Health Committee on May 7th, 2007

[The Chair, Conservative, Rob Merrifield]

I'd like to call the meeting to order.

First, I want to thank the minister for being with us. We have a full two hours today, and we certainly appreciate the minister taking the time, along with a good number of his departmental staff, to be here with the committee to talk about the estimates we have before us.

We want to get started and not leave too much time.

With the minister, we have Morris Rosenberg, the deputy minister; and then we have Frank Fedyk, the acting assistant deputy minister of the public health branch. Thank you for being here.

Of course, Dr. David Butler-Jones has been here many times. It's good to have you with us.

Marcel Nouvet is the acting chief financial officer from the chief financial officer branch. And then we have Luc Ladouceur. It's good to have you as well.

We thank you for coming and taking this time, and we look forward to your presentation, as well as a brisk round of questioning on the spending of this department.

With that, we invite the minister to start with his presentation, and then we'll move on to questioning.

I'll lay it out right now that when the minister is here, we have a different timing for the questioning. It's 15 minutes for the official opposition, 10 minutes for the Bloc, 10 minutes for the NDP, and then 10 minutes for the government; and then it's five minutes alternating.

Minister, the floor is yours.

[Tony Clement, Conservative, Minister of Health]

Thank you, Mr. Chair.

I am pleased to appear before your Committee once again - this time to discuss Main Estimates for the Health Portfolio. I expect that all of you have some questions for me today and I would like to start by making a few points that will provide some context for the discussion.

Many of my remarks will refer to budget 2007 items that may not appear in the main estimates but will be included later in supplementary estimates. I want to discuss our overall vision for a healthier Canada, of which budget 2007 is a major part.

First, at Health Canada we're pursuing a new way of doing things. Across our agenda, we're getting results by working with a wide range of partners. This includes provincial and territorial health ministers, of course, but also health care experts, providers, and practitioners. It includes patient advocates, patients, and industry as well.

All of our efforts aim squarely at serving the needs of patients and improving the health of Canadians.

The best known example is our work with partners to modernize and transform the health care system.

Mr. Chairman, a year ago, the question for some was whether we could work toward the patient wait times guarantees that our government promised. A year later, the investments made through Budget 2007 are enabling all provinces and territories to show how these can be delivered.

I'm proud that every province and territory has agreed to develop at least one patient wait time guarantee by 2010.

Mr. Chairman, another important related commitment in budget 2007 is the $400 million invested in the Canada Health Infoway. The additional funding for this public, not-for-profit organization will support early movement toward patient wait time guarantees, through maximizing the benefits of information technology.

All of this is in addition to our government's launching four wait time guarantee pilots, three involving diabetic care and prenatal screening for first nations on reserve, and one linking Canada's 16 pediatric surgical centres.

All of these steps forward are grounded in our commitment to collaborate with our partners. For example, we're working closely with first nations and Inuit partners to find new and results-focused ways of improving health outcomes. Of significance are the joint initiatives under way with the Assembly of First Nations and the Inuit Tapiriit Kanatami, along with a tripartite initiative with the B.C. government and the B.C. First Nations Leadership Council. I believe each of these are revolutionary, quite frankly, but each of these sets the stage for improved health outcomes.

As minister, I'm collaborating with many partners to take on numerous other health challenges facing Canada as well. Canada's new government is creating a new Canadian mental health commission, which will consist of experts, patients, and policy-makers. This commission will work to reduce the impact of mental health on our families, and in our workplaces and communities in Canada, by focusing on mental health prevention, recovery, and education. This is the first time in Canadian history that there will be a high level, strongly led, national arm's-length body.

Our government also took the leadership last fall to announce a new non-profit organization called the Canadian Partnership Against Cancer. By drawing on expertise from across Canada and internationally, this new agency will serve as a clearing house for state of the art information about preventing, diagnosing, and treating cancer. With $260 million from budget 2006, this agency will implement a strategy for cancer control with such goals as reducing the number of new cases of cancer amongst Canadians, as well as enhancing the quality of life of those living with cancer, and finally, improving the likelihood of survival for Canadians with cancer.

Of course, we know that science will contribute to our progress in fighting cancer, and science is also central to the chemicals management plan our government launched last December. Through an investment of $300 million over four years, Canada will become a world leader in testing and regulating the chemicals used in thousands of industrial and consumer products.

The chemicals management plan is an example of one of the most effective ways to improve the health of Canadians: preventing us from getting sick in the first place. This is the most effective way to reduce wait times, and this approach will become increasingly important as our population ages. I place particular emphasis on efforts involving prevention and protection.

Let me give you a prime example: obesity. It is one that we know will translate into higher rates of diabetes and cardiovascular disease if we do not act. In fact, we are developing a response to your recent report on childhood obesity right now.

In the meantime, we are building from consultations with experts to inform Canadians on making healthier choices. Our new partnership with ParticipACTION and a children's fitness tax credit will encourage more Canadians to lead more active and healthier lifestyles.

Meanwhile, the 2007 version of Canada's Food Guide and also the food guide for first nations, Inuit, and Métis offer Canadians guidance, helping all of us to make more informed, healthier eating choices.

Certainly direct disease prevention is also part of our agenda. This is what's behind our drive to develop a national heart health strategy, and of course this inspired budget 2007's $300 million investment, enabling provinces and territories to launch the HPV vaccine program, protecting women and girls from cervical cancer.

In addition, budget 2007 invests $64 million over two years in a national anti-drug strategy. This will provide a focused approach to supporting innovative approaches in treatment, developing system improvements, and reducing the supply of and demand for illicit drugs.

Of course the ultimate goal is ensuring that our communities are safer and healthier. Protecting the health and safety of Canadians is at the heart of the blueprint for renewal of health products and food regulation. This year, we will continue this effort to modernize our regulatory framework, ensuring we have the tools to protect Canadians in a world of rapidly evolving science and increasingly complex products.

But we also remain focused on the readiness for the influenza pandemic, which many health experts anticipate. The federal-provincial-territorial collaboration that has updated the world-renowned pandemic preparedness plan for Canada is helping considerably as we work to create a North-America-wide plan under the security and prosperity partnership.

Mr. Chairman, before I conclude my remarks, I want to touch briefly on our government's initiatives relating to health research and sharing knowledge. Our new initiatives take many forms, including the commitment of up to $111 million for the Canadian HIV vaccine initiative, in partnership with the Bill & Melinda Gates Foundation; budget 2007's $37 million annually in increased funding for the Canadian Institutes of Health Research; and the $30 million allocated to the Rick Hansen Foundation.

These are investments that translate research into practical benefits. This is a concept by which we focus on applying better what we already know, and this is of vital importance to sustaining our health care system. It's a concept that ultimately could save millions of dollars, but also improve productivity and of course improve the quality of life for thousands of Canadians.

Our research efforts also strive to ensure we're getting results in modernizing Canada's health care system. This is what budget 2007's $22 million per year for the Canadian Institute for Health Information is all about. It will help us track emerging issues and mark pan-Canadian progress on wait times.

And a final item I should note is our government's sponsorship of a national autism spectrum disorder research symposium, coming later this year. We expect that it will further the development of knowledge and communication between health care professionals, stakeholders, and of course Canadian families.

Mr. Chairman, the health portfolio estimates cover an extremely wide variety of responsibilities and actions.

Our government is working with many partners to use new models to get results. We are working together to put the patient at the centre of the system's modernization and necessary evolution. We are taking action to inform people's choices for a healthier population.

So your committee's efforts are a valuable contribution to those strategies and choices, Mr. Chairman.

I look forward to taking your questions today and of course to working with all of the members of the committee in the future.

Thank you very much.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your presentation.

We'll now move to the question and answer portion of the meeting, and we'll start with Ms. Bonnie Brown—new and improved.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Rob Merrifield]

She asked me to say that; that's why I did.

The floor is yours. You have 15 minutes.

[Bonnie Brown, Liberal, Oakville, ON]

He's known for insulting me, Minister, but today I'm getting lots of compliments. I think he's trying to soft-soap me for your appearance before our committee.

I'd like to start by complimenting your government on the establishment of the new mental health commission. I understand that it is going to have an addiction component to it because of the circularity of those two issues.

I'm wondering, on page 61 of the estimates, where it talks about mental health and addiction services for aboriginal people--who, after all, are your main health care responsibility or your largest direct health care responsibility--why the budget for that is going to slide between 2007 and 2009 from $125 million to $121 million next year and the year after to $110 million. While I appreciate the emphasis you're putting on mental health and addictions, the numbers don't seem to bear up under scrutiny.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Let me just check for one second on that. I believe I do have an answer, but I just want to double-check it.

We'll get a more fulsome answer for you, but I believe that one of the answers to the question is that there is additional moneys found in supplementary budgets and so that could attribute to the gap you see there. But we will double-check to make sure I'm not leading you astray on that.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you. That's encouraging, Minister.

I must say that I was impressed with the sustainable development strategy commitments, that is, how the environment relates to the health of Canadians. And they actually stretch for 11 pages, from pages 85 to 95, so there is quite a number of initiatives in there. But on page 47, where it talks about the money allocated to safe environments, the enforcement of CEPA, and all those things that go with making a healthy environment, I noticed that the money this year is $131 million but next year is only $80.9 million, and the year after $81.8 million.

I'm just wondering, is this just a one-shot deal or is it an ongoing commitment to link the environment to health to try to clean it up? Because the money is shrinking instead of growing.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Let me just talk a little bit about the general thrust first, while some officials give me some exact numbers in order to answer that question.

The general thrust is, of course, to continue some of Health Canada's work in tying in the environment with health care issues, and in fact a part of the chemicals management plan that was announced last December was specifically designed to fund the additional workload that would be required in order to provide the right kind of oversight for chemicals management. This is an area that has, shall I say, not seen a lot of attention in the past, but we know and you know that in order to do our job, we do need to have some resources designed to deal with that oversight. So that's the intention.

I know that based on my submissions to cabinet, which found their way into the chemicals management plan, there is a multi-year approach to the financing of that, and in some years there will be some additional funds in that particular budget year, as opposed to other years, as we power it up. But we'll just double-check to make sure that, again, that's the full answer.

[Bonnie Brown, Liberal, Oakville, ON]

I can understand that. If you're setting up an agency to do this job, it might be that you need more money in the first year. But it's quite a substantial reduction from $131 million to $80 million the next year.

But anyway, perhaps your officials can feed us those figures.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Do we have a supplementary answer on that?

Okay, we'll come back to you on that one too.

[Bonnie Brown, Liberal, Oakville, ON]

Yes, okay.

I'd like to move on to page 35, which is the pre-market evaluation and regulatory process improvement, which always sounds like good news for everybody, except for the phrase at the top that says “streamlining processes and collaborating more closely with other organizations”, etc. When we're talking about drug approvals, for example, “streamlining” is a word that rather scares me. I know that industry wants everything faster.

And I'm wondering what “other organizations” are. Is that the private companies, or is it other countries, or what?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Part of it, as my deputy is indicating as well, is that there are collaborations we do with other regulatory authorities in other jurisdictions, such as the FDA, for instance, in the United States. Part of it has to do with finding ways to not reinvent the wheel. If there has been, in our estimation, adequate scientific review of certain aspects of an application and if we make the determination in the interests of Canada that this can be part of our process, then it's something we are interested in pursuing.

That's part of the answer, but are there others, Deputy?

[Morris Rosenberg, Deputy Minister, Department of Health]

The only other thing I'd say is that generally speaking we would always be trying, first of all, to keep our eye on the main objective, which is the health and safety of Canadians. Within that overarching objective, we also want to find ways of being as efficient as possible in doing our work.

We have, as you may be aware, Mr. Chair, eliminated a number of backlogs over the past year. We're always trying to improve our processes, and so streamlining, while not the ultimate objective.... To the extent that we can do our work more efficiently, we will.

An important part of that, given that all industrialized countries have some sort of drug regulatory approval and that we're all working largely on the same chemical entities, is the sharing of information and, where appropriate, some reciprocity. The more we can have that, the more efficient we'll be—always, at the end of the day, keeping the decision-making authority within Canadian hands.

[Bonnie Brown, Liberal, Oakville, ON]

Yes, we're a little bit nervous about all this “security” and “partnership” at the security and prosperity partnership, because you'll notice in those two words that entitle that body that there is nothing about health, labour standards, better quality of life for Canadians; it seems to be more about money. It's all about money and security from the perspective of terrorism. We want to make sure that health and safety is kept aside from that process as much as possible.

I'm looking at the budget in this area, “pre-market evaluation and regulatory process improvement”. I see that in 2007 it's $106.5 million. The next year it goes down to $97.8 million, and the year after it's $95.6 million. Are you so sure of these efficiencies and improvements that you can actually predict it's going to cost less, when there may be a whole flood of new products to evaluate?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Another aspect of this is that we are predicting success in coming to an understanding with industry about more cost recovery. Cost recovery does not mean we lose control of the process, because the process clearly has to be within the Government of Canada. But it is an accepted practice in government that in certain cases, if there is a particular way in which industry is gaining some advantage from the regulatory process approving a certain product, they should also pay for the costs.

I believe that part of what we're doing here is understanding that there'll be some offset in terms of our costs as a result of moving ahead with that project.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you, Minister.

As you know, there's been a lot of hubbub in the media lately about assisted human reproduction and your new board and things like that. I'll not go into the details of that, because I actually think the media is off base. There's nothing to manage yet, as you know, because there are no regulations implementing the act, except one small section.

But it seems to me--and I think we talked about this with you the last time you came--it's taking a tremendously long time to get these regulations going. It seems to me we should be hiring extra people to do this work, because there's confusion out there amongst the providers, the patients, and the people who say they belong to the industry--that is, agents and lawyers, etc.--with the lack of regulations.

One would think there should be some impetus to get this done more quickly than is planned, but I notice that on page 27 it's $3.1 million this year, $1.5 million next year, $1.5 million the year after, and scarier to me is the fact that there are 25 full-time equivalents assigned to this task this year, which is reduced to nine next year and nine the year after, even though your long-range plan doesn't show the job being finished for a few years yet.

How do you explain shrinking the staff who are charged with this responsibility, while there's confusion out there, and shrinking the money they have to work with, and then making an announcement about who the board members are? That's like somebody who's starting a company in five years saying they've named their board. For what?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I appreciate your concern, obviously, and one of the things we are doing is ensuring that the staff complements do not go down, so there is going to be a certain amount of reallocation within our budget to make sure that that is the case.

What has been going on, as you know, is a series of quite robust public consultations in this area, which must continue as we move our way through the various regulatory aspects of this most important issue. We're absolutely committed to continuing the consultations. I guess what's happened between this year and last year, which I can certainly speak to, is that we actually have some regulations and we actually have a board of directors. If we'd been having this conversation last year, we would have had neither.

[Bonnie Brown, Liberal, Oakville, ON]

Yes.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I take that as a point of progress, and certainly it's my intention that we will continue to move through these issues in a responsible, collaborative way, because this is an area that Canadians care passionately about and I know members of this committee also care passionately about. So we'll be continuing on with our main thrust and we will continue to make sure it has the resources necessary to do the job.

[Bonnie Brown, Liberal, Oakville, ON]

So you're suggesting that the reduction from 25 people to nine people working on it may be adjusted in the supplementary estimates.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Correct.

[Bonnie Brown, Liberal, Oakville, ON]

That would be good.

Thank you, Mr. Chairman. I'm going to pass the rest of my time to Dr. Bennett.

[The Chair, Conservative, Rob Merrifield]

Okay, you have two and a half minutes.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Well, that won't do.