Health Committee on Nov. 30th, 2010

[The Chair, Conservative, Joy Smith]

Thank you.

With the permission of the committee, can I just ask a question?

Ms. Fuselli, you were talking about fencing around a pool. From what I understand, in some--well, in most--provinces and municipalities, they have a regulation where you have to have a six-foot fence around the pool. I'm talking about my province of Manitoba. It might be different in other provinces. That is my first comment.

[Pamela Fuselli]

Most bylaws or provincial laws are for only three-sided.... It's not four-sided pool fencing. When you look at the legislation, it actually is the pool enclosure, but the house can form the fourth side of that enclosure.

[The Chair, Conservative, Joy Smith]

I see. Thank you.

We'll go on to Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you, Madam Chair.

I wish to thank the witnesses for their presence here today.

Ms. Billings, in the beginning of your presentation, you said that in consideration of the aging baby boomers, health care costs are projected at $4.4 billion.

First of all, do you think that the government is aware of these expenses and that it has the means to handle them?

Furthermore, have measures been taken not only to prepare for the aging population but also to reduce the number of injuries by the elderly?

[Jane Billings]

Thank you for your question.

The expenses you speak of concern all levels of government in Canada. As everyone knows, hospitalization and health expenses are the governmental expenses with the fastest increase.

I think it's fair to say that no governments are ready for this type of increase in costs, and therefore it's very important that we continue to do what we can to prepare, through education, training, and prevention of injury, as we go forward.

As Pamela said, injuries are preventable. They're not accidents, so the more we can, through education methods and training, prevent these costs and prevent injuries, the better off we are for the individuals and for the system.

With respect to what we're doing now, the Chief Public Health Officer's report for 2010, which just came out a month ago, deals with aging. In the report, there is quite a lot with respect to how we should be looking at preventing falls and preventing injuries among seniors. It also addresses the whole spectrum of the aging population and how we should be looking toward aging in a healthy fashion and keeping our elderly in much better shape as we go forward. It's a very good report. We hope it gets the coverage it deserves. Thank you for the question.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much. This subject is becoming increasingly important. Take the people in my riding as an example. The aging of the population has been duly observed. It is the same situation all over Canada.

In your opinion, do concrete measures exist to reduce the rate of injury in the elderly?

[Jane Billings]

Absolutely. Concrete measures include, for example, providing information on fall prevention in the home and on vision improvement for the elderly.

Key among the elderly are falls, either falls outside or inside the house. It's ironic, though, that as people get older, they don't see as well. When they don't see as well, they fall. They don't see the obstacles either in the house or outside the house. Within the house, we're working with non-profit organizations on education on how to make environments safe for seniors, to ensure they have the aids: handles in the hallways; up the stairs; help to get out of bathtubs; age-friendly showers, for example. And how to take care outside--the icy sidewalks we have at the moment are not good for seniors.

I think a lot of the literature shows that once somebody has a fall, especially when they're in their seventies or eighties, and they break a hip, it's pretty much downhill from there.

It's extremely important to take these measures and to get the information out. The annual report that Dr. David Butler-Jones has released does have a section on concrete measures that we need to take collectively—governments, individuals, organizations, and the various environments we live and work in—to help keep seniors safe.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you.

There was one aspect of your response that I found particularly interesting: the desire to have these aging individuals remain in their homes. It is a matter of ensuring that there are no problems in their place of residence and encouraging them to live at home.

I will now address the child injury death rates. With this respect, Canada is ranked 18th among the 26 OECD countries.

Who is ranked highest among these 26 countries? Do channels exist in which we can communicate and share with these leaders in order to observe what they have done right and try to emulate it ourselves in the future?

[Jane Billings]

It is a disgrace that 17 countries surpass us in terms of injury prevention. Incidentally, injury rates in Canada have dropped by 40 percent since 1980; this shows that we have made improvements. The other countries, however, are still better.

At the Agency, we are studying the approaches implemented by the other countries, the majority of which are European. Nordic countries, for example, have implemented more dynamic methods. Our territory presents a problem that is particular to us. The injury rate in the North is higher. If we did not take this into consideration, our position would have been more favourable.

[Nicolas Dufour, Bloc, Repentigny, QC]

So the communities from the North have clouded the issue. Do you have any numbers that do not take into account the Northern community?

[The Chair, Conservative, Joy Smith]

Monsieur Dufour, you must pay attention to the chair. Your time is up.

[Nicolas Dufour, Bloc, Repentigny, QC]

As you know, Madam Chair, I have many questions.

Can she answer quickly?

[The Chair, Conservative, Joy Smith]

There you go. I know, Monsieur Dufour, but right now you're finished.

Now we'll go to Ms. Leslie.

[Megan Leslie, NDP, Halifax, NS]

Thank you, Madam Chair.

Thank you all for being here today.

My first question is picking up a bit on what Ms. Duncan was talking about, but suicide generally, not only in first nations and Inuit communities. We know that suicide is a significant form of intentional injury in Canada, particularly for first nations and Inuit Canadians, but also for youth. Then we also see links with a rising rate of suicide with seniors and suicide with gay/lesbian and transgender youth.

There isn't a national strategy to address suicide, as far as I know. We've been looking. So I'm wondering, is the government considering one? If yes, tell us about it. I'd be excited. If no, why not? I know a lot of community groups, a lot of civil society groups, have been saying this is what we need. We need a coordinated approach.

[Jane Billings]

I think we agree with you totally in that regard. However, the Mental Health Commission is working on its overall strategy. My understanding is that it will include a large element on a suicide strategy. So we're working with them.

[Megan Leslie, NDP, Halifax, NS]

Can I ask you about that? I know the Mental Health Commission.... Suicide is only a line in their mandate. It doesn't seem to be a big focus of what the commission is doing. I'm interested to hear about this, that they're actually taking on the suicide piece.

[Jane Billings]

My understanding is that we're supporting them in what they are doing. We, of course, do a lot of work with respect to the surveillance that...as we've noted, our data is a little out of date at this point--the surveillance, the analysis, the evidence, the interventions--but overall, we're really looking to the Mental Health Commission in that regard.

[Megan Leslie, NDP, Halifax, NS]

Can you tell me if they're tackling it broadly, or if they're targeting specific groups like youth or first nations? Do you have that information?

[Jane Billings]

I can't answer that.

Sylvain, would you?

[Sylvain Segard]

We've been maintaining contact with the commission on a regular basis and have encouraged them to take a broad look at the issue of suicide prevention by thinking about all the protective and prevention factors that should be considered. Instead of directing their attention strictly at suicide-related causes and focusing on a suicide response, it is part of the equation and it requires consideration of a variety of tools and initiatives. To have a comprehensive approach to mental health in Canada, to have suicide lines and counselling and the proper framework in the school environment and other environments so that our kids grow up healthy and understand how to recognize mental health, mental wellness, and so on, they are looking at a more comprehensive package.

I couldn't answer specifically whether or not they're looking at a specific aspect of suicide, or a breakdown for a targeted group. That's a question that perhaps you would want to ask them in due time.

[Megan Leslie, NDP, Halifax, NS]

We look forward to it. Thanks. Canadians around the country will be excited to know about that.

With the surveillance system you talked about, you said that you're routinely collecting health data to inform and guide timely public health action. I'd like to hear more about what that system looks like, what kind of information you're collecting, and I would specifically also like to know if you're collecting segregated or--I don't know the right word--delineated information about specific groups. For example, people living in poverty are at much higher risk of injury, as we've heard a few times. People living on reserve are at much higher risk. So I am wondering how the information is organized, I guess.

[Jane Billings]

The committee on several occasions has posed questions to us on our surveillance system, which is the accumulation of many different sources of information. Some we gather, some of it other organizations gather, and some Statistics Canada gathers, either on their own or on our behalf.

In some of the injury prevention information, we have these cards. We have a lot of information on various causes of death—by sex, age group, and injury. We also have some data on the various income classes, and that largely comes from Stats Canada.

We use and analyze data from StatsCan on mortality. From the Canadian Institute for Health Information, we have hospitalization data. We also gather information from the Canadian Red Cross—for example, we get our drowning information from them.

We have a system—the Canadian hospitals injury reporting and prevention program—from which we gather information. We support that program. On the family front, we also have the Canadian incidence study of reported child abuse and neglect.

So we work with StatsCan, with CIHI, and with Canadian coroners and medical examiners. All of them support us on the Canadian coroner and medical examiner database, which we also go into.

So we really gather data from just about everywhere we can, and in some cases we support the gathering of these data directly.

[Megan Leslie, NDP, Halifax, NS]

Do you feel that your sources are comprehensive enough, or are there gaps you're looking to fill?

[Jane Billings]

Every time we do some analysis or try to answer questions like the ones posed to us today, we find that there are gaps in some of the striations, some of the geographical spread, and in some of the timeliness. In an ideal world, we would be able to collect uniform data that would be comparable across the country.

Surveillance and the adequacy of data are a key support in the ability of the public health network, and the expert group under it, to prepare analyses, compare Canada with other countries, design workable interventions, and gather evidence to evaluate our work. Surveillance is a challenge throughout the organization, and we work every day to make it better.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Billings.

Ms. McLeod.