Evidence of meeting #10 for Health in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was social.
A recording is available from Parliament.
10:45 a.m.
Conservative
The Chair Conservative Joy Smith
Well, we're running out of time.
Would you like to answer, Dr. Hershfield?
10:45 a.m.
Professor of Medicine, University of Manitoba, Former Director of Tuberculosis, Province of Manitoba, As an Individual
Yes, I would.
I agree with you, but the fact of the matter is that when I was director of Manitoba, we had regular meetings with FNIHB, the province, and everybody. And that's the way the program ran. Right now in Manitoba it's fragmented to a bunch of different agencies and/or regions. And that's the problem. To come in and say the federal government wants to do an X-ray survey of Lac Brochet would take a year to negotiate. That's a problem.
10:45 a.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Well, yes, there are no performance standards nationally to direct the process. We end up with this fragmented approach. And surely that has to be one of our recommendations.
Do I have any more time?
10:45 a.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Ms. Wasylycia-Leis. Thank you.
We'll now go to Ms. McLeod.
10:45 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you, Madam Chair. Again, thank you to all the witnesses.
I'd first like to focus in and ask a question.
Dr. Graham, you talked about the SCRAP-TB program in British Columbia. Could you elaborate a little bit in terms of what's happening there?
10:45 a.m.
Chair of the Chronic Disease Policy, Chief Executive Officer of the Lung Association of Saskatchewan, Canadian Lung Association
Yes. SCRAP-TB stands for strategic community risk assessment and program for TB. It began in B.C. It was a way to involve the community, engage the community, and develop champions for TB within the first nations communities, to assist with the TB control program.
One of the other important aspects of it is that it wasn't a program that said you have to do it this way--a template. It was more of a way to say that we know that one size doesn't fit all. We've been talking about this problem all morning, saying words like “aboriginal”, as though it's a homogeneous group, which it isn't. And even among first nations we know there are many first nations at different stages with different players, different people, and different cultures. We need to recognize that. That's the kind of program that is being developed, to have people within the community become more aware of TB and become involved in the TB process, raise awareness, improve, participate in some of the directly observed therapy programs for tuberculosis.
10:50 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Can you tell me a little bit of the dynamics in terms of how the federal government interacted with the provincial government, interacted with the aboriginal communities? How does it all piece together?
10:50 a.m.
Chair of the Chronic Disease Policy, Chief Executive Officer of the Lung Association of Saskatchewan, Canadian Lung Association
There was some federal funding provided that went into this, but there were other agencies that were involved in it as well that helped to develop the idea. I believe it was tested in about six or seven first nations in B.C. and Alberta and one in Saskatchewan.
In terms of the direct involvement, it wasn't that there was somebody who prescribed it. It was more of a grassroots kind of thing that built up with this type of funding. I believe it's under evaluation right now, looking at the potential for expansion.
10:50 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
We've heard comments about health services and how the medical community cannot absolve itself of responsibility because of certain social determinants. So recognizing in these comments the absolute imperative that we move toward more equity, and that might take a little time, if we had a really good system without jurisdictional barriers, could appropriate treatment reduce this to very small numbers? I recognize that we have to move toward a much more equitable system, but I'm talking strictly about the medical services.
10:50 a.m.
Professor of Medicine, University of Manitoba, Former Director of Tuberculosis, Province of Manitoba, As an Individual
I'll say something Pam would say. Theoretically, yes, the treatment is known. TB is curable, and 98% of people who take their medication will be cured, everything else aside. If you give treatment to people who were contacts, positive tuberculin reactors, and they take their medication, they will not get tuberculosis in the future. So the answer is theoretically yes. The problem is the administration and setting it up in the field.
10:50 a.m.
Professor, Department of Medicine, Medical Microbiology and Community Health Science, University of Manitoba, As an Individual
Yes. To reiterate, from 1960 to 1980, the great physician, Stefan Grzybowski, oversaw a very aggressive medical program for TB under very difficult social circumstances in what is now Nunavut--poorer housing and nutrition, etc., than we have today--and they achieved the most remarkable decrease in the incidence of TB recorded in the world. So yes, it can be done. Of course, working on the social determinants is a justice issue and a credibility issue with aboriginal people. You won't get cooperation on one field if you don't address the other field. So it's the right thing to do, but the medical intervention works.
10:50 a.m.
Executive Director, Canadian Society for International Health
As everybody has been saying, nothing is as disarming as the truth. If there was a report card and if there were indicators, then a whole lot of other things would fall out, because people would be called upon to answer why not. Why didn't we get there? What's going on?
There are the federal-provincial-territorial mechanisms and there are interdepartmental mechanisms at the federal level and at the provincial level that allow for the true public health approach in terms of addressing TB in a vertical program, but they also allow for those other social determinants to weigh in. The report card and deciding on core indicators could work, because we've done it federally for other things and we can do it for this, and the interdepartmental approach allows that horizontal piece to play in as well.
10:55 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I'm not sure if anyone here can answer this, but in terms of on reserve, off reserve, does anyone know the statistics with regard to the rates of tuberculosis?
10:55 a.m.
Professor of Medicine, University of Manitoba, Former Director of Tuberculosis, Province of Manitoba, As an Individual
Manitoba has those statistics. I thought I brought them, but I don't think I did.
10:55 a.m.
Professor, Department of Medicine, Medical Microbiology and Community Health Science, University of Manitoba, As an Individual
The federal government has statistics, which I have in my briefcase and which are on the web. It's aboriginal/non-aboriginal, under Inuit, first nations, Métis. Many of the provinces do not publish on-reserve and off-reserve statistics, and that's part of what one might call a culture of secrecy. There are concerns about confidentiality. Nevertheless, one can release information while preserving both patient and community confidentiality.
10:55 a.m.
Professor of Medicine, University of Manitoba, Former Director of Tuberculosis, Province of Manitoba, As an Individual
The federal government produces statistics that talk about status Indians, non-status Indians, Métis, Inuit, and that's the way it's divided. That's because in provinces, those aboriginals not on reserve are counted as part of the provincial total as opposed to aboriginal totals, unless they have two addresses, which many people do. Then you have to choose which address you want to use for them.
10:55 a.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Hershfield.
We only have a couple of minutes left, but there is something we need to address. In a motion the committee had talked about submitting a report to the House of Commons. So we need to discuss that, but before we do that, I want to thank the witnesses for being here.
This will end your witness time on our committee and you are free to go at any time.
10:55 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
I have a point of order, Madam Chair.
Seeing that we will be reporting back to the House, based on today's testimony, if anybody has specific recommendations you would like to see in the report....
Because of the federal-provincial jurisdictional problems and the fact that quite often we don't have even national numbers, as Dr. Hershfield just said, it's very important for it to be accurate. I was wondering if you would entertain the suggestion, Madam Chair, that we may need expertise, even for the draft report, to make sure we've got it right. In certain situations we've been able to circulate a draft report to make sure the experts are comfortable with it before we send it in. We just have this one opportunity. We don't have an opportunity to bring it back and test some ideas--
10:55 a.m.
Conservative
The Chair Conservative Joy Smith
What we can do is ask that the recommendations be brought in. We don't generally ask the public to write our reports for us--the committee will do that--but I suggest very strongly that you submit all your recommendations and everything you would like to see in that report. That would be very acceptable.
Go ahead, Ms. Wasylycia-Leis.
10:55 a.m.
Liberal
10:55 a.m.
Conservative
The Chair Conservative Joy Smith
It's Ms. Wasylycia-Leis. I addressed her first.
Go ahead, Ms. Wasylycia-Leis.
10:55 a.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
I suggest we ask our analysts if they could come up with a draft report as quickly as possible--within a week, even--that is short on background but focused on the recommendations.
It seems to me that four or five key points have already been brought to our attention. One is not to delay in this federal strategy, but to get it kick-started immediately, as opposed to waiting for October. Other recommendations would be that there be national standards developed, with a built-in accountability and assessment process; that the Auditor General be called in to look at the books; that there be an emergency federal-provincial-territorial meeting on this issue; and that there be an emergency strategy to immediately send in teams to the hot spots for assessment, so that at least we begin to deal with the problem.
10:55 a.m.
Conservative
The Chair Conservative Joy Smith
Our time is up, so could I ask you to please put all your suggestions in and send them in to the analysts? We will have time next meeting to take a look and see how much more time we need.
Witnesses, could you bring all your recommendations in? Suggestions from anybody around this committee could be put in as well.
Thank you for coming. We are dismissed.
11 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
No, I had a point of order on Thursday's meeting. I had explained to the clerk that I wanted to ask for an update on what we have heard in the RSVPs for Thursday's meeting.
11 a.m.
A voice
Yes, that's a good question.