Health Committee on Feb. 10th, 2009

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that question.

The experience we had in Nunavut was that it was a challenge for us to address the shortage of health care professionals. Nunavut faced the same challenges as any other jurisdiction in Canada to address the whole issue of the shortage of health care professionals, recognizing that the approach we took was to try to train our own within our own territory and reflect programs that were culturally relevant to the people who would be served in that territory, to try to deliver programs and services in the home, in smaller communities, and to develop some mobile programs where we were able to take the training to the community level.

In the last four years we've made a lot of investments in Nunavut to train in Inuktitut, to train using traditional practices such as midwifery programs, to incorporate the knowledge of traditional midwives into the health care system, to train in the area of nursing programs in our territory reflective of the model of health care delivery that we use in the north.

We have one hospital in 25 communities. The jurisdiction of Nunavut is huge. How we deliver health care is quite different from other jurisdictions; we have limited access. Technology was also introduced as part of the teaching tools, with telehealth investments in every community.

So there are different models, but it involved the design of a health care system with the health care delivery people. The nurses were there at the table to design it along with us to address some of the challenges they face in remote communities in the delivery of health care. Nurse practitioners are our front-line workers, so trying to design programs that would support keeping them at the community level was very important to us.

So it was not a top-down approach; it was a bottom-up approach, a 15- to 20-year strategy involving tapping into high school graduations, supporting the students through the school system, maintaining them once they got into the system. It was quite long term.

We're facing the same challenges as every province and territory face in their jurisdictions in competing for a very small pool of skilled people in our country today, whether it be nurses, doctors, and so on. In my work and travels to various jurisdictions, we're struggling with this. My view is that, collectively, provinces and territories need to tackle this head-on. How do we come up with a strategy at a national level that would support each other instead of having provinces and jurisdictions compete against each other with that small pool?

We need to recognize the issues and concerns that have also been raised by provinces relating to credential recognition and to the lack of mobility within Canada of our health care professionals because of the processes that are in place. Some have expressed an opportunity to look at that, that there are ways to make it easier for our health care professionals to move around in our country, and at the same time to support our students and our nurses to have that choice to travel to jurisdictions.

So it's a huge challenge, and I'm open to discussions on that. I look forward to working with my colleagues, as well as stakeholders, on how we can perhaps address that, to address the issue of the shortage of health care professionals in our country.

[The Chair, Conservative, Joy Smith]

Thank you, Madam Minister.

Our time is up now for this session of 10-minute rounds.

Madam Minister, I know you said you needed to be here for an hour and then you had another commitment and the officials would stay for the duration, until 5:15, at which time we'll go in camera for our business. So it's just what you can do.

It has been a pleasure having you here. I don't know about your time, but my understanding is that you do have to get to another event.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I would like to thank my colleagues here, and I look forward to working with you. I would also like to say that I'm open to listening to your views and concerns. I think it's very important that there be a continued open relationship to discuss some of these challenges we face in our country. I'd like to thank the members for their questions and comments.

At any time, please feel free to speak to me on various issues. I look forward to working with you. I would also like to invite the committee members to Nunavut. I would love to host a health committee meeting at any time in Nunavut so we can learn about a part of our country that's very unique. I look forward to sharing that information with my colleagues.

Qujannamiik .

[The Chair, Conservative, Joy Smith]

Thank you so much, Madam Minister.

We will continue our questioning upon the minister's departure from the committee meeting. We will then start our second round, which will be five minutes in duration.

The officials will kindly stay, so you can direct your questions to them. We will have the same order, which is Liberal, Bloc, NDP, and Conservative, but just remember you will have only a five-minute time slot.

I would like to begin with Ms. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

I'm going to address three questions in three very different areas.

First, why is public health funding being used for security for the Olympics, and what health promotion will be done with moneys for the Olympics?

Second, we know today that if we have healthy children and keep them healthy, we have healthy adults. So if we can reduce obesity in children we can potentially reduce some cancers, diabetes, heart problems, etc., in our adults. I'm wondering what moneys have been directed to the prevention and remediation of childhood obesity.

Finally, what moneys have been directed to pandemic preparedness in Canada? The World Health Organization still considers pandemic flu one of the most pressing health issues facing the planet and it warns against complacency. What money is available for addressing the limited shelf life of Tamiflu? I believe the stock of it might reach its shelf life this year.

Thank you.

[The Chair, Conservative, Joy Smith]

Who on the committee would like to answer?

I know that Dr. Butler-Jones has had quite a bit of background on this. Would you like to start first on this issue?

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

Certainly. Thank you, madame la présidente.

I'll start on those questions, and then...because it's a partnership between us and Health Canada on this--and CIHR, for that matter, on the research and evidence side.

The short answer around the public health funding and the Olympics is that we're very much involved in issues of health security and preparation for the Olympics around both bio-terrorism as well as other events. If there were a pandemic, say, or even a seasonal flu or an outbreak during the Olympics, we would have our portable lab on site and be working very closely with the provincial health authorities around dealing with such broad-scale public health events. It's for those kinds of purposes that we're engaged.

On the health promotion side, a number of things are going on. Again, most of this, obviously, is in partnership with the provinces and territories. Specifically in B.C., there's ActNow BC, which has a whole-of-government approach to physical activity, nutrition, etc.

We have agreements with the provinces around healthy living. Most now are in place and are being talked about and worked on. There's funding for ParticipAction, and there's also the work generally that we're doing around fitness, lifestyle, and even the kind of community approach as to how we deal with it.

In terms of childhood obesity, that's clearly an issue. I've said it before, and it continues to be a challenge, that the risk is that if we're not successful in this, this generation of children may be the first to not live as long or as healthily as their parents. Fundamentally, it's a multi-sectoral issue in terms of the roles we play, working with both the food industry, etc., as well as with the provinces and territories. There are a number of mechanisms in place in terms of trying to address this more effectively across the jurisdictions. It's not like there's any one part of a system that can address it effectively.

Really, it's gratifying that people are actually talking about this. We kind of lost ten years, but people are actually starting to pay attention. Every jurisdiction now has an initiative or a focus on this. When Morris and I go and meet now with our P/T colleagues and with deputies, or at ministers meetings, these kinds of public health issues are on every agenda. Five years ago, it was rare to see that even talked about.

Morris?

[The Chair, Conservative, Joy Smith]

Ms. Duncan, did you have...?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I would like to hear about the pandemic preparedness.

[Dr. David Butler-Jones]

Oh, I'm sorry.

Yes, we continue to work on that. As the committee will probably remember, we do have a national plan for the health sector, as well as an international plan. We have a North American plan in place that continues to be revised.

We're unique in the world, still, in having a vaccine contract with a domestic manufacturer to produce sufficient vaccine for the total population. We also have in place stockpiles of antivirals, both held jointly with the provinces and territories as well as our own federal stockpile, that should be sufficient to treat anybody who needs treatment in the interim, until we have the vaccine in place, and for those for whom the vaccine is not effective. Planning at every level is taking place.

In terms of the shelf life, yes, some are starting to expire now. We're in active conversations with the provinces and territories about how we deal with that.

We're also adding to our national stockpile and looking to replenish some of the existing stock with new stock, including adjusting the kinds we have--adding, for example, amantadine, as we recognize resistance, and increasing the amount of Relenza--as well as having more pediatric doses in place.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Mrs. McLeod.

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

I would like to focus in on the aboriginal population within Canada, which certainly experiences significant health inequities, such as diabetes rates and cancer. I'd like to understand what the government is doing to look at improving health outcomes.

Closely related to that, when the Government of Canada works in isolation from the work of the provinces, how are they connecting in terms of improving the health of aboriginal citizens?

So I'd like to understand not only what we're doing independently but also how we're starting to coordinate.

[Morris Rosenberg]

Thank you for the question.

Madam Chair, with respect to the coordination, we have two initiatives under way currently, one with British Columbia and one with Saskatchewan, to work toward more integration of first nations health services into the provincial health system. We're a bit more advanced with B.C. than Saskatchewan.

We are in discussion with a number of other provinces to try to move in that direction as well, on the assumption that we will have more economies of scale and better service if we pool our resources with the provinces. We also recognize that services need to be provided in a culturally appropriate way for first nations. In the 2008 budget, $154 million, over five years, was provided to support greater integration with provinces and first nations health systems.

In this past budget there is $440 million for health programs and infrastructure. To break that down, $330 million is provided to stabilize the non-insured health benefits and primary care programs, and $135 million will be used to fund the construction and renovation of health services infrastructure in first nations communities, including health clinics and nurses' residences. We expect this funding will support more than 40 new projects and approximately 230 renovation projects over the next couple of years.

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

Thank you.

[The Chair, Conservative, Joy Smith]

You have a bit more time if you would like to ask another question, Ms. McLeod.

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

Certainly closely related to that, we did hear the minister talk of health professional shortages. Perhaps in line with the aboriginal community, are there specific things you are looking at in terms of health professional shortages?

[The Chair, Conservative, Joy Smith]

Mr. Rosenberg.

[Morris Rosenberg]

Thank you for the question, Madam Chair.

Specifically with respect to first nations, since the beginning of the aboriginal health human resources initiative, which was put in place, I believe in 2004, the government has been working with partner organizations and the National Aboriginal Achievement Foundation to increase the number of aboriginal students pursuing health careers, including nursing and medicine. Funding under that initiative has more than doubled the number of aboriginal health care students who are receiving support. In the last four years of the program, over 1,000 bursaries and scholarships have been awarded to aboriginal health care students, many of whom are studying nursing and medicine.

While increasing the number of doctors and nurses is critical, it's also important to ensure that medical and nursing students are receiving training that will increase cultural competencies in their future practice. Through this initiative, a framework for cultural competency has been developed collaboratively by the association that represents all 17 of Canada's medical schools, that is the Association of Faculties of Medicine of Canada and the Indigenous Physicians Association of Canada. Work is now under way to integrate this framework into medical school curricula. There is similar work under way to address the same issues with respect to the curriculum for nurses.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Very briefly, Ms. McLeod, you still have another quick question.

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

Okay. While primary health care is near and dear, mental health issues continue to be a grave concern for Canadians. I'd like you to perhaps talk briefly in terms of improving the mental health well-being of Canadians.

[The Chair, Conservative, Joy Smith]

Could you quickly respond, Mr. Rosenberg? I gave her some time within her time limit. Could you quickly make some comments on that?

[Morris Rosenberg]

I'll mention two things. One is the establishment of the Mental Health Commission of Canada a couple of years ago. I believe the government put in $130 million over 10 years. And then last year the Mental Health Commission received funding for a number of demonstration projects dealing with homelessness and mental health.

[The Chair, Conservative, Joy Smith]

Mr. Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

I will follow the same line of questioning as my colleague, Mrs. McLeod.

In her last report, the Auditor General noted that it is difficult to define and measure indicators to assess the health of first nations and the Inuit. In your opinion, what should be done in this regard in order for the federal government to adequately fulfill its responsibilities to first nations and Inuit people?

[The Chair, Conservative, Joy Smith]

Who on the committee would like to answer that question?

Go ahead, Mr. Rosenberg.