Health Committee on Nov. 21st, 2011

[The Chair, Conservative, Joy Smith]

Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

The minister still hasn't answered one of the questions I asked her, and that is on post-market surveillance of drugs. There is funding needed for research into drugs, their interactions, their reactions, and their effectiveness, which I think requires funding. The Health Council of Canada suggested that recently in their report.

Secondly, the fact is that the Ministry of Health lacks a regulatory ability to deal with post-market surveillance in an appropriate manner. I didn't talk about regulation for drug shortages, Minister. I think you got my question wrong. This is post-market surveillance I'm speaking about, which is a different thing entirely.

[The Chair, Conservative, Joy Smith]

Minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

Our government announced significant funding for that very issue. I believe it was an announcement that I made in Toronto to the Canadian Institutes of Health Research, where we have invested $32 million to establish the drug safety and effectiveness network. We have established the new and easier-to-use website called MedEffect, a one-stop online resource for the latest public health information and for easy-to-access dealing with adverse reactions for reporting.

Dr. Beaudet, do you want to elaborate on that important work...?

[The Chair, Conservative, Joy Smith]

Dr. Beaudet, I'm sorry, but we just have a few minutes. Could you do it very briefly?

[Dr. Alain Beaudet, President, Canadian Institutes of Health Research]

The drug safety and effectiveness network has been launched and is very successful. It has several collaborative centres we've set up that collaborate through the country.

One of the major successes is that, respectively, they've managed not only to access data banks from the different provinces, but also, for research purposes, to merge the results. That will give us, for once, a true national figure through merging the different data.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Strahl.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you, Madam Chair.

Thank you, Madam Minister, for being here.

I want to switch gears a little bit and talk about first nations health, which is a big issue in my riding and certainly in the province of British Columbia. While much of our health care system is delivered and administered by the provinces, Health Canada is responsible for first nations health.

I think we could agree that it has been difficult to make measurable progress in the area of first nations health. First nations don't tend to have much control over their health services, and federal and provincial health systems seem to work almost in complete isolation from each other.

You mentioned that you recently signed a tripartite agreement with the Province of British Columbia, so is the tripartite agreement a sign of a new way of doing business? As well, how will it make a difference for first nations in British Columbia?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you. That is a very good question and I'd like to thank you for asking that question.

With the British Columbia government and British Columbia first nations, we signed the framework agreement in October 2011. This agreement makes it possible for us to move forward in new and promising ways in partnership with the first nations and the British Columbia health authority. The tripartite sets up a first nations health authority in British Columbia and gives the British Columbia first nations a real voice in their health services. They're at the table; they're involved.

To do its job, the first nations authority will work very closely with the British Columbia regional health authorities so there is better integration, as opposed to providing services in silos for first nations and the rest of the citizens.

Our government will support the health authority with long-term funding, and that will be money we currently spend to provide services to B.C., but it also includes escalators to address the normal cost growth factor. With this agreement, we will have accountability in place for the first nations health authority. At the same time, as I said in my comments earlier, it's a health authority for first nations people by first nations people, on better ways to deliver programs more acceptable to first nations, but in partnership with the provincial government.

It's the first of its kind; it's taken over five years to get here, and it is a new way of doing business. It's about better integration of services in B.C. I commend the British Columbia provincial health authority, again, for their leadership and interest in working at better ways of delivering programs. This is historic. It's innovative, and it shows that the federal government can work with the provinces and first nations to deal with better outcomes for Canadians.

Thank you.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Sticking with the tripartite agreement, you mentioned accountability for tax dollars. Does the framework have an accountability mechanism built into it? How are we ensuring that there is accountability for the federal dollars and federal investments in first nations health?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

That agreement does include accountability measures, not only financially, in the area of annual audit functions, but also in terms of accountability measures on what population health indicators we're dealing with and targeted investments related to the challenges in population health. The accountability goes beyond just the dollars, but rather how we improve better health outcomes based on the health of first nations in that jurisdiction.

Through the signing of the agreement, we're promoting a better model of health services to integrate that. It integrates with provinces collectively for before hospital care and hospital care, because the provinces deliver provincial hospital care. So it's a better integration of that.

When we signed the agreement in October, we agreed to provide resources. As I said, the first nations health authority will organize a governance structure with principles that are legally binding. There are a number of provisions, again, for accountability of the board—they will need to meet, health outcomes, financial pieces. So the accountability measure is quite broad. But again, it’s the first of its kind in health, not just this agreement but with any agreement in Canada. This is the most focused in all aspects of delivering health, not just the financial piece of it.

Thank you.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Chair, how much time do I have?

[The Chair, Conservative, Joy Smith]

We have about another minute and a half.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

I was just going to switch again to a different topic that our committee has been studying: chronic disease and aging.

We've heard that our government has taken action to prevent chronic disease by filling knowledge gaps and developing tools that support and strengthen prevention.

Could you give us some specifics on what our government is doing to address chronic disease and aging in Canada?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

Our government understands the burden that chronic diseases place on the health care system in Canada. It is committed to reducing that impact. We are striving to create conditions for healthier aging by preventing or delaying the onset of chronic diseases and preventing complications when they occur.

This is really achieved through a number of investments in a number of areas, such as research, surveillance, and better understanding of the factors associated with aging. We launched the population health study on neurological disease, which looks at neurological diseases such as Alzheimer's disease, dementia, and Parkinson's—again in partnership with the Canadian Institutes of Health Research. They have taken it a step further and are collaborating with the international community, which is doing similar research activity, again, to deal with providing better support to our aging population.

In addition to filling that gap, our government has been working with a range of partners to provide information for healthy aging initiatives with seniors' ministries in the provinces and territories. As well, in September 2010, the provinces and territories endorsed a declaration on prevention and promotion. Again, that's a collaboration with the jurisdictions.

In addition to that, in September of this year, I attended a conference on non-communicable diseases at the UN in New York, and I signed the UN declaration on preventing and controlling chronic diseases. This important declaration addresses the growing threat of chronic diseases around the world, and the countries have agreed that they must take effective action to reduce that. That's why we have taken the action to reduce tobacco use, promote healthy living, and to deal with obesity as well as a number of initiatives. It fits right under that umbrella declaration.

We have taken significant steps in that. The UN agreement basically complements what we have signed in Canada—the declaration with health ministries on prevention and dealing with preventable illnesses before they come into our health care system.

[The Chair, Conservative, Joy Smith]

Thank you, Minister.

We're now going to our five-minute question and answer period.

Madame Quach.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you, Madam Chair.

I want to thank our Minister of Health, who was kind enough to make a presentation and answer our questions.

One issue is causing me great concern. I am talking about the comprehensive economic trade agreement that the European Union and Canada are currently negotiating. We are now at the ninth—and probably final—round of negotiations. It is of the utmost importance for us to know whether this agreement may have an impact on the price of medication, given that Europe is asking for a five-year extension on drug patents. That may increase the cost of medication by almost $3 billion. It may also delay generic drugs entering the market. That kind of medication is used by many sick people, especially those with cancer who, for the most part, no longer work and don't necessarily have enough money for patented medication.

Since 1985, the cost of prescription drugs has risen by 10% a year. If our government grants the Europeans' requests, access to medications will be compromised. That goes against the principle of accessibility set out in the Canada Health Act and against the commitment the Government of Canada has made to Canadians.

One of the 2004 health accord targets was to provide better coverage for expensive medication. If Canada grants Europe the patent extension in the economic agreement, all that will be jeopardized.

Do you promise to leave the issue involving patents out of the agreement?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

In terms of the trade agreement that my colleague, Minister Fast, is leading, those discussions continue. I can't really comment other than that it is a conversation that is occurring at the moment. I'm not the lead minister on the trade agreement discussions.

What I can say, though, just on the issue of the drugs is that he is well aware of our position in Canada. Again, it's too early to say what the outcomes of those conversations or discussions will be.

I'll leave it at that. Thank you.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

If you cannot participate in the negotiations, can you at least promise to defend public health care? Those proposals go against the Canada Health Act's principle of accessibility. We are talking about access to medication for patients who are suffering from serious or less serious diseases and need affordable medication. As a minister, you do have some power.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

In terms of your question, our government has stated time and time again that we would not cut transfers to provinces and the territories. That continues to provide support to the jurisdictions on health at 6%. It is up to each jurisdiction to deliver their health care. So under the Canada Health Act we've committed to do that.

In terms of the issue you raised around the negotiations, that is a separate process. It's a Canada-international agreement, but in terms of our government's commitment to provide support to jurisdictions, I think that's clear. We were dealing with the issue of the Liberal government cutting transfers to health and education. I was the finance minister for the north and health minister when that all transpired. Some of the things we're seeing right now in terms of health...when we cut funding to prevention, we're dealing with all the chronic diseases now, and we need to play a bit of catch-up. That's the work of provinces and territories around looking at prevention as a prescription, as opposed to dealing with drugs and treatment when you fall ill.

How can we shift some of the work we're doing so that it is more balanced, in that we look at prevention as a means to dealing with the challenges we face in the health care system today? We cannot continue to just focus on the “when you fall ill” system. Equally important to that, we need to look at a system to keep you from getting ill in the first place to mitigate the long-term impacts on a health care system.

The conversation we're having now across the country is very encouraging. The obesity initiative, the declaration from the UN, the conversations with provinces and territories who deliver health care are very encouraging. It's refreshing to hear the shift in some of the work we're doing to try to deal with the challenge that we will see in the health care system.

[The Chair, Conservative, Joy Smith]

Thank you, Minister.

Now we'll go to Mr. Williamson.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you, Madam Chair.

Minister, it's good to see you again today. I'm going to try to tie in some of my questions with some of the issues we've been studying on the health committee. One of the things I noticed over the last number of weeks is that folks are asking government to step in and do more, particularly when it comes to dealing with chronic illnesses. I heard you say it several times, and I believe there's a story to be told about what the government's done.

One of the points you've made is that it's important for individuals to take their health into their own hands. I tend to view the obesity epidemic, for example, as more of a challenge than a crisis. I believe it means eating well and staying fit, physically active. Could you tell us what our government has done to improve physical activity rates among young Canadians, or Canadians at large? What programs have been put in place to give people incentives to live healthier lives?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

Dr. Chan was in the House today. A year or two ago she said that the next global epidemic would be obesity. I think some of the illnesses we're seeing in our system today directly relate to the lack of activity and obesity. When you're dealing with diabetes, heart disease, and knee and hip replacement surgery, they all relate to obesity.

Canada has made important gains in how we can encourage Canadians to be more physically active, particularly our young people. Our government believes that physical activity is a shared responsibility with the provinces and territories and a number of stakeholders, such as municipalities, with parks and walking trails; the school systems; and parents. What can we do to provide information to parents so they can make informed decisions on the importance of physical activity or eating healthy food?

Our government also said we would invest in the fitness tax credit for Canadians to promote physical activity, recognizing that we need to start with this generation. All the statistics today indicate that our children will not live to be our age--and it's this generation--based on obesity. We need to start tackling that issue.

I believe our government has made significant investments. The commitment in the declaration we signed in Newfoundland last year with the Public Health Agency of Canada is the first agreement in Canada on keeping our people healthy. As opposed to saying, “Here's more money for when you fall ill”, it shifts the thinking to, “Here's what we can do to keep our children healthy”.

I am very encouraged when I hear someone say, “It's not up to you as my doctor to keep me healthy; it's up to me as an individual, but here's what you can do to help me”--shifting some of that kind of conversation. So how do we support that? I believe the commitments made by the provinces and territories in the initiatives they're now undertaking within their own jurisdictions are very encouraging.

On the second part, I told you we signed a declaration at the UN with global health ministers on what we need to do to deal with chronic diseases, and many of them stem from obesity, as an example.

I think we can be proud of our record in working to shift that thinking, and working with jurisdictions that are doing things to keep you out of the hospital in the first place. So it's quite encouraging.

This week in Halifax we'll be able to update Canadians on where we're heading with the work we did over the summer.

Thank you.

[John Williamson, Conservative, New Brunswick Southwest, NB]

I think you've hit it, in that it's a matter of providing people with the tools to live healthier lifestyles, as opposed to trying to mandate that they do so.

This next question is something I'm interested in, and again it follows through.... What has the government done to provide information on healthy eating for consumers? One of the challenges I find, for example, is that when you go into any store and lift things off the shelves, the information doesn't seem to be consistent. Yet to me it just comes down to informed consent. A Big Mac every now and then is not going to kill you--in fact it's all right--but you want to weigh it off against other things that are healthy. But if you can't find that information, it makes things difficult, particularly when people have busy, active lives today.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that.

The more I'm involved in this conversation around childhood obesity, the more I become aware, as the mother of a three-year-old child, of some of the food that's marketed to my child. Whether it's healthier or not is another question. Ultimately, at the end of the day, as parents we make those purchasing decisions, not the three-year-old. So we've been trying to provide information to parents on the nutritional value of the products sold in stores—we've updated that—so they can make informed decisions. We have updated our food guide. We have commercials to provide information to Canadians that too much sugar can lead to obesity. The Nutrition North Canada program provides affordable food to Canadians who live in remote, isolated communities. We provide information on tax breaks for physical activity, and what have you.

Our government has done a lot to support healthy living. At the same time we've made significant investments in injury prevention. My former colleague, Minister Lunn, made the announcement that we would focus on head injuries and a number of other injuries related to that.