Evidence of meeting #3 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was million.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Morris Rosenberg  Deputy Minister, Department of Health
Robert Clarke  Assistant Deputy Minister, Infectious Disease and Emergency Preparedness Branch, Office of the Deputy Chief Public Health Officer, Public Health Agency of Canada
Jane Billings  Senior Assistant Deputy Minister, Strategic Policy, Communications and Corporate Services Branch, Assistant Deputy Minister's Office, Public Health Agency of Canada
Clerk of the Committee  Mrs. Carmen DePape

9:05 a.m.

Conservative

The Chair Conservative Joy Smith

Welcome to the health committee. I want to especially say to you that it's a special day today. I'm very happy to welcome the minister to our committee meeting this morning. The committee, as you know, is studying the supplementary estimates (A) for 2007-08 under Health, pursuant to Standing Order 81(5).

This morning, as I said, I welcome Minister Clement and his officials, as well as officials from the Public Health Agency of Canada.

I would just say that the procedure today is going to be that we're having a presentation from the minister, and then following that I will give you your allotted times and we'll be able to have time to ask some questions of the minister.

So welcome today, and we so look forward to your presentation this morning, Minister.

9:05 a.m.

Parry Sound—Muskoka Ontario

Conservative

Tony Clement ConservativeMinister of Health

Thank you very much, Madam Chair, and let me take the opportunity to wish everyone a good morning and to welcome the committee's newest members and congratulate Madam Chair on her election.

I would like, as I begin, to introduce some of the senior officials who are attending with me here today. First, from Health Canada, I have Deputy Minister Morris Rosenberg and Chief Financial Officer Alfred Tsang. From the Public Health Agency of Canada I have the senior assistant deputy minister of planning and public health integration, Jane Billings, the assistant deputy minister of infectious disease and emergency preparedness, Dr. Robert Clarke, and finally, the chief financial officer, James Libbey. Of course, they may be able to help with some of the more technical questions that may come up today as well.

Before getting to questions, I want to take some time to address these supplementary estimates along with some of the other important health initiatives our government is taking.

During the last 22 months, we have taken important steps to get results in protecting the health of Canadians, and therefore, in building a safer and better Canada.

We've met our commitment to work with provinces and territories to develop patient wait time guarantees.

In March, with the support of more than $1 billion from Budget 2007, we were able to gain agreements with every province and territory to develop at least one guarantee each in one priority area.

On November 6 we took historic action for first nations health by announcing the communities that have been selected to carry out pilot projects on testing guarantees for prenatal and diabetes care. Madam Chair, we know that action is needed to improve first nations health, and that is why we are acting.

We also know that heart and stroke are the leading causes of death for Canadians and that cancer is occurring in epidemic proportions. These have affected the lives of almost every Canadian in some way. As a result, we have launched the start of Canada's very first national cardiovascular and cancer strategies.

We also know that mental illness claims have risen as the fastest growing category of disability costs in Canada. At the same time, the emotional toll it takes on our families is incalculable. Consequently, in Budget 2007 we lived up to our commitment to bring mental illness out of the shadows at last by creating the Mental Health Commission.

We've also made an investment in Budget 2007 to capitalize on innovation for the health of women and girls across the country. We did so by taking advantage of a breakthrough in women's health by providing $300 million to provinces and territories so they can develop and implement HPV vaccination programs and, as a result, take direct aim at the virus that causes 70% of cervical cancers.

Of course, along with capitalizing on health innovation, we're also investing in it. Around the world today, 40 million people are living with HIV, and AIDS has killed some 25 million more. It is, indeed, a global epidemic affecting all countries, including Canada. So we're making Canada part of the solution. In 2008-09 we will spend in excess of $84.4 million on HIV/AIDS, which is more than has ever been spent before. For instance, in partnership with the Bill and Melinda Gates Foundation, in February, our government launched the Canadian HIV vaccine initiative. Through our $111 million contribution and $28 million from the foundation, we're focusing the efforts of Canadian researchers toward the global pursuit of developing a safe, effective, and accessible HIV vaccine.

Madam Chair, all of these initiatives are about moving from knowledge to action; and taking action to achieve results for the health and safety of Canadians.

And with the Throne Speech of October 16, our government is committed to doing even more.

As part of the priorities to build the stronger, safer, better country Canadians deserve, the speech committed to improving the environment and the health of Canadians. In particular, it spoke about recent events, which have called into question the safety of products such as food for our families and toys for our children.

As a result, we are committed to taking new action, where needed, to provide better information to consumers, and to ensure our regulatory tools are updated to keep pace with the speed of globalization.

In the past two decades we have seen enormous change in terms of the increasing number of product imports to Canada. What remains the same, however, is that health and safety is and must be paramount, so we're looking at how to strengthen important legislation such as the Food and Drugs Act and the Hazardous Products Act and to make any changes necessary. In the end, of course, we want Canadians to be able to expect the same standards of quality for imported goods as we do for products made at home. Our direction here aims at helping achieve our government's core goal: getting results in achieving a safer, better Canada.

In addition, we continue the important work, Madam Chair, of ensuring taxpayers' dollars are spent as effectively as possible. You may have seen some media reports in the past week regarding some of the decisions we have been called upon to make. For example, as a result of cuts to spending made in the previous government's 2004-05 and 2005-06 budgets, we are now legally required to identify approximately $16 million in savings at the Public Health Agency of Canada. I can tell you, we are working very hard to ensure identified savings will have the minimum impact that is possible on service delivery, and of course this review is under way right now.

For instance, in searching for savings, we have determined that information now held on the Canadian Health Network website can be transferred to the existing Health Canada and Public Health Agency of Canada websites. Moving from three sites to two will result in saving $7 million per year. At the same time, Canadian consumers and health professionals will be able to find information more easily on these sites, which receive millions of visitors per month.

In the weeks ahead, Madam Chair, we will be making additional decisions to identify the remaining $9 million in savings mandated by the previous government's 2004 and 2005 budgets.

Let me now turn to some of the initiatives through which we will see improvements in quality and effectiveness and therefore help build a safer, better country.

First of all, our commitment to improving first nations and Inuit health is strong, and we're moving to make it even stronger. Of course, I've already mentioned our support for first nations and Inuit patient wait time guarantee pilot projects, and with the $75 million we're requesting for this fiscal year through supplementary estimates, we're increasing our support for first nations and Inuit health by 6.4% to $2.1 billion. Maintaining and improving health care means building a better Canada, and that's what this investment is all about.

Our supplementary estimates also include a funding increase for the Canadian Institute for Health Information. The information provided by CIHI informs decisions by health policy-makers and health system managers at all levels of government, and, most importantly, it provides a means for Canadians to measure the effectiveness of those decisions and to ensure they're getting value for their money. As a result, the increase for CIHI is an investment in getting results for a better Canada.

So, Madam Chair, through these supplementary estimates, we're also investing in a safer Canada. As I noted earlier, adapting to major changes in the marketplace is a regulatory challenge, and one that is felt globally.

One of those changes is the increasing prevalence of natural health products. Our priority is about protecting the health of Canadians by ensuring access to natural health products that are safe, effective, and of high quality. Certainly, due to the increase in availability of natural health products over the years, issuing licences on a timely basis has been, to say the least, challenging. At the same time, I am proud to tell you that we have made progress, and we have made process improvements that have led to a threefold increase in productivity during the last two years. To continue this momentum, the supplementary estimates provide an additional $12.4 million for this fiscal year.

Madam Chair, I want to turn from an issue where health risks are less than apparent to some to an issue where the dangers need to be made clear and present to all. Our government is very concerned about the damage and pain illegal drugs cause Canadian families. Years of ambiguous messaging can be blamed for leading many Canadians to question the illegality and the dangers of illicit substances. Incidentally, I might add that the number of Canadians smoking marijuana doubled between 1994 and 2004. At the same time, the number of Canadians reporting use of an injectable drug at some time in their lifetime increased from 1.7 million Canadians to more than 4.1 million Canadians. That is why Budget 2007 has invested $64 million in our national anti-drug strategy.

In addition to other ongoing efforts, this brings us to $417 million overall, which is the highest contribution ever provided to protect Canadians from illicit drugs.

The strategy will bolster prevention and treatment efforts, placing particular emphasis on educating Canadians, especially young people and their parents, about the dangers of illegal drugs. As part of our efforts, we plan on running a national ad campaign to raise awareness, the first one of its kind in two decades. It is my pleasure to tell this committee that this year's supplementary estimates include $12.1 million to get this funding started.

In closing, I would like to thank the committee members for giving me this opportunity to speak to them today. Together, I know you are well-informed when it comes to working for the health and safety of Canadians.

I wish you all very well in carrying out proceedings that put the health and safety of Canadian families above all else.

And as I thank you for listening to me, I look forward to taking your questions and answering them as best I can.

9:15 a.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Minister Clement, for that insightful presentation.

We'll now go into the questioning segment, but before taking questions from members, I am required to call vote 1a in order to open the discussion.

Also, the time allotted for questions when the minister is present, so everybody will know, is as follows: the first 15 minutes will go to the official opposition, the next 10 minutes for the Bloc Québécois, the next 10 minutes for the NDP, and the next 10 minutes for the government members. Following this, we'll have five minutes per party, alternating between the opposition and the government members, for questioning as well.

Madam Bennett, would you please begin the questioning?

9:15 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Thank you very much, and thank you, Minister.

I want to set the stage by saying that supplementary estimates are based on performance reports. I guess in health and health care, performance is very important. In terms of results-based management, in the foreword from the Treasury Board, we need to know whether we're winning with all the money that's being spent.

I guess I'm a bit disappointed that the performance report for Health Canada, and for all of the agencies, doesn't actually explain the results in a way we would expect, in terms of what is happening, whether it's wait times, whether it's HIV rates, or whether it's any of the things that matter to us.

I'm disappointed also, Minister, that the first report of the Chief Public Health Officer of Canada has not been tabled. I don't think it's good enough any longer to separate these two things, in terms of the money we're spending and the results we're getting in the health and health care of Canadians.

That being said, in the Public Health Agency performance report, there is a paragraph on page 34 that says:

There has been a steep increase in sexually transmitted infections over the last decade, and rising co-infections of HIV with diseases such as tuberculosis, hepatitis C and syphilis.

I guess we're admitting there that we're losing in terms of results—there's an increase in this—and yet there seems to be a decrease in the amount you're spending in community-based programs for prevention and whatever.

Certainly, we know there are 4,500 new cases of HIV/AIDS in Canada every year; this has plateaued. I guess I don't understand, the rumour being that in the rolling budgets of your department, Ontario has had the highest number of HIV-positive test reports in the country. In 2005, there were 1,670 HIV-positive tests; this is an increase from 2003-04. So I simply don't understand how we can be cutting Ontario disproportionately in community-based funding.

I know there's been an interest in the HIV vaccine. I know that the Gates Foundation is giving you some money. So my first question would be, how much money are you putting into the Canadian HIV initiative overall? How much every year? What is the source of that funding? Will those funds be additional to the $84.4 million that was promised through the federal initiative to address it? If not, how much is being taken out of that $84.4 million, and is that where you are achieving the necessity of these cuts to community-based programs, which actually are about prevention and the human response in supports and services to people with AIDS in our country?

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

Thank you very much for that series of questions. I will try to deal with some of them; I might be passing on to Madam Billings and Mr. Libbey some of the other details.

First of all, in terms of disproportionality, I want to assure you that over the lifetime of our spending decisions, it will not be disproportionate to Ontario or any other province. It will be proportional. Sometimes they start in one province, but they will be measured over the fiscal year.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

But these are cuts—these are people in the communities now, as of March, not having the money they need to continue even the programs they've been doing.

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

First of all, as I said, the spending in each province will be proportionate; it will not be borne disproportionately by one province or another.

I find this an interesting conversation because I'm obligated by law, because of Liberal budgets passed by Parliament, to initiate the decisions we're making on spending on the issue you've raised.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

No, I don't want to go there, Minister, because—

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

I know you don't want to go there, but I'm answering your question.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

That argument didn't hold for child care, for Kelowna, or for any of those.

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

The honourable member knows that she was my predecessor.

9:20 a.m.

Conservative

The Chair Conservative Joy Smith

Excuse me, Madam Bennett. Everyone is going to get a chance to speak, so would we be so kind as to let the minister finish his conversation? You still have quite a few minutes left in your time.

Minister, would you continue?

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

No, I don't want any more answers on that question, if you don't mind, Mr. Chair. That is just ridiculous.

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

I know you can't handle the truth, but I do have to deal with the facts.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

In the budget of 2006, you know those funds were cash-managed, because there was going to be another infusion of money in the 2006 budget—

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

Well, I know there were lots of Liberal promises that never came to fruition.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

—before the conference, so that's fine.

Minister, in the estimates there is no money for the safe injection sites. You keep saying you won't support projects without scientific evidence. I want to know whether you have read the very positive reports in 21 published papers on the importance of safe injection sites and how this program is doing, or are you continuing to deny this because of the ideology of your government on harm reduction?

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

Well, I sense there were two questions in there, and the answers to those questions are yes and no.

The answer to the first question is yes, I have read the reports. The answer to the last question is it has nothing to do with ideology. In fact, it's the exact opposite of ideology; it's being pragmatic by making sure a program that exists meets the community's goals that are expressed in a whole series of measurements. We are continuing—

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Okay, that's fine. Thanks very much.

Next—

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

—the research in this area, and of course that research will conclude with a decision—

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

No, Minister Clement, I think I've had a sufficient answer on that—

9:20 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

—on June 30, 2008. Thank you for your question.

9:20 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I now want to know about health research in this country.

I have to tell you that your video performance last night at the dinner for Alan Bernstein was not.... People just thought you were afraid to show up. For you to use the wording of $1 billion in the video when we know here that it's $843.3 million, and for you do this all-in stuff is an absolute insult to the research community in this country, who have been hoping for $1 billion for a very long time and have been asking for stable funding over three years so that they can actually plan.

Given the fact that American health research amounts to $28 billion in public dollars—that's public dollars—how can you defend flatlining health research in this country?

9:25 a.m.

Conservative

The Chair Conservative Joy Smith

Mr. Minister, we're going to give you a chance to answer that in full.

9:25 a.m.

Conservative

Tony Clement Conservative Parry Sound—Muskoka, ON

Thank you very much, Madam Chair.

First of all, I'd say that—