Evidence of meeting #13 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was arthritis.
A recording is available from Parliament.
4:05 p.m.
Conservative
4:05 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much.
I want to change the channel a bit and talk about seniors who have mobility problems. Many seniors have mobility problems, for one reason or another. There's a sense as well that if you move these seniors from their homes and put them into an institution or long-term care facilities, you actually increase the rapidity of them getting memory loss and Alzheimer's and disorientation and all of those kinds of things.
How, then, can one ensure that elderly mobility-challenged people can stay in their own homes, especially if these homes are not easily accessible? What sorts of changes do you see that wouldn't be very costly? You would have to change every single home, or every single unit of every single apartment in a community, if you wanted to improve their mobility without having to remove them to an institutional setting that has mobility access. How do you see that happening?
Today at the research caucus lunch, the woman from the United Kingdom was telling us that part of the multidisciplinary team they use in managing chronic care includes a housing person and a social worker. When we talk about multidisciplinary teams, we don't think about these two people.
Can you elaborate on that and tell us what model you think we could use?
4:10 p.m.
President, Canadian Health Services Research Foundation
That actually raises the much broader question about the way we organize health services. If you imagine Ottawa, there isn't anybody in Ottawa whose job it is to be responsible for all the initiatives that have an impact on people's health.
We don't have any locus of management in our health system. It's not like they've got a pot of money and can decide it would make more sense to subsidize ramps in people's houses than it would to do X, Y, or Z. Nobody has the control over reallocating money, and that's a big part of the problem in terms of the way we organize ourselves to look after people's needs.
I think the work that human rights commissions have done on disability have not been focused on elderly and chronic. On the positive side, there are benefits in the obligations that public spaces have for them, but that will not get at the issue of the adjustment of private spaces.
Who is going to pay for these kinds of questions becomes the issue. It helps their health. We save money if they're there. Whether it's a private or a public responsibility is going to be the debate on many issues over the next decade.
4:10 p.m.
Conservative
4:10 p.m.
Professor, Dalla Lana School of Public Health, University of Toronto; Senior Scientist, Toronto Western Research Institute, University Health Network, As an Individual
I have two very quick comments.
One is that only a tiny minority of older people are actually in wheelchairs. Most can walk, probably not very well, but they can walk.
So there are two things. One, as I indicated in my presentation, is to stop people from deteriorating because they lack physical fitness. They lack physical fitness. They get less fit. They're less able to do something.
The other thing is simple adaptations to the home: stair rails, getting rid of trip rugs, rearranging the furniture in somebody's home so they can hold on to the furniture as they walk around. These can keep people active in their own homes. Putting a grab bar in a bathroom, or a rail by a toilet so somebody can easily get out of the seat, raised toilet seats, don't cost a lot of money.
4:10 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I realize that. But I think Ms. O'Neil was saying that somebody has to coordinate all of this so they know what the needs are.
In some provinces there are regional health authorities, and they're given sums of money to look after these things. Is this the appropriate group to look after them? Or do we need to develop someone, like this woman from the U.K., who does that, or who is in charge of a group that does that?
4:10 p.m.
President, Canadian Health Services Research Foundation
The health authorities across the country have different scopes and responsibilities. Some have a lot more than others. We can't forget that in the United Kingdom there is an actual health service organization. We have payment systems that allow us to access health services. We have doctors who can work independently. We have hospitals where you find nurses, and so on, but we don't actually have systems that are integrated, and that's a really big difference.
The optimistic view of health authorities, say, 40 years ago was that they would become the locus of management for this range of questions. But I think if you look across the country, sometimes they have a lot of scope and other times they don't. Sometimes they are responsible for, say, just the hospital and long-term care budgets, but they might not even have public health. Then somewhere else there are community care access centres, and somewhere there's housing, but they don't have all of them together.
4:15 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Do you see this as part of a transformative change model that could go into a 2014 accord?
4:15 p.m.
President, Canadian Health Services Research Foundation
This is a really interesting question. Certainly, except for the extraordinary political difficulty of doing it, this is something that provinces can do. I guess the interesting question would be whether there is a way to sweeten the pot. The fact is that if a province is very brave, it can do that now. It, after all, holds the money for the physicians, holds the money for the hospitals. Now there's the problem of what is not funded, some professions that are not funded, that in fact could be extraordinarily helpful to people with chronic diseases. But the provinces can do this. The provinces could do this, but it's not easy. Every time there's a change in the health system, there are a lot of people who line up and are not keen on it.
4:15 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Our health system is based on hospital and physician funding right now. You cannot fund long-term care. You cannot fund community care, but the accord had a sweetener in it for doing just that in 2004.
4:15 p.m.
Conservative
November 2nd, 2011 / 4:15 p.m.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
Thank you, Madam Chair.
Thank you to our witness for being here. I'm truly enjoying this study we're doing. My first question will be for Ms. Badley. I'm very interested in the project you mentioned that you just received grant money for through the CIHR, because I'm an individual at the tail-end of the baby boomers, and I truly do believe that we need to take what appears to be a huge challenge looming on the horizon with baby boomers aging and turn it into an opportunity. It sounds to me that perhaps the project you've received funding for might contribute to doing that. I don't know if you'd like to describe for us even the process you went through to receive the funding. Perhaps give us a little bit more of an idea of what your project is going to look like.
4:15 p.m.
Professor, Dalla Lana School of Public Health, University of Toronto; Senior Scientist, Toronto Western Research Institute, University Health Network, As an Individual
Well, very briefly, first of all, I looked at the literature. I found over 1,000 papers that mentioned the baby boomer population, and they said things like, oh, it's going to be awful, there are going to be a lot more people, we won't have any health professionals. When I whittled it down, I found only 20 papers that actually had evidence out of that 1,000.
What I'm going to do is use data from the national population health survey, because I need to be able to compare people who are 55 or 65 now with people who were 55 or 65 ten years ago and look at time trends in their increasing disability, their self-rated health, and their use of care over time, and see if the slope of the trajectory is the same for different generations--older baby boomers, younger baby boomers, and what I've called the wartime babies, people who were born between 1935 and 1945. I hope that in about a year's time I'll be able to give you some of the results.
There are reasons to suppose we might be healthier. We know we've had better health care. We have better education. We've had antibiotics. On the other hand, we're more obese. One of the other difficulties is that people are living longer with chronic diseases when they otherwise would have died. So I think we're going to have two little groups in there: healthy people who look after themselves--probably those of better social class, the richer, the more privileged--and probably the poorer and the more obese, and then the survivors. So I think it's going to be quite complicated, but at least I think it might help us target health care a little bit more practically, and also it might mean that it's not going to be as bad as we think it's going to be.
4:15 p.m.
Conservative
4:15 p.m.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
My next comments will be for Ms. O'Neil.
First of all, I'd like to congratulate you on receiving the Order of Canada in June. That's quite an accomplishment.
I'm from Saskatchewan, so I do know Stephen Lewis, and I know him to be a very passionate and motivational speaker and advocate for reforming or reorganizing the health care system.
This committee has heard from many health professionals that the health care system should be transitioned progressively from one of acute care to one that is more about prevention, management, and health promotion. The committee has been told that over time such a model could incur significant savings. I'm wondering, from the work you're doing, can you share if you're aware of any research that absolutely supports that, or might even refute it?
4:20 p.m.
President, Canadian Health Services Research Foundation
I think the research on that question is rather like the research Dr. Badley looked at. In looking at all the papers that make a lot of very big assumptions, there isn't a lot of evidence associated with them.
I think the research that needs to be done is the kind of research we're doing together with Fraser Health in British Columbia and the Institute for Health Systems Sustainability, where we're in the process of looking at, first of all, how much money actually flows into that region for health, no matter how it's going in—whether it's for hospitals or for physician payment, whether it's for drug payments that turn up, all of that—so we know what the quantum of the money is. We know another study will look at what the population health characteristics are. Then we imagine the overlays like in those books on the body that little kids look at.
We know what the characteristics of a well-functioning health system are, that is, integrated—all of the words that Stephen Lewis used in describing it. Then the question is asked, how far are we from that? Given the amount of money we have, could we pay for that here in Fraser Health? What would the barriers be to getting the money flowing in that direction? As Dr. Fry said, our money comes in very specific ways in the health system, and that sometimes can be a barrier to doing the things we know need to be done.
That kind of study, where you're looking at a real place with calculations of real money flowing through the system, and putting that overlay of what a really good system looks like and then saying, how far are we away from it and how will we get there, I think, is the kind of study that's going to help us answer that question.
4:20 p.m.
President, Canadian Health Services Research Foundation
Again, as Dr. Badley said, in a year, if you're still studying this, we will have a much better answer, because this will have been looked at together with the organizations and institutions that are actually delivering the care.
4:20 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Mrs. Block and Ms. O'Neil.
We're now going to go into our five-minute rounds of Q and A.
We'll begin with Dr. Sellah.
4:20 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Thank you, Madam Chair.
I'd like to thank Mrs. O'Neil and Dr. Badley for enlightening us.
I did a little research on both of you and, as Mrs. Kelly Block, who preceded me did, I'd like to congratulate you, Mrs. O'Neil, on receiving the Order of Canada in June.
I know that the mission of your foundation is to accelerate healthcare improvement and transformation for Canadians. I know that your association works with governments, policy-makers and health system leaders. I also know that you have at least three priorities. One of those priorities in particular caught my attention. It was promoting policy dialogue. In your presentation, you also mentioned that among the existing barriers are the lack of collaboration between the various healthcare services and the fee-for-service model.
What do you think would be the best way for the federal government to contribute to resolving these problems? Should the federal government create a way to share best practices?
4:20 p.m.
President, Canadian Health Services Research Foundation
That's a very good question.
I think that the Canadian Medical Association has already suggested investing much more money into sharing innovations. We fully agree with the association. In fact, the opportunities for action by the federal government are limited, except in the case of the populations it is responsible for, such as aboriginals, people connected to the Department of National Defence, and so on. In those cases, it's different.
But if we're talking about the others, it's mainly a question of research funding, which is very important. We cited a number of studies today. It is absolutely essential that this continue.
There is always the possibility of creating very specific programs. A number of programs have been mentioned, such as the Canadian Partnership Against Cancer and the Canadian Mental Health Commission. I could add that our organization, as well, was supported by federal funds years ago. These are the levers available to the federal government.
However, there is something else. I find that the federal government could encourage exchanges between the provinces and researchers, and especially sharing between the provinces. They are not all organized in the same way, but in a fairly similar way. The broad outlines are the same. I think we need to continue having a pan-Canadian conversation to try to resolve the problems.
We have always worked very closely with Quebec. I know that Quebec is aware of the changes that take place in the other provinces. It's the same thing for the others, but the employees of the departments of health who work on the operational plan do not have the chance to share with the others.
To move forward, it is essential that Nova Scotia share what it has done with British Columbia, for example. Actually, the provinces all do things a little differently, and we can all win if we share with each other.
4:25 p.m.
NDP
4:25 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
My question is for Dr. Badley.
What do you think the federal government's role should be when it comes to establishing priorities and even new frontiers in healthcare? Chronic diseases are, in some way, a new frontier.