Mr. Speaker, it is an honour and a privilege to speak today on Bill C-18 which will establish the Department of Health.
Many in the House have observed that the health related duties, powers and functions which are set out in the proposed new legislation do not differ greatly from the previous act. Indeed, it can fairly be said that the old act has served us very well over the past half century.
At this point I would like to congratulate my hon. colleague from Fredericton-York-Sunbury for a motion he put forward. His amendment reincorporates a clause from the current Department of National Health and Welfare Act, an act dating back to 1944. This amendment explicitly defines the minister's personal and legal responsibilities for the department.
I am pleased to say that the government gave the member for Fredericton-York-Sunbury its full support on this amendment and it was passed at report stage. The Minister of Health as well shared the concerns of the member that this legislation makes things perfectly clear with regard to his powers, duties and functions.
There are some obvious differences in this bill which is to be expected in a knowledge intensive field like health. One of these differences is found in clause 4(2)(a) where there is explicit reference to:
-the promotion and preservation of the physical, mental and social well-being of the people of Canada;
This is an amplification of the reference in clause 4(1) to the promotion and preservation of the health of the people of Canada which corresponds to section 5 in the old act.
What does this mean? Some people have read into it something of a sinister message, a sign of an as yet undeclared plan by the federal government to occupy the full arena of physical, mental and social well-being. Such a move would have a significant impact on the division of responsibilities for health between the federal and provincial legislatures.
Others have observed that the inclusion of this clause seems somewhat odd, given the transfer of the welfare side to the Department of Human Resources Development. After all, would it not make sense to consolidate all federal responsibilities for physical, mental and social well-being in a much more inclusive health department?
My first observation is that the legislation makes it abundantly clear that the powers, duties and functions of the Minister of Health do not extend beyond the area over which the federal Parliament has jurisdiction. This means that the reach of Health Canada cannot and will not extend to the legal mandate of other federal entities. Rather, section 4(2)(a) says how the federal government views health. The choice of the words "physical, mental and social well-being" is no accident.
These are the exact words used by the World Health Organization to define health. It is a concept that goes beyond seeing health in terms of the presence or absence of disease. It is a concept that sees health in terms of the whole person. This is a concept of health that embraces quality of life rather than just duration of life. Including the phrase "physical, mental and social well-being" in the bill before us today does little more than to formalize what has long been a reality.
In my former life I was in the health industry for 30 years and for many of those years advocated bringing those three elements together. Rather than divide a person let us look at the person in a holistic fashion.
It is neither new nor startling. It makes it clear that health means so much more than the absence of disease. Good health across a society flows from an entire set of public policies and personal decisions.
The determinants of health are the complex web of factors that contribute to the overall state of a person's health. These are social, economic, physical, psychological and other elements. Is it any wonder that research shows that people who are unemployed experience both stress and greater health problems? Or perhaps
hon. members have seen some of the reports in the newspaper where researchers have found real differences between the health of people who feel a sense of personal control in their livesand those who do not. All of this simply reinforces what wealready know.
Despite the best technology and the advances in drugs and procedures, what takes place outside a doctor's office is more important than what goes on inside that office. This fact has become a common theme in the analysis of health policy options. For example, Health Canada spends a large sum of money each year to provide health services to status Indians and Inuit. Yet aboriginal people continue to suffer, with many of the poorest health statistics in our society.
This of course is not a place to discuss these health statistics but it makes clear the importance of the comprehensive focus on well-being. It also underlines one of the basis facts of health, system renewal. We cannot spend our way to good health through the health care system no matter how much we invest.
We are better off to help people achieve a state of well-being that results in better health and less need for health care. A growing appreciation for the many factors that contribute to the health of Canadians has sparked an increased focus on the elements of well-being. Progress in this area establishes a foundation from which our health care systems can operate more effectively. It is rightly seen as an investment that minimizes future health care costs and that is extremely important.
Some of these factors lie within the mandate and the programs of the federal health department. Others lie within the mandates and programs of other federal agencies. Some are within the reach of provincial and territorial governments and still others lie totally outside of the public sphere. This is the reality of health. It is the reality of Canada's health system. It is a reality that requires partnership and co-operation. It is a reality that places a premium on the evidence about determinants of health and the outcomes and effectiveness of health policies and programs. Most importantly, it is a reality that does not require any expansion of the federal health mandate.
Once this focus on partnership for well-being is put into practice, we see it as the practical concept that it is. Let me use the example of Canada's drug strategy. The ultimate aim of federal programming is to minimize if not eliminate the human tragedy that is the common consequences of drug abuse.
Looking at the problem of drug abuse in these terms allows us to also consider contributing factors in the context of a much broader array of health determinants.
Many here will recall the "Really Me" message that Health Canada coined for Canada's drug strategy. This message is meant to capture in two words the sense of confusion over identity and destiny that often contributes to a young person's decision to experiment with dangerous substances as well as the positive imagery of a drug free life.
Canada's drug strategy obviously encompasses a great deal more than slogans and messages but is aimed at addressing what physical, mental and emotional well-being is all about.
Let me offer a current example, the Canada prenatal nutrition program. This initiative arose from the red book commitment. Its goal is to promote the development and growth of healthy babies. However, the route to that goal means addressing the factors that can harm that development.
Clearly, a child in a mother's womb is no healthier than his or her mother to be. If the woman is eating poorly or in an abusive relationship or using drugs, the risks to the baby are very high.
This program, as members are well aware, supports comprehensive community based efforts aimed at reaching these high risk, pregnant women. At one level it includes food supplementation, nutrition and lifestyle counselling and related information. At another level it gives them more tools to take better care of themselves and their babies.
The mothers to be targeted by this program are usually poor. They are often underweight themselves. They may smoke, drink or use drugs. They also may be in abusive relationships. They often live in poor areas of our communities. They are often young, single and uneducated.
Such conditions are the determinants of health that lead to 40,000 low birth weight newborns a year who begin life at less than full capacity. These are the factors that this program is working to correct.
The focus on well-being goes far beyond many health promotion efforts by Health Canada. It extends into health care delivery. The phrase quality of care clearly means more than clinical outcomes.
Whether or not quality is the result will inevitably vary between individuals, not because the results vary in clinical terms but because identical health states may be valued differently by different people.
Take for example a surgical procedure for which there is a good chance of a known side effect. For some the side effect may imply a lower quality of life than living with the disease in question. For others the reverse would hold true. In both instances the aim of the clinical decision is to achieve the health states of greater value to the individual.
This is a choice that every one of us wants to have. Yet it is a choice that is not available if health is conceptualized in a way that sees it only as the presence or absence of disease. We are talking holistic medicine here.
At another level it is obvious that there remains much to be learned about the factors that underlie and shape a person's fiscal, mental and social well-being. I am reminded that health concepts in medical terminologies and technologies have evolved greatly since 1867 yet at no point has Canada's Constitution been a bar to the effective pursuit of health.
We are now at a point in which provinces and the federal government understand and accept the need to build well-being as a part of the overall health strategy. Governments work together. I am not aware of any province that seriously sees the Health Canada mandate for well-being as a threat to its responsibilities. If anything, it underlines the shared commitment to addressing the basis of good health and well-being. It underlines a longstanding commitment to the co-operation that has served us so well.
In terms of health status, we are second only to Japan in terms of neonatal deaths. In terms of our record in the development of health concepts, Marc Lalonde's 1974 "A new Perspective on the Health of Canadians" is still regarded internationally as a breakthrough, 21 years after its release. The record of our health care delivery system speaks for itself, a source of pride for all Canadians and the envy of the world.
The inclusion of section 4(2)(a) in the enabling legislation conveys a message about who we are and what we stand for. We stand for a commitment to the physical, mental and social well-being of Canadians and a readiness to work with others to achieve that end. This section simply recognizes the complex range of factors that influence health and that they deserve consideration as we promote health.
In short, this section tells us what we already know to be true. A department charged with promoting the health of Canadians needs to see its mandate in terms that reflect the reality of peoples' lives and all the elements that lead to good health.
