Health Committee on May 14th, 2009

[Dr. David Butler-Jones]

That's not the way it was set up.

But, again, in terms of the issue of governments and how they will deal with this, whether provincial or federal, we'll deal with what we face and then how we address it.

In terms of health promotion during this, we are involved with the provinces. You have seen ads. You have seen information at airports. You have seen other things, and those are pandemic-related health promotion and resources. The other $600 million, not just to the agency, but the $600 million divided between Health Canada, CFIA, and ourselves, was to address, to develop the plans, to purchase antivirals, to make sure that we have contracts in place for vaccine, etc. That has been applied and is a big part of the reason why we are in as good a position as we are today compared to five years ago.

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

Is the health promotion money for this coming out of pandemic preparedness response health promotion money, or is it coming from other health promotion money?

[Dr. David Butler-Jones]

It depends. Some of it is clearly from the pandemic money, because it relates to preparedness for pandemic and the kinds of information promotion around handwashing, etc. That fits. So it comes under the more pandemic-related activities. So there are promotional materials activities as part of our pandemic planning and response.

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

The health promotion money that used to be much higher is going to be much lower for this upcoming year. What are you going to have to cut in order to not be doing health promotion this year?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I think one needs to understand that there's also a health promotion responsibility from the provincial and territorial governments. In this year's budget under the Canada health transfer, we transferred $24 billion to the provinces, which are also responsible for prevention and front-line delivery. There's--

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

But, Minister, here on—

[Leona Aglukkaq, Conservative, Nunavut, NU]

There's a joint partnership relationship in responding—

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

Just look at the line I'm talking about.

[Leona Aglukkaq, Conservative, Nunavut, NU]

—to the pandemic plan and there is a relationship to the plan itself. Provinces and territories are part of the pandemic plan. Some of their role is related to prevention and they've taken a partnership role in the prevention part.

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

But, Minister, my concern is that you cannot do a plan unless there's public health infrastructure.

In the line item under “Grants”, and “Grants to individuals and organizations in support of public health infrastructure”, last year it was $325 million, and this year it's $137 million. How can they effect their plan if they have less money for infrastructure?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll get Mr. Butler-Jones to explain the change in the paper, how we presented it.

[Dr. David Butler-Jones]

It's not that there is a reduction. It is a movement from grants to contributions, a different mechanism for funding these activities. It's not that the money isn't being used and isn't there. It's no longer in the “Grants” column.

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

What about the “Strengthen Public Health Capacity” line, which is down from $44 million to $31 million?

[Dr. David Butler-Jones]

Let me speak to it generally, while Jim kind of looks at the specific numbers, because what we're doing and what we're developing, those kinds of things, and it's difficult in one single year to another.... We have, as an agency, increased substantially over the last four years. Both staff and resources have been put into public health activities, both for the support of the system out there, but also here.

So from year to year, moneys will go up and down depending on whether there are specific purchases, specific projects, etc., that are done. Some of them are moved into more effective areas or more appropriate areas. Because once we've done something, then we don't have to do it again. We use that money somewhere else so it moves in column.

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

So are you telling me that you think that public health infrastructure for Canada is perfect and that we can actually now afford to be rolling back?

[Dr. David Butler-Jones]

No--

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

Even contributions to universities and public health organizations to do workforce development are down. Contributions to individuals and organizations in support of public health infrastructure are down. The people I talk to the on the ground are still very worried that they are one-armed paper hangers. There are not enough resources to do this stuff. Why would we be ramping down at a time when we need more?

[Dr. David Butler-Jones]

Well, anyways, thank you for the question, just in the context of—

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

We just want to help you get more money. That's all.

[Dr. David Butler-Jones]

I very much appreciate that.

[Voices]

Oh, oh!

[Dr. David Butler-Jones]

We've always talked about how public health is a local activity. There's a provincial mandate and there are federal roles that we play to support and build that capacity. In the first full year of the agency, we had 1,800 staff and a budget of $423 million. Now, in these estimates, there is a staff of 2,400-plus and $648 million. That is applied to the work of public health in the country.

Is public health there yet? No. The neglect of the nineties clearly is a problem that was recognized in SARS. We are continuing to build that, not just federally, but also provincially, territorially, and locally. Is the system there yet? Of course not. It needs to continue to develop. But there's also an absorptive capacity in terms of how, if we hired 50 public health doctors tomorrow, that's 50 less to actually serve public health at the local level in this country. We need to continue to work on the training, the skills, the development, tools, etc., that support the whole system. That's where we focused our efforts.

So we're not reducing funding for public health in that sense.

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

Well, it looks worrying. In the estimates, I can't see the national antiviral strategy anymore. It was in previous estimates. It seems to just have fallen off the map.

[Dr. David Butler-Jones]

We have the joint stockpile with the provinces and territories, which we funded 60%. That's 55 million doses. We also have over 15 million doses in the national emergency stockpile. Plus, there are others in terms of the overall balance. We've been adding more Relenza as an alternative to Tamiflu. We just placed an order, jointly with the provinces and territories, for I think another 10 million doses of that. That will contribute to it.

We have a national antiviral strategy. The antivirals are in place, they're across the country, and they're ready to really be mobilized as needed, depending on what we see in the fall.

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

My concern, as you know, is that the human H1N1 that's circulating regularly is resistant to Tamiflu, and a lot of it is perhaps even resistant to Relenza. Where is the money coming from for the research for new antivirals? A real strategy would be trying to get ahead of the curve. Are we able, with cuts to CIHR, with cuts to everywhere we know, to have a national antiviral strategy that will give us what we need should this new and more severe virus in the fall end up resistant to the two drugs we already have?