House of Commons Hansard #255 of the 35th Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was health.

Topics

Department Of Health Act
Government Orders

12:20 p.m.

Liberal

Brenda Chamberlain Guelph—Wellington, ON

Mr. Speaker, I am pleased about the three points my hon. colleague brought up. People in the north not being able to access services as quickly is an important factor. We have to always be vigilant on that in our decision making. We should not look only at the cities or the large centres, which is convenient and easier. We must always be thinking about our constituents in the far north or the far south, wherever that may be.

The issue of waiting lists is also an absolutely valid point. Wherever we can we have to be constantly monitoring, constantly rechecking, constantly evaluating. What can we do better? I support the hon. member in bringing up these things because only through evaluating what we do now can we get better.

Regarding services in every hospital, I do not know that every service has to be available in every hospital. There are centres with several hospitals. From an economical point of view we may have to look at certain services in one hospital and others located in a hospital five kilometres away, perhaps heart and kidney machines or whatever.

I am in full concurrence with the three points the member brought up. Again I call on every member in the Chamber to keep looking at the points my colleague brought up. How do we make it better? How do we improve our health care? How do we save lives? How do we make a better quality of life in Canada?

We will do that not simply by feeding money into the system but by priorizing and by being very careful to hone our knowledge, to talk to other countries, doctors, nurses and caregivers who can tell us what we should be doing.

We have to make a call to all members that we need universal health care. We cannot start to erode this. I firmly believe in this principle.

Department Of Health Act
Government Orders

12:25 p.m.

Bloc

Francine Lalonde Mercier, QC

Mr. Speaker, beyond the nice rhetoric on Canada's health care system, the real purpose of this bill is to confirm and expand the self-proclaimed federal mandate in the health sector, a sector which clearly falls under provincial jurisdiction and which is clearly Quebec's responsibility.

I want to draw your attention to the amendments, the additions to that act. Paragraph 4(2)( a ) reads:

(2) Without restricting the generality of subsection (1), the Minister's powers, duties and functions relating to health include the following matters: a ) the promotion and preservation of the physical, mental and social well-being of the people of Canada;

Paragraph 4(2)( b ), which was not there before, reads: b ) the protection of the people of Canada against risks to health and the spreading of diseases;

We are talking about an expanded mandate regarding prevention. Incidentally, the former act included a section on the protection of the social well-being. That provision is no longer there. It has probably become a responsibility of the Minister for Human Resources Development, who will call it something else.

There is a federal will to take over the provinces' responsibilities-I will refer to Quebec throughout my speech; the other provinces can use a different approach if they wish-in fields which not only clearly fall under provincial jurisdiction-we will not discuss jurisdiction for the sake of jurisdiction-but in which only Quebec can work efficiently, because Quebec alone can implement an integrated policy.

As for amendment (b)

b) the protection of the people of Canada against risks and the spreading of diseases;

I find that this is evidence of incredible gall on the part of the government after the disaster-the word is not even strong enough-the horror of the tainted blood problem. There was a hue and a cry in that connection to identify those who were to blame for the tainted blood, and everybody seemed to be responsible except the department. And now this is the responsibility we want to broaden here to include risks to health.

Risks to health are so closely linked to general conditions of poverty, sanitation, access to healthy accommodation, education, life, organization of life that one wonders how, in what appears otherwise to be merely a technical bill, the department's mandate could be made that broad.

Either there is a need felt in the federal government, in Canada, to assign itself responsibilities it is not able to meet because they affect people, or there is an inability to admit that the exercise of those responsibilities falling strictly within federal jurisdiction has been a lamentable failure. And I am not referring only to the budget. I could also address transportation policies, communications policies, even, recently, international policies with the disgraceful events surrounding the visit of the Chinese Premier.

It is, nevertheless, dangerous to lead citizens to believe that one is responsible for preventing risks to health when, in reality, one does not and cannot have the means to do so. To really have the means would require taking over the provinces' place. So, far from putting an end to duplication and overlap, the bill is typical of the inefficiency that exists in areas where there is the most crying need at this time, when resources are increasingly scarce.

In reality, it is far more important to ask who is responsible than to ask who is competent, for this reaches people more directly. When talk is of competency, in reality the term that ought to be used is responsibility.

Quebec is the one with responsibility, but not with the means because, as the Minister of Health has pointed out, since 1982-83, eight billion dollars have been cut from health alone, money which represented firm commitments to supposedly allow establishment of the health and social services system in Quebec at a time when-not because money was any more plentiful in Ottawa than in Quebec-there was an extraordinary central concentration of tax dollars. The original reason for this had been financing the Second World War, and that concentration suited to a T all of the senior public servants and politicians who had worked to get decisions on economic and social policies centred in Ottawa, with the provinces only as subcontractors.

This policy was rejected unanimously in Quebec, by all parties. The money that was collected and is still being collected, something which Duplessis, yes Duplessis, tried to get around when he decided Quebec would have its own tax collection system, the federal government used this money so it could determine the direction, development and control of economic and social policies, instead of the Government of Quebec.

This bill confirms clearly and unreservedly the government's policy of overlap and duplication and the irresponsibility we saw in the tainted blood scandal, for instance.

The federal government takes credit for introducing the health care system, as though it would never have happened otherwise. I will not get into the history of this policy which, although its origins go back to Saskatchewan, became a Canadian policy. A respected author on the subject, Thomas Duperré, said in 1987

before the commission of inquiry on health and social services in Quebec that establishing federal programs merely shifted to the federal level a debate that had already started at the provincial level and would have led to the same results over the same period of time, give or take a few months or a few years.

Quebec Health Minister Jean Rochon is, as everyone knows, an expert on these issues. He was involved in the work of the Castonguay-Neveu Commission and later chaired the commission that started its sittings in 1985 and developed the policies of both the previous and present government. So this is not a partisan position, anything but. According to Mr. Rochon, the Canadian health system is a myth. The truth is, we had developed a health and social services system, despite the fact that the federal government centralized its control over resources while ignoring exclusive provincial jurisdiction in this area as conferred under the constitution of the Canadian confederation.

The minister went on to quote the Quebec Minister of Social Affairs and Welfare René Lévesque. At the federal-provincial conference on poverty in 1965, Lévesque, federalist minister in a Liberal government in Quebec, said that it had become imperative to establish a genuine economic and social policy. This policy should be integrated, flexible in its mechanisms and include a social security system centred on the family and based on the right to assistance on the basis of need.

The same sentence, with few changes, could be used to express the same urgency voiced by sovereignists quite recently.Mr. Lévesque went on to say that for the sake of efficiency and on constitutional grounds, the Quebec government alone could and should, within its own territory, design and implement such a policy. Quebec could not let the Government of Canada assume this responsibility. Quebec did not, however, exclude interprovincial co-operation and mutual consultation.

He also said that the social and economic development policy they had formulated would create an integrated social policy, regional development policy, manpower policy, health policy, housing policy and job training policy.

Fourth, the federalist minister said that the general policy, while he did not necessarily condemn it, did not necessarily correspond, in terms of its spirit and terms of application, to one the Government of Canada might opt for. The people of Quebec would enjoy at least as many if not more benefits than other Canadians might.

The central government's repeated interference, expanding into preventive medicine, is an affront to the intelligence of the history of the past 30 years. It is compromising, in a way-and here I am talking of Canada outside Quebec-and it compromises, it seems to me, a now necessary reorganization. Instead of decentralizing, the federal government is busy reaffirming ever more resoundingly its responsibility for all areas of economic and social development. Through cuts and the transfer of the deficit, it is, moreover, usurping the ability of the poorest provinces, at least, to replace them.

This is a historic moment in the history of Quebec and of Canada. It is not without some emotion that we view these bills-we will be debating Bill C-96 this afternoon or tomorrow and the human resources investment fund and unemployment in the days and weeks to come-that we note that the thinking behind all these bills is one of increasing centralization.

It is an approach, as the Canada social transfer demonstrated in the budget, whereby the only thing transferred to Quebec is the deficit. We are moved by the fact of having to say that the central government wants to take over protecting the public against health risks, when we know the extent to which poverty affects health significantly. We know that centralized and centralizing policies are not going to provide us in Quebec with the tools we need to fight unemployment, poverty and with poor health at the more disadvantaged levels of society.

We will continue to express the thoughts of the large majority of our fellow Quebecers. Even those who voted no, know that, through their municipal governments, their social groups and their Government of Quebec, closest to them, and the most effective integrator, they will not get to heaven, but at least they will have the assurance that every effort was made to provide equality for all in Quebec.

Department Of Health Act
Government Orders

12:45 p.m.

Liberal

Alex Shepherd Durham, ON

Mr. Speaker, I listened intently to the comments of the member for Mercier, as I always do. I am always very interested in her deep understanding of social issues.

As I listened to her speech, it ran across my mind what she was talking about were communicable diseases. I wondered whether she thought diseases like AIDS or other diseases knew national boundaries. Are specific diseases that could possibly occur in Quebec unique to the borders or indigenous to the borders of Quebec, or are they diseases that can occur throughout the country and indeed throughout the world?

When we are talking about research in diseases and communicable diseases it seems to me that as a country we need to consolidate our work in these areas to try to find solutions rather than be fragmented and have separate research areas throughout the country.

Next is the whole aspect of governments being closer to the people. We have talked a lot in the House about the issue. I have often wondered if it is psychological talk. We look at a map and we see Ottawa and we see Quebec City. However, what does it mean to someone in Chicoutimi, Arvida or other places in Quebec to get government services closer to the people?

I know in my province, for instance in the area of education, we say that it should be close to the people. The reality is our education system is run out of Toronto. It is not any closer to the people than if it were in Ottawa. I suspect this is true in Quebec as well. The actual government getting into the lives of people on the streets of those communities is not any more well developed from Quebec City than it is from Ottawa.

An issue that really concerns me about Quebec and its economy is the over-preponderance of provincial debt in that province. Also there is the preponderance of the province of Quebec to borrow, incidentally outside its borders. Some 54 per cent of Quebec's debt is funded outside Canada with foreigners. The referendum actually required the Government of Quebec to borrow $35 million from foreigners to ask its people if they wanted to be an independent country. It seems a little absurd, quite frankly.

Could the member address some of these issues but mainly the whole issue about how we are to get government closer to the people? The federal government, for instance, pays old pension cheques and the Canada pension plan. It deals directly with people. The Canadian employment services are right in our communities. They are the federal government but they are not in Ottawa. They are right in our communities and are dealing with community problems. I ask her whether some of this stuff is psychological.

Department Of Health Act
Government Orders

12:45 p.m.

The Deputy Speaker

The hon. member for Mercier will have as much time to answer as her colleague had to put his question.

Department Of Health Act
Government Orders

12:45 p.m.

Bloc

Francine Lalonde Mercier, QC

I have more time, Mr. Speaker? I will be brief, because the hon. member took a lot up of time asking his question.

Department Of Health Act
Government Orders

12:45 p.m.

The Deputy Speaker

I said that the hon. member would have as much time as the member who asked the question.

Department Of Health Act
Government Orders

12:50 p.m.

Bloc

Francine Lalonde Mercier, QC

Mr. Speaker, I mentioned health risks, and AIDS is not the only one. But for the sake of example, let us take the tainted blood issue. Do you think that it was any comfort to Quebecers to know that the so-called responsibility was being assumed nationally? It is important to know.

Second, our hon. colleague seems to be telling us that, in Canada in general, people may feel it is quite normal for the central government to try to be the one that is the closest to the people. But in Quebec, it is not so. René Lévesque himself said: "We have nothing to prove". We are a people and a nation, and we know that without one being necessarily better than the other, social, economic, cultural and political organization varies from one nation to another. That is what we are asking for with regard to health as well, and if I say so, it is because I know that I am speaking on behalf of the vast majority of Quebecers.

As for the debt, we think that when the debt is high, it is essential that we be the ones to make the choices, as hard as they may be, and also that we concentrate our resources in areas where a structuring effect can be expected, which is not the case at present in the federal system. Employment centers are indeed a case in point. We have been fighting unanimously for years with ineffective weapons in Quebec to get back control over manpower training, because we know that manpower training is an essential economic development tool.

Department Of Health Act
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12:50 p.m.

Liberal

Alex Shepherd Durham, ON

Mr. Speaker, I should like to ask the hon. member a question about education in the province of Quebec, an area that has always interested me.

Education, as the hon. member knows, is exclusively a provincial jurisdiction. Over the years Quebec has had complete control of it. If it was so important and useful in such a supreme system to have exclusive jurisdiction in this area and if it was better for the people, why is the dropout rate in Quebec one of the highest in Canada?

Department Of Health Act
Government Orders

12:50 p.m.

Bloc

Francine Lalonde Mercier, QC

Mr. Speaker, this is an excellent question, and I am convinced that the drop out rate is a reflection of our whole social organization. The drop out rate has something to do with poverty. It has something to do with the lack of hope within Quebec and, if you must know, many people are sovereignists like me and will continue to pursue sovereignty because they are convinced that this is the only way to give people hope and make them drop back in.

While there are technical means to bring young people back to school, we know that those who drop out do not do so because their teachers are boring. We know what makes them drop out. We know that an underprivileged youngster is much more likely to drop out.

Department Of Health Act
Government Orders

12:50 p.m.

Liberal

Judy Bethel Edmonton East, AB

Mr. Speaker, as I rise to speak in support of Bill C-95, an act to fix the name of the Department of Health, I am inclined to ask how many hon. members know that above all it is a department that puts its money where the greatest need is no matter where in the country.

Counting all Canadians from coast to coast to coast the greatest health needs are found among the First Nations. For native peoples life expectancy is seven years lower than the Canadian average. Newborn die four times as often. Substance abuse is prevalent. Sickness is more pervasive. Children are most at risk for malnutrition. For these reasons two out of every three dollars spent by the Department of Health excluding transfers to provinces go to enhance native health. More than 2,000 employees of the depart-

ment are in the direct care business, mostly dedicated to helping Indians on lands reserved for Indians.

At a time when most government programs are being cut back, the Minister of Health prevailed to secure additional funds for native health in the recent budget. The government remains committed to mending the inequities that have persisted far too long.

The growth in expenditure will gradually taper down but lead time has been provided for native leaders in consultation with the department to explore alternate approaches to achieving the same levels of quality care that other Canadians have come to expect as their right. It is an essential part of Health Canada's mandate to help First Nations achieve the highest possible standards of health care. The department is expanding some programs and introducing others.

Health Canada's building healthy communities strategy is funded by $243 million over five years to strengthen and expand existing health programs for native people in areas of critical need, including solvent abuse, mental health and home care nursing. The strategy is designed in consultation with First Nations and Inuit leaders.

Last May the minister announced supplementary funding under the solvent abuse program for six new permanent treatment centres to deal with solvent abuse among First Nations and Inuit people. The centres are located in northern B.C., Saskatchewan, Manitoba, Ontario, southern Ontario and Quebec.

Last May the minister also announced the aboriginal head start aimed at helping disadvantaged children overcome some of poverty's life-drag effects. As it evolves it will provide more and more children with a positive self-image, a desire for learning, and an opportunity to develop social, emotional, physical and learning skills.

Aboriginal people have told us there is a need for programs for young children and families that reflect the culture and experience of their communities. Together with Canada's aboriginal community we have embarked on a mission that will support the need. All Canadians can be proud of the program because its design was developed with input from aboriginal people in both urban and northern communities across the country.

Aboriginal head start represents a made in Canada approach that can begin to address the unique needs of First Nations, Metis and Inuit preschool children and their families. There is ample evidence of the health and educational differences that exist between the Indian, Inuit and Metis people when compared with other Canadians. We know that by working together we can better deal with these problems.

Over half Canada's aboriginal population does not live on reserves and this population is very young. While 7 per cent of Canada's total population is under four years of age, 13 per cent of the aboriginal population is under four, nearly twice as high. Studies of head start programs have proven that investing in young children is one of the best investments society can make. Head start programs for young children can have a profound and positive effect on their lives.

The elders tell us that every child has his or her own gift and that it is the responsibility of the community to identify that gift, nurture it and ensure that each child is aware of how special she or he is and that she or he is a gift from the creator. This traditional belief is a natural starting point for a healthy beginning in life. Aboriginal head start is similar to a community based early intervention program developed in the United States more than 30 years ago. Those who are familiar with the head start program will be pleased to know that while we will build on their many successes we hope to improve on what they have done.

An important recommendation from our talks with aboriginal people was to make the program flexible. Doing so allows the uniqueness of the First Nations, Metis and Inuit communities to be respected. Aboriginal head start is not complicated and it will have little red tape. It focuses on local non-profit organizations controlled and administered by aboriginal people who see the parent as the natural advocate of the child. Grandparents and elders play a significant role in aboriginal head start projects. Young aboriginal children will benefit from their wisdom and knowledge of tradition. All aboriginal head start projects will have strong parental involvement.

Aboriginal head start will be guided in each region by a committee comprised of aboriginal people who have been nominated by their peers and bring with them an appreciation and understanding of aboriginal cultures, values, traditions, experience and educational expertise. They will assist in identifying priority sites and selecting projects.

As well, a national aboriginal head start committee is being established to ensure the initiative has support and strength across Canada. Its members will be chosen because they have a broad understanding of early childhood development.

It is clear to the federal government that programs for aboriginal people, designed and delivered by it, are more successful than those delivered by outside agencies. I have no doubt that aborigi-

nal head start committees and local head start projects will succeed.

We have placed our investment and trust at the community level because we believe one of the ultimate goals of this initiative is to help parents and children build better futures for themselves. The Government of Canada will continue to work in strong partnership with Indian, Inuit, and Metis people in fulfilling the commitments made in the red book. Through the aboriginal head start program we are continuing to promote community action and empower communities by providing the tools and resources to improve overall economic and social opportunities for children and families.

Although it was inspired by a community based program of early intervention and had its start in the U.S. more than 30 years ago, this head start program is much improved, based on substantial input from aboriginal people in urban and northern communities.

Aboriginal head start will be flexible, respecting the unique characteristics of First Nations, Metis, and Inuit people. Grandparents, elders, and parents will play significant roles and the program will be guided in each region by a committee of aboriginal people nominated by their community.

Head start programs for young children have profoundly positive long term effects. Their impact on aboriginal communities will be even greater elsewhere because in these communities there are nearly twice as many children under the age of four, nearly twice as many in proportion to their share of Canada's population.

One specific program illustrates the care and concern manifest in this department. Last May, Health Canada was the major sponsor of the third annual international conference on diabetes and indigenous peoples, which was held in Winnipeg. Hon. members may be aware that diabetes is one of the most serious chronic diseases among aboriginal populations in Canada. Diabetes rates for natives are from two to five times greater than for Canadians in general.

Health Canada works in partnership with aboriginal people to improve knowledge and treatment of diabetes. The department recognizes what the minister calls the critical role for traditional aboriginal practices in the healing process. This recognition of the value of traditional practices is of fundamental importance and reflects the department's major focus on the native front, which continues to be transfer of control of programs to First Nations.

Over the years, Health Canada has come to recognize that health programs designed and delivered within aboriginal communities are often more successful than those delivered by outside agencies. Therefore, it now works with First Nations to enhance their control of health resources. There have been more than 40 health transfer agreements concluded, involving about 100 First Nations, and the annual expenditures are more than $43 million. About twice as many again are under negotiation. Self-administered health care is one of the powers that will eventually enable First Nations to achieve self-government.

I have used this occasion to remind hon. members and all Canadians of the commitment in this department to improving health and longevity for Canada's first peoples. There remains much to be done, but I know that our Department of Health, rechristened and recharged, will reconfirm its dedication to those most in need.

I am pleased to support this clearing of the deck and positioning for the future brought about through Bill C-95.

Department Of Health Act
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1 p.m.

Reform

Margaret Bridgman Surrey North, BC

Mr. Speaker, I would like to address a couple of things in the bill. One is that there is a tendency to think of it as a housekeeping bill because it is a change of name. There are a couple of reasons for changing name. First, it can be done because we do not like the present name. Second, the mandate or the content of the department can be changed. I would like to suggest that the bill represents a little more than just changing the name of the department.

I find it a little amusing that we are discussing the creation of the health department two years into our mandate. I believe we are going to be doing human resources a little later. Also, through Bill C-107 we have created the B.C. Treaty Commission approximately two years after it began functioning.

Getting back to the health department, the fact that it has been up and running under this mandate for two years gives me a little concern as to what its mandate actually is. Whether its mandate has been increased or decreased is the focus of what I am looking at here.

The Department of Health is a product of the phasing out of the Department of Health and Welfare and the Department of Consumer and Corporate Affairs. It is my understanding that most of the mandate that was the Department of Consumer and Corporate Affairs went to the Ministry of Industry. I am assuming that a lot of the welfare aspect of the Department of Health and Welfare went to the Department of Human Resources Development.

I am wondering what is left for the Department of Health. When we talk in our debates about health we tend to zero in on the health insurance or the medicare component of this department. I would think there is a lot more to health than that particular aspect. That is one component of what a good and functioning health department should be.

If we look at clause 4 of the bill itself, it states that the health department will promote and preserve the preservation of health for the people of Canada. I might add that it states it will do that where it has not been otherwise delegated to other jurisdictions within the government structure.

The second part expands on that a little more. Paragraph 4.2(a) refers to the promotion and preservation of the physical, mental, and social well-being of the people of Canada. I would argue that the social well-being, as we heard earlier in the debate, involves such things as housing, jobs, et cetera. It goes into great parameters from that point of view as to our individual well-being. I would suggest that possibly that aspect is being removed with the removal of the welfare component. Consequently, the health department is in a position of having to collaborate with a number of other industries in actually addressing some of these concerns.

The physical-mental component of that statement is relatively easy to address from a health point of view, because one can certainly look at that within this mandate. However, with the removal of the welfare component that mandate for health has been diminished to a point that now we are in more collaboration and co-operation with the other departments. There is not the same authority there the department once had.

When we move further down the list as to what the mandate of this new department will be, in paragraph 4.2(b) it talks about the protection of the people of Canada against risks to health and the spreading of diseases. One would tend to think immediately in that component of communicable diseases and such other diseases that do not necessarily meet the definition of communicable diseases such as HIV-AIDS and possibly hepatitis B and C. These are pandemic kinds of situations. I would hope that a health department would have a major role in addressing these types of things that affect the Canadian people.

We have had some experience in the past two years with both these issues. In my opinion, the response of the government has been reactive. I am wondering if this is a sign of some weakening in the department's ability to pick up the reins and lead when these situations occur.

We go down to paragraph (c), which is "investigation and research into public health, including the monitoring of diseases". I am not sure if it is the only reference, but I believe it is the only reference made in the act to research.

In this context, one tends to think of investigation and research, more studies. We are going to research this, study it. As we all know, we have done a lot of studies. In some areas the feeling is that we have done enough studies over the years and it is time to get into some action.

I also would like to suggest that the research component of health is very important. It not only should be addressing diseases that are out there, but we should be looking at where we are going in the future from a technological point of view and how these things will affect our health.

I am a little concerned that this is the only reference made to research. It tends to imply that we would be looking at diseases.

Paragraph (d) states that the health department will establish and control the safety standards and safety information requirements for consumer products and safety information requirements for the products intended for use in the workplace. That is a program called WHIMS, which is being carried out by the provincial governments. The federal role in that now tends to deal with a problem within a company in which they feel the giving out of that information on their product may violate the marketing aspects of their product, put them in jeopardy of being duplicated or whatever. I would suggest that the federal government's role in WHIMS is minimal now that it has actually been established and implemented.

Paragraph (e) refers to the protection of public health on railways, ships, aircraft and other methods of transportation. Here is a situation I made reference to earlier. The health department is in a position of not having necessarily authority in these areas but having to collaborate with other ministries. I suggest that this will weaken the leadership of this department.

Paragraph (f) moves into the promotion and preservation of health in public servants and other employees. That stands on its own. The health department definitely is a major player there.

Then we move into an environmental type of clause, international, dealing with the United States and others. Now we have another situation in which I am suggesting health is again in collaboration with another department, in this case environment, which means that there has to be a meeting of minds between the two departments for leadership to evolve in whatever situation has to be there.

Paragraph (h) refers to the Statistics Act and the collection, analysis, interpretation, publication, and distribution of information relating to public health. I would like to say that this aspect is being well done and has been well done in the past. We have had experience in our past in which people have been able to get information about specific things. Having worked in the health care field before, I know that if one put the effort into obtaining information one certainly could get it. I suggest that the various departments in Health Canada, the bureaucratic component, have been the major bonus in this aspect of things.

We are gathering information and correlating it and then disseminating it to the people. I have dealt with the health programs and services branch with Kay Stanley, specifically in relation to cardiac situations. I must say it has been excellent.

Two positive mandates of the health department have come up in my dialogue so far. One is the education and correlation of information and the other is public servants' health care.

The last item is the co-operation with provincial authorities with a view to the co-ordination of efforts made or proposals for preserving and improving public health. My interpretation of that is it is the one which addresses medicare or health insurance. Again, the role has been delegated to the provinces to provide the service. The federal role is the Canada Health Act and the five principles thereof which ensure that the provinces meet those five standards.

Through the amalgamation of departments we have weakened our health department with respect to giving it the necessary authority to address a great number of issues. Many other aspects of the health department, other than the health insurance aspect which has been transferred to the provinces, are tied up with other departments. One really does not know who has jurisdiction.

Being the critic for aboriginal concerns I have seen many studies. We just heard a member speak about programs. There are numerous studies, such as the EAGLE study which is being done in collaboration with the environment department. There is a drinking water study in progress on which the department of health is collaborating with the department of Indian affairs. As a matter of fact, with respect to the drinking water project, I believe an education program has been established.

All of these things are necessary. There is a great concern regarding the health of our aboriginal people which we should be addressing. We know that breast cancer is another problem which we should be addressing. There are many problems which need to be identified and addressed.

The authority to address these health problems within other jurisdictions, for example, aboriginal people falling under the department of Indian affairs, tends to weaken the authority of the health department. We can get caught up with money, priorities or other things. My point is that I think it is a weakness.

There is an abundance of money in the health care budget. There is a tendency to think of that money in relation to the health care insurance plan. We hear all kinds of dialogue about withholding transfers to the provinces and cutbacks in services. I realize there is a formula which is based on a dollar amount per head.

I might suggest that when we start looking at all of the areas in which health is involved, such as the studies and the various programs in collaboration with other ministries, possibly some of that money might be better used on the other side of the health department which is health insurance and medicare. I realize that entails changing the formula.

The moneys available in health care for health insurance-and I do not know what the percentages would be on that through the whole budget-should be revisited in relation to all the other things the health department should or could be doing with the dollars it has but has allocated elsewhere into studies and various individual programs.

Returning to the reference I made earlier that this bill is creating the health department, this department has been functioning for two years. It may support my argument that the department has been weakened. I hope there is a little more activity coming from the health department. We have had no legislation to date other than this bill. Bill C-7 was referred to the health committee but it was not introduced by the health department to this House.

We had the tobacco situation early last year which again had a negative effect on the health situation. We have had the blood tainting and HIV-AIDS situations. We have had the comments about the transfer payments to the provinces in the west. We have had TB in the women's prisons and also the assisted suicide issue arise. There was not really any leadership from the health department. The medical profession actually expressed the pros and cons and the ethics of this and the other House undertook the study on palliative care issues.

I have concerns. We are not just dealing with a name change. I have concerns about the role of the government. I have great concerns that it is being diffused.

I have had some discussions with the Canadian Nurses Association. The association expressed the concern that with the removal of welfare the department would be restricted in its ability to address the whole human being which is important. The approach of health care workers in Canada has changed from an illness approach to a wellness approach where they must look at the whole body. There are concerns from the Canadian Nurses Association on that.

The association is also concerned that the national standards coming from the department relate specifically, from what we have heard so far, to the Canada Health Act and the five principles which relate to the health insurance program.

Those are some of my concerns. I will certainly be supporting this bill when the vote comes. I am concerned that it is being diffused. The team leader, the Prime Minister, calls the shots when

it comes to setting up the ministries. I do have concerns that this department has been extremely weakened.

Department Of Health Act
Government Orders

1:20 p.m.

Vancouver Centre
B.C.

Liberal

Hedy Fry Parliamentary Secretary to Minister of Health

Mr. Speaker, I appreciated the hon. member's comments, some of which were well thought out. I appreciate her supporting the bill.

The most important recurring theme I heard the hon. member refer to was that this new act will weaken the Ministry of Health in that the Ministry of Health will have to collaborate and co-operate with other departments. I do not see it that way.

As the hon. member rightly said, health is more than just the absence of disease. Health has to do with environmental issues. It has to do with issues relating to poverty and socioeconomic status. It has to do with issues of public health which has to do with contagious or transferable diseases.

Departments such as environment, Indian affairs and northern development and human resources development are already in existence and are already dealing with these issues. What happens is a duplication of efforts. In the past, programs were going on within other departments and health would be duplicating some of them. The idea is that if there had been a concerted effort, then health and the other department, which in turn deals with its colleagues at the provincial level, can create a better understanding of the issue. Then the appropriate department working with health can set a healthy public policy with regard to those things.

The positive thing about it is that in the past many departments have always felt that what they did did not impact on health. There is now a real opportunity here for departments to understand that health touches every single aspect of our lives. Those departments, whenever they make policy, can focus on looking at the healthy public policy component of their policy instead of just focusing on the other aspects of their policy that did not include health and left the health components up to health, in which case it was very diluted. It was more diluted in that case than it would be in this way.

For example, let us look at the issue of poverty and the transfer of the welfare component of health and welfare to human resources development. We know that one of the things that has to do with poverty has to do with creating opportunity for people for employment training to become independent contributors to society. This is already a major part of human resources development. Therefore, developing human resources is going to decrease poverty in the long run which will then impact on health.

This gives better focus to all of the departments which will in turn see that health is an important component of whatever they do across the spectrum. It also gives the Ministry of Health the ability to look at developing clear health promotion and disease prevention guidelines, focusing on research and some of the things the hon. member spoke about.

Research in terms of disease is not the only component of research one wants to do. The Medical Research Council is looking at health promotion research which will lead to the promotion of positive health status as opposed to just looking at the disease components.

This gives the Department of Health a better focus on some of those issues including public health which, as members well know, means taking healthy public policy with regard to things like sewers, contagious diseases, quality of drinking water and safety, as the hon. member mentioned, which is an important part of what the department does right now. The department will focus on those issues very clearly and will work in co-operation and collaboration with the other departments. This will be a learning process with the other departments to see how what they do impacts on health.

Department Of Health Act
Government Orders

1:25 p.m.

Reform

Margaret Bridgman Surrey North, BC

Mr. Speaker, I appreciate the hon. member's comments. I also appreciate that progress can be achieved much more quickly if we work together.

I recognize the validity of ministries getting together and talking to avoid duplication and channelling their energies in the correct direction. This just does not apply to health; it can also be applied to the environment. Environment affects all the ministries as well.

My concern is that somebody somewhere has to have the authority to take leadership in these situations. When one starts collaborating to that point, is it a committee decision, a health decision, or a ministry decision that we are talking about? How does the priority for recognizing the problem which has been identified actually come into being?

The authority of the department is diminishing because its role is becoming more of an associate role or an advisory role to the other ministries. It is picking up the gauntlet and running with the program out of its own budget or this type of thing. That is where my concern is. I have no problem with collaborating. That is excellent and it is time we got to it.

I do not see any authority in this paper. If we have a health problem what authority does the department have to put it on the front burner? That is what I am concerned about.

Department Of Health Act
Government Orders

1:30 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Mr. Speaker, I understand the hon. member's comment. It is like the chicken and the egg syndrome.

According to the member's vision of health it would be a super ministry encompassing all the ministries that will in turn look to the Department of Health to make decisions. Obviously that is not possible but it is an interesting concept.

This is what we have to move to. If we are talking about sharing jurisdictions and incorporating, we are also educating other departments so that people do not continue to focus in a narrow tunnel vision in specific departments on only one component of what they do. It is better for public health policy if the Ministry of the Environment recognizes that whatever it does impacts health, as opposed to the Department of Health constantly saying that it must do this and that, and so on for every other ministry.

I see it as a positive move as opposed to a negative move.

Department Of Health Act
Government Orders

1:30 p.m.

Reform

Margaret Bridgman Surrey North, BC

Mr. Speaker, it might be the chicken and egg syndrome, but the concern first came to me with the EAGLE program. To my understanding that program is being done with the involvement of an aboriginal group. There is probably a specific group around the Great Lakes. The program is studying the effects on aboriginals of the Great Lakes environment. I believe it is being done in collaboration with Indian affairs.

This collaboration is ongoing. We are studying the effects on aboriginals of the Great Lakes environment. I am sure it is affecting other people as well but because it was done in collaboration with one department we have zeroed in on a specific group. This is the trend I am seeing. Instead of the effects on Canadians, we studying the effects on aboriginals because of the ongoing collaboration. That could get out of hand eventually.