Evidence of meeting #31 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was plan.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Shelagh Jane Woods  Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health
David Butler-Jones  Chief Public Health Officer, Public Health Agency of Canada
Jean-François Lafleur  Procedural Clerk
Chief Ron Evans  Grand Chief, Assembly of Manitoba Chiefs
Shawn Atleo  National Chief, Assembly of First Nations
Don Deranger  Vice Chief, Prince Albert Grand Council
Chief Sydney Garrioch  Grand Chief, Manitoba Keewatinowi Okimakanak
Gail Turner  Chair, National Inuit Committee on Health, Inuit Tapiriit Kanatami
Joel Kettner  Chief Public Health Officer, Government of Manitoba
Pamela Nolan  Director, Health and Social Services, Wellness Centre, Garden River First Nation
Maxine Lesage  Supervisor, Health Services, Wellness Centre, Garden River First Nation
Jerry Knott  Chief, Wasagamack First Nation
Albert Mercredi  Chief, Fond du Lac First Nation
Vince Robillard  Chief Executive Officer, Athabasca Health Authority
Paul Gully  Senior Advisor to the Assistant Director-General, Health, Security and Environment, World Health Organization

1:10 p.m.

Conservative

The Chair Conservative Joy Smith

I call the committee to order.

I welcome all my colleagues today on this very important occasion. Once again we meet on the H1N1 issue. It's very important to all of us here in Canada.

I would like to welcome all the guests who are joining us today. Thank you for taking the time to be here.

I especially want to welcome Minister Leona Aglukkaq. It's so nice to see you.

We will start right away. We have from 1:15 to 2:30.

I understand you're going to give a 15-minute briefing to everybody, Minister, and then we'll have questions and answers. Please begin.

1:10 p.m.

Nunavut Nunavut

Conservative

Leona Aglukkaq ConservativeMinister of Health

Good afternoon, everyone.

Madam Chair, members of the committee, it's once again my pleasure to be here to talk about our response to the H1N1 flu virus, in particular our efforts to support and assist on-reserve first nations communities.

With me today are Dr. David Butler-Jones, our chief public health officer, and Shelagh Jane Woods, director general of primary health care and public health for Health Canada's First Nations and Inuit Health Branch.

I would also like to introduce Dr. Paul Gully, who has joined Health Canada as a special medical adviser. He will help coordinate the provisions of emergency health services in first nations communities affected by the H1N1 virus. Dr. Gully is joining us following his assignment at the World Health Organization as the deputy UN system influenza coordinator. He has also worked with Health Canada and the Public Health Agency of Canada in the past.

During our time together, I'll turn to them for information in answering your questions as fully as possible.

In my remarks today, I want to talk about how we've been managing the H1N1 virus for almost five months. In particular, I will delve into why focusing on first nations communities is important in preparing for the fall, how we're collaborating with the provinces and first nations leaders in helping communities get prepared, and what we're planning to do going forward to strengthen our response and raise awareness in protecting the health of our communities.

Understanding the virus, how it's spread, and who is most vulnerable to it has been our priority. We immediately saw the need to implement our national pandemic influenza plan. Since then, we have followed the guidelines of the plan, and it has served us well. For that reason, we must stay the course and see it through as we prepare for a possible increase in the spread of the disease in the fall.

Communicating with Canadians has been and will continue to be an essential part of the plan. Collaborating with provinces, territories, first nations, Inuit, and health agencies across the country has enabled a clear and consistent approach to the disease nationwide. Health Canada is committed to working with stakeholders and domestic and international partners to help further our understanding and our methods of preventing and treating the H1N1 virus.

Next week, the Public Health Agency of Canada will host a conference that will be the first of its kind in Canada. Public health officials, intensive care specialists, and medical experts from Canada and other countries will meet in Winnipeg to discuss the best methods for treating and managing the severe cases of H1N1. We hope to develop new guidelines for treating and managing severe cases and new guidelines dealing with the impact they will have on hospitals.

Development of a vaccine is going according to plan. Clinical trials should start in October, if not earlier. As you know, we will make more than 50 million doses of the vaccine available so that every Canadian who needs and wants it can be immunized. Vaccination is key to managing the disease. I hardly need remind you that prevention of the disease is our primary goal.

I would like to turn my attention now to the work we've been doing with first nations. It is important to note that there are different health care delivery models for different aboriginal Canadians. I am focusing today on on-reserve first nations because the provision of health services is a shared responsibility between federal and provincial governments. Territorial and provincial governments have primary responsibility for health care for Inuit, but the Inuit remain a priority of Health Canada as well. In fact, I met with 25 mayors in Nunavut on Wednesday.

There are demographic and social factors that make on-reserve first nations and northern and remote communities a priority as we prepare for the fall. While Inuit are also a priority for Health Canada and are supported by Health Canada's regional offices, I will focus on first nations today.

Our research has shown that some segments of society appear to be at greater risk of developing complications if they contract the virus. We know, for example, that younger people age 16 to 25, pregnant women, and individuals with underlying health conditions, such as diabetes, fall into this category.

Many of you already know that 50% of the people on reserve are younger than 25. In fact, the median age of the first nations population as well as Inuit is 25, as compared with 40 in the rest of Canada. In addition, the birth rate on reserves is three times higher than in the rest of the country, which means there are more pregnant women per capita in first nations communities.

Finally, there are higher rates of chronic disease within first nations communities.

All told, a higher percentage of the first nations population is at greater risk of developing a more serious case of H1N1 than in the rest of the population. On top of this, we know well that social conditions, including overcrowding and communities having limited access to water for handwashing, pose challenges in minimizing the spread and impact of any virus.

For all these reasons, we're putting greater priority on preparing for a possible stronger wave in the fall by ensuring that care is well coordinated for communities when they need it, that needed supplies are both available and accessible, and that communities are well prepared and well informed.

When it comes to providing care to first nations communities, ensuring effective collaboration between levels of government is paramount. When someone from a remote first nations community needs to be transferred to a provincial hospital, Health Canada provides for the emergency medical transportation. This means that on-reserve first nations with severe H1N1 symptoms receive hospital care through their provincial health systems.

When there are many players involved, we need to make sure that our roles are clearly defined and our tasks well executed. I would like to mention that H1N1 preparations for first nations communities will be on the agenda for discussions with my provincial and territorial counterparts at our meeting on September 17.

Health Canada officials from our regional offices have been strengthening working relationships with provincial counterparts. In Manitoba, for example, First Nations and Inuit Health attend regular tripartite meetings with the province and Manitoba first nations. These networks have proven to be effective, particularly at the height of the outbreak in Manitoba earlier this year.

In British Columbia, first nations are well positioned to deal with an H1N1 outbreak through their collaborations with the tripartite H1N1 partners group. Other members include Health Canada, provincial health officials, including the office of provincial health offices, and the British Columbia aboriginal health physicians adviser. Similar activities have taken place across the country.

In addition to our communication with provinces, our officials have also been working directly with first nations leaders, as they always do. In July, officials from the health portfolio were on hand to both provide presentations and answer some questions before the Assembly of First Nations annual general meeting, held in Calgary. On a regular basis, Health Canada's regional offices distribute information bulletins and hold teleconferences with first nations community leaders. On top of this, we also provide financial and technical support to communities for preparing their pandemic plans.

I should note that since his election in July, I've had a chance to speak with AFN National Chief Atleo, and H1N1 was central to our discussions. I should also add that I had a meeting with him again this morning. I'll also be meeting with British Columbia chiefs in the next two days.

We do have a national plan, the Canadian pandemic influenza plan, but we need pandemic plans at all levels in all sectors. In other words, a one-size-fits-all approach does not work for a country like ours. For first nations, the Canadian pandemic influenza plan includes annex B, which defines the roles and responsibilities of all partners in pandemic planning for on-reserve first nations, including federal and provincial governments and first nations communities themselves.

We also have plans that meet the needs of individual first nations communities, plans inspired by the principles of national and provincial plans but developed by community leaders. The community plans map out in greater detail how a particular community will respond in case of an outbreak. To date, more than 90% of the first nations communities in Canada have completed and tested their plans.

Health Canada officials in each region have been contacting and visiting communities in recent weeks to determine if any additional plans are needed. We know that many first nations have not only completed but also tested their community pandemic plans. I was in Saskatchewan last week and noted that practically every first nations community in that province had tested its plan. Those communities and many others across Canada have put a lot of effort into their preparations.

We are also committed to ensuring that first nations nursing stations are equipped with all the supplies they will need to treat patients affected by H1N1 virus. We have distributed antivirals in advance to nursing stations in remote communities and regional medical storage facilities so that they can be accessed quickly.

Of course, during a pandemic our most important resource is our hard-working front-line medical worker. If the H1N1 virus reaches its potential, there will be an unprecedented demand for nurses. Because Health Canada depends on nurses to provide the bulk of its services in remote communities, we need to be ready to respond to the communities where the need is greatest.

Earlier this summer, in response to the elevated situation in northern Manitoba, we reallocated our nursing staff among nursing stations to meet the urgent need. We will be ready to take similar approaches this fall.

In preparing for the fall, we're providing additional training to workers to respond to emerging needs. For example, we're making sure that the nearly 400 home care nurses on reserves are trained to administer vaccines. As you are already aware, we are also collaborating with other jurisdictions to provide supplies, training, and guidance to first nations communities.

All of these preparations should convey the fact that our top priority is to gear up for the possible stronger second wave of H1N1 during the upcoming flu season. This is the kind of outbreak that members of our health portfolio have been preparing for since SARS in 2003.

During those years of preparation, it became clear that public awareness and education would be a key component of our strategy. That's why we're now in the midst of placing public service announcements in aboriginal print publications. It's also why we've been providing information to band councils, chiefs, and Inuit organizations. It's why we're planning to run community radio ads with calls to action translated into 26 aboriginal languages and dialects, along with TV ads on aboriginal networks and community stations.

In addition, we're providing information specifically geared to first nations on fightflu.ca, and we've been launching a social media campaign to ensure that our reach is as broad and deep as possible. As our ad campaign reads, knowledge is your best defence.

Through our communications effort, we're seeking to ensure that first nations community residents have all the information they need. I look forward to continue working with the community leaders, many of whom are here today, on how to best support and strengthen preparedness for the fall. We know that we have to remain vigilant.

I look forward to receiving your questions this afternoon. Thank you very much.

1:20 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Minister Aglukkaq. Thank you once again for coming here today and for being so available.

We'll now go into our first round, with seven minutes per person. That's seven minutes for the questions and for the answers.

We'll start with Dr. Bennett.

1:20 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Thank you for agreeing to come.

Minister, are you aware of whether Canada's pandemic plan is available in Inuktitut?

1:20 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

As far as I know, it has been translated into Inuktitut, yes.

1:20 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Because yesterday the representative from ITK was saying during our conference call that it wasn't available in.... Also, we've heard that the Dene nations are concerned that in annex B it's not available in those languages. I would suggest that if ITK doesn't know it's available, it just speaks to a breakdown of communication.

Minister, have you been to any of the first nations communities?

1:25 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

I have.

1:25 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Where?

1:25 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

In Nunavut--

1:25 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

No, first nations, like in terms of.... Have you been to a first nations community?

1:25 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

Let me start off with the ITK issue.

In regard to Inuit health care delivery, the Nunavut territorial government as well as that of the Northwest Territories deliver health care, and not ITK.

Second, I've been to all the provinces and territories. I have met with the chiefs in Saskatchewan and Manitoba. On Sunday I'm meeting with all the chiefs in British Columbia. In Nunavut I met with all the mayors. So those are the communities I have been to.

This morning we had discussions with Chief Atleo. He and I will be organizing trips to various parts of the country to visit first nations communities.

1:25 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Minister, you were in Saskatoon for the CMA meeting, I believe. So I'm taking this to believe that you have not made one special trip to see a first nations community since you've been minister.

1:25 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

I've indicated that I've met with every chief...that I've been to in the provinces. I have not made a specific trip to a first nations community. If you want to call Nunavut communities first nations aboriginal communities, I'm from there. I've been to every community in Nunavut, as an example.

In terms of visiting first nations communities across the country, as I said earlier, I will be making plans with the new chief to visit various first nations communities across this country.

Thank you.

1:25 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I have concerns about what is being communicated to you in briefings, and indeed the way the organization and revising and testing of the planning is being done on conference calls. You actually have to be in the community to understand whether or not they are feeling confident about what they will do this fall.

As you know, we have been to a number of communities, and this figure, that 90% of the communities have completed their plan, is not our experience. So I want to know whether people are on a conference call saying “Yes, we've completed our plan” when they aren't really sure what that means and what they need to do. I want to know from the communities that we've been to, that seem extraordinarily well prepared and that we'll hear from today, from Garden River, to some of the others that seemed very insecure about what will happen this fall....

How are you measuring and testing their capacity to revise or test their plan?

1:25 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

I'll start off the response in terms of the planning going forward for the fall.

I said in my opening comments that my officials have been teleconferencing as well as visiting communities, and I will have my staff elaborate on the work they're doing with the community in developing and preparing for the fall.

1:25 p.m.

Shelagh Jane Woods Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health

What we have is regional staff who in fact are going to all of the communities. As you know, Dr. Bennett, a lot of this work has been going on since really just after SARS. Really, within about a year and a half of SARS we had started to organize information sessions with communities to talk to them about the importance of pandemic planning, and we then got into the actual pandemic planning some time after that.

You're quite right, some of the initial work has been done by conference calls. We've used e-mail and whatever means are available to get to the communities. Of late, and particularly since H1N1 emerged, but before it emerged in any of the first nation communities, the regional offices put a more intensive effort into going to the communities. Our pandemic coordinators have been to virtually all of the communities by now, and they know which communities have a plan. In fact, not only do 90% of them have a plan, but 70% of those have been table-top tested.

So we're quite confident. We do take the word of the community organizers who tell us that they've completed the plans. We've provided templates and we've provided examples. We do trust that they know when they have a plan.

1:30 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I understand that in Quebec they have been prepared to twin a community that is feeling prepared with one that's not feeling so prepared. Is there any plan to offer that or to pay for the communities that feel pretty ready to go and help in other communities?

1:30 p.m.

Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health

Shelagh Jane Woods

Where the regions are identifying additional needs, they're working to make sure there's a plan in place so that every community has completed its plan at or near the end of September. So they're using a variety of mechanisms.

1:30 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

Do you have any access to extra resources? The minister, in her opening remarks, said that you reallocated nursing staff amongst.... Certainly when we were in Manitoba they weren't thrilled that you were stealing nurses from one community to give to another. Is there any capacity to have extra nurses, extra resources? Are you training pharmacists? What's happening? Where's the money?

1:30 p.m.

Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health

Shelagh Jane Woods

That's a numbers question.

1:30 p.m.

Conservative

Leona Aglukkaq Conservative Nunavut, NU

Let me start off.

Since 2006, when we put the plan in place, a huge number of investments have been made to the implementation of the pandemic plan. I think it was about $1 billion for that, and $2.3 million has been provided to strengthen public health capacity, $1.5 million has been provided for training and education at the community level to respond to the pandemic plan, and $1.6 million has been provided to date to support the community-level emergency plan. As well, this week I also announced an additional $2.7 million in the area of research.

In terms of how we were responding in Manitoba when the greatest needs were in pockets, health care professionals from other communities were put into that community for assistance.

The challenge we have from province to province is that, as you know, the licensing and credential recognition of nurses is a provincial jurisdiction. So in a pandemic it becomes a huge challenge for us to move staff from one province to another province when we have to go through the process of reviewing their credentials each time to be able to practise in that province. That applies to physicians as well. So within Manitoba, when we were responding to the pockets—

1:30 p.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

But there's a memorandum of agreement on that, Minister.

1:30 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

We'll now go to Monsieur Malo.

1:30 p.m.

Bloc

Luc Malo Bloc Verchères—Les Patriotes, QC

Thank you very much, Madam Chair.

Thank you, Minister. Dr. Butler-Jones, thank you for being with us this afternoon.

In a document that identifies the responsibilities associated with pandemic planning and response for on-reserve First Nations communities, it says that the provinces will basically be working with on-reserve First Nations communities with a view to coordinating management of the flu pandemic in these communities.

Having taken the pulse of Aboriginal communities in Quebec, it seems that what the Public Health Branch in Quebec has done is satisfactory and that the communities are, for all intents and purposes, ready to respond in the event of a new outbreak of the H1N1 virus.

Are you able to confirm that? Also, the communities are concerned about their peers living in Manitoba. I imagine that is because, last spring, infection rates in Manitoban communities were among the highest in the country, and very substantially so, given the percentage of the population these communities represent.

I imagine you have done some studies. So, are you able to tell me why communities in Manitoba are more affected? Also, is there reason to be more concerned for these communities?

1:35 p.m.

Conservative

The Chair Conservative Joy Smith

Madam Minister?

Or who would like to take that, Ms. Woods?