Health Committee on Nov. 20th, 2012

[Glenda Yeates]

I think there will be ongoing challenges.

[The Chair, Conservative, Joy Smith]

Ms. Yeates, I'm sorry, I'm going to have to cut you off.

Ms. Block, you can continue along that vein if Ms. Yeates has something else she has to say, whatever you wish, but you're on now.

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

I'm going to carry on with some of my own questions, Madam Chair.

I did have a question for the minister, but I'm sure that you or any one of the other officials who are here today will be able to answer it as well.

First of all, I should say welcome. It's always good to see you, Ms. Yeates, and it's always good to have the minister here to speak to the estimates and other issues that are at the front of our minds as parliamentarians.

I did want to ask if you could comment on the supplementary estimates (B). One of the items is to maintain the provision of supplementary health benefits to eligible first nations and Inuit. Could you explain the background of the increase of $226.4 million and how this protects front line services?

[Glenda Yeates]

Yes, and thank you very much for this question on the supplementary estimates.

It is a significant sum. The background here is that this is a program for which we have a base budget that this committee would have seen in the main estimates, but in addition, we go through a process of determining the actual amount that it will take for the program. There are no changes in benefit levels, but we determine as we work through our estimations of, again, what new drugs have come on, and what new mechanisms have been put in place to control costs, as the minister mentioned, we refine the estimates.

In this year, for example, we have new clients who are covered with the implementation of the McIvor decision and the new Qalipu recipients, so we have new individuals who are coming on who are eligible for these benefits. As we refine those estimates, we then come back to Parliament as part of supplementary estimates (B) for the additional funds. That's what the $226 million that you see in the supplementary estimates relates to, which is for the main programs. Our biggest components here would be prescription drugs, medical transportation, dental benefits for eligible clients, as well as vision care, and some other smaller portions. This is for clients who are on and off reserve, first nations and Inuit clients.

That's the reason for the supplementary estimates. It's a continuation of the program. All told, when you combine it with the main estimates, it's a program where we would estimate expenditures to be in the $1.1 billion range this year.

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

Thank you. I'd like to ask another question in regard to the supplementary estimates.

I notice that under the Canadian Institutes of Health Research there is an item with respect to funding for patient-oriented research to improve health outcomes through evidence-informed care. I'm very interested in the strategic patient-oriented research initiative that the minister announced in 2011. I'm wondering if you could give us an update on that initiative and how it will have an impact on health care and on health outcomes in Canada.

[Glenda Yeates]

Madam Chair, I think I'll ask my colleague from the Canadian Institutes of Health Research, Mr. James Roberge, to answer the question.

[James Roberge, Chief Financial Officer and Executive Vice-President, Resource Planning and Management Portfolio, Canadian Institutes of Health Research]

Thank you. Dr. Beaudet sends his regrets.

The momentum around SPOR is really building. We are in negotiations with the provinces with regard to the first rollout of what are called support units. These are regional centres that will be established across the country, centres of excellence to find creative ways of integrating health research findings into the health care system for the benefit of Canadians.

We're also in discussions with various partners around the launch of research networks. These are national networks that are thematically based. The first one was with respect to mental health and was announced with the Graham Boeckh Foundation, a $25-million jointly funded research network. We've also launched the network on primary health care and we are in discussions with other partners, as I mentioned.

We're expecting over time to have six to eight of these networks with respect to SPOR.

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

As I have some time left, I'm going to pass on some of my time to my colleague, Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you, Ms. Block.

There's a line item regarding Indian residential school settlements, and it's for $55.9 million. Could you tell the committee about that? Is that just in the supplementary estimates? Is it in the main estimates and the supplementary estimates? What exactly are those dollars for?

[Glenda Yeates]

Again, Madam Chair, I think this is an important and substantial part of Health Canada's supplementary estimates. As was noted, it's $56 million to continue the resolution health support program under the Indian Residential Schools Settlement Agreement.

Under that agreement, as individuals come forward through the process to identify themselves and to go through the support program, we very much understand that individuals and their families, through that process as these meetings are held across the country, need to have the kinds of mental health supports, whether they be access to mental health practitioners or access to elders and cultural supports. Those are very critical because these are very heartfelt and sometimes very challenging times for families, obviously.

[Ben Lobb, Conservative, Huron—Bruce, ON]

What would the total expenditure be on the 2012-13 budget year?

[Glenda Yeates]

This was in the supplementary estimates. Again, this is one of the estimation challenges. We didn't initially know how many people would come forward or in what year they would come forward, so we didn't have a main estimates ongoing budget base for this. Now, there may have been some small amount in the base, and I'd have to check that for the member, but in general, as we understood the demand for the program and the need for our services, that's when we came forward and sought the supplementary estimates here.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's fair enough.

You touched on mental health as one of the line items. Can you list some of the other line items that would go towards that nearly $60 million?

[Glenda Yeates]

Yes, and there was about $8.8 million remaining in our base budget, to which this $56.7 million is added. That's a total of $65.6 million for the IRS resolution health support programs in 2012-13.

Again, we have people who attend at the sessions and provide support to people. Individuals choose different kinds of supports, depending on what they or their families might need.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates. I'm sorry, we're way over time.

When you're answering questions could you please try to keep your eye on the Chair, because I try not to go over too far. Thank you.

Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

There are a couple of things I want to have clarified.

On the whole idea of public health, the minister said that the role of the Public Health Agency was to protect Canadians. Can you tell me, therefore, what is happening with regard to trans fats and salt content in food, which we know adversely affect the health of Canadians?

The minister said this would be regulated by the industry, that it would be self-regulatory. She hasn't made any regulations of her own. Surely it is a job of the Public Health Agency of Canada to regulate these things when evidence shows very clearly that high levels of trans fats in foods and high levels of salt are contributing to the mortality of Canadians.

[Glenda Yeates]

Madam Chair, I'll try to keep my eyes on the right spot. I very much appreciate the question.

It is Health Canada's responsibility to regulate food. We have a substantial regulatory role there. Internationally, all countries are understanding and trying to find ways, as was mentioned by the honourable member, to reduce our intake of sodium and sugars and trans fats. We do this in a number of ways.

In some ways, it's partly the mechanism or the most effective way that is perhaps the source of some of the discussion. We provide consumer information. We've been working with some partners in the provinces and territories and with some of the industry partners to try to make sure that consumers have an awareness and can build an understanding of how to make healthy choices.

We also have seen—

[Hedy Fry, Liberal, Vancouver Centre, BC]

Ms. Yeates, excuse me. I asked a specific question and I don't have a lot of time, so I'd like to get a specific answer. It was about actually regulating.

It was agreed in 2007 by the Minister of Health that there would be self-regulation and that it would be a trial process. It is my understanding that the Department of Health and the advisory committee on salt and trans fats has said it didn't work.

It's now five years later. The mandatory regulation must occur. I'm asking specifically about mandatory regulation, not about anything else, awareness, etc., but about mandatory regulation.

[Glenda Yeates]

I would say that governments have been very clear that a variety of voluntary approaches have been used, including guidance to industry setting benchmarks. We've released guidance benchmark levels. What we're seeing, for example, is that in a number of food categories, sodium levels are now down by about 10%. We are a third of the way to where we wanted to be by 2016.

The approach has always been to understand how and whether these mechanisms and tools we're using are working, and we have seen significant progress.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you, Ms. Yeates.

I want to ask you one question, and it is specifically with regard to access to drugs. By access I mean the ability for Canadians, when they're chronically ill or terminally ill, to afford outside of a hospital setting the drugs they need to keep them healthy.

The 2004 health accord clearly talked about not only bulk buying, but also about working to “develop, assess and cost options for catastrophic pharmaceutical coverage”—I think that was one of the first things—and “establish a common national drug formulary for participating jurisdictions based on safety and cost effectiveness” and to “strengthen evaluation of real-world drug safety and effectiveness”.

None of this has happened. It was supposed to have been done. It was agreed upon. The minister said she was at the table and nobody agreed. It was agreed. It was signed in the accord that these things would happen and to report back by March 2006.

Can you give me some reason why this never occurred, especially when money had been put in specifically for it to happen?

[Glenda Yeates]

The question again of access to prescription drugs is a critical one and one which concerns many of us. The honourable member cited some of the aspects, such as a common formulary, and I mentioned the common drug review. In fact that was the response to having a common formulary. We have had a common drug review. In fact, we see many of those decisions being taken up in a common way across provinces.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Ms. Yeates, excuse me—

[Glenda Yeates]

We see the strength—

[Hedy Fry, Liberal, Vancouver Centre, BC]

Ms. Yeates, excuse me. I have to focus. I'm sorry if I'm cutting your off; I don't mean to be rude. What about the piece that I read out that says, “develop, assess and cost options for catastrophic pharmaceutical coverage”? That specifically was never done. Why not?

[Glenda Yeates]

There was a great deal of work done at that time between the provinces and territories in the federal government. A great deal of policy work was done.