Health Committee on Dec. 14th, 2010

[The Chair, Conservative, Joy Smith]

Good morning, everybody. Welcome to the committee today. I am very happy to see you all here.

We will be suspending at 12:30 because we have a half hour of business, so we'll do that in camera.

I want to welcome Mr. Lamoureux to my committee. He's from Winnipeg. I'm very happy to have you here, Mr. Lamoureux.

Pursuant to Standing Order 108(2), we're doing a study on injury prevention in Canada.

We have, from the Canadian Association for Suicide Prevention, Tim Wall.

From Lakehead University, we have Dr. Susan Forbes, adjunct professor. She's with the injury research program. Glad to have you here.

From the Royal College of Physicians and Surgeons of Canada we have Dr. Louis Francescutti. We also have with him Danielle Fréchette, director of health policy. Happy to have you here as well.

From Safe Communities Canada and Passport to Safety, we have Paul Kells, president and founder of that association.

Welcome to all.

We have a lot of very important witnesses today we want to hear from. I'm going to be giving you ten minutes.

I would like to start with Mr. Wall, please.

[Tim Wall, Executive Director, Canadian Association for Suicide Prevention]

Thank you.

On behalf of the Canadian Association for Suicide Prevention, our board of directors, and our members across Canada, I want to thank this parliamentary committee for providing us with the opportunity to speak to you today about the intentional injury side of injury prevention.

Over the past two decades, close to 100,000 Canadians have died by suicide. Last year, almost 4,000 Canadians died by suicide, more than the total number of fatalities from all other unintentional injury-related deaths and homicides combined. Death by suicide is the leading cause of death over all other injury-related fatalities. Yet suicide, like injury prevention in general, has been largely ignored by the federal government.

Canada ranks in the top third of countries with the highest suicide rates. Suicide is not the result of a single cause; it is complex. Suicide prevention requires a multi-faceted approach.

Suicide is the result of an interaction of complex biological, psychosocial, and spiritual factors that can include social isolation, trauma, stress, family violence, poverty, poor mental health, and physical and mental illness.

In Canada, suicide prevention is fragmented, disconnected, and lacks a national vision. There is currently nothing under mental health or injury prevention that unifies suicide prevention in Canada.

If one examines the impact that suicide and suicide-related injuries have on our already overburdened health care system, the cost is alarming. It is estimated that in Canada there are in excess of 88,000 visits to emergency departments for suicide-related behaviour.

In 2004 over 7,000 Ontarians were admitted to hospital for suicide-related behaviours. Of this group, permanent partial disabilities were suffered by almost 1,500 people and 76 suffered permanent total disability.

Given the need for hospital and/or rehabilitation services and additional family support following a suicide attempt, the estimated cost of non-fatal suicide-related behaviours ranges anywhere from $33,000 to $308,000. There are many other economic costs associated with intentional injury deaths, but they fade in comparison to the price that is paid by the families of those who died by suicide.

Over three million Canadians, and no doubt some of us in this room today, have known the pain and anguish that comes when someone we love dies by suicide. What adds to this tragedy is knowing that many of these intentional injury deaths were preventable. Sadly, when someone dies by suicide, the pain is not gone. It is merely transferred to their family, their friends, and their community. Their injuries are largely invisible and mostly suffered in silence.

The Canadian Association for Suicide Prevention is made up of a group of dedicated volunteers. Since it began in the 1980s, CASP has conducted its work with no public funding or support from the Government of Canada. CASP and its board have volunteered thousands of hours to promote suicide prevention on a national level, often at great personal sacrifice.

For the past two decades, CASP has done the yeoman's share of the work without support, acknowledgement, or encouragement from federal sources. Up until now, we have only heard silence from Ottawa. The Government of Canada contributes to the stigma and the problem of suicide by its silence, rather than publicly and vigorously declaring its support for suicide prevention. Thank you for helping to break the silence.

While the United Nations, the World Health Organization, every other developed country, and every province and territory recognize suicide as a major public health issue and a priority, the Government of Canada has yet to do so, and has demonstrated little leadership on this intentional injury issue.

Your thoughtful and courageous decision to make the intentional injury of suicide part of this injury prevention discussion gives us hope.

As the UN recognized in 1993, suicide is not the responsibility of a single sector domain. It belongs to public health, mental health, social wellness, and injury prevention. No one can say this is not my problem or responsibility, and yet that has been largely the message we have heard from the Government of Canada.

To date, the federal government's response to our pleas has been that this is a provincial and territorial responsibility and not theirs. Suicide, as a serious intentional injury, is in fact everyone's responsibility. Everyone has a role to play, and that includes the Government of Canada.

Our national government has, in the past, demonstrated leadership and has worked collaboratively with the provinces and territories on numerous public health issues and pandemics, such as H1N1, SARS, and AIDS. It is now time for our national government to get involved, in a meaningful way, in addressing Canada's suicide pandemic. Our national government can no longer ignore the injury prevention issue and simply pass it off as a provincial and territorial issue and walk away.

While our federal government has made important investments in suicide prevention in first nations communities, it has failed to take action beyond this very limited and selective response. It has made no investments in suicide prevention outside of first nations communities.

The good news is that suicide-related injuries are preventable. We know what to do. We can do it, and we must do it together. For the past six years we have been offering the Government of Canada the gift of a national strategy for suicide prevention that was developed by CASP in 2004. I have a couple of copies that I brought with me today. It is a gift that keeps being returned. We invite you today to accept this as our intentional injury prevention gift in the spirit in which we are giving it. Please, let's work together to save lives and comfort those who grieve.

Over 15 years ago the United Nations and the World Health Organization recognized suicide as a major public health issue but didn't confine responsibility to a single domain. In 1992 the United Nations asked Canada to take a lead role in developing international guidelines for suicide prevention, which were later adopted by the UN, in 1996.

The UN guidelines and the subsequent World Health Organization guidelines asked that every country develop both a national suicide prevention strategy and a national coordinating body. Shortly afterwards, countries around the world began developing their strategies. To date, all developed countries have national strategies--all of them, with the exception of Canada. All of these countries overcame obstacles. Why can't Canada? In fact, not only has Canada failed to act on and recognize the UN and WHO guidelines, it has yet to even acknowledge suicide as a national public health issue.

Currently, suicide prevention is no more than a footnote on the Public Health Agency of Canada's website. Once an international leader in suicide prevention, Canada is now not even a follower. We are shamefully out of step with the rest of the world. It is now our turn to learn from other countries and follow their example.

So what can the Government of Canada do? The Government of Canada can do for suicide prevention what it did for mental health, which was to recognize mental health as a priority issue and establish the Mental Health Commission of Canada. When the Mental Health Commission of Canada was established, they were mandated to develop a national mental health strategy.

It is important that we not confuse the Mental Health Commission of Canada's strategy with a suicide prevention strategy. And note that in their excellent report, Towards Recovery and Well-Being, only one passing reference is made to suicide prevention.

We are asking that the Government of Canada do the following: formally recognize suicide as a serious public and community health and injury prevention issue and policy priority; appoint and adequately fund a national suicide prevention coordinating body that will serve as a knowledge broker; promote knowledge exchange, best practices, research, and communication; commit to working collaboratively with the national coordinating body, the provinces, and the territories on establishing a national suicide prevention strategy; and mandate and adequately fund the national coordinating body to develop and implement a national suicide awareness and education campaign.

In conclusion, too many lives are being cut short and are being deprived of a future that could be hopeful and fulfilling. Too many people and families are being deprived of loved ones who would have continued to enrich their lives and their communities.

There are hundreds of thousands of people in this nation whose lives have been forever altered by a tragic and needless suicide death. Some of them are your constituents. Some of them are maybe your neighbours, your friends, your families, and even your colleagues here in Parliament.

Suicides are preventable. When asked what you did to help prevent suicides in Canada, how will you answer?

There is hope, and with your support, we can and will save lives, and heal those who grieve.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Wall, for your very insightful and heartfelt presentation. We appreciate that.

We'll now go to Dr. Forbes, from the Lakehead University.

[Dr. Susan Forbes, Adjunct Professor, Injury Research Program Manager, Play It Cool Injury Prevention Program, Lakehead University]

My thanks to the chair and the honourable committee members for the opportunity to come here today and speak with you.

I'd like to focus my comments on three areas: first off, the long-term implications of sport injuries; secondly, where are we at with sport injury prevention; and finally, what are our options.

With respect to the long-term implications for sport injuries, both individually and collectively in terms of their impact on the health care system, these are significant. The 2005 general social survey showed that 7.3 million Canadians, 28% of them 15 years of age and older, were engaged in some form of sport and physical activity. This is approximately 59% of the population. Unfortunately, it also represents a 20% decline in participation rates from 1992. Paralleling that, we are seeing a rise in obesity rates, not just in our youth but across all age groups.

From an economic perspective, the SMARTRISK 2009 “Economic Burden of Injury” report found that sports-related injuries cost the Canadian health care system approximately $188 million in direct and indirect costs. This is simply a snapshot of the scale of these injuries, because these are the ones that are reported at hospitals and actually capture data on a very small category: either you were struck by a piece of sporting equipment, like a puck or a stick or a baseball, or you ran into something, like the boards, a net, or things of that nature. It's not capturing all of the information that we need.

Recent work in the area of sports concussion has also revealed a very strong relationship between multiple concussions—so athletes having two or more concussions throughout their career—and Alzheimer-like symptoms such as cognitive impairment, loss of memory, dizziness, and things of that nature. And we have yet to have been able to calculate what the long-term emotional, personal, and economic impact of those types of injuries will be both for the individuals, their family, and our society.

But even with limited data, the impact of sports-related injury is clear. Furthermore, we don't know the implication sport injuries have on participation rates of children and youth. For example, are kids quitting sports because they're getting hurt, or they fear being injured? Or are they not even bothering to participate because they're afraid of getting hurt, or their parents perceive the sports as being too dangerous, and keeping them out of sport?

That said, we all know that the benefits of physical activity outweigh the risks, but there are risks that are preventable, and we have to find a way not only to prevent them, but at least reduce their incidence where we can. There are several ways we can work to accomplish those goals.

As an academic, I would be remiss if I didn't focus on research. I wouldn't be doing what I get paid for. But from a research perspective, the sport injury research, both domestically and globally, really has exploded in the last two decades, which is a recognition of our area, understanding and pursuing this more deeply.

Many of the research initiatives have entailed injury surveillance as well as efforts to determine the causes of those types of injuries as well as to develop prevention programs. Looking at the research and examining those few research centres—for example, the sport injury prevention research group at the University of Calgary—their focus on sport injury is clear that everybody's counting what's happening: the number of head shots that lead to concussions, the number of knee injuries, and things of that nature. And they're doing a good job of describing what's happening.

As valuable as this information is, they are not exploring or explaining how and why behaviour plays a role in injury, or how external factors influence this type of behaviour—for example, the pressure to win on both players and coaches, the pressure to make it to the next level.

From a government perspective, we are starting to see some recognition of injury and injury prevention as a significant health-related issue. For example, the federal government's throne speech last fall drew attention to the fact that there is a need to address the issue of injury prevention. Even in 2005, the ministers of health document “Creating a Healthier Canada: Making Prevention a Priority” articulates a need to focus on injury prevention. While none of these documents specifically speaks to sport injury, we can certainly imply its presence within their documentation.

What are our options? We can continue to count and describe injuries, but in doing so we need to capture more information in order to understand sport injuries more fully.

More importantly, we need to shift our thinking from merely injury prevention to sports safety, to emphasize that injuries are not inevitable; they are not an inherent part of playing sports. One way we can accomplish that is through skills-based education programs such as Play it Cool, the program in which I am involved.

What is Play it Cool, and how does it differ? It's a safety-oriented intervention program aimed at reducing injuries in minor hockey. The beauty about a program like Play it Cool is it's adaptable to any sport. It provides an online education program that helps coaches learn to teach skills, but with an emphasis on safety.

Going into the initial project we asked kids why they wanted to be good skaters. Overwhelmingly the answer was, from the boys at least, “Well, it means I'll get to go to the NHL”. That is fine and admirable, but the real reason is, “If I get bumped or take a hit, I'm stable, I can absorb it, and I'll be less likely to get hurt”.

We're not changing the game of hockey. We're trying to change the way we think about hockey to give the kids all the skills, in both hockey and all the other sports, to play successfully and for a long period of time. More importantly, we're also trying to help those who are educating these young people to rethink the way they approach teaching skills so the emphasis is on safety, and not simply trying to be the next Wayne Gretzky or Sidney Crosby, or things of that nature.

What would we like to see from a government perspective? Help us understand sports injuries and their implications more thoroughly by enhancing the injury surveillance systems we have in place, as well as helping us to develop new systems and new expanding partnerships.

Help us raise awareness of the seriousness of this type of injury. By elevating sports injuries as a distinct category, such as traffic and suicide, through a national sports-focused safety policy and related infrastructure for coordination, implementation, and support, we can help the public understand that it's not okay for kids to get hurt playing their favourite sports. It's not a normal part of the game.

Help us work toward solutions and best practices. By helping us improve collaborations and partnerships between researchers and injury prevention advocates, both governmental and non-governmental, and lead health and sports agencies, we can come to viable solutions to reduce the incidence of injuries in sports.

Finally, help us shift thinking from prevention to promotion of safety and safe sports.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Forbes.

Now I'll go to Mr. Paul Kells.

[Paul Kells, President and Founder, Safe Communities Canada and Passport to Safety]

Okay.

[The Chair, Conservative, Joy Smith]

You sound surprised, Mr. Kells.

[Paul Kells]

Absolutely.

I sort of outweigh you on this. My daughter works for the House of Commons, so they put me ahead of you.

[The Chair, Conservative, Joy Smith]

Mr. Kells, you just ruined it.

[Paul Kells]

Now my daughter will be eternally embarrassed, and for that she will not be grateful.

Robin and I experienced a tragedy some 15 years ago, on November 19. Her brother, my son, was killed in a workplace explosion in Brampton, Ontario. He died by fire. You have a graph from Louis that will show you that 2% of fatalities occur from that source. Sean had third-degree burns to 95% of his body in a workplace that had many different violations.

It's a bit discouraging to be here, as much as I relish the opportunity to speak to you. In Nova Scotia last week a verdict was handed down for a young man who died of third-degree burns to 95% of his body handling the same kinds of chemicals in the auto industry, and the fine levied in Nova Scotia was half that of the one issued for the employer of my son 15 years ago.

After spending 15 years trying to work on changing attitudes and culture and workplace safety, and understanding that these things are preventable, and demonstrating across the country--not me, I don't mean I've demonstrated--there has been a radical reduction in workplace injuries, which will go to prove the point that if you focus on this stuff, you can find solutions. But it is sad to see that the attitudes that underlie this, meaning accountability in workplaces and the weight we place on that, are still uneven across the country. It sends a terrible message from Nova Scotia to the rest of Canada. I certainly do hope there will be an appeal of that in the province.

That notwithstanding, what I wanted to talk to you about today is the national.... Well, pick what you'd like: would it be the national injury disparity or the national lifespan gap? Here's the reality. If you live in Ontario and send your child to Saskatchewan or Manitoba--I don't know the numbers exactly--you're one and a half to two times more likely to have your son or daughter die or be permanently disabled at work. The same would be true across other forms of injury where mortality rates and injury rates are higher from province to province across the country.

Provincial jurisdiction, the Confederation model that serves us well in so many ways and on so many fronts, causes some serious gaps or discrepancies.

By now we understand there are some huge best practices. Some interventions work, but they're applied in different provinces in different ways. Where is the national leadership on the issue?

About seven or eight years ago I went to see an assistant deputy minister in the federal labour department, which has some role in workplace injury but not much. I told the fellow at the time that I was trying to figure out what role the federal government might play in impacting workplace safety, at least through bureaucracy. It's such a provincial jurisdiction. It's all regulated by the workers' compensation boards, etc., and there was no money in his department. I understood that. What would it take for a federal government of any political stripe to assume some sort of leadership role in setting a standard for the country as a whole? I said from what I could tell, from what I understood, from what I saw, there was really no leadership on that issue in the federal government. He looked at me--and he knew why I was there, and how I came to be there--and said I was right, there was no leadership at the federal level.

This is in part an appeal. We need to set some national standards. They don't exist. They do exist in other countries. You've heard all sorts of testimony from other people about national strategies, yes. Mental health, suicide threat, yes. So what's the issue, really?

There are lots of technical solutions, and I'm not going to pretend to present them to you because there are people who are far more qualified than I am to do it. But I can tell you that by the end of today there will be 35 more dead Canadians and there will be more than a dozen quadriplegics and that there is no discrimination or political stripe to this--a director of communications for the Liberal Party, the team doctor for the Senators, a quadriplegic from Manitoba who is serving as an MP, the suicide of a son of the Minister of Finance in a Tory government, and on and on--there's no politics around this. We need some unified national leadership.

It is discouraging, I've got to tell you. After 15 years of this, it is discouraging not to have seen this evolve.

It is just great that you're in here talking over these issues and there's an opportunity maybe to achieve some consensus on what is of course a relatively divided country in political terms these days.

There's one thing we all value. Our kids, our moms, our dads, our friends, and human life are meaningful to all of us.

I want to conclude by saying there are really five things that you do need to focus on. Forget the specifics. You need to focus on five things, and they are really general and vague.

First is consistency. You need to get consistent on this. I heard in one province, on the worker safety piece of it, a few years back, Alberta to be specific.... No, they said, we did young workers' safety last year--as though they exposed one generation of kids in one year to a workplace media campaign, and now they're going to be on to road safety this year. No. Consistency is key to this.

In Ontario, for example, where there are 45% fewer severe trauma injuries for young workers than there are anywhere else in the country, by rate, it's because for ten years they have been doing it. They did cut it out this year. They stopped it this year because there's a new financial regime in town, and of course it's a good financial question. Yes, we have a lower workplace injury base than anywhere else in the country, but we spend $90 million a year in Ontario on workplace injury prevention alone. That would be compared to zero dollars, by the way, at the federal level, but $90 million dollars a year.... But could we have done it for $50 million? A good financial question. Now, let's cut that out, and let's cut that out, and in the process this reduction of consistency could potentially cost human lives. Who dies because they weren't aware of it? I don't know. We can't attribute it to that. That is the concern, the consistency that's required.

The other parts are commitment. If you say there should be leadership and you're committed to it, you will make it happen. I expect that of my MP, who is sitting in the room.

[The Chair, Conservative, Joy Smith]

Who is that, Mr. Kells?

[Paul Kells]

Megan Leslie.

[The Chair, Conservative, Joy Smith]

There we go. I just wondered.

[Paul Kells]

She represents Halifax very ably.

[Megan Leslie, NDP, Halifax, NS]

Thank you.

[Paul Kells]

I say all this non-politically.

Then there's leadership. I'm not going to lecture you. Please bring your leadership abilities and your capacity to this. Please do that.

Yes, you need to bring the resources. If the commitment, the understanding, the passion, the leadership, and the focus are there, the resources will come. There will be people who will be more intelligent than I who would give you advice on how to spend that.

Really, those are the five pieces you need. Put them in any order you want. Please address the national leadership or lifespan gap, the national injury disparity, and the injury problem--all those things that could hurt you. It's actually more than anything else an attitude issue. That you can fix.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Mr. Kells, for your very insightful presentation.

I've chaired this committee for quite a while. One thing I can say about the people on this committee is I've always been very impressed with how, for the most part, they leave it at the door. This committee has elected, as a group, to study this because we all believe, regardless of party preference, that this is of paramount importance to bring to committee and examine it.

Thank you for your very compelling.... My condolences on the death of your son, Mr. Kells.

We will now go to the Royal College of Physicians and Surgeons, Dr. Louis Francescutti.

[Dr. Louis Hugo Francescutti, President, Royal College of Physicians and Surgeons of Canada]

What I'm going to do is try to build on some of the colleagues' comments that you've heard so far.

I will speak French from time to time. I left Quebec 30 years ago and I am out of practice. If there are any questions in French, my colleague Danielle will answer them.

My MP, Mr. Tim Uppal, is in the room as well. The whole point is that I want to try to synthesize what you've heard so that you can actually start practising medicine without a licence, because a group like this one has the power to save more lives than I can ever save as an emergency physician.

I have assumed the role of presidency of the Royal College. The Royal College represents 44,000 international specialists. It's one of the world's most respected specialist organizations. We've recognized that injury is a major problem and we're asking our members--whether they're trauma surgeons, neurosurgeons, orthopedic surgeons, physiatrists, or pediatricians--to get involved in this problem.

Health care spends $194 billion a year, and people are questioning openly what we're getting out of it. Part of the problem is that so many of our patients are there as a result of trauma--suicide attempts, motor vehicle collisions, occupational injuries, sports-related injuries, transportation injuries, injuries around the home, injuries on our farms--and of all the diseases that we treat, this is probably the most preventable.

It's the leading cause of death in the aboriginal community. For our brothers and sisters in our first nations communities, injury is the leading cause of death, exceeding cancer, heart disease, and all others combined. For kids between the ages of one and 19, injuries are the leading cause of death.

If I were to say to you, “pink ribbon”, right away you would focus on that disease and know that it's well mobilized across the country. There is interest, there is research, there are dollars, and the public's really interested in that problem, but you don't understand the injury problem because your constituents don't understand it. To them, they're accidents. When you ask the average Canadian about injuries, they think they're accidents. If they really don't want to assign responsibility, they'll call them freak accidents, but I've never seen anyone in the emergency department clutching their chest and saying ”I'm having a freak heart attack”. However, because the public reports injuries--or so-called accidents--so often, and because they are the leading cause of death among Canadians under the age of 45, what ends up happening is that we become habituated and we think that's the way things are.

About 50 years ago Sweden had a death rate this high compared to Canada. Sweden's death rate was almost twice ours 50 years ago. Sweden now has one of the lowest death rates due to injuries in the world, and Canada has come down modestly.

Australia has shown us how to do it with a national strategy. New Zealand has shown us how to do it. We just came back from Saudi Arabia and Oman, and they're now starting to try to tackle this injury problem at a national level.

If you wanted to go after the low-hanging fruit within the health care system, injury is the only disease you can eliminate overnight through concerted efforts of education, enforcement, engineering, and economic incentives. We know what needs to be done. You could reduce your injury burden almost overnight.

What would that do? It would free up the wait times in the emergency room. I can tell you as an emergency room physician that sometimes 30% to 45% of what we see in emergency is injury-related. It would free up elective surgery time, because our traumas are bumping all of the elective cases. About 12% of all our hospital beds are trauma patients, and what Paul didn't tell you is the impact that injuries have on families in terms of divorce rates, separation rates, and substance abuse down the road. It has devastating impact. It's probably the most under-recognized public health problem facing us today.

That's all bad news, but the good news is that you could do something similar to what was done in the United States in 1985. The Institute of Medicine produced this little red book. That little red book was entitled Injury in America, and it laid out what the injury problem was. As a result, a centre for injury control and research was developed within the CDC in Atlanta, Georgia.

We have the Public Health Agency of Canada. I'm sure that Dr. David Butler-Jones, with a little probing, would be able to house a national centre for injury control and research that would encompass all the different diseases of injury.

Injury is caused when the body can't tolerate excess energy that is transferred to it. That's the only way people get injured. The injuries could be intentional or unintentional, or they could be a result of what we do in health care. We injure patients in health care. That's why, several years ago, the federal government and the Royal College established the Canadian Patient Safety Institute. We've taken care of that problem, or we're working on it, but nobody's really tackled the injury problem with the national perspective that's required.

I am aware that health care--other than aboriginal, RCMP, or military health care--is a provincial responsibility, but I think the federal government can play a very meaningful role in health by telling the provinces, “Listen, we're not going to tell you what to do within your provinces, but as a country, this is what we'd like to do. Here's our strategy for injury reduction within the country. This is what we'd like the territories and the provinces to do, and here's how we can help you get there.”

In other words, you can lead without owning, and you can target the provinces that have problems.

There is a high rate of suicide in Quebec and Alberta.

In Alberta, more people die from suicide than die in motor vehicle collisions.

If you want to know how many Canadians are dying from injuries every year, it's the equivalent of a fully loaded 737 crashing every five days. Take one of WestJet's 737s, fully loaded, and crash one every five days. By the end of the year, that will be about 14,000 Canadians who die.

Do you think the feds would be doing something if a 737 were crashing every five days? You'd probably shut down the airline industry until you figured out what the problem was. But because these deaths are occurring a few here on our roadways, a few within our homes, a few as a result of suicide--more than a few--a few at work, a few at play, among kids, aboriginals, old people, and young people, we've partitioned it all off. And no one has brought the numbers together.

What we have to do is bring the numbers together and say that enough is enough. Sure, Paul's frustrated. I'm frustrated too. What a glorious opportunity presents itself today, on this day when you can say that we have to do something about this problem.

Every party has to step up to it. Then provide the lead so that the provinces do it as well.

What's the investment we're looking for? A modest number would probably be something in the range of $30 million a year to get started. In Alberta, where we've costed it out, we expected that to get motor vehicle injuries under control within Alberta would probably cost us close to $5 million to $6 million a year, just for that problem. You can bring people in to help you with the figures.

If Santa were to leave something under my tree from this committee, it would be the committee saying, “Wow, we didn't realize that injury was such a problem, because our constituents didn't tell us that it was a problem, because they didn't realize that it was such a problem”. Yet 14,000 Canadians are dying. A quarter of a million are being hospitalized. Our emergency rooms are bursting at the seams.

Other countries have been able to show us that this is a preventable problem with great returns. Australia halved their motor vehicle fatalities, from 733 to 300 or something, within four or five years and maintained that. For every dollar they put into motor vehicle safety, they got a $22 return. The numbers are staggering.

I'm not going to use up my full ten minutes. What I'd like to do is engage in conversation with you to answer the last questions you may have so that when you deliberate you can say that either we were trying to bamboozle you or that this is a problem we've neglected for far too long and have to do something about.

The Royal College, I can tell you, is more than prepared to mobilize 44,000 specialists to see how we can engage municipalities, provincial governments, various levels of departments within those governments, and, more importantly, the Canadian population so that nobody has to suffer what the Kells family went through.

The worst thing I do in emergency is walk from the trauma room to the family room to tell another family that their loved one has died.

I have to tell you that close to 60% of all trauma deaths occur at the scene of the injury. More doctors and nurses and helicopters are not going to solve the problem. We have to prevent the problem. The only cure for trauma is its prevention.

I started by saying that you could be practising medicine without a licence, and I wasn't joking. If you do this and do it properly, you can go back and say to your kids and your family members that you were part of the movement that reduced injuries in Canada.

Things cannot get any worse. Canada is an embarrassment internationally when we take a look at our childhood injury rates. When you take a look at developed countries, we rank among the last. It's really a national embarrassment.

This is a problem that's solvable.

We thank you for the opportunity to come before you today. We look forward to engaging with you.

[The Chair, Conservative, Joy Smith]

Thank you for your very compelling presentation, doctor. It's very helpful to us.

We're going to go into our round of Q&As, of seven minutes, beginning with Mr. Dosanjh.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Thank you.

Thank you for your presentations, which were all very moving.

I have two questions. I'm going to ask them both at once, and I would like all of you to answer them, rather than have me wasting your time.

You've made a case, particularly Mr. Wall and Dr. Francescutti, and as well Mr. Kells, that no government has done very much or anything at all, regardless of political stripes, and I agree.

I want to know why you think that has not happened. Why do you think no action has been taken on the suicide file, for instance, federally, or on the sport injury brief mentioned in the speech, or on the issues you and Mr. Kells were talking about?

The second question for all of you is what would federal leadership look like in concrete terms in each of the areas?

[The Chair, Conservative, Joy Smith]

Who would like to begin with that?

Mr. Wall.

[Tim Wall]

When it comes to intentional injuries and suicide, I think there are a number of things that possibly get in the way—the stigma around suicide, the shame.... Suicide is shrouded in secrecy, and I think that's a barrier. Because suicide is so complex and requires a multi-faceted approach, I think the task sometimes feels overwhelming, and people say they're just going to walk away from it. It's not like coming up with a pill or an injection that you can give to prevent something. As Louis was saying, it's very preventable, but it really requires a collaborative approach. I think those are some of the things that get in the way.

To address your second question, there are a lot of wonderful things happening throughout Canada around suicide prevention, and they're making a huge difference. One of the problems, on which we need the federal government to show some leadership, is that one region doesn't know what another region is doing. There are no opportunities to learn from each other and to engage in conversations to find out that something worked here and may work there.

I was on a flight with one of your colleagues recently, and we were having this conversation. The response was that you don't send an electrician to do a plumber's job, meaning that you don't send in the federal government to do the job of the provinces or territories. My response was: that's true; the electrician doesn't tell the plumber what to do, but you need both to build a house, and more importantly, you need a contractor, somebody who can facilitate communication.

We have no knowledge broker, no one who can help synthesize the research and help us put research into practice and into policy. As Louis or Paul was saying about developing best practices, they're there, but we're not sharing them. The role of the federal government is to show some leadership, I believe, in helping us to coordinate—not to tell the provinces or territories what to do, but to help to exchange the information.

[The Chair, Conservative, Joy Smith]

I think Mr. Dosanjh wants some others to....

Those are very insightful comments. Thank you, Mr. Wall.

Who else would like to make comment?

Dr. Forbes.

[Dr. Susan Forbes]

I'll keep this very brief.

I think the reason we haven't seen much action is the diverse and multi-faceted nature of injury. It's complex, it's multi-layered, and there are so many different areas of injury.

The question I would have if I were a politician is where do we start? The start, I think, lies—in answer to your second question—around leadership. I like Tim's analogy of the general contractor to oversee everything and to help us coordinate.

I'll admit that as academics we're probably some of the worst people in the world for silo mentalities and not sharing what it is that we do. I frequently tell my colleagues that we need to get over ourselves. And we seriously have to, because there are best practices and initiatives out there that all of us can learn, not just from sport but from a lot of the other injury prevention initiatives hatt we can look at and embrace to try to find out what the best viable solutions are.

I feel that the federal government in particular can help give us that guidance. I like Louis's suggestion about having, either within PHAC or within our own CDC, an area focused on injury. That's as good a place to start as any.

[Dr. Louis Hugo Francescutti]

On the first question, I've asked politicians in Alberta why this isn't an issue, and it's because their constituents don't think it's an issue. If three kids were to die from meningitis in Ottawa today, you would rest assured that it was an issue, but because 50 kids are going to die from injury.... The point is, we have to get Canadians to understand that this is a priority, and that's where this body could say that it should be a national priority and that you're going to work with the provinces on it.

There's no sense in reinventing the wheel. Let's steal what New Zealand has done and what Australia has done. We know these colleagues; they have told they will share their national strategies with us. In the document that we'll be providing to you—it just wasn't translated—we call for the establishment of a Canadian injury prevention network that would do exactly what you're describing, bringing together the people who are out there.

The trouble with the people who are out there is that they are getting frustrated. As Paul said, they have been struggling for 15 years to try to make this happen, and it's a revolving door. There's not enough “stick power” in it, because they see that our provincial and federal counterparts really don't have an interest in the problem.

Injury in America, from the Institute of Medicine, is the stage you're at. You create that document with some seed dollars and then look towards the creation within the Public Health Agency of Canada—which is, I think, where it should reside—of a focus on injury. I can tell you that the Royal College of Physicians and Surgeons will be there to work with you on it.

Does that answer your question?