Health Committee on Dec. 2nd, 2009

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

We'll now go to Dr. Martin.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

Thank you very much, Chair.

Thank you all for being here today.

I have a couple of questions and a couple of comments.

First, this past summer, the minister made a commitment at the CMA meeting in August to fund 15 new residency positions and implement a repatriation program for Canadian physicians and students abroad. I'd like to know when that initiative will be implemented.

Second, if you look at the estimates, you'll see that the drug treatment funding program has been cut 94.9%; the drug strategy community initiative, 63.7%; and the federal tobacco strategy, another staggering 52.9%. I find that to be absolutely, completely remarkable, given how prevalent this is.

Mr. Rosenberg, you mentioned quite correctly the changes that have been implemented, such as sizing on packaging and such with tobacco. But the major problem we're having, as you know, is the trafficking in illegal tobacco products that are coming in across border, primarily driven by organized crime gangs from the United States. I would just impress upon Health Canada, if they have a plan to work with other counterparts in the government, to stop this, because this is a much larger public health threat with respect to a tobacco strategy.

I have two more comments.

First, the most profound impact we could have on reducing an array of chronic diseases and improving population heath is to implement, with the provinces, a national head start program, an early learning program for kids. That would have the most profound impact, particularly, as you know, with the increasing prevalence of childhood obesity and what that is going to do down the road in terms of the prevalence of chronic diseases.

Finally, there is a way, as you know, of actually getting medical isotopes without using nuclear reactors. It is a non-nuclear-reactor-generated mechanism for getting the isotopes we need. I would just impress upon Health Canada that this might be a route it would want to look at in terms of getting sustainable access to medical isotopes in Canada.

The last two were the comments, and the first couple were the questions.

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. Rosenberg.

[Morris Rosenberg]

Thank you very much.

I'll try to get through as much of that as I can.

In terms of the health human resources issues, there has been some progress with respect to pilot projects in support of the recruitment and retention of nurses. Those are already under way. There is an investment of $4.2 million over three years to support the Canadian Federation of Nurses Unions on a project entitled “Research to Action: Applied Workplace Solutions for Nurses”. The goal of that initiative is to implement retention and recruitment strategies in nursing workplaces across the country.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

I deliberately mentioned just the first two, Mr. Rosenberg, because I know, absolutely, that's been done.

[Morris Rosenberg]

Those are commitments that were made during the election campaign by the party. We are in the middle of the mandate. They are working through health human resources issues.

I also understand that this committee will be issuing a report on health human resources, and that will help the government decide, as it moves forward, on what other initiatives it will be putting forward.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

It was actually the commitment the minister made in August. There were three parts. They've done a good job on the nursing file, but the other two I mentioned--the 50 residency positions and the repatriation program--are the two that are missing in action right now.

If there's a plan on that, we'd be grateful to know that. But if you don't have it now--

[Morris Rosenberg]

I can't answer you on the 50 residency positions right now.

On repatriation, I do know that there was some information that came out from CIHI last week that actually showed that we are making progress in terms of the numbers of physicians in Canada, year over year, and the number of people in medical school. As well, the number of Canadians who are actually going to the U.S. is lower than it was.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

Are you going to work with the provinces to fund the 3,000 targeted undergrad medical school positions that have been requested?

[Morris Rosenberg]

We are working with the provinces on health human resources issues, both with respect to increases in medical school enrollment--there has been some good progress on that--and through the training and integration of international medical graduates. We're working with the provinces through our committee on health human resources on all these fronts.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair.

In her remarks, the minister mentioned our communications. There was a question, but you were cut off. You didn't get a chance to really go through what we have been doing with respect to communications on H1N1. I bring it up because as we were going through the process, there was some criticism of Health Canada.

My eight-year-old came home, and she was coughing into her sleeve. She was washing her hands. It appears to me that the message has been getting out very well.

I wonder if you could elaborate a little bit more on the communications rollout and how it compares. Has there ever been such a comprehensive communications rollout before by Health Canada?

[Dr. David Butler-Jones]

There has not been one, from a public health perspective, that I can remember, on either side of the House. It is something the minister has referred to several times: the importance of communications and the challenge of communications when there are so many voices out there, particularly when people are looking for divergent views. It is the nature of science that you will have divergent views. Even if it's 99 to one, it is important that they be explored.

Interestingly enough, given the nature of the pandemic and the nature of the coverage and the general interest in it here in Canada, we're actually watching those debates play out in the media. Even if it is 99 to one for the public, it gives the sense that maybe it's just different views as opposed to a minority view versus the majority view.

In terms of the communications themselves, we've been involved in everything from Google ads to radio to television to print media. We've been working with schools and with the provinces and territories on materials that can be used in schools. So you're right, people coming home from school and coughing into their sleeves....

I haven't been out of North America myself, but as you heard before, people are saying that they can tell who the Canadians are, because they're coughing into their sleeves. The level of awareness is actually quite high in Canada as a result of a range of communications, everything from the press conferences, which are well picked up, to advertising. We've spent well over $39 million already. That, for something like public health, is really quite unprecedented, and there is more to come.

[Colin Carrie, Conservative, Oshawa, ON]

I was going to ask how we compare to other countries. Obviously I've been impressed with your testimony in the past as to how Canada is taking the lead. We're not only communicating with the provinces, but internationally we've been taking a real lead in this entire pandemic. I wonder if you could comment on how we're doing compared to other countries.

[Dr. David Butler-Jones]

Each country has had to respond to the pandemic in the way that really befits them. As we survey the international media, the level of interest in Canada by Canadian media and the level of political interest, too, actually, has been much higher, it appears, than anywhere else in the world. There are all kinds of reasons for that.

The point is that Canadians are paying attention. The media are interested, and the messages are getting out, both the ones that we and public health authorities across the country want out there and also others that express different views. We have had to be even more engaged than many others have been in communicating those messages. We have been actually quite consistent. If you look at the comments I made in May and the ones I am making now, they really haven't changed a whole lot. The principles still apply.

It's important to get those basic principles about basic prevention and the importance of immunization out there, because we still have a way to go. This virus still has a way to go before it's done. The only way, ultimately, to protect against that is to be immunized, not just for us but obviously for others as well.

[Colin Carrie, Conservative, Oshawa, ON]

I want to ask you about the H1N1 plan rollout for the first nations. How is it going? Is it going as expected? Would you be able to comment for the committee and let us know how things are working for our first nations? There was some original concern. It would be very interesting for Canadians to know how we have handled that.

[Morris Rosenberg]

Thank you for the question.

There has been a lot of work done on first nations. Importantly, we wanted to make sure that we actually recognized that specific responsibility that Health Canada has to provide health services to first nations. So we did an important organizational thing, which was to bring in an incident commander, Dr. Gully, who's been here I think many times to report on progress. He met with first nations leadership across the country to ensure that some of the lessons learned out of the spring session were in fact being implemented: that protective equipment and other key medical equipment was put in place; that there was an adequate supply of antivirals; that vaccination campaigns were ready to go.

Having looked at this just the other day, my sense is that first nations are actually participating in numbers far in excess of the general population in vaccination campaigns. The numbers that I saw were around 50%, just below 50%, but they didn't actually have figures from last week. That's opposed to where we are now, which would probably be in the 25% to more than 30% range across the country for the general population. My sense also is that in terms of the incidence of H1N1 that we've seen this fall, the incidence in first nations seems to mirror much more closely the incidence in the general population as opposed to what we saw in the spring.

We've also invested heavily in working with the AFN on getting the message out to first nations. The minister referred to the virtual summit that took place a couple of weeks ago that involved the national chief, Dr. Butler-Jones, Dr. Gully, and you. I think a lot of work has taken place and the results I think have improved.

[The Chair, Conservative, Joy Smith]

Thank you so much for your comments.

We'll now go to Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you very much.

The first question I have is with respect to the reallocation of money from within the department to the tune of $5,394,000 for first nations communities for pandemic planning. Where did the money come from?

[Alfred Tsang]

The reallocation of the $5.4 million from vote 1 to vote 10 provides contribution funding to first nations communities for pandemic planning. So it's an internal reallocation of resources but we need to line it up properly under vote 10.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

But where did it come from?

[Alfred Tsang]

It came from our vote 1, our first nations.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

It came from money already allocated for first nations. So in effect what the first nations communities were worried about all along has come true, that money would be taken from valuable programs to help in terms of the systemic issues they have to deal with and put towards pandemic planning, which is really the responsibility of the federal government. Correct?

Can you tell me, then, what programs there are to reinvest in first nations communities, to help them deal with the difficult underlying conditions they're working with? Is there any attempt--any new money, any new programs--to assist in terms of the conditions that make them ripe for the spread of the pandemic, and where we continue to just repeat the same old problem?

To anybody: is this all we're going to get in terms of an answer on this?

[Morris Rosenberg]

I'll try to answer.

These are supplementary estimates (C). We're not looking at the budget now. I would note for the record that last year's budget, budget 2009, did provide $440 million over two years for first nations and Inuit health programs and first nations health facilities and infrastructure. So there was money in that budget.

We're not here to speak about next year's budget.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

No, I'm speaking about that money--money from there and wherever else you took it--put into pandemic planning. Presumably it was needed to begin with. It was there for a purpose. Suddenly $5.4 million is diverted for pandemic planning.

That's cutting off our nose to spite our face, isn't it?