Bill C-237 (Historical)

National Framework for Diabetes Act

An Act to establish a national framework for diabetes

This enactment provides for the development of a national framework designed to support improved access for Canadians to diabetes prevention and treatment.

National Framework for Diabetes Act

[Sonia Sidhu, Liberal, Brampton South, ON]

moved that the bill be read the third time and passed.

Mr. Speaker, it is an honour to speak on my private member's bill, Bill C-237, an act to establish a national framework for diabetes in Canada.

I want to begin by thanking the member for Marc-Aurèle-Fortin, who generously traded his slot so we could begin third reading on this bill today. I would also like to thank all my colleagues in the Standing Committee on Health who unanimously supported this bill in March.

As members of this House know, 2021 is the year we are celebrating the 100th anniversary of the discovery of insulin by Sir Frederick Banting and his colleagues at the University of Toronto. This is still recognized as one of the greatest achievements of medicine in the 20th century and made them the first Canadians to win a Nobel Prize. It has been inspiring to see how the world has recognized this monumental achievement.

On April 14, the University of Toronto hosted 100 years of insulin symposium, which drew more than 6,000 attendees from around the world. This was also the occasion where Canada Post chose to unveil a new stamp that features a quote from Banting's unpublished journal, in his own handwriting, as well as the original insulin bottle with a red cap. I was proud to advocate for the creation of a stamp like this, as it serves both as a celebration of the achievement and as a reminder that the search for a cure continues.

On the same day, the Minister of Health opened the World Health Organization's summit to launch a Global Diabetes Compact, which seeks to improve the diagnosis rate and care for people living with diabetes. She highlighted this bill and said:

Canada has a proud history of diabetes research and innovation. From the discovery of insulin in 1921 to one hundred years later, we continue working to support people living with diabetes. But we cannot take on diabetes alone. We must each share knowledge and foster international collaboration to help people with diabetes live longer, healthier lives — in Canada and around the world.

The director general of the WHO said:

The number of people with diabetes has quadrupled in the last 40 years. It is the only major noncommunicable disease for which the risk of dying early is going up, rather than down. ...The Global Diabetes Compact will help to catalyze political commitment for action to increase the accessibility and affordability of life-saving medicines for diabetes and also for its prevention and diagnosis.

This is why now is the time for all levels of government in Canada to work with stakeholders and create our own strategy to fight and ultimately end this disease, one that coordinates funding for awareness, prevention, education, data collection, treatment and research that will improve health outcomes for all Canadians and one day lead to a cure.

Diabetes rates are three times to four times higher among first nations than among the general Canadian population. Furthermore, indigenous individuals are diagnosed with type 2 diabetes at a younger age than other individuals.

In my own community of Brampton, every sixth resident has diabetes or prediabetes. The COVID-19 pandemic has increased the challenges faced by people living with diabetes, who are at an increased risk of developing severe symptoms and dying from this infectious disease. Furthermore, the economic insecurity, lack of physical activity and mental health struggles associated with the pandemic all have a negative impact on those living with diabetes.

A national framework for diabetes would provide a common direction for all stakeholders to address diabetes and other chronic diseases with the same common risk factors. It would enhance coordinated efforts across federal, provincial and territorial jurisdictions and provide a mechanism for tracking and reporting on progress.

The government needs to conduct its own consultation and stakeholder engagement. However, one proposed strategy that could be taken into consideration for the national framework, and which has been considered by the health committee, is diabetes 360°. This was developed in collaboration with more than 120 stakeholders and has strong support not only from the entire diabetes community but also from other key health stakeholders.

I would like to thank all the individuals and organizations that have supported this bill and helped it come together. That support means a lot to me and I know it will make a difference in the lives of 11 million Canadians living with diabetes or prediabetes.

Back in the spring of 2019, I was proud to bring forward the unanimously supported motion to declare November as Diabetes Awareness Month in Canada, but now it is time for more than awareness. It is time for action. Canada, 100 years ago, made the biggest leap in the treatment of diabetes.

Let us pass Bill C-237 today and send it to the Senate. I am very hopeful that passing this bill will help millions of Canadians who are fighting this disease. Canada gave insulin to the world. Why can we not lead the way?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, I would like to thank the member for Brampton South for all of her advocacy on diabetes all these years and for a great speech today.

Beyond the national framework that is definitely needed, there are other things the government could do. The member mentioned a 360° Canada plan. Diabetes Canada has been asking for $150 million of funding from the federal government for a number of years and it has not been funded. Also, the pharmacare the Liberals have been talking about has not been brought forward and there are many people who cannot afford to buy their diabetes medications.

Can the member say whether the Liberal government will support those two things?

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I would like to thank the member, who I serve with on the health committee, for her leadership. The government, of course, needs to conduct its own consultation and engage stakeholders. Diabetes Canada has done great work in putting together its 360° strategy. I hope the minister will take this work into consideration when crafting an official framework, as well as the other testimony and recommendations found in our HESA report. She was in the committee when we did the HESA report. It was a great report.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Madam Speaker, we have to applaud our colleague's hard work and dedication with respect to this important disease.

Each of our provinces has an association, and Diabetes Québec is doing great work in Quebec.

What does my colleague think of the purpose and scope of this national strategy given that this is a provincial responsibility?

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I would like to thank the Diabetes Québec association. While I recognize my colleague's interest in creating health transfers to the provinces, during the pandemic the federal government has been there to support that. This includes over $19 billion in the safe restart agreement. It was announced that an additional $4 billion would be given to the provinces through the Canada health transfer and another $1 billion to help with the vaccine rollout. We have stepped up to help all provinces, including Quebec. We will work Diabetes Québec and all provinces. As I said in my bill, we will work with the Diabetes Québec association, provinces and territories—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

The hon. member for North Island—Powell River.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I want to thank the member for bringing forward this private member's bill on this really important issue. Not too long ago, before COVID, I had two young people come and speak to me about juvenile diabetes. One of the biggest challenges was that in one province, all of the things they required were free and part of the program, but in another province they were not. We had outcomes of health that were completely different simply because of the province people were born in.

Does the member agree that diabetes-related medications, supplies and equipment should be included as part of a universal, comprehensive and public pharmacare program?

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I would like to thank the member for sharing her story and for her advocacy. I agree that no Canadian should have to choose between paying for prescription medication and necessities, like rent or putting food on the table. I would like to remind the member that since taking office, this government has taken historic action to lower drug prices, including by introducing new rules for patent drugs so Canadians can buy their medicine easily. We need to do a lot more. I thank the member for sharing her story and for her advocacy for her constituents. We will work together to pass this bill—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

We will go to a very short question from the hon. Parliamentary Secretary to the Minister of Finance.

[Sean Fraser, Liberal, Parliamentary Secretary to the Deputy Prime Minister and Minister of Finance and to the Minister of Middle Class Prosperity and Associate Minister of Finance]

Madam Speaker, I want to start by thanking my colleague for championing the issue of support for families and individuals with diabetes since I have known her, when we were both elected in 2015.

The families I speak with talk often about the serious burden that exists to manage diabetes for themselves or their children, but we do not often hear about the importance from an economic point of view, given the immense cost of diabetes across the health care systems in Canada. I wonder if the hon. member can offer comment not only on the importance of doing this because it is the right thing to do to support people and families, but also the fact that it is the smart thing to do to alleviate the immense burden that lack of proper diabetes care puts on our health care systems.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I would like to congratulate the member on the great work in the budget regarding diabetes. I am so thankful. I know this is very important because it is a big burden on the health care system, as we know through the Diabetes Canada website, with $40 billion until 2026. This budget is a recovery plan for job growth and resilience, to finish the fight against COVID-19 to ensure that we—

[The Assistant Deputy Speaker (Mrs. Alexandra Mendès), Alexandra Mendes]

Resuming debate, the hon. member for Sarnia—Lambton.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Madam Speaker, it is a pleasure to rise and speak to Bill C-237, the national framework for diabetes act.

I would like to thank the member for Brampton South for bringing it forward and for all her advocacy. From the time we were both elected in 2015, I have participated alongside her. We were both on the health committee when it came up with recommendations to the government on what it should do about diabetes. It is a serious issue for 11 million Canadians who have diabetes or prediabetes. That report was important.

The hon. member has also done numerous other things to raise awareness of diabetes on the Hill. I can remember an event for all the MPs to get tested, to understand how they could see the risk factors for diabetes and find out whether or not they actually had prediabetes or diabetes. That was great. There was another time when we brought in a mobile unit that had the ability to test and treat. These mobile units are very important here in Canada, especially in rural and remote places where, in many cases, it is very difficult to get access to a physician and the medical care that is so important to people who are living with diabetes.

For that, I congratulate the member. I am happy to see this bill being supported unanimously at committee, along with the support for the amendment that the Conservatives brought forward.

For those who are not aware of the different types of diabetes, 11 million Canadians have diabetes or prediabetes. Type 1 diabetics are people who cannot produce insulin, and there are 1.1 million of them. In order to get the insulin they need, they need to either inject it or use insulin pumps, a new technology that has really upgraded the quality of life for individuals. However, those pumps are $7,000 or $8,000, so affordability is a key issue there.

The most common type of diabetes is type 2. These individuals cannot use the insulin they are producing, or they are not producing enough insulin, and there are 9.9 million Canadians in this category. There are things that can lessen the risk of developing type 2 diabetes, including healthy eating and regular exercise. However, once people have this condition, they are going to require insulin therapy, medications and sometimes glucose monitoring. There have been good advances in the technology of glucose monitoring that have really improved the quality of life. Again, there is an affordability issue for some.

Canada began this 100 years ago, with Banting and Best and insulin, and we have continued to excel in technology in this area.

The bill itself is a national framework, and as part of that it is going to bring prevention and treatment. There will be training and an emphasis on educational needs, which I think is important. The more people know about diabetes, the risks and how they can prevent or minimize the impact, the better. There is also an important part on research and data collection. The government, over decades, has done excellent work to support diabetes research in Canada, and that needs to continue, along with the data collection.

The other part of the bill is information and knowledge sharing, related to preventing and treating diabetes. This will be important because this is a disease that can develop into other complicated conditions. Kidney disease is a common outcome for those who are at risk and who cannot control their insulin levels. Many have foot and leg problems that can result in amputation. There are eye diseases, and increase in heart attack and stroke. All of these issues are not just tragic for the individual, but also a cost to the health care system.

The parliamentary secretary previously made a comment that bringing in this national framework is not just the right thing to do, but it is also a cost-benefit. We know that if diabetes is not adequately controlled in an individual, an emergency room call is $1,500 and an amputation is $90,000. All of these things are incredibly costly to the health care system.

Although some concerns have been raised about whether or not the bill will be a problem with provincial jurisdiction, I would say that the provinces absolutely are open to receiving more federal funding to cover things and to do the right thing to prevent more expensive conditions from developing.

In fact, my own national framework on palliative care is a great example of how the federal government can work alongside the provinces to provide the supplemental things that do not exist at the provincial level and to have the provinces use their funding to accelerate the plan. With the palliative care framework, many things related to education, research and data collection, as in this bill, were put in place, but then the provinces also came alongside with money for hospice and for training paramedics and extending all kinds of things that have resulted in more people having access. My hope is that we will see the same thing with this bill. It is important.

The amendment that the Conservatives brought had to do with the disability tax credit. Members may remember that a few years ago there was a change made by CRA and 80% of people who previously were approved for the disability tax credit, which helps people pay for the medications and supplies they need as people living with diabetes, now became 80% rejected, and it was a long period of time of outcry from the opposition parties before the government set that right.

To be fair, the intent of the government was that if people were not eligible for the tax credit, they also were not eligible for the disability pension plan. That plan had been in effect for 10 years, and each individual who qualified had about $150,000 in the account, so there was a bit of a nefarious attempt to try to take that money away, which fortunately we were able to correct and get that in place.

Our amendment was to make sure that the CRA is administering the disability tax credit fairly and that the disability tax credit is designed to help as many persons with diabetes as possible and is achieving its objectives. This will provide a bit of oversight to ensure that this kind of thing does not happen again, and that will be very important.

What the bill does not do is provide some of the other funding that will be needed, and some of it has been talked about already. Diabetes Canada does an amazing job of making people aware, helping people living with diabetes, and providing tools and training, but it has a 360° initiative, calling on the federal government for quite a number of years, from the time I was the shadow health minister, and it has not been funded at any point. We need to see the government seriously consider, with 11 million Canadians living with this condition, that we have to be preventive in nature.

There are a lot of initiatives that also could be supported, like Participaction, getting people more fit. If we can get children more fit and eating more nutritiously, this is a key factor in preventing people from having type 2 diabetes, so that is an action that the government could take.

When it comes to pharmacare, the Liberals have been talking about this since 1992. Many provinces have plans already in place, and there is a very small number of Canadians who do not have coverage, but in particular there are people with diabetes who are not able to afford their medications. It is a larger cost to the system overall and something that should be addressed and could be quickly addressed through organizations like Diabetes Canada.

In terms of this framework, obviously I am a passionate advocate as well for eliminating diabetes and doing everything we can to help those individuals. I, as well as the Conservative Party, will be supporting this private member's bill. The member is to be commended for her continued advocacy and for her persistence in bringing more and more good ideas to the table. We can see from the reaction of the various parties that everyone wants to work together, alongside the provinces and territories and our indigenous organizations, to make sure that all people living with diabetes receive the help they need.

[Monique Pauzé, Bloc, Repentigny, QC]

Madam Speaker, some diseases quietly besiege their victims and can eventually compromise their health and threaten their very survival.

Diabetes is one such disease. More and more people are aware of diabetes because a growing number of Canadians and Quebeckers are being diagnosed with it. Personally, the disease has not affected me or any of my family members or friends.

However, in my work as the member of Parliament for Repentigny, I met Juliette Benoît for the first time in October 2018. Juliette was 13, and she came to Parliament Hill to raise parliamentarians' awareness of a disease that tends to be poorly understood by the general public, type 1 diabetes. This disease generally appears in young people under 20 and is characterized by the total absence of insulin production. People with this type of diabetes must have daily insulin injections or be fitted with an insulin pump to survive. Like Juliette, approximately 10% of people with diabetes have type 1 diabetes.

This young girl captured my attention the moment I met her. A few words that come to mind when I think of her are eloquent, precise, determined and brave. She wants to help advance the research on a potentially life-threatening disease that she has had since she was 11 years old. That is why she got involved in the Juvenile Diabetes Research Foundation, which could not ask for a better ambassador.

I have to say that it is because of Juliette Benoît that I am currently a member of the all-party juvenile diabetes caucus. Juliette took a personal problem and used it as an opportunity to shine the light on a disease that affects nearly 300,000 people in Canada. She convinced me to get more involved in this cause and she used her disease to become a force for change. That is wonderful to see.

I thank the member for Brampton South for introducing Bill C-237, which seeks to establish a national framework for diabetes. Section 2 of the bill explains that the national framework must include measures to:

(a) explain what diabetes and prediabetes are;

(b) identify the training, education and guidance needs of health care and other professionals related to the prevention and treatment of diabetes, including clinical practice guidelines;

(c) promote research and improve data collection on diabetes prevention and treatment;

(d) promote information and knowledge sharing in relation to diabetes prevention and treatment;

(e) take into consideration any existing diabetes prevention and treatment frameworks, strategies and best practices, including those that focus on addressing health inequalities; and

(f) ensure that the Canada Revenue Agency is administering the disability tax credit fairly and that the credit, in order to achieve its purposes, is designed to help as many persons with diabetes as possible.

Bill C-237 gives the government one year to develop the strategic framework and five years to report on its effectiveness. The bill provides for the strategy to be designed in consultation with the provincial governments and Quebec. If the bill moves forward, the Bloc Québécois must ensure that the national framework reflects the demands of Quebec and respects its jurisdiction, because that matters to us. Certain aspects of clause 2 fall under the jurisdiction of Quebec and the provinces.

I already mentioned Juliette, who is living with type 1 diabetes, and now I would like to talk briefly about the two other kinds of diabetes, type 2 and gestational diabetes.

In Canada in 2020, of the more than 3.7 million diagnosed cases of type 1 and type 2 diabetes combined, 90% were type 2. This type of diabetes usually appears in adulthood, in individuals 40 years of age and older. Because of rising obesity rates, diabetes is starting to appear in increasingly younger populations, sometimes as early as childhood in certain risk groups. People with type 2 diabetes cannot properly use the insulin made by their bodies, and they eventually produce less and less of this essential hormone.

Between 3% and 20% of pregnant women experience an increase in blood glucose levels beginning in the second or third trimester of pregnancy. In most cases, this gestational diabetes disappears after the birth, but the mother is at risk of developing type 2 diabetes in the years that follow.

It goes without saying that women should be monitored properly in the months and years after they give birth. That being said, we can all agree that this bill provides a framework that proposes objectives, actions and ambitions that have already been broadly discussed in several specialized forums, including the annual meetings of doctors who specialize in endocrinology and pediatric endocrinology. Seminars, symposiums and research institutes also investigate this sometimes misunderstood and long-stigmatized disease, which may affect more than 13.5 million Canadian citizens in 2030.

Canada is the birthplace of the discovery of insulin. This year marks the 100th anniversary of that discovery, and it is to Canada's credit that it is allocating resources to the advancement of research into diabetes, among other things. This is precisely where the government should be providing support, in addition to increasing transfers, of course.

Research into diabetes and medical treatment for it are advancing quickly. Note that the fact that there are five different types of diabetes has eluded researchers until very recently. In 2019, the renowned scientific journal The Lancet Diabetes & Endocrinology published this finding, made by a team of Scandinavian researchers. Having looked at cases characterized as atypical, these researchers are better prepared to prevent the onset of the disease and better treat people who develop it.

Also in 2019, American scientists in California grew insulin-producing cells in a laboratory. They describe their work as a major breakthrough that could lead to a cure for type 1 diabetes. I invite interested colleagues to read the journal Nature Cell Biology to learn about the science that could lead to a cure for insulin-dependent diabetes within a few years.

The prevalence of this disease is alarming, especially with children developing type 2 diabetes, which used to affect only adults, so the need for research will grow. Every aggravating factor leading to the development of diabetes should be meticulously studied, because not only will the health and social costs be enormous, but the direct costs to the health care system could reach almost $5 billion Canadian by 2030. This was a question asked earlier by the Parliamentary Secretary to the Minister of Finance. We may not have the same figures, as the member for Brampton South had a different figure, but it is important to remember that a great deal of money could be directed to other issues if we could find a cure for diabetes.

I spoke about Juliette at the beginning of my speech. What is she doing now, three years after our first meeting? She continues her advocacy with the Juvenile Diabetes Research Foundation. Last November, she participated in Kids for a Cure Lobby Day and shared her personal story with some MPs. She was surprised to see just how young some MPs are. Several are in their thirties, and some are even in their twenties. I believe that she is considering getting into politics. She is ambitious, disciplined and has everything it takes to make the world a better place. I thank her for talking to me about her hopes of making a difference for people with diabetes.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Madam Speaker, I am incredibly pleased to be here today to speak on Bill C-237, an act to establish a national framework for diabetes.

This is an incredibly important private member's bill, because it addresses something that really concerns me: The reality that people with diabetes across Canada are being treated very differently depending on what province or territory they live in. I thank the member for bringing this bill forward and for her passion on this very important issue. I am very happy to be here to discuss why it is important.

A couple of years ago, Juvenile Diabetes spokespersons came to have a conversation with me. I met with two teenagers, one from Alberta and one from British Columbia. As members in the House, we all have moments where we hear stories and think, “This is wrong,” and that we have do something to make it better. That day, I learned that people living with diabetes could have something inserted in their arms that would allow them to scan their blood sugar levels very quickly with their phones. There was no more need for pricking fingers or carrying around those tools: They could quickly scan to see how things were going and address them as needed. The problem is that in one teen's province, there is a monthly fee for this service, and in the other teen's province, there is no fee at all.

It really broke my heart when I heard from the mother of the teen who was in the province where a monthly fee was required. She and her husband had been doing really well paying that monthly fee, until her husband got hurt on the job and was off work. Their income went down significantly. The mother told me that one of the hardest choices they had to make was to acknowledge that they could no longer afford the monthly fee, which meant that their daughter had to have the pump removed and move forward.

No parent ever wants to do that. It completely broke my heart. I do not think any parent in the country would be happy if they had to make a decision between the health and well-being of their child and feeding them. I recognize that across Canada, many parents have children who have health issues. They really struggle to afford, or cannot afford, the basic medication they need to make sure that their children are well cared for, and this is one example. We need a better strategy. It is important to point out that a national pharmacare program would address this issue and ensure that parents would not be making choices, such as these parents had to, between their children's health and well-being and feeding them and keeping a roof over their heads.

The facts are very clear. Individuals with diabetes cannot regulate their blood sugar properly. Diabetes causes many physical health issues, and is a cause of debt for more than 7,000 Canadians every year. Diabetes also impacts the mental health of people who have diabetes, as well as their families. It is time for Canada to take this seriously, and the bill before us is one step towards doing so.

This bill asks the government to bring together all provinces, territories, indigenous leaders and stakeholder groups to create a plan to support those living with diabetes more holistically. Diabetes is a chronic disease, and it is so important that the federal government do more to support Canadians living with diabetes, particularly those who incur significant out-of-pocket costs because of it. Too many Canadians living with diabetes are unable to afford the medications, devices and supplies they need. When medication and supplies are unaffordable it leads to bigger health issues, which can lead to an early death. That is just not acceptable in a country as wealthy as ours. Families and loved ones feel this reality, and it is really scary for them to always worry about what they will do if they cannot afford what those people need.

Not too long ago, I received a message from a constituent who had just been diagnosed with diabetes, and she was really scared. She was not sure how she would afford the medication. When dealing with a chronic illness, the last thing the body needs is the stress of wondering, “Can I afford the most basic supplies and medication that I need?” We know that this is true. A recent report from the Canadian Federation of Nurses Unions found that 57% of Canadians with diabetes reported failing to adhere to their prescribed therapies due to affordability issues related to their medications, devices and supplies.

Fifty-seven per cent is more than half of Canadians who have this chronic disease. This is important because research indicates that when a chronic illness is managed, the expense is lower and the health of the individual increases. Preventative supports matter. They allow people to care of themselves and prevent repetitive visits to the emergency room caused by a lack of access to medications, devices and supplies.

Again, we have to think about what this means in Canada. It is one of the wealthiest countries in the world and these realities exist because people cannot afford their medication.

This is why Canada's New Democrats recognize that there is an urgent need to for universal, comprehensive and public pharmacare, a plan to ensure that all Canadians have access to the medications they need when they need them, that we do not have people like my constituents staying up half the night wondering how they will afford this new expense in their lives. This must include coverage for diabetes devices and supplies, such as test strips, syringes, insulin pumps and continuous glucose monitors.

Sadly, we have seen the reality that the Liberals and the Conservative governments, one after another, continue to deny this measure that would create a more affordable and a fair system to care for the well-being of people across Canada. It would save significant money by lessening emergency health care costs, which are extremely high and terrible for the health of people who cannot afford their medication. Universal health care would also support businesses that have multiple challenges when they have a team member or a loved one who has health issues. In some cases, even with health insurance people cannot afford the cost of their medication.

Just weeks ago we heard the government make promises, but when it actually had an opportunity to support pharmacare, it said no. How many times do Canadians have to wait and ask again for this human rights-based approach?

I will be supporting this bill. It is a step that will at least support people living with diabetes. I hope the government will support it as well. The concerning reality is that so many families that apply for the disability tax credit when they have children who are born with diabetes lose it when those children come into adulthood. The Government of Canada has rejected these applicants in the past. When is in place, I hope it stops denying this small tax credit. Most important, ensuring that people have access to the RRSPs they invested in for many years is absolutely key for me.

There is a lot of injustice for people living with chronic illness. I hope the bill will at least help one portion of the community. However, I want to remind everyone in the House that only pharmacare will make it a more fair system for everyone in the country.