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

[Mark Gerretsen, Liberal, Kingston and the Islands, ON]

Mr. Speaker, it is an honour to rise today to speak to this private member's bill, which has been brought forward by the member for Brampton South. I want to congratulate her on taking her private member's opportunity to bring forward a bill or motion and put it to such a meaningful and important cause.

I used to sit very close to the member for Brampton South in the House, and I know her passion for health care and making sure that the most vulnerable in our communities, especially as related to health, are taken care of. In the last session of Parliament, on a number of occasions while sitting next to each other, she talked to me about the need for something to be done nationally on diabetes. In this Parliament's lottery, she was very lucky to have her spot near the top of the list and had an opportunity to do something. To see this bill brought forward by the member for Brampton South is truly rewarding, because I now that she is doing something that she is extremely passionate about. Indeed, she has been a leader in bringing members from different parties in this House together to talk about diabetes and the strategy that the federal government should take.

When we talk about a disease that affects over three million Canadians, I must admit that I was kind of surprised to learn that we did not already have a strategy of some form in place as it relates to making sure that we have a coordinated effort across the country in fighting diabetes. As indicated by a number of people in this House in the previous hour of debate on this bill, it is something that affects so many Canadians and their quality of life.

In many instances, diabetes is a preventable disease. Of the roughly 200,000 Canadians newly diagnosed with diabetes, approximately 90% is the preventable type 2. When we think of the growth in the aging Canadian population, the number of Canadians expected to live with diabetes obviously grows as well. Putting in measures to make sure that we have a national strategy as it relates to educating health care professionals on how to prevent and treat diabetes is critical, probably more important than at any time previously in fighting this particular disease, with the exception, of course, as mentioned by the previous speaker from the NDP, of the invention of insulin.

I am so glad to see so much support throughout the House from various parties, and it appears as if the bill might pass unanimously. It is telling of how this Parliament can come together and work together here in this place, but also show the desire to work with our counterparts at the provincial, territorial and municipal levels to make sure that all Canadians throughout Canada can have a meaningful framework in place so they are taken care of in the event they get diabetes and, in fact, to help prevent that from being the case.

It is very rewarding and I am very proud to be part of a government that has brought forward many initiatives on health care throughout the various budgets that have been presented since 2015. I would note that, in budget 2021, there is $25 million over a five-year period, starting in 2021, specifically for Health Canada for additional investments in research on diabetes, specifically juvenile diabetes, surveillance and prevention, and to work towards developing a national framework on diabetes.

This private member's bill dovetails nicely with what this government is already in the course of doing in terms of making sure that we continue to advance the research, prevention and education around diabetes. Indeed, Bill C-237 will be developed in consultation with provinces and territories, indigenous groups and other stakeholders to help support improved access to prevention and treatment and better health outcomes for all Canadians.

One of the various elements that have been brought forward is the $25 million over five years, which I mentioned, but in budget 2021 there is also a proposal for $10 million over five years for the Public Health Agency of Canada for a new diabetes challenge prize. Specifically, this initiative would help surface novel approaches to diabetes prevention and promote the development and testing of new interventions to reduce the risks associated with type 2 diabetes.

As has been illustrated by both the government approach and members of this House, including the member who brought forward this bill and members from other parties who have been speaking in favour of it, this is something this Parliament really does see as an opportunity to seize on this issue and to advance the objectives of Parliament and those health objectives for the benefit of all Canadians. I am very proud to be supporting this. Knowing we can have such a great impact on the lives of so many Canadians is something deeply meaningful to all members of this House.

I will conclude with where I started, which is that I am very encouraged to see this member use her opportunity through this private member's bill to bring forward something that will have a meaningful, large impact on a number of Canadians throughout this country. Indeed, if the national strategy is developed in the right way and brought forward in a way that really helps prevent people from getting diabetes, the value of her impact will be immeasurable, because down the road many people may end up not getting type 2 diabetes in particular because of the prevention measures that would be put in place here.

This member knows a lot about this topic. As I indicated before, she was very passionate about it and spoke very passionately about it. I know that before coming into Parliament she was in the health profession specifically. I always like to see examples of people who come to this House with previous knowledge outside of government and its workings, people who have a specific passion, perhaps from a former profession, and bring it here and apply it to policy. What could be more rewarding than working in a profession and then bringing it to the seat of democracy for our nation and putting that knowledge into actual, practical use and turning it into legislation, as it appears this member will be doing through this bill, given the fact that all parties have indicated they are going to be supporting it?

I will not use up any more time, but I am very much looking forward to adopting this and having a vote on it at the end of this hour of debate, and moving on with this strategy so we can see the national framework be developed for all Canadians.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Mr. Speaker, we are here this evening to discuss Bill C-237, otherwise known as an act to establish a national framework for diabetes.

The purpose of this legislation is to promote and improve access to diabetes prevention and treatment. It is sponsored by my colleague from Brampton South and is going into the third stage, in other words, third reading.

To summarize Bill C-237, it seeks to explain what diabetes and prediabetes are; identify the training, education and guidance needs of health care and other professionals related to the prevention and treatment of diabetes; promote research and improve data collection in order to enhance the knowledge and information sharing required to conduct research; and ensure that the Canada Revenue Agency is administering the disability tax credit fairly so that it can help as many persons with diabetes as possible.

The legislation gives the government one year to develop the policy framework, and within five years the government must evaluate its effectiveness and revise it, of course, if necessary.

It should be noted that since 2016 Health Canada's Centre for Chronic Disease Prevention and Control has been managing the diabetes strategy. This plan is very general and contains more policy statements than meaningful measures.

Key aspects are essentially the same as the previous plan. That is why countless organizations are calling for a national plan or framework.

The Bloc Québécois is in favour of developing a national framework for diabetes. To oppose it in light of the medical catastrophe that this chronic disease represents would be just wrong.

However, it is imperative that this framework be developed with the demands of Quebec and the provinces in mind and, again, that the division of powers be respected.

In a way, health is a competitive jurisdiction since it involves some overlap between the provincial and federal governments. In the area of health, Quebec must have maximum authority and control. That is what we want and that is what we will have.

The federal government does have a role to play in prevention, and that includes working to stop the rampant obesity rates in this country. Obesity significantly increases a person's chance of becoming diabetic. Although Quebec is doing well compared to the other Canadian provinces and many major countries in the world, one in four Quebeckers is obese and will be obese in the coming years.

Diabetes Canada, the most influential diabetes organization in Canada, does not operate in Quebec. Instead, Quebec is fortunate to have Diabetes Québec, which provides information and support to its members and contributes to research. In 1994, the organization even founded Entraide diabétique du Québec, a separate organization that collects donations to help people with diabetes.

There are three main types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes. In all three types, the disease is characterized by chronic hyperglycemia, or high blood sugar, which means that the person's glucose levels are too high.

Insulin abnormalities mean that sugar does not enter the body's cells to provide energy, but remains in the bloodstream anyway. This condition, which is lethal if left untreated, has a strong impact on susceptibility to cardiovascular disease, blindness and kidney failure, among others. Obviously, this type of disease can lead to limb amputations due to the factors listed previously.

With 442 million adults affected worldwide, diabetes truly is a global scourge, and Quebec is not spared. According to the Public Health Agency of Canada, one in 10 Quebeckers has diabetes or pre-diabetes. The financial burden of diabetes is naturally staggering. According to Quebec's public health department, we are talking about $3 billion a year.

The good news is that almost 90% of type 2 diabetes cases can be prevented or even cured by adopting healthy lifestyle habits. This is why it is imperative to take preventive action by educating people about healthy lifestyle habits, including good nutrition and exercise.

However, we would be deluding ourselves if we thought that the ball is entirely in our court. The sugar lobbies are obviously working hard to slow down, dilute or nip in the bud any form of legislation that might seek to reduce refined sugars.

Legislating for a tax on products containing refined sugar, honest labelling or a restriction on the advertising of these products would prove to be a difficult but necessary task.

Conversely, we must also point out that the diabetes epidemic is a boon for pharmaceutical companies. In 2016, global profits from sales of insulin reached almost $50 billion. It is extremely difficult to conduct an effective prevention campaign when going up against powerful pharmaceutical companies, which boast that they can help people with diabetes live a normal life, even though that may be stretching the truth.

While waiting to win this battle, it is vital that we continue and even redouble our efforts to provide adequate services. Medical research is making great strides, but it is not enough. We also know which communities are the most vulnerable to diabetes. In Quebec and Canada, it is first nations. The rate of diabetes in these communities is five times greater than that in Quebec and Canada.

To address this problem, Health Canada has invested approximately $50 million per year since 1989, mainly through the aboriginal diabetes initiative. Organizations are tasked with working with indigenous peoples to reduce health inequalities. At this time, much more still has to be done, and the federal government will have to invest far more than $50 million a year to reverse the current trend. That, however, is a debate for another day.

It was exactly 100 years ago in Ontario, in the magnificent country of Canada, that insulin was discovered by a team of medical researchers. For their work, Frederick Banting and John Macleod were awarded the Nobel Prize in Medicine two years later, in 1923.

As a pioneer in diabetes research and its treatment, Canada must have a clear and ambitious national framework. Nevertheless, the Bloc Québécois's support is contingent on the federal government respecting input from the provinces and Quebec and on the division of powers, which is what the Bloc Québécois wants. We will vote in favour of the bill as is because it does meet all the necessary criteria so far. Bill C-237 does not promise to eradicate the scourge of diabetes within the next few years, but it is a very acceptable solution even so.

Before I wrap up, I want to highlight the work of an organization in my riding, the Association du diabète Laval, Laurentides, which has been working tirelessly since 1984 to educate people about diabetes and share knowledge through presentations and workshops.

I would like to take this opportunity to thank hospitals and clinics in my riding and the rest of Quebec for the work they do every day to fight diabetes.

I applaud the medical professionals responsible for diagnosing and supporting patients with diabetes and improving their quality of life.

Lastly, I want to thank the researchers—

The House resumed from May 3 consideration of the motion that Bill C-237, An Act to establish a national framework for diabetes, be read the third time and passed.

[Tony Baldinelli, Conservative, Niagara Falls, ON]

Madam Speaker, it is my pleasure to rise today to speak to this bill. Bill C-237, the national framework for diabetes act, would direct the Minister of Health to develop a national framework to support diabetes prevention and treatment in consultation with relevant stakeholders. That is a key aspect of what this bill talks about. It would require the Minister of Health to hold at least one conference with relevant stakeholders to develop the described framework.

As we talk about stakeholders, it is my pleasure to stand in my place today to share with the House the advocacy efforts and work of one of my own constituents, Maya Webster. Maya is 10 years old, and she will continue advocating for type 1 diabetes research until a cure is discovered.

This past November, Maya took part in a lobby effort with more than 30 other delegates as part of the Juvenile Diabetes Research Foundation's Kids for a Cure Lobby Day 2020. JDRF is a global charitable organization with the goal of ending type 1 diabetes through research funding and advocacy. Kids for a Cure 2020 was a week-long virtual event that connected youth delegates with Canada's decision-makers and politicians. They were able to illustrate the daily challenges faced by people living with type 1 diabetes and to ask for more direct support from the government.

The foundation had three main asks during that lobby effort. They asked for the federal government to renew a partnership with JDRF and the Canadian Institutes of Health and Research, and for the federal government to create a national diabetes strategy, which is why we are here today. They also asked for more people to be able to access the disability tax credit. As Maya explains, “What I'm doing this year, and what I did in 2018 with this, is trying to find the cure because as much as I have insulin it still isn't a cure”.

As part of their consultation, delegates created virtual slide shows to give personal overviews of what living—

[Len Webber, Conservative, Calgary Confederation, AB]

Madam Speaker, it is my pleasure to speak today to Bill C-237, which proposes a national framework for diabetes.

The bill has been brought forward by our colleague, the member for Brampton South, and I would like to take a moment to comment on her dedication to seeing this bill passed and her overall concern for the health of Canadians.

The member, who I served with for many years on the health committee, has always been one of the most non-partisan and collegial members of the committee. Her sincere desire to improve health outcomes for Canadians has always been her underlying motivation, and it has been an absolute pleasure to work with her on that committee.

The situation with diabetes in Canada is truly shocking. About three million Canadians live with diabetes. One in three children and one in 10 adults live with the disease. People with diabetes are over three times more likely to be hospitalized with cardiovascular disease, 12 times more likely to be hospitalized with end-stage renal disease and almost 20 times more likely to be hospitalized for non-traumatic lower limb amputation compared to the general population. Diabetes contributes to 30% of strokes, 40% of heart attacks, 50% of kidney failure requiring dialysis, 70% of all non-traumatic leg and foot amputations and is leading the cause of blindness in Canada.

The direct cost to our health care system just last year was $3.8 billion. It is estimated to rise to about $5 billion by 2030. That is a huge weight on our health care system.

There is no doubt that diabetes is a serious chronic disease and it is on the rise. It is a disease that occurs when the body is either unable to sufficiently produce or properly use insulin. Over time, left untreated, it can damage blood vessels, nerves and organs such kidneys, eyes and heart, resulting in the serious complications that I mentioned, and ultimately death. It poses a challenge not only to those living with the disease, but also to their families, communities and the health care system. Therefore, any investment in reducing the rate of diabetes in our country should translate into long-term savings to our health care system. It just makes senses that we deal with this issue head on and deal with it now.

Also, each year close to 200,000 Canadians are newly diagnosed and many more diagnosed as prediabetic. Not all individuals with prediabetes will develop diabetes, but the chances increase if steps are not taken to manage it. Fortunately, recent studies have shown that changes in lifestyle, primarily diet, physical activity and weight management, can delay or even halt the progression. However, there is no question that we need to look at diabetes as a national problem and come up with a national framework, which Bill C-237 proposes.

The aging of the Canadian population, largely a result of baby boom cohort, has been one of the major factors contributing to the increase in the number of Canadians living with diagnosed diabetes. The increasing incidence is shocking. If any other health issue like cancer had increased in comparison, we would declare a national emergency and pull every fire alarm. Why do we not do it in this case? I believe it is because of the ongoing and unfair stigma that those with diabetes are simply lazy, unhealthy and authors of their own problems, which is simply not the case.

Diabetes is complex and the people affected by it are not always in full control of their health conditions. We need to stop thinking that this is entirely a lack of personal health. At the same time, we should also not underestimate the importance of maintaining a healthy weight and lifestyle.

As part of any national framework on addressing diabetes, it is critically important that we look at the issue of organ donation. I know the member for Brampton South is also very supportive of organ donation and improving our system in Canada.

Diabetes, at its root, is a malfunctioning pancreas that fails to make the necessary amounts of insulin at the right time. For type 1 diabetes, there is some hope people could receive a pancreas and/or a kidney transplant. A transplant can cure this problem and eliminate the need for insulin shots, but we need more people to donate these life-saving organs.

For those who undergo a pancreas transplant, the survival rate exceeds 95% after one year and more than 88% after the five-year mark. It is possible to be a living donor and donate a pancreas, but this is rare and most donations come from deceased donors. Typically, these transplants last 10 to 12 years, so unfortunately multiple transplants and multiple donors are required over time.

When it comes to kidney donations, the situation in Canada is quite dire, with more than 3,300 people on the waiting list. The demand is high because kidney transplants are in need for more than just diabetics. The wait time can range from months to years. Many never get their second chance at life.

The good news is that people can be living kidney donors. They can donate one of their kidneys to save another. I admire the member for Edmonton Manning, who did so for his son. Of course, live donations are a complex process and are required because we do not have enough deceased donors.

The point is this: Canadians can dramatically improve the life and health of type 1 diabetics by becoming organ donors, so I strongly encourage all Canadians to register on their provincial organ donation registries and let their loved ones know of their decision.

Sadly, a pancreas transplant is not really an option for those with type 2 diabetes because that type of diabetes occurs when the body generates a resistance to insulin or is unable to utilize it properly. Type 1 diabetics make up about 10% of those with diabetes. Their bodies just do not make insulin, which is a situation where a pancreatic transplant would be required.

A constituent of mine, Brooklyn Rhead, a grade 12 student at St. Francis High School, was diagnosed with type 1 diabetes in February of last year. She suffered severe symptoms for about a year before her diagnosis. Her symptoms included extreme thirst, hair loss, fatigue, inability to concentrate and weight loss.

As part of Brooklyn's efforts, she has set out to increase awareness of type 1 diabetes and to raise $5,000 for diabetes research at her high school. So far, she has raised $3,900. I am confident that she will reach her goal, so I applaud her. More than 300,000 Canadians have type 1 diabetes, and Brooklyn's efforts are creating awareness. It is an important contribution to finding the answers.

Many are desperately longing for a cure. We know there is a need for a cure. We know there is political will. We know the need is urgent. We know the need is growing. As Parliamentarians, we need to move this bill along as quickly as possible to make that difference.

From my own personal experience, I have seen excellent pieces of legislation die when an election is called, so I hope we can get this to the Senate and get it passed as soon as possible before a writ is possibly dropped. Brooklyn and three million other Canadians are watching. They are counting on us to get the job done, so let us get it done.

[Kevin Lamoureux, Liberal, Parliamentary Secretary to the President of the Queen’s Privy Council for Canada and Minister of Intergovernmental Affairs and to the Leader of the Government in the House of Commons]

Madam Speaker, it is a pleasure to speak to Bill C-237, an act to establish a national framework for diabetes. Once again, I applaud my colleague and friend from Brampton South who has been a staunch advocate for such an important issue that affects millions of Canadians.

Having a national framework for diabetes is long overdue. I want to take the time, first and foremost, to recognize the need. It is important to note the impact diabetes has on the health of over three million people in Canada. Including Canadians who are prediabetic, that number is closer to 10 million-plus, keeping in mind our population of 37.5 million people today.

As a government, we continue working with our partners, including provinces and territories, indigenous organizations, stakeholders and organizations such as Diabetes Canada, to strengthen the efforts that support diabetes prevention and care for all Canadians. For me, it is about prevention and treatment, and there is so much we can do.

I have had the opportunity to speak on this before. I want to emphasize Diabetes Canada and the fantastic work it does. In fact, people can get all the relevant information they need from it, not to mention all the things they can do to improve the quality of their lives or, in some cases, minimize the negative impacts diabetes has on people through healthy living and so forth. If they go to diabetes.ca, there is ample information.

From my perspective, Diabetes Canada clearly shows leadership. As a national organization, it can assist regional organizations. My colleague has hit this right on, that there is a need for a national perspective, a national framework designed to support and improve Canadians' access to information on diabetes prevention and treatment. This bill is all about that. It is about working with provinces and territories, indigenous leaders, communities, different stakeholders, bringing them together and making a real difference. I am hopeful that we can pass the bill.

There are two types of diabetes, and I got this information from the diabetes.ca website, which contains quality of information. Type 1 diabetes is an autoimmune disease and is also known as an insulin-dependent diabetes. People with type 1 diabetes are not able to produce their own insulin and cannot regulate their blood sugar because their body is attacking the pancreas. The website states:

Roughly 10 per cent of people living with diabetes have type 1, insulin-dependent diabetes. Type 1 diabetes generally develops in childhood or adolescence, but can also develop in adulthood. People with type 1 need to inject insulin or use an insulin pump to ensure their bodies have the right amount of insulin.

There is so much we can be doing from a national perspective by encouraging, promoting and supporting, in whatever ways we can, a national strategy.

I commend my colleague from Brampton and those individuals who were there to support her initiative to bring the bill to the floor of the House of Commons. I trust and hope that my colleagues on all sides of the House will see fit to pass this bill as soon as possible, maybe even today.

[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 most 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.

[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.

[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.

[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?

The House proceeded to the consideration of Bill C-237, An Act to establish a national framework for diabetes, as reported (with amendment) from the committee.

[Chris d'Entremont, Conservative, West Nova, NS]

Mr. Chair, I move that Bill C-237, in clause 2, be amended by adding after line 21, on page 2, the following:

(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.

Simply put, there has been an ongoing challenge for people with diabetes to qualify for the disability tax credit. A number of organizations have expressed the difficulty of that. I can attest as a parent that it was probably the third try before we were able to get it for André. I can imagine for individuals who are not as lucky as we are to be able to work for themselves and get these kinds of things done....

It's simply to try to facilitate the work and to acknowledge that there is a disability tax credit there. I think it's a very easy and calming kind of resolution, without changing the intention of the bill.

[Sonia Sidhu, Liberal, Brampton South, ON]

That is why Bill C-237 is a pathway towards a strategy. Diabetes 360° is an example of such a strategy.

It isn't appropriate to tell Health Canada what should be implemented at this point, but I [Technical difficulty—Editor] and research plan, and we must let Health Canada look at it for implementation. That is why it's a pathway. I know Diabetes Canada is working well together with us. That is why I brought forward Bill C-237.

We need that strategy. I personally support diabetes 360° and the next level. That is why I brought forward Bill C-237. We need a strategy.

[Kimberley Hanson]

Yes, thank you, Monsieur Thériault.

I think there's no difference between a national framework and a national strategy. When we were drafting diabetes 360°, we debated strongly which words to use to describe what we were trying to accomplish. It is Diabetes Canada's fervent hope that when Bill C-237 passes into law, the framework that it requires to be tabled before Parliament will be heavily inspired by or informed by the diabetes 360° strategic framework.

I can't speak to why we find ourselves in the position that we do in 2021, but I can say that we've seen in the case of other illnesses or disease groups—such as cancer—that when we take a coordinated approach, when we help facilitate information sharing and the sharing of best practices across jurisdictions, we can materially improve the health care of Canadians and really make a difference in reducing the impact of these diseases. I would definitely agree that it's past time that we acted, but the only time we have is now, so let's act now to embrace this bill and move forward.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Van Bynen. It's a great question. Thank you for your support all the way.

You're right. We need to consult with the indigenous stakeholders as well because, as you know, on reserve and in indigenous populations there are higher rates than with any others. We need to consult with indigenous stakeholders, provinces and territories. The government needs to consult with the stakeholders such as Diabetes Canada and JDRF and listen to the proposals.

Ms. Hanson mentioned diabetes 360°, which we all supported in the HESA committee. It has very good aspects and I hope it can address many indigenous concerns as well.

There have been consultations on subjects that help those with diabetes. For other aspects, like Canada's food guide, there has not been a national holistic consultation called for, and that is why my bill calls for that. It would bring together both levels of government, indigenous partners and other stakeholders with the common goal of creating a national diabetes strategy, which I'm asking for in my bill, Bill C-237.

It's also to address Canadians of all different ages and demographics, and will be sensitive to cultures and socio-economic backgrounds, too.