Health Committee on Oct. 5th, 2011

[Kim Elmslie]

Thank you. That's a really important question.

In the context of the federal role, we're not directly creating those spaces, but through our partnerships and through our support to community organizations and to community work being focused on seniors, that's happening. So many of the projects that we are funding are allowing networks of seniors to come together, and the message around prevention and the tools to help seniors live healthy lives and be supported in their communities are being developed. So the short answer is that indirectly we are facilitating the creation of those spaces.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Let us stay on the same topic but address the nutrition aspect.

You say that people need to eat better to avoid becoming overweight or obese. Have you established a link with agriculture? Many areas are agricultural or rural. We know that people who work in agriculture have a little bit of difficulty selling their goods on local markets. We are encouraging local food production more and more, particularly as a means of protecting local jobs.

Has a link been established between diet and the agri-food system, namely between the quality of crops and the freshness of products?

[Kim Elmslie]

That's a really good point you're making and is something that comes up repeatedly in our conversations with the agri-food sector.

We have worked with the Canadian Agri-Food Policy Institute to determine how we can encourage consumption of local food. There's certainly an interest in the agri-food community in being more active in promoting healthy food products and in innovating so that healthier food is available to Canadians.

If you look at what has happened in New York City, for example, the city has taken some really important innovations around healthy food and around the availability of information on menus. They are keeping unhealthy food out of schools but also looking at planning schools so that they're not in the vicinity of fast food restaurants. You may take the unhealthy food out of the school, but if the kids can just walk out and go around the corner and get unhealthy food, you're really not advancing that agenda very far. So all of those discussions—how do we do that better in the context of our partnerships, what can the federal government do to bring folks to the table and facilitate that conversation so we understand what's working well in other places, and how can we apply it in Canada—involve the agri-food sector. They're an important partner for us.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

You said that seniors who are the most economically disadvantaged have more chronic diseases. Are there any diseases that are exclusive to economically disadvantaged individuals? If so, why?

[Kim Elmslie]

I would say that there are not particular diseases. The fact is that the incidence of diseases like diabetes and cancer, which are driven by risk factors of overweight and obesity, physical inactivity, and unhealthy eating, are more common in these populations because they can do less to reduce their risk factors.

[The Chair, Conservative, Joy Smith]

Thank you for your very insightful questions.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

And I do want to welcome back our Liberal colleague. It's nice to have you back on the health committee, even though it's for a short period of time.

I wanted to pick up on what my colleague started off with.

I was a little bit surprised when I saw that number: $190 billion as the cost to our economy for chronic diseases. You might as well be running a government when you're looking at the size of that figure. Again, it was mentioned how it seems that we focus a lot on acute care.

My background, as you know, as a chiropractor...we've always been trying to focus on wellness and prevention. It's nice to see the NDP placed one of my colleagues on the committee as well.

Once you have diabetes, it's too late in many cases, and the cost and the expense of treating it and managing it for the rest of a person's life is huge. The same with cardiovascular diseases.

I wanted to move a little bit towards the prevention and wellness side of things. I was wondering, are you aware of any programs for kids? Is there any research out there on what we can do to get kids thinking about wellness and prevention?

Again, my colleague brought up the jurisdictional issues, because many things that we can do, I suppose, would have to be done at schools, where kids are spending the most hours out of their day. But I was wondering if you could elaborate a little bit on what you see as challenges when we're dealing with the provinces and territories and different jurisdictions we work with.

[Kim Elmslie]

I'd be glad to, and thanks a lot for the question. It's really important.

I keep coming back to the notion that what we're really trying to do is build prevention into our norm and change our approach from thinking about the health care system to thinking about a health system in which prevention is embedded in every aspect. Let me give you an example. When we talk about education and health, one of the programs we are involved in is the joint consortium for school health. The federal government provides funding to that program, and the provincial and territorial governments are partners in it. Through that consortium, we're bringing health into the schools in a way that is context-specific. It's never one size fits all. Different jurisdictions will have different needs. Different schools will have different needs. But that program is allowing the policy and program discussions to be front of mind as schools develop their curricula, and as they think about physical education and healthy eating in schools. We've joined up health and education.

We're also joining sports and recreation into that kind of partnership. That came about through the work done to develop the declaration on prevention and promotion, which our health ministers signed onto last fall. In that declaration they said that we need to partner up with all of these organizations that can have an impact on disease prevention. Doing that will take us way outside the health system. That's the track we're on now. Education, sports and recreation, health, agriculture and agrifood, transport: bringing these ministries into the conversation is allowing us to start moving down a track that is saying health promotion is everyone's business. If you're focused on economic growth and you invest in health promotion, you're going to improve economic growth as well. The conversation has turned, and it's about programs that are broader.

Prevention as a landmark of a quality health system is another principle that health ministers have signed on to. By doing so, they're saying that we care about prevention in the health care system. While our system was built on acute care, it's not serving the needs of our population any more. The conversation then goes to talking about greater investment in prevention and talking about our health care system from a prevention standpoint.

[The Chair, Conservative, Joy Smith]

Thank you.

[Colin Carrie, Conservative, Oshawa, ON]

Do we have another minute?

[The Chair, Conservative, Joy Smith]

Actually we're running out of time. You have about two seconds.

[Colin Carrie, Conservative, Oshawa, ON]

I was going to say that you used the term “prevention norm”. I've never heard that before, but I liked it. I was wondering if you might be able to elaborate on that and if there was any update on the 2010 declaration.

[Kim Elmslie]

Sure.

Prevention needs to become the norm when we think about health care. The prevention declaration has become the foundational piece that's guiding our federal, provincial, and territorial work. It's strong, and everyone has bought into it. Internationally, people are looking at it and saying Canada has moved in the right direction. This is the right way to go, and starting with our first emphasis on childhood obesity, we are putting it into action.

[The Chair, Conservative, Joy Smith]

That's a very good question and a very good answer. Thank you.

Dr. Morin, you're next.

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

So many questions, so little time. I'll try to squeeze in as many as I can.

You did answer Anne's question about low-income seniors, but I'm also interested in aboriginal seniors and LGBT seniors. You mentioned that good data leads to good programs. Do you have good data regarding aboriginal and LGBT seniors who might face some obstacles or difficulties that the general population might not face?

[Kim Elmslie]

I'll have to give you the short answer: no. We don't have good data.

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

Is there a plan to find that information somehow?

[Kim Elmslie]

Yes. In our surveillance work, that's exactly what we're doing. We're identifying where the gaps in data are and how we can do a better job of filling those gaps.

For instance, in the context of our aboriginal populations, we are in a partnership with the Métis Nation of Canada to help them develop their own surveillance system so that the data they gather can serve their own local needs. We see this as a model for other types of surveillance.

I could talk about this for hours; maybe you and I should go for a coffee.

Oftentimes we gather all of this data and then it can't be used at the local level to make real change. We've turned that around with the work we're doing, particularly with the Métis Nation of Canada, to say “Okay, we want to facilitate you in developing what you need so you can use it to make change and transform your local situation”.

I'm really excited about that, because I think when we have that in place it's going to be a model for how we do surveillance in other areas as well.

I'm sorry that I can't tell you that we have good data right now, but we don't.

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

Regarding long-term care, what's the best strategy that you have found regarding long-term care and seniors?

[Kim Elmslie]

I haven't found a strategy that I would tout as the best strategy for long-term care. What I will tell you, though, is that a chronic care model was developed by a researcher named Wagner, in the United States, and it's called the Wagner model. It has been expanded and extended, but it's a model that takes chronic disease management out of acute care, out of the health care system, and joins it up with the community. It activates the patient, the consumer, so that he or she becomes an essential partner in their own care. It activates the family so they can provide support where needed, and it creates the partnerships we've all been talking about, so that chronic disease management over the long term, including in long-term care, can be of high quality.

I think we all have concerns at times about the quality of long-term care. These types of models are helping us learn more about how to do that better, but I haven't seen a model applied yet that I would point to as the gold standard.

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

You've mentioned that a lot of people don't know they have diabetes. Do you have a strategy to improve the percentage of people who get screened?

[Kim Elmslie]

Yes, actually, we do.

Many Canadians have pre-diabetes. They have not been diagnosed with diabetes, but they are on that cliff and are about to move over. We've developed a risk assessment tool called CanRisk, which has been adapted from a Finnish tool, actually, and which helps individuals assess their risk of diabetes. It encourages them to seek a dialogue with their health care provider in order to manage their risks in the hopes that they will not develop diabetes or, in the case where they do develop diabetes, to diagnose it early so they can control it and reduce the risk of complications.

[The Chair, Conservative, Joy Smith]

You have about 30 seconds.

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

That's good.

You spoke about communities that are part of the Age-Friendly Communities initiative. I believe there are 500. Can you provide examples of model communities?

[Kim Elmslie]

Of community action to promote health of seniors beyond the age-friendly communities....