Finance Committee on Oct. 6th, 2014

[Dr. Barry McLellan]

I'll start with the third part of your question. It is happening right now. I believe the context for your question and the last few that have been put to other witnesses really comes down to return on investment. What is the best use of dollars in order to get the greatest impact? In support of what others have said, I believe the investment should be selective. That doesn't mean only one centre in the country, but it means the investment is made strategically, that it's made in centres where there is expertise and where there's an opportunity to grow, and then the end result will be maximized by having networking and coordination.

With respect to what it means to actually have disorders of the brain and mind treated together, our brain sciences program at Sunnybrook is unique. We bring psychiatrists together with neurologists and neurosurgeons and those who specialize in imaging as well as the non-medical professionals, and we look at the total patient.

It is unique in that in most organizations there is still a separation between disorders of the mind, which is the domain of psychiatry, and disorders of the brain, which usually fall to neurologists and neurosurgeons. We believe there are many benefits to this, including the destigmatization of mental health. I mentioned earlier the fact that there's an intersection between many of these disorders. There's a relationship between depression and stroke and dementia, and only by taking all of these together will we get the best result, so we're doing it right now.

I'm now going to go to the innovation piece, Mr. Adler. We have actually built a significant program around focused ultrasound for treating disorders of the brain. This is a way of actually doing surgery without a scalpel, of treating disorders inside the brain without actually cutting through the skull.

We focused initially on disorders related to the brain diseases, and we focused on tremor and tumour, but we are now expanding this to disorders of the mind. We're going to be looking at opportunities to treat obsessive-compulsive disorders. We believe that through another application of ultrasound, we can break down the blood-brain barrier and get medications across and into the brain to treat depression and other disorders.

From our perspective, actually focusing on the total patient and bringing disorders of the brain and mind together will truly have impact, and as I hope I have emphasized, it's happening today.

[Mark Adler, Conservative, York Centre, ON]

You've mentioned that you are doing it now, so if you're doing it now, why are you here? What are you asking for? Why the $30 million? What do you plan to do with that $30 million?

[Dr. Barry McLellan]

We are doing it now, but we have treated fewer than 10 patients with benign essential tremor. What we have identified is what we call a preclinical model for breaking down the blood-brain barrier, which means that we're not yet doing this in humans. We have the opportunity, by investing in infrastructure, to bring those individuals together in the same environment and get the synergy that we believe will actually help to change the future of disorders like dementia and depression for those patients across the entire country.

The infrastructure, the environment of bringing everyone together in one centre, is different from what exists in Vancouver. In Vancouver, it's more around research. This is research embedded in care, and we believe this is the model that's going to result in the best return on investment.

[Mark Adler, Conservative, York Centre, ON]

That is unique, right? That's not happening anywhere right now.

[Dr. Barry McLellan]

That's right. What I have described to you, the totality of the program, the focus we have in research, is not happening elsewhere.

[Mark Adler, Conservative, York Centre, ON]

Our government has been funding $100 million for brain research, I'm thinking, between 2011 and 2017. That is not what you're talking about, is it?

[Dr. Barry McLellan]

It is not. This is around an investment in infrastructure to bring all of those various individuals together, the researchers, those who are treating clinically, and then building the networking across the entire country to have that dementia strategy, that strategy for treating disorders of the brain and mind that doesn't exist right now.

[Mark Adler, Conservative, York Centre, ON]

You mentioned $30 million. In your presentation, you mentioned private sector funding, so you're not here with your hand out simply asking for the government to fund a centre for $30 million. You have matching private sector funding. Can you talk about that?

[Dr. Barry McLellan]

We are building on that right now. I anticipate that by the end of this month we'll be in a position to announce a lead gift of $20 million against the $60 million. We have other donors who are incredibly interested in disorders of the brain and mind. We see that as a great trend for the future at Sunnybrook and beyond. Our commitment is to continue to work with our donors in order to raise at least 50% of the $60 million total.

[Mark Adler, Conservative, York Centre, ON]

Thank you very much.

[The Chair, Conservative, James Rajotte]

Thank you, Mr. Adler.

On behalf of the committee, I want to thank all of our witnesses for partaking in the pre-budget consultations. We appreciate your input very much.

Colleagues, we'll suspend for a couple of minutes and bring forward our second panel.

[The Chair, Conservative, James Rajotte]

I call this meeting back to order. This is meeting number 46 of the Standing Committee on Finance.

We are starting with our second panel for today.

We're very pleased to have our guests with us. Thank you so much for being with us.

First of all, we have with us the Assembly of First Nations, with National Chief Ghislain Picard.

Bienvenue.

We also have with us Jessica McCormick, from the Canadian Federation of Students; Ms. Kathryn Hayashi, chief financial officer, the Centre for Drug Research and Development; and Bill Rogers, adviser, with the National Initiative for Eating Disorders.

Welcome.

Also, we have a former colleague back with us. From Partners for Mental Health, we have with us the Honourable Michael Kirby, former senator and founding chairman.

Welcome back, and welcome to the House of Commons finance committee.

It's a pleasure to have all of you with us. You will each have five minutes maximum for your opening statements, and then we'll have questions from members.

We will begin with Mr. Picard, who has five minutes for his presentation.

[Chief Ghislain Picard, National Chief, Assembly of First Nations]

Thank you very much, Mr. Chair.

I would like to thank the committee for inviting us to appear today.

My name is Ghislain Picard. I'm the national chief of the Assembly of First Nations. The Assembly of First Nations is the national political advocacy organization for first nation governments in Canada.

I am joined today by my colleague, Manitoba Regional Chief Bill Traverse, who is also the national portfolio holder on the AFN executive for housing and infrastructure.

The need for investment in first nations will not be a surprise to this committee. For over a decade the AFN has been raising chronic issues of underfunding directly to this committee as part of the pre-budget process.

Additionally, first nations and other organizations have been bringing your attention to these urgent needs. This year alone, there were 67 submissions that had direct recommendations regarding first nations. Chronic underinvestment in first nation communities creates widespread and long-term impacts on all aspects of the economy.

We have moved beyond having to prove that a disparity exists. The deep inadequacies in federal funding to first nations in all areas—core operations, education, child welfare, infrastructure, and health—are known and accepted. However, what we lack is the clear political commitment to address these. Within this context, the AFN once again is put in the position where we are forced to advocate for continuing already inadequate funding, because even losing that would be untenable.

When we look at the budget cycle for this year, we see a number of programs that support first nations where funding is not currently identified beyond this fiscal year. This includes the aboriginal skills and employment strategy, a critical support for training first nation citizens and creating linkages with employers. Also, numerous programs that support the health of first nation citizens need to be continued in the next budget, including the health services integration fund, the aboriginal health human resources initiative, the aboriginal diabetes initiative, maternal and child health, the children's oral health initiative, and the national aboriginal youth suicide prevention strategy.

The specific investments required in the 2015 budget are outlined in the AFN pre-budget submission, but we all know that we cannot continue with piecemeal, inadequate, and discretionary project-based funding. A fundamental transformation of the relationship between first nations and Canada is required in order to achieve significant change for first nations. New funding mechanisms are needed that move away from arbitrary and coercive contribution agreements to a fiscal mechanism that recognizes first nation titles and rights.

I would like to specifically refer to funding commitments made last year by the Prime Minister for first nations education. Our children cannot continue to face inequities in education across Canada. The AFN has been directed to ensure these funds are provided to our communities immediately and to engage with Canada on a new financial framework on education that supports predictable and sustainable transfer payments to first nation schools.

I will turn to my colleague now, who will make brief remarks specific to infrastructure.

We welcome the questions you may have. Thank you.

[Chief William Traverse, Manitoba Regional Chief, Assembly of First Nations]

Thank you. Meegwetch. Good evening.

[Witness speaks in Ojibwa]

I am here tonight to speak to you about the dire situation in first nations communities related to housing and infrastructure.

In Manitoba we have 64 first nations, and 31 of them are remote or isolated. They rely on winter roads for access, for supplies, but with climate change these are lasting for less time. They are often unreliable and unpredictable.

There are substandard and deplorable housing conditions in first nations communities. Recent environmental disasters affecting first nations communities, such as flooding, especially the flood of 2011, and forest fires, have just made this worse in Manitoba. Two first nations have been forced out of their communities due to floods, and are facing great hardships in temporary housing or hotels in Winnipeg and other urban centres. They have been there for over four years now. Many of them are passing on, are dying.

We are facing a housing crisis in our communities. The government knows this. A recent report identified that between 2010 and 2034, there will be a housing shortfall of 130,197 homes, that an additional 11,855 homes will be required to replace existing ones that are inadequate, and that at least 10,000 will need major repairs.

[The Chair, Conservative, James Rajotte]

Chief Traverse, I'm sorry, but we are out of time. Could I get you to conclude your opening remarks, please.

[Chief William Traverse]

Just like with education, we need to move forward on a framework that respects and fulfills our treaty and inherent rights and that responds to the real needs of our people.

Meegwetch. Thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much for your opening statements.

We'll move now to Ms. McCormick, please.

[Jessica McCormick, National Chairperson, Canadian Federation of Students]

Good evening. My name is Jessica McCormick. I'm the national chairperson of the Canadian Federation of Students.

The Canadian Federation of Students is Canada's largest and oldest student organization, representing more than 600,000 students across the country. Our association advocates for an accessible, affordable, high-quality public post-secondary education system.

My presentation to the committee today comes at a time when students are facing significant hardships. Students are struggling to cover the increasing costs of a post-secondary education, an education that has become a prerequisite to participating in the workforce, and are graduating into a precarious labour market.

More than ever, students are looking to the federal government to build on its long history of involvement in funding post-secondary education in Canada. For more than 60 years, Canadians have benefited from federal education funding, either through direct or indirect transfers to the provinces, or from student loans and grants. It's this kind of national leadership that is critically needed to advance Canada's economy and reduce socio-economic inequality.

Our budget recommendations focus on making post-secondary education more affordable for students and ensuring graduates have access to good jobs. Throughout our lives, students have been told that we need some form of higher education in order to get a good job and participate in the workforce. However, rising tuition fees have made getting that education increasingly difficult. Across the country, educational choices are limited based on the region you live in or your socio-economic background.

Growing up in Cape Breton, Nova Scotia, I knew I had to get an education in order to get a good job, but my options were limited. I could stay at home and live with my parents and go to school in Cape Breton, or I could move to St. John's, Newfoundland and Labrador, and attend Memorial University. Other public post-secondary institutions in Canada were completely out of reach for me. After we compared costs, my parents and I soon realized that it would actually be more affordable for me to leave home and go to school in Newfoundland and Labrador, where tuition fees are about half of what they are in Nova Scotia.

Ensuring that all students, regardless of which province they're living in, are able to pursue a higher education and get the training and skills they need to succeed must be part of any long-term economic strategy. While the federal government makes significant investments in education each year through the Canada social transfer to the provinces, there's no mechanism for accountability of these transfers. A dedicated transfer payment for post-secondary education would not only increase accountability but also help establish long-term post-secondary education objectives that target quality and affordability. In return for upholding these principles, provincial governments would receive increased and predictable funding from the federal government.

In 2008 the federal government answered our call for a national system of grants. However, high tuition fees erode this historic investment by forcing many students to borrow in order to finance their education. Each year more than 450,000 students borrow through the Canada student loans program. On top of that, an increasing number of students are enrolling in the repayment assistance program because they're unable to make the minimum monthly payments on their loans upon graduation.

The long-term impacts of carrying student debt include delayed participation in the economy, the inability to invest or save for retirement, choosing to move out of the country to find work, starting a family later in life, and an aversion to taking financial risks. Increasing the value and number of non-repayable grants available to students could significantly reduce student debt in Canada. In Newfoundland and Labrador, the provincial government recently announced that they had completely replaced the provincial loans program with grants. The expansion of the grants program in that province has greatly reduced student debt and is an example for the rest of the country.

Young workers and recent graduates enter a labour force riddled with high youth unemployment, a characteristic that experts agree harms our economy. Young Canadians are highly educated; however, many have difficulty getting a foot in the door in today's workforce. While investing in education is one of the primary vehicles for reducing youth unemployment, there are other areas that need attention. The precarious labour market means that many new graduates take on unpaid internships in order to gain relevant work experience. Although Canada does not track the numbers, it's estimated that there could be as many as 300 unpaid positions per year. More robust protections are required to safeguard interns, and increased enforcement is required to ensure employers who break these laws face consequences.

While Canada is not the only country facing high youth unemployment challenges, there are lessons that could be learned from peer nations that could be successful here. One such model is the German dual system of vocational education. The system combines classroom-based academic learning at public colleges and universities with practical on-the-job vocational training. This model has a proven track record, and contributes to Germany's low youth unemployment rate and one of the strongest labour markets in the world. Additionally, Germany's private sector plays a vital role in the system. Unlike many employers in Canada who have reduced on-the-job training over the years, employers in Germany are providing training that gives students applicable skills that help them advance within their jobs and are portable to other work.

I would be remiss if I didn't note that less than a decade after they were introduced, Germany recently eliminated tuition fees.

Five minutes is never enough time to do justice to the recommendations we've put forward for this year's budget, but more details and background research on our recommendations are provided in our written submission.

I'd be happy to take any of your questions.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

We'll now to go Ms. Hayashi, please.

[Kathryn Hayashi, Chief Financial Officer, Centre for Drug Research and Development]

Good afternoon, ladies and gentlemen. On behalf of the Centre for Drug Research and Development, CDRD, and our commercialization vehicle, CDRD Ventures, I'd like to sincerely thank you for this opportunity to speak with you today.

First, I will introduce our organization. Headquartered in Vancouver, CDRD is Canada's national drug development and commercialization centre, the only one of its kind, providing the expertise and infrastructure to transform basic health research into commercialized therapeutics, improving human health, while at the same time growing our national health sciences industry into a fully optimized generator of economic prosperity.

CDRD represents an effective means to advance innovative technologies forward along the innovation continuum, adding value throughout that process. These value-added technologies can then form the foundation of a critical mass of new health sciences companies, thus creating long-lasting high-paying jobs for Canadian families, and supporting continuing Canadian brain gain by providing biomedical researchers with attractive opportunities in Canada.

At the same time, training opportunities that generate new, industry-ready, highly qualified personnel to lead the industry into the future is also a key cornerstone for CDRD's success.

CDRD-developed technologies also represent an opportunity to improve patient care while reducing health care costs through more effective treatments and front-line care for Canadian families, for example, better management of chronic diseases and subsequent reduced hospitalization.

In terms of supporting families and helping vulnerable Canadians specifically, CDRD represents a new way to bring innovative therapeutics to patients, a national model that fosters collaboration, sharing of resources, leveraging of investments, and mitigation of risk. It also offers the opportunity to improve patient care while reducing health care costs through more effective treatments and front-line care.

To further illustrate the potential impact on patients, I refer to our partnership with the Multiple Sclerosis Society of Canada announced earlier this year. This partnership has been created with one goal in mind: to speed up the development of new treatments and find a cure for people living with MS.

I'd like to cite a related passage by MS Canada's vice-president of research, Dr. Karen Lee. She said:

When I look back over the years I can recall a lot of great research that has been done to better understand, diagnose and manage MS. Studies funded by the MS Society, in addition to what has been conducted around the world, have changed the landscape of MS research in monumental ways. But one thing that always seems to come up in my conversations with people with MS is that advancements in research still take a very long time, and they fear that they will not see the true benefits or impacts of the research in their lifetime. This led to the establishment of a very important collaboration with an organization that not only has the tools and resources to speed up treatment delivery for MS, but is located right here in...[Canada], CDRD.

Next week we will in fact be announcing our very first drug development collaboration under this partnership, one which is very reflective of the strength of our model as it brings together a lead researcher from Memorial University in Newfoundland, CDRD's drug development and commercialization experts in Vancouver, clinical collaborators at the Montreal Neurological Institute, and global industry funding partners.

To ensure Canadian families are provided with the best treatments and to further support this type of critical collaboration and CDRD's ongoing sustainability as a large-scale national endeavour, CDRD is therefore requesting a unique federal investment to support its next five years. This will provide the foundational support CDRD requires to ultimately reach the point of self-sustainability.

The federal government has a tremendous opportunity to build on CDRD's success and further optimize what it has already helped to seed. We have established an international competitive advantage for Canada and now have the opportunity to leverage this advantage to realize the full potential of Canada's health sciences industry and improve the health of Canadian families while creating good jobs. In doing so Canada will not only be the generator of world-class health research that it is today, but also be the generator of world-class innovation from the translation of that research.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

We'll now hear from Mr. Rogers, please.

[Bill Rogers, Advisor, National Initiative for Eating Disorders]

Thank you very much for letting us present today.

I am a volunteer for the NIED organization. I'm here with my associate, Lauren Jawno, who is a founding member of NIED and a recovered eating disorder patient. She also works with people with eating disorders.

Who is NIED? NIED is a for-purpose, not-for-profit coalition of parents and children challenged by eating disorders, sufferers, health care professionals, and counsellors. NIED's aim is to increase the awareness and education of eating disorders to promote change in the understanding, treatment, and funding of the disease in Canada.

What does eating disorders mean? First of all, it's a disease that has one of the highest mortality rates of mental illness in the world, but it can be prevented and cured, which makes it unique. It is prevalent in young girls and women, but is expanding its presence to citizens from all walks of life—recently a seven-year-old boy who was admitted to Sick Children's hospital in Toronto with eating disorders, all the way up to an 86-year-old woman who'd had bulimia for over 30 years.

As to the cause, the blunt reality is that we don't know. There is lots of research but there is no true cause. What we do know, and it's more important than anything else, is that it can be prevented if it's treated at an early stage.

The number of eating disorder cases in this country continues to increase. There are very few data points on eating disorders. One of the more recent ones, and this was done in 2006, may be representative. Researchers in Edmonton studied 700 children in grades 5 to 7. Of these children, 15% were purging or over-exercising, 16% were binge eating, and 19% restricted themselves to one meal or less per day—very disturbing facts.

How is it currently being treated? The only thing I can say is not well. The number of family doctors trained in treating eating disorders in Canada is almost nil. The community health care agencies lack both the time and the funding for training in eating disorders, and are generally overwhelmed by mental health referrals. There's also a huge shortage of psychiatrists who specialize in this. Currently there are 4,100 psychiatrists in Canada, of which 12 specialize in eating disorders. Of these 12, only a handful specialize in treating children and adolescents, where it's most prevalent. However, there are evidence-based programs that have been developed by researchers and doctors over the years that work. They've been proven in test studies to work; however, there have been no funds and no initiatives to develop them among our health care system.

What do we need? In order to really beat this disease, and many doctors and researchers we talk to believe it can be done, we have to develop an infrastructure that can build the capacity for the delivery of timely, age appropriate, evidence-based treatment and support services. These services have to span prevention, specialized outpatient treatment, intensive treatment, and residential services. We have to educate and train. We need to train family doctors to screen for eating disorders, to have the language to talk to our children about nutrition, body image, and eating disorder thoughts, urges, and symptoms. We need to send more trained mental health nurses and health care counsellors into our high schools to help young people who are struggling with these issues.

How do we get there? We know that this disease is pervasive in Canada. There's no data that tells us how many people have it. However, the NIED phones ring off the hook. We're all volunteers. We fund it with our own money. People and families are looking for help. They're looking for help for their children, their loved ones, because so many of them end up dying as a result of this disease.

Provincial health care systems typically need hard data to be able to allocate their scarce resources to this disease. Provincial health care systems inadvertently have developed their charting systems to hide the data on ED. That's not on purpose; it's just the way it has developed. For example, there's no charting category for eating disorders in any of the doctors' charts, which ultimately are being used for the data on many of the health care decisions that hospitals and health care administrations have to deal with.

[The Chair, Conservative, James Rajotte]

Mr. Rogers, could I have you conclude, please.

[Bill Rogers]

In conclusion, we believe it's an insidious disease that can be prevented and cured, but today it continues to kill people. We welcome and would love your support to help us make the first step to get there.

[The Chair, Conservative, James Rajotte]

Thank you for your presentation.

We'll now go to Senator Kirby, please.