Government Operations Committee on June 20th, 2011

[Leona Aglukkaq, Conservative, Nunavut, NU]

No, we're not limiting the access issue. We're trying to address the public safety aspect, as you've outlined.

[Peter Braid, Conservative, Kitchener—Waterloo, ON]

Right. Thank you, Minister.

Moving forward, in your remarks this morning I noted that you used the word “innovation” a lot. Perhaps you could elaborate, Minister, on some of the initiatives Health Canada has been undertaking specifically with respect to mental health programs and good mental health promotion, anti-smoking measures and partnership programs with first nations.

Could you elaborate on some of the innovative measures and initiatives Health Canada has been undertaking in any or all of those areas?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Can I--

[The Chair, NDP, Pat Martin]

Actually, in future there is no need for me to recognize you on this committee.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Okay. Every chair is different, so thanks.

[The Chair, NDP, Pat Martin]

Every committee is different.

[Leona Aglukkaq, Conservative, Nunavut, NU]

In terms of innovation, I've been on the health portfolio for about six or seven years, provincially and now federally. I have seen a lot of changes in the provincial jurisdiction, a shifting to focus more on areas of better integration and prevention. I've always stated that equally important to treating people when they get ill is preventing them from getting ill in the first place.

When you consider the health indicators of the Canadian population, you will note very quickly that many of them are preventable. When it comes to illnesses associated with obesity, cancer rates associated with tobacco use, the lack of physical activity, and injury prevention, there are a number of startling statistics in Canada.

The shifting we're doing is the first of its kind. In September, for the first time, we signed a declaration on keeping Canadians healthy. That was signed with the provinces and territories. We committed to work together to combat the issue of obesity. There are other areas within our portfolio over which we have direct control, such as consumer product safety legislation and tobacco legislation. We're looking at prevention, illicit drug use by our children, and addressing mental health. These are programs designed to keep people healthier as well as to support individuals who require support, the more vulnerable. That is quite exciting.

Another area that is innovative would be the tripartite agreement discussions we are having in British Columbia. British Columbia first nations, the province, and the federal government have been working for four or five years on how to better integrate health care services for the first nations people within the province. The work we are doing with the British Columbia first nations is innovative. It integrates first nations to be part of finding solutions. They are at the table in terms of providing better programs in their communities.

It is an exciting time to be discussing some of those initiatives. I think they are changing how we deliver health care, in less of a silo environment, how we better integrate all residents in each jurisdiction to provide health care services, as opposed to first nations having certain services and that type of thing. It doesn't work, and we know that. The work has been--

[The Chair, NDP, Pat Martin]

Minister, I'm sorry to interrupt you.

[Leona Aglukkaq, Conservative, Nunavut, NU]

The work has been very exciting.

[The Chair, NDP, Pat Martin]

Perhaps you can continue that thought in response to another question.

It's now the Liberal Party and John McCallum.

[John McCallum, Liberal, Markham—Unionville, ON]

Thank you, Mr. Chair, and thank you to the minister and to all her colleagues for being with us this morning.

Last week, Finance Minister Jim Flaherty made a trip to the United States. He gave a speech in New York in which he explicitly endorsed the views of Paul Ryan, who's the Republican chair of the budget committee of the House of Representatives. Mr. Ryan has called for the total repeal of President Obama's health care initiative, and also for a 33% cut in medicare in the U.S.

One can question the propriety of a Canadian finance minister getting engaged in a U.S. budget debate, but that's not my question. If the finance minister is telling the U.S. to balance the books by slashing health care, doesn't that logically imply he would pursue a similar policy in this country?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I think our government is very clear on how we will continue to provide the provinces and territories with the health transfers. We've kept the 6% escalators, and we've stated that we will continue to roll out that commitment to provinces and territories so they will have predictable funding to address health care delivery in their jurisdictions.

[John McCallum, Liberal, Markham—Unionville, ON]

I know that's what it said, but why would he go to the U.S. and tell them to slash health care?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I can tell you what our government has stated on health care to Canada. You know in your party that there were huge cuts in transfers to provinces and territories. I was the health minister for Nunavut when we were dealing with all the cuts.

Our government is very clear that we will continue to transfer the funding to jurisdictions. We will be reviewing the health accord and looking at the success of the programs that were identified as priorities in the 2004 accord. We'll continue to do that. We're committed to working with the jurisdictions.

[John McCallum, Liberal, Markham—Unionville, ON]

Thank you.

I'd just point out that, yes, our government had to make some cuts in the nineties because we inherited this $42 billion Conservative deficit and we were in a state of crisis. But having balanced the books, don't forget it was the Liberal government that initiated the 10-year health accord, where funds would grow at 6% per year for 10 years from 2004 to 2014.

Let me move to a different subject, which is the topic of funding for first nations and Inuit health care. I have two concerns. If one looks at the estimates on pages 163 and 164, in the current year we're getting less information than we did in the previous year. Under first nations and Inuit health care, for 2010-11 there were 10 categories of spending that were revealed in the estimates. In the more recent years, 2011-12, there are only three categories. So you've amalgamated a whole bunch of smaller amounts into a much smaller number of categories, thereby providing less information.

I have two questions. One, why do you think it's appropriate to give so much less information to Canadians and to this committee? Second, I note that the total expenditures are very similar for each of the two years, whereas the Assembly of First Nations has estimated a nearly 10% increase in the number of first nations people eligible for non-insured health benefits. So you have expenditures that are nearly flat, and the demand or need in terms of population growth is rising very quickly.

I guess I have two questions. Why collapse the information, and why are expenditures not nearly keeping pace with the population growth of aboriginal and Inuit people?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you.

[The Chair, NDP, Pat Martin]

You have less than one minute to answer.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I believe the non-insured health benefits on the items will be reflected in the supplementary budget piece.

On the question around the issue of less information, as a former territorial health minister, and looking at community-based programs, I'll give you one example of a community that had to apply 15 times for programs.

The community wanted to deliver programs to pregnant women to deal with obesity, tobacco, FASD, and diabetes. The way the program was designed before was disease-specific, so the community group of volunteers had to apply five times to be able to deliver to a pregnant lady prenatal programs on FASD, diabetes, and whatnot.

So the clustering of the programs means they are better aligned to address the need for a broader delivery of programs at the community level, as opposed to spending their entire time and resources reporting 10 or 15 times to deliver programs. That's the explanation around that.

[The Chair, NDP, Pat Martin]

Minister, you're well over time, please.

Scott Armstrong.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Minister, thank you very much for being here today. We appreciate your coming and presenting to us.

I'm going to read you a quote from what you said. It's on page 11, if you want to refer to it. You said:

Through the Canada health transfer administered by Finance Canada, the federal government provides long-term and predictable funding to support provincial and territorial health systems. Canada health transfers in 2011-12 will amount to $27 billion and will grow to an all-time high of $30 billion in 2013-14.

You are a former territorial health minister. What would having consistent and predictable funding mean to someone trying to operate a local health care system or a provincial or territorial health care system?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you. As a former finance and health minister for the Nunavut government when we were dealing with the cuts to education and health, I can tell you it was very difficult. We didn't have that predictable funding arrangement.

Our government has stated that we will continue the growth to the jurisdictions. The provinces and territories deliver health care. They know their areas best in terms of the resources, and they'll be able to allocate accordingly.

The predictable funding transfers to jurisdictions allow us to think long term about how we address health care in Canada. Ten years is not long enough. We're still rolling out the 2004 accord priorities, and the Health Council of Canada has been able to report some progress, but the 10 years is not up yet. So in terms of going forward with jurisdictions, looking at the accomplishments of that 2004 accord, predictable funding will allow us to focus on areas where we need to focus collectively, as a nation. But we can't deliver health care and improve health care when we're dealing with cuts, and that's what we were dealing with back in 2003, and in 1998 and 1999, those years.

I can say the predictability goes a long way when you need to deal with long-term planning around health care.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Many provinces, as well as the federal government, are trying to shift the focus toward more health promotion and prevention of health care problems, injuries and other long-term disabling sicknesses and things that are happening to us.

Would you please update us on your discussions with the provinces and territories regarding healthy eating and awareness and education?

[Leona Aglukkaq, Conservative, Nunavut, NU]

The provinces and the territories worked really in hard the last four or five years to talk about how we can keep our population healthy. As I stated earlier, equally important to treatment when you fall ill is to keep you from getting ill in the first place. I believe that jurisdictions...and I've stated before that with the trends we are seeing, with predictable funding going into health care.... You can't keep up, unless you start to shift, keeping the people out of the institutions in the first place.

So the work that we signed off on in September is an agreement with the provinces and territories for the very first time to keep people healthy, whether that be dealing with obesity, developing food guides, affordable food, diabetes, or tobacco. There are a number of initiatives and programs that we're funding through cancer initiatives. There are a number of projects that we're working on collectively that will benefit jurisdictions.

At the same time--you will not see the results overnight--we need to start focusing initiatives on the injury prevention piece. I'm excited about the work, and the group is looking at finalizing some of the recommendations this fall. You will see some announcements being made across the country on a number of initiatives. I can say that the commitment to working collaboratively across the country in the area of prevention is well received.

[Scott Armstrong, Conservative, Cumberland—Colchester—Musquodoboit Valley, NS]

Thank you.

The last question I have deals with electronic health card records. We've been talking about this for many years now. Could you update us on the status of that project and where your negotiations are in terms of electronic health records?

[Leona Aglukkaq, Conservative, Nunavut, NU]

As you know, our government made a commitment on developing electronic health records. The program will reduce duplication and provide better information to physicians on patient care. At the same time it will improve the efficiency of how we manage and provide services to our patients.

As of March 2011, over 50% of Canadians have electronic health records available. In March 2010 we were at 22%. So we have accomplished a lot in terms of rolling that out. Infoway continues to work with the provinces and the territories and the health care deliverers in moving those projects forward.