Health Committee on May 11th, 2006

[The Chair, Conservative, Rob Merrifield]

I'd like to welcome everybody to the third meeting of the Standing Committee on Health of the 39th Parliament. We want to encourage everybody to take their seats, and we'll proceed as quickly as we possibly can.

I want to thank the minister, the Honourable Tony Clement, for joining us this morning. I understand that time is tight and we only have 45 minutes with the minister, so we don't want to delay getting to him.

Dr. David Butler-Jones, and Jane Allain, general counsel, legal services, thank you for coming.

I welcome you all to the Standing Committee on Health. We want to get right to it. We are introducing Bill C-5, the Public Health Agency bill.

I want to remind the committee that the minister has a very tight timeline, so we'll restrict our comments specifically to the bill. The minister will soon be coming back to the committee to talk about other issues.

I'll remind the committee, before we get into the questioning, that it's a different process when the minister is here. There are 15 minutes for the official opposition, 10 minutes for the Bloc, 10 minutes for the NDP, and then 10 minutes for the government side. Then we'll proceed with five-minute rounds.

We'll start with the minister's comments.

Thank you for coming.

[Tony Clement, Conservative, Minister of Health]

Thank you very much, Mr. Chairman.

I am pleased to appear before the Standing Committee on Health to discuss Bill C-5, An Act respecting the establishment of the Public Health Agency of Canada and amending certain Acts.

As we've heard in the House of Commons, there's strong support for public health in Canada and for providing a federal focal point to work with provinces, territories, and other public health stakeholders to address public health issues. I was pleased to see the strong support of my colleagues for this particular piece of legislation. I hope I can continue to count on their support, depending upon how well I do at committee today, I suppose.

Mr. Chair, we have an opportunity at this committee to discuss key elements of this bill and why we need legislation for the Public Health Agency of Canada.

With me, by the way, is Dr. David Butler-Jones, who serves as the Chief Public Health Officer, and he will be here beyond my testimony to answer any questions as well.

In the wake of the 2003 SARS outbreak, we had discussions and debates on the state of public health throughout the country. Two subsequent expert reports—one completed by Dr. David Naylor and the other by Senator Michael Kirby—pointed to the need to establish a federal focal point to address public health issues. Specific recommendations included the establishment of a Canadian public health agency and the appointment of a chief public health officer for Canada.

In response to these recommendations, the Public Health Agency of Canada was created in September 2004 through orders in counsel; however, this agency currently lacks parliamentary recognition in the form of its own enabling legislation. This legislation would give stability to the agency and to the Chief Public Health Officer of Canada that only an act of Parliament can provide.

This legislation is needed not just to provide the stability for the agency to continue its leadership, partnership, innovation and action; it is also needed to be able to respond to public health threats.

In the event that we are faced with a public health emergency, such as an influenza pandemic, the agency and the CPHO must have the authorities and tools to be able to effectively respond. For example, the Chief Public Health Officer must be formally recognized as Canada's lead public health professional, with the expertise and authority to communicate to the Canadian public. In providing a statutory footing for the Public Health Agency of Canada, this legislation gives the agency and the Chief Public Health Officer the parliamentary recognition and tools they need to promote and protect the health of Canadians.

Let me, Mr. Chair, briefly highlight the three key elements of this piece of legislation, which collectively will help to protect and promote the health of Canadians.

First, the legislation establishes the agency as a departmental entity separate from Health Canada, but part of the health portfolio.

So this will bring greater visibility and prominence to public health issues. As a key player in the federal system, the agency will be able to have a greater influence in informing and shaping public policy than it would have as an isolated arm's-length body. Further, the departmental model will give standing to the agency and to the CPHO to work with other federal departments to support a more coordinated and integrated approach to addressing public health issues and to prepare for public health emergencies.

For example, the agency developed, in collaboration with provinces and territories, Canada's Pandemic Influenza Plan, which is recognized by the World Health Organization as one of the most comprehensive in the world.

As the federal focal point, the agency will be better able to engage provinces and territories and link into worldwide efforts in order to provide the best public health advice to Canadians.

Bill C-5 does not expand existing federal activities relating to public health. I want to make that point absolutely clear. It simply creates a statutory foundation for the agency and establishes the position of the Chief Public Health Officer as Canada's lead public health professional.

The federal government has a well-established leadership role in public health. It's been around since 1919, working in collaboration with the provinces, territories, and other levels of government.

We intend to continue this approach. The preamble of Bill C-5 clearly states the federal government's desire to promote cooperation with provincial and territorial governments and to coordinate federal policies and programs.

For example, the agency is working with provincial and territorial authorities through the Pan-Canadian Public Health Network, which is a forum for multilateral, intergovernmental collaboration on public health issues that respect jurisdictional responsibilities in public health.

So in establishing a departmental model and in providing a statutory footing for the agency, this legislation continues the strong tradition of cooperation and collaboration that has been part of Canada's approach to public health for decades.

A second key element in the legislation is that it formally establishes the position of the Chief Public Health Officer and recognizes his unique dual role.

As deputy head of the agency, the Chief Public Health Officer will be accountable to the Minister of Health for the daily operations of the agency and will advise the minister on public health matters.

The Chief Public Health Officer will also have standing to engage other federal departments and be able to mobilize the resources of the agency to meet threats to the health of Canadians.

In addition to being deputy head, the legislation also recognizes that the Chief Public Health Officer will be Canada's lead public health professional with demonstrated expertise and leadership in the field. As such, the Chief Public Health Officer will have the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He will also be required to submit to the Minister of Health, for tabling in Parliament, an annual report on the state of public health in Canada.

Stakeholders have made it clear that they want the Chief Public Health Officer to be a credible and trusted voice. Providing the Chief Public Health Officer with authority to speak out on public health matters and ensuring that the Chief Public Health Officer has qualifications in the field of public health will confirm this credibility with stakeholders and with Canadians.

Finally, the legislation provides specific regulation-making authorities for the collection, management, and protection of health information. This authority will ensure that the agency can receive the health information it needs to fulfil its mandate. More precisely, the regulation-making authorities will allow parameters to be set around information-gathering and use in a way that ensures that information is collected and used in compliance with the Charter of Rights and Freedoms and the Privacy Act and is consistent with federal, provincial, and territorial privacy legislation.

The SARS outbreak clearly showed the importance for the federal government to have not only accurate information but also the ability and means to receive this information in a timely manner. With the potential threat of an influenza pandemic, the Public Health Agency of Canada must have clear legal authority to collect, use, disclose, and protect information received by third parties.

This will provide the needed assurance to provinces and territories that they can lawfully share information with the federal government.

Thus, the provisions in the agency's enabling legislation and the regulations enacted under them will clarify the agency's authority to gather information, while ensuring protection of confidential information.

In conclusion, by providing a statutory footing for the agency and supporting a dual role for the Chief Public Health Officer, we will be demonstrating to Canadians that we have listened to their calls to establish a permanent federal focal point to better address public health issues and that we are taking the necessary steps to strengthen the public health system as a whole.

As we all know, preventing and managing disease and promoting good health is key to having a healthier population and to reducing pressures and wait times on the acute health care system.

From my own experience as Minister of Health for the Province of Ontario, and dealing with the SARS outbreak, I can tell you how important it is to have such legislation, which will provide a statutory foundation to the Public Health Agency of Canada and support our collective efforts to strengthen public health in this country.

Clearly, we all have a shared interest to protect and promote the health of all Canadians. In providing a statutory footing for the agency, this legislation continues the strong tradition of cooperation and collaboration that has been a part of Canada's approach to public health for decades.

Ultimately, this legislation will give the Public Health Agency of Canada a sound legislative footing to assist me, as Minister of Health, to protect and promote the health of all Canadians.

Thank you, Mr. Chairman.

[The Chair, Conservative, Rob Merrifield]

Thank you very much, Mr. Minister, for coming to the committee to give us your insight on this important subject. You speak with quite a bit of knowledge on this. In a past life you were deemed to be “Mr. SARS”, not Mr. Clement--not that you have a disease, but that you did such a great job of leadership during a crisis situation in Canada. We thank you for that.

We will now move into the section of the meeting where we will be opening up questioning, first of all to the official opposition.

You have fifteen minutes, but please don't feel compelled to take all of it. That time is for questions and answers. Who on your side would like to start?

Madam Brown.

[Bonnie Brown, Liberal, Oakville, ON]

I'll share my time, so tell me when it's five minutes.

I'd like to welcome the minister, both to his new job--to Parliament Hill--and to the health committee, where he'll have the most fun.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you very much.

[Bonnie Brown, Liberal, Oakville, ON]

I complimented you in my speech in the House on this bill and the exciting prospects for Canada that the Public Health Agency of Canada represents and the opportunities it presents to do great things.

I had some questions here for you; one of them was about the money. When the population and public health branch was part of Health Canada, it had a budget of about $310 million, and then the allocation for the newly created Public Health Agency of Canada was $430 million in the 2005-06 budget. The main estimates for the current fiscal year list the budget at $506 million. I'm wondering if you can explain first the first jump of $120 million and then another 20% in this year's estimates. I'm wondering if you're changing the mandate at all, or just what is going on that's suggesting a need for these increases? I'm not saying I'm against them; I'd just like to know why.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

In terms of the history, I'll defer to Dr. Butler-Jones. But let me say certainly as we know, in Budget 2006 there were significant additional resources put into public health, including the $1 billion over five years, which is shared by other departments and by Health Canada and the Public Health Agency, to improve pandemic preparedness. There's also the $52 million a year allocated to the Canadian strategy for cancer control. So there are some specific items that were earmarked and noted in Budget 2006 in Minister Flaherty's remarks to Parliament.

At this point, maybe I'll just defer to Dr. Butler-Jones, who has a better sense of the history of the expenditures than I would have as the newcomer.

Dr. Butler-Jones, please go ahead.

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

The initial jump was really a reconciliation, because there are elements of the agency that were a branch there that had common functions with Health Canada. Some elements moved into the agency; some stayed in Health Canada; some continue to be shared. A large part of that change was a reconciliation because now the agency has its own budget accountabilities to reconcile what is actually agency budget versus what is Health Canada budget. So there's some overlap there.

In terms of the second year you're referring to, much of that relates to the augmentation, for example, in chronic disease prevention, health promotion, and some initial investments in increasing our capacity to prepare for pandemics, etc. The most recent budget, assuming it passes, will add to that capacity. The other thing is that much of the budget is not devoted to supporting the agency in terms of people, but is for resources that are used in the country to support public health activities at the community and provincial levels, as well as for our own responsibilities.

[Bonnie Brown, Liberal, Oakville, ON]

Considering that, and considering the minister's experience with SARS, you and he will both know the tremendous importance of the medical officer of health in each--sometimes it's a county, sometimes it's a region; it depends on the type of government in which province. My understanding is there's a tremendous shortage of medical officers of health, and there are many areas where they simply don't have one. I'm wondering if, as part of the pandemic preparation, there is some money to encourage--maybe through scholarships--or some way to entice medical students to pursue their studies to become members of the public health field as medical officers of health. If not, and if we run into a pandemic, we could have a situation in which one medical officer of health who knows his own area very well is actually going to be in charge of a couple of others because there's nobody there in those other regions. It seems to me we need some leadership from the federal government here to try to help the provinces fill those spots. I'm wondering if there are any plans to use this extra money for that particular purpose.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you for the question.

Certainly I'm very well aware, having been a former provincial minister of health, of some of these challenges, although when always looking for silver linings where you can find them, one of the things we observed post-SARS was that there was an increased interest among medical students in public health, because it really underlined just how fragile public health is and how it can be, quite frankly, an exciting, very important, and very rewarding line of work to be involved in as a medical doctor, or a nurse, or any other kind of medical professional. So you find these silver linings where you can, sometimes. I'm not trying to diminish the suffering during SARS, but this is one thing we observed after SARS was over.

In terms of our role and responsibility, I'm going to let Dr. Butler-Jones say his piece on this, but we're very cognizant that, in terms of pandemic planning, it really cannot be the federal government acting as an island in its preparations. To be very effective, there has to be a seamless approach, involving local public health authorities all the way down to the municipal level, the provincial public health authorities, the national public health authorities, as well as the continental and the international.

There's an immense degree of collaboration now. So we have to be respectful of each other's duties and responsibilities, but also aware that in the end we're all in this together.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Madam Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Minister, for coming here.

I also want to thank your government very much for continuing to support the initiative of our last government in setting up this particular public health agency.

The question Madam Brown had was one that I wanted to follow up on.

As you know, if we're going to be coordinating public health, there needs to be a rapid response. Dr. Butler-Jones might be able to answer this: what is the role of the federal government's Public Health Agency in coordinating that, especially in areas where certain provinces and certain municipalities may not have the resources for rapid response?

Secondly, is there going to be a linkage with researchers and with clinical places such as ERs and so on, and with community groups and hospitals? That's the kind of rapid response....

I know in British Columbia, when SARS came down, we had the ability to respond very rapidly because we had genomicists who tested to see if it was a man-made or mutated organism. It was mutated. We were able to move seamlessly throughout all the emergency rooms and we were able to contain it very rapidly in B.C.

So what is the role of the federal government if there isn't the ability for provinces and municipalities to do that? Do we have resources to help them?

The next part is, what will be the position of the agency with regard to setting measurable benchmarks for population health in Canada? Is this going to be a federal responsibility? We're going to work with provinces, obviously, but will there be one standard across the country for benchmarks on this issue?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

I think Dr. Butler-Jones is going to take a run at this one.

[Dr. David Butler-Jones]

Clearly, first of all, public health is a local function. That's where the action happens. But it needs to be connected regionally, provincially, nationally, and internationally.

The other thing is that no jurisdiction has the capacity alone to deal with these issues. So what the federal government brings, and through the agency and others--not just the agency--is, in that partnership, looking at what the capacities are and how we can contribute to that in a collaborative way.

We bring special expertise. We bring resources. For example, when there are outbreaks, in virtually every jurisdiction in the country we have sent field epidemiologists to help with the investigation. It's still managed locally and it's still in their authorities, but we can support technically and otherwise, as well as in an intelligence-related way elsewhere.

In terms of the research community and so on, there are intensive linkages not just to public health laboratories, but under the public health network that is now established there are expert committees and other federal-provincial-territorial and expert connections that could look at these issues across the country and internationally and identify who can do what best and who is in the best position to respond to those issues.

As the committee knows, the health goals for Canada were accepted by ministers of health previously. The intent is that each jurisdiction takes those to work up in terms of their strategies, targets, and so on, as appropriate to the jurisdiction, including federal jurisdiction. So we will be having conversations across departments as to how, as Canada, we deal with our accountabilities in this or what we hope to achieve in this, as well as, through the network, coordinating to the extent that people want to coordinate, sharing information, sharing ideas, and so on, and doing that collaboratively across the country.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We're now going on to Madam Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you, Mr. Chairman.

We are pleased to have you here today for the first time before this committee.

Mr. Butler-Jones, congratulations on your new duties. We have many questions to put to you this morning.

The Bloc Québécois is concerned on several fronts about the establishment of this new agency. The bill provides the agency with a statutory footing. We know that you are currently in office. The responsibilities granted to this agency are far broader than you stated this morning, Minister. The goal is far broader than the intent to create a legislative framework and provide public health support in the event of pandemics or of an avian flu outbreak.

The various documents provided to us by the Public Health Agency of Canada regarding the division of powers state that the new agency will now be promoting health and chronic disease prevention, for cancer for instance, diabetes, and cardiovascular diseases. There are going to be integrated strategies for this.

We have some concerns about the encroachment into provincial areas of jurisdiction. Moreover, in your preamble, you speak of a vision which may be cause for concern with respect to provincial areas of jurisdiction.

You speak of disease and injury prevention and public health emergency preparedness and response. You then go on to say you intend to encourage collaboration and cooperation in this field.

Encouraging cooperation is not the same thing as respecting provincial areas of jurisdiction. In my opinion, this is rather weak. There is some cause for concern as to how this bill will be received by the various governments, specifically the Government of Quebec, which will see this as an independent authority, under your control, but giving the agency far more latitude. So, we are concerned about encroachment.

We are also concerned about the cost. I don't know to what extent you drew inspiration from the Naylor report, which is over 300 pages long. In fact, there were recommendations on the order of $200 million per year, plus a budgetary increase to deal with the findings of the Naylor report on SARS. You started out with SARS, a pandemic, but you have spread your tentacles out with respect to the Public Health Agency of Canada's responsibilities.

I think this could lead to a monster, a white elephant in terms of bureaucracy, in terms of paperwork. We've been given a great deal of documentation, and we believe that is cause for concern. This nation's bureaucracy is a concern for us on several fronts.

Could you respond to that, Minister and Mr. Butler-Jones?

[The Chair, Conservative, Rob Merrifield]

That's about a four-and-a-half minute question.

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

Thank you, Mr. Chairman.

I would like to tell Madam Vice-Chair, that it is important to note that the preamble of this bill sets out the public health measures which will be taken regarding health protection and promotion, population health assessment, health surveillance, disease and injury prevention, and public health emergency preparedness and response.

Moreover, when this institution responds to emergencies and issues involving public health, it will have to collaborate and share information with the provinces and territories, because we all recognize that provinces all have a part to play in the matter.

So, Bill C-5 does not broaden the federal government's activities in the field of public health. It simply aims to ensure collaboration, and the creation of an agency that can respond in emergencies.

Doctor, go ahead.

[Dr. David Butler-Jones]

The Naylor report not only mentions infectious diseases, but also the other issues relating to public health. Moreover, it emphasizes the importance of having cooperation between jurisdictions. Our collaboration with the provinces and territories will have to include all public health issues , not only infectious diseases.

There is collaboration with Quebec and the other provinces. We collaborate with the Institut national de santé publique du Québec because joining our forces together is important for the benefit of all. It is an important collaboration, but the agency does not encroach on other areas of jurisdiction. The bill recognizes that public health is a shared area of responsibility between the federal, municipal and provincial governments.

[The Chair, Conservative, Rob Merrifield]

Thank you. Our time is gone.

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

It's very nice to see the minister and the Chief Public Health Officer, and Jane Allain as well, here to both share information and answer our questions.

I know that people across the country, who either observed SARS from perhaps some distance or lived in the middle of it and were quite terrified by what was happening, will I think feel some real reassurance about the fact that the act deals with this in this way. So I wanted to acknowledge that.

One of the questions I wanted to ask, because public health is about a variety of communicable diseases--and you could name your disease, I guess--is about the information that gets reported to you. Some of us who were around when the last TB hospital closed and thought we would never see it again are now seeing it in major cities. There is not, as I understand, a mandatory reporting to you, and you can correct me if I'm wrong. So I can have an outbreak in Vancouver of tuberculosis or another communicable disease that is quite significant, and I don't have a legal responsibility to inform you of that. Or do I? Or to pick another one: immunization. We're seeing some very different trends across the country in immunization and a drop-off in immunization rates. How does that information get to you, other than through people's good will and because morally people should report it to you? I understand all of that. But am I correct that there's no mandatory responsibility for me to call and tell you that?

[Tony Clement, Conservative, Parry Sound—Muskoka, ON]

If I can take the first part, there is no mandatory reporting, you're quite correct. We do see this in the domain of the provincial level of government. At the same time, as you may be aware, I'm meeting with my provincial and territorial counterparts starting tomorrow night and we'll have an all-day session in Toronto on Saturday. One of the topics of conversation is a means by which we can come to federal-provincial agreements with each province and territory on reporting. So this is a topic that I'm addressing immediately, and I'm quite convinced that everyone knows what's at stake.

In SARS we ran into some problems because the type of reporting that we were getting in Ontario from our local health departments was different from the type of reporting that the World Health Organization was expecting. It was just a breakdown in communication. That breakdown in communication created the travel advisory against Toronto. These can have huge impacts.

So I'm very conscious of that. I would suggest to you that the way to go about it is to have those agreements, and I'm quite expecting that the provinces will understand the necessity of this as well.

Doctor?

[Dr. David Butler-Jones]

The legal basis for reporting generally, I guess, is because it's a local activity and it is reporting to the local medical officer who then reports to the province. There are a number of diseases that provinces then report to us--not nominally, not with names--so we can track things, etc.

[Penny Priddy, NDP, Surrey North, BC]

I realize that.

[Dr. David Butler-Jones]

Also, the practical thing is that they're dealt with locally. But then we have systems in place to track, nationally and internationally, patterns of disease so that we can actually go back and see that there might be five cases in Vancouver and three in Saskatoon and four in Toronto, but they're all the same bug with the same genetic pattern. Then we can say what is in common. For example, perhaps there's a meat processor that distributes to only those three cities. So it really has to be a collaborative effort. And the same is true internationally in terms of how that's approached.