promotion addresses those factors that lead to ill health. The result of effective health promotion is a reduction in demands on the health care system and ultimately reduced health care costs.
With this ultimate objective in mind, you will undoubtedly pose the question of how health promotion is achieved. A series of population health strategies has been designed to impact on the health of populations. These strategies are based on core determinants of health: our social and economic environment; our physical environment; health services; our own personal health practices; and our individual capacities and coping skills.
By focusing on these broad determinants, our population health strategies cover all aspects of Canadians' physical and mental health. They offer a holistic and integrated view of health that enables us to respond to complex issues such as AIDS, alcohol and drug abuse, child development, health and environment, tobacco use, heart health, and nutrition.
Each of Health Canada's population health strategies has a research component, a policy component, a program component, a public education component, and an information dissemination component. Most involve grants and contributions to community-based organizations or national not-for-profit associations that are funded by a combination of A-based and sunsetting resources.
Branch officials' work is carried out in collaboration with clients and stakeholders across society. We work closely with vulnerable populations, communities, non-governmental organizations, voluntary groups, the research community, professional organizations, and provincial and territorial governments, in addition to the other areas of Health Canada and other federal departments.
[Translation]
Collaboration is essential to the success of our strategies. It allows us to pore ressources among governments, non governmental organisations and the private sector. It increases the efficiency of health care delivery, reduce duplication of services and insures the best long-term return on health related investments.
Health promotion is a sound investment. Surveys and evaluations show that the population health strategies significantly increase knowledge of health issues and healthy behaviours and life styles. They contribute to the overall social stability and economic well-being of Canadians.
[English]
Let me give you two compelling examples of how these strategies result in long-term financial benefits to society. The first involves early prevention and intervention programs for children.
.0915
Research shows that health-related services for children at risk, such as those provided through our Community Action Program for Children, provide significant savings. It is demonstrated that every dollar invested in the health of a young child can result in a saving of $7 down the road in reduced social expenses, including reduced welfare and criminal justice costs.
Another example is prenatal care and nutrition. Health promotion and prevention activities aimed at ensuring a healthy birth weight for babies cost on average about $400 per child. On the other hand, the cost of neonatal care is roughly $60,000 for each baby of low birth weight.
These two examples give you a bottom-line indication of just how cost-effective our population health strategies can be.
In the management of health risks, the federal government's National AIDS Secretariat coordinates a wide variety of programs under the National AIDS Strategy. These activities focus on education, prevention, research, community action, care, treatment, and support activities across the country.
[Translation]
Another vital area of risk management is heart health. Cardiovascular disease is a major cause of death and illness in Canada. It accounts for more than 20% of our health costs. Canada's heart health initiative is a partnership among the federal and provincial governments and over 300 public and private sector organizations.
Through this initiative, we have set up a Heart Health Data Base. Our research directorate also cofunds research demonstration programs with the provinces, evaluates and approves drugs for cardiovascular disease and does research on assessments of drugs used in the treatment of heart failure.
[English]
In the area of breast cancer research, the Research Directorate is working with a number of partners, including the Canadian Cancer Society, to fund a broad base of research.
The Canadian Breast Cancer Research Initiative, located in the branch, supports cancer prevention, early detection, diagnosis, treatment, rehabilitation, and palliative care. This initiative has increased the resources available for breast cancer research in Canada by 150% over the past fiscal year.
Canada's Drug Strategy is another area of successful collaboration for the branch. Last year we funded over 200 community-based projects across the country. This enabled communities to be proactive in working towards solutions to their alcohol and drug problems.
I would like to take a few minutes to highlight some of the important programs aimed at the most vulnerable segment of our population, Canada's children.
Children continue to be an ongoing priority, especially those living in conditions of risk, including poverty. Our Community Action Program for Children, commonly called CAPC, funds community groups to establish and deliver services to meet the health and development needs of at-risk children ages 0-6.
This program is a model for how different levels of government can work together with community groups to address children's health and social needs. CAPC is managed with the provinces and territories through a joint management committee, with representatives from Health Canada, officials from the lead provincial ministries, and representatives from community groups.
Two of our most recent programs for children stem from the federal government's red book commitments. They are the Canada Prenatal Nutrition Program and the Aboriginal Head Start Program. Together they provide some of the most comprehensive and cost-effective investments ever made on behalf of Canadian children.
[Translation]
These new programs, like long established ones, are a response to the health needs of Canadians. They are being implemented at a time of increased public pressure for effective response to health issues and greater public expectations for accountability and fiscal responsibility.
.0920
As a branch, we are responding to changes in our working environment. Just last month, the health programs and services branch undertook a restructuring aimed at increasing our overall effectiveness. We are rationalizing business activities along strategic lines with the goal of being more efficient at what we do.
Members of the committee must have received some information about our new structure. I would be pleased to elaborate if there is a requirement for further detail.
[English]
Members of the committee should be assured that the Health Programs and Services Branch is responding to change with many positive steps, both internal and external. By adhering to our principles of health promotion, partnership, community action, and collaboration with stakeholders and clients, I am confident the branch can continue to play a leadership role in responding to the health care of Canadians.
Thank you.
[Translation]
Thank you.
[English]
Mr. Chairman, I await the committee's questions.
The Chairman: Thank you.
First of all, let me go back to a formality that I should have dealt with at the beginning of the session. Since we're beginning our examination of the estimates, since we are dealing this morning - or ought to be - with three heads of expenditure, heads 1, 5, and 10, and since it is procedural to be dealing with one at a time, I need the unanimous consent of the committee to deal with all three simultaneously. I hope it's just a formality, but with unanimous consent I would call votes 1, 5, and 10 of the votes under health. I should have done that before introducing the witnesses.
Some hon. members: Agreed.
The Chairman: So just consider that done, if you don't mind.
Secondly, Kay, this is not particularly aimed at you, it's aimed at all those who come to us from the Department of Health. They never seem to get the message, so I make this speech every time.
This examination of estimates is about accountability and what you've just given us is a marvellous 15-minute speech, but I think it has very little to do with accountability. That's not said in any personal fashion. It's said to get the message through to all people who come here that the role of the committee is to examine witnesses. We can't do that if they talk all the time. We ask them to come to make a brief statement directly related to accountability and to then let us ask questions about accountability. What we've just heard, as I said, is a marvellous speech but it gets in the way of our asking questions.
I don't mean to be impertinent this morning, but it's a question of establishing what this committee wants to do and should be doing. Our mandate is not to give witnesses a forum to make speeches. Our mandate is to examine witnesses on issues, and we can't do that if they talk all the time. So I say to other witnesses, when we say brief statements - and I ask the clerk to tell them again - brief means five minutes or less, so that we can do what we're supposed to be doing here.
We have some interventions.
[Translation]
Mrs. Picard.
Mrs. Picard (Drummond): Good day, Mrs. Stanley.
First, about your health promotion activities, what kind of projects does the federal government fund through your community action program for children? Secondly, how much money will you put into your prenatal care and nutrition program? Thirdly, there is in Quebec a pre-natal program called OLO (orange, lait, oeuf) which is managed by our CLSCs. Don't you think there is duplication here?
Ms Stanley: Thank you, madam.
[English]
With respect to children - and I'm conscious of the chair's remarks - I did take some time at the beginning to talk about the reorganization of Health Canada's Health Programs and Services Branch to show that we have taken all of the entities supporting our investments in children's programming and have placed them into a new directorate. Catherine Lane, the director general, is the head of that. She is here and I will ask her to comment.
.0925
In terms of the Community Action Program for Children, a program in place across the country, through joint management committees and through colleagues at the provincial and community level, we have devised programs to assist children at risk from 0 to 6. One of those groups, of course, is infants. The program that you mentioned, the OLO program, is ideally suited to support the objectives of the prenatal nutrition program because it has already been well established in the province of Quebec.
There are many components to community action for children. At the time of the previous government's approval of the Brighter Futures initiative, there were over 35 child development initiative programs under that broad heading of Brighter Futures and child development initiatives. Those are ongoing programs in the province.
In the matter of the prenatal nutrition program, the amount for 1994-95 is $3 million for this year. Additional resources devoted to that, because when you deal with the community action program for children, you're also dealing with prenatal and young mothers. There are therefore additional resources under CAPC to support the prenatal nutrition effort.
[Translation]
Ms Catherine Lane (General director, Health Promotion Directorate): I would like to elaborate on this matter of potential duplication with regard to the OLO program. We work very closely with our provincial colleagues in order to make sure that there is no duplication. We have the CAPC program and the Canadian Prenatal Nutrition program, which are managed by a joint committee made up of representatives from the federal and provincial governments. That is how we make sure that there is no duplication.
Mrs. Picard: I would like to know how you contribute to that program. Is this a contribution which goes directly to the province or is it the health minister of each province who distributes the money to the various services in order to help women feed themselves better?
Ms Lane: That's a transfer payment. It's federal money which is paid out, but only through the joint committees, as I said earlier. An amount of money is allocated to each province and community groups send in applications. These applications are managed, recommended and reviewed by the joint committee. Recommendations are sent to our department.
Mrs. Picard: Don't you think that this is a duplication of the programs which already exist in Quebec?
Ms Lane: No. It is rather supplemental.
[English]
Mrs. Ur (Lambton - Middlesex): Thank you for your presentation. I have a few questions.
How do you choose your programs? What are the criteria, the priorities? Spending or allocating dollars for funding to a particular project doesn't necessarily mean it's effective if there isn't any accountability. Most of all, being a former constituency assistant in a former life, do you have a form of accountability so that you have something to collect data from on the effectiveness of that program?
Another concern I have deals with the Tobacco Demand Reduction Strategy. How much money did the government spend under the program in 1994-95? Are you aware of whether or not dollars were allocated to pro and con groups on this subject for this program in order that they could exercise their concerns?
.0930
Another concern I have comes under the National AIDS Strategy, and the dollars budgeted for it for the upcoming year. How do you prioritize where the dollars are spent there? Who governs that?
Also in relation to budgeting, we're all asked to cut back. I'm a former nurse who worked in a hospital. If there were cutbacks, they always seemed to be at the patient level, not in administration. Have your administrative offices been reduced accordingly, as per budget-cutting programs, so that we are not just cutting programs but are seeing staffing being addressed as well?
Ms Stanley: Thank you, Ms Ur, that's quite a list. So let me -
Mrs. Ur: I'm quite interested.
Ms Stanley: Let me begin and I will again ask the DGs who have comments to supplement my remarks.
First of all, as public officials in the federal public service, our direction with respect to choice of programs comes from the minister or from the decisions of the cabinet. If you take a program such as the child development initiative, the National Drug Strategy, or the National AIDS Strategy, those decisions, plans d'action or strategies lay out where and how officials should respond and where the priorities are. So it's not a matter of my staff saying that we'd like to do some work in a certain area this year. Those elements are usually pretty defined in the memoranda to cabinet and the resultant cabinet decisions that say the government wishes us to pursue a strategy in a given area.
In terms of when you get down to the actual choice of program - and you raised the issue of the Tobacco Demand Reduction Strategy - when we have resources to reach defined objectives for community action, we have both an internal, and sometimes an internal-external sort of peer review process. Community groups or organizations submit plans to us and they are vetted by a panel, which is usually made up of officials and non-governmental people who have expertise in the area. They are rated and the ones with the highest ratings are usually the ones that are supported, but again it's always in the context of the overall strategy that has been approved by the cabinet and certainly approved by our minister.
So in terms of how we choose, it is usually a combination of the directive, the direction given by cabinet, and the process of assessment and evaluation of the submissions from the community groups.
Let me now speak a little bit about accountability in the sense of how we know we're getting good value for our money. First of all, with community projects it's not a matter - and as a former constituency staff person and now as a member of Parliament, you will often see from time to time the approval of contributions to an organization in your constituency - of handing that money over and saying, do what you will with it. Under all of the population and health strategies, there are very well-defined criteria, assessments and monitoring of those. Money is expended in three-month allocations as the feedback, assessments, and evaluations come back to us.
In those contribution agreements, there are conditions stating that if an organization doesn't live up to what it said it was going to do - the terms and conditions of the contract - we have the obligation to cease and desist, to no longer fund. So there's an accountability on our officials to monitor and ensure that a group follows and does what it said it was going to do. There's also an accountability factor on the group to report and submit at regular intervals its accounting of how it is utilizing funds.
In terms of the Tobacco Demand Reduction Strategy, there was certainly.... You asked whether or not we balance between pro and con groups. I have to say we did not in the sense that in the Tobacco Demand Reduction Strategy, there isn't anything that would lead me to think I have to fund anyone associated with the Canadian Tobacco Manufacturers' Council. I think they have quite enough money to do whatever they want without any help from Health Canada or government.
.0935
So the dollars definitely do go to people and to the various parts of the strategy in which we are trying, with a targeted kind of effort towards young people, to stop the addiction before it begins. We have some very specific programs in that area.
Mrs. Ur: In that regard, how many dollars were given to groups in that program?
Ms Stanley: Catherine, you've got the numbers right there in front of you.
Ms Lane: We don't have the final numbers in, but the allocation was $36 million last year for the strategy. Of that, about $6 million would have gone specifically to community group activities.
Mrs. Ur: Where did the other $30 million go?
Ms Lane: Some of it went into enforcement. That was a large chunk of it. Some of it went into public awareness and information activities, such as media campaigns and some of the other information-dissemination activities that we carry out.
Some of it went into a survey. We've done a very extensive youth-smoking survey. We're in our fourth wave of that.
So the four basic components were: research, enforcement and legislation, community-based activities, and public education and awareness.
Mrs. Ur: Is there a report available on that?
Ms Lane: About two months ago there was an update on what we've done with the strategies. So, yes, that is available. We can certainly make it available, Mr. Chairman, to members of the committee who are interested.
Ms Stanley: You asked about AIDS strategy dollars this year and how we prioritize. As you know, the National AIDS Strategy is a five-year strategy with a set amount each year. About half of the $40 million that's allocated each year is in areas of research. But once again, the strategy determines the allocation of the resources to the various components of the strategy.
I know that I'll have an opportunity on two occasions later this month to appear before the HIV/AIDS subcommittee. If the members of the committee have views with respect to alternative ways in which they think AIDS dollars should be expended, then I'm sure the minister would feel that it would be necessary to take that strategy back to cabinet to have some realignment of the priorities in it. But we are following the defined priorities in the AIDS strategy at this time.
As a nurse, I'm sure you felt the sting of cutbacks sometimes and often wondered about the administration of the hospital. I have a very small branch, as I said at the outset, with 548 people in six regional offices across the country and here at headquarters. The majority of those people are in health-promotion and disease-prevention programming areas. We do not have a high number of admin and support for that. Our program officers are pretty used to fulfilling all of the administrative side of what they do.
There has not been a significant decrease in our numbers for a couple of reasons. One, we are into a new program with Aboriginal Head Start. We are moving to expand, because of prenatal nutrition, our community work with children at risk.
Also, if I can use the seniors program as an example, because the emphasis of the program has now shifted to vulnerable seniors and seniors at risk and trying to contribute to the independence of seniors, the actual work of the program consultants is enhanced or increased somewhat. It's a little more labour intensive; it's not like just working in an office and waiting for seniors groups to come in and ask for grants and contributions under the old sort of recreational-social orientation. Reaching seniors community groups at risk does take more time. We have to build new linkages with some groups in the community that the seniors' program traditionally, or at least historically, did not touch.
.0940
So the actual numbers in the branch have not gone down, even though our overall level of resourcing has stabilized.
The Chairman: I remind members of the committee that we're going in camera at 10 a.m. to deal with another issue, so we have 20 minutes for this.
We have five interveners in the following order: Margaret, Harold, Bernard, Hedy, and Paul. We will have to appeal to the respondents and to the witnesses to be brief and to the point. We want to hear five members and the responses in 20 minutes.
Ms Bridgman.
Ms Bridgman (Surrey North): Thank you, Mr. Chairman.
Thank you very much for your presence here and your presentation. I have three questions.
The first is in relation to the estimates showing an increase of $9 million from 1995-96 over 1994-95. That was really $15 million more than 1993-94. I would like some sort of explanation for the increases. This was in relation to health promotions contribution programs. I believe it was the only program of the four grant programs that was actually increased in 1995-96, and I would also like to have an explanation for that.
I would also like to know why the principal nursing officer's position was disbanded and the office closed. I believe that was in December 1994. I heard some rationale that the nursing component or the information about nursing was no longer considered as necessary.
Your department is responsible for the New Horizons Program grants. I have some specific examples here that I'm having a tremendous amount of trouble identifying as health programs. You just finished mentioning that the parameters included looking at recreational and social groups. I'm talking about criteria. I'll use only B.C. examples for some of these grants. I have not yet travelled across the country to see this.
A program in Delta received $56,240 to continue, to expand, and to enhance a friendly visiting program. In another case, there was a grant of more than $7,000 to a Métis association in Prince George for teaching the Cree language. I'm questioning whether or not we're duplicating here. In my opinion, this type of program should be in the education department. That seems more like education to me than it does health. So I'm wondering why that comes under the health department. Another one was almost $64,000 to a Yukon first nation group for organizing a founding conference. To me, that seems more an Indian Affairs program.
There are a number of these. I have eleven of them listed. I've used three examples and I would like some explanation as to why this was seen as health. I assume the criteria was prior to the reorganizing.
Ms Stanley: Mr. Chairman, given your concern about time, I would be pleased if Ms Bridgman would provide me with her list. I would then give her some details with respect to each of these as opposed to going through them.
But it is true that we are now beginning a new phase of New Horizons. We're phasing out some of the programs that had more of a social-recreational orientation and some of them may fall in between the cracks. But there certainly are criteria, and I'll be very happy to share them with you.
With respect to the principal nursing officer, as many members around the table will know - because I know there was quite a vigorous lobby to retain this position within Health Canada - it was a position established in 1954 when Health and Welfare was much more involved in the day-to-day operations, hospital design, and a number of elements that are no longer our responsibility.
.0945
It was the result of a rather intensive exercise of looking at our business lines, our core businesses, strategic planning and also realizing that nursing professions across the country were so sophisticated they did not access the department through one particular office. Just as we no longer have a senior dental officer or a senior medical officer, this was a position that had become redundant to the needs of the department.
There are still lots of opportunities for input by many nurses employed in the department, but there was a certain emotionalism and traditional aspect to this position that caused some concern among those in the nursing community. We have attempted to assure them that the views of nurses are held very highly in the department and the loss of the position is not to be seen as any step away from our commitment to bring nurses' perspectives to the table.
On the overall increase in health promotion, I'm going to ask Orvel to comment on that, but you know that the Tobacco Demand Reduction Strategy contributed to this increase, as well as some ongoing commitments under the Community Action Program for Children. Orvel may be a little more specific.
Mr. Orvel Marquardt (Director General, Departmental Planning and Financial Administration Directorate, Health Programs and Services Branch, Health Canada): Yes, that's correct, Kay. The major reason for the increase was the increased funding for the Tobacco Demand Reduction Strategy.
Comparing mains to mains, and I know some of you have your blue book, page 276 outlines all the ups and downs for that particular program. You'll see there's a $27 million increase for tobacco, offset by budget reductions and other reductions as a result of the program review over the summer. There are some other minor changes, but those are the primary reasons.
Mr. Culbert (Carleton - Charlotte): Good morning, Ms Stanley and colleagues.
First, I note that you're projecting a $14.2 million cut, specifically as a result of the program review. Is it feasible for you to give us a list of the programs that are being cut? Is that something you could provide to the committee?
Second, with regard to the health promotion part, the section on your tobacco demand strategy or reduction thereof and your advertising of the program, a day or two ago the newspapers reported that Health Canada was participating in this Italian Alps forum that's coming up about tobacco growth around the world.
From your perspective, because Health Canada is investing in that, what is it supposed to do for us? Can we justify that type of expenditure when we're cutting in other areas?
Ms Stanley: One thing about reading the The Ottawa Citizen now that it's a morning paper is it does sort of jolt you when you read those things at 6 a.m. I assure you that the journalist's numbers are not accurate from Health Canada's perspective. As the ADM for health programs and services, I have made no contribution toward that particular activity.
Under the Policy and Consultation Branch, there is an international aspect to the Tobacco Demand Reduction Strategy, which did make a contribution to that.
Orvel, I think I read the number yesterday. You might comment.
Mr. Marquardt: The number was $700,000 maximum to IDRC over a period of three years, starting in the current year.
Ms Stanley: I think a little journalistic licence was used in that particular article.
.0950
In terms of the impact of program review or the budget, we could provide the members of the committee with a list. Some programs have had resources diminished. Others, such as the aboriginal Head Start Program and prenatal nutrition, have had a little reduction and will now be stretched out over a longer period of time.
We have had to make changes. The big one of course, as you mentioned, is the Tobacco Demand Reduction Strategy, which has had a $27 million cut in community action initiatives and in the advertising area. That still leaves a healthy $35 million to do effective programming, but it will reduce the number of community initiatives by between one-third and one-half.
Seniors programs, as a result of decisions, have been mainstreamed at about $18 million a year for community action for seniors, which reduces some of the potential growth. It has been $18 million for the last couple of years, so we've been holding the line on that. But we could provide a tabulated list for the members of the committee.
[Translation]
Mr. Patry (Pierrefonds - Dollard): Ladies and gentlemen, in your excellent presentation you said that health promotion was a good investment. I would go further: I think it's about the best of all investments, and I'm quite disappointed that the health programs and services branch, with only 2.9% of the total health budget, has to undergo some cuts.
As Chairman of the subcommittee on AIDS, I'm also surprised that the enveloppe for the National AIDS Strategy has been reduced by $2.7 million, in spite of very strong demand in the field. Could that cut be explained by the fact that last year's envelope was not totally used up, for reasons that are still unknown and that the subcommittee on AIDS was also unable to ascertain?
Secondly, what aspect of the strategy be mostly cut? Is Health Canada going to consult with the main stakeholders within the strategy, before the cuts are carried out? Finally, what will be the total budget for the national AIDS strategy 1995-1996?
[English]
Ms Stanley: Thank you, Dr. Patry. I don't think I'll comment on the share of Health Canada's budget my branch gets. You've pointed out that health promotion and disease prevention are absolutely fundamental and we support that, but we also acknowledge that the activities of other branches in the department are also fundamental. Certainly, the work of the Health Protection Branch and the Medical Services Branch are also very vital. Yes, I'd like more resources for health promotion and disease prevention, but I'm also cognizant of the need to get the deficit under control, and we're making our contribution to that.
With respect to the AIDS strategy, the fact that funds were lapsed in the AIDS strategy is a function of a late approval of the renewal of the strategy and some inherent structural difficulties with respect to the 1993-94 year, with the severance of Health and Welfare and restructuring within the department.
The specific area you mentioned in terms of a reduction falls primarily in the area of the care and treatment function. The federal government assumed a leadership role in terms of instructions to physicians and professional bodies about how to provide for the care and treatment of HIV/AIDS sufferers. We now see that as a responsibility the medical schools and the faculties of medicine should assume. Therefore, under program review, we felt it was appropriate for us to make an adjustment to that particular area.
.0955
Orvel has the numbers in front of him, and I'm going to ask him to give you some details on the actual amounts.
Mr. Marquardt: The strategy was renewed at $40.7 million in 1993-94. I'm going to use a term here that I used when we appeared here on supplementary estimates: we had to reprofile some money. We did not spend it all, as Kay said, in 1993-94; $2.7 million of it was reprofiled to 1994-95. So 1994-95 looks as though it has $2.7 million more than the strategy does for 1995-96.
It's $40.7 million every year. We lapsed a little bit in 1993-94. We moved that into 1994-95. In these estimates, when you compare 1994-95 to 1995-96, it looks as though there's a drop of $2.57 million, but there really is not. Strategy has not been cut.
Ms Stanley: Dr. Jeans, did you want to comment on the research on AIDS?
Dr. M.E. Jeans (Director General, Research Program Policy and Planning Directorate, Health Programs and Services Branch, Health Canada): I'd like to make just two comments. I am somewhat new at this and I recognize, Mr. Chair, that we're here to talk about accountability. But I think that when we get into strategies, we need to put it within the perspective of the work of the whole department.
For example, in AIDS research, Health Canada took a lead in stimulating research in the field of AIDS long before the strategy. You can be assured that Health Canada, through the Extramural Research Programs Directorate and through the Medical Research Council of Canada, will continue to support research in that field, long after there's a strategy.
I think that applies to all of the strategy. While I recognize that you are asking how we have used the money within the strategy, we do need to put it in context.
I would also say that on the research side, we support research across the spectrum. About 60% of the research supported, in fact, is in basic and biomedical research to try to really understand how we can prevent and cure this devastating disease. The other 40% of it is spent on research into helping people change their lifestyles and practise safe sex, and on finding ways to best care for people who are already afflicted.
I would say that in addition to the money in the strategy, a lot of resources that support the strategy come from the basic budget of the research program. There is another side to it.
Mr. Patry: Thank you.
The Chairman: Our time is up, so unless we have a burning question from the other people on my list... Go ahead, Paul.
Mr. Szabo (Mississauga South): Mr. Chairman, it is unfortunate we had only a brief amount of time. Since Ms Stanley has offered to take questions from Margaret if she has concerns, I'd like to submit as well the questions that the staff have prepared. I think they're quite relevant, and I would ask Ms Stanley and her people if they would please provide the committee with their best effort on responding to some of these questions related to the estimates.
The Chairman: Our time is up. We thank the witnesses.
While it appears we have the briefest time, the fact is that we've allocated in total several hours to hearing from various witnesses in various departments. We've heard this morning from one of five branches. We have four to go. We will hear also from the agencies and we'll hear from the minister.
At the end of that, we will have spent more than the briefest time on this issue. That's why it's important that we discipline ourselves to get the information out but in as efficient and brief a manner as possible.
One other thing while we're on this issue, before we recess very briefly, which is just a formality procedurally, is that we need to stand over the estimates. This morning we've been dealing with votes 1, 5, and 10 under Health. We need the consent of the committee to allow these to stand because the procedure we're going to be using in the committee is to wait until we've heard from all the branches, plus the agencies, plus the minister. Then there will be a meeting to go through the individual votes.
.1000
Votes 1, 5 and 10 allowed to stand
The Chairman: I want to say, particularly for Margaret's benefit, but also for the benefit of the committee as a whole, that, as I alluded to a moment ago, it's our intention to entertain amendments or other procedural fun and games you want to play after we've heard all the witnesses from the department, the agencies, and the minister herself. Then we will have that meeting in which we will deal with the actual heads of expenditure. During that time, you'll be able to propose amendments.
I thank the witnesses. We will recess for one minute flat and then come back for an in camera meeting.
[Proceedings continue in camera]