Health Committee on May 30th, 2006

[Dave Batters, Conservative, Palliser, SK]

I have one more real quick comment, Mr. Chair.

If that is indeed the case, that 50%, perhaps, of our prisoners in this country suffer from FASD, then we have a massive problem on our hands. If we can address it, and you've indicated that you're willing to show this leadership, Dr. Butler-Jones, then this certainly fits in with the goal of this government and all parliamentarians and all Canadians to reduce crime, as well as to cut down on what Dr. Fry called the human wastage, the terrible potential that's lost as a result of this very preventable condition.

So I look forward to seeing your report at some point, sir.

Thank you very much, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

Just to follow up on that, you said you would be prepared to do a report. Can you tell us how quickly you could make that happen?

[Dr. David Butler-Jones]

We'll have to look at that in terms of capacity and focus and other activities the government is engaged in.

[The Chair, Conservative, Rob Merrifield]

The reason I'm asking is that I'm going to try to encourage the committee to actually do a report on this as well, but it would be valuable for us to have your ideas as part of that.

[Dr. David Butler-Jones]

Certainly I would be pleased to engage in that conversation to whatever extent is useful for the committee. In terms of a chief medical officer report, that's a timing issue that I can't predict at the moment. I'm sure the committee would like to report probably in advance of when I could do that. So I would be happy to collaborate or cooperate as you see fit.

[Dave Batters, Conservative, Palliser, SK]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Butler-Jones, let's go back to page 4 of your speaking notes. You say that many provinces and territories have identified fetal alcoholism as a serious issue for their governments to address and have developed strategies to address fetal alcoholism and have also called upon the Government of Canada to demonstrate leadership and to develop a federal strategy. Those are your words. I'd like to have a little more explanation on what has raised interest in a national strategy. Tell me what provinces have made these observations and in what order they detected certain problems they were incapable of solving. Why did they have trouble achieving certain objectives? Is it because this is a growing phenomenon? Is it because they don't want to put a strategy in place? I find it hard to imagine Quebec calling on the federal government to develop a national strategy in this area. Have all the provinces called on the federal government? Is it one province or two? Since public education, advertising and awareness campaigns and the enforcement of health regulations fall under provincial jurisdiction, that must be done in the provinces. What is the problem causing the provinces to call upon the federal government?

[Dr. David Butler-Jones]

The situation differs from province to province. Their capability and approach are very different. For the provinces and territories, the notion of leadership by the federal government includes a process of facilitation and collaboration so that they have assurances that diagnosis and approach will be the same. That can also facilitate their access to international information. They aren't asking the federal government to do programs for the provinces, because that's a responsibility of the provinces and territories. Collaboration between the federal government and the Public Health Agency of Canada improves the program and facilitates collaboration among the parts of the nation.

[Christiane Gagnon, Bloc, Québec, QC]

You're talking about developing a federal strategy because that's what you've been asked to do. Tell me clearly and specifically at what level you will act. What problem have you identified? When you ask the federal government to develop a federal strategy, it's because a problem has been identified by a large number of provinces. I'm trying to see where the problem in general is.

In Quebec, there have been regulations and acts. There is Éduc'alcool. We have a way of doing things in Quebec. We've taken action, and an action plan was put in place in 2006. I'd like to know where you're headed. Are you informed enough to prepare a national strategy that responds to a set of problems? The provinces may have adopted different ways of doing things, but that may be producing results. The results of Quebec's strategy may be good. Why is it you're going to contribute to that?

In reading the various files and gathering information, I learned that clienteles are targeted, that certain population segments are at greater risk. Reference is also made to alcoholism. You know how hard it is for an alcoholic to stop drinking: it's a disease. It's often in the family; it's transmitted from generation to generation. So it's very hard. I wonder in what area you'll be taking action.

[Dr. David Butler-Jones]

It's a joint federal-provincial strategy. That's our contribution. Federal activities are a complement to provincial and territorial activities. Those activities depend on the jurisdiction in question, on capability and on other stakeholders working in the collaborative effort.

[Christiane Gagnon, Bloc, Québec, QC]

Didn't the provinces ask you instead for money to assist them in establishing programs? If you develop a federal strategy, funding has to be distributed to the various provinces for that purpose. If you say you're not going to do the programs and that you won't implement them, how are you going to...

[The Chair, Conservative, Rob Merrifield]

Okay, your time has actually gone, but I'll ask for a very quick answer to that.

[Dr. David Butler-Jones]

It's a collaborative effort. We allocate funding to federal activities, and the provinces allocate funding to their activities. There isn't a single strategy imposed by one order of government on the other. The various strategies complement each other.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

We're getting a sense of some frustration around the committee; however, now being on the government side, I have been able to witness firsthand the dedication that the bureaucracy and you, Dr. Butler-Jones, have in trying to resolve this issue.

I can understand my colleague Mr. Batters' frustration of 10 years of Liberal inaction, but this government takes this very, very seriously. I'm wondering what we can do, what resources this government can provide you and Health Canada to work to make the best impact possible to help prevent FASD.

[Dr. David Butler-Jones]

Well, I very much appreciate the offer.

It is, as I reflected earlier, a matter of policy and financing of cabinet and others and their authorities, so I'll defer to them, but certainly we will engage in the conversation that will lead to whatever this government might choose to pursue.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

I have four points I'd like to make. One of them is, if I were pulling together stakeholders to ask about this, there are moms who will talk about the fact that they binge-drank when they were pregnant and as a result had a baby with FASD. So other than the higher-level people, I would actually ask the people who had engaged in the activity about what kind of information or what kind of mentoring might have prevented that activity.

My second point is, these are lovely. The brochures in the doctor's office are lovely, and often they are, and sometimes people read them, but let's remember a large part of this country is not literate, although you did make the point. We have to get information out in other ways, assuming that not everybody is able to pick up the fancy brochure and read it. By the way, in languages, there is no point in my picking up the English brochure if all I speak is Punjabi. So that's one of the points I'd make.

Let me put my previous minister of health, or minister of education, or minister of labour hat on, or whatever they give you when they can't find the job that would fit for you, and say that without empirical evidence, I have no way, as a minister in a province, of budgeting for what kinds of resources I'm going to need, either in the education system, in the post-secondary system, or in--I hope not--the prison system, but at least in the rehabilitation part of the corrections system. So without any kind of empirical evidence, I can't budget. This becomes one more very large piece when you talk about $1.5 million--although I don't think most people with FASD live to be 65. This is not my understanding, so I think that is an age that probably is further.... Without that information, I can't budget and I'm not going to have enough money to be able to provide the services people need, because it is a reasonably new item, although 20 years old, but reasonably new in budgets.

So those are the things that concern me. If you could comment on those, I'd appreciate it. Thank you.

[Dr. David Butler-Jones]

Certainly, and I'll pass it over to Kathy in just half a minute.

Certainly the service delivery at the provincial level is challenged by that. We also, in a complementary way with the provinces, fund local projects that work with communities and engage the individuals, as you've talked about. Actually, there are quite a few across the country. But they also develop answers, strategies, etc., that then can be used by other community groups in terms of modules for training in community colleges as well as activities and programs at the community level that we share across the country, for example, children's programs, etc.

So there are a number of activities that are going on in that.

I'll just turn it quickly over to Kathy.

[Kathy Langlois]

Yes, just quickly, with regard to engaging women who've engaged in the activity already, that is the basis of our mentoring program. We look for experienced mothers in the community who've walked that road and who have recovered and are prepared to take on the challenge of working with women at risk.

With regard to literacy, that is exactly the reason for working with communities and asking what the best way is to communicate around the issue of FAS. We've had examples where communities have decided to bring women together in a community kitchen environment, where an elder will speak to them about alcohol and the impact it will have on a developing child.

I would just say that with regard to empirical evidence, this is where we are pinning our hopes on the diagnostic work that the Public Health Agency is leading, because as you build the evidence in diagnosis, you will build the evidence base of the prevalence and you will know whether it's going up or down and whether our programs in our communities are having any impact. We look forward to that.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Brown

[Bonnie Brown, Liberal, Oakville, ON]

Thank you very much. I think it will be pretty instructive when we get the answer to my question about the amount spent on anti-smoking and then we can compare the two. I think you'll find that what is spent on this is absolutely minuscule, comparatively speaking. Look at the success we've had with the anti-smoking campaign and the second-hand smoke and all those kinds of things. If you put in the money, you get the impact.

But I wanted to go back to Dr. Butler-Jones. He kept talking about how resources and allocation of responsibilities are a political decision, a cabinet decision. I think you can hear around the table that we find it pretty frustrating that there's some money here and there's some money there, and different people are in charge of that money. I always find when responsibility is shared, nobody is really responsible.

So I want to ask Dr. Butler-Jones, considering that this has a great deal to do with disease prevention and health promotion, is that the vision he has for the agency? I know the agency's new, it's just growing, and you have to grow at a rate that is manageable. But 20 years from now, do you envisage a public health agency in Canada that is something like the Surgeon General's office in the United States, which is responsible for leading the charge in public education? Even its website is tremendously impressive.

Is that what you see for yourself eventually, that all the prevention-promotion activities will come under the Public Health Agency and your role will be somewhat like that of the Surgeon General?

[Dr. David Butler-Jones]

The role is somewhat of a combination of the role of the Surgeon General, in terms of its public role, and the head of the Centers for Disease Control.

In terms of the role of the agency itself, there are many players. In public health, it isn't any one. Going back to tobacco control—because I've been around this for a long time—it was the municipalities and local health units. It was provincial, federal, and NGOs and others that actually came together to take different pieces of it to move that agenda forward. But it took 20, 30 years. I'm not sure we have 20 or 30 years in terms of fetal alcohol, so we need to find strategies. But again, we need to respect the jurisdictions, respect the different roles that the players, even within the federal system, play.

The issue of having different points in the system that have different pieces of it does not mean there's no coordination. Your concern is absolutely right that we need to actually come at it as a federal family with a coherent voice, but also with our partners across the voluntary sector and the provinces and territories. So in that sense, I think there really is a desire. Clearly, this committee has expressed its very strong.... “Desire” is too mild a word in terms of forward movement on this. We look forward to continuing in that direction.

Thank you.

[Bonnie Brown, Liberal, Oakville, ON]

You still didn't tell me if your vision for the agency is that it will be in charge eventually. I don't mean in charge over provincial jurisdiction, but as the main federal voice and receiver of the moneys to dispense on health promotion and disease prevention.