Health Committee on Feb. 7th, 2012

[The Chair, Conservative, Joy Smith]

We're going to begin now.

Good morning, everybody. Thank you for being here.

We want to have a special welcome to our witnesses. As you know, we're doing the study on health promotion and disease prevention, and you're a very important part of our study today. We're anxiously waiting to listen to your presentations.

From Consumer Health Products Canada, we have Mr. David Skinner, who is the president, and Mr. Gerry Harrington, who is the director. Welcome.

Ms. Rebecca Nesdale-Tucker, of ThinkFirst Canada, is going to be arriving, I think, in a few minutes.

From the University of British Columbia, we have Dr. Paul Kershaw, human early learning partnership. I understand you have a presentation.

[David Skinner, President, Consumer Health Products Canada]

I have a PowerPoint.

[The Chair, Conservative, Joy Smith]

A PowerPoint, yes. You know that the presentation is ten minutes, just to make sure the PowerPoint coincides with that.

By video conference, we have Ms. Pamela Fuselli, executive director, Safe Kids Canada. Welcome, Pamela. Can you hear me this morning?

[Pamela Fuselli, Executive Director, Safe Kids Canada]

I can. Thank you very much.

[The Chair, Conservative, Joy Smith]

We're very pleased. I know when we have the PowerPoint, you won't be able to see the PowerPoint that comes up, but you'll be able to hear it.

So we're good to go now. We'll start off each with ten-minute presentations, and we'll begin with Mr. David Skinner, please.

[David Skinner]

Thank you, Madam Chair and members of the committee, for allowing us the opportunity to be here today to participate in this study of health promotion and disease prevention.

Consumer Health Products Canada is a century-old trade association, representing the makers of products Canadians use to practise self-care, including OTCs and natural health products. Our members' products account for the vast majority of sales in this $5.3-billion market, and range from lip balms and sunscreens to cold medicines and pain relievers, vitamins, and herbal remedies.

CHP Canada's mission is to advance evidence-based self-care. We believe this will not only lead to better health outcomes for Canadians, but contribute greatly to the sustainability of our health care system.

I will introduce now Gerry Harrington, who will take you through some more detail and some statistics about how that can happen.

[Gerry Harrington, Director, Public Affairs, Consumer Health Products Canada]

Thank you, David.

Consumer health products have an important role to play in thoughtful health promotion and disease prevention strategies. OTC medicines and natural health products are vital elements in the toolbox Canadians have access to when they practise self-care and engage in the management of their own health.

An ever-increasing body of evidence supports the role that consumer health products play in disease prevention. Nutrients like omega-3 fatty acids and vitamin D have been shown to have a considerable impact on the incidence of non-communicable diseases such as heart disease and cancer, and OTC nicotine replacement therapy has shown to be an effective means of reducing tobacco consumption, another major cause of morbidity and mortality.

In Canada we're especially fortunate to have a consumer health product environment in which physicians and pharmacists play an exceptionally important role. There is strong evidence that Canadians avail themselves of the advice of pharmacists in particular to help them select and use consumer health products appropriately to a much higher extent than in other populations. For example, self-care-practising Canadians are three times more likely to rely on the advice of pharmacists in product selection and use than their American counterparts, and are significantly more likely to do so than their European counterparts. This is something Canadians do by choice. It shows that they're eager to use the tools available to them, such as the advice of an available and accessible front-line health care professional, to help them practise responsible self-care.

The Canadian government also has a direct role to play in the role of Health Canada to ensure that the products available to consumers are evidence-based, and that their labelling provides reliable information on which Canadians can base their treatment decisions and usage patterns. So Health Canada, in its regulation of both OTCs and natural health products, has a critical role to play to ensure that Canadians are making decisions about the use of these products that are evidence-based and consistent across all product categories.

Our main purpose today is not to underline the important role that consumer health products themselves play in the health of Canadians and the sustainability of the health care system. Our main purpose is really to highlight the overall importance of self-care more broadly. In this study on health promotion and disease prevention, as in most of the issues the committee explores, self-care plays or can play a critical role in influencing the outcomes in question and the cost at which they are achieved.

At a time when we struggle to get the most out of the $200 billion that is dedicated to providing health to Canadians, it is alarming to think of just how little policy consideration is given to the management of the biggest single resource in our health care system, which is Canadians themselves. That's right. When most of the academics who study these things tell us that between 80% and 90% of the health care interventions are self-care interventions, the system's most valuable resource is in fact the patient.

Allow me to illustrate that point with findings from a study conducted for CHP Canada last year. This study examined the behaviour of Canadians who suffered from three minor ailments: colds, headaches, and heartburn or indigestion. Looking at cold sufferers in particular, we found that of the 7.1 million Canadians who suffered from colds in April 2011, 12%, or 850,000 Canadians, made appointments with their physicians. The annualized cost of those doctor visits and the associated prescriptions and laboratory costs exceeded $1 billion.

We're not suggesting that all of these doctor visits were inappropriate; in fact, they can play a very valuable role in health promotion and disease prevention. But we can take a look at these doctor visits and get a sense of the opportunity they represent by looking at ways of potentially reducing the impact.

We looked at the 16% of those Canadians who went to the doctor, despite reporting mild symptoms from their colds. So it's a fairly arbitrary number. We looked at a target for reducing those doctor visits. If we took 16% of the 12% who went to the doctor and encouraged them to practise self-care instead, we would free up enough family physician access to provide primary care services to 500,000 Canadians. That's 10% of the five million Canadians who currently don't have access to primary care physicians, and of course all of the health promotion and disease prevention opportunities that this represents.

Now, I'm not suggesting that the role that Canadians play in their own health is something that is ignored by this committee or by the other policy bodies that impact the Canadian health care system. Nothing could be further from the truth. For example, many of our fellow witnesses in this study have spoken to the importance of promoting healthy lifestyles, including diet and exercise, in order to achieve our health promotion and disease prevention goals. But in the grand scheme of things, what proportion of our health policy discussions take into account the self-care considerations underlying a given issue from the perspective of the everyday Canadians who want to take greater control over their own health?

In this age, exploding with new and ever more accessible sources of information on health, what are we doing to help ordinary Canadians navigate through the maze of sometimes valuable, sometimes misleading, and sometimes downright dangerous sources of guidance on self-care? How do we help them differentiate between the good and the bad, and then integrate and act on critical decisions, on the guidance that is of real value and relevance to them? How do we ensure that the critical decisions and investments being made on health infrastructure, such as electronic health records, are done in a manner that empowers Canadians to make a more meaningful contribution to their own health and well-being?

CHP Canada doesn't have the answers to all of these questions, but we urge the committee to recognize the importance of giving them due consideration in this study and in all of the work that you do. Last year, former deputy minister of health and Bank of Canada governor David Dodge wrote an extremely thoughtful and thought-provoking analysis of the future of Canada's health care system in which he urged Canadians to have an adult conversation about the sustainability challenges the system faces. CHP Canada believes that self-care, the decisions and actions that people take to manage their own health, is a vital part of that conversation.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go to ThinkFirst Canada. Ms. Rebecca Nesdale-Tucker, please.

[Rebecca Nesdale-Tucker, Executive Director, ThinkFirst Canada]

Thank you very much. And thank you very much to the committee for the opportunity to speak here today.

Health promotion is such an important issue, and preventable injury is the leading cause of death for young Canadians under 44. Indeed, it's a leading cause of disability and death across a lifespan. We often consider injuries to be accidents or acts of fate, whereas research tells us that most injuries are in fact preventable. And Canada can and must do a better job at protecting our greatest resource, our children.

That's why ThinkFirst Canada exists, and Safe Kids and the other national organizations that address this issue. We were founded in 1992 to reduce serious preventable injury in Canada. We're a national charitable organization, with chapters in every province, and we're working to collaborate more in the territories. We work with our chapters and partners to increase health literacy and safety promotion through school, sport, and recreation-based programming, concussion education and awareness, and helmet promotion.

We develop our programs with multi-disciplinary committees, by drawing from different sources of expertise, and we deliver our messages with what we call VIPs, who are the voices of injury prevention--and they are injury survivors.

Keeping Canada's children safe should be everyone's concern. Trauma and head injuries, in particular, are at epidemic levels, and of course we've seen that in the media throughout the past couple of years. In Canada, injury is the leading cause of death and a major cause of hospitalization for children and youth. Injury kills an average of 290 Canadian children age 14 and under each year. It's estimated that 21,000 children are hospitalized for injury each year, or approximately one in every 300 children. Injury kills more children and youth than all other diseases combined.

The impact of injury on these children is often life-long. Head injuries alone account for substantial changes in learning ability, including delayed cognitive development in children and behavioural challenges. Children with spinal cord injuries may require wheelchairs full-time. This can inhibit their ability to play and severely limit future employment opportunities.

[The Chair, Conservative, Joy Smith]

Excuse me. Can I interrupt you for a minute? You're going too fast for the interpreters. Can you slow down a bit?

Thank you.

[Rebecca Nesdale-Tucker]

In terms of overall child injury rates, Canada lags behind most OECD countries in tackling this problem. In addition—this is from Smartrisk—unintentional injuries cost Canada approximately $20 billion per year.

The great tragedy is that most of these injuries are predictable and preventable. Protection can be as easily afforded as wearing a properly fitted helmet and buckling up appropriately in a car. Our framework for injury prevention is the three E's, at least three: enforcement, engineering, and education. Enforcement includes rules, policies, laws, and regulations, which are important. Engineering includes vital safety devices, such as helmets, car seats, and safer built environments such as CSA-regulated play spaces. Education includes awareness, the self-care that my colleagues were talking about, but also awareness of what the risks are and how to best protect yourself. And that's for the caregivers for a child and also at the individual level.

The top 15 causes of fatal injuries for Canadian children and youth are largely preventable, and these include passenger injuries in motor vehicle crashes, choking and suffocation, drowning, pedestrian injuries, poisoning, and falls. Safe Kids may be telling you more about these.

All Canadian children and youth are at risk for injury. Children and youth at special risk include boys, aboriginal children, Inuit Canadians, and also those of lower socio-economic status. Children in remote and rural areas may be more at risk. This can be because of lack of access to injury prevention but also distance to care. An all-ages injury prevention strategy has been called for by ThinkFirst Canada and its partners for many years. Our partners in this effort include Smartrisk, Safe Communities Canada, and Safe Kids Canada. Together we are calling and will be continuing to call for a national strategy to address child and youth injuries and indeed injuries across the lifespan.

We really welcome the announcements from the last federal Speech from the Throne, when a prevention strategy for children and youth was announced. This led, of course, to active and safe initiatives, which we really appreciate. We also appreciate the funding of strategic teams for injury prevention research, including the STAIR grants--“strategic teams in applied injury research”. This has been an important milestone, but we have a lot further to go. We look forward to the realization and renewal of enforcement of Canada's product safety legislation, and we'd also like to see the new CSA standard for ski and snow helmets regulated.

Our vision is a Canada that enjoys the lowest rates of injury of any nation in the world. Right now, we're in about 22nd place out of 28 OECD countries, and that's cited in the Leitch report. We look forward to opportunities to lower the incidence of injuries. On a high level, that would be the three strategies: health literacy, including injury prevention; safer sports and recreation; and public policy for a safer Canada. We'd also like to see continued injury prevention and research and evaluation. One thing we've been calling for, for some time, is a national entity to address this problem. With increased resources and partnerships we look forward to an entity, Injury Canada, that can be a focus for these efforts. With funding levels more commensurate with the burden on society, we can better achieve our goals.

We see this entity taking a leadership role in coordination and collaboration, including researching injury prevention, taking a knowledge broker role, and developing strategies to encourage potential stakeholders to act.

We believe that a pan-Canadian strategy should adhere to the principles of keeping a societal focus and therefore should direct efforts to those who are in greatest need, including the social determinants of injury.

Thanks again for the opportunity to speak here today.

[The Chair, Conservative, Joy Smith]

Thank you so much. We appreciate all your insightful comments.

Now we'll go to Dr. Paul Kershaw and we'll get that PowerPoint going.

Go ahead.

[Dr. Paul Kershaw, Human Early Learning Partnership, University of British Columbia]

Thank you very much for the invitation to present today.

As I travel across the country, encouraging Canadians to think more about promoting health rather than treating illness, more and more I say that boils down to thinking a lot like our national animal. Now, some have heard senators recently critique our national animal for being a dentally deficient rodent, but I think such critiques are all wet. Our beaver is a builder to be proud of, because when do we notice beavers? We notice beavers when they build dams. The thing is, no beavers live in those dams. Beavers build dams because the dams create reservoirs, and if those reservoirs are deep enough, then beavers gain efficiency because they can swim faster than they can walk on land. If the reservoir is deep enough, beavers gain security out of the reach of predators. And if the reservoir is deep enough, they also gain ample room to build woodsy little lodges as homes for their individual beaver families.

Then what happens when cracks appear in the dam? Well, like all good managers, beavers adapt. They come and repair the hole in the dam, not because any individual beaver stands to gain, but because the entire community of beavers depends on that dam to safeguard their shared standard of living.

I think that in Canada that kind of beaver logic has served us well for most of our history. By the 1970s we had spent a long time building our own national policy beaver dam. We had built public schools and universities, we had built veterans benefits, workers' compensation, and unemployment insurance. In the sixties we put in place our old age security plan and our hospital insurance and capped it all off with a Canadian public pension plan and the Medical Care Act. It is a policy tradition we all must be proud of. You know it better than most Canadians, and I encourage all of us to remember it.

But as I travel across the country I also ask what we have done since. There is no doubt that we've continued to build our markets and expand our banks, and what not, which have allowed us to weather the global recession better than most countries. But on the social policy side, we also see two somewhat worrisome trends. If you look at municipal, provincial, and federal revenue as a share of GDP, it has gone down by about $90 billion since 1980. Simultaneously, our expenditures on medical care have gone up about $47 billion as a share of GDP, which then crowds out our ability to use policy to adapt to the declining standard of living for the generation raising young kids.

I can show you that decline in three simple facts. It turns out that for young couples in Canada, household incomes are stalled between 1976 and today. They are stalled even though we have far more young women contributing employment income today than we did a generation ago. With that stalled household income, they have to pay for housing prices that have gone up across the country by 76%—and in my province, 150%—which leaves the generation raising young kids squeezed. They are squeezed for time at home because they're having to devote so much more adult time to making a household income that is stalled; they're squeezed for money even when they're not technically poor, because of the rising cost of housing; and they are squeezed for services like child care, which grow instrumentally more important when you need two earners to make the same level of income that one often could a generation ago.

That squeeze is happening even though the economy has more than doubled in size, producing on average an extra $35,000 per household, which does help to explain why it has become easier—although not easy—to retire. For those age 55 to 64, across the country incomes are up 18%. Wealth is up because if you owned a home in the seventies and eighties, and they almost doubled in price, that is very helpful for your personal wealth. Poverty has been dropped among seniors from 29% in 1976 to less than 5% today.

While personal financial circumstances of people approaching retirement have improved, that group of people is leaving larger government debts than they inherited as young people in the seventies. The debt-to-GDP ratio has now doubled since 1976. We've made no progress on our carbon dioxide footprint per person in this country, even though the constraints of global climate change have become more familiar to us.

This brings me back to our national policy beaver dam. Because we have not managed to adapt to generation squeeze, there is indeed a huge hole in that national policy beaver dam. The reservoir is draining out. As a result, we have a generation raising young kids that is increasingly stuck in the mud, leaving almost one-third of our children arriving at kindergarten vulnerable, either physically, socially, emotionally, or in terms of their ABCs and one-two-threes.

And all of the research shows us that vulnerability when one reaches school contributes to far higher rates of school failure and/or incarceration as a young person or a young adult, and in their thirties, forties, and beyond to a range of health ailments, whether it's obesity, high blood pressure, mental illness. By our fifties and sixties it contributes to coronary heart disease and type 2 diabetes, and in our final decades to premature aging and memory loss.

That is a bad generational deal, made worse by the fact that organizations like UNICEF routinely, over the last decade, have ranked Canada among the worst industrialized countries when it comes to investing in families with young children. We are only going to overcome this poor international ranking if we move from a bad deal to a new deal for families, and ask for baby boomers across the country to get on board for that better deal for their kids and grandkids.

A new deal means getting back to some basics in Canada. It's about ensuring that we still have the family at the heart of Canadian values, while acknowledging the diversity of households that exist from coast to coast to coast. It's really about using public policy to encourage people to spend more time together and possibly less on stuff. It's about promoting genuine choices for women and men alike to be able to succeed in the labour market and at home, rather than talking about that balance being a possibility but leaving it a fiction for so many. It's about using policy to promote personal responsibility.

I believe we live in a country context where most of us think that Canadians should do all they can to pay for and care for their own, but here's the deal about the generation raising young kids today: those under age 45 work longer hours than any other group of Canadians. They then go home and perform more unpaid caregiving hours than any other group of Canadians. So by any traditional metric, their work ethic is impressive. But despite that impressive work ethic, they are still struggling to maintain a standard of living that often one person could achieve in the labour market a generation ago. We could never use public policy to remedy that in its entirety, but we could at least mitigate the new challenges.

I think that would require three public policy changes that need to compete with our approach to illness treatment through medical care for today's scarce resources. As public policy change number one, we need new mom and new dad benefits that would allow all parents--dads as much as moms, including the self-employed--to share up to 18 months at home with a newborn and to make that affordable, not cost the equivalent of a second mortgage from your disposable household income. Thereafter we need to make it affordable for moms and dads alike to have enough time in the labour market to deal with rising costs of living and stagnant wages. You do that by putting in place $10 quality child care services that make it affordable for people to rely on stimulating, nurturing programs that supplement and never replace what parents do at home. Last but not least, these two public policy changes need to occur in the context of a greater commitment to either flex time, or since we're all talking about when we should be retiring now, I'd call it let's have longer work lives, because we're living longer, but shorter hours of work per year. The typical Canadian works 300 more hours per year than the typical Dutch, Norwegian, or German citizen. We can change that in part by tinkering with our full-time employment norms, saying instead of it being 40-plus hours per person per week, can we get it closer to 35 hours? That extra five hours to ten hours a week can make a great deal of difference in terms of balancing the squeeze at home.

At bottom, it's a question of what kind of Canada we want. I ask Canadians to consider, is it one that ignores all of the negative health implications of a Canada that has a growing breach between those approaching retirement and those younger, or is it one that will once again commit to working for all generations?

Thank you very much.

[The Chair, Conservative, Joy Smith]

That was extremely creative, and I have a new appreciation for our toothy friend. That's wonderful.

[Dr. Paul Kershaw]

Exactly. They're not the dentally deficient rodent.

[The Chair, Conservative, Joy Smith]

Now we'll go to Safe Kids Canada, Ms. Pamela Fuselli.

[Pamela Fuselli]

Thank you very much for the opportunity to speak today and to share Safe Kids Canada's views on disease prevention and health promotion.

Safe Kids is a national leader in preventable injury. By building partnerships and by using a comprehensive approach, we work to advance safety and to reduce the burden of injury for Canada's children and youth. We welcome the opportunity to share with the committee our opinion that addressing injury prevention is a key component of a sustainable health care system in Canada.

Despite its devastating impact, injury remains an invisible issue in the health care system and with the public. Few are aware, as my colleague Rebecca mentioned, that unintentional injuries are the leading cause of death for those aged one to 44 and that they kill more children and youth than all other diseases combined.

The numbers are shocking and revealing. In 2004, injuries claimed over 13,000 lives and accounted for over 200,000 hospitalized visits and 3.1 million emergency room visits. Furthermore, sustained injuries to Canadians led to nearly 70,000 disabilities. Each day approximately 60 children are admitted to a hospital for an injury. And every month, 25 children die from an injury, which is the equivalent of one classroom.

These sustained injuries, which are potentially fatal, place immediate and unplanned demands on the system, resulting in a significant allocation of health resources for treatment as a result of injury. No part of the health care system is untouched by an injury. Emergency room visits, wait times for services such as orthopedics, community-based care, family physicians, and acute-care and rehabilitation services are all involved in responding to the short- and long-term impacts of injury.

For injury survivors, the need for care and rehabilitation of the injury and the potential for permanent disability can have far-reaching impacts on health, education, social inclusion, and the family's livelihood. Many are left with ongoing physical, mental, or psychological disabilities, which have a major impact on their lives and on the lives of their families.

The financial cost of these injuries is also very high. Injuries to children and youth, aged birth to 19, cost Canada's health care system $5.1 billion in direct and indirect costs annually.

Unintentional injury is a leading public health issue that directly impacts the health, well-being, and quality of life of those injured and their families, communities, and the greater society, as well. Nevertheless, injury is often neglected, and investment has not been equal to the magnitude of the problem. The reality is that injury prevention has not kept pace with other public health interventions, such as tobacco control or infectious disease prevention programs.

Currently, health care dollars tend to be focused on disease treatment, not prevention. The amount of resources and the priority given to health research for injury research is proportionately minuscule when compared to the huge economic and social burden. And it is somewhat tragic, given that almost all injury events are both predictable and preventable.

A number of years ago it was estimated that injury received one per cent of research funding, and not much has changed since then. The challenge is balancing the immediate needs of people seeking medical advice, treatment, and care with the possible future benefits accruing from disease prevention and health promotion.

We know that effective strategies for injury prevention save lives, substantially reduce health care costs, and offer a high return on investment. The cost of primary programs is much cheaper than treating a child, sometimes for months, because of a preventable injury. Studies have shown that a $46 child safety seat generates $1,900 in benefits to a society, and a $31 booster seat generates $2,200. A $10 bicycle helmet generates $570, and so on.

Attention must be paid to aspects of health that include preventing individuals from requiring health services in the first place, thereby alleviating pressures on the system overall. We know that unintentional injuries are often described as accidents, something we have no control over. In reality, as I've said, we can predict and therefore prevent unintentional injuries.

Injuries generally result from combinations of adverse environmental conditions, equipment, behaviour, and personal risk factors, any and all of which can be changed. It is estimated that 90% of injury deaths could be prevented if known proven strategies were implemented.

To address the injury burden, Safe Kids Canada, along with other national, provincial, and territorial organizations, strongly encourages the government to take a leadership role. As you've heard, Canada currently ranks disappointingly on the OECD nations for deaths from unintentional injuries. It's estimated that if Canada had enjoyed the same injury rate as Sweden between 1991 and 1995, 1,233 children would not have died, between 23,000 and 50,000 would not have been hospitalized, and more than 250,000 children would not have visited emergency rooms.

The time for action is now. Human resources and funding at a level more in line with the burden of injury on society and more in keeping with resources dedicated to other comparable health issues are urgently needed. We recommend a comprehensive approach based on the principles of national leadership and coordination, a strategy that should include leadership in data and surveillance, coordination and collaboration, injury prevention research, working with NGOs to broker knowledge in Canada, developing a strategy to engage potential stakeholders to encourage full investment and engagement, and increasing awareness of and attention to the injury prevention problem in Canada.

Enacting a pan-Canadian injury prevention strategy would not require starting from scratch; rather, it would build on existing structures and activities. Both within and outside Canada, initiatives and strategies have been in place for some time and their efforts should be applauded. However, we urgently require government leadership, with collaboration from NGOs, to facilitate coordination and efficiency. In establishing and funding a national injury prevention strategy and thereby setting priorities and accountabilities, Canada could position itself at the forefront of health promotion and disease prevention, both at home and abroad.

Internationally the principles of prevention and health promotion have been acknowledged as the most effective means to address persistent health issues, requiring long-term and coordinated strategies. Most notably, in May 2011 the World Health Organization adopted its first ever resolution on child injury prevention. The resolution calls for child injury prevention to be recognized as a key determinant of health in children. The resolution also calls childhood injuries a major threat to child survival and health, and notes that injuries are often a neglected public health issue, with significant consequences on mortality, morbidity, quality of life, and social and economic factors. The WHO further recommends that a government agency take on the leadership role in child injury prevention, and this is based on the acknowledgement by member states that child injury prevention should be part of each country's plan for child and adolescent health, and that child injury prevention should be integrated within child survival programming.

Countries that have created injury prevention strategies and programs have seen a 50% reduction in injury rates over a 20-year period. In general, countries that use a combination of broad approaches in addition to encouraging a culture of safety and displaying strong political commitment have made the greatest progress in reducing their child injury burden.

The injury prevention community has been encouraged by recent government investment in injury prevention. As we heard in 2011, the government committed to a $5 million investment over a two-year period into keeping children active and safe by focusing on community-based activities. The major focus of this investment is on injuries such as concussions, drowning, and fractures--all important. However, significant reductions in injury rates can be achieved through more concerted national coordination and investment.

Health promotion, coupled with preventative measures, not only advances the overall health and quality of life for Canadians, but also improves the sustainability of the health care system by creating significant cost savings in the long term. The cost of inaction, when it comes to safety and the health of Canada's children, youth, and adults, is simply too high.

Thousands of lives could be saved each year. We're pleased to share our experience with you in order to achieve our mission, which is fewer injuries and healthier children, and a safer Canada.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Fuselli. I would like you to please forward your sources in your presentation, where you got your numbers from. If you could, forward those to the clerk, and the clerk will disperse them to the committee.

[Pamela Fuselli]

Absolutely.

[The Chair, Conservative, Joy Smith]

Thank you so much.

I want to say to the committee that we will be going until 10:15. At that time we'll suspend to go into committee business.

We're now going to start with our first round of seven minutes Q and A, and we'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson, and thank you to the witnesses for being here and on the video conference today.

I guess if Canada were doing a bang-up job on health promotion and disease prevention we wouldn't be having this meeting today. It's certainly a big topic. I guess the crux of the problem is that it's something we all talk about, but we don't seem to do much about it in terms of where money goes or how we organize our health care systems and so on. I think it's a good opportunity to have a discussion about that.

Mr. Kershaw, I did want to focus on a couple of comments you made. I did quickly read your article from The Vancouver Sun, I think when it came out. You make some very good points, but there's one thing I don't quite agree with. I could be interpreting this wrongly, but I get the sense that you pit medicare against other social spending and say that it has to be either/or. I think the information that we've looked at shows that in actual fact, medicare costs, relative to the GDP, are pretty stable over a long period of time. It's the associated health costs like private drug costs, like other benefits, that are skyrocketing, particularly the drug costs. So I think we do have to differentiate.

I would certainly agree with your three policy choices. I think they're absolutely critical in terms of health promotion, healthier families, healthier communities. But it seems to me that nobody is saying the status quo in the health system is okay. It's very much under challenge. I think our challenge is to strengthen medicare and to make sure that we are focusing on disease prevention, on keeping people out of ERs, having much better community health centres, primary care reform, and so on.

I just wonder if you could clarify that when you say let's consider a cap on medical care spending. I think you say the greatest barrier to social policy is medical care. I have some concern about how you pose that question, because I see them as part of the same package. It's like here's the pie, and yes, the pie has shrunk because public revenue has gone down--you're totally correct on that--but then how do we make the pie more efficient?

Could you address that?

[Dr. Paul Kershaw]

I think in many cultural contexts outside of Canada there isn't necessarily a trade-off between medical care spending that's oriented around illness treatment and other public policy and social policy spending. But in Canada we've run into a bit of an issue. Our greatest social policy achievement is indeed our medical care system, which allows us to go from coast to coast to coast, and we will go to the wall for individuals to treat their illness when they become sick. But that is crowding out space for our thinking about doing something even more impressive--preventing them from becoming ill in the first place.

Between 2007 and 2010, over a recession, we watched as public--not private--investment in medical care went up by $22.5 billion a year, phased in over those three years. That's over a recession. Simultaneously, we don't see an appetite among Canadians to increase taxes to do other things. If Canadians generally are pretty modest in wanting tax growth but we are seeing dramatic increases in medical care, then yes, our greatest social policy achievement is now actually a huge barrier to innovating and adapting public policy for the day in today's context. So it's impossible for people who have to be elected to actually raise that argument, because just 10% to 15% of Canadians trust you. More of us trust new-car salespeople than trust you, which is just a terrible reality. So we need people like me trying to put the provocative questions out--

[The Chair, Conservative, Joy Smith]

Point of order, Dr. Kershaw.

[Voices]

Oh, oh!

[Dr. Paul Kershaw]

All right, I'll bring that study next time, and I can show it to you on my computer.

But this is the issue. Because there's so little respect for politicians, having difficult conversations about the policy issue about which we are most proud is now difficult. I think we need to either say we're open to increasing taxes moving forward, in which case medical care doesn't have to be in opposition to other things, or if that's not on the table, then we do have to pose the question of what we owe one another through our medical care system, and what we might do differently to create space to make us healthy in advance, as opposed to treating illness after the fact.