Health Committee on Nov. 21st, 2011

[The Chair, Conservative, Joy Smith]

Good afternoon, ladies and gentlemen. Welcome to the health committee.

I'm very pleased to have with us today the Honourable Leona Aglukkaq, Minister of Health. We will be doing the estimates today.

Joining us also, from the Public Health Agency of Canada, is Dr. David Butler-Jones and Mr. James Libbey, the CFO. Welcome.

From Health Canada, we have Glenda Yeates, the deputy minister, and Jamie Tibbetts, the chief financial officer. Welcome to the committee.

From the Canadian Institutes of Health Research, we have Dr. Beaudet, president, and James Roberge, CFO.

Our minister will give her presentation, following which we'll go into Qs and As. We will finish off the meeting with votes on the estimates.

Welcome, Minister Aglukkaq.

[Leona Aglukkaq, Conservative, Minister of Health]

Thank you, Madam Chair. I'd like to thank you for introducing my officials.

Good afternoon, everyone. It's a pleasure to be back.

Today I am here to discuss supplementary estimates (B) for the health portfolio. For that reason, joining me are officials from Health Canada, the Public Health Agency of Canada, and the Canadian Institutes of Health Research. As well, each deputy head has brought along their financial officials. If you have any specific or detailed questions, they'll be able to answer them.

Madam Chair, I would like to give you a quick overview of the 2011-12 supplementary estimates (B) before we go into the discussions.

On the Health Canada side, supplementary (B) provides $330 million in new spending for 2011-12. That increase raises the total budget to $3.8 billion for the current fiscal year.

The major increases include $218 million to provide health benefits for pharmacy and dental services and to continue nursing services in remote and isolated first nations communities through the first nations and Inuit health branch; $64 million for the chemicals management plan; and $26 million for the clean air regulatory agenda.

With respect to the other parts of the portfolio, the Public Health Agency of Canada received a net increase of $31 million, increasing the Public Health Agency of Canada's total budget to $675 million for the current fiscal year.

The major increases include $16 million for the short-term replenishment of the national antiviral stockpile; $8 million to secure Canada's pandemic influenza vaccine supply; and $2 million to renew funding for the genomics research and development initiatives. These increases for various health portfolios programs all help to maintain and protect the health of Canadians.

Since my last appearance at this committee, I have had the opportunity to travel from coast to coast to coast, and to talk to Canadians about a broad range of health concerns. While I've been on the road making health announcements, I've also had the privilege of seeing first-hand some of the great work being done by medical professionals and researchers at labs, in hospitals, and at the community level.

Here are some of the main priority files that have been progressing over the past several months.

We are working to reduce the impact of non-communicable diseases, or chronic diseases. I was very pleased to attend the United Nations in September and sign off a political declaration on non-communicable diseases. I sat among health ministers and leaders in health care from all over the world. We acknowledged the direct impact of chronic diseases on social and economic development, and we made national and international commitments for their prevention and control.

Here at home, chronic diseases have been a priority for our government as well. Most of you will recall that last year Canada's ministers of health signed a declaration on prevention and health promotion. It sets out guiding principles, including the need for more emphasis to be placed on the promotion of health, with the aim of preventing or delaying chronic diseases, disabilities, and injuries.

I am particularly interested in the prevention aspect. There are many ways to encourage our population to be instrumental in their own healthy living lifestyles. That means getting back to basics of regular exercise, healthy eating, and making informed lifestyle changes.

I'd like to thank you, as the committee, for the important work you're doing for prevention. I think it's an essential part of making the health care system more effective and more sustainable in the long run. On behalf of Canadians, thank you again for your committee's hard work in this area.

When it comes to prevention, you can't get much more ahead of the game than by dealing with childhood obesity. That is one of our main priorities. Again, in September 2010, the federal, provincial, and territorial ministers of health agreed to a framework through which we could make childhood obesity a collective priority. It will allow us to coordinate our work with many sectors of Canadian society and support healthier weight among children and youth.

As a first step in implementing the framework, FPT partners brought together a diverse group of more than a thousand citizens and stakeholders to identify ways in which we can create the conditions that will help achieve healthy weights. I'll be discussing this further with my provincial and territorial counterparts when we meet in Halifax this Friday.

An all-too-common chronic disease is diabetes. Approximately two million Canadians have already been diagnosed with diabetes and many more are unaware that they have the disease. Type 2 diabetes is the most common type, accounting for between 90% to 95% of all cases.

With Type 2 diabetes, the sooner it is detected, the fewer the complications. Also, it can often be prevented or delayed by adopting a healthier lifestyle, but first, Canadians have to be aware of their risk of developing Type 2 diabetes.

Last week I was in Toronto, where I announced that Shoppers Drug Mart will be making our CANRISK survey available through pharmacies across the country. By putting this helpful tool in people's hands and having pharmacists on hand to discuss the results with them, I believe there is a huge potential to help people make informed decisions that will help them to avoid developing Type 2 diabetes.

We're also investing $6 million through the Canadian diabetes strategy to fund 37 new community-based projects across the country. This funding will address screening, early detection, and management of diabetes, as well as the prevention of secondary complications from the disease. By giving Canadians information they need, we can help them make healthier choices so they can live longer and healthier lives.

An ever-present health concern is the use of tobacco. It is still associated with the deaths of almost 37,000 Canadians every year. To get more people thinking about its negative health effects, we have changed tobacco labelling regulations so that in the coming months smokers will begin to see much bigger health warning labels on the tobacco packages.

We have unveiled new graphic images that will cover 75% of the package so they cannot be ignored. One of those images is of a dying Barb Tarbox, who wanted to discourage others from suffering like she did and offered her image for use in this context. It was a powerful experience for me to announce the new label with Barb's widower, Pat, and her daughter Mackenzie, who shared very honestly with students the pain she experienced by losing her mother to cancer. We are grateful for the work that was done with her family and for their support in this campaign.

We want to get the attention of smokers with those images and we also want to help them quit. That is why we worked with the provinces and the territories to create a quit line that all Canadians can access. The phone number and web address will be on the new packaging so that all Canadians can get help, no matter where they live.

In 2010 smoking among teens aged 15 years to 17 years was 9%. This is the lowest rate we've ever recorded for this age group, which is critical in our fight against smoking. We are encouraged to see overall smoking rates at historic lows, and we will keep up the fight.

A month ago, I was pleased to represent the Government of Canada in signing the B.C. Tripartite Framework Agreement on First Nation Health Governance, along with the Province of British Columbia, the B.C. First Nations Health Society, and the B.C. First Nations Health Council. This agreement is the first of its kind for first nations health in Canada. It promotes a more integrated model of health service delivery for British Columbia first nations, and it creates a health governance structure that will more effectively respond to first nations needs.

A British Columbia First Nations Health Authority is at the heart of the new structure. Through this authority, programs and services will be designed, delivered, and managed by first nations for first nations, and in ways that best meet first nations needs.

I am proud of the work we are doing in collaboration with first nations. We know that this hands-on approach will better meet the needs of first nations in British Columbia.

To have the best health care system in the world, the patients must always come first. We are working to make sure that it is also true when it comes to research. This summer, at the annual meeting of the Canadian Medical Association, I announced a new national strategy to better integrate health, research, and health care. We want to be sure that research doesn't just stop at the lab. We want it to translate into better treatments in clinics, hospitals, and doctors' offices throughout Canada. This new approach will foster research that will help health care providers compare the results of different treatment options and determine the best course of action for patients. Putting the needs of patients first will bring meaningful changes to our health care system.

One of the ways we can put patients first relates to making sure that there are safe drugs available on the market. One of the many duties of the health portfolio is to conduct a thorough review of drugs to ensure that they are safe before patients can use them.

Health Canada scientists can be asked to review more than 4,000 drug submissions in any given year. This obviously is a significant number of reviews, and it poses a challenge to the organization. Earlier this year we updated Health Canada's user fees. This has allowed the department to progress reviews more efficiently and effectively.

We also have taken action to address the global issue of drug shortages. This summer I wrote to drug companies and asked that they take action to develop a system that provides patients and health care providers with the information they need about possible drug shortages so that they can make informed decisions about treatment plans.

I told these companies that if they did not come up with an approach that accomplished this goal, then as minister I would be prepared to take action and regulate a solution.

I'm pleased to report that the response was positive. In the near future, Canadians will be able to log on to a public website to see if there are drug shortage issues that affect them. This is in addition to existing communication channels that industry and Health Canada have with the medical community.

In conclusion, as you can see, a great deal has been accomplished and work continues on several fronts. As I mentioned earlier, this week I will be meeting with my provincial and territorial counterparts, and we'll begin talking about what should replace the 2004 health accord.

As you know, our government has committed to increase total health transfers by 6% beyond 2014. Our government has committed to working with the provinces and the territories to reach a new agreement that provides accountability, meaning better results for patients.

I would like to thank the members of this committee for their time. I am prepared to answer any questions you may have.

Thank you.

[The Chair, Conservative, Joy Smith]

We thank you, Minister Aglukkaq, for coming. I know you're always so open to coming whenever we need you here. Thank you for that insightful presentation. We appreciate it.

We'll now go to our first round, seven minutes of Qs and As, and we'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

To the minister, thank you for coming today and for your presentation. You've presented some information, but I have to say from hearing you and reading through your brief, I think there are several major issues facing our health care system that are not being addressed by the federal government. I'd like to focus on that by asking you some questions.

You've spoken a little about one of the issues, which is the shortage of drugs. I noted in the House today that you said you're very happy there's now a plan; you asked these drug companies to come up with something. I would point out that this was all done behind closed doors.

We wanted to study this at the health committee. There's been no discussion here. There's been no public disclosure. I think it's very obvious that a pledge to post information is just that: it's just providing information. It doesn't actually resolve the problem of the drug shortages themselves. As I'm sure you're aware, a number of medical journals, academics, and health professionals seriously question why these shortages exist. It's very interesting that the shortages seem to be mostly among the older generic drugs—some of which have been around for 50 years—forcing people to pay more.

I'm very perplexed that your government's response, your response, to this is basically to say, well, post the information. That's not resolving the question, Minister. We'd like to know what you intend to do to ensure that these shortages, which put people in jeopardy, don't continue to exist. I think this is very much related to the whole question of affordable drugs and accessibility.

As you know, in the 2004 health accord, a commitment was made for a universal prescription drug coverage plan. We can go as far back as 1964 to 1997 to 2002—the Romanow commission, the 2004 accord—and when we look at the reality of what's going on, we can see again that the federal government has taken no action in addressing this critical issue.

So these two things are related. I find it very problematic that we've seen nothing from you or the government to address what is now the biggest cost in our health care system, and that's the cost of prescription drugs, and now we've got shortages as well.

I'd like you to respond to that and say why nothing has been done and what is intended to be done, to address these two issues.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

Just on the issue of drug shortages, I said earlier that I was working with the industry over the summer months. It's a very complex area. It's not just going to the drug store and asking what the shortage is. It's a whole chain of organizations involved, from the users to the producers to the distributors to the agencies that dispense prescription drugs.

The response I received from the industry over the summer months is the first of its kind in Canada, pulling all the players together that provide prescription drugs to the front-line individuals who prescribe them. I'm very encouraged with the work they've done, and this information will be coming forward.

[Libby Davies, NDP, Vancouver East, BC]

But, Minister, could you—

[Leona Aglukkaq, Conservative, Nunavut, NU]

Of course, in terms of providing the best care for your patients, you need to understand what shortages are coming up. If you don't collaborate and bring the players together who actually produce, dispense, and distribute prescription drugs, how are you ever going to really know, unless you read it in an article? So that's one piece of the information.

[Libby Davies, NDP, Vancouver East, BC]

But, Minister, I'd really like you to answer the question about why the shortages—

[Leona Aglukkaq, Conservative, Nunavut, NU]

I listened to your question, so I can—

[The Chair, Conservative, Joy Smith]

Order.

[Libby Davies, NDP, Vancouver East, BC]

But why will you not say—

[The Chair, Conservative, Joy Smith]

I'm going to ask you—

[Libby Davies, NDP, Vancouver East, BC]

I just want my question addressed.

[The Chair, Conservative, Joy Smith]

I'm going to ask you—if you would just listen for a few minutes, Ms. Davies, I think you would get the answer.

[Libby Davies, NDP, Vancouver East, BC]

Not so far.

[The Chair, Conservative, Joy Smith]

Could you just listen for a few minutes? Thank you.

[Libby Davies, NDP, Vancouver East, BC]

Minister, could you continue?

Could the minister tell us whether she looked at the shortages themselves and why that has not been resolved? Information is one thing, but what about the shortages?

[Leona Aglukkaq, Conservative, Nunavut, NU]

How are you going to be aware that there's a shortage if there's no information?

[Libby Davies, NDP, Vancouver East, BC]

Well, that's what we expect the minister—

[Leona Aglukkaq, Conservative, Nunavut, NU]

In terms of bringing the players together to find out where the supply chain is in terms of production, what's coming off patent, what's going to generic, and all these things, that has to be a coordinated approach. The industry has gotten together for the very first time in this country to address this issue. Over the summer months they initiated this project, and you'll be receiving more information.

If you're on the front line giving out prescriptions and you don't have the information, how can you adequately provide a patient response plan for your patient without it?

The second point I want to raise is that the provinces and territories decide what they will cover for drug shortages through their formulary. Health Canada approves the drugs and then each jurisdiction will make the determination on whether they want that publicly covered or not. That is their responsibility within their jurisdictions.

The other side is that the provinces and territories have collaborated to deal with ways to better manage their pharmaceutical programs, by collective bulk purchases, as an example. Most jurisdictions, with the exception of two, have put in plans to deal with catastrophic drug plans, which was part of the accord, by the way. So there is progress in that work and they'll continue to do that.

In terms of moving forward, a lot of progress has been made since 2002 in this particular area.

Thank you.

[Libby Davies, NDP, Vancouver East, BC]

Madam Minister, are you not concerned that in asking the drug companies themselves about these shortages you're getting a very one-sided view? It seems to many people, including academics and health care professionals, that somehow there is a shortage of generics, which happen to be the cheapest drugs.

I really don't understand your answer in terms of a lack of responsibility to follow through on this question and determine for the public interest why these shortages actually occur.

And could you also answer my other question, which is why hasn't the federal government done anything in terms of its commitment in 2004 for a universal drug coverage plan? We've made no progress on this. This is an issue that has gone into the decades. What is your government intending to do about a universal program?

[The Chair, Conservative, Joy Smith]

I'm sorry, Ms. Davies, your time is up.

We'll now go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I would like to thank the minister for being here, along with her guests.

I want to thank you for your opening remarks and your leadership in this very important work. You've touched on a number of issues today in your opening remarks, and I'm interested in following up on a number of them. However, I only have seven minutes, so I'll try to pick the ones that stood out to me the most.

While you didn't raise this in your opening remarks, my first question is in regard to suicide prevention.

Suicide is a very tragic event that affects far too many Canadian families. I am one of those families, a survivor of suicide in my family 23 years ago. Each year several thousand Canadians lose their lives to suicide. The World Health Organization estimates that in Canada the rate of suicide is 15 people for every 100,000.

In the House of Commons last month we had an important debate on suicide prevention. Could you tell us what our government is doing to address this very important issue?

[The Chair, Conservative, Joy Smith]

Minister, go ahead.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

As I've stated many times, as Minister of Health and someone from the north, I really appreciate the importance...on suicide prevention in the House. I was very pleased that members of the House also rose above partisanship to discuss this very important matter.

I will be meeting with the ministers of health later this week, on Friday, to discuss the many issues around health, including suicide prevention. I want to find out about the programs they currently have in place and to see if there's a better way to coordinate programs across the country on suicide prevention.

It's also very important to note that I will have the discussions with the provinces and the territories while keeping in mind and respecting the fact that the provinces and the territories are ultimately responsible for the delivery of health care. Our role here would be to work with the jurisdictions as well as collect any information that we have.

In terms of our initiatives in Budget 2010, we made significant investments to address the national aboriginal youth suicide prevention strategy and to support community-based projects. The strategy was developed in partnership with the first nations and Inuit, and it was based on statistics and review across the country in that area.

The other thing I will say is that our government has also established, for the first time in Canada, the Mental Health Commission of Canada. That commission is to develop a strategy to prevent and help reduce the number of suicides in our country. The commission will be releasing their recommendations earlier in the year.

For the information of the committee, I've also invited the Mental Health Commission to speak to the provincial health ministers this Friday to give them an update in terms of what will be going forward in the area of mental health that would also support jurisdictions in the area of suicide prevention.

Thank you.