Health Committee on May 30th, 2006

[Dr. David Butler-Jones]

Quite honestly, at this point, as it's articulated in the legislation, certainly my role is key adviser to governments and of the agency as a key focal point, but to have everything under one I don't think would do it. I think there are elements and expertise that lie outside of the agency, and we need to find ways to ensure that there is a coherent voice. There may be other programs and activities appropriate to the agency that are elsewhere, but that's for future discussion. Anyway, I'm not a kingmaker.

[Bonnie Brown, Liberal, Oakville, ON]

You're unlike some of your colleagues in the sense that you have no desire to build an empire here.

[Dr. David Butler-Jones]

Empires usually don't work well.

[The Chair, Conservative, Rob Merrifield]

Kings usually get slain; that's the problem.

Madame Demers.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

Ms. Langlois, I'm pleased that you referred to mentoring. It's an effective method. It's easier for women who have this problem to listen to other women who have experienced it. Can you tell me in how many places this is being done and how many women you can currently count on to do the mentoring?

[Kathy Langlois]

With the funding we have, we'll be offering the program in 30 places across the country. We drew on the model developed in Manitoba to set up the program, which serves 20 to 30 women.

[Nicole Demers, Bloc, Laval, QC]

I was asking how many women were acting as mentors.

[Kathy Langlois]

We have three or four mentors for 15 to 20 women.

[Nicole Demers, Bloc, Laval, QC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you.

We have Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thanks.

I know you don't want to be a kingmaker, Dr. Butler-Jones, or queenmaker for that matter, but I do think there should be...and I have always felt this, so the fact that I differ on what this Public Health Agency is going to look like is not for lack of trying. I believe the Chief Public Health Officer of Canada should not be restricted by being a bureaucrat. I think he or she should be someone who becomes an advocate for the health status of Canadians, in every single way.

I understood you were going to take over, or this agency would take over, much of the work of the population health agency, or the population health strategies that went on in the Department of Health. I think that while I agree with you that coordination is absolutely important—and obviously provincial jurisdictions and all of that must be taken into consideration—I think you can duplicate a lot at the federal level if you have too many people doing the same things within the same department. I think there has to be one person who has to set the strategy and has to be responsible for it at the end of the day, or if it doesn't happen, unlike a bureaucrat, they must be able to say: this isn't working, I don't think this is appropriate, we should set these kinds of goals, and this is not right. One can't do that if one is trying to wear two hats. So that concerns me.

I would like to see, for instance, the Public Health Agency set measurable goals—10-year goals for achieving health status, for achieving population health, for bringing down FASD. However, how can you do that if you don't even have incidence currently?

I go back to my question: is there a role that the federal government sees itself playing as being the clearinghouse for bringing together evidence from the provinces and putting it in one place, for setting up a national incidence levels...and then using that to set measurable goals for 10 years for bringing down the incidence of FASD in Canada?

The second question I want to ask is to the Department of Health. That is, are you working horizontally with Correctional Service Canada, with the RCMP, and with other agencies that look after criminality, etc., again to train them to understand the different behaviour patterns of people with FASD, as opposed to a criminal?

There is a real difference between the two. A lot of these young people go to jail because they are thought to be criminals when really they are not. There is a certain level of mental competence that they don't possess and a certain level of behavioural problems they have that need to be identified. So you don't criminalize what in effect is a health syndrome. This is a question I want Health Canada to answer: are you working across...?

I'd like Dr. Butler-Jones to answer about whether he sees the federal government having a role and whether he's going to take that role on.

[Dr. David Butler-Jones]

Our sense and our clear mandate is that we are the lead. The Public Health Agency is the lead on this file and other departments look to us in terms of the overall strategy. As I say, we don't currently have a policy or funding to address some of those elements.

In terms of the role of the Chief Public Health Officer in the legislation, which we discussed the last time we met, the dual role of deputy and to speak independently is actually taken seriously. There is always the risk of conflict between those two roles. But in the debate that led up to the establishment of the agency, it was viewed as more important to have that position as part of government, within government, and the ability to influence development policy, etc., than to have it seen as independent and then risk marginalization as a result of that.

It was a trade-off; it was a debate, and that's where we've ended up. I think it's very important in my role that I do speak to public health issues independently, as need be, but also to actually have the programmatic levers to try to deliver, as an organization, on those issues to the extent that we have the mandate and resources to do so.

In terms of the issue of the criminal justice system, etc., it's absolutely true. Many of these kids, quite honestly, because of the nature of the deficit, don't make the connection. It's not that they want to do bad things, but they don't make the connection. They don't even recognize it when it happens. But that's a larger challenge that we can't deal with directly. I know the criminal justice system is trying alternate ways of dealing with these situations, but it is something that collectively we need to do, and the more we can do to prevent the problem in the first place, a whole lot of kids--adults later on-- will be better off.

[The Chair, Conservative, Rob Merrifield]

One more quick question.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Prevention is the long-term strategy, but right now we have people in the system who have FASD, and I haven't had my question answered as to whether or not Health Canada is working horizontally. I remember that our government tried to develop horizontal structures within government, so that the health department would work cross-wise with the justice system in order to train police officers, to train corrections officers. Has any of that been done?

[Dr. David Butler-Jones]

There is an interdepartmental committee, and, yes, there has been training, work with RCMP, police, corrections, lawyers, judges, and people operating homeless shelters. So there are activities that have been ongoing to this point.

On the issue of surveillance, as Kathy referred to earlier, we now have diagnostic guidelines, so we now have a standard upon which we can develop surveillance systems over time, hopefully, and have baseline data in order to be able to track it, as well as recognize and evaluate what works and what doesn't work and in what settings. Again, the settings differ across the country.

[The Chair, Conservative, Rob Merrifield]

I think that takes us to the end of the questioning.

I want to thank Dr. David Butler-Jones for coming in. I thank the Canadian Institutes of Health Research as well as the Department of Health for being witnesses here and contributing to the debate. I hope you get a sense, first of all, of the frustration of the committee, and also the passion of the committee to actually get something done with regard to fetal alcohol spectrum disorder. I hope you don't see us as the enemy. I believe we are actually all pushing for the same thing, although there is some frustration in not getting things done as fast as we should. I think that's fair, from all sides of the table, in understanding and discerning that.

I believe we will be issuing a report on this, and that'll likely happen, hopefully, next week, but I want to thank you for coming in and contributing to this.

Thank you.

To the committee, for your information the researchers will have a report ready for us likely by next week. Perhaps we can extend the meeting when the minister is here June 6 from 1 p.m. to 1.30 p.m. to review that report, and hopefully approve it and table it.

Madam Gagnon, I made a commitment to you to make sure that you understood what we were doing before an action item was to take place. Are you okay with that?

[Christiane Gagnon, Bloc, Québec, QC]

Oui.

[The Chair, Conservative, Rob Merrifield]

Fair enough.

This meeting is adjourned.