Health Committee on March 13th, 2012

[The Chair, Conservative, Joy Smith]

Good morning, everybody. I'd like to call our health committee meeting together, pursuant to Standing Order 81.(4), for the main estimates for 2012-13.

I want to welcome the Minister of Health. We're very pleased that we have the minister here this morning.

Minister, I would like to give the floor to you, and we look forward to your talk this morning.

[Leona Aglukkaq, Conservative, Minister of Health]

Good morning, everyone.

Madam Chair and members of the committee, it's a pleasure again for me to be here to discuss the supplementary estimates (C), as well as the main estimates for the health portfolio.

Before I do that, I would like to introduce the officials who are here with me this morning, many of whom you already know. With me is Glenda Yeates, the deputy minister, Department of Health; Dr. David Butler-Jones, chief public health officer for the Public Health Agency; and Paul Glover from Health Canada, health products and food branch.

Before I begin, let me say a few words about the important debate that took place last night in the House, and I believe most of you were there. Being able to explain the different roles and responsibilities with respect to the drug supply was important for me to get across and emphasize. We are responsible for access to drugs, using the highest standards of safety and efficacy. We provide guidance and insight to the purchasers—namely, the provinces and the territories—but our government is extremely respectful of their jurisdictions.

Provinces and territories are responsible for the delivery of health care. They know the needs of the Canadians who live there. They know what drugs are consumed and in what quantities. They know what to order when entering into a contract with the pharmaceutical industry. They also know whether their supplier is a single source for drugs they order, and it is up to them to ensure that there's a plan B. They're also responsible for the terms of these contracts.

As I stated, I wrote to industry last summer and requested that they take the issue seriously. They have responded and are setting up websites that will inform provincial and territorial health care professionals of impending drug shortages. In fact, just yesterday, I heard from Sandoz officials, who responded to my letter in a very positive manner. They have agreed to post information about drug shortages online and give a 90-day notice of any other drug shortage that will arise in the future. This is very encouraging, and I hope they will live up to their commitment.

This is far from being a Canadian issue. We work with our global communities to alleviate any stresses on our system, as we witnessed during the isotope shortage. We will continue to provide our jurisdictions with the support and guidance they need, as always.

I'm pleased to be invited here this morning, not only to discuss the supplementary (C) and main estimates, but also to update members on progress made in the health care portfolio. As the needs of Canadians change, so do the demands on our health care system. In many of the discussions I have had with my provincial and territorial minister colleagues, there are two issues that are always acknowledged.

First, there is a keen interest to provide information to Canadians regarding healthy living and healthy lifestyles. Maintaining a healthy weight and healthy diet, as well as doing regular exercise, will ensure that the number of health-related issues in this country, including chronic diseases, will go down. This will have a significant impact on the provinces and the territories in the delivery of health care to their jurisdictions, as the number of doctors' visits would decrease, as would the number of hospitalizations.

Second, the provinces and territories are keenly aware of the fact that they will need to be more innovative. They realize that they need to adapt the system in their jurisdictions to the needs of their citizens, and that the emergency room is not always the band-aid solution.

One of the ways we have made much progress, and we are very proud of it, is the creation of a new model of health governance for first nations in British Columbia. Most recently, we also hosted an important meeting between the crown and first nations that included important discussions about health care. In the months and years ahead, the sustainability of our health care system will be a recurring subject of our discussions.

I suggest, Madam Chair, that sustainability will come from innovation and cooperation. Providing Canadians with the information they need to make healthy decisions for their loved ones is key to optimum population health.

Madam Chair, since I was named Minister of Health, I have continued to work with my provincial and territorial colleagues towards a more sustainable health care system that achieves better results. Our government is committed to strengthening the health care system, and we have delivered on our commitments under the 2004 health accord: we have made progress in reducing wait times, increasing the number of doctors and nurses, and introducing electronic health records.

Since 2006, the federal health care transfers have been growing at a rate of 6% annually. In 2011-12 we provided $27 billion to the provinces and territories through Canada health transfers. By 2013-14, that will be more than $30 billion. It will reach $40 billion by the end of the decade, and our government has been clear that we will not cut health transfers.

Last November, I met with the health ministers in Halifax, where we discussed health care priorities and challenges and our common focus on health care renewal. In December, the Minister of Finance announced long-term federal funding for health care beyond 2014. With the growing funding guaranteed, governments can focus on health care renewal.

I have already met with several health ministers to talk about ways in which we can work together to ensure a more sustainable health system. I believe there is a great deal of will to work towards this common goal.

As the jurisdictions responsible for the delivery of health care, it is up to the provinces and the territories to decide on the direction and the pace of change for their own health systems. I am interested in working with them to see how federal tools and levers can support them in their reforms to improve health care, and I continue to dialogue with my counterparts on a regular basis.

Innovation comes from rethinking what we do. We need to analyze every aspect of health care to see whether it is delivering what it should and whether it is being done efficiently. We invest over $1 billion annually in innovation through the Canadian Institutes of Health Research, Canada Health Infoway, the Canadian Agency for Drugs and Technologies in Health, and other programs that support research, health human resources, and the assessment of technology.

The Canadian Institutes of Health Research is leading research in many areas. For example, the CIHR is funding research into the way we deliver primary care through family physicians, nurse practitioners, pharmacists, and other front-line services. We can see the day when medicine is personalized or tailored to the needs of the individual based on their genetic profile. It is the next step in the evolution of the way we treat disease.

Right now, we treat disease based on what we know about the disease. In personalized medicine, we will treat the disease based on what we know about the disease and what we know about the person. Treatments that are tailored to the patient will be more cost effective and, more importantly, will mean better health outcomes.

To get us closer to making that a reality, we are working in partnership with Genome Canada, the Canadian Institutes of Health Research, and the Cancer Stem Cell Consortium to invest $67.5 million in research for the development of personalized medicine.

While we are creating new models of health care delivery, we are also working to prevent as many health-related problems as possible. We already know that unhealthy weights can lead to many health problems, and we know there is a growing problem of overweight and obesity, especially among our children. To reverse that trend, we will need the help of individuals, industry, and organizations that can help create the conditions that lead to healthier eating and more active lives.

In September 2010, I was proud to join my provincial and territorial colleagues in endorsing the “Declaration on Prevention and Promotion” and “Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights”.

In September of last year, I added my signature to the UN declaration on the prevention and control of chronic diseases. The role of active living and healthy eating in preventing chronic diseases, such as diabetes and heart disease, is highlighted in the declaration.

A few months ago, my provincial and territorial colleagues and I endorsed the recommendations and key areas of action that can be taken by government to support healthy weights and reduce childhood obesity. But governments alone cannot address the growing obesity epidemic. We all have a role to play in promoting healthy weights and helping our children get the healthiest possible start in life.

I recently co-hosted a summit on healthy weights with my colleague from Nova Scotia. This summit brought together a variety of sectors: industry, the voluntary sector, and governments. In my view, this was a historic event. We challenged everyone to think outside the box and to build partnerships for collective action. We are also developing partnerships with a variety of organizations, and those bonds will serve us well in combatting obesity in order to reduce the incidence of chronic disease in this country.

Regarding HIV/AIDS, and in order to speed up the pace of research, we are funding five major research projects that will drive the development of a vaccine. These projects represent an investment of $17 million. They are the kind of research that will bring us closer to finding a vaccine and that will foster the next generation of HIV researchers. As well, Madam Chair, to help administer and guide future research, we are providing funding for the creation of the Canadian HIV Vaccine Initiative Research and Development Alliance coordinating office. It will be funded for the next five years by the Government of Canada and the Bill and Melinda Gates Foundation. It is an additional investment of $3.2 million and is an important part of the Canadian HIV vaccine initiative.

Our government has been very proactive and serious about ensuring the health and safety of Canadians. As you know, there have been important changes with the passing of legislation such as the Canada Consumer Product Safety Act, which has given us new tools to improve the safety of products in the marketplace. It is an important piece of legislation that has helped us to protect Canadians from dangerous products. In fact, in late December, our inspectors found children's jewellery that had high levels of cadmium and lead being sold across Canada. Backed by the new authority in our act, we were able to work with the companies involved to accelerate the removal of these products from shelves.

Another area we have been working on is that of traditional Chinese medicine. While many Canadians look to modern medicine for treatment, many others use traditional Chinese medicine to maintain or improve their health. We want to make sure that those products are both safe and effective, and we want to get input from those who are most knowledgeable about them. Late last year, my parliamentary secretary, Colin Carrie, and I hosted round table discussions with practitioners and representatives from industry in Toronto and Vancouver. The face-to-face discussions were very useful from both points of view. We appreciated their input and they appreciated being heard. This has inspired us to create a TCM advisory committee to provide advice on emerging issues related to traditional Chinese medicine.

Also making headlines in recent months has been the debate on MS and CCSVI. I want members of this committee to know that the government shares the desire of MS patients to find a cure for this disease and to better understand the procedure proposed by Dr. Zamboni. That is why we are funding research on MS. To date, the government, through CIHR, has invested $55 million in MS research. In partnerships with the MS Society of Canada, the Canadian Institute for Health Information, and the networks of MS clinics, we are building a Canadian MS monitoring system that will become a valuable source of information for patients, doctors, and researchers on MS.

CIHR is also currently selecting a research team to conduct a clinical trial on the proposed procedure. This research initiative is being conducted in collaboration with the provinces, the territories, and key stakeholders, such as the Multiple Sclerosis Society of Canada, to determine whether this new procedure is safe and effective. These important questions have not been answered unequivocally by the international research community. Our clinical trials will provide the answers we seek.

It is also our role to move forward on this important health issue without putting the lives of Canadians at risk.

In conclusion, Madam Chair, health care is a priority for most Canadians. I know that each member of this committee shares the desire to provide Canadians with the best tools we can for leading healthy lives and to access the best health care that can be made available to them.

I'd like to thank the members for your hard work. If you have any questions, I would be pleased to answer them this morning.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Minister. We so appreciate your coming today. We're all looking forward to this time with you.

We'll now begin our questions and answers.

For seven minutes, we'll have Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you, Madam Chairperson.

Thank you, Madam Minister, and all the officials who have come here today. We appreciate your making the time, because obviously we have many important issues to discuss, some of which you've raised in your comments today.

Thank you also for being at the emergency debate we had in the House last night.

I think there is a fundamental question about why the voluntary agreement on drug shortages is not working. I hope we'll have further discussion on that, because clearly the approach the government is taking has not solved the problem, and we have quite a crisis before us.

I want to focus today on two questions to do with health care funding and the regulation of processed foods. If I may, I'd like to put the two question to you.

On the first one, Madam Minister, the premiers have made it very clear that they expect much more from the federal government than a non-negotiable funding package. In fact, the premiers have repeatedly called for a collaborative health care funding process that would uphold the commitments of the 2003-04 accords. Despite your comments today that those commitments have been met, there is still a long way to go even to uphold the 2004 commitments and to ensure accountability.

It's very interesting that the response of the government has been this unilateral decision. We know that you sent a letter to the premiers, but there hasn't been any significant process. There haven't been any meetings jointly, other than the one that took place last year. I think there's a real question about where your leadership is on this issue, because that's what Canadians expect. Why is the federal government, and why are you, as minister, walking away from this collaborative and joint process with the provinces and territories?

My second question has to do with processed foods. Not only have you walked away from talking to the provinces and territories about health care funding, you've also not acted to reduce salt, sugar, and trans fats in our food, despite repeated calls from health care organizations and practitioners.

You might know that the British Medical Journal singled out Canada as blocking an international agreement to reduce salt, sugar, and trans fats in processed foods. It was recently revealed that you personally ended a plan to reduce trans fats in processed foods.

Why are you continually siding with industry rather than looking out for Canadians who are trying to make healthier food choices?

[The Chair, Conservative, Joy Smith]

Minister Aglukkaq.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll start with the transfers to the jurisdictions under the health accord. Under our government and the health funding plans, we've increased the transfers to the jurisdictions. I was at the table when cuts were made to health care transfers. I was finance minister for Nunavut when significant reductions were made to education and health. What our government has stated time and time again is that we will not cut transfers. The finance ministers met in December and outlined the funding beyond 2014. The funding that's gone to jurisdictions is predictable and sustainable, and each jurisdiction can now focus on health priorities.

Since that time, I have had a number of meetings with provincial and territorial health ministers to talk about what lies beyond 2014, looking at innovative ways to make improvements in the delivery of health care. I outlined those in my opening remarks to the committee this morning.

I will continue to meet with my provincial and territorial counterparts in health to discuss health care, which was not the discussion in 2004. The health accord was about funding at the time and it had nothing to do with what health indicators this country should be focusing on. That's precisely what I'm doing with the jurisdictions on the issue of priorities for Canadians.

In the area of sodium and trans fats, we continue to move forward. As with any other program, there are recommendations that come forward, and a number of options are laid out, together with proposed initiatives. We've had some discussions with the federal-provincial-territorial health ministers. I'll use sodium as an example. For a lack of better words, there are 10 ways to skin a cat, and there are different ways we can get to the outcomes we're looking at. I think right now we are making progress in the right direction.

We cannot deal with the health of Canadians one ingredient at a time: trans fat, salt, sugar, whatnot. We need to look at a broader strategy for keeping the population healthy in Canada. That declaration was signed off by federal-provincial-territorial health ministers in Nova Scotia. It was on building healthy Canadians, and it focused on combatting childhood obesity, which is an epidemic now. We had an historic meeting that brought a number of sectors together—the food industry, the health care professionals, the volunteer groups—to look at how we deal with this issue on a broader scale.

[Libby Davies, NDP, Vancouver East, BC]

Madam Minister—

[Leona Aglukkaq, Conservative, Nunavut, NU]

We cannot deal with the health of people one ingredient at a time. It has to be much broader than that—physical activity, obesity, and a number of other problem areas.

[Libby Davies, NDP, Vancouver East, BC]

Madam Minister, on the issue of sodium, it was your own panel of experts that made these recommendations, and the provinces were in agreement. This debate has gone on forever. There have been clear expert recommendations made. It's your government that is now holding up the agreement. We know from the BMJ that Canada blocked the international agreement on a number of issues, whether it was salt, sugar, or trans fats.

[Leona Aglukkaq, Conservative, Nunavut, NU]

That's not true. That's not accurate.

[Libby Davies, NDP, Vancouver East, BC]

Why is your government blocking these agreements and not listening to these experts? The provinces have come to an agreement—

[The Chair, Conservative, Joy Smith]

That's your time, Ms. Davies. Thank you.

I will now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair, and my thanks to the minister for being here. You've been busy the last little while and we appreciate your taking the time to come to this committee to answer our questions.

You referred in your opening statement to traditional Chinese medicine. I want to thank you for allowing me to participate in a round table. We all know that Canada is changing, and Canadians want choices. In my own community of Oshawa, I had the opportunity a while back to talk to an Afghan veteran who had an eye problem. He came back home, and he tried everything to find a cure. His brother sent him to a traditional medicine practitioner and within two weeks his eye cleared up.

Canadians are looking for more choices like this, and you're taking a leadership role by talking and listening to different communities. I was wondering if you could explain to us why you decided to set up the committee for traditional Chinese medicine. What is it going to do for Canadians?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for the question.

Traditional Chinese medicine, also known as TCM, refers to natural health products that Health Canada regulates. There are over 1,400 of them available for sale in Canada. Our government recognizes the unique nature of TCM and wants to hear from the communities their views on these products. So my officials meet regularly with representatives of this industry, but we also held two dedicated round tables in Vancouver and Toronto last fall to hear back from the TCM stakeholders.

Based on what I heard at those discussions, I called for the establishment of a TCM advisory committee, and this committee will provide a single window for TCM community members to interact with my department to bring their views and concerns forward. The advisory committee is being established in recognition of the unique characteristics of TCM. It also acknowledges the concerns of the TCM community about the appropriateness of the western medicine model for these products.

The mandate of the new committee is to provide my department with advice on current and emerging related issues on TCM, including the importation, sale, and use of TCM in Canada. Potential members have been identified from a cross-section of key stakeholder groups, including the industry, TCM practitioners, consumers, and patient groups. The advisory committee will have their first meeting sometime this spring, and I'm looking forward to hearing their views on this very important issue.

Thank you.

[Colin Carrie, Conservative, Oshawa, ON]

Me too, because like I say, Canada is changing. We're also seeing a huge demographic shift on the part of the baby boomers. I think they said this year is the first year that baby boomers are turning 65.

We've just finished up a study here on the health committee on chronic diseases and aging. We heard a lot about our health care system and how it evolved into an acute care system, and it seems we're going to be having to shift into a more chronic care system. We heard of the expanding incidence of things like diabetes, heart disease, and arthritis, and how many of these conditions are preventable.

I was wondering if you could tell our committee what the government is doing to help prevent these chronic diseases in Canada.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Our government understands the burden that chronic diseases place on Canadians and the health care system. As I stated in my comments, we are committed to reducing their impact. We are helping to create the conditions for healthy aging by preventing and delaying the onset of chronic disease. We are also helping to prevent the complications when those diseases occur. This is achieved through a number of federal investments, initiatives that allow us to better understand the wide range of factors associated with aging. As an example, we launched the $15 million four-year national population health study of neurological conditions in collaboration with Neurological Health Charities Canada. This study will cover a wide range of neurological diseases such as Alzheimer's disease, dementia, and Parkinson's.

As well, the CIHR, through the Canadian longitudinal study on aging, will examine health and socio-economic issues of Canadians aged 45 to 85 over the next 20 years. In addition to filling the knowledge gap, our government is working with a wide range of partners to provide information and tools to promote healthy aging and prevent chronic disease. Preventing chronic disease and promoting healthy, active living are themes that cut across all of our disease strategies, including the Canadian partnership against cancer, the Canadian diabetes strategy, the Aboriginal diabetes initiative, the national lung health program, and the Canadian heart health strategy and action plan.

In addition to that, as I mentioned earlier, there was the federal-provincial-territorial meeting that endorsed the declaration on prevention and promotion in September 2010, which gives priority to the promotion of health and the prevention of disease, disability, and injury. Through the age-friendly communities initiative, we're also working with the provinces and the territories to bring older Canadians into the planning and design of their communities to create a healthy, safe, supportive environment where they can live and thrive. Those are examples of initiatives.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Minister.

We'll now go to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I want to thank the minister for coming to answer questions today, and to discuss the supplementary estimates.

I want to go straight to something that my colleague, Libby Davies, from the NDP talked about. I see that one of the major points made by the minister is that maintaining a healthy weight and a healthy diet, as well as doing regular exercise, will ensure the numbers of health-related issues in this country, including chronic diseases, go down.

The minister then went on to discuss the importance to the health care system of decreasing chronic disease and managing chronic disease well. The minister also spoke about signing a health promotion and disease prevention initiative and focusing on that.

I know, as the minister said, that there are more than 10 ways to skin a cat. But the only really important way to skin the cat is the one in which evidence has proven is the most effective way to skin the cat. We know that the most effective way to get healthy weights in this country and to bring down chronic diseases, such as diabetes caused by obesity, chronic heart disease, is to look at three very important issues: salt, trans fats, and sugar.

The minister absolutely has in her power the ability to mandate those amounts. Her own department has told her so. Advisory committees have told her so. All of the health care providers she's met with have told her so.

I'd like to know why the minister doesn't follow evidence-based decision-making in her department. It would seem to me that all of this is just a lot of talk, which we have been hearing since 2006, and nothing has been done to deal with this most significant issue.

I would like to know why the minister has in her power the ability to do this and has done absolutely nothing about it.

There is a second thing I want to ask the minister. She talks about money being spent on HIV/AIDS for a vaccine. This is good. This is very good. But is the minister aware of the fact that in British Columbia there is a proven, again evidence-based, drug that will not only treat the patient who has HIV, but by the second dose will bring down the viral load so completely that HIV will be prevented from then on. If I could not think of a better way to look at something in place of a vaccine while we're waiting for a vaccine, that's the way to do it.

I would hope that the minister would work with provinces to talk about a way of ensuring that this is part of a major HIV/AIDS strategy. It's called the HAART program. British Columbia is spending $18 million a year to treat every single person who is HIV-positive. This is a smart, evidence-based way of doing things.

So that's the second thing I want to ask the minister about.

There is a third thing I want to ask the minister. She talks very much about the crown and first nations model of health governance. Since the money for the aboriginal healing fund was transferred from the aboriginal communities into Health Canada, can the minister give me an update on how that aboriginal healing fund has progressed within Health Canada? How much of that has gone to actual aboriginal communities to work on healing, to make a difference?

In fact, INAC originally told us it was so effective they hoped this fund would continue within aboriginal communities. Health Canada should give evidence to me about the outcomes that are better than the aboriginal healing fund outcomes.

Finally, on personal health, the minister talked about a genetic profile and that you cannot pick different things to solve a problem. Well, does the minister believe that genetic profiles are the only things that cause disease? What about poverty and unemployment? What about the environment? What about smoking? What about obesity? What about alcohol? Those are things that also create disease, not merely your genetic profile.

If the minister has that kind of money to spend, I would like to know why the minister isn't dealing with bringing down chronic diseases.

[Leona Aglukkaq, Conservative, Nunavut, NU]

On the issue of the sodium conversation, our government has taken a number of steps to help Canadians make healthy food choices, including mandatory nutrition labelling that requires that sodium content be declared. We have also revised Canada's Food Guide. Consumer information on Health Canada's website is also available.

We have also released a national sodium reduction message, in October 2011. The provincial, territorial, and federal partners, in collaboration with industry and health and other stakeholders, are working together to lower the sodium intake of Canadians to 2,300 milligrams per day by 2016. We are on target and we are moving forward.

Health Canada, with its partners and stakeholders, is moving on three fronts to reduce sodium consumption. That includes education, awareness, and guidance to industry on efforts to reduce sodium in processed food, and research—

[Hedy Fry, Liberal, Vancouver Centre, BC]

Minister, we only have seven minutes, and with all the respect in the world—

[Leona Aglukkaq, Conservative, Nunavut, NU]

The sodium-reduced diet is part of broader efforts to improve the healthy outcome—

[Hedy Fry, Liberal, Vancouver Centre, BC]

—could you answer my question about why you have not gone to mandatory—

[Leona Aglukkaq, Conservative, Nunavut, NU]

—so we are moving forward in the area of sodium reduction.

In the area of tobacco, it was this government that introduced the legislation. My first legislation was to deal with big tobacco marketing their products to children. That legislation was passed, and we have seen a significant reduction in young people smoking in this country. It's the lowest it's ever been. We're quite proud of that, and we continue to move forward in tobacco warning labels.

As an example, we are working with the provinces and territories to combat this issue. These are the collective efforts of provinces and territories in reducing smoking by our young children.

In the area of evidence-based HIV...I think the initiatives that we have undertaken—in partnership, again, with the Bill and Melinda Gates Foundation—are to pull together the experts in developing a vaccine. After 25 years of doing research in areas of HIV, we were concerned that the investments we were making were not resulting in the production of an HIV vaccine. So in partnership with the Bill and Melinda Gates Foundation, we pulled together the experts, to focus the experts and the resources we have, in coming up with a vaccine. This is, again, an innovative way of dealing with and moving forward in addressing the issue of developing a vaccine for HIV/AIDS.

[The Chair, Conservative, Joy Smith]

Thank you, Minister.

Now we'll go to Mr. Gill and Mr. Brown.

Mr. Gill will begin.

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

Thank you, Madam Chair.

I also want to thank the minister for taking the time out of your busy schedule to be with us here today, and also all the officials.

I also had the opportunity to participate in the drug shortages debate that we had last night. I want to thank Health Canada for the role it is playing and also, under the leadership of the minister, for doing a tremendous job. I have full confidence that issue will be addressed in the very near future.

My question, Minister, is related to obesity. Canada is facing an obesity epidemic. I understand that addressing childhood obesity is a complex problem, but I believe it is critical we do so. I believe that all sectors of society and all levels of government will have to work together to find the solutions.

I understand that you recently participated in a summit on healthy weights. What was that all about, and will it help us to address this issue?