Evidence of meeting #5 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was fasd.

On the agenda

MPs speaking

Also speaking

Linda Dabros  Director, Office of Drug Strategy Secretariat and Strategic Policy, Department of Health
Kathy Langlois  Director General, First Nations and Inuit Health Community Programs Directorate, Department of Health
Kelly Stone  Director, Childhood and Adolescence Division, Centre for Health Promotion, Public Health Agency of Canada
Barbara Beckett  Assistant Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research
David Butler-Jones  Chief Public Health Officer, Public Health Agency of Canada

11:55 a.m.

Conservative

Dave Batters Conservative Palliser, SK

Thank you very much, Mr. Chair.

I appreciate all of you coming before this committee today. I'm going to ask a number of questions. If I can have relatively short, succinct answers, then I will be able to get through a lot more questions in my five minutes.

The government and the department have been looking at a variety of strategies and plans for a decade, and I'm going to ask perhaps Dr. Butler-Jones or any of you to comment. Where are the results? Are we seeing concrete, measurable evidence that we are achieving results? I guess what we're looking for--what I'm looking for--is accountability and value for money. I appreciate that all of us want to tackle this very serious problem, and it saddens us greatly that there is such a high level of this problem in Canada, but we need to see some value for the money that's been spent thus far.

That's my question. Where are the results from all the studies we've had, the comprehensive plans, and the flow charts? What can we point to as value for money in terms of results?

11:55 a.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Basically, where we're at now is looking at tracking value in change in terms of diagnostic behaviour; use of guidelines; levels of surveillance; the number of organizations that are engaged; the tracking, the polling that we've done in terms of public awareness. Is there more that could be done? Absolutely. But with the resources, we tend to focus on trying to get the activities based on value for money recognized in terms of practices elsewhere, where studies have been done, and applying them in Canada, as opposed to tracking them here.

Certainly in the future, both through CIHR and some of the things we're doing, looking at returns on investment is obviously key, but given the evidence that exists elsewhere, with limited resources we'll focus it on the activities rather than the other.

11:55 a.m.

Conservative

Dave Batters Conservative Palliser, SK

Your estimates in the brief we were provided from the researchers indicate that we don't really know how many people have FASD in Canada. Estimates range from one to nine live births per thousand individuals. Do we know that the incidence of FASD is on the decline? Do we have any idea of whether or not the rate is going down?

11:55 a.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

That we don't know, and the same is true in other countries. What we do have is a series of studies that look.... Part of the issue for the range is that if you look in certain communities the rates are very high and in other communities they're very low. So part of it is the range being taken in.

11:55 a.m.

Conservative

Dave Batters Conservative Palliser, SK

I understand. I want to just back up what Mr. Szabo said. I think changing the wording in some of this literature is essential. With all due respect, Dr. Butler-Jones, it wouldn't take much to put that wording in a pamphlet. You said some things are difficult to word. I'm certain we could do something like that.

I would like to ask Ms. Langlois quickly, in educating first nations and Inuit people on reserves, do you use a pamphlet that gets your message across?

11:55 a.m.

Director General, First Nations and Inuit Health Community Programs Directorate, Department of Health

Kathy Langlois

In the early years of the program there was a poster that I think got significant attention, and we did use it. But to be the most effective, we've allowed communities to develop their own ways of messaging.

11:55 a.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Can I just say very briefly that they have to be targeted and appropriate for the communities. So in public health locally and provincially, there are lots of materials out there. An additional federal one may or may not be useful.

Noon

Conservative

Dave Batters Conservative Palliser, SK

But my understanding is that this is a condition—you can correct me if I'm wrong—that is of much higher prevalence in first nations communities than in the general public. I know Mr. Szabo said it crosses all demographics, and we all know that, but I think in terms of incidence, at least speaking from Saskatchewan and our perspective, it's higher among our first nations people.

I just leave you with the thought that perhaps a pamphlet that can be passed out to every individual in their childbearing years could be very beneficial.

Dr. Butler-Jones, you might find this question interesting. I know you made reference the last time you were here to the fact that you're from Saskatchewan. Do we know how many children are estimated to have FASD in Saskatchewan?

Noon

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

I don't have the answer to that.

Noon

Conservative

Dave Batters Conservative Palliser, SK

Does anyone? I certainly don't.

Clearly, this is information that we need to strive to get, with all the research that's been done.

How much money was invested by the previous Liberal government in an FASD strategy?

Noon

Director General, First Nations and Inuit Health Community Programs Directorate, Department of Health

Kathy Langlois

I believe the program started in about 1999 with $5 million a year. In the 2002 budget it grew to $19 million to $20 million per year. It has been at that level since then, with $16.7 million with the first nations and Inuit health branch and $3.3 million with the Public Health Agency.

Noon

Conservative

The Chair Conservative Rob Merrifield

It's time to move on.

Ms. Fry.

Noon

Liberal

Hedy Fry Liberal Vancouver Centre, BC

Thank you very much. I don't want to repeat what Paul Szabo said, but I do reflect a lot of what he says. I really agree with him.

Now everyone talks about it being 10 years. Let me tell you something. Before I became a politician in 1989, I was on a national task force to deal with what was then commonly known as FAS/FAE. I was the Canadian Medical Association representative.

On that we had representatives from the alcohol industry, distillers. We also had parents of children who had FAS/FAE. We set out a beautiful plan to have short-, medium-, and long-term goals. It was all nicely done, and one of the goals had to do with labelling. We looked at some of the things that went on in California that were being shown to be very successful in terms of posters in restaurants, posters in liquor outlets, and of course the labelling of alcohol. I know everyone was shocked--and that was about 17 years ago--to find the alcohol industry in Canada labels its bottles to send to the United States but doesn't label its bottles here; that tells you the bottles can be labelled. It's because we lack the will to do this in this country, and given that this is a very preventable cause of what I consider to be human wastage in terms of generations of people who are born with a syndrome that is fully preventable, it really distresses me that 17 years later we are still hearing things like, “It's going to cost too much. Public awareness campaigns are very expensive.”

The cost of the human wastage is very expensive. Nobody has even calculated the lack of productivity of young people with FAS and FAE. Nobody has calculated the cost of people who go to jail who are not really criminals at all, but are actually put into our prisons because of this particular issue. No one has done some of the things we mentioned a long time ago, such as to train corrections officers and police officers to identify the difference between someone who is in fact criminal and someone who has a fetal alcohol spectrum disorder. None of that has been done. We have done absolutely no prevention.

Now, I could talk about the fact that $900,000 to CIHR for this issue is a joke. I can talk about the fact that when the committee on the non-medical use of drugs came up with some recommendations, everyone gave a million dollars over two years, which was a joke.

So we have to ask ourselves--and I know it's a provincial issue--two things. Is the federal government under the new national Public Health Agency going to do certain things that the federal government can do within its jurisdiction? Get a database going. Become a clearinghouse for information. And, thirdly, is the federal government going to be able to pull together the best practices of certain provinces and move on it? This is the role of the federal government, a coordinating role and a leadership role in facilitating certain things. That was identified and it has not been done. I want to know if it's going to be done.

I want to know if training of corrections officers and police is going to be done. I want to know if we're going to talk about putting the appropriate amount of money into research. I want to know if we're going to deal with labelling and prevention. This is preventable. We have to prevent it. I want to know if that's going to happen.

Seventeen years later, I am sitting here as a physician. There were brochures in every physician's office. You should know that. In 1988 the British Columbia Medical Association produced brochures with its own dollars, and it was taken up by the local medical associations in every province. The medical associations came and said they were doing it and would Health Canada assist them with the costs of doing this for a longer period of time. Every patient who came into the office picked it up, read about it, talked to the doctor about it.

That was never done. Why not? Now let me have the answers. I'm just fed up.

12:05 p.m.

Conservative

The Chair Conservative Rob Merrifield

Now you've got a minute to answer.

12:05 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

The short answer is we're working within our existing authorities and resources. An effective surveillance system needs appropriate diagnoses. We've taken that step and we're continuing to build on what we can from there.

12:05 p.m.

Conservative

The Chair Conservative Rob Merrifield

Thank you. Ms. Davidson, five minutes.

May 30th, 2006 / 12:05 p.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

Thank you.

I hardly know where to start. As a newcomer to this table and to this topic, I find it very distressing. I hear a huge disconnect about what some members who have previously been here feel should have happened and what obviously hasn't happened.

I guess my questions are more for you, Dr. Butler-Jones. We heard the amounts that you said have been set aside--the $5 million per year in 1999, and then in 2002 that amount being increased from $19 million to $20 million. Is that correct? Did I hear those figures correctly?

12:05 p.m.

Chief Public Health Officer, Public Health Agency of Canada

12:05 p.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

I guess my question is, what have we received for that money? I'm not seeing a strategy in front of me. If those dollars haven't gone toward a strategy to move forward, what have they gone for?

Secondly, who is responsible for moving it forward? We have three different segments of the health organization here. Is it too fragmented? Is there a lead person? I think this question has been asked, but I guess I missed the answer because I'm not sure who the lead person is.

You just made a statement in response to Ms. Fry's question that you were working within your existing authority and resources. Is that the problem?

Where do we go from here? I am totally confused as to the millions of dollars we've put into this, what we've received, and where we go. I guess that's my basic question: how do we move forward with this very serious issue?

12:05 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Currently, the health portfolio is the only federal entity that has dedicated resources. The bulk of those resources is for programs on reserve. A smaller amount in the agency is for the development of the strategy. The work has been ongoing, and that's the point we're at now, the diagnostic guidelines, etc. So that's where we're at with the resources to this point.

12:05 p.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

So what's the plan to move forward? Is there a plan?

12:05 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Given issues of cabinet and other things, I'm not the one to speak to that. We continue to plan, and we continue to work with what we have. Future plans will be addressed as a government. I can't speak to that at this point because it's not my role as a deputy.

12:05 p.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

Is there someone within the organization who takes the lead to set the strategy?

12:05 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Certainly, the Public Health Agency, within the health portfolio, has the lead in terms of the overall strategy, of which elements are in Health Canada and CIHR. And we partner with other departments of government. That's where we are now.

12:05 p.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

Then perhaps I should be asking Ms. Dabros about the strategy to move forward.