Health Committee on May 14th, 2009

[Anne-Marie Robinson]

First I'll talk about the infrastructure.

We have $135 million over two years. Normally, we spend about $50 million a year on infrastructure. This would increase our spending by about another $62 million, so about $112 million, $115 million a year. We have a 10-year capital plan. What we've done is accelerate that capital plan forward, so we're able to bring a 10-year plan forward by four years. We will be building nursing residences and nursing stations and health centres in communities.

As well, we have money for investments in improving 24/7 nursing coverage and for innovation in nursing. With that, we will be trying to hire additional nurses, and particularly broadening the practice of our nurses, so, for example, hiring more nurse practitioners or even other practitioners, such as paramedics, who can support our nurses in different contexts.

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

Thank you.

[The Vice-Chair, Liberal, Joyce Murray]

Mr. Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chairperson.

I thank the witnesses very much for having come before us today.

As I was listening to the minister earlier, something seemed paradoxical in her introductory remarks. She stated that: “Research is essential to finding new ways of protecting and improving Canadians' health.”

Unfortunately—we saw this in the last budget—the Conservative government cut close to $160 million from research budgets. In the health field, we can see that in 2006, the Canadian Institues of Health Research indicated that they had an urgent need for 150 million additional dollars for the necessary funding of investment in employment and infrastructure. The problem is that the CIHR, the NSERC and the SSHRC will see their budgets cut by $148 million over the next three years.

So on the one hand, we hear that there is a crying need for investments for researchers, that this is a priority for the minister, that you absolutely want to invest in research to attempt to find new vaccines. We can see, particularly these days with the H1N1 virus, that there is an important need to fund research to attempt to find new cures, new antidotes. However, by the same token, we see budget cuts to everything that could help scientists obtain the tools they need to try to find these cures.

I would have liked to put the question directly to the minister, but perhaps you could enlighten me concerning the funding?

[Morris Rosenberg]

Thank you, Madam Chairperson.

I will attempt to answer the questions. I would say, firstly, in French, that the government over the past four years has increased the base budget of the Canadian research institutes by somewhat more than $142 million. This year, these Canadian research institutes have investment plans of approximately $926 million in peer-reviewed health research projects. These projects will be conducted in university, hospital and research centre laboratories throughout Canada.

Also in the 2009 budget, $35 million were allocated to the Canadian Institutes of Health Research over three years to support the Vanier Canada Graduate Scholarships.

You put some questions concerning some decisions in the context of the strategic review. As is the case for all of the other departments and agencies subject to this exercise, we are attempting to review each government institution every four years. And so, approximately 25% of government bodies are reviewed every year. The idea is that things change, there are changing priorities, some things are less effective and less in keeping with the Canadian context which evolves over time.

It is, consequently, normal that there be certain cuts and it can be said that the changes that were made, the reallocations that were made with regard to the Canadian Institutes of Health Research are of that nature.

[The Vice-Chair, Liberal, Joyce Murray]

Dr. Butler-Jones would like to add a comment.

[Dr. David Butler-Jones]

Thank you for those questions.

In that context, there are two very important things to point to. The first is our research capacity. For the past four years, we have improved our research on certain infectious diseases such as influenza. Our research capacity was really successfully put to the test, in that situation.

Also, there is a budget for immediate research on the H1N1 virus or other very urgent matters, together with the Canadian Institutes of Health Research...

[Nicolas Dufour, Bloc, Repentigny, QC]

Would this explain...

[The Vice-Chair, Liberal, Joyce Murray]

Thank you. The time is up.

Madam McLeod.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

First of all, I'd like to pick up where my colleague left off with some questions about aboriginal issues. We recognize the huge disparity in health status, and we have talked about the need to focus on those inequities. There are significant dollars being spent to support aboriginal health. Are we having some success? Are things tracking in a positive direction?

The other thing I'd be interested in exploring is understanding the agreements. For example, with respect to the agreement with the Province of British Columbia, how well is it supporting our aboriginal communities?

[Morris Rosenberg]

We are currently in discussions with the Province of British Columbia and with first nations in the province to try to reach a tripartite agreement on providing health services to first nations people there. We've had a bit of a delay because of the election. But we spoke to colleagues in B.C. just a few days ago, and we expect that as soon as cabinet is formed and the new minister is named we will be back at it. In June or July, we hope to meet with first nations leadership and political leadership in the B.C. government to talk about progress.

The idea would be to integrate first nations health services into the broader health services within the province. Recognizing that Health Canada will continue in the role as funder, we believe that first nations health will be better served through provincial health services. Taking into account all of the attendant cultural sensitivities and particularities is an important part of developing this agreement. We're dealing with two other principals, but those principals, especially first nations leadership in B.C., have to consult with a large number of first nations communities with different health needs and preoccupations. That's taking a bit of time, but we want to do this in a way that is as respectful and consultative as possible.

[Anne-Marie Robinson]

On the other part of the question, we're doing a number of things to improve aboriginal health. We're trying to shift our resources into promotion and prevention, so we can prevent disease, rather than just be in the business of treating it, as other health care systems are. For example, we're putting a lot of emphasis on things like prevention and management of diabetes, maternal and child health, and research to make sure that we take an evidence-based approach. We're also looking at the underlying determinants of health. We recently released a report on this topic and are working much more closely with first nations and our federal partners to ensure that we address health outcomes in a comprehensive way. We have the first nations regional longitudinal health survey and other techniques that we use, and continue to improve on, to ensure that we have health indicators that enable us to target our interventions and programming in the most efficient and effective way.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I understand that you're doing some things on the health portfolio to modernize the management and delivery of the grants and contribution system.

[Anne-Marie Robinson]

I can talk about that in relation to first nations and Inuit health. We're proud to announce that we've just launched a 10-year contribution agreement. We now have agreements with two first nations. We've taken a risk-based approach to ensure that we're being prudent in the use of taxpayer dollars. We're also looking at streamlining the management of this initiative and using a more intensive risk-based approach. For first nations, it's much less of an administrative burden with respect to the paperwork and reporting they have to do. For first nations who have gained experience in health care delivery, they have much more flexibility in taking the bundles of money that are passed down from governments and recombining them in a way that makes more sense for their own local needs.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you, Mrs. McLeod.

Dr. Bennett.

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

Thanks very much.

These estimates represent what was part of a budget that was to be part of a stimulus project for the economy, and I think there are many experts who believe that investing in health and social services is one of the most important ways of getting dollars down to where they can do good work.

Other than the good increases in terms of first nations and Inuit health and to the Mental Health Commission, virtually everything else in the Health Canada estimates went down--health systems, environmental health, health products, substance abuse, food and nutrition, pesticides, workplace health, international health. Everything went down.

Why couldn't you have made a better case that at this time, in a recession, investing in health is a good stimulus? I am really disappointed that from health human resources, all those people losing their jobs.... Couldn't we have had training for these people to become nurses, or all the things that we're lacking? There doesn't seem to have been any creativity in actually designing a budget, other than all these cuts.

I'll go back to public health for a second. If you want to answer the other one, that's fine.

Is any of the $500 million for Canada Health Infoway going to public health--in terms of tracking of the new money that went into Infoway? I think a lot of us felt that....

And then for Dr. Butler-Jones, I have to go back to this contingency for a pandemic. I think Canadians believe you were quietly and wonderfully spending the $120 million a year to get ready. I think most Canadians would believe that the $80 million a year is sitting nicely in a pot such that should we end up in trouble, all of that money is sitting there. I don't think I feel very confident knowing that you have access to only $80 million in the event of a severe pandemic this fall. So $80 million doesn't seem like a lot of money; $400 million makes me more confident that you can tap into that amount that was set aside. It was booked in the 2006 budget--$1 billion over five years. What happened to the $80 million in 2006-07, 2007-08, 2008-09? Where is that money, and why isn't it sitting there for you to access should you need it?

[Dr. David Butler-Jones]

Thank you very much.

First, on the Canada Health Infoway, there was the original investment leading to the development of Panorama, which is the surveillance and case management system that the provinces have been actively involved with, and we're continuing to work with them on that development. That's in addition to Sin-Fi and other technologies that have allowed for the rapid dispensing and sharing of information across the country, not just with public health officials, but with health care institutions and others, which has really facilitated quick and accurate information-sharing.

Second, on the $80 million a year, that's the way the budget was set up, because nobody could predict whether the pandemic would be next year or in ten years. So there was a contingency set aside for $80 million a year should it be needed in that given year, as a pre-positioning. That does not mean that is the end of the story. That is pre-positioned, that we can apply for and access if needed. Then if there are additional resources required, we will address that at the time. But by having it in the budget, it allows quicker access than trying to react in other ways.

At this point we don't know for sure that it will be the pandemic, and we don't know for sure even then if it's going to be severe or mild, or basically like a really nasty regular flu year, or something different from that. So I think all governments are planning. And we're fortunate in Canada. We now have the summer to build on the existing plans to make sure we have vaccine, etc., in place--and we believe there are enough antivirals in the country to treat everybody who would need treatment, whether they're health care workers or not--and to have all of those plans really refined before we get into the fall and we see what happens.

Again, it could peter out, in which case we don't need it this year, or it could continue, in which case we'll have to address that at the time.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

It's the turn of Mrs. Wong.

[Alice Wong, Conservative, Richmond, BC]

First of all, thank you very much for coming and giving us so much detail on the budget and what the government has been doing for the needs of the different Canadians in our nation.

My question is more about seniors, because in the riding of Richmond, a lot of seniors have talked to me and I know their concerns, and I just want to know the government's point of view.

Our senior citizens are the fastest-growing age group in Canada. They will need better services and better care. What is the Government of Canada doing to make sure that we properly understand their issues and are prepared to face this demographic change and the health challenges of an aging population?

[Dr. David Butler-Jones]

I think there are a number of things that governments at all levels are quite conscious of.

And you know, I'm getting awfully close to the age....

Actually, most seniors are active and fairly healthy and living well into advanced age. So all levels of government, I think, are looking at the best ways to support that.

One way we have is the age-friendly cities and age-friendly communities we work with—and for which we have funded WHO—to give guidance and support to these municipalities and communities on the kinds of things that will actually make a big difference and are legitimate for the federal government to do. In addition, there is planning around emergencies and on working with municipalities and others if there is an emergency, such as an outbreak or a heat wave, as occurred in Europe and affected Paris so badly. What are the kinds of things that communities can do to actually be more responsive and to recognize those who are vulnerable, etc.?

Those are just a couple of examples of the many kinds of things we're doing. There is, as you know, an advisory group to both the health minister and the minister of HRSDC. We work very closely with our sister departments to really address those things in a more effective way.

Those are just a few examples.

[Alice Wong, Conservative, Richmond, BC]

My next question is about family violence, because that has become somewhat of an issue too. What is the Government of Canada doing to address the issue of family violence?

[Dr. David Butler-Jones]

There are a couple of things. Certainly in terms of the federal role, there is the initiative and support we provide around guidelines and best practices, bringing various groups together to try to approach this strategically.

Again, these events happen locally. But having the connections provincially, nationally, and internationally, and bringing best evidence and practices and a profile to the issue are all important roles that we play.

[Alice Wong, Conservative, Richmond, BC]

Do I still have more time?

[The Vice-Chair, Liberal, Joyce Murray]

Two minutes.

[Alice Wong, Conservative, Richmond, BC]

Okay, thank you.

I'm also very interested in the drug safety and effectiveness network. In January 2009, the government announced additional investment in that network. What activities do we expect the network to undertake in the near term, using this investment?