Health Committee on May 11th, 2006

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Dr. Butler-Jones.

I'm going to preface this, and I know this is not really for you to answer, but you well know that the Naylor report included a recommendation that the new Public Health Agency have a careful review of the public health provisions and health promotion provisions for Inuit and first nations people. I know this is not for you, but this government decided to cancel the Kelowna accord, which was one of the vehicles that was going to be used to do that, and $5 billion of that has gone somewhere else.

The point is, has this recommendation been addressed by the Public Health Agency, and do you have any comments with respect to this, because you know very well that if you're going to deliver health promotion and effective prevention, it must be done in a culturally sensitive manner. We know that we have been telling aboriginal people what to do for so long and that it has not resulted in any measurable outcomes. If we are going to get measurable change and outcomes, we have to work with aboriginal people; that was what the Kelowna accord was for.

Do you think you can address this with no resources whatsoever for this specific group of people?

I'm sorry to put you on the spot, Dr. Butler-Jones.

[Dr. David Butler-Jones]

I won't go there, in terms of the debate about the amount or other aspects that I can't go into, but what I can go into, quite clearly, is that Health Canada and the first nations and Inuit health branch, which has responsibility on reserves, work very closely with them. We bring some added value in terms of public health expertise. We also have relations with national first nations and aboriginal groups. We are now exploring with them what are the best means by which they can be represented in the public health network, in its expert and oversight activities, which will help to make sure that the issues of aboriginal communities are included as part of the planning and thinking that builds even further than we've been able to do at this point. It really is a partnership, and it's something we're continuing to pursue and will do.

[Hedy Fry, Liberal, Vancouver Centre, BC]

But with no resources?

[Dr. David Butler-Jones]

Well, I would not say there are no resources, because we have people—

[Hedy Fry, Liberal, Vancouver Centre, BC]

No really good resources?

[Dr. David Butler-Jones]

We do have people.

Let me just make a general comment. The more we can invest in public health generally, the better off as a population we will be, but it's up to society to decide the relative proportions.

[The Chair, Conservative, Rob Merrifield]

Thank you for the answer.

It's leadership season around here, so forgive some of the members for some of the comments.

Nonetheless, let's move on. We have Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you.

I would like to be very clear on one point. We are not averse to there being projects under your strategy to fight pandemics and viruses, etc. What concerns the Bloc Québécois is the increase in responsibilities being given to Public Health Canada, because that will cause an increase in human resources.

It started out with the Naylor report on SARS and now, with this large structure being built, there is going to be some duplication. Money will be earmarked for the bureaucracy rather than being spent appropriately. Money needs to go to the provinces, because the idea of having Canada-wide standards and objectives is all well and good, but at the end of the day, the provinces need the means to implement their own structures.

I'd like you to explain some numbers in the field of human resources. We have noted that 1,200 Health Canada officials were sent to the Public Health Agency of Canada, but there are 1,825 of them. Mr. Naylor in his report said that there needed to be an increase in funding for the Public Health Agency of Canada in order to meet all the goals outlined in his report, and to respond to public health requirements. When you add in health promotion and chronic disease prevention, such as cancer, diabetes, cardiovascular illnesses... These are control measures. Given the resources in place, I wonder how you're going to deliver the goods. I think that costs will skyrocket over time. We know that the federal government is responsible for aboriginal people. Yet, with some 1,200 or 1,300 public servants, it is unable to deliver the goods in terms of public health or health in general for aboriginal people. This is one of the reasons why I was very critical of the new Public Health Agency of Canada and of all of the responsibilities you have given yourself under this bill. Moreover, in the preamble to the bill, you did not mention that you were going to respect provincial areas of jurisdiction, but rather that you intend to collaborate. Respecting provincial areas of jurisdiction and collaborating with the provinces are two different things.

Thank you.

[Dr. David Butler-Jones]

You have several questions there. I will deal with the last one first because aboriginal health is a Health Canada responsibility. We collaborate with them, but the services are offered by Health Canada.

[Christiane Gagnon, Bloc, Québec, QC]

I'm sorry to interrupt, but I simply wanted to make a point. I was alluding to the fact that there are 1,200 Health Canada officials working on aboriginal health and they're not delivering, and now you are saying that with 2,000 officials... I was drawing a parallel.

[Dr. David Butler-Jones]

I understand. We're working on moving things along and there may be an opportunity to collaborate with Health Canada on this, but according to me, this is a very important step. This debate is very important for the future and for the health of all.

With respect to your first question, we have to frame the issue in terms of Canada's ability to ensure public health overall, not only with regard to infectious diseases. All governments understand that a treatment approach focused on decreasing prevention is a problem. Our new public health investments will be good for the population, for the provincial and federal governments, as well as for others in this country. It is important to maintain balance. If the challenge we want to take up is to have better public health, we have to strike a balance between prevention, promotion, treatment and other things.

You readjust the balance.

[Christiane Gagnon, Bloc, Québec, QC]

I read in the documents that there was a transfer of 1,200 employees from Health Canada and that there are now between 1,825 and 1,850 employees in the agency. Where do the other employees come from? Are they also from Health Canada, or from somewhere else in the system? There is a gap of 400 to 500 employees, approximately. I don't know where you found them.

[Dr. David Butler-Jones]

There are some people from Health Canada, but there are also new positions under the budget to develop collaborative strategies with the provinces and territories, as well as to work on other public health activities.

[Christiane Gagnon, Bloc, Québec, QC]

Are these new public servants?

[The Chair, Conservative, Rob Merrifield]

That will be the end of the questioning.

One quick response.

[Dr. David Butler-Jones]

There aren't only public servants, there are experts as well.

[The Chair, Conservative, Rob Merrifield]

Thank you, Madame Gagnon.

Mr. Batters has a quick question.

[Dave Batters, Conservative, Palliser, SK]

I have a quick question for Dr. Butler-Jones.

I want to pick up on Ms. Fry's comments on our new Conservative government's commitment to the health care of first nations and Métis people. In her comments she finished up with saying, “with no resources”. I did some quick fact-checking, and in the 2006-07 main estimates, if I'm reading this correctly, we are committing $1.19 billion to advance the health care of first nations and Métis people.

I'm wondering, sir, if you have any plans to produce a report and report to the country on the health crises that face our first nations and Métis people. It's certainly a very important priority for this government and for, I'm sure, all members of the House. Of course, diabetes has already reached epidemic proportions among our first nations people.

Thus, my first question is whether or not you're considering a report on the health care of first nations and Métis people. And second, are you perhaps considering a report on the need for primary prevention for Canadians as a whole in terms of health care? We know that heart disease is a major killer in this country, and there are things that can be prevented. Major changes can be effected by simple lifestyle changes, dietary changes. I wonder if you're considering a report directed at primary prevention, which is ultimately the way we are going to control the expenditures of health care and have healthier Canadians.

[Dr. David Butler-Jones]

In all the list of things that we've been doing over the last year and a half, I do not have a list of reports yet. Clearly, those are important issues. Some aspects of that will be dealt with in the first report.

I think on the issue of first nations aboriginal health, it's important that a report, a discussion of that, would take place with the aboriginal community, first nations leaders, etc., in terms of how can we collectively address these issues and what would be helpful in moving this thing that we share an interest in forward. And if a report would be helpful to that, then it's clearly something I would want to consider.

[The Chair, Conservative, Rob Merrifield]

I want to thank the committee for their questioning. I think it's very good. Dr. David Butler-Jones, thank you for coming in, and Ms. Allain.

You've been at this for a while under order in council. Hopefully, we'll be able to get you a piece of legislation that will give a little more solidity to the position and to what you're doing. We know you're doing good work, and we continue to encourage you to keep it up. But thank you for coming in. You have been a witness before our committee many times and have always been very well informed, and we want to thank you.

[Dr. David Butler-Jones]

Thank you. It's always a pleasure.

[The Chair, Conservative, Rob Merrifield]

Thank you.

We'll take a quick break of maybe five minutes to refresh our coffee, and then we'll get into the four motions before the committee.

[The Chair, Conservative, Rob Merrifield]

Could we take our seats.

We'll get started on the last part of our meeting, if we can come to order.

Just to give the committee a little bit more information, before we start into the motions that are before the committee, if we were to move into clause-by-clause on Bill C-5 on Tuesday, we could do that if we had all of our amendments in--if there are any amendments; I don't know. And we don't want to necessarily limit witnesses. If there is an insistence upon having witnesses come on this bill, could we have that in very quickly? We asked for it on Tuesday, actually.

If there are no witnesses and no amendments, we can move to clause-by-clause on Tuesday very quickly.

So I'll just leave it at that. If you have either of those, get it to the clerk by the end of the day, and we can make the plans.

Let's move on to the motions before the committee. We have four motions. Madam Demers has introduced them. She gave us notice of motion on Tuesday. We'll start with the first one.

Madam Demers, would you introduce that motion, and we will debate, discuss, and vote on it.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

The motion reads as follows:

That the Standing Committee on Health ask the Minister of Health to maintain the moratorium on the sale of silicone gel breast implants in Canada until the Committee has received convincing evidence of the safety of the implants for women.

This is particularly important since, in 2001, 300 applications from surgeons on the special access program for medical devices were accepted, while in 2005-2006, 8,000 applications were authorized. There is a huge difference there. Of those 8,000 breast implants, 64.7 per cent were used for breast augmentation. So they were not used for health reasons or to prevent death or physical suffering, but in fact for esthetic reasons. This is really a very worrisome situation.