Health Committee on Nov. 30th, 2010

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

Thank you.

I would like to pick up on my colleague's line of questioning as it relates to surveillance. In this day and age of computerization, if you looked at the hospital injury reporting system—and that's from eleven pediatric hospitals and four general hospitals— I would think some of our small, rural hospitals that are servicing our north might provide a whole new dimension of data.

Are our provinces streaming into one system that they will feed federally? Are our public health units feeding into the provincial system, so that provinces are getting a pretty good perspective on what's going on? Can you talk a little more about that?

[Jane Billings]

I'd be pleased to.

The collection of uniform data across the country is still in the development stage. The Canadian government, along with the provinces, has invested a large amount of money in the development of electronic health records. The provinces and territories, together with our agency, are working on a system called Panorama, which CIHI has supported to the tune of about $100 million so far. That system is ready to go in some provinces. It will facilitate the uniform gathering of health records, which would allow much better transferability of information and much better management of patient files. It would also allow provinces, territories, and the federal government to get that direct information. But it's some years away.

I think B.C. is ready to test a pilot and their new modules. We're working with them on the steering committee looking at standardization development—what the needs are, what the various modules are—but it's not there yet.

Each province and territory is a little different, and they each have some pluses and minuses in what they're able to gather.

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

So if where we're going will probably be electronic medical summaries, will data from hospitals feed into Panorama? Is that part of the concept?

[Jane Billings]

That's part of it.

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

And specific data around injuries and ages--

[Jane Billings]

Right.

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

So ultimately there is a vision of an electronic solution to surveillance.

[Jane Billings]

There is absolutely a vision. But the complexity of implementation is enormous because this means that individual doctors' offices and all the individual hospitals are really going to have to change how they keep records.

It doesn't sound that difficult, especially since many of our doctors are in the information age, but in fact the transformation and the cultural change is very demanding.

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

I think we've done a remarkable job in terms of moving forward in areas like car seats, in terms of cribs and putting your baby to sleep. I think we've done lots of great work. I think we're doing some good work in terms of falls with the elderly.

Of course, I live in the middle of the mountains, and I also live in more rural and northern communities. We've made good progress in some of the easier areas, but I look at the 14-year-olds in my community hurtling down the mountains on their mountain bikes and into the parks. We talked about injuries all being preventable, but I don't know. There are some sports with some inherent risks, and I think mountain biking is probably one of the bigger ones.

Do we really focus on some other areas, recognizing there are probably going to be some injuries we're going to be able to impact less in terms of rates?

I don't know who could answer that one...maybe Pamela.

[Pamela Fuselli]

You're right, there is a variation in terms of risky activities that people can undertake.

There are ways to mitigate the serious injuries. When I talked about bumps and bruises and scrapes and things like that, that's not the type of injury we're interested in mitigating. It's the life-threatening, life-long disabling types of injuries.

So even with the mountain bikers going down the mountains wearing the correct gear and knowing the terrain and where they're going over that next hill, there are definitely steps that can be taken so they can still engage in those types of activities but do it in a safe way, and perhaps if they do fall--

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

Safer.

[Pamela Fuselli]

Safer. So they fall off the bike, but they're wearing a helmet or they're wearing the right gear for whatever sport they're engaged in.

We have made good strides in terms of car seats, but motor vehicle crashes with child passengers remains one of the top three causes of death in Canada. We still have a lot of work to do in terms of getting those known, effective interventions embedded in the Canadian culture.

One of the things we want to do more of in terms of the at-risk populations, like those living in the north, is to learn...because obviously a car seat on a snowmobile is not the right intervention. What we don't know is what does work up there.

So it's what does work, what protective things are those communities already engaging in, and what can we evaluate and engage with them in recommending for those communities? We know they're probably doing things that are keeping their children safe; we just don't know about them, or they haven't been evaluated. There's lots of work still to be done.

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

Okay. If I have another quick second, when we were looking at our comparison with other countries, I think they used the word “aggressive”—aggressive strategies.

Perhaps you could talk a little more about what aggressive strategies these countries are using, and in terms of north versus the rest of Canada.

[Sylvain Segard]

I guess what's aggressive to one may be modest to another. But what we have to understand is that in the Canadian context, as a federation and with the separation of responsibilities, our ability to have a comprehensive--call it aggressive--or effective approach requires collaboration amongst many sectors. In a recent workshop that PHAC sponsored, bringing together representatives from provinces and all sectors of the injury prevention area, it was concluded that in the Canadian context, to be fully effective, it will require coordination of messaging, loose coordination of a cohesive response, and similar objectives and priorities so that we can make a concerted effort in given areas and slowly chip away at it.

That being said, I think as Madam Billings pointed out, the summation of the efforts that Canada has made over the last 30 years has been quite spectacular in reducing the injury rates overall. Are we the best? Not yet, and we have much, much more work to do, but we're definitely trending in the right direction on many injury types.

So I think we can.... Through initiatives like the PHN's review and work collaborations with the provinces, this group on injury prevention has looked at what other countries are doing and is trying to extract the best practice from other countries and see how we might adapt them to a Canadian context.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Segard.

We'll now go to our second round.

Five minutes, starting with Dr. Dhalla.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Thank you very much for your most interesting presentation.

I wanted to touch upon something that my colleague, Megan, spoke about, an issue that became very personal in our constituency. We had a young woman by the name of Nadia Kajouji, who my colleagues around the table may know of, and perhaps you have heard of, who committed suicide. She was a student here at the University of Ottawa. Her brother, Marc, in her memory, subsequently got involved with a great organization called Your Life Counts, which was founded by Rory Butler. They've done tremendous work trying to reach out to young Canadians, helping them change self-destructive and addictive behaviours.

We've had a chance to meet many, many times with them. They've come forward and presented to an all-party committee as well, and some of the stats they provide are alarming. There are youth 15 to 24 years of age who are dying daily. They found from their research that there is a young person dying almost every 90 minutes, and in an entire year in North America they identify almost a million young kids who are committing suicide.

So when you take a look at all of those stats, and you realize that suicide has become the second leading cause of death amongst youth, it is quite surprising that we don't have a national suicide prevention strategy. And in talking to organizations like Your Life Counts and the tremendous work they're doing, it is also disheartening to hear that they have no funding and no support and no resources being provided.

Now on the question that my colleague had asked, you said that the Mental Health Commission was in the process of developing...is it a support mechanism? Is it a national prevention strategy? How is your particular organization with the Public Health Agency of Canada going to be involved? Is the work that the Mental Health Commission is doing going to provide a national strategy? Is there going to be funding put in place? Are there going to be support and resources? And lastly, can organizations such as Your Life Counts expect some coordination or collaboration with government to continue on the great work they're doing?

[Jane Billings]

Thank you. I'll answer the latter part of the question first, if I may.

At the moment, I don't think we're dealing with Your Life Counts. We run a number of contribution programs and we do fund organizations, not for their core funding as a rule, but to do research in areas that are of mutual interest.

Most recently, we have asked for proposals from a number of NGOs like Safe Kids Canada, ThinkFirst foundation, SMARTRISK foundation, and the Canadian Agricultural Safety Association, in terms of specific areas in which there are some gaps. For example, we have asked Safe Kids Canada if they would be interested in adapting some of the European child safety guidelines to be used in Canada. We've been in conversation with them about that. In addition, at our workshop last December, we drew together about 50 different people from different organizations, territories, provinces, and educational organizations to really kick-start some of the discussion on what needs to be done overall on injury prevention, including suicide.

At this point, it's premature for us to know what exactly the Mental Health Commission is going to do in framing suicide within its overall mental health strategy. As Sylvain said, we are in communication with them and working with them. We are very hopeful that when they do come out with their strategy, it will have an articulated national suicide element and it will be put forward to the government to see whether there are funding needs. But at this point, it would be premature for us to answer on their behalf.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

So where would organizations like this go within government to be able to get funding and resources and some mechanism of support for the actual delivery of services? You are saying that you guys focus only on research, which is great, but for a young person who is even in contemplation, you can have all the stats and the research in the world, but they're going to need tools to gain back either the self-confidence or empowerment or whatever the case may be to help them not make that wrong decision.

[Jane Billings]

At the federal level we focus on surveillance, knowledge development and transfer, support for research, filling the gaps, and working on the leadership role with the provinces and territories.

The actual service provision is at the provincial level and often the municipal level, so we'd encourage organizations to go through every door they can find, and to come to us if there are areas of interest for which they want to work up some best practices, but likely to go to other levels of government for actual funding support for the service delivery, such as youth help lines and those types of things. We might well be interested at some point in working on some of the tools, seeing what works in other countries and what they might be looking at, and also giving you the evidence.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you to our witnesses here today. Certainly this is an extremely important and interesting topic that we're looking at this morning. I appreciate you being here to bring us the perspective that you have.

I was interested to hear in the opening remarks, and I think it was referred to by a couple of you, that among the OECD countries, 17 are doing better than we are. Certainly I agree with you that that does not make us feel very good, and we certainly need to be doing better.

We've also heard this morning that we're using 2004 data, I believe. That data is six years old now. So I have a couple of questions surrounding that. Are the other countries that we're being compared to using 2004 data? What stats are they using? Do you think that data is in any way reflecting the reality that is out there today? Or is the situation in fact better or worse than what it might have been in 2004?

[Jane Billings]

Our data is from 2004-05. Much of it circles around the census, so that we are linked to that type of cyclical information. I would be guessing to say which way it was going, but it would be based on these different little bits and pieces that we get in. We're hopeful it's gone down.

There's been a huge effort through organizations like Pamela's and other organizations, and some coordination among the provinces and territories, to bring this down. The regulations have also been tightened up virtually across the country on car seats and boosters so that bigger children are now in boosters. There has been much done in terms of education about car seat safety. In many cases of car accidents, the children might have been in car seats but those weren't installed properly. So there's been much education there.

There has been a great deal of education around water safety in recent years. There has been a large emphasis on bicycle helmets and safety for those types of things. We still see trampolines in our neighbours' backyards, which gives me a certain worry. I don't think I would go that direction myself as a parent. But my sense is that we probably are improving because there have been many steps taken. In addition, Athana talked about the improved regulations on product safety and consumer safety that are coming into place.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Do you have any sense of what era of data the other countries might be using that we are being compared to?

[Jane Billings]

Most of them use census data as well.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

You've talked quite a bit about some of the successful initiatives. We've talked about car seats and bike helmets and those types of things and the product safety legislation.

Are there other things, or could you elaborate any more on those? Ms. Fuselli, from your perspective, what do you see as successful initiatives?