Health Committee on Oct. 24th, 2011

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you.

We've had some good testimony. Thank you for appearing today and presenting your views. I suppose it's left me looking for some answers on where to go next, or where the federal focus ought to be. As an aside, and almost as a joke, I would have to kind of boil down a lot of the testimonies today and elsewhere: I've concluded that if we live long enough, something is going to kill us. By that I mean it seems that, as a country, we've done a relatively good job of curing diseases, and now we're struggling with extending lives and lifestyles in a way that people are happy, or enjoy life to the fullest.

I suppose there's a question I kind of want to drill down on, and I'd be curious to get your answer on. It was touched on by a couple of people, and I'm not sure if it's what you meant when you talked about cure versus disease prevention, and shifting the focus from one to the other. But I can't believe that you would be suggesting that governments or doctors remove the emphasis from curing disease, removing resources, to focus on disease prevention. If you're not, then what would your message be to the federal government, which has under the 2004 health accord increased spending by 6%, and then going forward, at least for two years, increased it by another 6%? Are you suggesting that the federal government mandate to provinces a third of that 6% to disease prevention, or are you suggesting that 6% isn't enough and that more needs to be done? How would you balance that off with other priorities that governments have to face, including managing tax dollars at the end of the day?

[Susan Eng]

I would be pleased to answer that.

The importance of the health accords was their focus on five major strategic choices that would in fact improve on the delivery of health care overall. That was the last set of accords. The opportunity now arises to not necessarily add lots more money to the current spending and federal transfers, but to do it more wisely, to be much more targeted so that there is money in fact to do what people need and want, which is to age gracefully at home. If you do that, you have the opportunity to actually bring down your health care budget, because you are at the same time taking them out of institutional care, likely preventing additional conditions worsening and drawing upon the acute care system and so on. So there is an opportunity for cost savings in huge amounts of money. We're not saying take money away from anything. We are saying restructure it so that you're actually getting more value for the dollars that are spent.

In terms of prevention, the opportunity there arises because we know that one of the original promises of medicare was prevention, health promotion—don't get sick, don't get into the formal health care system. The ethic now among Canadians has been to look at healthy aging, and there's an opportunity even as people are already older that they can prevent the onset of chronic disease.

If we put all this there, the chances are that we'll be saving dollars later. Our membership tends to be very cautious of fiscal balance. They will pay dollars, pay taxes for good public services, but they just hate waste in any form whatsoever. So they want to hear sensible solutions that re-manage, restructure how we're spending now $192 billion a year. We're certainly not taking money away from curative efforts. We are looking at using our money more wisely, to prevent having to get into that system.

[Dr. Yves Joanette]

I totally agree. But in making these decisions together, I think we have to have the evidence to make the right decision. So these decisions have to be evidence-based, not anecdote-based. This is why I think we have mostly all the questions; we don't have all the answers. That's why we need more research, and the kind of research we need is more integrated. That's what the Institute of Aging is trying to do, to put all participants together on these very complex questions.

Also, the second thing is to bring this evidence to public deciders. CIHR has for instance introduced very recently a “Best Brains” program, which offers researchers meetings with public deciders in order to provide them with the evidence in order to do that kind of research. I think that's the kind of action that will help.

[John Williamson, Conservative, New Brunswick Southwest, NB]

I'm a bit hesitant to go down this path, but I will. I think in the past we've talked about how four million Canadians don't have a family physician. I'd be curious to hear from you and from CARP as well. You talked about evidence. In reallocation of resources, what role does private delivery, for example, play within the medicare system? The evidence would show that Canada is unique in this area. European countries all mix the two. The countries you listed as having higher life expectancies than Canada does--particularly Japan--mix the two. Are there not solutions there as well to encourage...?

I agree with you completely. We need to ask provinces to do more. At the same time, they need to have the resources to do that, and we almost need to treat the provinces as ten laboratories of experimentation that can go out and find best solutions, as opposed to having terms dictated to them by the federal government.

[Dr. Yves Joanette]

I won't provide you with an orientation, but I can tell you that we have the capacity to do that kind of research, to compare the provinces and compare these systems internationally. And you're right--we have to do that kind of analysis in order to have evidence that one model versus another will be best for the individual, for the society, for the economy, and for the sustainability of these systems. That's exactly the kind of research that is supported.

In fact I must say that Canada is well recognized internationally for its quality of that kind of research. I think we have the capacity to provide this. I don't think we have the ultimate answer yet.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Joanette.

We'll now go to Mr. MacAulay.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Thank you very much.

Welcome. I'm a substitute on this committee, but I was involved in seniors' issues a number of years ago when I first arrived here.

To ALCOA, how does our health care system adapt, or does it adapt to seniors? Often you'll hear--and this is a bit rash--that when you get to a certain age, there's not quite as much done and this type of thing. You hear this type of complaint pretty often.

[Susan Eng]

You're absolutely right. We get complaints from our members all the time on that very issue. Their concern--whether warranted or not, and here's the evidence issue--is that they feel not well treated within the health care system. Already there's a lot of confusion and mystery, and then they think they're not getting the best treatment because they're too old. We've had people say that to us. We have people writing in on that. When you hear the language heads of hospitals and other agencies use in some public pronouncements, they do give you the sense that after a certain age, you're not going to get the best care. We would like to believe that's not the case, but we need it to be proven.

You will find that the efforts now on offer to try to reduce hospital budgets and so on bring situations that are really quite miserable for people. One example is in the alternate level of care. You hear the phrase “bed blockers”. What do you suppose that means? It refers to a person who has fallen, has broken their hip or has had a stroke, and is assessed as not being able to live at home independently. It's not appropriate that they be in an acute-care bed, but that's where they are. They don't have access to long-term care. It could be an issue of language or culture. It could be an issue of cost. It could be an issue of location. But whatever the reason, they are still there. So the hospitals are turning themselves inside out to find a way to get rid of them, not to help them find a place where they're going to rehabilitated or taken care of or find proper home care services or someone to manage their care or anything like that. No, it's to get them out of those beds. It's the attitude rather than the effort. So we do worry about that very thing.

[Lawrence MacAulay, Liberal, Cardigan, PE]

A lot of times you hear that when someone is on a whole lot of medication, perhaps another doctor will take them right off of all the medication and this idea. You'll find there is some medication abuse. There's a problem, of course, with medication abuse and there's also a problem with people needing medication and not being able to get it. There are both.

Mr. Racine, in case I'm cut off, I want to indicate to you that I am sorry, and I understand that does happen, given the language issue. Unfortunately I speak one language only, and if I were put in a situation in which I could not speak to anybody who was caring for me, it would be a pretty horrible situation. And I can get up and walk today.

I'd like you to respond to that.

[Susan Eng]

The issue of how people are treated with their medications.... Geriatric medicine doesn't carry a lot of panache. And even though many of the provinces have given extra funding for people who take on older patients, nonetheless, doctors do not encourage it. My own brother is a GP, and he tells me it's not a choice.

So unfortunately the interaction of drugs in an older, smaller body are not well understood by the average practitioner. Therefore, do we hope we're going to get more geriatricians, or do we want to make sure every medical graduate has that understanding of how drugs play with comorbidities within an older body?

We don't have that right now. There is a real fear when people go into hospital that they're not going to be able to tolerate the care they get. And this is the stage we're at because there is a lack of an overall focus on making sure that older people are well treated within our hospital system. What we do have are erstwhile plans to make age-friendly hospitals, for example here in Ottawa. They have to consciously institute a new program to do that. Why? Because it's not happening yet.

[Lawrence MacAulay, Liberal, Cardigan, PE]

Thank you very much.

Dr. Joanette, you touched on that too, and you also touched on health training. I'd like you to elaborate on what additional training we need to make sure our medical people are well trained to take care of the seniors in our institutions, if that's where they are.

[Dr. Yves Joanette]

Thank you so much.

You've raised a very relevant question, the question of a form of agism vis-à-vis older people. This is one aspect we have to better understand. People like Professor Martine Lagacé here in Ottawa are working on that question.

We also talked about hospitals that are not prepared, so what does that mean? That we need to have all Canadians followed by geriatricians, who are paradoxically in one of the youngest specialties in medicine? It's a very young specialty, so there are not a lot of people, but we won't have all Canadians followed by geriatricians.

As was said, it has to be something that will be integrated in the training and in continuing education. With France and Quebec, CIHR has introduced a program based on the translation of what's called the Cochrane Reviews on best practices, which are evidence-based practices to the physician, in this area among other things. This was available in English and now it's also available in French due to this accord with France.

This is how we can not only train the new, young ones but also provide continuous education and changes of mentality both to the physician and other health professionals, and also try to find the best way to help the system. And the hospitals will take care in an integrated manner of those people coming with lots of little bits and pieces of diseases.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. MacAulay.

We'll now go to Mr. Strahl.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Thank you very much, Madam Chair.

Ms. Clark, you've had the misfortune of being cut off a couple of times, so I'm going to start with you.

One thing I've noticed since we've undertaken this study as a committee is that mental illness seems to be a common thread when we're talking about chronic disease. Seniors affected by chronic disease often have to contend with mental illness as well.

I note that you have a pamphlet here in the material you've provided, “Brain Fitness: As Important as Body Fitness”. I wonder if you can speak a bit about brain fitness, as well as what benefits active living could have, not only on cognitive ability but also on the mental health of older Canadians.

[Patricia Clark]

I can certainly speak somewhat to that, not to the in-depth research, but the document we have there is something that is quite new in the industry. The simple relationship is that what's good for your body is good for your brain.

That happens because the neuroplasticity in your brain helps you to learn better and retain better. You can learn new things. Just because we get older, it doesn't mean we can't learn new things. That's so very important for older adults because of the obvious concern with Alzheimer's and dementia. If people are able to stay physically active and challenge their brain at the same time, they will be able to improve and maintain their mental capacity, their memory, and also ward off mental illness and Alzheimer's. There is a definite link between physical activity and mental health.

[Dr. Yves Joanette]

It so happens that as a researcher—I'm a cognitive neuroscientist—this is the kind of question I'm working on. We have this notion of cognitive reserve, or brain reserve, which we can nurture throughout our life. All of this should not start at 65. We should start early with the kind of physical activity that has a direct relationship with brain reserve. CIHR is funding studies by Dr. Louis Bherer, who's showing that physical exercise has a direct impact of the oxygenation of the brain. You have a better reserve to face problems later in life. Having some intellectual activities provides the same benefit. In some countries, you have areas where people do this systematically. Recently I had the chance to be in Shanghai. There are many centres within the city where Chinese people can go to play mahjong, do tai chi, and exercise. They prepare their brains to be stronger.

Mental health is not only cognition. It is also depression and so on. One thing that is important at that point is social isolation. We have to make sure we understand the social insertion and network determinants of mental health and provide evidence to support decisions on the best way to provide these environments where older people will maintain their social participation in our society. That's how you feel happy about living.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

Has your organization done specific studies on mental illness in seniors or aged populations? If so, what are some prevention measures that have been identified in those studies?

[Dr. Yves Joanette]

Yes, the Institute of Aging within CIHR supports that kind of research. We also work with another institute, the Institute of Neurosciences, Mental Health and Addiction. There is a lot of good research done in Canada. One thing we can do is maintain and nurture the social interactions and social support of the family and societal interconnection, along with elders' satisfaction of contributing socially. Isolating older people in an area where they will lose these occasions will not be good.

[Mark Strahl, Conservative, Chilliwack—Fraser Canyon, BC]

I want to talk a little bit about home care since it seems to be something that is driving the discussion here today. As far as I know, home care is under the exclusive jurisdiction of the provinces. I would be interested to hear how the federal government would reconcile withholding funds from a province if they didn't go in the direction that the federal government led. You said the federal government should lead. If this is an area of exclusive provincial jurisdiction, why wouldn't the provinces be leading and the federal government doing what it always does, which is to provide financial supports? There has been a 36% increase in health and social transfers since we took office, with the escalator built into the budget. Could I have some comments on that?

[Susan Eng]

The way I understand the health accords, but for the fact that the federal and provincial ministers actually agreed on the accord, no federal funds would have flowed from the federal government to the provincial government, since health care is exclusively a provincial jurisdiction. Once you have the accord, you set aside a sum of money according to certain priorities. That's when you have an opportunity as a group to name your priorities and conditions, and to impose accountability.

In the case of home care, you are absolutely right. It is within the provincial jurisdiction to set those parameters and spend those dollars. But as a national organization, we see a terrible patchwork of availability, quality, and access to health care services. You can't give someone three hours when they need 24/7 care. We feel there needs to be a minimum standard across the country.

During the federal election campaign, there was a reference to including home care within the Canada Health Act, which is an important protection for making sure everybody at least gets a basic level of home care services.

There is an opportunity with the health accords, which are outside the scope of the two constitutional jurisdictions sharing this field. They can go some way towards setting standards.

As to the dollars involved, if the federal government--

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Eng. I'm sorry. Thank you.

We'll now go to our second round.

I want to let you know that I've given all of you extra time. But as much as everyone thinks their question and answer are the most important, my role is to make sure everybody gets an opportunity to ask and answer. I've bent the rules a little to try to get everybody, so don't be personally offended if you're cut off. It has to be done; otherwise you could have the whole hour and a half. Then everybody else would be offended. I just want to clarify that, because some of you get kind of a shocked look on your face when I shut off the mike.

If you watch the mike here, when it turns red it's an indication that your time is up. I try to not cut you off, but I just want to explain that so you understand what it's about.

We're going into five minutes now of Qs and As.

Dr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

My colleague, Mr. Strahl, pointed out that home care comes under provincial jurisdiction. But the aboriginal populations are under the responsibility of the federal government. How do you see home care for aboriginals? Do you have broader information on the situation of our aboriginal seniors? If so, I would very much like to hear it.

[Dr. Yves Joanette]

I could give you a partial answer but not a full answer. The Canadian Institutes of Health Research comprises 13 institutes, including the Institute of Aging. There is also the Institute of Aboriginal Peoples' Health, which deals with the big challenge of the health of these populations. Right now, discussions are under way between these two institutes to better integrate the health issues of the aboriginal and aging populations and the particular challenges that will arise very soon. It's a concern we have.

For the moment, studies are being done, but not enough. When a gap or a lack of research becomes apparent, the role of the institutes is to support the research in a particular way beyond the good and excellent ideas that Canadian researchers have.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Are there any other comments on this matter?

[The Chair, Conservative, Joy Smith]

Mrs. Clark.