Health Committee on Feb. 5th, 2007

[Barbara Beckett, Assistant Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research]

The researcher who did the meconium studies is Dr. Gideon Koren from the Hospital for Sick Children. He did a fairly extensive study in Grey-Bruce County in Ontario. Obviously, that's something that would need to be extended to other parts of the country if you wanted to have a really good snapshot of what's happening nationally. I would have cited that as one of the examples of research with practical impact that CIHR has funded.

Another one is the eye movement study that Sylvie referred to that is coming out of Queen's University. James Reynolds has done that. If it pans out, that would represent a simple and easy-to-use diagnostic tool that could certainly help get the statistical data you were talking about.

Another important piece of research is by Dr. Caroline Tait, at the University of Saskatchewan, who has done some research with first nations women, accepting the reality, I guess, that there are women who are alcohol dependent and working with them to try to minimize the impact on their children.

Those are three practical examples.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Fletcher, you have five minutes.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chairman.

I wonder, Sylvie, if you could describe the leadership on the FASD file. That was probably the key recommendation the committee had in the previous report--who would be taking the lead?

Also, could you expand on the role of the Public Health Agency in dealing with fetal alcohol syndrome. And what more needs to be done in a timely manner? I think the committee is frustrated that not a lot seems to have happened in the time the committee has been looking at it.

[Dr. Sylvie Stachenko]

The first question I think you mentioned is around the lead. Basically, the lead is something that will defer to the minister. At this stage, the Public Health Agency, whatever the lead will be, has a key role to play. Public health has a number of essential functions, one of which is health promotion, and another one, surveillance. I think those two functions are clearly important in advancing the FASD agenda. So in that context I would say that the Public Health Agency will remain a key player.

When we say health promotion, it's not about campaigns. It's also about a definition that means, how do you facilitate healthy public policy? How do you work with your other sectors to advance issues? It's very much like tobacco, which uses a health promotion approach. You have to take a number of measures that span policy interventions, community interventions, and health care interventions, and have a number of players and partnerships.

So you need, somewhere, a broker to bring all this together, and I think that is an area where public health has had a fair amount of experience over time, that brokering role, that stewardship role of bringing all the players.

We're working in complexity. All these issues are no longer the issue of one jurisdiction. It's basically an issue that requires a breadth of players and partners. As I said, one of the first important measures in the future, if we want to better plan and evaluate our programs, is really to develop robust surveillance systems, and that is a key function for public health. So those two dimensions, for me, mean that we will continue to work in a very important way to advance this agenda.

With respect to what the Public Health Agency does, we—and not just the agency, I would say, but the entire portfolio—have structured the entire activities around this framework for action.

There were five goals in that framework for action, and for each one of those areas or themes, we have a number of activities. For example, we have had a number of efforts in the area of professional and public education. The latest one has been the diagnostic guidelines with the professional organizations. As I said, this is a very important step for the future.

What we're going to be doing now is working on the implementation of this. So we have the guidelines, and now we'll work on the implementation, not just for physicians but also all allied health professionals and other front-line workers, because they're not only in the health sector, they're in other sectors, as I mentioned. So that's one aspect of professional education.

The other aspect is that we completed a survey around all health professionals to really understand what are their attitudes and their levels of awareness of the FASD issue. That will be extremely important in orienting any future work with the professional organizations.

On the public side, we have, obviously, a website. We have a number of tools. If you go into our FAQ website, you'll see quite a number of tools and, basically, pamphlets. But we are also working with this healthy pregnancy website to look at how we can advance and look at new activities around specific vulnerable groups, and this is part of some future direction.

So, again, on public and professional education, we've done things. We've done things in terms of surveillance, which I've mentioned to you and I'm not going to go more into it. We've done things in terms of building capacity. We have the national strategic projects fund, which is an extremely important tool for us to support organizations and communities across the country to develop resources and tools.

We work for the Canadian Centre on Substance Abuse, in terms of looking at and collating best practices.

We organized our work very clearly around some of those themes, and the issue of coordination is one we took very seriously. Since we've had this framework for action, we led an interdepartmental group, which included Justice, and obviously HRSDC, INAC, and quite a few federal departments.

We are also leading the health portfolio efforts internally, and this helps us have a coherent response.

It's not just about saying it's good to partner. We actually have mechanisms and joint funding, joint projects, and a lot of in-kind leverage through these various partnerships.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Davidson, you have a few minutes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chairman.

Thank you very much for your presentation this afternoon.

Certainly we undertook an extremely interesting study, and there were many heart-wrenching aspects.

I appreciate what you've had to say here this afternoon, regarding the leadership that was developed and is further developing and regarding the cross-departmental cooperations, the identification and data collection, and all of those processes that are in place, are increasing, and are trying to resolve this issue.

But given the role that the alcohol industry could play in the prevention of FASD, I was wondering, what does the health portfolio do with them? Do they collaborate with the alcohol industry on this issue? Is there a coordinated effort with them?

[Dr. Sylvie Stachenko]

I would say yes, we do collaborate, but I'll let Beth respond more specifically as to how we do that.

[Beth Pieterson, Director General, Drug Strategy and Controlled Substances Programme, Healthy Environments and Consumer Safety Branch, Department of Health]

The most recent collaboration is the development of a national alcohol strategy. As Sylvie noted in her opening presentation, the strategy is being printed and about to be released. We collaborated with the alcohol industry—with the vintners, spirits, and brewery industries—as well as with academics, provincial governments, and a wide range of stakeholders on the development of that strategy.

It has 41 recommendations. They are targeted at the federal and provincial governments—at all the stakeholders, including the industry.

The industry is very much willing to work with us on preventing alcohol use during pregnancy, as well as preventing alcohol use that creates harm right across the board.

So they are collaborating with us.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Do you know when that strategy will be released?

[Beth Pieterson]

It's being printed now. That will depend somewhat on the Minister of Health's willingness. It's not just a Health Canada publication. It was co-chaired and led by three organizations: Health Canada, the Canadian Centre on Substance Abuse, and the Alberta Alcohol and Drug Addiction Commission. So it was sort of tri-government, organization-led, and it should be released in the spring.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you, all of you.

I scanned the presentation quickly and was thrilled to see partnerships across government departments and in the whole sector.

My concern was where you said that with the provinces, territories, and partnerships, you collect and report the data in a common manner. Do you think you now have the tools to do the surveillance? If not, how do we do better on this, in understanding the incidence and gravity, but also in evaluating best practices?

[Dr. Sylvie Stachenko]

Thank you for your question.

Yes, we have the mechanisms right now. I mentioned that we have the perinatal surveillance system, which includes the provinces and a number of academic centres in the country. We also have the congenital anomalies surveillance network. Basically those platforms exist.

What we really don't have is the diagnosis and how we could standardize it. So, yes, we have the tools. As opposed to other areas, this surveillance network has been in place for the last 10 years and consists of a fairly robust group of provincial representatives and academic centres across the country.

Canada is in the lead in this area, and basically we can accelerate the development of a good surveillance system, given the fact that we have these platforms in existence now with the provinces.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Is FASD now considered something that would be included in a congenital screening program? How far have we moved in being able to do the knowledge translation from Dr. Koren's study on meconium screening to a universal screening program?

[Dr. Sylvie Stachenko]

I think we're not there yet. My understanding is that this is not generalized yet, so—

[Carolyn Bennett, Liberal, St. Paul's, ON]

Because on this side, when Dr. Beckett presented, there's a.... From what I understand when I was in Owen Sound, they turned up four, five times more than they had expected in that study. What that means is that probably across this country we're looking at much greater incidents than we had thought. What would be the impact of having universal meconium screening across Canada?

[Barbara Beckett]

Well, that study did turn up a high rate of alcohol exposure to the newborns. But if you estimate that 40% of those infants would actually be affected by FASD--which I think is the figure that's used, and I'm not sure where it comes from--you end up with perhaps 1%, which is in line with some data that's come from the United States. I don't think it indicates that there's a huge increase in cases over what we would expect.

[Carolyn Bennett, Liberal, St. Paul's, ON]

In what we learned from some of the communities, the earlier you identify a child, the more likely you'll be able to do an intervention with the mom and prevent four or five more children who might be affected being born to that same mom. Do you see that we're starting to turn some of this around? Is there hope?

Other than data and whatever, when we say we're the leader, on the contrary, we're a leader in being able to wring our hands and say how bad it is. Or are we actually turning this around?

[Dr. Sylvie Stachenko]

I think we've made some progress. That's what's important. There has been progress on a number of fronts. There has been progress on awareness of the issue, that's for sure. There has been progress in terms of professional awareness, and that came out of our survey. We now have guidelines in terms of professionals having some tools to use.

I'm going to ask Kelly to talk a little bit more about this, but in terms of community interventions, we have been able to develop some and look at some good practices that we implemented in terms of how well they are working. My understanding is we're into the evaluation stage of this, because it's only been a few years.

On the aboriginal front I think there's a lot of examples and there's very good progress. So I'm going to let both Kelly and—

[Carolyn Bennett, Liberal, St. Paul's, ON]

Maybe Kathy and Kelly could tell us something, but in telling us, could you tell us a little bit about the importance of aboriginal head start and prenatal nutrition programs in your surveillance?

[The Chair, Conservative, Rob Merrifield]

We have another questioner or two, and her time is actually up. So keep it tight. Go ahead.

[Kelly Stone, Director, Division of Childhood and Adolescence, Public Health Agency of Canada]

I would just comment, then, that we do have a national strategic projects fund, a grants and contributions fund that allows us to develop tools out in communities with communities, which then, with the help of the federal government, can be disseminated into other communities. Certainly we use our national children's programs, such as the Canada prenatal nutrition program, the aboriginal head start program, and Canada's action program for children, all three of them, as a way to disseminate to high-risk populations. We use those tools and the opportunity to have those at-risk moms there with their children to share as much of the practical information as we possibly can about the risks of alcohol, either when you're thinking about becoming pregnant or when you are pregnant. And we also use interventions that help the child who may already have been exposed to alcohol to perhaps get screening or diagnosis, as is appropriate through the program.

Kathy, can I turn to you?

[Kathy Langlois, Director General, Community Programs Directorate, First Nations and Inuit Health Branch, Department of Health]

I believe the programs you're talking about, in terms of interventions of mums who've already had one baby and then preventing further ones, describes very well the mentoring programs we've been implementing with our FASD funding in first nations and Inuit communities. In this coming fiscal year we'll have 30 communities that have mentoring projects.

There are some results that are coming out of the Stop FAS program in Manitoba, on which we have modelled our programming. That program is starting to get preliminary evaluation data, and some of the results are indicating that 60% of the women in that program were no longer at risk of delivering a child with FASD because they've been abstinent from alcohol and drugs for six months or more and were using a family planning method regularly. Sixty-five percent in that program had completed an addictions treatment program. So the model of mentoring--particularly among aboriginal women--is starting to show some results, that it's an effective strategy.

In terms of the aboriginal head start and CPNP youths in our surveillance, the new element we've introduced this year is our maternal child health program, which is introducing home visitors on reserve who will come in pre/post pregnancy. It will be able to make linkages to support programs such as the mentoring program, should that be needed.

So the maternal child health program is building off the head start and the CPNP in that we're starting to look more at operating those programs in a clustered approach, so the programs are all linked and effectively supporting each other.

[The Chair, Conservative, Rob Merrifield]

Okay, thank you very much.

Mr. McKay, you have a quick question.