Health Committee on Feb. 10th, 2009

[Morris Rosenberg]

We have received the report dealing with indicators and we have accepted the Auditor General's recommendations for improving our health indicators. Progress has already been made in this regard. Obviously, first nations health indicators, for which the federal government is responsible, are an important priority. So we are working to improve the way results are measured for this population.

[Nicolas Dufour, Bloc, Repentigny, QC]

You are saying that you already started working on the implementation of the Auditor General's recommendations.

[Morris Rosenberg]

Madam Chair, if I may, I would like to introduce Anne Marie Robinson, the assistant deputy minister for First Nations and Inuit Health Branch, who may be able to elaborate a little bit.

[The Chair, Conservative, Joy Smith]

Please go ahead.

[Anne-Marie Robinson, Assistant Deputy Minister, Department of Health]

Madam Chair, thank you for the question.

I will answer in English.

We're working closely with our partners, the Assembly of First Nations and the Inuit organizations, to ensure that as we develop these new indicators, they're culturally appropriate. As the deputy said, we do accept the findings of the report. Also, going forward, as the deputy said, one of our key strategies is to make sure that our health care services are aligned and integrated with provincial services. So we're also working in that context to make sure we have indicators that make sense and that are useful in measuring aboriginal health outcomes.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Dufour, you have some more time.

[Nicolas Dufour, Bloc, Repentigny, QC]

In a different perspective, the Standing Committee on Health recommended last year that the $84 million earmarked for the federal initiative to address HIV/AIDS in Canada be allocated. But, out of this amount, $11 million were diverted to the Canadian HIV vaccine initiative. The money was used to promote organizations in Quebec as well as in Canada and to heighten awareness of AIDS.

I would like to know if all of theses organizations will receive the funds initially planned for the federal initiative to address HIV/AIDS in Canada.

[The Chair, Conservative, Joy Smith]

We'll go to Dr. Butler-Jones.

[Dr. David Butler-Jones]

Madam Chair, thank you for the question.

There are presently many programs to address AIDS. Expenditures related to community-based programs have increased. In 2006-07, $10.5 million were allocated. In 2007-08, there was a slight reduction, but this year, $12.1 million are allocated, and it will go on. This is an increase, an improvement for local agencies.

[The Chair, Conservative, Joy Smith]

Monsieur Dufour, you have more time.

[Nicolas Dufour, Bloc, Repentigny, QC]

In the case of budget 2009, do you intend to renew the $84.4 million funding for the federal initiative to address HIV/AIDS in Canada?

[Dr David Butler-Jones]

Yes.

[The Chair, Conservative, Joy Smith]

You have half a minute, if you want to add another quick question.

[Nicolas Dufour, Bloc, Repentigny, QC]

I do not have any other questions. Thank you very much, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We will now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I was wondering if you could elaborate a little bit more on mental health. Last year, when I was with Industry Canada, I had the privilege of attending an announcement in Toronto. I think we gave one of the largest grants to CAMH, in partnership with some of the other hospitals in Toronto. I'd like to ask the officials for a little bit more detail on what the government is actually doing to improve mental health. Are we doing enough for wellness and prevention? Are we doing enough to target our youth? What exactly are we doing at this time to help improve the mental health and well-being of Canadians?

[The Chair, Conservative, Joy Smith]

Which member of the panel would like to comment on Dr. Carrie's question? Can we have Dr. Rosenberg?

[Morris Rosenberg]

Mr. Rosenberg.

[The Chair, Conservative, Joy Smith]

Mr. Rosenberg, sorry. Go ahead. Too many doctors around here, Mr. Rosenberg.

[Morris Rosenberg]

Thank you, Madam Chair.

As the committee will know, mental health is a complex multi-faceted problem that is the concern of all governments in Canada and I would say the concern of lots of other folks in Canada.

I think the Mental Health Commission, just to speak a bit more about that, has been a unique opportunity coming out of the report of the Senate committee on social affairs, and then of course the former chair of that, Mike Kirby, became the first head of the Mental Health Commission and has worked with all jurisdictions and with stakeholder groups to bring them on side.

As you know, one in five Canadians has a mental health issue. That means that just about every family in Canada is touched by mental health. And it touches us with respect to children and youth. It touches us in the workplace--workplace mental health. Depression, for example, is one of the major causes of loss of productivity, not just absenteeism, but what is called by some people “presenteeism”, that is, people who are coming to work who aren't really working because they're not able to do that.

There's also the issue that has to be dealt with of reintegration. If you look at the long-term disability claims in this country across all industrial sectors, including, I would say, the Government of Canada, a larger and larger percentage of those claims relate not to physical illnesses but to an inability to work for mental health reasons. One of the real challenges is not only to pay those claims, but then to find a way to get people to reintegrate, because statistics have shown, research has shown, that if people are away for an inordinately long time...the longer they're away the more difficult it is to ever get them back into the workplace.

The Mental Health Commission, as you may know, has set up a series of expert advisory groups. It has a very elaborate structure, with a board of directors, but also with all sorts of people who are really interested in every aspect of this. There is, for example, an expert advisory group on workplace mental health. There's an expert advisory group on child and youth mental health. There's a group on aboriginal mental health. There's a group on mental health and the justice system, from two aspects. One, the justice system is sometimes used as a way of housing people who have mental illness who may act out violently, and on the other side there are justice system issues in terms of contract and civil law issues that need to be worked out.

There's an awful lot of work going on through the Mental Health Commission. As I mentioned, there are the homelessness projects that are being carried out across the country to determine the specific comorbidity around homelessness and mental health, and it manifests itself very differently in different cities, so we hope to get a lot of good research coming out of that.

The Mental Health Commission is also involved in a number of key activities, the most pressing of which I think is the creation of an anti-stigma campaign. If I were to ask people in this room if they had a mental illness, they probably wouldn't volunteer it. If I asked you if you'd ever had cancer, probably people would say yes. A few years ago people wouldn't talk about cancer either. We've come a long way with physical diseases. We have a long way to go with mental illness.

The other thing the Mental Health Commission is doing that's very important is developing a knowledge exchange, a place, whether it's web-based or otherwise, where people can go to actually get information about mental illness with respect to caregivers, families, and patients, information about the conditions and information about the resources to help.

And finally, the commission is developing a national mental health strategy. They have a 10-year timeframe to do their work. They're off to a very good start.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Rosenberg.

Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I'd like to get some more detail about Bill C-51. The minister mentioned that it would be coming back in front of the committee. In her remarks she demonstrated a strong commitment to keeping people well and to disease prevention, and that's what natural products practitioners and industry believe their products do. Mr. Rosenberg, I'm sure you're aware that despite the reassurances that natural products would remain available, there was great concern across Canada about Bill C-51.

I have a series of questions that will be pretty quick to answer. With your indulgence, I'll read them all out. The perspective I'm most familiar with is the practitioners'. I know you've consulted with health products industries, but the practitioners of traditional Chinese medicine, the naturopathic physicians, and other complementary health practitioners were concerned that they would lose access to some of the products that they believe are essential for their patients.

I have five questions. One, has Health Canada consulted with the associations representing the complementary health practitioners?

Two, if Health Canada has not consulted these associations, is Health Canada planning a fuller consultation before reintroducing this bill with its amendments? I think they need to address the complaint that little consultation was done regarding an extensive rewrite of a very complex act.

Three, will Health Canada be removing natural products from the same category as pharmaceutical drugs? I know this was one of the key requests, but there were many other concerns.

Four, is Health Canada investing in research into natural products and complementary medicine modalities? Unlike the products of pharmaceutical companies, primarily natural products and natural medicine are a public good. There isn't a private benefit from that research, so there isn't the incentive for the private sector to do it, and we need more of it. I know that the natural and complementary practitioners would like this, too.

Lastly, how is the $12 million of additional voted appropriation being allocated? Thank you.

[The Chair, Conservative, Joy Smith]

Mr. Rosenberg.

[Morris Rosenberg]

Thank you, Madam Chair. I will attempt to answer all of those questions with a little bit of help from Meena Ballantyne, who is the assistant deputy minister for the Health Products and Food Branch.

First of all, the first question was, did we take into account the practitioners' perspective on this? I think the short answer is yes.

On natural health products, there was a regime put in place several years ago by regulation under the Food and Drugs Act to regulate natural health products. There is nothing in Bill C-51 that was ever intended to change any of that.

We recognize that there's a very broad range of products that are natural health products, from the most benign products—olive oil, let's say, might be a natural health product in that context—to other products at the other end, where there may be significant interactions with pharmaceuticals, or where the evidence for claims needs to be ascertained if these products are being used, for example, as remedies for serious illnesses.

We recognize that there's a broad spectrum of risk that needs to be dealt with and that what is appropriate at one end of the spectrum might be a very, very light touch, almost nothing, while at the other end of the spectrum you would want significant evidence, recognizing that the evidence in the case of natural health products is different from the evidence you would have with pharmaceuticals. So for Chinese or Indian traditional natural health products that have been used for decades or, in some cases for hundreds of years, there are a lot of traditional sources of evidence that are available, and we recognize legitimacy of that evidence.

The second question was, have we consulted complementary health practitioners? Yes, we have done some consultation of complementary health practitioners. Is there going to be fuller consultation? Yes, absolutely, there will be fuller consultation, and I think on all aspects of Food and Drugs Act reform.

Remember, the reform isn't really about NHPs. The NHP regime was largely in place. It was our intention to basically just import that. What we were doing was a more fundamental reform of food and drug regulation in this country, recognizing, in light of some of the food-borne illnesses we had seen, that Canada's legislative regime had somewhat fallen behind where our trading partners were, including the United States.

We're often criticized for harmonizing to the United States, but this is a case where we're actually harmonizing up to the United States. They have stronger powers, the ability to recall, and tougher fines and penalties. Canada's Food and Drugs Act dates back to the 1950s. All modern jurisdictions have moved ahead. It was time for us to move ahead. That was the crux of the amendments.

You asked about the amendments. Last year, Bill C-51 died with the dissolution of Parliament. It's not currently before Parliament, so in a sense we're really not talking about Bill C-51. The government still has to finalize the package it's going to put forward. But at that point, in response to the concerns of natural health product practitioners, a number of amendments were proposed by the government that I think would have assuaged the concerns of those practitioners. I think they would have made it quite clear that we are not treating natural health products in the same way that we're treating pharmaceuticals. We made quite a clear definitional distinction between natural health products and pharmaceuticals.

As far as research is concerned, I guess the answer I would give is that the research we would do would be research within a regulatory context. As I mentioned, we are going to be taking a risk-based approach. We will be looking for evidence of safety and efficacy of products. Again, the evidence is different, and we will use traditional sources of evidence. But to the extent that we have this regime, which is really no different from what was there before, we would be doing that kind of regulatory research to satisfy ourselves that the products were safe and efficacious.

Finally, on the $12 million, I'll turn it over to Meena Ballantyne.

[Meena Ballantyne, Assistant Deputy Minister of Health]

Thank you.

Thank you, Madam Chair.

To speak to the $12.5 million, when these regulations came into force in 2004, there was no stable source of funding associated with the regulations. What has happened with these supplementary estimates is that we now have a program of natural health products. The bulk of the money, about $8 million of it, is going to go to the natural health products directorate so that we can clear the backlog by 2010, which is what the minister talked about.

We have a variety of business process improvements in place—the natural health product online system—whereby industry can come in with pre-cleared information. This is like having a recipe, whereby we say that if we know something about this product and it conforms to this recipe, then companies can make these submissions online and can receive their application and their licence within a few days. For those low-risk products on which there's a lot of information, we can do this. In the case of other kinds of products, we'll have to work on them.

We're doing a lot of business process improvements, and that's what the natural health products directorate will use that money for.

We now also have in place, with the marketed health products directorate, a system to monitor adverse events that happen or adverse reactions to natural health products. As we all know, “natural” doesn't mean it's no risk; it's really low risk. With the increasing problems of contamination and counterfeiting, this is an area we need to really pay attention to, by monitoring the adverse reactions and events that happen with the use of natural health products. As the deputy said, sometimes they're used in combination with pharmaceutical products as well, so there are a lot of reactions we need to be on the alert for.

Part of the money will be used to put in place a compliance and enforcement regime as well. The inspectorate in the Health Products and Food Branch will also get part of this money to make sure that we work with industry to help them with compliance promotion with respect to these regulations and also to take enforcement action whenever necessary and reasonable.

Let me add, Madam Chair, on the point of consultations, that Canada is hosting an international conference on the harmonization of complementary health products, with the WHO, China, India, Australia, the Europeans, the United States. It's on February 24 and 25 in Montreal.

Thank you.