Health Committee on Feb. 7th, 2012

[Libby Davies, NDP, Vancouver East, BC]

Thank you for your answer.

Just to follow that up, I think part of that equation is to have a fair and progressive taxation system, and we've been calling very strongly.... There are people prepared to go out there and speak the truth and to point out that because of the shrinking pie.... Just look at the corporate tax cuts. You mentioned the $90 billion we've lost. The corporate tax cuts alone I think have been $60 billion. If we're not contributing to a fair taxation system, then the burden is increasingly on middle-class and poor families, and it stretches the system to the limit.

Again, I think the analysis that we bring to the debate is really important. I would argue that yes, there are tough questions, but I think there are some pretty clear answers we can move towards. The trouble is getting the government to agree to that. As you know, there was in effect a cap put on that was tied to GDP, and the provinces didn't even get to talk about that; it was just slapped down. So this is very much part of the debate that we're having.

[The Chair, Conservative, Joy Smith]

You can comment on that. You have one minute.

[Libby Davies, NDP, Vancouver East, BC]

If you want to add anything more, please do. It's a fascinating debate.

[Dr. Paul Kershaw]

I'm the kind of academic who's willing to say that if we want to spend more in some areas a cap on medical care spending may be appropriate, especially if it's targeted at going at GDP, which is effectively what we're talking about after 2017. Even between now and 2015-16 we will see medical care spending go up publicly, just through the Canada health transfer. It's $7 billion a year.

Are we confident that this investment will actually get us the biggest bang for our buck when we want to have a healthier society? It's no longer clear to me that an additional investment in illness treatment is the way to be promoting health when we are reasonably strong at doing medical care already, yet we have a range of policy issues, not the least of which is policies for families with young kids, in which we are consistently ranked terribly poorly.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Dr. Carrie. And you'll be sharing your time with Mrs. Block, right?

[Colin Carrie, Conservative, Oshawa, ON]

Absolutely. Thank you very much.

Dr. Kershaw, I come from Oshawa, and I would be happy to sell you a brand-new Camaro with cylinder deactivation that will help our greenhouse gases.

I want to thank the witnesses for being here today. You're talking about something that's near and dear to my heart. I came from the wellness prevention background, and I like the talk about personal responsibility. I think we really have to start focusing on that.

I liked what Mr. Harrington said about 80% to 90% of our health care being patient-oriented. I'm wondering if you could expand on that a little bit. What are other countries doing internationally to help encourage self-care, from a policy stance?

[Gerry Harrington]

I think probably the best example of the most aggressive policy being pursued is in the United Kingdom. In 2000 the then Blair government issued a new ten-year plan for the National Health Service, which is roughly equivalent to what we loosely call medicare. In that blueprint, that ten-year plan, there were four pillars upon which they based the entire exercise. One of those pillars was self-care. It was recognized from the very outset, in the very structure of the plan, that self-care was an integral part of the entire system. It was not something that happened outside the system, which I think is one of the challenges we face in Canada.

In pursuing that, the U.K. government set a lot of goals around providing new opportunities. It really was a two-part exercise. One was to provide new opportunities for Britons to practise self-care. One of the things, for example, in the consumer health products area was that the government took a very aggressive stance on examining medications that were on prescription and those that might be made available for self-care in the form of OTCs.

Over the course of that decade the U.K. fairly quickly became one of the world leaders in prescription-to-OTC switching, which is a regulatory exercise. They involved health professionals such as pharmacists and physicians in the decision-making of what products would be appropriate for switching to consumer status, and by doing that they really expanded the range of options that consumers had.

Towards the end of the plan there was a greater focus, as well, on addressing the consumer behaviours—the behaviours of U.K. citizens. One of the challenges they faced is that the structure of the NHS itself provides incentives to rely on professional care because you have your prescribed medicine and your doctor visits paid for under the insurance schemes. If you choose to go to a self-care option, you're on your own and it comes out of pocket.

There were schemes attempted. For example, in Scotland there was a minor ailments scheme approach, where the role of the pharmacist was compensated. As a baby step between full self-care and physician care, the idea was to shift some of that burden for minor ailments away from the doctor's office, or the surgery, as they call it, and into the pharmacy, by providing compensation to pharmacists for their interventions on minor ailments.

There were a variety of approaches, and I guess what it really came down to was that there were two real branches to the strategy: one was to provide more options, and the other was to encourage behaviour change.

[The Chair, Conservative, Joy Smith]

Thank you.

I think Mrs. Block has a question too.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I want to thank all of you for being here today. It's been incredibly interesting hearing from you. I think so many of your comments are bang on, in terms of where we are today with our health care—or illness care—system that we have in place. We know that we are living longer, but not necessarily healthier.

I think the observations that you've made, Dr. Kershaw, are right on, in terms of being able to demonstrate whether the amount that we are putting into the health care system is actually getting us the results that we need.

Mr. Harrington, your comments around self-care certainly support that we do need to address the tension that we have within our system between illness care and looking at health promotion and disease prevention.

I thank you so much for those comments. As my colleague said, it's a very interesting debate and a very timely one for us to be having.

I firmly believe that on the heels of the introduction of medicare there was meant to be a second phase, which would encourage individuals to choose healthy lifestyles. I think that's the conversation we need to have, and I'm so thankful that we're doing this study.

I know that both of the other presenters spoke as well to the fact that health care funding has been focused on treating diseases rather than prevention.

The question that I want to pose is to Ms. Nesdale-Tucker. It was around the comments that you made regarding health literacy. You said that Canada can and must do a better job in protecting our children, and obviously we know that by doing that we will be making investments in the future of our health care system. I just want to give you an opportunity to talk a little bit more about health literacy, and perhaps the strategy that you are implementing in order to do that.

[Rebecca Nesdale-Tucker]

I agree with my colleagues about opportunities at the medical level, as well, to increase that interchange. At ThinkFirst Canada we work in schools and we work with a range of medical practitioners and VIPs, as I mentioned, to get the message to children, their families, and their teachers that there are ways to protect yourself from serious brain injury and other traumatic events, and that these are not fun situations to be in. It's not cool. You may not think it's cool to wear a helmet, but it's far less cool to have a brain injury and have your mom looking after you for the rest of her life.

We try to speak to children on that kind of level, but we also see there are opportunities to increase health literacy through a discussion with the Canadian public. My colleague Pamela spoke to that as well—the awareness of Canadians.

Do Canadians know that the greatest risk to them for death, up to the age of 44, is a preventable injury? I think it's rare that people would know that, and that there are preventable ways you can avoid a lot of suffering. What we see is that we're going to pay for this anyway, so you can pay for investments in children's safe play—

[The Chair, Conservative, Joy Smith]

Can you wrap up your comments, please?

[Rebecca Nesdale-Tucker]

Other ways to connect with the medical system would be a prescription for a helmet, as well as a well-baby visit--

[The Chair, Conservative, Joy Smith]

Thank you very much.

Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

As my colleague Ms. Block said, it's very interesting, the diversity of interventions that we have this morning in witnesses. I wouldn't want to ask Dr. Kershaw about the issue of funding, because we well know that the problems with medicare are not simply about funding. The problems with medicare are about making the changes that we need to make in terms of how we deliver care, where we deliver care, who delivers care, and that is really what we should be talking about.

If you're going to have a lot of people who, as they live longer, become chronically ill, then you need to be able to have multi-disciplinary family primary care clinics with a whole range of people delivering care, in an appropriate scope-of-practice manner. And then you're going to also talk about making sure that you don't let chronically ill people go to hospitals. If they don't get management of their chronic care outside of a hospital, it's the hospital that causes the increased costs, and of course the illness. By sitting around in a hospital when you could be at home or in a community care setting, you're going to get all kinds of secondary diseases that come on to you, including infections.

What I wanted to follow up on was something that you did say. I think one of the things that we tend to get the squeeze on in terms of talking about health promotion and disease prevention is that as you transition to keeping people healthier, there is still going to be a whole generation of people in that generation who are going to be as sick as others because that prevention didn't come before. So you have to have a point in time, as you transition, where you're going to be doing both. And I think that is the issue we're facing now. As we transition, there's going to still be the high cost of spending until maybe ten years from now, when it starts to kick in on health promotion and disease prevention.

What you said, though, that really struck me very hard is the squeeze of that generation—the 35- to 45-year-old generation. You talked about a lot of other social programs that must come in place, and the one about ensuring family leave is a really important one. Norway did this three years ago, and the result not only in terms of savings, but in terms of mental health and in terms of just basically a healthier population is an extraordinary one.

They have the 18 months for leave, as you suggested, to look after kids at home, but the man—the father in the family—must take six months of that. They give you an 80% salary when you go off. People don't want to take time off if they're getting 50% to 55%, so you're looking at increasing the cost of social spending to achieve results ten years down the road, in which case they're going to have to find the money now.

That's a problem most governments are faced with: trying to find that extra money now to create a better whatever ten years down the road. How do you see that happening? How do you see people doing that transition? That is, as far as I'm concerned, the core of the issue. How do you spend more money now in that simple generation so you can save down the road in the next generation, when prevention and promotion takes a dip?

[Dr. Paul Kershaw]

There's no doubt that the investment in smart family policy to promote a healthier population isn't going to yield savings in the health care setting for young kids for 10 or 15 years. It is a medium-term investment.

That's the issue about health promotion all along. At some point we need to start.

We've been looking at a range of short-term issues that Canadians are paying for in the absence of having this new deal for families. The business community actually happens to be one of the biggest payers for the status quo. What I mean by that is when generation squeeze comes to work, they bring their time, service, and income squeeze with them, and that means a number of things. First off, they're more likely to be absent in any given year from the firm, on a given day. And who pays for that? Our employers.

That costs the business community about $2 billion a year. Then, thousands upon thousands of employees, more often than not women, say it's just too difficult to balance the caregiving at home and the responsibilities on the job. So they say “Forget it, I'm going to leave the firm for an indefinite period”, and then firms have to pay about another $1.5 billion to $2 billion to go out and recruit, retrain, and wait for the productivity of a new person to get up to the place where it was for the person being replaced.

Then, because people are squeezed, they're more likely to have greater work-life conflict, which leads to more stress, and then adults are going to the medical care system now for drugs, or to our physiotherapists, etc., more regularly. Who pays for a large part of that? Our employers, through our benefit plans.

In combination with the chief financial officer at Sierra Systems and two of his chartered accountants, my team at UBC has estimated that the business community right now is paying over $4 billion a year for the squeeze on the generation raising young kids. We can get short-term returns, and this is just the business community, by investing in a new deal. Then there are the returns coming back in some ways to government through better use of education dollars, less on crime, less on poverty reduction, because these policies will actually eliminate poverty for kids under age six, even though it doesn't do anything through welfare.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I wanted to ask a question about the whole idea of injuries to kids. I think this is something people have not discussed. I was really glad you brought it up, because so many of those injuries, not only to kids but also to seniors, are very preventable, and they can cost a lot of money in the long run. With seniors, when they break a hip, that's it. If you're a 70-year-old, when you break a hip you become dependent on the system, because you have all these added complications.

How do you see a national strategy for preventing child accidents or childhood illnesses? What form do you think that would take? What are the elements of it?

[Rebecca Nesdale-Tucker]

We appreciate the work you've done with helmets in skiing. We would see research as a pillar, we would see public awareness as a pillar, and we would want policy to be a pillar. We want to wrap up the three E's: enforcement, engineering, and education. We would like to see work with the NGOs. We'd like see to a leveraging of efficiencies. We should all use the same numbers, the same messages—it's evidence-based. Those are some of the pillars we'd like to work with.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Fry.

We'll now go to Mr. Gill and Mr. Brown, who will share their time.

Mr. Gill.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Madam Chair.

I want to thank all the witnesses for being here with us and for providing us with such wonderful presentations.

My first question is for Pamela from Safe Kids Canada. I understand our government passed a Consumer Product Safety Act last year. How will this legislation help to prevent not just injuries but also illnesses among our children?

[Pamela Fuselli]

We were involved with the Consumer Product Safety Act. What it does is take a precautionary principle perspective. It requires manufacturers to keep records and report incidents. It also gives the government the power to ban a product. Previously, there was only a negotiated ban with industry. While that has worked to some extent for the larger retailers, it doesn't get those really dangerous products off the market, like those sold in second-hand stores or smaller retail outlets. What we need is a more reactive system, a number of different options for government to address, and a mechanism to make parents aware of products that have been recalled. This way products that have been recalled are going to get off the shelves much faster.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Can you tell us how much of your information is tailored to adults and caregivers, as compared with the children themselves?

[Pamela Fuselli]

Safe Kids Canada focuses on parents of younger children. Our information is with the parents and caregivers, because they're the ones making the decisions on purchasing the safety gear and ensuring that their children are wearing it. They are the ones who tell children they should be wearing a bike helmet and buckling up every time they get in a car. They're the ones who are going to be setting the rules and enforcing them. Our approach has been to focus on parents and caregivers, getting them the information they need to make safe choices.

[Parm Gill, Conservative, Brampton—Springdale, ON]

In your online strategic plan you mentioned that aboriginal, rural, immigrant, and economically disadvantaged communities are at an increased risk of injury. What techniques have you employed to communicate with these groups, and what challenges do these communities face?

[Pamela Fuselli]

We've done a number of different activities in this area. A number of years ago we launched an ethnocultural program that investigated what languages were spoken most in ethnocultural communities in the Toronto area. We selected three. We have limited funding, so we were looking at a pilot project for this. Instead of just translating the material from one language to another, we spent a lot of time with these communities, understanding their needs and their cultural norms, and really translating the materials in such a way that they are culturally relevant. What we learned was that in some communities it was very important to put information about contacting emergency services as well as the actual safety information that we wanted to communicate. We've done a bit of outreach to that.

In terms of rural areas, I've been very active in engaging with the agricultural community and looking at children living on farms, because not only are they living in a home and exposed to the same general injuries as other children living in homes, but they are also living in a workplace. It's the only scenario that we have in Canada like that. They are at most risk under age five because they're taken onto the work site very often for purposes of child care. They're taken there so they can be watched while someone else is engaged in work.

I sit on a couple of committees on that, and I'm trying to get guidelines out to parents around the most appropriate child development ways to engage their children in farm work, if they are going to do that. For the younger ones, there are guidelines to look at options for child care, such as creating a safe play space on their property while they're working.

[The Chair, Conservative, Joy Smith]

Ms. Fuselli, I'm sorry to interrupt you, but Mr. Brown has a question, and we're running out of time.

Go ahead, Mr. Brown.