Debates of June 17th, 2010

Lawrence Cannon Minister of Foreign Affairs

Mr. Speaker, the Government of Canada aims to reaffirm its collective commitment to the Nuclear Non-Proliferation Treaty, NPT, and to make balanced progress on the three pillars of this important international instrument: disarmament, non-proliferation and peaceful uses of energy.

On May 3, 2010, the Minister of Foreign Affairs made Canada’s opening statement at the start of the NPT review conference. The minister noted that on nuclear disarmament, states party must strive for implementation of commitments already accepted. In this regard, Canada welcomed the new START agreement, the newly released US nuclear posture review, and US efforts towards ratification of the Comprehensive Nuclear-Test-Ban Treaty (CTBT). Canada calls upon all states party required for the entry-into-force of the CTBT to ratify this essential treaty as soon as possible.

Regarding the threat of nuclear proliferation, the minister noted that Canada has a long-standing commitment to strengthened national and international efforts to ensure that weapons of mass destruction do not spread to states or terrorists prepared to use them under any circumstances. In this regard, he argued that an important step forward for the review conference would be to recognize that a comprehensive safeguards agreement together with an additional protocol represents the new verification standard.

Carolyn Bennett St. Paul's, ON

With respect to Health Canada’s vitamin D recommendations: (a) does the government plan to update them and, if so, (i) how, (ii) what is the timeline for the update, (iii) what research is Health Canada using in conducting the update; (b) what are the qualifications of the experts who will evaluate and select the research used to support any decision about the adequacy of Health Canada's current vitamin D recommended daily allowances; (c) is there current, accepted evidence to suggest that taking vitamin D in amounts higher than the recommended daily allowance is harmful; (d) what amount of vitamin D, if any, would be harmful to Canadians' health; (e) if there is an amount found to be harmful, what “harm” did the said amount cause; and (f) which studies were used to draw any conclusions found in (e)?

Leona Aglukkaq Minister of Health

Mr. Speaker, in reponse to a)i) In late 2008, the Canadian and US governments contracted with the US Institute of Medicine, IOM, to convene a multi-disciplinary panel of Canadian and U.S. experts, the expert committee, to undertake a study to reassess current relevant data and to update as appropriate the dietary reference intakes, DRIs, for vitamin D and calcium, last published in 1997. This will result in the delivery of a detailed report that is peer-reviewed according to the protocols of the Institute of Medicine and the U.S. National Research Council.

In response to a)ii) The report from IOM is expected to be publicly available in the fall 2010. It is planned that the implementation process for government programs, policies, guidelines and information will take place in 2011.

In response to a)iii) Health Canada supported the IOM review in a number of ways. Health Canada provided publicly available data on usual distributions of vitamin D intake, based on the 2004 Canadian Community Health Survey. Health Canada also worked jointly with Statistics Canada on a preliminary public release of blood 25-OH vitamin D results from the 2007- 2009 Canadian Health Measures Survey. These results were essential for the IOM expert committee to take into consideration the Canadian vitamin D status in their deliberations. In addition, Health Canada, the Public Health Agency of Canada, the US Office of Dietary Supplements/National Institutes of Health and the US Food and Drug Administration funded the Agency for Healthcare Research and Quality (AHRQ) to prepare the report “Vitamin D and Calcium: A Systematic Review of Health Outcomes”, which was published in August 2009. The purpose of this review was to systematically summarize the evidence on the relationship between vitamin D, calcium, and a combination of both nutrients on a wide range of health outcomes.

In response to b) The review of DRIs for vitamin D and calcium is being conducted by a 14-member expert committee appointed through standard procedures of the national academies. Expertise includes, but is not necessarily limited to the following areas: nutrition, infant nutrition, reproductive nutrition, pregnancy and lactation, dermatology, gerontology, epidemiology, biostatistics, bone and skeletal health, cardiovascular health, immunology, oncology, cellular metabolism, toxicology, genetics, factors affecting intensity of UVB radiation, and population monitoring methodology.

In response to c) An AHRQ report published in August 2007 entitled “Effectiveness and Safety of Vitamin D in Relation to Bone Health” did examine the question of whether intakes of vitamin D above current reference intakes lead to toxicities. A total of 22 trials reported data on toxicity-related outcomes, 21 of which used doses above current reference intakes.

Overall, there was fair evidence from adult trials that vitamin D supplementation above current reference intakes, with or without calcium supplementation, was well tolerated. However, there were challenges in conducting this part of the review because harms are often secondary outcomes and may not be reported completely, especially if they are not significant. Most of the trials were not designed to evaluate harms, were of small sample size, and had short duration of exposure to vitamin D. There is also a lack of data on toxicity outcomes in infants, children, and specific ethnic groups.

In response to d) As part of its review of the evidence, the IOM expert committee will try to set a tolerable upper intake level, UL, defined as the highest level of daily nutrient intake that is likely to pose no risk of adverse effects for almost all individuals in the general population. The UL is based on an evaluation conducted by using the methodology for risk assessment of nutrients.

Until the recommendations for vitamin D have been updated, Health Canada continues to recommend that Canadians follow the existing tolerable upper intake level, which for anyone over one year of age is 50 micrograms, 2000 IU, vitamin D per day from all sources, including milk and supplements.

In response to e) According to the dietary reference intakes, DRIs, for vitamin D and calcium published in 1997, the adverse effects of excess vitamin D are probably largely mediated by increasing calcium levels in the blood, and limited scientific evidence suggests that direct effects of high concentrations of vitamin D may be expressed in various organ systems, including kidney, bone, central nervous system and cardiovascular system. Human case reports of pharmacologic doses of vitamin D over many years describe severe effects at intake levels of 250 to 1250 micrograms per day, 10,000 to 50,000 IU/day.

The IOM expert committee is looking at more recent clinical scientific data with regard to amounts of vitamin D that may be considered harmful and the indicators of adverse effects.

In response to f) The full set of studies used will be made available in fall 2010 in the IOM report.

Carolyn Bennett St. Paul's, ON

With respect to the $500 million allotted in the 2009 budget and reallotted in the 2010 budget to Canada Health Infoway: (a) when will the funding be released; (b) how will the funding be targeted; (c) how much of the funding will be focused on acute care facilities; (d) how much of the funding will be focused on physicians and integrated points of service for hospitals, pharmacies, community care facilities and patients; and (e) how much of the funding will be focused on physician electronic medical records?

Leona Aglukkaq Minister of Health

Mr. Speaker, Canada Health Infoway, Infoway, is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records (EHRs), telehealth and public health surveillance systems on a pan-Canadian basis. Its corporate members are the 14 federal, provincial and territorial deputy ministers of health. Infoway supports the development and implementation of eHealth technologies on a cost-shared basis with its provincial/territorial partners.

As part of the Government of Canada’s economic action plan, EAP, budget 2009 included $500 million for Infoway to support the goal of having 50% of Canadians with an EHR by 2010, to speed up the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients. Subsequent to the budget 2009 announcement, the federal government indicated that further due diligence would be conducted before the funds would be released. This included the monitoring of Infoway’s response to the Auditor General of Canada’s fall 2009 report, which contained a chapter on EHRs. Budget 2010 announced the government’s intention to move forward with the transfer of these resources.

With regard to a) In March 2010, Health Canada and Infoway signed a funding agreement related to the $500 million allocated through budgets 2009 and 2010. Under the new funding agreement, Infoway will periodically draw down on the allocation and is thus required to submit an annual cash flow statement, with supporting details, to access the federal funds. The first cash flow statement to draw-down upon the new funds is due by the end of June 2010. Funding will be disbursed to Infoway within forty-five, 45, days of the receipt and acceptance by the minister of the cash flow statement.

With regard to b) Through budget 2009/2010, the $500 million funding is intended to continue work on EHRs and to support the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients.

In this context, Infoway is working to establish corresponding funding strategies. These will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

With regard to c)d) and e) As noted above, Infoway is working to establish funding programs for the $500 million allocated through budgets 2009 and 2010, which will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

Since the provinces and territories are responsible for the delivery of health care, they also set their respective priorities and funding allocations for eHealth. Accordingly, within the parameters set out in the annual summary corporate plan, Infoway will work with individual provinces/territories to disburse funds based on jurisdictional priorities.

Sukh Dhaliwal Newton—North Delta, BC

With regard to Health Canada’s research on the stress response to aircraft noise: (a) what studies have been conducted; (b) what are their results and conclusions; and (c) what future research is planned?

Leona Aglukkaq Minister of Health

Mr. Speaker, in response to a) From 1993 to 1996, Health Canada published three conference papers on the development of a laboratory study of aircraft noise-induced stress on people.

The only Health Canada published studies with a specific focus on aircraft noise were two reviews of the scientific literature on aircraft noise. One is a peer reviewed journal article in 2007 on aircraft noise-induced sleep disturbance and the other is a 2001 report on aircraft noise, stress and cardiovascular disease.

Aircraft noise has appeared in other studies by Health Canada, such as a very preliminary field study designed to examine possible relationships between noise annoyance and stress. This was presented in a poster at a 2007 University of Ottawa 4th year honours thesis symposium.

Aircraft noise was also noted in a national survey of noise annoyance published in a 2002 HealthInsider report, Number 7, and a peer reviewed literature article in 2005.

Aircraft noise annoyance was also used as an example in a 2008 published analysis of how noise annoyance can be used as a health impact in environmental assessments.

A study of annoyance and disturbance of daily activities from road traffic noise was also published in 2008 based on a 2005 HealthInsider report (Number 14)

Health Canada has also published a total of three laboratory studies on the potential for noise-induced stress in either rats, two studies, one published in 2003 and the other in 2005, or people, one published in 2006, using noise sources other than aircraft noise.

In response to b) Results are listed below from the various published studies that are relevant to the potential for a stress response to aircraft noise.

In the review of aircraft noise and sleep disturbance, it was found that people living around airports show disturbed sleep in the form of awakenings and increased body movement. Aircraft noise is one reason, but it is responsible for less sleep disturbance than spontaneous awakenings and other indoor noise events.

The review of the scientific literature on aircraft noise and cardiovascular disease indicated that average blood pressure levels of schoolchildren exposed to aircraft noise were slightly elevated, however there was no conclusive proof that aircraft noise caused chronic stress in children. Also, in adults, although scientific studies have shown that short term exposure to intense noise can cause temporary stress responses such as increases in heart rate and blood pressure, there is no consistent evidence that chronic noise leads to hypertension. Furthermore, it was found that, although there was insufficient evidence to conclude that aircraft noise causes heart disease, some studies suggested that people who live for many years in areas with intense road traffic noise, may face a slight increase in the risk of developing heart disease.

In the review of the scientific literature on noise annoyance, it was found that there was some evidence to suggest an association between road traffic and neighbourhood noise levels and some stress related adverse effects e.g., hypertension and migraines. It was also found that on average a given long term exposure to aircraft noise makes a greater percentage of a population highly annoyed than would road traffic noise. Furthermore, in a national survey of road traffic noise annoyance in Canada, it was found that people who were highly annoyed by road traffic noise, also thought this annoyance had a negative impact on their health.

In a laboratory study, exposure of people to noise events during sleep did not appear to create a stress response. It was also inconclusive as to whether there were adverse effects on their sleep.

In the very preliminary field study where exposure to aircraft noise occurred, the number of subjects was too small to obtain reliable conclusions about any possible relationships between stress hormone responses and annoyance level.

In response to c) Health Canada plans the following research studies to help assess plausibility of a cause-effect relationship between noise, including that from aircraft, and stress related adverse health effects: i) examination of potential correlations between annoyance to road traffic noise and actual health effects reported in surveys, ii) a study of stress markers in noise exposed rats that are predisposed to hypertension.

The following future reviews are also planned: (i) for fiscal year 2010-2011, an interim review taking into account recent developments in the scientific literature on the potential for aircraft noise-induced stress-related adverse health effects - to update the Health Canada It’s Your Health document on aircraft noise, (ii) for fiscal year 2011-2012, a comprehensive review paper on the scientific literature on potential links between stress, cardiovascular disease and environmental noise.

Judy Foote Random—Burin—St. George's, NL

With respect to the New Veterans Charter, does Veterans Affairs Canada experience a cost-savings associated with the granting of the lump-sum Disability Award and Death Benefit, as compared to other longer-term assistance measures such as, but not limited to, the disability pension and health care benefits?

Jean-Pierre Blackburn Minister of Veterans Affairs and Minister of State (Agriculture)

Mr. Speaker, programs under the new veterans charter were implemented with the objective of changing the focus of Veterans Affairs Canada programming from disability to wellness for Canadian Forces clients and their families. The new design provides an up-front, lump sum payment to recognize the non-economic impacts of service-related disability, as well as ongoing support through rehabilitation and financial benefits to those who need it. This means that those with the greatest need receive the greatest support from Veterans Affairs Canada to aid in their successful transition to civilian life, where possible. Savings are possible in the longer term if the wellness programs of the new veterans charter work as planned to support modern-day Veterans through the transition to civilian life, thereby reducing dependence on pension payments to provide adequate, ongoing income support, a purpose that disability pensions were never intended to have. The object of the new veterans charter is not reducing cost but rather getting better value for money.

To cover additional front-end costs, government injected $740 million into Veterans Affairs reference levels to cover the first five years of the implementation of the new veterans charter programs. Over time, as the effectiveness of the rehabilitation programming is realized, financial savings are possible, but savings are not a goal of the new veterans charter. This new programming strikes a balance between being financially responsible and accountable to Canadian taxpayers while still providing required benefits and services to meet the needs of our clients. At the time of its development in 2005 and implementation in 2006, the new veterans charter was projected to breakeven by 2025. However, it should be noted that the projection is impacted by the nature of military operations between the date of the forecast and 2025.

Judy Foote Random—Burin—St. George's, NL

With respect to the new Veterans Charter and the tax-free, lump-sum Disability Award and Death Benefit for fiscal years 2005-2006 to 2008-2009: (a) how many Disability Award or Death Benefit files have been forwarded to the Deputy Minister or Minister of Veterans Affairs' because of problems associated with the lump-sum payment; (b) how many recipients of the lump-sum Disability Award or the Death Benefit filed a complaint with the department about the lump-sum payment; (c) after receiving a lump-sum payment, how many recipients or their dependants have requested additional funds; and (d) has Veterans Affairs Canada reviewed or evaluated the lump-sum Disability Award and Death Benefit programs and, if so, what findings or conclusions have been made?

Jean-Pierre Blackburn Minister of Veterans Affairs and Minister of State (Agriculture)

Mr. Speaker, in response to a) Veterans Affairs Canada does not have a process to capture this specific information.

In response to b) Since the start of the new veterans charter program, from April 1, 2006 to March 31, 2009, there have been 1, 234 medical departmental reviews requested specifically for disability awards. This represents approximately 5% of the total number of applications received.

Of those 1, 234 medical department reviews, 758 have been deemed favourable after applicants provided new evidence. 406 have been deemed unfavourable. There are 70 cases where no decision could be made as it was determined that the department did not have jurisdiction at the time to proceed with the review, for example the Veterans Review and Appeal Board had jurisdiction.

In response to c) Since the start of the new veterans charter program, April 1, 2006 to March 31, 2009, there have been 6,082 reassessments requested specifically for disability awards.

In response to d) The new veterans charter was implemented on April 1, 2006. Monitoring is underway and adjustments to new veterans charter programs will be considered accordingly. In addition, Veterans Affairs Canada’s audit and evaluation division is currently conducting a comprehensive evaluation of the new veterans charter. This evaluation is divided into three phases with a report developed for each phase.

Phase I--focus on the relevance and rationale of the new veterans charter and its programs; Phase II--focus on outreach and the service delivery framework; Phase III--focus on unintended impacts and the success in achieving desired outcome.

The reporting is scheduled to be completed by December 2010.

The department also evaluates feedback on the new veterans charter programs, including the disability award and death genefit, as it is received. For example: 1) The department continues to consult with veterans' organizations to hear their concerns. 2) The special needs advisory group, which has been in place since the beginning of the new veterans charter, has submitted four reports, providing observations and recommendations for Veterans Affairs Canada’s consideration with regard to improving the new veterans charter from a special-needs veterans’ perspective. 3) The new veterans charter advisory group has also undertaken a study of new veterans charter programs. Their findings and recommendations were detailed in a report, which was submitted to the department in October. The department will continue to explore and analyse the findings of evaluations/reviews of the new veterans charter, as well as feedback received internally and from clients, to maximize existing authority to the benefit of our clients and to consider if, and where, there might be gaps in that authority.

The Speaker Peter Milliken

Is that agreed?