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.

Financial Statement of Minister of Finance

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I rise in the House today to discuss our government's priorities in budget 2024. I will be splitting my time with the member for Winnipeg South Centre.

In my speech today I want to focus on certain priority areas for my residents in Brampton South that I believe this budget responds well to. As I met with families, businesses and organizations in my riding, I have heard about serious issues and challenges that they wanted their federal government to address. Issues such as addressing auto theft, implementing national pharmacare and supporting our youth, seniors and families are just some of the concerns I have heard from my residents. I am going to highlight some effective advocacy of the members on this side of the House that has helped us achieve important progress and fairness in Brampton and for millions of Canadians.

Let me start with the response to auto theft. I have heard through consultation, as well as on the doorsteps of my residents, that we need to work together with all levels of government to urgently respond to this issue. This is exactly what we are doing.

Hundreds of cars have been stolen. Auto theft is not a victimless crime. It harms thousands of Canadians every year. No one should wake up to discover the car they use to get to work, school or the grocery store has been taken from them. This is why the Liberal government is cracking down on auto theft with a robust plan to make it harder to steal and export vehicles.

Members of the 905 caucus, the auto caucus and the Brampton caucus have also advocated for tougher penalties for the offenders, something we have heard from our local law enforcement. This is why the government is also moving forward with harsher penalties under the Criminal Code for those who commit an auto theft-related offence.

Budget 2024 announces the government's intent to amend the Criminal Code to provide additional tools for law enforcement and prosecutors to address auto theft. New criminal offences will be created related to auto theft, such as possession of an electronic device used to steal cars, and new offences for those who involve youth in their crimes.

Most stolen cars leave our country through the ports, and this is where we are putting our attention. Earlier this year, I attended the national summit on combatting auto theft where we raised the concerns of our residents about making sure we take measures to secure our ports. One of the key resolutions of the summit was the commitment of Transport Canada to work with public safety partners to identify cargo-handling risks through targeted security assessments of port facilities.

CBSA has been an important partner in fighting auto theft. Our local Peel Regional Police has one of the largest investigative teams in the country, and we are directing our federal agencies through this funding to increase collaboration on investigations. This includes exploring detection technology solutions and exploring the use of advanced analytical tools, such as artificial intelligence. We will continue our work to protect Canadian families.

Speaking of Canadian families, this budget reinforces an important national program that has already been delivering for thousands of Canadians, which is child care. Before I go any further, I want to recognize the work of our status of women committee on this file in our ongoing study on women's economic empowerment. I also want to take a moment to thank all members of the Standing Committee on the Status of Women for their hard work.

It is important to do everything we can to support our children. That is why the government launched a Canada-wide affordable child care system in 2021, with the final agreement announced in my riding of Brampton South. We know that more needs to be done to ensure that even more families are able to secure space for their children. This is why budget 2024 proposes to launch a child care expansion loan program. The program would offer low-cost loans and non-repayable contributions to public and not-for-profit child care providers to build more child care spaces and renovate child care centres. The new child care spaces created through the program would increase access to affordable child care in Brampton and across Canada, saving more families thousands of dollars per child every year.

We know that we need to do more to support our children, as nearly one in four do not get enough food. This has real impacts on their opportunities to grow and learn, which is why the federal government is taking decisive action to launch a new national school food program and work with provinces, territories and indigenous partners to expand access to school food programs. The national school food program is expected to provide meals for more than 400,000 kids each year. This program would ensure that our future generations have what they need to grow and help make Canada a better place for all.

As a mother, I know that it is important for us to support our children when they grow up and start their careers. Those of Canada's generation Z need the confidence of knowing they will find a good job that will help them get ahead. To help younger Canadians pursue and achieve their dreams, the government is investing to create more youth job opportunities and ensure that hard work pays off for the next generation. Budget 2024 is proposing that the Government of Canada creates 90,000 youth job placements across the country. That includes a significant expansion of the Canada summer jobs program and the youth employment and skills strategy program.

This would mean that moms and dads in Brampton could count on the availability of good jobs for their children who are starting their careers. These jobs will help students gain much needed work experience and support in areas facing labour shortages, such as health care or in senior homes. In my riding of Brampton South, I know Holland Christian Homes. There are many senior homes where students have worked before, and they will now have the opportunity to work again.

Speaking of our seniors, we know that, after a lifetime of working hard, Canadians deserve to know they have a secure and comfortable retirement. Their golden years are meant to be spent in retirement with their families. Canada's social safety net delivers the promise of a safe and secure retirement for everyone.

Seniors rely on these investments to keep a roof over their heads and food on their plates. The government's largest program, old age security, will deliver security to more than seven million seniors this year, and our government has increased the maximum GIS benefit for single seniors.

Nine provinces and territories have announced agreements with the federal government so far. We have also been working hard on the aging with dignity agreement, which would provide $5.4 billion to include access to home care. After a lifetime of their hard work and helping Canada through some of its toughest times, we have our seniors' backs.

As chair of the all-party diabetes caucus, I am proud of our government's commitments to the national diabetes framework and launching a national pharmacare program. This is something I have been advocating for since I passed my Bill C-237, an act to establish a national framework for diabetes. Our government is now investing in a national pharmacare strategy with a focus on diabetes medication and supplies.

Budget 2024 proposes to provide 1.5 billion dollars over five years, starting in 2024-25, to Health Canada to support the launch of the national pharmacare plan. This investment would save Canadians thousands of dollars per year on contraceptives, as well as diabetes medication and supplies. Improving access to diabetes medication will help improve the health of millions of Canadians. That will reduce the risk of serious life-threatening health complications.

Budget 2024 is delivering fairness for every generation. That is why I urge all members of Parliament to support the passage of the bill.

Diabetes

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, November is Diabetes Awareness Month in Canada.

Earlier this week, I attended the Canadian screening of The Human Trial, a Hollywood documentary by a Canadian filmmaker, Lisa Hepner, on the incredible work of researchers to find the cure for diabetes.

Canada is not only the birthplace of insulin, but Canadian researchers also discovered stem cells, islet cells and developed the Edmonton protocol.

Canadians living with diabetes know that we are united in our support for them as we supported Bill C‑237, which established the national framework for diabetes.

Next week on November 14, I will be proud to host the third annual World Diabetes Day flag-raising ceremony in my city of Brampton. I invite all residents to join me.

Let us continue to combat diabetes together.

National Strategy for Eye Care Act

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I will be careful of that.

Unfortunately, the COVID-19 pandemic worsened the issue of vision loss in Canada, as eye surgeries were cancelled or delayed. Wait times to see vision care providers also increased over the course of the pandemic. That is why a national strategy for eye care is essential. It would provide a comprehensive road map, laying out a common direction and shared leadership. It would build collaboration among researchers, medical professionals and community organizations to develop innovative approaches to combat eye diseases and preserve sight.

In 2021, the CNIB opened a new centre in Brampton South, providing access to innovative technology and training for Bramptonians with sight loss. It is doing incredible work, and I am confident that Bill C-284 would bring us one step closer to empowering Canadians impacted by blindness with an integrated approach.

As members in this House know, Bill C-237, the National Framework for Diabetes Act, passed unanimously in 2021. I want to touch on how blindness can be a serious complication because of diabetes retinopathy, and I also want to recognize Diabetes Canada's work on this issue as well.

Earlier this year, I met an advocate named Ryan and his dog named Joe. Ryan lives with diabetic retinopathy. He told me about the challenges Canadians with vision impairments face using their insulin pumps. He and many other Canadians are experiencing these hardships, so we need to work together to remove those barriers.

Living with blindness, especially as a result of chronic disease, is an experience that is difficult for people without visual impairment to truly understand. This further underscores the need to have a coordinated strategy so that we can work together with provinces and territories, indigenous peoples and other partners to improve health outcomes. Through this approach, we can proactively identify and intervene in cases of diabetic retinopathy, mitigating the risk of vision loss.

We know that with early intervention and coordinated care, vision loss can be preserved. Of vision loss cases, 75% can be prevented if patients are diagnosed early and have access to treatment. We know that providing hope and better health outcomes for individuals affected by eye diseases is transformational. Already, the Government of Canada is leading and supporting a range of activities related to eye disease prevention and treatment.

I would like to talk about the investments announced in budget 2023 to strengthen our public health care system.

Budget 2023 commits $196 billion in funding to support our health work force; reduce backlogs; expand access to family health, mental health and substance use services; and modernize our health system. This is to ensure provinces and territories can provide the high quality and timely health care Canadians expect and deserve.

We see the surgical backlogs and the impacts on our systems, and we are addressing that need. Surgical backlogs, including vision-related surgeries, are a key part of this plan and are a health system priority of this government. Budget 2023 includes a $2-billion one-time top-up to provinces and territories to address urgent pressures in emergency rooms, operating rooms and pediatric hospitals. In addition, Indigenous Services Canada’s non-insured health benefits program also provides vision care to eligible first nations and Inuit beneficiaries where they are not otherwise covered by other plans or programs.

The government has also made significant investments in vision loss prevention and research. Over the last five years, the Canadian Institutes of Health Research has invested approximately $61 million in vision-related research. This research spans the spectrum of prevention, diagnosis, treatment and management of various vision-related conditions.

These investments contribute to the evidence base needed to improve health systems and health outcomes for Canadians experiencing vision loss.

Finally, I wish to highlight that medically necessary vision care services are covered by provincial and territorial health insurance plans. Any vision care service that must be performed in a hospital is covered and supported under Canada’s public health care system. The federal government is committed to continue working with provinces and territories on our shared health priorities, including those related to vision care.

In conclusion, Bill C-284 would allow the Minister of Health to develop a national strategy to support the prevention and treatment of eye disease. It would facilitate engagement with provinces, territories, key stakeholders and partners to ensure that we are all pursuing common objectives in the vision care space, along with sharing best practices. This bill would complement existing work and research efforts, supported by provincial and territorial governments, and the Canadian Institutes for Health Research.

Once again, I wish to thank the hon. member for Humber River—Black Creek for putting forward this important bill. I know that my residents in Brampton South and, indeed, all Canadians are counting on us to act quickly to prevent and treat eye diseases. I encourage members to vote in favour, as we continue to strengthen our efforts on vision care in Canada.

Child Health Protection Act

[Jean-Denis Garon, Bloc, Mirabel, QC]

Madam Speaker, I am very pleased to see you back here in the House. I sincerely hope you had a nice summer. It was probably much like mine, with a lot of time spent resolving problems with passport applications. Of course, we always enjoy helping our constituents.

We are considering a bill with noble goals and intentions. Bill C-252 deals with the prohibition of food and beverage marketing directed at little children. I am pleased to speak to the bill because I will probably be at the standing committee on health for the clause-by-clause study. There are a number of items that I will be very interested in looking at; I will come back to that later.

First, we must acknowledge that there is an obesity problem among adults and children. If we believe a report from the public health officer for Quebec dating from 2016, the trend is still clear. Fully 52% of the population is overweight. Approximately 18% of people are obese, and that is also true among children between the ages of two and 17. In children aged two to 17, the prevalence of obesity or excess weight has increased from 15% to 26% over time. The diagnosis is clear. We need to act. I think there is a role for public policy-makers and governments to play. That is essentially what this bill does, without claiming to fix everything.

We know the long-term consequences of childhood obesity. There is no clear cause-and-effect relationship, but we do know that there is an epidemiological link to cardiovascular disease, diabetes, musculoskeletal conditions and certain cancers. Preventing these diseases becomes even more important. Obviously, this is a prevention bill. However, the Liberal government, which includes the member who introduced this bill, refuses to give Quebec and the provinces the health transfers they are calling for in order to be able to provide people with the necessary care.

I would therefore encourage my colleague to pressure her caucus and her government. I know her well because her riding is not far from mine. I know her constituents are like mine. They think health transfers are important. I also know she has a member of the National Assembly in her riding, one of the MNAs who unanimously called for health transfers. It is important to listen, but it is also important to look ahead, and there are a lot of good things in this bill.

Some will see this as proof the government thinks it knows everything. They will see the bill as a socialist conspiracy. That is pretty much what my Conservative colleague was insinuating.

I can actually hear a small child in the House of Commons. That child may one day be protected by this piece of legislation.

Children cannot differentiate between information and persuasion. Their brains are not capable of it. The Standing Committee on Health heard from the president of the Association des pédiatres du Québec about child development. Children begin to distinguish persuasion from content around four or five years of age, but it is not until they reach seven or eight that they can really tell the difference between ads and content. They may not really understand until they are 11 or 12.

Most of the time, these ads are not meant to convince anyone, to provide information or to help consumers make informed decisions. It is persuasion aimed at children who are not in a position to make rational and informed decisions, which is why we need to support them.

I can assure the House that the Bloc Québécois will vote in favour of the bill and this principle. I think it is a good thing. This bill is also consistent with the Quebec government's 2019 action plan to reduce the consumption of sugary drinks and promote water. Water can be drunk, but oil cannot. The Quebec government states in its report that the consumption of sugary drinks and the marketing practices that promote their consumption must be de-normalized. There is, after all, a cause and effect relationship.

Of course, someone in Alberta could always make comparisons and think they are just as thin as a Quebecker, and wonder why Quebeckers have advertizing laws. Such statements do not work. These statistics and comparisons between different jurisdictions are pretty shaky. This is counterfactual thinking, and these arguments are pretty weak. At the very least, it is hard to imagine that this bill will make the situation any worse.

Quebec's policy was obviously designed to prompt a reduction in the consumption of sugary drinks. The Bloc Québécois is here in Parliament to express the consensus of the Quebec National Assembly, the vision of Quebeckers and the vision of the Government of Quebec. It would be consistent with our mission in the Bloc Québécois to support this bill, at least at second reading so that it can be sent to committee.

This bill also reflects the recommendations made by the WHO in 2010. The Government of Quebec was not alone in considering this issue. This WHO report applies to the whole world, not just Quebec. One of the recommendations made by the WHO in its 2010 report reads as follows: “Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids...”. In short, we need to take action.

Experts have recognized that there is a link between marketing and consumption. We are not saying that it is a definitive link. We are saying that there is a link and we must act. That is consistent with the Quebec government's position, the Quebec government's strategy, the WHO's position and how the Bloc Québécois has voted in the past. I am thinking in particular of Bill C‑237, which, I believe, was passed unanimously by the House of Commons at first or second reading. We are being consistent with our past voting and support. We will continue in that vein with the bill being studied. There is also Bill C‑228 on food and beverage marketing directed at children; it died on the Order Paper.

It is only fitting that we support this bill. I invite my colleagues, including the Conservatives, to vote in favour of this bill. Let us support it because as parliamentarians we know that second reading is not a final step. If there are concerns to be addressed, corrections to be made and discussions required, I can assure my colleague on the Standing Committee on Health that she will find a colleague ready to work constructively on this bill, which I find quite promising. I know that it is well intentioned. Let us refer it to committee.

We are looking for some assurances in committee. First of all, Quebec did not help develop the federal, provincial and territorial framework for action to promote healthy weights. Quebec does not endorse any pan-Canadian response that encroaches on its jurisdictions, so we will have to ensure that this holds true for this bill. Furthermore, Quebec alone is responsible for developing and implementing programs to promote a healthy lifestyle within its borders. I say that, but, at first glance, it does not appear that the bill currently under consideration encroaches on our jurisdiction.

Plus, a simple reminder that Quebec has full jurisdiction over health matters, which I feel needs to be pointed out every day, if not every hour. Furthermore, we must ensure that the bill will not interfere with Quebec's jurisdiction over civil law. Section 248 of Quebec's Consumer Protection Act already prohibits advertising directed at children.

The bill does not seem to go much further, except that the Quebec legislation does not currently regulate store windows, displays, containers, packaging, labels, and so on. Some procedures will therefore need to be reviewed. Perhaps we will find out why my Conservative colleagues do not like the Quebec legislation.

I have said it many times and I will say it agin. The intention is good. The public health objective is good. The reasoning behind the bill is quite rational and well thought out. Now, once again, as is often the case with issues related to health legislation, there is a fine line between Quebec's jurisdiction and the federal government's jurisdiction. However, it is obviously worth it, because the health of our children is of the utmost importance. It is worth passing this bill at second reading, sitting down and studying it diligently. I invite all my fellow parliamentarians to do just that.

[Andrew Jones, Executive Director, Government Affairs, Policy and Advocacy, Diabetes Canada]

Thank you, Mr. Chair.

I'm Andrew Jones, executive director of government affairs, policy and advocacy at Diabetes Canada. It's a pleasure to be here this morning to assist in your study of Bill C-19. I'm looking forward to discussing an important issue for people affected by diabetes that aligns with your current study, which is the disability tax credit.

Before I dive into the details surrounding the disability tax credit, let me tell you a little about the burden of diabetes and a number of federal government initiatives from 2021 that are intended to address this burden.

Many of you will know that Canada gave the world the gift of insulin more than 100 years ago. It's a discovery that ranks among the leading achievements of medical research. Because of insulin, millions of people around the world with diabetes live long lives. However, insulin is not a cure and we are not at the finish line. Recently, Diabetes Canada released new diabetes figures that show a steady, continued increase in diabetes in our country, with 11.7 million people in Canada living with diabetes or prediabetes. Just a decade ago, that number was 9.2 million. That's a shocking 27% increase.

Diabetes continues to affect more Canadians than ever before, despite concerted effort and numerous diabetes-related accomplishments in Canada and throughout the world. There is no denying that diabetes is an epidemic.

The good news is that in 2021, in honour of the 100th anniversary of the discovery of insulin in Canada and in recognition of the huge and growing burden of diabetes on Canadians, the federal government and all parliamentarians made significant and laudable commitments to improve prevention, management and research in diabetes. Canada proudly co-hosted a World Health Organization symposium on diabetes in April 2021, and jointly with them, launched the global diabetes compact.

The 2021 federal budget contained important commitments to funding research and developing a national diabetes framework. On June 29, 2021, royal assent was received for Bill C-237, An Act to establish a national framework for diabetes, which was unanimously supported by all parliamentarians. These commitments laid a critical foundation that we can build upon to meaningfully reduce the burden of diabetes in Canada by implementing the recommendations of Diabetes Canada's diabetes 360° nationwide strategy.

Diabetes Canada is eager to continue to collaborate with the federal government on this important and urgent work. Diabetes Canada continues to recommend that the federal government dedicate the necessary financial and human resources required to realize the 2021 budget and Bill C-237 commitments to implement a national diabetes framework, based on the diabetes 360° framework, as quickly and comprehensively as possible. Previous stakeholder consultations suggest an investment of $150 million in funding over seven years.

I'd like to also take a moment to discuss with you our concerns surrounding the disability tax credit.

I know our friends in the diabetes community, JDRF, appeared before you last week. You may be comforted to know that our position regarding the disability tax credit is well aligned with what you heard last week from JDRF.

We at Diabetes Canada ask that the federal government consider granting eligibility for the disability tax credit to all Canadians with diabetes who are on insulin therapy. We maintain that the current eligibility criteria that requires a life-sustaining therapy for an average of at least 14 hours per week is antiquated and unfair.

Furthermore, we support recommendation 14 of the Canada Revenue Agency's disability advisory committee. They recommend replacing the current eligibility requirements, including the 14-hour rule, with the following: “Individuals who require life-sustaining therapies...are eligible for the [disability tax credit] because of the time required to administer these therapies.... Without them, the individual could not survive or would face serious life-threatening challenges.”

Insulin therapy is on the recommended list of therapies. We believe that anyone who is on insulin therapy, regardless of whether they are living with type 1 or type 2 diabetes, would qualify for the disability tax credit following the advisory committee's recommendation because unfortunately without insulin, they would not survive or they would face serious, life-threatening challenges.

Everyone with type 1 diabetes and some people with type 2 need to use insulin as a treatment. To determine a dose of insulin multiple times a day, people with diabetes must problem solve, make numerous decisions and undertake many activities. These include consulting regularly with their diabetes specialist, checking blood sugar six or more times a day and maintaining a record of the blood sugar levels. With that, they must identify trends requiring alterations to treatment, make complex calculations accounting for such things as the time of day, the amount or type of food they are eating, the activity or exercise they plan to do in the coming hours, how much stress they are under and whether they are fighting a cold or flu.

All of these factors can affect blood sugar levels. Many of these activities are not easily quantified and/or permitted to be counted towards the antiquated 14 hours a week disability tax credit eligibility criteria.

The disability tax credit helps offset costs and enables eligible Canadians with diabetes to manage their condition. We trust that you will amend Bill C-19 to make it easier and fairer for people living with diabetes and relying on life-sustaining therapy to qualify for the credit.

Thank you for your attention. I look forward to answering any questions you might have.

[Julie Dzerowicz, Liberal, Davenport, ON]

Thank you so much, Mr. Chair.

I want to thank all the presenters for their excellent presentations and for being here today.

My first question is for JDRF Canada.

In the last Parliament, my colleague Sonia Sidhu sponsored Bill C-237, which was adopted with support from all parties. Bill C-237 set a requirement for the government to present a national framework for diabetes. This framework, I understand, is due by the end of June.

Have you been consulted by the government on this framework, and what do you hope to see from it?

Health

[Jean-Yves Duclos, Liberal, Minister of Health]

Mr. Speaker, I would like first to thank the member for Brampton South for her strong advocacy on behalf of the diabetes community in Canada. We want to recognize the severe impact that diabetes has on three million Canadians who live with the disease and their families.

Thanks in large part to the hard work of the member of Parliament for Brampton South and her bill, Bill C-237, we are now developing a national framework for diabetes, strengthened by a $25-million investment from budget 2021. There is much more work to do, but thanks to the member and what we are going to do to prevent diabetes and care for people, we are going to get there.

[Sonia Sidhu, Liberal, Brampton South, ON]

Mr. Speaker, to commemorate the 100th anniversary of the discovery of insulin in Canada, we raised the World Diabetes Day flag in Brampton to raise awareness. In June, the House passed Bill C-237, which will lead to a national diabetes strategy.

Can the Minister of Health tell us what steps the government is taking to ensure that Canada is leading in the fight against diabetes?

[Justin Trudeau, Liberal, Prime Minister]

Mr. Speaker, I want to thank the member for Brampton South for her unwavering advocacy on behalf of Canadians living with diabetes.

We recognize the impact that diabetes has had on the health of Canadians and their families. That is why, in budget 2021, we are investing $35 million to develop a national framework for diabetes to help Canadians get access to prevention and care. This will build on the important legislation put forward by the member in Bill C-237.

We will keep working to support diabetes prevention and care for all Canadians.

[The Chair, Liberal, Ron McKinnon]

Welcome, everyone, to meeting number 40 of the House of Commons Standing Committee on Health.

The committee is meeting today pursuant to Standing Order 106(4), as requested by four members of the committee, to discuss a work plan until the summer recess.

Before I recognize Ms. Rempel Garner to move her motion, I would like to acknowledge and recognize that Ms. Sidhu's private member's bill, C-237, an act to establish a national framework for diabetes, just passed third reading in the House. On my own behalf, and since it passed unanimously, I dare say on behalf of the committee as well, congratulations indeed.

Ms. Rempel Garner, if you please, go ahead.

National Framework for Diabetes Act

[The Speaker, Liberal, 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 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.

[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. Ken Cloth 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.

[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.

[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.