Health Committee on Feb. 5th, 2007

[The Chair, Conservative, Rob Merrifield]

I'd like to call the meeting to order.

I want to first of all thank our panellists for coming.

We have two sets of panellists today. We're going to be talking about FASD, the fetal alcohol spectrum disorder, and looking at the report to us on where we're going with the FASD and how we're going to be able to do as much as possible to prevent it. That's in the first hour.

In the second hour we're going to talk about the report on breast implants, and we'll have a subsequent panel that will come before us at that time.

Without any delay, I would like to thank the witnesses for being here. I would ask that you introduce yourselves and start with your presentation; then we'll follow it with questions.

[Dr. Sylvie Stachenko, Deputy Chief Public Health Officer, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Thank you, Mr. Chair.

Mr. Chair and Members of the Committee, I am pleased to be here to discuss the Government's Response on FASD.

I would like to introduce my colleagues. Kelly Stone is the Director of the Division of Childhood and Adolescence, and is responsible for the FASD work within the Public Health Agency. Beth Pieterson is Director General of Drug Strategy and Controlled Substances and leads the National Alcohol Strategy work. Kathy Langlois, Director General of the Community Programs Directorate in First Nations and Inuit Health Branch, is responsible for the First Nations and Inuit FASD Program. And from the Canadian Institutes of Health Research, we have Dr. Barbara Beckett, Assistant Director of the Institute of Neurosciences, Mental Health and Addiction.

Mr. Chair, I'd like to thank the members of this committee for your thoughtful analysis of the challenges confronting all of us in addressing the issue of fetal alcohol spectrum disorder.

We're here to address issues raised in the Standing Committee on Health report on FASD and to speak to the government response to this report that was tabled on January 17, 2007.

The first recommendation calls on the Government of Canada, and the health portfolio specifically, to develop a comprehensive action plan for FASD with clear goals, objectives, and timelines. The Government of Canada recognizes the importance of this recommendation. In fact, since 2003, Fetal Alcohol Spectrum Disorder (FASD): A Framework for Action has guided the efforts to address FASD in a comprehensive way.

Both the framework and its companion document, It Takes A Community, developed in 2000 with first nations and Inuit experts, focus on two key pillars: the prevention of future births affected by alcohol and the improvement of outcomes for those individuals and families already affected.

These foundation documents resulted from a series of consultations with provincial and territorial representatives and key stakeholders. They provide agreement on the common vision, goals, and objectives across a range of jurisdictions and sectors. The government affirms the federal role by providing consistent access to culturally appropriate evidence and knowledge for decision-making, as well as tools, resources, and expertise across the country.

As to the question of leadership and coordination for the FASD initiative, that issue is presently under consideration by the Minister of Health. The minister has the lead with respect to FASD within the government and takes an integrated approach to the issue by deploying resources or calling on expertise from across departments and agencies. However, the government and key stakeholders recognize that FASD is more than an alcohol and addiction issue. It has impacts related to a range of aspects of public health, including women's health, disabilities, family violence, child welfare, and criminal justice, to name just a few.

As such, FASD is a public health issue, but also a social and economic issue, in which there is an important role for health promotion and disease prevention in government's efforts on FASD.

The second recommendation also deals with a need for public and professional awareness. The health portfolio's commitment to preventing and managing the health impacts of FASD is evident through its support for new and better information. The government supports publications, websites, tools, and shared awareness efforts spanning multiple jurisdictions.

As a result, public opinion surveys reveal that general awareness of FASD and the harm alcohol can cause to a baby have increased significantly over the past decade. Tangible results include new resources for use at the community level, such as parenting guidelines for families of children with FASD or the Canadian diagnostic guidelines.

Many federally supported tools and training programs are being used in the government's community-based programs, such as the Canada prenatal nutrition program and the community action program for children, to help address FASD among the vulnerable populations they serve.

The health portfolio has a website that provides good information on healthy pregnancy to women of child-bearing age. We are currently looking at additional ways to promote this information to the target audience, including women who are pregnant or planning to become pregnant and aboriginal women.

We will soon be releasing the new solicitation for the FASD national strategic projects fund to seek proposals on training to implement the diagnostic guidelines. As well, the national alcohol strategy, developed by a multi-disciplinary and multi-jurisdictional working group, is almost ready for release.

The Government of Canada provides health programming in first nations and Inuit communities. In fulfilling these responsibilities, we work in partnership with many stakeholders to reduce the number of newborns affected by FASD, through prevention programs to reduce drinking during pregnancy.

The FASD program has played a key role in raising FASD awareness on reserve.

The report's third recommendation calls for more robust data collection and reporting for FASD. As FASD is difficult to diagnose accurately, particularly early in life, the development of a surveillance system will be a long-term effort. The government continues to work in partnerships that span jurisdictions to standardize approaches to identify, screen, and diagnose those with FASD, and to collect and report the data in a common manner.

Along with the provinces, territories, and national aboriginal organizations, the government recognizes that health data must be distinct for each aboriginal group, including first nations, Inuit, and Métis.

Correctional Service Canada is working to establish accurate estimates of the numbers of individuals in federal institutions who may be affected by prenatal alcohol exposure, as no such data exists at this time. A reliable screening tool is also being developed to identify possible FASD-affected offenders so they can be referred for full assessment.

An important part of the government's response to FASD involves supporting research. Since 2000, the Canadian Institutes of Health Research have invested nearly $4 million into FASD-related research. This funding is helping to support researchers such as Dr. James Reynolds from Queen's University. His team has developed a fast, simple, and portable eye-tracking tool to determine if a child has a brain injury indicative of FASD.

The government recognizes the need to build the evidence base in our country, and in this regard, work has begun to develop a Canadian economic impact model so that all potential costs for FASD are part of these calculations, including costs for those who are within the justice, correctional, or homeless systems.

Within the range of FASD work we undertake, the health portfolio is a world leader through its constructive collaborations with the World Health Organization, the Centers for Disease Control and Prevention, and the Indian Health Service in the United States.

The report's fourth recommendation also notes the importance of value-for-money evaluation to frame FASD activities and the importance of ensuring that this is undertaken in partnership across the country. The health portfolio's FASD initiative is part of two major results-based management and accountability frameworks. Value for money is one of the major aspects of the associated evaluation plans.

Reporting mechanisms such as the report on plans and priorities and departmental performance reports will continue to provide Parliament the means to review the government's FASD programs and activities.

The Government of Canada has carefully considered all of the recommendations in the Standing Committee on Health's report and is addressing them through its wide range of current and planned activities.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for being here and presenting, and for bringing so many experts with you.

We'll now open the floor up to questions.

We'll start with Mr. Owen.

[Stephen Owen, Liberal, Vancouver Quadra, BC]

Thank you very much for your presentation, and for being here today.

You've talked a lot about this committee's recommendations for more data and the different efforts that have been made to improve data in the country. Do we have a sense that on one hand there are fewer cases and fewer incidents of cases because of the educational or other preventative actions? Is this a declining problem? Is it something that is out of our control at the moment?

And on the treatment side, are we finding that while there may not be cures, there are effective opportunities to treat the condition in a way that assists people to have a higher quality of life?

I ask both of these questions bearing in mind the wide range of concerns this raises at all levels of government and in different sectors of society. But are we effectively collecting data from the various sectors you mentioned--the homeless, the prison population, and kids in school? It seems to me that based on the numbers we were seeing a few years ago, if it's not plateauing or indeed the incidence is not being reduced, there's a ticking time bomb here in terms of costs, but more importantly, in the deterioration of people's lives.

I'd like to get from you a little better sense of what kind of grip we have on this issue.

[Dr. Sylvie Stachenko]

Thank you very much for the question.

In terms of whether or not there are fewer incidences, fewer cases, we do not have currently a national incidence system for FASD. However, we do have indirect measures in terms of alcohol awareness during pregnancy. So we know that at least at the first stage there are more people who are aware of the impact of alcohol during pregnancy.

What is absolutely needed...and that's why the development of an incidence system for FASD is a key piece in terms of all program planning in the future. We have basically two vehicles right now. The first one is that we have in this country a perinatal surveillance system, and already in that perinatal surveillance system there are 27 health indicators that are being collected, one of which is alcohol ingestion during pregnancy.

Secondly, we have a very important platform, which is the congenital anomalies surveillance. In Canada we are extremely privileged to have opportunities for data linkage. Basically, this surveillance system allows us to link various anomalies over a period of time from the birth registry. So in the future, what we're looking at with our colleagues in the provinces, the academic centres, the diagnostic centres is how we could register FASD in those various, I would say, administrative databases. The problem is--and that again is another very important step--accurate diagnosis. We need standardized procedures to say that this is a case of FASD.

I think the major step has been reached for Canada right now. We have these diagnostic guidelines that are key in terms of setting up any system with accurate diagnosis in the future.

So that's basically what your question is, and I'm answering in a very long-winded way.

[Stephen Owen, Liberal, Vancouver Quadra, BC]

Do the congenital abnormalities identify particular predispositions of different sectors of society?

[Dr. Sylvie Stachenko]

You could do some further analysis on that database. It just describes what some of the prevalences of various congenital anomalies are. What I'm saying is that we could, in the future, work to add FASD as a component of the anomalies surveillance system we already have.

However, one of our biggest challenges right now is the diagnosis, because the recording of diagnosis needs to be accurate, standardized across the country, and at this point we're not there.

I would like to say that with respect to what we know from other countries, Canada has the greatest chance and greatest opportunity to do record linkage than many other countries. So that opportunity exists, and basically that is work that is ongoing with our partners, with our players, in the surveillance arena, and it is a possibility that we can do that.

[Stephen Owen, Liberal, Vancouver Quadra, BC]

Thank you.

Chair, if I have a moment left, the question of treatment—

[Dr. Sylvie Stachenko]

Yes, in terms of treatment aspects, at this point, as you know, the impact of FASD is very much in terms of learning disabilities and various other neurological disorders. Basically, it's more to optimize the societal integration of these individuals.

So, yes, there are a number of efforts, not just from the health sector but also from other sectors. It's how you best integrate and what are the good practices that we have learned over time in being able to afford these individuals—

[Stephen Owen, Liberal, Vancouver Quadra, BC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Now we'll move on to Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chairman.

I welcome the witnesses. Thank you for being here this afternoon.

I believe that we are unanimous around this table in saying that the Fetal Alcohol Spectrum Disorder is a significant problem and that we must act and put in place the best practices in order to deal with some of the aspects of this disease.

In this context, the Bloc Québécois issued a dissenting opinion vis-à-vis the recommendations made in the committee report, in order to underline the fact that we believe that it is up to the provinces, to Quebec and each and every province, to establish the best practices and the best models in order to eradicate this problem within their respective jurisdiction.

Let me quote from the government response to this report. I will then ask for some clarifications.

It says:

The GoC agrees that strong federal leadership around FASD is important and that accountability and governance structures are essential for program effectiveness and concrete improvements in outcomes.

I am simply asking who will be accountable. Will the provinces be accountable to the federal government on this issue?

[Dr. Sylvie Stachenko]

That is an excellent question. I will first deal with good practices.

It is indeed up to each province to offer the programs. However, as far as best practices are concerned, it is important to know the full range of good practices, be it in other provinces, in France or anywhere else. There is a need to synthesize; we have to see the big picture. This allows provinces to decide what they want to do. Our role is not one of service delivery, but it is rather a complementary role, a supporting role.

Regarding your question on accountability, you know that the framework was developed by the provinces, by all actors, because at the end of the day, it is not only about the government, but it includes a whole range of actors. The federal component is where the accountability lies in terms of what we are doing, be it in the area of Aboriginals, in surveillance or tools and resources. There will be accountability on that for which we have received money. However, the federal is not the only actor, it is really a shared jurisdiction.

What I was saying about accountability is that as far as federal money is concerned, there should be accountability because it is part of our mandate.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

So it only concerns the federal government's share of the funding?

[Dr. Sylvie Stachenko]

Yes.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

If I understand correctly, to come back to the first element of your answer, you do not consider that provinces are able to find out about best practices everywhere in the world, to collect this information and to put in place a structure that could be their own.

[Dr. Sylvie Stachenko]

Every province can do so, but we have precisely done a sort of sampling of the provinces' capacity to proceed in this way. Capacities are quite different from one end of Canada to the other. One simply needs to have the capacity to disseminate the information in all provinces. This does not prevent provinces to do their own work as well.

However, there is a difference in the capacity of provinces throughout Canada to do that kind of work themselves, and that difference has been confirmed by a survey that we have done on this matter.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much.

Further on in the report, you indicated that:

Key partners work together to address sectoral and jurisdictional barriers to implement a well-coordinated system of services.

If I understand correctly, there are obstacles between jurisdictions. Could you tell us more about this?

[Dr. Sylvie Stachenko]

In fact, I was saying that the approach must be multisectoral. This does not only concern the health sector. There are many sectors committed to this exercise and we must try and facilitate the integration of the work being done. Within the framework of this initiative, especially at the federal level, we have many joint projects, which enables us to do some pooling of resources to meet the needs of the situation.

So it is between sectors that there are definitely some silos and we often need to facilitate exchanges because the health sector is not the only participant. There are impacts in all areas, even at the level of identification. We can identify some cases in prisons or other places.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I also see that there is an enquiry—

[The Chair, Conservative, Rob Merrifield]

I'm sorry, your time is gone. You can come back for another round if there's time.

Mr. Dykstra, you have five minutes.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you, Mr. Chair.

My questions follow along the same lines. One of the things I listened to with interest in your comments was about the number of times we've come trying to determine when we could actually achieve some statistics so we can actually do some analysis, actually do a review, and begin to focus a little more clearly. You mentioned in your remarks, Sylvie, the long-term goal, and I've read about it in the report that was prepared for us here. I'm wondering if you might be able to be a bit more specific. In terms of a timeframe, what do you think “long term” might represent?

[Dr. Sylvie Stachenko]

If you look at other surveillance systems that we've established--and basically you have to go through the step of getting common definitions, right through to getting all the provinces on board--I would say it usually takes a period of five to 10 years, from our experience in other areas.

I can't tell you. I think we're really at a very important stage right now, because of the diagnostic guidelines and the fact that all professionals in this country have something in common. It's a very specific tool, and our efforts are going to be to try to disseminate it and implement it throughout the country. That will be the first step.

Potentially we can accelerate some other steps, because we have the platforms. If we can get better dissemination of these guidelines and work very closely with all the professional organizations, as well as institutions, I think we'll be well on our way to accelerating the process. On average, if we look at others--we've got cancer surveillance systems for children in this country, and we've got a number of others--it takes about five to 10 years, just because of all these processes and standardization. As I said, that first step--getting a common definition agreed to--is crucially important, and I think we're well on our way. I would even say that we are international leaders currently.

[Rick Dykstra, Conservative, St. Catharines, ON]

Yes, I noticed that in your comments. I actually bridge that a little bit, because the research portion of your presentation mentions that since 2000 the Canadian Institutes of Health Research has invested nearly $4 million into FASD research, and I am a little bit hopeful that it will correlate to levels of awareness.

What do you think of the results of that research? Could you come up with a couple of specific examples of how it has assisted in terms of awareness?

[Dr. Sylvie Stachenko]

I'm going to let others speak to this, but I can say that in terms of some screening tools, Canadians are leaders. We have some work around the meconium, which is the first stool of babies when they're just born. It is important because it gives you an important indicator of whether or not the mother drank alcohol during the whole pregnancy. That came out of research, and it's a Canadian researcher. I don't remember the name, but it's somewhere in Ontario. There is hair analysis. There are all these new tools that will be extremely important, because they will validate the diagnosis in the future.

Maybe you could say a little bit more, Barbara.