Health Committee on June 15th, 2010

[The Vice-Chair, Liberal, Joyce Murray]

Good morning.

We will be commencing the meeting of the Standing Committee on Health pursuant to Standing Order 108(2) with the consideration of the subject matter of supplementary estimates (A) 2010–11 under Health.

I want to welcome all of our witnesses and guests.

At 10 o'clock, the minister will be appearing, but we will be hearing from the deputy minister of the Department of Health, Glenda Yeates, and also from Dr. David Butler-Jones, the Chief Public Health Officer, before we go into our first round of questions.

Ms. Yeates, the floor is yours.

[Glenda Yeates, Deputy Minister, Department of Health]

Thank you very much, Madam Chair.

Bonjour, tout le monde.

Thank you very much for the invitation to be here today.

I am very pleased to be here today. With me are Germain Tremblay, Acting Chief Financial Officer of Health Canada, and other senior department officials.

By way of introduction, this is my first appearance before you in the role of deputy minister of health, and I just felt I should mention that while I am new to this position and feel very privileged to be here, I'm not new to the health field. I've had the great privilege of serving in the health and health care policy fields for approximately 20 years, most recently as the president and the CEO of the Canadian Institute for Health Information, but previously as the deputy minister of health for the Province of Saskatchewan. It is a great pleasure for me now to continue in the health field as the deputy minister of Health Canada.

The minister appeared before you on March 16 to discuss the main estimates of the health portfolio. At that time, Health Canada requested and subsequently received a net increase of $50.7 million in the 2010–11 main estimates.

Specifically, those investments supplemented first nations and Inuit health services and the food and consumer safety action plan--

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

Madam Chair--

[The Vice-Chair, Liberal, Joyce Murray]

Dr. Bennett.

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

--I have a point of order. It's highly irregular anyway for the officials to come before the minister. We only have an hour with the minister and an hour with the officials. If the minister were here and speaking first, as she would, she would have been the one giving the opening remarks. We only have two hours and we're going to get three sets of speeches.

I don't understand why. The estimates speak for themselves; I don't think we need a narrative. This is a time for Parliament to get to hold government to account. We need the full hour with the officials and the full hour with the minister to ask questions.

[The Vice-Chair, Liberal, Joyce Murray]

Ms. McLeod.

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

You know, Madam Chair, I certainly think five minutes just to put things in scope is very appropriate.

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

There's one from David and there's one from the minister. How much time are we going to be spoken at and how much time do we get to speak? This is not okay.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you, Dr. Bennett. We'll continue with the remarks and ask that they be kept as brief as possible.

Thank you.

[Glenda Yeates]

Absolutely. I will keep this very brief.

Health Canada is seeking additional funding of $241.4 million in 2010–11 to focus on the following priorities: $130 million to renew federal aboriginal health programs; $30 million to improve health access and to support innovations and reforms in the medical travel systems for the three Canadian territories; $26 million to provide first nations living on reserve with safe drinking water and waste-water services; and $22 million to continue work on environmental health risk assessment. These will build on key priorities that were in the main estimates in budget 2010.

In terms of the first nations and Inuit health branch, there is $130 million. Those dollars are to renew federal aboriginal health promotion and disease prevention programs in the areas of diabetes, suicide prevention, maternal and child health, health human resources, and the aboriginal health transition fund. We're also seeking funding to support the first nations water and waste-water action plan. And additional funding of $25.6 million would bring the total investment in this plan to $54.8 million over the next two years.

On the health regulatory front, Health Canada is seeking additional investments in support of the Canadian Environmental Protection Act and the chemicals management plan. We're making significant progress here, but we are completing assessments and continuing our work on the 200 highest-priority substances and initiating risk management measures for those substances that pose a risk to human health.

We are also looking for funding that is needed to maintain support of the regulatory review of drugs and medical devices, and funding to support the health and safety regulatory activities under the Food and Drugs Act.

Finally, in support of the Weatherill recommendations following the listeriosis outbreak, we are requesting an additional $3.9 million to review the ways we prevent, detect, and respond to outbreaks of food-borne illness.

The health and well-being of Canadians will always be Health Canada's main priority. Ultimately, resources requested through the supplementary estimates (A) will be used to help all Canadians maintain and improve their health.

Thank you very much for your time. I look forward to your questions.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Now, Dr. Butler-Jones, brief remarks, please.

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

Excellent. Thank you.

Thanks to the committee again for the opportunity to speak on our supplementary estimates (A). With me today is Jim Libbey, the chief financial officer for the agency.

As you know, it's not quite six years ago that the Public Health Agency was created. In this fiscal year, $664.8 million has been allocated to the agency, and I'd like to briefly outline a few of the areas that illustrate how these funds are put to good use.

Firstly, the agency spends that money on disease and injury prevention and mitigation.

A prevention agenda is among our highest priorities, for which we plan to devote over $115 million this fiscal year. As the Honourable Dr. Bennett rightly said, the goal is to have a great fence at the top of the cliff, not a great ambulance service at the bottom.

That's why the agency will continue to enhance Canada's ability to prevent and manage diseases and injuries. In 2010-11, for example, we will help to increase awareness of risks such as lung disease and increase capacity and knowledge on prevention and control of HIV/AIDS. We will continue to gather and analyze data on the rates, trends, and patterns of injuries in Canada and will initiate a national study to help close knowledge gaps in the area of neurological diseases.

Health promotion will also remain a top priority.

By definition, health promotion is the process of enabling people to increase control over and improve their health. In 2010-11, through our planned spending of $178 million, we will continue to build this through programs for vulnerable populations, such as the Canada prenatal nutrition program, the community action program for children, and the aboriginal head start program.

In Canada, as elsewhere, the obesity epidemic—especially among children and youth—has become a major public health challenge.

While this is a very complex, multi-faceted issue, there's a lot of evidence out there to inform our work, so one of our roles in facing this challenge is to bring the players together on this issue and ensure the lessons we see in one province can be applied to others. In 2010-11, as part of this work, we will be updating the national physical activity guides and we will continue to work with all partners on initiatives that support Canadians in the attainment and maintenance of healthy weights.

I will now turn my focus to infectious disease prevention and control.

Last year's H1N1 outbreak solidified our place as global leaders in responding to infectious disease outbreaks. Since the day we were aware of a novel flu virus circulating, the agency was at the forefront of the federal pandemic response.

The H1N1 pandemic saw quite possibly the country's greatest mass mobilization since the last world war. It marked the country's first pandemic in 40 years and the first pandemic in an information age.

All of these factors required a multi-faceted response: helping to secure enough vaccine for every Canadian who needed and wanted to be immunized; leading national surveillance activities; and communicating regularly to Canadians to provide them with the information they needed to make well-informed decisions related to their health, among many other activities.

Committee members have heard me say this on many occasions: disease and illness know no borders.

H1N1 was certainly no exception to the rule and the scope. It is critical that the scope and breadth of a response reflect that reality. That's why in 2010-11 the agency will continue to collaborate with our many partners, both domestically and internationally, to ensure that we can build on the lessons learned from H1N1 and strengthen our preparedness for future pandemics.

Our work goes far beyond plagues and pestilence. The agency will also work to increase public health capacity and enhance our national and international collaborations. We will strengthen surveillance and increase capability in assessing the health of the population. We remain the government-wide lead on efforts to study and address determinants of health.

In facing all of these challenges and embracing the opportunities they present, the Public Health Agency's vision remains constant and relevant: healthy Canadians and communities in a healthier world. All of Canada will benefit from these efforts.

Madam Chair, I am very proud of our work over the last five years and of the fact that the agency maintains and strengthens its reputation as a global leader in public health.

Thank you for your time. I will be happy to answer any questions.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you very much for the introductory remarks.

The first round of questions will be seven minutes per questioner.

We'll start with Dr. Bennett.

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

Thank you very much.

In the government advertising program, $65.4 million, including $8 million from Health Canada, was allocated. In the explanation of recruiting Canadian Forces and Royal Canadian Mounted Police, it also says “to raise awareness of social issues”. Could you tell me what advertising Health Canada has been doing?

[Glenda Yeates]

Thank you for the question. I will certainly begin with the $8 million you mentioned, as noted in the supplementary estimates. It is actually for a child safety initiative.

The $8 million there is a one-year interdepartmental initiative with the Public Health Agency of Canada, Transport Canada, the Canadian Food Inspection Agency, and Public Safety Canada. This is the notion of pulling together key messages for parents and families about child safety to try to avoid parents having to go to many different websites—for example, one on toy safety or crib safety and perhaps another on car seats—and to try to pull together a one-stop shopping place for parents to increase parents' awareness and give them streamlined access to health information.

This is under the auspices of the Department of Health. You see the $8 million there. It will in fact be a child safety campaign that bridges other departments as well. We intend to work together and create a holistic child safety and injury prevention focus.

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

Okay.

In the focus on maternal child health leading up to the G8, as Canadians we're embarrassed that the plight of our aboriginal people is getting worse in terms of maternal child health. Now that we've dropped to sixth place, according to the OECD, I would like to know where in the supplementaries we can find that additional money has been put to what is now clearly a national embarrassment.

[Glenda Yeates]

I think all Canadians would view the health of babies and mothers to be a huge priority. There is funding for supporting maternal and child health, particularly in programs on first nations reserves, both in the supplementary estimates that are before us today and in the regular programming--

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

But you're coming from CIHI, Ms. Yeates. We don't even know the numbers. We don't have disaggregated data on this. When will we get it? And then when will we be able to target sufficient funds to improve their outcomes?

[Glenda Yeates]

Thank you.

I'll touch on the three points that were raised: the first being the question of data; the second being the question of the international ranking; and the third being what is in the Health Canada programming to address maternal and child health.

Focusing first on the question of data, I think there is an ongoing challenge, as you mentioned, to make sure that we have good and comparable data for subpopulations. We certainly have data at the provincial level. In some cases, regional health authorities across the country will have data at the regional health authority level. It is challenging to be able to track it, for example, in small populations.

There is an ongoing dialogue with the first nations organizations—certainly there was when I was at CIHI—to try to understand what is an acceptable way, from their point of view, to collect and analyze the data. I think that dialogue is important to do in conjunction with first nations communities and that is the process that's going on.

That said, I think we're all aware, from the data we do have and from the extrapolations, that there is a challenge. So none of us, I think, need to wait for better data to feel that we shouldn't be acting at this point....

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

I mean, seeing that Cuba just beat us in terms of infant mortality, it seems embarrassing that we are stuck. They are at 4.8% and they actually have 2009 data. I don't see that it looks like a priority in anything we're doing in terms of actually allowing us to get the data. As we said to David last week, the information-sharing agreements just aren't good enough anymore when our Canadian representatives can't even give us the data based on our most vulnerable populations.

On that, I know there are some good things happening on maternal and child health, particularly in CIHR. Maybe, Dr. Beaudet, you would like to tell us if you have received any money to be able to profile those good things that are happening in light of the Prime Minister's commitment to maternal and child health. Also, do you have money to be able to showcase what's happening in Canada?

On maternal and child health, where in CIHR is there the evidence on global health, on maternal and child health? Where are we creating the evidence as to what full reproductive services look like? And then, who decides in terms of the ethics of your organization, in terms of recommending...? Does CIHR have any ethical impression of what it is to not follow the evidence and to follow ideology instead?

[Dr. Alain Beaudet, President, Canadian Institutes of Health Research]

First, I perhaps would like to address the question of aboriginal health, because I agree with you that it's a very serious issue.

One of the reasons for that seriousness is that very often we don't exactly know how to tackle these issues. As you know, one of the five priorities of CIHR in our next strategic plan is to look at vulnerable populations, and specifically at aboriginal health issues. We are planning a major strategic initiative in that area to try to address some of the issues, which go from the social determinants of health to the organization of health care services. Really, they are critical issues for which we need answers.

I would like to reassure you that we are projecting to invest in that very important area, which is also a priority area for CIHR.

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

But how do you do research if you don't have the numbers?

[The Vice-Chair, Liberal, Joyce Murray]

Excuse me, Dr. Bennett.

Mr. Beaudet can make some quick final points. Then your time is up.

[Dr. Alain Beaudet]

With regard to the question regarding maternal health, it also is an area that, as you know, we at CIHR are looking at. Our institute of maternal health and child development is focused on that issue.

As you know, we look at each proposed project on its merit, on the basis of excellence, on the basis of relevance. In the end, it's certainly not on the basis of ideological issues that the project is funded. It is funded purely on the basis of relevance and scientific excellence.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Mr. Dufour.