Health Committee on Oct. 3rd, 2006

[Penny Priddy, NDP, Surrey North, BC]

I know that, yes.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Batters, you have five minutes.

[Dave Batters, Conservative, Palliser, SK]

Thank you very much, Mr. Chair.

I want to thank every one of you for being here today and for your presentations on a crucial topic that some have called the next big epidemic. It's certainly a big problem that's going to face our first nations people. It's going to face all Canadians, but particularly first nations people because of the increased propensity for type 2 diabetes especially.

There have been discussions at this committee in recent meetings, though, affecting all Canadians. We need to work toward improving education in this realm, and I'm the first to step up and say boy, do I have a lot of work to do in terms of understanding food labelling. I think part of our report and part of what government needs to do here is to assist our communities and our first nations communities in terms of education and materials.

We've suggested a shortened or simpler version of the Canada food guide, maybe a two-page laminated document that's pretty easy to understand. Then Canadians can go and dig as far as they want in terms of examples that fit that food guide. Undoubtedly, there are many, many recipe books that conform to that.

I will direct my question toward Ms. Langlois, but I'd welcome input from anyone who'd like to tackle this.

I don't believe we're doing a good enough job in terms of the general practitioner's or nurse practitioner's offices when patients--be they first nations or frankly any Canadians--go in to see their doctors. Are they currently getting educational tools? Here's the issue: it's a big problem, and we need to push healthy eating and we need to push physical fitness and exercise. For our first nations communities, maybe these materials...well, I'd suggest they definitely need to be culturally sensitive and they definitely have to be in languages that everyone understands. These need to be translated documents that absolutely everyone can understand. I think we need to do a lot better in terms of promotion of healthy eating and physical fitness at the health care practitioner level. As well, I've talked about the Canada food guide, etc.

I'd like your opinion as to what kind of job we're doing right now. When families go in.... First nations is our focus today, so let's focus on that. First nations citizens going to see their doctor or their nurse practitioner, are they getting that information--healthy eating and physical fitness--and is that information in their first language?

[Kathy Langlois]

Thank you very much.

As you may be aware, the government has recently moved forward with the renewal of the aboriginal diabetes initiative. This is a strategy that puts resources into first nations on reserve and into Inuit communities and attempts to bring awareness and offer prevention strategies for diabetes. So in terms of putting information into the hands of communities, there will be resources there, and there are resources for communities to design programs that are meaningful to them, that are culturally relevant in the appropriate language, that bring the messages to the people in terms of healthy eating, physical activity, and so on. In fact, the Kahnawake project has benefited in the past, I think, from resources from that initiative.

The renewal of the program--I guess it's into its second year now--was $190 million over five years. So this is a significant increase over what has been there in the past, and we anticipate moving forward with comprehensive strategies.

We work closely with the Assembly of First Nations and the Inuit Tapirit Kanatami to bring both programs into place, design program frameworks, and it may be that my colleagues from AFN and ITK may want to speak to that program.

[Dave Batters, Conservative, Palliser, SK]

I'm anxious to hear how they're looking at this.

[Kristy Sheppard]

With the question posed, is that for Inuit as well, because I noticed you mentioned first nations three or four times without the inclusion of Inuit?

[Dave Batters, Conservative, Palliser, SK]

And my apologies. First nations and Inuit people...yes, thank you for correcting me.

[Kristy Sheppard]

That's one of the primary points. We need to have an identity within that, because we often don't get program-specific dollars or materials due to the fact that we're lumped into one. So that's a good point to keep in mind there.

[Dave Batters, Conservative, Palliser, SK]

That's a great point. Thank you.

I make my point: it's really for all Canadians. I'm focusing on--and thank you for pointing this out--first nations and Inuit people today, but really I think this is an issue for all Canadians. I don't think we do a good enough job in terms of educating people.

The focus, though, for first nations and Inuit people is we need to stress the importance because of the increased risk for diabetes. As all of you are well aware, it's a major deal of major importance to first nations and Inuit people.

I'd like to hear some other comments as to how we're doing at getting this material out. I've heard just from Ms. Langlois so far, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

That doesn't really matter; your time has gone, but we'll entertain a very short intervention.

[Valerie Gideon]

I just want to make a quick comment. I think what needs to be understood is the overall context of health care in our communities. For instance, 30% of our communities are located more than 90 kilometres from a GP. The nursing shortage in our communities, although the nursing shortage in Canada is very severe, is much more severe. Nurses are facing a huge primary care burden. They're constantly pressured to evacuate people out of the communities for emergency care. They don't have the time to sit there and talk for fifteen minutes with people on how they should improve their children's nutritional habits.

We do not have school-based nutrition and activity promotion programs in our communities, unless the communities have found a way to resource those and found a way to implement them. We were left out of the healthy schools initiative. We were left out of the pan-Canadian healthy living strategy, the $300 million. None of it was dedicated to first nations or Inuit, despite the fact that we had been engaged in the development of that strategy.

So the recognition has not been there that our population is at greater risk. It may seem self-evident, but it has not been the case, generally, of federal government policy.

[The Chair, Conservative, Rob Merrifield]

Your time has gone twice now.

I'll ask for one more intervention by Ms. Willows.

[Dr. Noreen Willows]

I just want to say that the speaker had asked whether people get appropriate information from medical doctors and nurses. I would like to make people aware that the health care professionals who are most knowledgeable in nutrition are registered dieticians, not nurses or physicians, who get very little education with respect to nutrition. All health care teams should include a registered dietician, and yet very few first nations and Inuit communities have full-time registered dieticians available to help people understand things like food labels and the complex relationship between good health and nutrition.

So that should be actually one mandate to include, as in all health care teams in these communities, a registered dietician with the appropriate knowledge.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Keeper, you have five minutes.

[Tina Keeper, Liberal, Churchill, MB]

Thank you very much.

I'd like to thank all the presenters as well.

As has been mentioned, this is a critical issue. Throughout Canada, and especially in aboriginal communities, we have seen, and we have heard today, that there are significant numbers in terms of our youth.

One of the things I think I heard from every presenter today was that self-determination and empowerment are significant health determinants. We talk about chronic disease being on the rise; it was in the presentations. I'm sure everybody at this table is aware of how chronic disease is a critical issue in the first nations and Inuit communities.

We have program dollars that are being announced, and I know from the past Liberal government there were significant dollars announced. One of the things that has been mentioned, though, is that there's not a lot of first nations or Inuit access to those dollars, or control of those dollars.

We talk about children who are two years old, in kindergarten, and somebody mentioned that obesity levels are already recognized at those early ages. And we look at programs such as the maternal health program, where Vice-Chief Whitecloud mentioned there's not universal access to that program. It has also been discussed that there is not enough work between departments on these issues. You know, we have INAC and we have FNIHB.

I'm wondering what we need to take forward in terms of the communities. These are people right at the grassroots. This is their lives. They're aware that this is an issue, and obviously it's critical. What recommendations do we make, in terms of self-determination, program services delivery, research?

[Valerie Gideon]

Certainly I think the point we've tried to bring forward to the committee is in the fact that we are facing a 3% cap on the overall health budget on April 1, 2007. There will be cutbacks and pressures, and budget resources will be oriented towards those critical services such as nursing and transportation, where if you don't provide them, people will die.

The emphasis on population health, health promotion, and disease prevention will be reduced even more significantly than it currently is. We would very much like the committee to recognize the need for that broader population health approach. We've developed a public health framework for first nations that includes a list of core and mandatory programs--which define public health with a big “P”, so to speak--that would empower first nations governments to really address the root non-medical and medical determinants of diseases.

I think this type of approach would give them the flexibility to look at the school environment, as you just mentioned, and to really invest in a capacity to be able to deliver effective programs. If we continue to fund very specific programs that are highly targeted, there are some benefits, in that some materials can be provided and some standards can be developed. But at the same time, the limitations are that those programs are not made universally accessible to communities. For instance, the head start program is still a pilot program, and it was created almost ten years ago now. So is diabetes prevention. These are still pilot programs. Obviously there needs to be some real rethinking about how resources are invested and how the system overall is organized and structured. I think there needs to be that flexibility and an annual growth rate in transfers to first nations, so they can take greater control over how their programs and services are delivered.

You still need the economies-of-scale supports at the regional or sub-regional level to provide some broader population health capacity and expertise such as in the area of public health surveillance. That's still something that would be agreeable to first nations. But ultimately, that flexibility and that holistic approach needs to be fostered in first nations communities.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Mrs. Davidson, you have five minutes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chairman, and thank you to the people who have come here to present to us today.

Certainly the presentations have been very informative, and I think we've run with a common thread through everybody's presentation. We've heard a lot of very difficult issues being discussed and we've heard about some solutions that have been put in place or that have been tried, but I'm not sure that they've been solutions.

I'm not sure where we go. We've heard the measures and the evaluations that have been done in the Kahnawake school project. You said you saw modest behavioural changes, yet the obesity increased drastically, if I remember correctly from the percentages that you gave. You learned some lessons about children being obese at a younger age; that there was a potential, from what you were doing, to motivate communities; and that you were seeing some community commitment. But I don't see where we have really gained from that.

Are there other areas? We've talked about different things, and other presenters have talked about things that we need. We need to have better data. I don't know how we get that data or whether we have a program that's going to give you that data.

You talked about continued financial support. Of course, everyone needs continued financial support to carry forth with other programming. You talked about promoting breastfeeding and active living. All of these things are common across all children in this country, and all of these things are ones we need to be promoting. Affordable, healthy food is a huge issue in all areas. I think it's more of an issue in first nation and Inuit areas because of the isolation in many cases, and the high costs.

You talked about promoting self-government in health. I'm not sure whether or not or how that fits in, and how that benefits.

I know those are a whole lot of things, but I just can't see a clear direction to take. If there are one or two things we could be working on, what would they be? I don't know who wants to comment on that.

[The Chair, Conservative, Rob Merrifield]

The floor is open. Do we have anyone who wants to try to answer this one?

[Dr. Margaret Cargo]

I can comment on that a little bit.

If you look at the interventions that were included or examined by the Cochrane review, it could be that the interventions weren't sufficiently intense for the changes in behaviour to lead to the changes in body composition that we would hope to achieve. If you look at the number of dollars that are invested in a lot of school-based interventions in the community, health promotion doesn't get a lot of money. If you look at the billions and billions of dollars that marketing companies have to market these foods to little children and parents, I think that's something we need to look at, because the local-level interventions need to be supported by broader-level policies that are supported by the government.

Also, we did see some changes in the Kahnawake schools diabetes prevention project, in increased physical activity around 1999. In 2004 we lost that effect, and it could be because the number of physical activity minutes in the schools dropped. So there are changes that could be made. While teachers and school administrators are trying to uphold academic standards, at the same time they have to address physical activity and health education. Changes could be made within the school system by mandating a minimum number of physical activity minutes.

[The Chair, Conservative, Rob Merrifield]

Ms. Sheppard.

[Kristy Sheppard]

When you're asking for a direction to go in, there is one thing that we require. A lot of programs that are in place now have amazing intentions and I'm sure they work in a lot of southern communities, towns, and provinces in Canada, but we require engagement that we don't receive. Many programs that are put out are modeled on southern communities but don't apply when they have to go in the north. But the only dollars we're getting are for the specific program that's modeled a specific way and has to be done like that.

Without appropriate Inuit engagement, you're not going to get the effective results, because they're not tailored to what the community needs. You're also not putting in appropriate evaluation tactics that go on what our Inuit communities would see as improvements. For example, if you used the BMI to measure someone before they got into a better eating program and then measured them again, they're probably still going to be overweight. They may have lost 25 pounds, but based on the standard BMI system, it doesn't apply.

So we need engagement in the development of projects, we need it in legislation, we need it in delivery, we need it period. We need engagement for aboriginal programs if they're going to apply and be successful in our communities.

[The Chair, Conservative, Rob Merrifield]

Thank you. Your time is gone.

We have Madame Demers.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

Chief Whitecloud, Dr. Gideon, my first question is for you. I browsed your website to better understand the issues you face. I noticed that financing allocated to the health of the First Nations had been cut by $269 million. I presume that has had a serious impact on your work. I want to say that I believe wholeheartedly in your holistic approach. I believe that it is a very intelligent way to tackle problems.

I wonder whether Health Canada consults with you before deciding to implement new programs in your communities. Do they consult you? For example, were you consulted on the preparation of the new Canada Food Guide? Did you participate in the development of those programs and guides so that they might fully satisfy your needs?

[Valerie Gideon]

I will begin with the question of the $269 million. Yes, the impact of those cuts will be felt more deeply over the next fiscal year. These reductions were announced in the 2005 budget. They therefore do not include the budget cuts in the Smoking Cessation Program that have just been announced. Those will be added to that amount. The effect will be mostly felt on non-insured services. The E-Health Program will be completely eliminated. We will therefore forgo new technologies in the communities.

In 2004, we were not consulted when $700 million in new investments were announced, which notably included the renewal of the Aboriginal Diabetes Initiative. On the other hand, we participated in the evaluation of the Aboriginal Diabetes Initiative and we insisted that it be renewed. The amount of money allocated is much higher than before but we were not consulted on how the $700 million would be used. We are dissatisfied with the way in which communities have access to financing. For example, the First Nations communities will have access to only 4% of the $100 million allocated for human resources in the health sector over the four years of the Initiative. The budget is over four years because it was difficult to have it approved. We are quite dissatisfied with this.

With regard to the new Canada Health Guide, we are part of a small working group that the First Nations and Inuit Health Branch created with the Inuit. However, we were not really consulted on the contents of the Canada Health Guide but rather only on its presentation so as to ensure that the recommendations would be appropriate to the needs of the populations. We should really consider this issue. In-depth research would, however, be required to ensure that the recommendations are adequate rather than to presume that the rate of...