Finance Committee on June 3rd, 2024

[Carolyn Webb]

What the coalition has been calling for is that all schools that have a program would provide access to all children in the school.

We know, as you say, that this program will not reach all children and youth to start. It is a start. It will allow some programs to scale up from one small snack to a full meal during the day. It will allow expanding into more rural and remote areas and really supporting the programs that we want to see.

Our call is that this is a first step along the way. It is that we need more provincial-territorial investment and that we need more federal investment as we move along. Our vision is a full program whereby all students will have access to a healthy meal at school each day.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm not in the room, but my spider senses tell me the chair is.

[The Chair, Liberal, Peter Fonseca]

I know time is short and we have had excellent witnesses here for our first panel today. We want to thank them for their testimony and wish them the best for the rest of their day.

Now we're going to suspend as we transition into our second panel for today.

Thank you.

[The Chair, Liberal, Peter Fonseca]

Welcome back, everybody.

We are going to get started with our second panel of witnesses for today. We're going to hear their opening remarks right now.

From the Giganawenimaanaanig #231 implementation committee, we have Ms. DeLaronde.

From the Heart and Stroke Foundation of Canada, we have the vice-president for policy and advocacy, Manuel Arango.

From the Natural Health Products Protection Association, we have Mr. Shawn Buckley, who is a constitutional lawyer with them.

On that, we'll hear from Ms. DeLaronde, please.

[Sandra DeLaronde, Executive Director, Gi-Ganawenima'Anaanig #231 Implementation Committee (Manitoba)]

Good morning.

Thank you for the opportunity to attend this morning's hearing, and thank you for taking a run at pronouncing the name of our organization in Anishinabe. It means “we all take care of them”.

Today I would like to speak to you about the inclusion of the red dress alert and the financing provided to Search the Landfill. My remarks will be brief.

We appreciate the inclusion of up to $1.3 million over a period of three years for the creation of a pilot project on the red dress alert for missing indigenous women and girls and gender-diverse relatives.

We acknowledge that in May 2023, Parliament unanimously recognized that there is a Canada-wide emergency as a result of the disproportionate number of missing and murdered indigenous women, girls and 2SLGBTQQIA relatives in Canada. For those of us directly involved, this acknowledgement represented recognition of the ongoing gendered and race-based genocide occurring in our country. This decision gave us hope for real and substantive change.

Throughout the winter of 2023, while most Canadians were preparing for Christmas, we as a committee and as a community were involved in providing our input into the consultations around what a red dress alert system should look like.

In February 2024, the federal-provincial-territorial indigenous organizations table reviewed the findings of these consultations. We are pleased that these findings have been incorporated into the 2024 budget.

We remain concerned that this allocation addresses only engagement, not the full implementation of the red dress alert, or whatever it will ultimately be called. The safety and well-being of our vulnerable and targeted populations continue to be at risk. Families, survivors and all those involved in these matters need decisive action. We remain hopeful that this allocation will pave the way for meaningful progress and meaningful implementation of a red dress alert.

Further, we are grateful for the support provided by Canada and Manitoba to the families that have been impacted by the murder of their loved ones—Mashkode Bizhiki'ikwe Iban, Morgan Harris, Rebecca Contois and Marcedes Myran—and are currently involved in the court case. The contributions of governments have made a difference in providing support to their families to attend court and to receive the necessary support as they see fit.

We remain concerned, based on the evidence that has come out in court, that this is not simply a recovery operation but that this landfill remains a crime scene. We want to see this investigation or recovery led by those responsible for criminal justice.

We continue to call for United Nations oversight of this operation and investigative process, given Canada's commitment to the UN Declaration on the Rights of Indigenous Peoples.

The difference in searching for loved ones between the municipalities of Winnipeg and Saskatoon—Saskatoon began its search in May for one individual—further affirms that there must be additional investigation on how this decision-making process was made by the Winnipeg Police Service. At this point, it is not believed that the Winnipeg Police Service can be left alone to do this important work. Again, we call on oversight by the United Nations on this case.

Thank you.

[The Chair, Liberal, Peter Fonseca]

Thank you, Ms. DeLaronde.

Now we will hear from the Heart and Stroke Foundation of Canada. Please go ahead, Mr. Arango.

[Manuel Arango, Vice-President, Policy and Advocacy, Heart and Stroke Foundation of Canada]

Thank you very much, Mr. Chair.

Heart and Stroke appreciates the opportunity to appear before this committee to discuss Bill C-69, the budget implementation act.

I would like to address four measures today that were included in budget 2024, namely the school nutrition program funding, tobacco and vaping taxes, measures to address nicotine pouches, and pharmacare funding.

First, the $1-billion investment over the next five years to implement a national school nutrition program will greatly benefit the health and well-being of children in Canada. This investment is important to the one-third of students in elementary schools and two-thirds of students in secondary schools who do not eat a nutritious breakfast before school, leaving them at risk for learning, behavioural and health challenges at school.

The reality is that food insecurity puts people at risk for various chronic diseases, including heart disease and stroke. The annual economic burden to Canadians of chronic diseases, which is attributed to unhealthy eating and other modifiable risk factors, has been estimated at a staggering $28.2 billion. Canada is seeing increases in the rates of illnesses, such as type 2 diabetes, heart disease and cancer, much of it stemming from poor diets. In 2019, dietary risk factors contributed to an estimated 36,000 deaths in Canada.

Evidence shows that school food programs help to produce better health and education outcomes, including a reduction in the risk of chronic disease and improved mental health, as well as improved concentration and learning, which are associated with improved graduation rates.

School food programs can have significant positive economic impacts. A preliminary University of Guelph study suggested that a national program could stimulate the development of over 200,000 jobs. Also, a national school nutrition program can help to educate our kids on the value of local agriculture and the important role that local farmers play in supporting healthy diets. It will be key for this measure to be implemented, given that Canada is the only G7 country without a national school food program.

Heart and Stroke is also pleased to see strong action on tobacco and vaping control by way of increased taxation. Smoking remains the leading risk for premature death and disability in Canada. It places a burden on our economy, with over $11 billion in lost productivity and health care costs in 2020.

Also, Canada has some of the highest youth vaping rates in the world. The reality is that increased taxes on tobacco and vaping products are one of the most effective strategies to reduce consumption, especially among price-sensitive youth and young adults. Young people have lower disposable incomes, and research shows that they are more sensitive to e-cigarette and tobacco price increases.

Heart and Stroke is also pleased to see the federal government's resolve to move towards a healthier nicotine-free generation. The budget includes a proposed amendment to the Food and Drugs Act that will help address the alarming uptake of nicotine pouches amongst our youth. The reality is that the unregulated sale of nicotine pouches, such as Zonnic, is a real danger to young people in Canada. With attractive flavours, such as Tropic Breeze, Chill Mint and Berry Frost, and colourful small packages, these packages entice youth to try nicotine pouches. The devastating result is that youth will become trapped in a cycle of nicotine addiction.

This proposed amendment will restrict the marketing, restrict the use of attractive flavours, impose a minimum age for sale, require placement of these products behind the counters at pharmacies, and impose warning labels and other measures. These are key to helping to protect our youth from these harmful products.

Finally, as a last point, the allocation of $1.5 billion in funding over five years to support the launch of the national pharmacare program is critical in order to improve drug coverage among the seven and a half million people in Canada with no insurance or inadequate insurance. The current patchwork of public and private plans in Canada has created fragmented drug access, leaving millions struggling to afford their prescription medications.

While many people in Canada have some form of drug coverage, it is often not sufficient and poses affordability issues for some. A 2024 poll commissioned by Heart and Stroke and the Canadian Cancer Society found that one in five people in Canada do not have sufficient prescription drug coverage. Over one in four Canadians had to make difficult choices in order to afford prescription drugs, such as cutting back on groceries; delaying paying rent, mortgage or utility bills; and/or incurring debt.

One in 10 people in Canada diagnosed with a chronic health condition were more likely to visit an emergency room due to a worsening health issue because they were not able to afford their prescription medications.

People with diabetes are more likely to develop heart conditions at a younger age and are three times more likely to die of heart disease. As such, the budget 2024 investment in pharmacare will support 3.7 million people in Canada living with diabetes in managing their condition at home. It will also reduce their risk of developing heart conditions, among other complications.

We hope to see the coverage expanded to cover heart disease and stroke drugs in the near future.

I'll be happy to address any comments or questions. Thank you very much.

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Arango.

We'll hear now from the Natural Health Product Protection Association and Mr. Buckley, please.

[Shawn Buckley, Constitutional Lawyer, Natural Health Products Protection Association]

Thank you, Mr. Chair.

I'm here to address division 31 of the bill, which includes changes to the Food and Drugs Act.

As I give my opinion to this committee, understand that I'm of the opinion that the messaging by the government, the Minister of Health and Health Canada on this issue is actually fraudulent to the Canadian people.

This is because I watched a video by the Minister of Health in which the stated reasons for these changes were to protect vulnerable youth from nicotine products, such as flavoured vaping products and nicotine patches that aren't approved for their age group. In May, Health Canada held a stakeholder meeting and used baby formula as an example. What if we have a baby formula shortage? We have to have a workaround to allow it to be imported.

Health Canada basically said it needs the power to respond to unanticipated events, like supply chain disruptions and to gaps. They also said they need to address the unintended use of drugs. I say this is fraud, because the powers it's seeking don't address any of these issues.

One of the powers is to basically exempt food and drugs from fundamental safety provisions in our act and regulations. The Minister of Health will be able to exempt a food or drug from our protection against fraud. This means that a drug could be marketed to the Canadian populace, both by Health Canada and by the manufacturer, with fraud in not protecting us against adulteration—and we mean adulteration whereby there are substances in the food or drug that are dangerous. This should exempt us from being sold drugs that are manufactured in unsanitary conditions, but it will exempt them from any part of our safety regulations.

That's not going to protect youth from nicotine products and it's not going to solve any supply disruptions for baby food.

The next power is for the Minister of Health to be able to prevent and even criminalize the promotion of the off-label use of any drug. Well, that has nothing to do with protecting youth from nicotine products. Surely “drugs” doesn't include prescribing flavoured vaping products to youth. This measure is also not going to address any supply chain problems.

The power that is totally unexplainable is that the Minister of Health can basically take steps to make sure that humans can't access veterinary products and can prevent the off-label promotion and use of veterinary products.

Why are we talking about veterinary products when we're talking about youth using nicotine patches, or access to baby formula? It makes zero sense at all. The minister will be given the power to approve drugs for use in the Canadian population that were not assessed by our drug approval experts at Health Canada.

A “foreign entity” is defined so broadly in the bill that it could include organizations like the World Health Organization. It doesn't have to be a regulatory body of a country, and there are no standards set, so this could be a regulatory authority of a third world country that doesn't have the resources to do a proper analysis. If a foreign entity approves a drug, we don't even need an application. The Minister of Health could just approve a drug and circumvent our experts at Health Canada.

How does that address the stated purposes? It doesn't. Not a single one of the powers in division 31 will give the minister a whit of ability to address the stated purposes, and that's how we know there's a bit of fraud here.

The real purposes are not being addressed by the minister or Health Canada before this committee, and the crazy thing is that the Food and Drugs Act already contains too much power to address the issues that Health Canada and the Minister of Health are telling you they need to address.

Let's just talk about nicotine products. Under paragraph 30(1)(a), the minister could make regulations saying if you add any flavours, that's adulteration. Under paragraph 30(1)(c), they can set whatever purity standards they want to deal with that. Under section 30.1, the minister can make any interim order—it's law for a full year; it just has to be approved by cabinet within 30 days—solving any issue.

Health Canada and the minister take the position—and have for decades—in section 9, the section preventing fraud in the act, that it's fraudulent if you promote a drug for an off-label use. I can tell you that in my law practice I have seen case after case in which Health Canada has gone after individuals and companies for promoting off-label use. Under section 27.3—

[The Chair, Liberal, Peter Fonseca]

Mr. Buckley, I'm sorry to interrupt, but you're going to have to wrap up in 15 seconds.

[Shawn Buckley]

Okay.

The minister can make this order. What this is about is that this is a shopping list to basically exempt the government from any liability for the next pandemic. Health Canada could be liable for adulteration, for the DNA contamination, for their own messaging for fraud and for unsanitary manufacturing, and they had a problem with non-doctors promoting things—

[The Chair, Liberal, Peter Fonseca]

Thank you, Mr. Buckley. That's the time for opening remarks.

Now we're going to go to members' questions.

In this first round, each party will have up to six minutes to ask questions of our witnesses.

We're starting with MP Calkins, please.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

Thank you, Chair.

I will start my questions with Mr. Buckley.

Going back, Bill C-69 is a budget implementation act. It's not an actual act tabled by the health minister. It's an act tabled by the finance minister. These are substantive changes to the Food and Drugs Act. This follows on the heels of other substantive changes to the Food and Drugs Act passed last year in the budget implementation act bill, Bill C-47.

Do you and your organization have any comments for this committee about the appropriateness of having these discussions in a finance committee rather than tabling an individual piece of legislation that specifically deals with health and can be scrutinized and vetted through the appropriate channels here in our Parliament?

[Shawn Buckley]

Thank you for that question.

I can tell you that we're really a consumer organization and we get a lot of feedback from ordinary citizens. Citizens were already really upset with what happened last year, because the same thing happened, and now this seems to be a trend. There is actually a concern—and I share the concern—that we're really circumventing the democratic process.

Could you imagine if a bill were introduced to amend the Food and Drugs Act and included substantive financial changes and this committee wasn't addressing it but the Standing Committee on Health was? It's a huge concern.

These are fundamental changes. Basically, the minister can exempt any food or drug from fundamental safety protections. We're very concerned. Budget bills, by necessity, tend to get passed quickly, so what's the rush with this? We clearly are inviting this committee to recommend that division 31 be excluded or taken out of this act so that the Minister of Health could introduce it as a stand-alone bill.

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

My assessment of the minister's arguments in using nicotine pouches and flavoured vaping products as a rationale for this power grab, both in Bill C-47 and in Bill C-69, is that they're a bit of a red herring.

Under the Food and Drugs Act as it existed even before Bill C-47, Health Canada has the ability to stop the sale of any product it deems unsafe. It has the ability to seize any product. It has the ability to stop any personal use imports across the border if it wants to. It could mandate a label change, adding any warnings that it wants to, and it can withdraw any natural product number. It actually approves a natural product number in the first place, and it has the power therein to withdraw a natural product number.

Is the issue actually the regulated use and sale of these nicotine pouches or is it actually the contraband sale of these nicotine pouches?

[Shawn Buckley]

I actually think that we're even conflating the issues. If we're asking if the existing powers in the Food and Drugs Act are too broad, I would say they are, because there's a real danger with a regulatory authority that is there for drug approval having any powers that would interfere with the doctor-patient relationship, which is based on a completely different set of information and with a different purpose.

The minister already has powers that are too extensive for the purpose. My difficulty with the minister and with Health Canada messaging—that this is to protect youth from nicotine and this is to allow for any shortages from baby formula, which is an emotional issue—is that it's not what this is about. The minister already has powers to address that, and none of these powers address this. This is so the government can be exempt from any liability during the next pandemic if we have to rush through a treatment and so as to basically ensure that there's no messaging on or promotion of off-label use. Whether or not that is a good idea, and whether or not these powers are appropriate for that purpose, that purpose at least should be publicly identified and then a conversation on that.... My concern is that we're not even having an honest conversation.

You're asking me about off-label use. Doctors are not promoting nicotine patches to youth. We're basically talking about black when we should be talking about white. That's the concern, and that's why I use strong language. How do we address whether or not these powers are appropriate for their real purpose if we're not having an honest discussion about why they're really there?

[Blaine Calkins, Conservative, Red Deer—Lacombe, AB]

On the supplementary rules under therapeutic products, right now there's a bill in the House, Bill C-368, that seeks to undo the changes that were made in Bill C-47 in relation to therapeutic products.

As the voice of the Natural Health Product Protection Association, if Bill C-368 does pass in its current form, can you tell us what impact that could have for the natural health product industry in regard to changes in Bill C-47, and now in Bill C-69, should they pass in their current form?

[Shawn Buckley]

Well, it's really not going to have a whole lot of impact.

Basically, in the last budget, Bill C-368 snuck in fundamental changes to the Food and Drugs Act that move natural health products into the therapeutic product category. The therapeutic product category was created by Vanessa's law back in 2014 to basically say that we have a class of drugs, chemical pharmaceutical drugs, with a risk profile that's extremely high, so we actually need to give the minister more powers to address that risk. The minister can actually be extremely intrusive and make orders, whether they're good orders or not, and has extraordinary power over that industry.

They then brought in a structure for fines that are more realistic, a $5-million-a-day maximum fine. Interestingly enough, there is less jail time than there is for the regular drug provisions, two years of jail. For a big pharmaceutical company like Pfizer, $5 million a day for an ongoing offence is really nothing.

In 1998, the Standing Committee on Health held the broadest consultations in Canadian history of any standing committee to ask how we should regulate natural health products—

[The Chair, Liberal, Peter Fonseca]

Mr. Buckley, I'm going to need you to wrap up.

[Shawn Buckley]

Anyway, Bill C-368, if that passes, is not really going to have much of an effect on this. It's just going to move natural health products back to the regular drug category, where they're not subject to such strict provisions.

[The Chair, Liberal, Peter Fonseca]

Thank you, MP Calkins.

We'll now go to MP Sorbara for the next six minutes.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Thank you, Chair.

Good morning, everyone.

Mr. Manuel Arango, thank you for being here. We've met a number of times with respect to the Heart and Stroke Foundation.

Obviously, in all our communities, when we do lose somebody to heart disease, whether it's a heart attack or stroke or the disease they have, it's always a sad story and a loss for their loved ones.

We chatted briefly, and in your testimony you identified a number of measures within the budget, starting with the national school food program, that aim to lower heart disease and the impact thereof.

Can you comment on that, please?

[Manuel Arango]

Absolutely.

If I may, Mr. Chair, I would like to address some of the points raised just now regarding nicotine pouches.

To all MPs, if you speak to parents in all ridings across the country, without a doubt many parents who have teenage kids or tweens and so on will report back on the great concerns they have about the increased uptake of nicotine pouches across the country. They're very, very concerned. Tobacco and vaping companies are busily marketing these products to youth, and that is a real concern.

The reality is that we don't have three to four years to wait for regulations and legislation to be developed for nicotine pouches. That's why these measures in the budget are really important to address nicotine pouches. There's urgency, because with vaping we have seen what happened with the increase and how difficult it is to reduce consumption once it gets out there and once the companies are out there marketing to kids. It's very critical to address this issue of nicotine pouches in the budget.

Mr. Chair, Rob Cunningham from the Canadian Cancer Society is here, and I'm wondering if he may want to add a few more comments related to this issue of nicotine pouches. I'm not sure whether or not that's possible.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Arango, I have only limited time, so I'm going to limit your commentary to just your own. I'm not sure if he's an official witness or not. If he's not an official witness, then there are other issues that would need to be resolved.

I do wish to move on to the indigenous loan guarantee we put forth in the budget, and I believe it's in the BIA.

How important is it for the process of what I would call economic reconciliation?

[The Chair, Liberal, Peter Fonseca]

Ms. DeLaronde, you're muted.