Mr. Speaker, the NDP will be supporting the motion and I thank the member for Charleswood St. James—Assiniboia for bringing it to the attention of the House and for some very vigorous debate around an issue that is very important to Canadians.
I will not read the whole motion but I will read the last part which states:
--the government should immediately develop and initiate a comprehensive national strategy on mental illness, mental health and heart disease.
Earlier in the motion it talks about the need for a national strategy on cancer.
The member referred to the coalition of a number of organizations that have been working very actively and very vigorously for a number of years on this very initiative. In a document entitled Establishing the Framework for a Comprehensive Canadian Strategy for Cancer Control, it lays out a number of factors that are critical in looking at a national strategy. These include prevention, screening, diagnosis, treatment, supportive care and palliative care.
I know a number of other members will be talking about various aspects of this national strategy but I would like to focus on prevention and wellness.
In the document it is stated:
True cancer control aspires not only to treat and hopefully cure the disease, but to prevent it, and to increase the survival rates and quality of life among those who develop it. The process encompasses interventions aimed at both individuals and populations.
This is a very critical statement in this document.
After looking at this initiative and after speaking with a number of advocates in the cancer community, one of the things that dismayed me was that this conversation has been going on for years and years. In 2005 one would hope that we would not be in the position of having to spend an entire day of members' time talking about this very important issue and instead we should be talking about the success of a national cancer strategy.
In preparation for the debate today I pulled out a document called Cancer Care in Canada, the voice of the Cancer Advocacy Coalition of Canada. I talked earlier about being dismayed. The coalition produced a report called report card 2003. One of the lead in statements in the report card says:
Since the year 2000, the Cancer Advocacy Coalition of Canada...has been asking for hard facts on the issues that matter most to the country’s cancer patients. Year by year, our mantra has been, “We cannot manage what we cannot measure.
This group did a report card on the provinces throughout Canada. It looked at a number of measures: mortality, which provided rankings for the provinces; 2002 waiting times; per capita funding; rates of funding increases; and transparency and accountability.
When we take a look at a factor such as waiting times, we are looking at a range that goes from unacceptable, borderline, to acceptable. Throughout the provinces we have no consistent way of looking at waiting times, of gathering the information or of reporting the information back to Canadians. What the organization pointed out in this document was that often we were talking about apples and oranges.
My favourite topics are transparency and accountability both at the federal level on how federal dollars are spent on health care, but also at the provincial levels in how they report back to the federal government on how dollars are spent.
The analysis on how provinces reported out information went from unacceptable to borderline to accessible, to actually one case of outstanding. It talked about the fact that the transparency and accountability in the province of Ontario was outstanding. Unfortunately, in my own province of British Columbia it was merely acceptable.
One of the challenges we have when we are talking about cancer control and prevention is that often we do not know what we are measuring, we do not know how to gather the information and we have no consistent framework to talk about this.
Before I go on to talk about prevention and wellness, my good friend from the Bloc referenced the Romanow report and implied that the federal government had actually been working progressively on the Romanow report. I must beg to differ.
The federal government has talked about the fact that it has closed the Romanow gap by allocating some funds over the next 10 years to health care. The only Romanow gap that it has closed is by making a commitment to funding, but when we talk about many of the other initiatives that were addressed in the Romanow report, we are talking about inertia and inattention.
The final report from the commission on the future of health care in Canada specifically talked about prevention and wellness and this is a very good context in which we can speak about the cancer prevention strategy. One of the things the report talked about was anticipating an aging population. We know that age is a factor when we talk about cancer. The demographic trends show that the proportion of Canadians 60 years and older is expected to grow from 17% to 28.5% by the year 2031.
When we talk about the need for a national strategy, the fact is that not only are we seeing cancers identified in people under the age of 60, but we have a very serious demographic bulge that is going to happen over the next few years. If we are not out in front in developing a strategy to address this, it is going to present some serious challenges for our medical system.
The Romanow report goes on to say that much of the international evidence indicated that modest growth in economics should ensure that most countries are able to manage the growth in their elderly populations and increase health care spending in the future. It is worth remembering that there are countries which already have larger elderly populations than Canada, spend significantly less, and achieve similar health outcomes in comparison to Canada.
Romanow also addressed the issues of needs and sustainability. He talked about the fact that Canada's health outcomes compare favourably with other countries. Evidence suggests we are doing a good job of addressing factors that affect the overall health of Canadians. There are, however, areas where there is room for improvement and there are serious disparities in both access to health care and health outcomes in some parts of Canada.
Clearly, more needs to be done to reduce these disparities and address a number of factors that affect the health of Canadians, such as tobacco use, obesity and inactivity. In a few moments I am going to talk a bit more about those determinants of health.
Romanow made some very specific recommendations to strengthen the role of prevention. Recommendation 22 stated:
Prevention of illness and injury, and promotion of good health should be strengthened with the initial objective of making Canada a world leader in reducing tobacco use and obesity
Recommendation 23 stated:
All governments should adopt and implement the strategy developed by the Federal, Provincial and Territorial Ministers Responsible for Sport, Recreation and Fitness to improve physical activity in Canada.
When we talk about promoting good health, we know that many of the factors that lead people into acute care systems and requiring treatment for cancer are directly related to other factors such as lifestyle. In the report Romanow talked about the fact that over 90% of lung cancer deaths and 30% of all other cancer deaths could be prevented in a tobacco free society. Those numbers are from Statistics Canada. They are not made up, pie in the sky numbers.
We are certainly taking steps and I applaud many of the non-profit groups, like Physicians for a Smoke-Free Canada, on their vigorous pursuit of making Canada a tobacco free society. Clearly, there are many issues in prevention that need to be incorporated in the pan-Canadian strategy. I must add that the coalition has advocated for that.
He goes on to say that the impact of determinants of health and lifestyle choices is well known to government and health organizations. Unfortunately, the key problem lies in turning the understanding into concrete actions that impact on individual Canadians and communities. That has been a huge challenge in seeing that translation from talk into action.
Canadians are losing an appetite for more reports. Canadians are losing an appetite for more promises that do not actually result in concrete action.
There are more facts about smoking and again these are addressing the leading major causes of health problems. The Romanow report said:
Estimates are that smoking costs our economy more than $16 billion each year, including $2.4 billion in health care costs and $13.6 billion due to lost productivity through sick days and early death.
Surely if we developed a national strategy, we would be talking about these factors and incorporating these into these factors.
I am going to come back to the coalition specifically because it has done some good work on developing a cancer prevention system for Canada. A report was produced by the Canadian Strategy for Cancer Control: Prevention Working Group in January 2002 . It outlined some important principles regarding a cancer prevention system for Canada. I want to talk about some of the principles that it outlined because these would be important factors to include in a national strategy. It stated:
A cancer prevention system should embody the following principles:
- Population-Based Public Health Approach that takes into consideration the Determinants of Health
The risk factors for cancer are widespread and have an early onset. Public health is our best vehicle for reaching healthy people in their communities with interventions designed to decrease these risk factors.
- Integrated and Coordinated
The risk factors for cancer are common to many other major non-communicable diseases. Collaborative action is cost effective and increases the opportunities for learning. There are many stakeholder organizations in cancer control and coordination among them is needed to enhance effectiveness and create synergy.
- Focus on Community Capacity Building with Strong Linkages
The most promising interventions have multiple interventions in multiple settings at the community level with supportive action at provincial and national levels.
Funding is needed to bring partners to the table but this must be done in a responsible way that requires participants to meet the performance of set standards in order to receive funding. Standardized data collection is needed to measure the impact that activities are having on established short-term goals.
It will take time and committed effort to establish a system. An implementation body with clear responsibilities and adequate resources is needed to provide strong leadership.
These are critical principles to guide the development of this national strategy. They have been developed by pan-Canadian consultation and by not only health care providers and practitioners but by advocates in the cancer community. These five key principles would go a long way to addressing many of the things that need to be addressed at the community level, for example.
We know that many of these strategies and ideas come out at the national level and are developed at the provincial level, but the impact is felt at the community level. I was pleased to see that part of the principles in this strategy focus on community capacity building because it is there that we need to develop our strength.
There is one other element in this document that is really important. Under the case for a cancer prevention system, it lays out the fact that:
Estimates range but most experts agree that at least 50% of cancer cases and deaths can be prevented through healthier lifestyle choices. These include: reducing exposure to tobacco, a diet that is high in vegetable and fruit consumption, protection from overexposure to the sun, adequate physical activity to maintain a healthy body weight, and reducing environmental/occupational exposure to carcinogens.
When we hear this kind of information coming out of prevention that says 50% of cancer deaths and cancer cases could be prevented by paying attention to some of this front-end information, it makes me wonder, in this day and age, why we have not addressed these factors.
I talked a little bit about tobacco earlier, but this document also focuses on tobacco because it is one of the contributors.
I talked a little bit about tobacco earlier, but this document also focused on tobacco because it was one of the contributors. It said that simply educating people about a healthier lifestyle was not enough to effect change. It is not adequate to educate children in school about the hazards of tobacco if they go home and their parents are smoking, or they go to their local sports facility and public smoking is tolerated, or if the price of cigarettes is too low to discourage uptake. The social environment, including public policy, needs to support healthy choices.
Clearly, many good minds have come together to talk about the fact that we need to not only look at treatment, and it is very much a part of this cancer strategy, but we must look at prevention. We must look at lifestyle factors. We must concentrate on educating Canadians and health care providers and practitioners about the necessary factor of prevention.
I am going to shift gears a bit here, from talking specifically about prevention, to talk about some of the challenges that we have when we talk about information systems that would support a national strategy. Although this is broader than the cancer strategy, there was an interim report put together called “No more time to wait--Toward benchmarks and best practices in wait time management” by Wait Time Alliance for timely access to Health Care. Of course, when we are talking about timely access to health care, we are talking about people who have cancer as well as a number of other issues that bring them into the health care system.
The report talks about principles for medically acceptable wait time benchmarks. One of the challenges that we have come across as we look at many of these issues is that we do not do an adequate job of gathering information. We do not do an adequate job of analyzing the information that we do gather and we are often talking about factors that are not gathered in the same way from coast to coast to coast, so we cannot even do comparative studies across the country.
When we talked many months ago about Bill C-39, we talked about accountability in the health care system. One of the critical factors of accountability is that we must have information. When we are talking about programs and services, we talk about what we measure. Well, if we do not even know what we are measuring, how do we know what we are getting? The report talks about medically acceptable wait time benchmarks and I am going to paraphrase from the report.
It talks about the fact that benchmarks need to be pan-Canadian in approach, so that we avoid things like duplication of effort. We want to maximize economies of scale. It talks about the fact that wait time benchmarks need to be derived from an ongoing process. Life is not static in Canada, so it needs to be an ongoing process in order to review the benchmarks and talk about their significance.
There needs to be ongoing and meaningful input of the practice in community and many of us talk about the fact that we all do the statistics around policy. It is great to have policy developed in Ottawa, but we need the ongoing community practitioners and the community residents to be involved in these kinds of initiatives. Public accountability and transparency are exceedingly important and I am going to read this part:
--Canadians must see tangible results in terms of reduced waiting times for health services in the 5 priority areas.
We keep talking about accountability and transparency. Yet, we continue to see an opaque veil drawn over the operations in Health Canada and other government departments as was demonstrated a couple of weeks ago by journalists across Canada about accessing information. Transparency and accountability are fundamental to ensuring that we are getting what we want out of the money that we are spending. Wait time benchmarks and provincial targets to reduce wait times must be sustainable.
Mental health is a critical issue and in the statement of issues that the Mental Health Association put together, it talked about things like affordable housing.
In conclusion, we support this motion before the House and I urge all members to support it. I have an amendment to the motion that I would like to put forward. Following consultation with my colleague, the member for Charleswood—St. James—Assiniboia, I move:
That after the word “provinces” the words “territories and municipalities” be added.