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.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Mr. Speaker, I would like to thank all of the speakers tonight because I think they have brought so much warmth to this discussion. The fact is that diabetes, as all speakers have said, is something that is preventable in 90% of cases. I think this is a great time to all join together and talk about this.

I am so glad it is you in the chair, Mr. Speaker, because I can share with you the types of phrases that are used in my house, or my mom and dad's house, every day. Any time I walk into my parents' house I hear, “Karen, your father's sugar is high. Ask your dad how many cookies he ate today. Your father's sugar was at 15 and he is miserable." This is all I hear: “Your father's sugar is high” and “Karen, are you watching your sugar?” These are my parents. They love me.

I am from a family where many of my elderly relatives have been challenged with diabetes. That is why I am so happy to speak on this bill today, Bill C-237, a national framework for diabetes act, which is focused on prevention and treatment. According to Diabetes Canada, there are 11 million Canadians living with diabetes or prediabetes. These are really important things, so we have to understand the three different types of diabetes there are and what we can do as well.

I am going to start off with the least simple one, which is type 1 diabetes, and then I will talk about what many of us have discussed, which is type 2 diabetes.

Type 1 is an autoimmune condition where the immune system mistakenly attacks and destroys the beta cells in the pancreas that produce insulin. The damage is permanent. If we look at who is going to have these issues, we recognize that type 1 diabetes mostly impacts people before the age of 35, though it can develop later on in life as well.

It is one of those things that people are born with, or there is something determining that they will end up with type 1 diabetes, whether genetics or whatever it may be. There is no solution to what is causing these issues. These are things I think many families are very concerned with because having a child who has diabetes is life altering. This is something I look at as a mom.

The research being done through our juvenile diabetes associations and all of those groups is really important because of the impact type 1 diabetes has, especially on our youth. I am sure everybody in this House has probably seen a young person on a field playing soccer, baseball, or whatever it may be, with a pump on their side.

The first time I saw that was probably about 15 years ago. A young girl came to my house to visit with the kids and she had her own insulin pump. It is incredible to think of this very active child and of her parents knowing she is on the soccer field and there is a chance of her passing out or having issues at any time. This national strategy is important because it would help all families.

We understand this form of diabetes is an autoimmune disease where the body is not able to create insulin, so we have to ensure we have the technology and the advancements to make sure that person has a whole life. I am talking about these young children. Earlier in my career, I had some people come in from the Juvenile Diabetes Research Foundation, the JDRF.

It was great when they came in because they were talking about some of these little pieces they were wearing on their hips that showed how many carbohydrates they had in their diet, what proteins and all of these things. Having a framework and funding is so important because this is a disease we can do more about.

Type 2 diabetes is something that we talk about most often, and 90% of diabetes cases are type 2. This has more to do with insulin resistance, where the insulin hormone is not used efficiently. That takes me back to first year university biology, when we talked about the impacts on the kidneys if the pancreas is not working, which can have a very negative effect on a person's life.

We will talk more about that because I think, when talking about type 2 diabetes, we can really pinpoint what we can do. There truly is a path to limit and reduce the number of people who are living with diabetes. There is prevention, and that is why I think this is a really important strategy as well.

Gestational diabetes is an issue that pregnant women have when insulin-blocking hormones occur, and we see many women going through their last weeks of pregnancy with diabetes. In many cases, it goes away quickly and they will be fine, but there are some cases we have to be concerned with.

Diabetes, as I indicated, has been an important part of my life. I think of my family members who have lived with it. I remember back in the mid-1970s when my grandmother came to live with us because she had to have her leg amputated due to diabetes. Of the common issues there are with diabetes, amputation seems to be very common, especially when we are talking about 45 years ago. It is incredible to see how things have changed in the last 45 years. We are not seeing as many amputations. We are seeing that proper care and maintenance that needs to be done.

With someone who has type 2 diabetes, we have to be worried about heart and stroke issues, nerve damage, and the eyes and retinopathy. There are many factors that we use to control and manage these things. That is why I think that with type 2 diabetes, we really need to look at a national strategy.

This plan would be very useful in seeing how can we have a national strategy that really takes some of the best practices from our provinces and territories. We can work together, ensure that the research is being done and see how we can assist by funding. We can assist the provinces and territories in recognizing that we are a partner here. We are not the main game holder, but we can enhance people's lives.

In some of the key factors of managing and controlling, we need to look at nutrition and fitness, including meal planning, healthy eating, exercise and activity, and weight management. To drill down into this more specifically, I pulled out a report from 2012 done by the Government of Ontario focusing on some of the key recommendations. Many of the diabetes factors and many of the things we can move forward on are truly common sense things.

For instance, we can reduce obesity. We know that being overweight is a key factor to diabetes. What can we do? How can we ensure that somebody is going to increasing their physical fitness and activity? We know that with insulin, when someone is exercising, it is more controlled. Over those two or three hours of exercising, one's glucose tolerance actually starts to change with those activities. People should be aware of this.

We know that overall the physical exercise someone does will give them better health, including for their heart. We need to make sure that we are maintaining healthy weights. That is something I will be very honest about. I am not sure what I would be at a healthy weight. We know that, especially women. We can look at stress as another factor that can lead to this. Right now people are sitting at home due to stress, due to COVID and doing different routines.

We know a lot of people have packed on what some people call the “COVID 15”, or the “frosh 15”, if one went to university back in the nineties. A lot of people have gained a lot of extra weight. What are some things that we can do to ensure people are going to be healthy again? We know that maintaining a healthy meal plan and making sure we are eating proper foods are other ways of doing so, by having a healthy diet. Another thing is not to smoke. We know that with diabetes, smoking is something that can cause great complications.

I heard my colleague from the Bloc indicate this also, and I am very proud, being from Elgin—Middlesex—London, that we have a statue honouring Sir Frederick Banting who, in 1923, along with John James Rickard Macleod, was awarded the Nobel Prize in Medicine. They codiscovered insulin. This is the type of great work that we need to do. This was over a century ago. This is what we need to do. This is what makes our country better.

I really like the direction we are going in. I recognize that members from the government have talked about all the funding they have given and what they are doing for this. I just hope they stay on target, stay focused and get it done right. We know a lot of times that sometimes we may put money into it, but we are not sure if it is being spent properly. Are we focusing on what the provinces and territories need? How can we do that? I hope we do get it right.

To the member who put this forward, I do have great respect for her. I know she was one of the persons putting a motion forward so that we studied this in HESA. It is really important that we are doing that as well. I hope that we get this right.

This is something that we can do together. This is something that we should be proud of, if we come up with a strategy that works. I wish everyone the best on this going forward to make sure it gets to committee and we can look at it as thoroughly as possible.

[Christine Normandin, Bloc, Saint-Jean, QC]

Mr. Speaker, I, too, am pleased to speak to Bill C-237 on a national framework for diabetes, which was introduced by the member for Brampton South.

I think it is worth pointing out that we are talking about a bill and not a national strategy, even though we have had a lot of discussions about this in the past. The advantage of a bill is that the legal framework makes it possible to ensure better enforcement and better follow-up.

The bill states that the government has one year to establish the strategic framework and that it must assess the effectiveness of this national strategy five years after the report is tabled. That means that the bill already sets out a schedule and includes it in a legal framework, which is a positive step forward.

I am saying that because I am referring to the work that the Standing Committee on Health did after second reading and because my colleague from Montcalm asked the sponsor of Bill C-237, the member for Brampton South, some questions about the difference between what is happening now with the legal framework and the discussions that took place in the past with regard to national strategies. There have been discussions since 2005, and there have been debates about Diabetes 360° since 2018, so we wanted to know why we now need a legislative framework for all of this.

We were told that having a legislative framework is ultimately a good thing. It ensures that these intentions are not just wishful thinking and that there is follow-through.

Ms. Hanson of Diabetes Canada was asked about Diabetes 360°, the strategy that was recommended three times in a row and is also included in budget 2021. She was asked if the government had backed the strategy with funding. She answered that it had not yet done so.

After conducting a study on a national strategy, the Standing Committee on Health issued its recommendations. We tried to determine if these recommendations had been implemented by the government. It was not clear.

Thanks to the work of members, we now have a legislative framework and we can expect, or at least hope for, further outcomes and concrete action to fight diabetes.

I want to talk about Bill C-237 sponsored by the member for Brampton South by quoting from subclause 2(2) and speaking about the concerns that the bill addresses. Paragraph 2(2)(a) states that the national framework must include measures to “explain what diabetes and prediabetes are”. It is important to know this and, as MPs, the bill informs us.

I would like to provide some statistics. Diabetes affects 11 million Canadians. Diabetes Quebec estimates that in Quebec alone, roughly 880,000 people have diabetes, and a quarter of a million do not even realize it. They are living with diabetes without knowing it.

Every day, about 20 Canadians die of complications from diabetes. Diabetes is responsible for roughly 25% of heart operations, 40% of kidney failure, and 50% of non-traumatic limb amputations, even today.

For Canadians with diabetes, the risk of getting seriously ill from COVID-19 is twice as high, and the risk of dying is three times higher than normal. It is often harder to treat people with diabetes for viral infections because of the blood sugar fluctuations this can cause.

This is also about the people affected by diabetes. One in five adolescents with type 1 diabetes also suffers from depression, which is twice as high as the average. This affects people differently than the illness itself. Diabetes is also the primary cause of blindness in adults under 65. Diabetes has a major impact.

Paragraph 2(2)(b) of the bill states that there must be measures to “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”.

The Bloc Québécois position on this is that Bill C-237 must not have an impact on Quebec's jurisdictions. However, we are not against virtue, and I will refer to the principle of the bill, which states that everything must be done in collaboration with the other levels of government, but also with the different stakeholders on the ground.

We hope that this means there will be a better distribution of tasks related not only to diabetes prevention and research, but also to caring for individuals with diabetes.

Paragraph 2(2)(c) of Bill C-237 states that the bill aims to “promote research and improve data collection on diabetes prevention and treatment”. Just today, we adopted Motion No. 38, which calls for the creation of a standing committee on science and research. We expect that this issue will be of interest to the committee and that it can look into diabetes.

Data collection can be done through the Public Health Agency of Canada, which is a federal entity. It is important to do it because Ms. Hanso of Diabetes Canada mentioned in committee that currently, in Canada, it is difficult to say how many of the people who have been diagnosed with diabetes have type 1 and how many have type 2. Apparently that is not yet clear.

Prevention is especially important, because over 50% of cases of type 2 diabetes are preventable. The importance of prevention in this context is vital.

Paragraph 2(2)(d) of Bill C-237 requires measures to “promote information and knowledge sharing in relation to diabetes prevention and treatment”. In terms of prevention, some things fall specifically under federal jurisdiction, like the labelling of less healthy, sugary products. That is part of disease prevention, and it falls under federal jurisdiction.

As I mentioned earlier, regarding the importance of coordination, that has to be done with the provincial governments or health officials, indigenous groups and other stakeholders, to be sure to avoid any duplication in the services offered and in terms of responsibilities. We have to make sure no one falls through the proverbial cracks.

Paragraph 2(2)(e) of Bill C-237 requires measures to “take into consideration any existing diabetes prevention and treatment frameworks, strategies and best practices, including those that focus on addressing health inequalities”. It is worth taking a moment to discuss the situation of indigenous people. For various reasons, in some communities, the prevalence of type 2 diabetes is four to five times higher than in the general population.

Investments have been made in the past to try to correct this situation, but we can expect a national framework to be more effective, particularly in three areas. In terms of prevention, we must ensure that awareness campaigns on healthy living are conducted in the communities. We also need better screening to ensure that residents of indigenous communities who have diabetes without realizing it can receive treatment quickly and avoid complications. It is also important to ensure that the treatments adhere to the guidelines and that a consistent approach is taken in order to reduce mortality and comorbidity, since this is a matter that may fall under federal jurisdiction.

Paragraph 2(2)(f) of Bill C-237 reads as follows:

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.

As we know, the expenses associated with diabetes are very high. It can cost people with diabetes more than $1,500 per year. It has been reported that 30% of Canadians with diabetes cannot follow prescribed treatments because of the cost. These aspects speak to the relevance of Bill C-237.

Bills like this remind us that it is important for members to work together. It is nice to see something other than what happens during question period, to remind us that we can achieve a great deal when we work together. It also gives us the opportunity to learn more about one another. For instance, I learned that the member for Brampton South is a trained cardiology technologist and worked in health care for 18 years. I saw how much she cares about this issue.

In closing, I want to emphasize the wonderful collaboration we have seen on this issue with a quotation from my colleague from Repentigny, who is a member of the all-party diabetes caucus. She often says this in another context, but I think it really applies here: “If you want to go fast, go alone, but if you want to go far, go together”.

I hope that we will be able to go a lot further to tackle diabetes, for we will have done it by working together as parliamentarians.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, it is an honour to speak in support of my bill today. I want to start by thanking my colleague for Beaches—East York who generously gave up his slot so we could complete debate on this bill.

I also want to thank everyone who supported my private member's bill, Bill C-237, an act to establish a national framework for diabetes in Canada, and all members who contributed to the debate on this bill.

I would especially like to thank the organizations that have helped to support the bill: Diabetes Canada, JDRF, Diabetes Action Canada, the CNIB and many more organizations. I would like to thank researchers, like Dr. Peter Senior from the University of Alberta and Dr. Karen Cross from St. Michael's Hospital in Toronto, not just for supporting the bill but for the hard work they do fighting diabetes that will some day lead to a cure.

Locally, I would like to thank people like Mayor Brown and the Brampton Council, Mayor Crombie of Mississauga, our Medical Officer of Health, Dr. Lawrence Loh, and the CEO of William Osler Health System, Dr. Naveed Mohammad. They know how important this issue is in our community and across Canada.

I know that when we pass the bill and send it to the Senate it will have just as much support there. I give thanks for the support of senators Marie-Françoise Mégie, Nancy Hartling, Patricia Bovey and many others. With a national framework for diabetes we can introduce a nation-wide effort to prevent, treat and finally end diabetes. If we pass this framework, it will help millions of Canadians living with pre-diabetes or diabetes.

A national framework for diabetes must identify the training, education and best practices of health care and other professionals who treat diabetes. It must improve data collection and promote information and knowledge-sharing in relation to diabetes prevention and treatment. It must take into consideration any existing frameworks, especially those that focus on addressing health inequalities. Finally, it must fund and promote research that will one day lead to a cure.

Last week, I met with Laura from Ottawa west, Nepean. She is a 23-year-old who has been living with diabetes type I since she was seven years old. She spoke about how there were early signs. Her teachers and parents did not immediately recognize it for what it was. This is why we need to improve education and awareness so that everyone can recognize the early signs and get treated accordingly.

I also met with Dr. Cathy Felderhof from Cape Breton Island, who told me about the challenges of providing care for rural indigenous people and how diabetes interacts with mental health and other social factors of health. It is so important that experts like her and doctors who treat a variety of patients in the regions across Canada are brought together to help develop this strategy.

Indigenous populations face many factors, including socio-economic factors, that contribute to high rates of diabetes and create barriers to accessing proper treatment. In my city of Brampton, one in six community members has diabetes or pre-diabetes. The COVID-19 pandemic has increased the challenges faced by people living with diabetes who are at an increased risk of developing severe symptoms. Economic insecurity, lack of physical activity and struggles with mental health during this pandemic have all had a negative impact on those living with diabetes.

Treating diabetes is expected to cost the health care system in Canada almost $40 billion by 2028. This projected cost is concerning and it could be reduced if we pass Bill C-237 into law. A national framework for diabetes would provide guidelines to address diabetes and invest in prevention and education about the disease and in data collection. With this framework, we can see valuable input from stakeholders such as Diabetes Canada, JDRF and programs such as Diabetes 360°. This year, we are celebrating the 100th anniversary of the discovery of insulin at the University of Toronto by Sir Frederick Banting and his colleagues. Canada gave insulin to the world. It is time for Canada to once again lead the way in the fight against diabetes.

[The Deputy Speaker, Bruce Stanton]

Accordingly, the question is on the motion. If any member of a recognized party present in the House wishes to request a recorded division, that the motion be adopted on division or that the motion be carried, I would invite them to rise and indicate so to the Chair.

[Rosemarie Falk, Conservative, Battlefords—Lloydminster, SK]

Mr. Speaker, I would ask for a recorded division.

[The Deputy Speaker, Bruce Stanton]

Accordingly, pursuant to order made on January 25, the division stands deferred until Wednesday, June 2 at the expiry of the time provided for Oral Questions.

The House resumed from May 26 consideration of the motion that Bill C-237, An Act to establish a national framework for diabetes, be read the third time and passed.

[The Speaker, Anthony Rota]

It being 3.18 p.m., pursuant to order made on January 25, the House will now proceed to the taking of the deferred recorded division on the motion at third reading stage of Bill C-237, under Private Members' Business.

Call in the members.

(The House divided on the motion, which was agreed to on the following division:)

Vote #124

[The Speaker, Anthony Rota]

I declare the motion carried.

(Bill read the third time and passed)