Health Committee on May 15th, 2008

[The Vice-Chair, Liberal, Lui Temelkovski]

I now call the meeting to order.

Pursuant to Standing Order 81(4), we are considering main estimates 2008-2009, votes 1, 5, 10, 15, 20, 25, 30, 35, 40, and 45 under Health, referred to the committee on Thursday, February 28, 2008.

Today we have the minister with us. Minister, you've been here before. We'll have you give us a statement and then we'll go through the questions. It's a pleasure to have you with us.

[Tony Clement, Conservative, Minister of Health]

Thank you very much, Chair, and welcome as well to members of the committee. It's always nice to be here.

I'm addressing the health portfolio's main estimates for 2008-2009, of course, and I have with me and am pleased to introduce our deputy minister of Health Canada, Morris Rosenberg; Alfred Tsang, who's the chief financial officer for Health Canada; and on the Public Health Agency of Canada side we have Dr. David Butler-Jones, who's the chief public health officer, and James Libbey, who is our chief financial officer. I may from to time, if it pleases the committee, turn to them to assist me with any technical matters that might arise in answering your questions.

To begin, I'm happy to be appearing before this committee during what has been a very active time for the portfolio.

We're taking action and making good on commitments for a healthier environment, safer communities, safer food, health and consumer products, along with more patient-centred health care. In doing so, we're building from the expertise of our officials as well as provinces and territories, health care stakeholders, first nations and Inuit community leaders, patients and industries.

Our range of partners needs to be broad because our policy spectrum is wide. Health policy is not only about working with doctors and nurses on dealing with illness, but working with all sectors of society on promoting health.

As written in the Ottawa charter, signed at the first international conference on health promotion on November 21, 1986,

Health promotion goes beyond health care. Health promotion policy combines diverse but complementary approaches including legislation....

It is characterized by action that

...contributes to ensuring safer and healthier goods and services, healthier public services and cleaner, more enjoyable environments.

Mr. Chair, as you can see, those words do well at defining and explaining the approach of today's federal health portfolio, and therefore, I would put it to you and the committee, these main estimates.

For instance, we know that more than two-thirds of deaths in Canada are the result of chronic diseases. These estimates thus contain an incremental funding increase of $8.6 million, for instance, for our integrated strategy on healthy living and chronic disease, which encourages healthy living and includes disease-specific strategies for diabetes, for cancer, and for cardiovascular disease.

These estimates also include an increase of $2.7 million for new and ongoing public health information programs, including our healthy pregnancy initiative and the children's fitness tax credit campaign, which of course raises awareness of the credit and encourages families with children under the age of 16 to be more active.

In addition, I want to highlight that these estimates refer to $10.65 million annually to renew our response to hepatitis C. This will be spearheaded by the Public Health Agency as it works closely with community and provincial and territorial partners to implement a renewed prevention, support, and research program.

Planning our preparedness and response to a pandemic also remains a priority. We are implementing a balanced, multi-faceted approach that includes securing a domestic vaccine supply, as well as a comprehensive pandemic influenza plan. Stockpiling of antivirals, of course, and other public health measures are included to minimize the impact of a pandemic. Indeed, we have now reached our target for the purchase of 55.7 million doses of antivirals for the national antiviral stockpile, the number of doses estimated to treat all Canadians who become ill in a pandemic and who require and seek medical attention.

On top of this, the main estimates contain a $28.3 million increase for a cleaner, healthier environment. This includes a $17.4 million increase for the chemicals management plan. Through this plan we've committed to assessing chemical substances used by industry that are of potential concern. We are challenging industry to show they're using them safely and we're taking decisive action to protect the public.

Health Canada's assessment of bisphenol A is a great example of how we have moved forward, because as long as no new compelling information arises during the current public comment period, we will be moving to ban the importing, selling, and advertising of polycarbonate baby bottles. The assessment found that when it comes to its use of producing items like hockey helmets and DVDs, BPA is not a concern, but when it comes to polycarbonate baby bottles, there is a risk that very hot liquids may cause the chemical to leach into the formula, be ingested by newborns and infants, and possibly have negative effects on their development. As a result, we're acting promptly on our knowledge and taking action to best protect our kids' health.

Mr. Chair, our estimates also include a very important investment to protect the health and safety of our youth and communities. On April 29 I had the pleasure of joining the Minister of Justice and Minister of Public Safety in announcing $111 million for critical drug treatment and prevention initiatives for provinces and territories under the national anti-drug strategy.

Under this strategy, we're strengthening enforcement as well as treatment—and providing help to parents in talking to their kids and protecting them against the threat of illicit drugs.

I'm proud to say that these main estimates also include a contribution of more than $27 million to support our awareness-building efforts and implement our treatment actions. With the recent announcement of a $230 million investment over five years, our government is investing more than any previous government in order to safeguard Canadian families from illicit drugs.

Alongside this unprecedented action for safer communities, we're also moving forward with action for safer products. As you know, the Prime Minister announced Canada's food and consumer safety action plan last December. Although it is not covered in the main estimates and will be discussed later this year during supplementary estimates, budget 2008 backed this plan with a two-year investment of $113 million. On April 8 we moved this plan forward by tabling Bill C-51 and Bill C-52.

Respectively, they seek to modernize the Food and Drugs Act, which has not been upgraded for some 40 years, and replace Part I of the Hazardous Products Act, which was written in the late 60s.

Together, they propose important tools to strengthen Canada's approach to safety.

These bills represent important action--the important action we need to take to better protect Canadians in a modern world. I look forward to discussing them in greater depth with you in the weeks to come, as those bills come before committee.

However, right now I want to address our proposed approach to strengthening drug safety under Bill C-51. There are some who are maintaining that this bill will in some way weaken our drug approval process. I want to say right here and now that this is not the case--in fact far from it. The current process calls for a vigorous assessment of health products before they gain access to market, and under Bill C-51 that won't change.

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

On a point of order, Mr. Chair, Bill C-51 will come to this committee at another time. This is about the estimates.

[The Vice-Chair, Liberal, Lui Temelkovski]

I'm sure the minister doesn't have much to say about Bill C-51 right now.

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

That's quite true, Chair. Let me just say that this government is for more safety, not less, and when these bills come to committee we'll have an opportunity to thoroughly debate those.

I want to emphasize that we know full well of the immense importance of strong support for health research and health care. Our main estimates back this assertion with action. For example, we know very well that health research is the backbone of effective health policy. As a result, our main estimates include an increase of more than $59 million to the Canadian Institutes of Health Research. With this funding CIHR will support excellent health research and turn the knowledge into concrete benefits for Canadians, including better health, a stronger health care system, and a stronger economy.

In addition, the estimates contain increases for quality health care. For example, there's an additional $60 million to address the health needs of the growing first nations and Inuit populations and to improve health care delivery through greater integration with provincial and territorial health systems.

There's also support for the commitment we made to working with provinces and territories to develop patient wait-time guarantees.

In March 2007, each province and territory agreed to develop and implement a guarantee by 2010, in either: cardiac surgery, cancer care, joint replacement, sight restoration or diagnostic imaging.

Budget 2007 provided more than $1 billion to support their efforts.

One key component of this investment, which is included in our main estimates, is funding for interested provinces and territories for pilot projects to test innovative approaches to establishing guarantees. So far I've had the pleasure of announcing projects in Nova Scotia, Manitoba, and P.E.l.

In closing, Chair, I'm very confident that the actions we're taking today within Health Canada, in research settings throughout Canadian society, and within these main estimates, along with the steps we're taking through legislation and regulation, are getting results for Canadian families. I want to assure you that our government is dedicated to building a safer, better Canada. The actions of the health portfolio are strongly supporting this objective.

With that, I want to thank you again for the opportunity to provide my comments. I would be pleased to take any questions that might crop up at committee.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Mr. Minister.

I am advised by my very capable adviser, the clerk, that this will be in discussion of vote number 100, the Health Act.

Dr. Bennett, you have 15 minutes of questions and answers.

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

Excellent. Thanks very much.

Thank you very much for coming. It is always a pleasure to be able to look at whether we're putting our money where our mouth is in terms of the most cherished program of Canadians. My questions will probably deal with three areas, more around partnerships and relationships than actually around the money. I think a laudable new goal for the Public Health Agency is around health disparities.

I'd like to just begin in terms of the rather lofty phrase at the beginning of your page 9, on “Health Canada: A Partner in an Interwoven Community of Stakeholders”. The number one bullet says:

provinces and territories--who bear primary responsibility for health care administration...and have their own roles in health protection and promotion. A strong relationship with provincial and territorial counterparts is a critical factor in achieving our mandate;

I guess I would first like to ask the minister why, then, he cancelled the meeting with the other provincial counterparts in December and has again refused to meet with them this spring at all, particularly in view of the rather damning report of the Auditor General in terms of being able to get agreements with the provinces on the reporting of particularly infectious diseases, such that you wouldn't be able to report in a timely fashion to the WHO. She has identified the fundamental weaknesses in the surveillance system and is saying that this has not made satisfactory progress on strategic direction, data quality, due to gaps. You're not--particularly at the Public Health Agency--receiving timely, accurate, and complete information. It's impossible to get a consistent national picture on infectious diseases, and therefore you are unable to obtain the information necessary to prevent and respond to a disease outbreak.

So I'm very concerned that we can't meet around a table and negotiate this important next step, particularly when the public health network has been cited as one of the most important things in 30 years in Canada.

Out of the 10-year plan, things like being able to set goals and targets for improving the health status of Canadians through a collaborative process, all of these things that require partnerships you seem not to have done.

Sadly, at the committee, as we're doing the post-market surveillance, it seems that the national pharmaceutical strategy has ground to a halt in terms of even the federal co-chair not being named.

Tell me about how you're going to have a partnership with the provinces when they think they have no partner with you.

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

Thank you for your questions. I appreciate that very much.

First of all, it was unfortunate that the last federal-provincial-territorial meeting was cancelled. It wasn't cancelled by me. Unfortunately the co-chair was Saskatchewan. They were having the election, and then the post-election period in Saskatchewan, with the change in government. The collective decision of all of the partners, including the provinces and territories, was that this was not an ideal time. In fact, many health ministers cancelled out of the meeting before a decision was made by the co-chairs to not go forward.

I am very much looking forward to having our meeting this fall instead. In fact, I can assure this committee that I've had many successful bilateral meetings with ministers of health. Just recently, this week, I met with the Minister of Heath from Nunavut. Last week I met with the Minister of Health for Alberta. I could go through the list--the Minister of Health for P.E.I., and so forth.

That has been a priority of mine, to at least have these bilateral discussions as much as possible, in the absence of a multilateral meeting.

On infectious diseases, perhaps I might just defer very quickly. I know you want to preserve your time, but if Dr. Butler-Jones can talk about the Auditor General's report, I think that would be helpful to the committee.

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

Certainly from our perspective the AG's report was actually a good-news story in the sense that she recognized that we have made tremendous progress since the formation of the agency. The areas she focused on for further work were around formal agreements, for instance, for routine information. There was the concern or the question of the possibility in an outbreak--she didn't say it was happening, because it isn't happening, we are getting the information we need--that we might not get that information.

The reality is--as we saw with the people on the train in northern Ontario last Friday--the system does work. We do get the information we need, we do coordinate and collaborate very effectively with the provinces and territories, and we have the processes and protocols in place. I expect shortly we'll have those formal agreements for routine information-sharing as well. We do actually have an agreement for information-sharing that all ministers have agreed to. We're just finalizing some final wording, but they have agreed to it, in principle, across all jurisdictions for the sharing of information in emergencies.

Finally, the WHO tells us that 40% of all their reports from around the around come from us first. Our surveillance system actually identifies things before the countries themselves know about them, and most countries look to us as a model for how we do that work with provinces and territories.

Thank you.

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

Mr. Chair, I would like to focus on the money now, in that it seems disappointing, with the aging demographics and the challenges that the summary information shows, that by 2010-2011 the ministry will have less money than they will have this year.

I don't know how one explains that the budget for the whole health portfolio goes down, but particularly in terms of the main estimates for the Public Health Agency that it would go down from $658.3 million to $590.5 million. I think it is extraordinary that in things like health promotion, the planned spending can go down to $197 million by 2010. The money for public health capacity goes down, the money for infectious disease goes down. Emergency preparedness is the only thing that seems to stay. Is that not embarrassing?

And the one thing I'm sure the minister expected us to ask, and which every day we're being asked by community organizations: what is going to be the funding on HIV/AIDS? I wonder if the minister would like to tell me how many new HIV/AIDS infections there are per year and how he can justify cutting community funding and not even letting them know how much money they will have so they are able to plan.

These organizations want long-term, medium-term.... They don't even know the short-term funding now, and it's not clear in the estimates. I'd like to know whether the money for the vaccine initiative has been used. And when was the last time you met with the ministerial council on HIV/AIDS in terms of what I think is their concern?

So the community is furious, as you know. They don't know what to spend, and yet cases of HIV/AIDS are still climbing in this country.

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

Thank you for your comments.

Certainly I wish committee members to know that this year in the 2008-2009 budget we're putting more than $84 million toward HIV/AIDS, which is more than has ever been spent by the Government of Canada in our country's history.

The budget cuts the member is referring to are those that were found in the 2005 Liberal budget, which of course, despite the Conservative Party's position, was passed by Parliament, and we have an obligation to implement those cuts as a result of the 2005 Liberal budget.

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

Minister, with due respect, you have choices to make every year, and those were Treasury Board allocations, as you know, so don't go there.

But explain to me why your overall budget is down for all of health, and for all of public health in your projections. It seems to be very difficult for you to go downtown and get the money.

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

Part of it is because sunset funding requirements are found as a result of Treasury Board requirements.

You might want to say something, Mr. Tsang.

[Alfred Tsang, Chief Financial Officer, Department of Health]

Mr. Chair, there are indeed some sunset programs there during that intervening period. The flip side of that is that incremental funding has been announced, for example in budget 2008, that has not shown up in the main estimates only because of a timing issue.

And equally, as I was saying, there are some sunset programs during that intervening three-year period for which Health Canada may wish to seek incremental funding from the government too. So there's a timing issue related to that trend.

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

And there was a final thing--

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

Sunset is a passive activity. You can choose not to sunset programs, and things like the primary health care transition fund, which people had thought was doing good work, you chose to let sunset. These are ministerial decisions, and I don't think the bureaucratese is very helpful to Canadians as to why this government would be choosing to reduce the budget for health and health care for Canadians over the next five years in what they are able to do within the whole of the health portfolio, but particularly in the area of public health in terms of what we know is the number one goal of medicare, which is to keep people well, and not to patch them up once they get sick. This is a shared responsibility. How on earth can you defend the money going down?

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

Sure. As I said, there are sunsets, there are one-time expenditures where the budget goes up and down, depending on the one-time expenditures. But to say we're spending less on health care is false.

When you look at the ten-year accord on health care renewal that was signed, which we have implemented, that means extra transfers to the tune of $1.2 billion to the provinces this year alone, extra, for health care.

You mentioned the primary health care transition fund, but that was part of the 2004 deal. You were a member of the government that signed that deal, which wound down that program. So I certainly feel no need to defend your decision.

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

In the Public Health Agency, on page 9, the notable change was that healthier Canadians reduced health disparities in a stronger public health capacity. Now, we've already dealt with the fact that the budget for public health capacity is going down--which I don't really understand at all. But I guess I'm most disturbed, in terms of the program activity for first nations and Inuit health, that the planned spending for 2010-2011 is dramatically reduced, in terms of gross expenditures, as is even the number of people doing it.

In terms of what we've known about equity and the things that work best, the health human resources of our aboriginal people--this is the $100 million that I've asked you about many times--how many more aboriginal physicians and aboriginal nurses are we able to show for the $100 million that was put into the health accord? Not just cultural sensitivity and nice things that we want all Canadians to do, but how many more aboriginal nurses and how many more aboriginal doctors do we have in this country?

How on earth can you be reducing the money in the program activity on first nations and Inuit health at the same time as you are saying that you want to reduce health disparities? We know this is the biggest embarrassment for our country: the gap in health status of our aboriginal peoples.

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

Thank you for that.

I'll just give you some raw statistics.

Through the aboriginal health human resources initiative--which, as you say, has been funded, and we support that--we have been able to more than triple the number of aboriginal health care students receiving support. So there are over 1,100 bursaries and scholarships that have been awarded in the program, and over 60 aboriginal medical students are part of that funding. So I believe that we are being helpful to the needs in the community; there's no doubt about that. As these estimates show, we have in fact injected many tens of millions of dollars more into the first nations and Inuit health branch for the provision of services.

We know that the populations are rapidly increasing to a greater extent than the population as a whole, so we have more people who need more medical services. We're certainly trying, at the same time, to transform the system, because I have a great deal of concern about the sustainability of the system for first nations and Inuit health. That's why we're working with the leadership--and the provincial leadership--to try to get to some better health models and some better health results. So I think we're on the same page on that.

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

Except that on page 66 the gross expenditure for first nations and Inuit health programming and services goes down.

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

In each budget there's a one-time expenditure that seems to be added on to this budget. We have a one-time expenditure this year that goes towards meeting the services but also goes towards this transformational funding that is designed to help us get to a better place when it comes to the long-term sustainability of the program. So as the program gets transformed, then of course you don't need the transitional funding for that transformation.

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

And that explains the 150 fewer staff.

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

No, but--

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Minister.

Thank you, Dr. Bennett.

We'll move on to Madame Gagnon, pour dix minutes.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you, Mr. Chairman.

I'd like to continue the discussion on the aboriginal clientele, for which the federal government is the first level responsible in health. This week, the committee heard from representatives of the Wait Time Alliance, the organization that is supposed to provide information on the evaluation that was done on the achievement of the objectives of the 10-Year Plan to Strengthen Health Care.

As regards aboriginal people, no one had any information to submit to us on follow-up to the five priorities of the wait plans or on operations. On a number of occasions, I tried to question various witnesses who appeared before the committee regarding the 10-Year Plan to Strengthen Health Care so that they could show the government is serious. Earlier you told my colleague, Ms. Bennett, that you wanted to revolutionize the health system, but one witness said it is quite hard to revolutionize it when you don't have any data.

I particularly emphasize the case of aboriginal people, since you are responsible for their health and that is not a provincial jurisdiction. What are you doing to correct this lack of data? Do they need more support? We're talking about cuts to the main estimates. Are you able to help them more than you are doing now? Could there be a new plan in three or four years without you having achieved the desired objectives?