Health Committee on Feb. 24th, 2009

[The Chair, Conservative, Joy Smith]

I'm sorry, we have to go to Ms. Hughes now.

[Dr. Karen Dodds]

Madam Chair, if I might just add, in regard to the Organisation for Economic Co-operation and Development, OECD, it's actually Health Canada that supplies them with their data. So the OECD data are indeed passed to them from us.

The Health Council, which got the mandate in the health accords for reporting, has certainly produced annual reports addressing the accord commitments, health outcome reports. If you go to their web page, their list of reporting is quite extensive. It is there and it's available.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Hughes, you're next. You have five minutes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

I want to thank you again for all your input. It's certainly greatly appreciated, and the work that you do.

We find quite serious the problems identified in chapter 8 concerning the quality of Health Canada reporting. One other glaring illustration is the department's annual reporting on the Canada Health Act. It shows that the problem is systemic in the culture of the department, if not the government, not limited to the Healthy Canadians report, and that it really must be dealt with.

The latest Canada Health Act report was basically slipped into the parliamentary record again with the Clerk of the House on February 12. There were no bells, no whistles, not even an announcement. It's very much like last year, when it was tabled while the House wasn't sitting.

We find that the quality of the report is very inadequate. Just as in the Healthy Canadians report cited in chapter 8 in front of us, there is no contextualization, no explanation of what the data signifies for a public health system, and once again there are huge gaps in information.

This is a report to the Canadian public on its number one social program. We really rely on this. It is a report to Parliament in order that we as members of Parliament are able to assess the state of the public health of Canada and that we be able to make some changes or suggestions or at least try to improve it.

In preparing for today's meeting, I reviewed past Auditor General reports and referred specifically to the 2002 report, chapter 3, Health Canada, federal support for health care delivery, and its earlier chapter 29 in the 1999 report. The conclusions can still be applied directly today, more than six years later.

So to the Auditor General, basically are you satisfied that your conclusions and recommendations are not treated seriously by Health Canada?

[Neil Maxwell]

Thank you, Madam Chair.

Just by way of a little bit of information, we do monitor on an annual basis how well departments are doing on our recommendations. I'll turn to Health Canada specifically in a moment, but in general what we find—it's one of our performance indicators and we publish it in our own departmental performance report—is that, by and large, departments do listen to what we have to say. Our statistics have consistently shown the majority of our recommendations and such get acted on. That's the general case.

More specifically in this case, we have not recently returned to looking at the state of the monitoring of the Canada Health Act, which we looked at in 1999 and again in 2002, as the member has mentioned. So without further study, I wouldn't want to opine the extent to which we're satisfied with the action taken.

[Dr. Karen Dodds]

I think within Health Canada, as in all federal departments, we also keep track of our action and follow-up in terms of Auditor General reports. Part of each Auditor General report is obviously a response from the department on the action we plan. The Auditor General comes back and checks, but we check regularly as well on making progress.

I know that just within the last week in Health Canada we've done a status report on any outstanding recommendations. Certainly from what I saw, there's nothing going back to 1999 or 2002 that hasn't been fully met in terms of an Auditor General report, but we'll take it back and look at as well.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Your feedback says that will change with regard to how Healthy Canadians will move forward. We'll have to wait, I guess, until we see the Canada Health Act report as to how that actually comes about and whether they're going to coincide or whether it's going to be a totally different report.

I have one more question, if I have enough time.

[The Chair, Conservative, Joy Smith]

You have 30 seconds.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Okay, I think I'll just leave it at that. Thanks.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

First of all, I would like to briefly talk about indicators. The collection of indicators is an ongoing science, and we have increasingly sophisticated opportunities. I think we are making great strides as a government. We've talked about the OECD reports and how they feed through. We truly are doing much better now than we were a number of years ago in looking at these questions.

Perhaps I can also state that to think that anyone who has ever worked at the provincial level is not incredibly accountable to the public for those health care dollars.... You're under an incredible pressure, as I'm sure Madam Murray could attest, of accountability for those dollars. Having said that, it is a responsibility of the provinces, and they are often under a lot of heat for it. The ability to look across Canada is, of course, very important.

I have a few questions, and the first would be this. I appreciate the look at indicators and how you're going to monitor indicators. Where are you going, over time, with that particular piece? You mentioned that there will be some consultation, but is there talk about a framework of regular dialogue to look at the ever-changing opportunities for gathering data on indicators?

[Dr. Karen Dodds]

One of the great benefits of having the Auditor General come in, even though you're feeling that the Auditor General is always criticizing your program, is that it has people interested in the work you do. For the first time, you get a lot of feedback on the work you do. I have with me colleagues who are involved. I think it is wonderful to hear that there's interest in improving it. We'll take all of these comments into consideration.

As I said, we have indicated that we'll do consultations in this calendar year. We'll certainly feed into them what we've heard from around the table. We heard and paid attention, obviously, to the Auditor General's recommendations. In looking at what we've done with Healthy Canadians 2008, which comes out next month, our determination is that we've met five of the seven recommendations. But there are clearly some dealing with the broader interpretation of helping Canadians that we'll still work to improve upon, for sure.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I believe we're going to have more opportunities for more sophisticated information as our electronic health and medical records are implemented.

My other question—I have two more, if I have time—is this. There must be real challenges around the aboriginal population, when you have very different groups responsible for the delivery of health care services. Is there anything you can do by way of reporting on some of these populations?

[The Chair, Conservative, Joy Smith]

Ms. Dodds, do you want to answer that question?

[Dr. Karen Dodds]

Thank you.

As I said, one of the issues is that when we get the information from the provinces, there's no differentiation with respect to ethnicity. We get a big pool and we can't pull it out. Not all reserves participate in surveys. We have continued to support specific surveys looking at first nations, Inuit, and aboriginals. I've mentioned them before. There's a regional longitudinal health survey, which we've helped support by funding of $12 million. There's another one that we've worked on, the Aboriginal Peoples Survey. With time, with improved relations between government officials and first nations and Inuit health people, and a collaborative approach to indicating what data you want and why.... For Inuit and aboriginal people, their data is their data, so you have to approach surveys and research with them in a specific way. Increasingly, we're able to do that and get better data.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

And I would—

[The Chair, Conservative, Joy Smith]

You have 30 seconds, Ms. McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Okay, I'll leave it. Thank you.

[The Chair, Conservative, Joy Smith]

Are you finished? Okay.

Let's go to Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you very much, Madam Chair.

And thank you all for coming and taking the time.

I'm actually going to split my time with Mr. Carrie.

My question may be a simple one, but I think it's important because the report is important and we're into having several of them. I think Canadians in general should know more about the report and should be able to make their own assessments and understand more about it. What are you doing to make the report more available to Canadians or just to make Canadians more aware of the report itself?

[Dr. Karen Dodds]

In response to one of the Auditor General's recommendations, we are making sure there's going to be a media release this year. The report itself will be available on the website. We'll have some printed copies, but most people now are using the Internet and the web as a way of accessing information. So the report will be available on the website.

We will notify interested parties, because from previous reports we've had connection with some people. All of them will be informed that the report is out, as will other stakeholders we have on our lists. We also intend to make reference to the report in different announcements and speeches that the department's responsible for to try to raise awareness of the report.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

I know you touched a bit on this previously, but just what are you doing to improve the report itself from one report to the next? On this report coming up, how would Canadians know it's been improved?

[Dr. Karen Dodds]

Actually, in the report itself I don't know if we note the improvements. We have more than doubled the number of indicators. We had 17; we've added another 19. In each section there's clearly an interpretation as to how this relates to an accord commitment and a narrative that's in plain language to help Canadians understand the purpose of the indicator.

We decided we wouldn't do the consultations before finalizing the 2008 report because then we wouldn't get the 2008 report out until too long in 2009. It was a hard decision to make. So the consultations that we do this year will feed into our work on the 2010 report.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Okay, thank you.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair.

I think a lot of Canadians don't understand sometimes the difficult place that the Government of Canada is. It's kind of a juggling act, because the provinces take such a large role in health care delivery. But many people don't understand that the federal government is responsible for the first nations and the Inuit. So Health Canada does that. But then there's the military and National Defence, the veterans and Veterans Affairs, the RCMP, Public Safety, refugees and Citizenship and Immigration, inmates...we're looking at Correctional Service Canada.

Would you be able to explain to us how you work with the different departments that are responsible for these different populations and how you can use that to improve future Healthy Canadians reports?