Health Committee on Nov. 20th, 2012

[Leona Aglukkaq, Conservative, Nunavut, NU]

On November 5, my colleagues, Colin Carrie and the honourable Mike Lake, announced that Dr. Weiss of York University accepted the position of chair in autism spectrum disorder treatments and care research. This followed a rigorous selection process through the Canadian Institutes of Health Research.

Dr. Weiss is a clinical psychologist at York University who works with children, adolescents, and adults. His research focuses on the prevention and treatment of mental health problems in people with autism spectrum disorder.

As the new chair, he will work to improve the lives of Canadian children and adults with autism and of their families. He and his team will study innovative approaches to expand treatment and care research to address mental health problems in Canadians with autism across their lifespan. They will also examine why people with autism are prone to develop mental health problems. They will also evaluate novel treatment strategies to help youth and young adults with autism deal with these issues as well as with other stressful events, such as bullying, and find ways to improve access to care for these individuals.

To achieve their goals, they will also work with people with autism and with their families, service providers, governments, and agencies to share cutting-edge research that informs mental health care policy and practice across the country. This research will also have a lasting impact on families that are dealing with this situation and on generations to come in Canada.

[The Chair, Conservative, Joy Smith]

Thank you, Minister. Our time is up.

Dr. Sellah, we're going into five-minute rounds now, and it's 12 o'clock. I'm sorry, but we'll have to—

[Libby Davies, NDP, Vancouver East, BC]

Madam Chair, given that the minister didn't show up until about seven after, maybe we've got another—

[The Chair, Conservative, Joy Smith]

Excuse me, Ms. Davies, let me finish, please.

I've just been informed that the minister is able to stay for 10 more minutes. Thank you.

Dr. Sellah, I'm glad you will get your chance.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

Madam Minister, thank you for coming before the committee. With all due respect, I would ask you to give us clear, succinct and specific answers.

I would like to go back the matter of the Health Canada ombudsman. Are you going to establish the position, yes or no? That is my first question.

This is my second. The matter of transfers to the provinces is not going to go away; it is always going to be with us. Imposing the new funding formula unilaterally on provincial and territorial governments is going to deprive them of $36 billion. But the Prime Minister promised that there would be a 6% increase. In his Fiscal Sustainability Report 2012, the Parliamentary Budget Officer confirmed that this funding formula would hurt the provinces and territories and would increase the pressure they are under. This would put our public, universal health care system at risk.

Why impose that funding formula despite the promise your party made to Canadians? Why conduct the war on the deficit on the backs of the provinces, as the Liberals did previously?

Your government also decided to make major cuts to the public service and your department was not immune. It is the fourth to have been affected. According to Treasury Board figures, we are talking about 1,416 jobs lost and annual cuts of over $300 million by 2014-2015. Not only did you refuse to provide the details to the Parliamentary Budget Officer, you have also refused to answer questions clearly.

We know that the First Nations and Inuit Health Branch has been severely affected. Your deputy minister has just said that organizations like the Assembly of First Nations, Pauktuutit, an Inuit women's organization in Canada, or other programs in research, education, nutrition and policy development would also be affected. I know that is not front-line care, but do you not think that all those cuts will have an impact on the promotion of Aboriginal health and, eventually, on their health itself?

Could you tell me, in whatever way you want to handle the question, what is going to prevent disease and save money in the health care system?

Thank you.

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll try to be very precise in answering the many questions that the member raised. With respect to the issue of an ombudsman, we have no plans to establish that position.

The increase in transfers to the provinces and territories, at $40 billion, is not a decrease. There are no cuts to health transfers to the provinces and territories. I was in the health care system, as finance minister for Nunavut, when the Liberals cut transfers. The $40-billion increase is not a decrease.

In regard to the areas of front line and whatnot, every effort that we took in Health Canada was to not cut front line health care services. On the reductions in programs with organizations, those organizations do not deliver front line health care services.

In terms of the areas of prevention, we're doing a lot of great things through the Public Health Agency of Canada. At the federal, provincial and territorial health ministers meetings in Newfoundland two years ago, the first declaration was signed in this country that starts to concentrate its targets and efforts in relation to chronic disease prevention.

As well, in the next year we'll be reporting on those through a conference in Ottawa. We'll be bringing in not only governments but the private sector, in their efforts to reduce chronic disease in Canada. This is the first of its kind in Canada, and it was our government's efforts to mitigate some of the preventable illnesses we're seeing in our hospitals.

Equally important is to keep people from getting ill in the first place. Much of the work we're doing is to tackle areas where we're trying to prevent illness, for example, tobacco use, obesity prevention, injury prevention in a number of physical activities, and to stress the importance of that in our health care system. Many of the investments we're making are targeting that, and at the same time we're protecting the transfers to the provinces and the territories.

[The Chair, Conservative, Joy Smith]

Thank you.

Mr. Lobb, go ahead.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Minister, thanks for coming here.

Obviously, when it comes to first nations, Inuit, and Métis communities in Canada, there's huge potential not only with what they can share with us, but the contributions they can make to our economy and the betterment of Canada.

You've made some announcements in terms of investments to better the health and the research of those communities, to give them a better chance. I wonder if you could elaborate on that aspect.

I will be sharing my time with Ms. Block.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Again, congratulations on your appointment to the committee.

Overall, our government has invested over $30 million a year in aboriginal health research and more than $2.2 billion in first nations and Inuit health programs.

In June I made an announcement with my colleague, Minister Duncan, involving a federal investment of $25 million over two years. This will be used to conduct innovative health research that responds to pressing needs identified by first nations, Inuit, and Métis people across Canada. The long-term plan will focus on four areas: suicide, obesity, tuberculosis, and oral health.

The health researchers will only be able to access that funding if they work with leadership in aboriginal communities. This aims to find meaningful health solutions that will lead to healthier communities. Basically, in a nutshell, all the investments in research that we are making must involve partnerships with aboriginal communities at the community level.

The Canadian Institutes of Health Research recently hosted a partners forum in this initiative. The forum brought together national first nations, Inuit, and Métis organizations along with government representatives and researchers from the private sector. The efforts show that CIHR and our government are committed to a new and better way of working with first nations, Inuit, and Métis people in looking at research for better health outcomes of the most vulnerable population.

In the coming months I look forward to reporting on the progress of this investment. We will continue to work hard with aboriginal communities to improve the health outcomes over the long term.

[The Chair, Conservative, Joy Smith]

Mr. Kellway, you have time for one question, if you could get it in.

[Matthew Kellway, NDP, Beaches—East York, ON]

I'll try to be quick.

Minister, thank you for being here today.

This has to do with access to medications and the speculation that, in the current negotiations over the comprehensive economic trade agreement with the European Union, there will be provisions to extend patent protection, which is going to cost our health care system up to $2 billion, but the speculation seems to be around $1 billion.

I am wondering how, when there are such great challenges to access to pharmaceuticals already within our health care system, we can justify adding those kinds of costs to our health care system and those barriers to Canadian citizens in their efforts to access health care.

[Leona Aglukkaq, Conservative, Nunavut, NU]

The Minister of International Trade is the lead on that file. The CETA negotiations also involve consulting with my departments on other related issues, but the provinces as well as territorial governments and stakeholders are part of this forum. What I can say is that the negotiations are continuing, and negotiation teams are engaged in focusing discussions on a wide range of remaining issues.

I don't want to speculate on the outcome of those negotiations and the final outcomes as the negotiations continue.

[Matthew Kellway, NDP, Beaches—East York, ON]

I would just like your perspective on this issue, as the Minister of Health, of increasing barriers to health care for Canadians through increases to the cost of pharmaceuticals.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Again, those negotiations continue. I won't speculate what the outcome will be.

With regard to the increased cost of pharmaceuticals, we have to do our part within what we're dealing with today. I made it very clear in my opening remarks that currently within our own health care system we have to look at why, for example, we are seeing increases in prescription drug abuse. We need to do our part with the current systems we have in place to mitigate what is happening across the country.

Under the non-insured health benefits program, we have been able to detect fraud and we are now recovering up to millions of dollars. This fraud is costing our health care system. We need to continue to look at some of those challenges that we are facing today. I encourage my provincial and territorial counterparts to work with us to address some of those challenges.

[The Chair, Conservative, Joy Smith]

Our time is up. I apologize to you.

I am going to suspend for three minutes to give the minister a chance to leave. Thank you very much, Minister, for coming today and giving us your insightful presentation. Thank you to the committee for all their questions.

We will suspend for three minutes and resume at 12:15.

I very much welcome the department, the Public Health Agency of Canada. I am so pleased. We really appreciate all that you do. You've been here for a couple of hours and .

We're going to begin at the top of the chart. We're going to begin with Mr. Kellway, who has four minutes, and Ms. Davies is going to take three.

Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Madam Chair.

Thank you to all of you for being here today. I had my questions framed for the minister so I'll try to reframe them appropriately for you, given your roles in all of this.

I had asked about CETA and the potential for adding about $1 billion to the cost of pharmaceuticals and the challenges that creates for Canadian citizens accessing health care in this country.

We've heard testimony at this committee about the cost of pharmaceuticals in Canada. They are about 30% above the average cost in industrialized countries, and they're even higher in Quebec, about 40% higher. We've also heard testimony about the potential cost savings of having a national pharmaceutical strategy in the order of $10 billion a year. We've heard as well about best practices around the world. New Zealand is getting 50% in savings in the cost of their pharmaceuticals through plain and simple negotiations with pharmaceutical companies.

I heard the minister say on the issue of the cost of pharmaceuticals and that detecting fraud is reaping potentially millions of dollars in savings. The order of magnitude that we really need to consider in this country at this point in time is in the billions. I'm wondering if there is a policy justification for not taking major steps to reduce the cost of pharmaceuticals in this country, by setting aside, for the moment, the CETA issue and the potential impact there.

[Glenda Yeates]

Madam Chair, I think this is a very important question and I'm very pleased to address it with the committee.

The cost of pharmaceuticals is an issue worldwide. It is an issue for health systems generally and there are many facets to it. The minister referenced the appropriate use of pharmaceuticals. That's an area where we see variation internationally in terms of the use of pharmaceuticals. We see that variation within the country. There are a number of agencies, including the Canadian Agency for Drugs and Technology in Health that try to support provinces, the colleges of physicians and others to try to give people the tools to use best practices in terms of appropriate prescribing.

We also have a number of factors like the common drug review. Again, Canada has moved to a one common drug review. Provinces and territories are able to take up those recommendations or not, but we do the kind of evaluation of the cost benefit of the appropriateness of the drugs once in the country and give that as a tool. That's a considerable commonality in drug programs that wasn't there before.

[Matthew Kellway, NDP, Beaches—East York, ON]

If you forgive me, Ms. Yeates, it seems that we're playing around the edges of the main issue here when we are talking about billions of dollars of potential savings and that we know how to get those savings, it would seem. Why do we continue to retain a barrier for Canadian citizens to get access to health care by retaining average pharmaceutical costs at 30% above industrial averages? All these programs I understand, but it's nibbling around the edges of a very large problem in access to health care for Canadians. Why don't we tackle the problem directly?

[Glenda Yeates]

I'm not aware of the precise study that's been cited, Madam Chair, but I think there are a number of aspects that countries tackle to try to get their drug prices down. Some of it is in things like price control. Canada has the Patented Medicine Prices Review Board, for example, to try to deal with the prices of patented drugs. Again, you see various reports on how our drug prices compare there.

One of the ways that I think we get costs down is through bulk purchasing, and the minister spoke of that as well. One of the ways is through, again, common listing, having formularies that list drugs that have a common basis. There are a number of factors, but I think the policy world would say these are the things that help bring drug prices down. It's typically not one specific angle—

[The Chair, Conservative, Joy Smith]

Ms. Yeates, I have to tell you that Mr. Kellway went overtime, so Ms. Davies has only two minutes. Maybe we should give her a chance to ask a question.

[Libby Davies, NDP, Vancouver East, BC]

Thanks very much. I'll try to be brief.

I also wanted to follow up on another aspect of the whole drug question in Canada. I'm sure you're aware that in March the House unanimously passed a motion concerning drug shortages. The key words in that motion were a call for a national strategy “to anticipate, identify, and manage shortages of essential medications”.

I don't see any funds in the estimates pertaining to the prevention and management of drug shortages. What has the department done since that motion was passed to anticipate, identify, and manage shortages of essential medications?

[Glenda Yeates]

Thank you very much, and I will try to be brief in my answer, too.

We have been working extensively with a number of partners. I think we've all understood from the situation that it is no one area of government or one sector that can handle all of this. We worked with industry to make sure that we get the best notification we can in terms of where they see potential drug shortages or where they see potential disruptions in supply.

We worked with the provinces and territories very specifically to deal with some of the areas that were raised in the motion and in the recommendations from this committee in terms of looking for how we work together and how we get the best clinical information on the use of therapeutic alternatives.

We worked very much with the provinces and territories to try to provide some of those alternatives, for example.

[Libby Davies, NDP, Vancouver East, BC]

Do you feel assured that we won't be facing shortages? For example, I know that Zarontin, which is an epilepsy drug, is no longer accessible, so there still are issues with certain drugs. Are you satisfied with the progress that is being made? It sounds like we've still got a big problem out there.

[Glenda Yeates]

Everyone in the field would acknowledge that this is going to be an ongoing issue that needs to be managed. That's why we need to bring the parties together.

We are satisfied that the parties are very much alerted to this. We are dealing with issues of sole sourcing. How do we ensure that we don't have—

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Yeates. I'm sorry, but we're out of time.