Veterans Affairs Committee on April 26th, 2007

[Dr. Victor Marshall]

Will do. Thank you.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Now over to Mr. Sweet with the Conservative Party for five minutes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you very much.

Dr. Marshall, I want to echo what has already been said. It has been one year, with volunteers, and the robustness of this report is excellent. Thank you very much.

I have also had the experience of having a father who served in the military during the Second World War. He came to live with us, when he was 71 years old, with a cane, with glasses, and hardly able to go up and down stairs. He has now moved out. He goes up and down stairs with vigour. He does not wear glasses—he got laser surgery for his eyes—he threw the cane down, and now he coordinates a walking program at a shopping mall, and frankly, he can probably outrun me.

[Dr. Victor Marshall]

That's outstanding.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Yes. So of course I was listening with fascination about the health promotion programs. I want to ask you about that, but I also want to agree with you that I think one of the things the departments have to do is step back and look at aggregate costs.

You mentioned two provinces in your report. Could you tell me what those two provinces are that do not pay for veterans' long-term care?

[Dr. Victor Marshall]

I can tell you one of them off the top of my head, and that's Nova Scotia. I just cannot remember what the other one is. I am sorry. I could find that out for you if you like.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, Doctor.

There is one thing I wanted to ask you, because I did not want to assume what you meant by health promotion programs. I am looking at the screening tool you have. It is quite simplistic, the one you have on page 35. Do you feel that those are deep enough questions to solicit enough answers to really find out how you can intervene with services?

[Dr. Victor Marshall]

No. That's why we have this committee. I think what we've come up with is going to be part of a screening tool. There actually will be more than one screening tool. But the PRISMA-7 screening tool that is used, on page 35, which is from one of these projects in Quebec, is the kind of thing that, literally, someone with five minutes of training could actually administer if someone called in to Veterans Affairs Canada. Right? But there will have to be other components.

That is why this committee will be meeting on that. Then there will be more. You get screened to one level, and then at that level you might be screened more intensively. So we have to come up with the right package of screening tools. The department already has several different screening tools it uses for people to help tailor services to their needs. We are looking at all of those, but we are also looking at other tools.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, doctor.

There have been a couple of questions about younger veterans. I appreciate that the scope of your research was for older veterans.

With the different consciousness of physical fitness we have now in this generation, do you think there is a higher level of awareness of continuing and good practices of health promotion among this new generation of veterans?

[Dr. Victor Marshall]

You know, I would like to think that there is. This may be wishful thinking. I have been in the health promotion field since I came to the University of Toronto, I guess. We had, actually, the first health promotion master's program in the country. This was back in 1978.

I really would like to believe, and the data would show it, that there is increasing participation in physical activities by younger people and that it is extending somewhat in the later years. But the data are not that strong yet.

As you know, fitness is one thing. Related to fitness, but also related to nutrition, we have an epidemic of obesity going on. I really notice it in the U.S., where it is worse, but I've seen the data for Canada, as well.

So I think it is getting marginally better in the fitness area. It is not getting better in the nutrition area, and we have a long way to go.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay. At least we know there will be a lot less transfat, anyway, over a lifetime.

[Dr. Victor Marshall]

That's true.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

I began by telling you that I wanted to ask you about health promotion programs. Am I visualizing your description the right way? You're suggesting that you would have a counsellor at Veterans Affairs who would be able to hook you into health services, dietary counselling, gyms, pools, and that kind of thing. Is that what you mean by health promotion programs? Could you just expand on that, please?

[Dr. Victor Marshall]

That is basically correct. I don't know how much you've been able to pick up on this ecological model that we have in the report, but it's also possible that, for example, at the local area offices of Veterans Affairs, additional steps could be taken to enhance, let's say, physical fitness, at a community level. So you could have people from Veterans Affairs taking some leadership in motivating communities to increase the conditions that make it possible for people to walk more.

There are programs like this that work at that level, at the community level. For example, you do walking surveys. You assess sidewalks for accessibility. Are people going to stumble over them or are they good for walking? Are there curb cuts and things like that? Then you work with town councils, for example, to improve those conditions and make sure that people have safe places to walk, adequate lighting at night, and things like that.

So it could be at that level as well, but basically, it would be a referral process but a referral that is knowledge-based. Again, you're not going to refer to just any program. You're going to refer to a program that is known to be efficacious.

[The Chair, Conservative, Rob Anders]

Thank you.

We'll now go over to Mr. Shipley for five minutes with the Conservative Party.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I'm going to turn it over to Mrs. Hinton.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

I have a couple of questions.

This has been a most interesting discussion today. Even though you're not physically here, it feels as though you are.

[Dr. Victor Marshall]

Thank you. I wish I could be there.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

This is not, by the way, a new committee, but it's the first time we've ever been a stand-alone committee, so maybe we have a little bit to learn here.

I have had an opportunity to read your report. I just haven't read it thoroughly. It's like reading Coles Notes on a book. But I assure you, I am going to go home and read this from cover to cover now. It has been very enlightening. You've also reinforced, for me, anyway, the need for this committee to move forward with the health care review. The dragging out that was referred to has sort of been caused by some who have an interest in different parts of health care and are going off in a different direction.

In order for us to actually have some serious input as a committee, I think I hear you saying it's time for us to move forward, that you want us to get moving on this so that we can actually make a difference for veterans. Is that an accurate assumption?

[Dr. Victor Marshall]

Absolutely it is. As I said, you'll find the veterans groups big allies in this, including this report. They've read it, they know it, and they support it.

We really do have this sense of urgency. In fact, I really regret that I didn't move the council forward to produce this report ten years ago instead of waiting as long as we did.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Don't feel badly at all. You've done a fantastic job, and as my colleague said earlier, the fact that you're all volunteers speaks volumes about the way you feel about people and how you care.

You're in the United States practising at the moment, you said.

[Dr. Victor Marshall]

Well, I'm not a medical doctor. I have a PhD in sociology. But yes, I direct the Institute on Aging here at the University of North Carolina, where we're part of a national health promotion network that focuses on evidence-based practice in health care.

[Betty Hinton, Conservative, Kamloops—Thompson—Cariboo, BC]

Right.

Because you are in the United States, and I know they have some different views of health care from those we embrace wholeheartedly here in Canada at this point in time, I'm wondering if you see any benefit, when we do get involved in this health care review in a serious way, to us bringing in practitioners such as naturopathic physicians whose practices are basically preventative, versus allopathic physicians who do more care after the fact?

When you talked about preventative medicine, what kind of people would you like to see us talk to?

[Dr. Victor Marshall]

A lot of it can just be done by people who don't actually have training in one of the traditional or complementary health professions such as those you mentioned. Public health people are being trained in this area in departments of public health, in Canada as well as here.

There's a new name for it now. It used to be called “complementary medicine”, but it's more “partnership medicine” now. I can't remember the buzzword, but increasingly there is evidence that it's beneficial for people in the traditional areas, such as allopathic medicine and nursing and physical therapy, let's say, to be working in a broader context, in partnership with people from chiropractic and naturopathy, and things like that.

So, sure, I think that's the wave of the future.