Evidence of meeting #8 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was dementia.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Eleanor White  President, Canadian Chiropractic Association
  • John Haggie  President, Canadian Medical Association
  • Barb Mildon  President-elect, Canadian Nurses Association
  • Frank Molnar  Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society
  • Maura Ricketts  Director, Office of Public Health, Canadian Medical Association
  • Don Wildfong  Nurse Advisor, Policy and Leadership, Canadian Nurses Association

4:10 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

There's an army of senior volunteers out there. Do we have tax credits for volunteers? I don't know. Certainly that's something. Can you find a way to engage that army of senior volunteers to help in the health care system? You're already giving some tax credits to people who are caregiving, but we have to look at how much support we can give to caregivers. Are they still allowed to contribute to CPP while they're doing the caregiving role?

If someone has multiple chronic diseases and a family member is not taking time to care for them, they will end up in hospital. That is almost guaranteed. So as other people have said, you really have to look at caregiver support. We've talked about tax incentives, but that doesn't really help low-income seniors. Think about other incentives that could bring low-income seniors into the volunteer pool.

We've talked about mobility and falls, and those are other huge issues. We really need to look at exercise programs that prevent de-conditioning. There's a lot of literature out there on programs that prevent de-conditioning and falls. Then we have to look at incentives to bring seniors into those programs. We can't just build them; we have to entice people to come in.

The bottom line for us is that the weak link in the health care system is really community care. I agree 100% that we have to look at health promotion and prevention measures. However, we have to recognize that people eventually become ill, and then we need to have a community care system that is strong enough and integrated enough to keep them out of hospital. Right now we don't. We have a bunch of community care silos that compete for money. They do not cooperate or collaborate, and they have no accountability. There is really no connection between community care and acute care. So we have to look at the system itself. If you do research, it will have to look at the entire system design.

Thank you.

4:10 p.m.

Conservative

The Chair Joy Smith

Thank you, Dr. Molnar. We appreciate so much all your insightful comments.

We'll now go to questions and answers, and we'll have seven minutes per person.

We'll start with Madam Quach.

October 17th, 2011 / 4:10 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Good afternoon. I would like to thank everyone for providing us with very relevant information. I have a number of questions. I will start with my questions for the Canadian Chiropractic Association.

You are saying that we must focus on preventive care to help people be in better shape and healthier. Do you have an estimate of how many more chiropractors would be needed to cater to the aging population and provide more appropriate care?

Can I ask all of my questions?

4:10 p.m.

Conservative

The Chair Joy Smith

No. Perhaps we'll take that one first.

Who would like to take that question?

Ms. Mildon.

4:10 p.m.

President-elect, Canadian Nurses Association

Barb Mildon

My apologies. I am so sorry. I didn't have my interpretation working properly and didn't understand the question.

4:10 p.m.

Conservative

The Chair Joy Smith

Could you repeat the question, Ms. Quach, please?

4:10 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

My question is for the Canadian Chiropractic Association.

You were talking about preventive measures and about implementing education and care programs. Is there an estimate of how many more chiropractors should be in the system to provide more effective care to people in order to prevent chronic disease?

4:15 p.m.

Conservative

The Chair Joy Smith

Dr. White, would you like to try that?

4:15 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

I'd like to start with an appreciation of the question. You finished your question with how could we prevent chronic disease. I'd like to first make clear that as one of the primary care practices, it would always be a collaborative approach.

We've all spoken to essentially the same topics. The common points have been collaboration; having a medical home, or a health home; integrated services and research; and primary care reform. So taking those points into account and answering your question, I would suggest that we don't perhaps need any further numbers of chiropractors to assist in the job. What we need is better access to the patients and them to us.

We also need to disseminate information in a manner that is much more imaginative. For every practitioner who is successful in his or her office, whether it is medical, psychiatric, chiropractic.... For nurse practitioners, the problem is time management. To educate patients on what they may need to know is no longer always possible to do, need to need. Often you can. Often extra time is set up. But we have to be much more imaginative in how we deliver material.

First, I would think, is that material is consistent, not only within a profession but inter- and intra-professional. Second, the use of social media, of having things on our websites, of having things on Facebook, is very appropriate.

I'd like to suggest another small program that might be of use, particularly to a federal audience. All our patients now come to us with what they have read on the Internet: I have such and such a condition. I have read this. Is it of use? I'm aging. I have a husband with such and such, or a mother. How do I deal with this? So they're researching information.

The federal health minister has brought the importance of clinical guidelines to mind, and so have the provincial premiers. Those guidelines are currently geared toward practitioners finding treatment for chronic disease as one of many things. Perhaps what the federal government could do very well is take those clinical guidelines and turn them on their sides and find an adjudicated, authorized manner of taking the successful approaches to treating a disease and make that accessible to people for self-care.

If you have diabetes and you look online to see what you can do, instead of finding some sort of approach that you wonder about in terms of validity or usefulness or safety, have an authorized report so that when you look at diabetes you would see this is what the following practitioners all do--they have been shown, through the research, to be effective to the following degree, particularly when done in conjunction with so and so's approach.

We know that all our patients are doing a lot of self-care. I think we have a role. If we all do our clinical guidelines properly, and compare them and find common points on the side instead of silos, we could serve in a capacity that way as well as our treatment and education of patients in the office.

4:15 p.m.

Conservative

The Chair Joy Smith

Thank you, Ms. Quach.

You have a minute and a half for your next question and answer.

4:15 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

My next question is also for the representatives from the Canadian Chiropractic Association.

You talked about progressive public education programs. What exactly do you mean by that? Could you give us examples to get a better idea, please?

4:15 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

I mentioned three. We have more, but one program that has been very successful has been the falls prevention program. This was developed in conjunction with Canadian Public Health. This is a program on CD and on paper, which is presented by chiropractors to long-term-care facilities, to retirement facilities, or in office, and it is made available through the website to younger, more fit individuals who could take advantage of the material. Again, having that accessibility in a more modern approach is one way to attack it.

Another way is to have in-office groups and speakers. But really, this should be done on a multidisciplinary basis. That is where it is most effective. Again, chiropractors are not accessed through the community care portal, and they could be very well.

4:20 p.m.

Conservative

The Chair Joy Smith

Thank you, Ms. White.

Dr. Carrie.

4:20 p.m.

Conservative

Colin Carrie Oshawa, ON

Thank you very much, Madam Chair.

First of all, I want to thank all the witnesses for being here today for this very important study. One of our earlier witnesses said that the impact in Canada is $190 billion per year. The fact that we are getting this input at this time is very timely.

I would like to talk to the chiropractors, too, seeing as you are here. First, I want to congratulate you. You had a really good write-up in Consumer Reports recently on the profession. I have a couple of questions specifically, if you could answer. One, could you provide us with an example of how chiropractic could be involved with both the prevention and treatment of chronic disease? Also, we hear a lot about collaborative care. There are some good examples out there, and I was wondering if you could give us good examples of that and also some of the hurdles you see.

4:20 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

If I may draw from personal practice, I will be brief with this. I will give you an example of a 65-year-old woman who came into my office about two years ago with general bone pain. She was also diabetic. She hadn't had a bone density test in almost ten years. We phoned up the physician. She had been lax with her medical care. We got her in, and sure enough we found greatly advanced osteoporosis.

That obviously affects the manner in which one is treated. We got her referred to a good exercise practitioner who could help her develop a safe program and a nutritionist who could help her with a program for bone health.

Down the road, however, she mentioned her granddaughter, who was about 15 at the time and who was having headaches at around eleven most mornings. She brought her granddaughter in, and her granddaughter was moderately obese and was a single child of a single parent. She tended to not eat her breakfast. Of course, by eleven in the morning she was hypoglycemic and would go out and have pop. She drank a lot of pop, maybe five or six cans a day, as an awful lot of kids do. Pop has phosphoric acid, which leaches calcium out of bones. Here you have a child with the red flags in her family of diabetes and osteoporosis. You have a diet low in dairy, high in phosphoric acid, along with lack of activity in the young girl, and she is pre-diabetic and will probably be a candidate for osteoporosis down the road, if not other conditions.

That is a good example of how primary care practitioners—and in particular, chiropractors for musculoskeletal things—will take a look and ask where they can collaborate with other professions and how they can get this person well looked after.

Good access to laboratory and imaging material is essential to all primary care practitioners. That is one hurdle we have. It varies from province to province. These situations allow for education of a patient as well as early intervention and prevention. It allows us to increase activity. It allows for consultation with other practitioners. Again, the message has to be ubiquitous and universal. All practitioners need to be speaking the same way.

You mentioned barriers. Barriers for us are often differences between provincial jurisdictions. Having now worked federally, I see how different it is from province to province for not only coverage of care, but also the access to lab and imaging materials. An easy consultation and referral base with medics in the community is on the whole so much better than it used to be, but still there are some barriers. We've implemented a huge amount of effort into research in the last ten years, and that is helping greatly. But we need more, and we need more interdisciplinary research. Those would be some of the highlights.