Health Committee on Oct. 5th, 2011

[The Chair, Conservative, Joy Smith]

Good afternoon, everybody, and thank you so much for joining us today. We have some wonderful witnesses.

Pursuant to Standing Order 108(2), we're doing the study of chronic diseases related to aging. I'm sure that will keep some of us on our toes as we're listening to all this inside information.

We're so glad to have with us today, from the Public Health Agency of Canada, Kim Elmslie, director general. Is it Dr. Elmslie?

[Kim Elmslie, Director General, Centre for Chronic Disease Prevention and Control, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

No, it is not.

[The Chair, Conservative, Joy Smith]

Kim is from the Centre for Chronic Disease Prevention and Control, Health Promotion and Chronic Disease Prevention Branch.

And we have Cathy Bennett. Is it Dr. Bennett?

[Cathy Bennett, Acting Director, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada]

No, it isn't.

[The Chair, Conservative, Joy Smith]

Cathy Bennett is the acting director, division of aging and seniors, Centre for Health Promotion.

I'll give you each 20 minutes or whatever you need. If you want a little bit more time, that will be fine.

Kim, you're the one who is going to be presenting today. Okay, please fill us with all this wonderful information. Thank you.

[Kim Elmslie]

Thank you so much.

First, I want to start by thanking the committee for inviting us here today. I can't tell you what a pleasure it is for the Public Health Agency of Canada to come to this room and to speak with you and to share with you many of the things we are doing in the agency, working across the country to address chronic disease and specifically to address chronic disease and aging.

Madam Chair, honourable members, thank you for the opportunity to speak to you today regarding chronic diseases and aging.

I will provide you with an overview of current federal actions which promote healthy aging and address the increasing chronic disease burden on Canadian seniors.

As we all know, Canada's population is aging. While today people age 65 account for about 14% of our population, by 2036 they will account for 25% of our total population, equalling some 10 million Canadian seniors. The good news is that Canada's chief public health officer in his 2010 report “Growing Older—Adding Life To Years” notes that older Canadians are living longer and having a stronger sense of belonging to their community, and the majority report being healthy.

When older Canadians retire from paid employment, they continue to play vital roles in their communities. I think we all see that in our own communities. Clearly, our seniors are taking action to look after their health and well-being. We can all feel good about that, but there's more to the story.

We also know that while Canadians are living longer, we are not necessarily healthier. Almost 90% of seniors over the age of 65 have at least one chronic disease or condition, the top three causes of death being cardiovascular diseases, cancer, and respiratory disease. Many Canadian seniors are living with chronic conditions such as diabetes, heart disease, cancer, arthritis, Alzheimer's disease, mental illness, respiratory diseases, and obesity. One-quarter of seniors are living with two or more of these diseases or conditions, and that's important, because we often think of our senior population as having chronic disease, but rarely do we think of the numbers of chronic diseases that our aging population faces. Our most vulnerable seniors, such as those who are economically disadvantaged, are at even greater risk.

We all know that chronic disease accounts for a significant burden to the individuals, their families, their informal caregivers, the health care system, and our Canadian economy. The majority of hospitalizations, disabilities, and premature deaths in our country are related to chronic diseases. These diseases cost the Canadian economy about $190 billion annually. That includes costs for medical treatment as well as the cost of lost productivity when our workforce develops chronic diseases or when our workforce is caring for elderly parents with chronic diseases as well as children living with chronic diseases.

When we look at tomorrow's seniors, there is serious cause for concern. Obesity rates are rising in working-age adults. One out of six Canadians over the age of 20—that's about 4.5 million of us—are obese. Diabetes rates are rising. In 2006, just over 2 million Canadians were living with diabetes, but many more are unaware that they have the disease. With earlier onset of chronic diseases, working-age adults are less able to support seniors both personally and financially.

I've told you the good news and I've told you the bad news. Now I'm going to talk to you about what we are doing to create the conditions for healthy aging. This is really what will be of interest to you around this table in the jobs that you are doing. Creating the conditions for healthy aging, preventing or delaying the onset of chronic disease, and preventing complications when diseases occur makes sense at all ages. I want to really stress that with this group because what we are focusing on is healthy aging across a life course. That begins at birth. It does involve ensuring that our children are eating healthily and adopting healthy practices as early in life as we can possibly make it happen, so that across their life course they have the greatest possible chance of continuing to be healthy and delaying the onset of those chronic diseases until well into their 80s or even into their 90s.

Promoting healthier living in children sets the stage for maintaining good health and reducing risks of disease in their senior years. To achieve this, we need to work really closely in partnership with provinces and territories, non-governmental organizations, and business to find ways to collaborate and to improve health across the life course and of course the health of our seniors.

Let me expand a bit on partnership. And why do I want to do that? We always talk about partnership. I want to talk to you a little more about that because achieving good health needs to be viewed as everyone's business. It's not just the business of the health sector. The health sector needs to be working in partnership with a variety of other sectors, including agriculture, as we want healthy food, and transportation, as we want to provide for safe, active, healthy ways that people can move about in their communities. Sport and recreation need to be key partners in this, and the health sector of course needs to be there. But I can't stress enough the importance of what we all refer to as multi-sectoral collaboration if we're really serious about moving the healthy agenda forward.

The commitment to helping all Canadians lead healthier lives is illustrated through a really important declaration. That declaration, called the declaration on prevention and promotion, was endorsed by all federal, provincial, and territorial health ministers last fall. And it sets the stage for unprecedented collaboration among federal, provincial, and territorial governments in supporting good health.

It sets out some principles that are exceptionally important to understanding that health promotion is everyone's business, and that prevention is part of treatment. So we want to instill when we need to use the health services in our country, and we want those health services to also put an emphasis on prevention. When you prevent diabetes you're also preventing cardiovascular disease. So the prevention norm needs to become much more part of the way we think as individual Canadians, but also the way we think about how we design our communities, how we work together, what we do in our recreational time, and how we make healthy choices that can be sustained over time.

At the federal level we have a broad portfolio of work on seniors' issues. I want to come back to seniors for a minute. The National Seniors Council, which was established in 2007, is providing advice on emerging issues and opportunities specific to the quality of life and well-being of our seniors. This council reports both to the Minister of Human Resources and Skills Development Canada and to the health minister. And it's a mechanism for inviting our seniors into the policy conversations, ensuring their voices are at the table as governments tackle health challenges and work to keep seniors active and healthy.

It's not news that seniors are vital contributors to the development of innovative and effective solutions. The age-friendly communities initiative is one that embodies Canada's approach to promoting healthy, active aging. This initiative brings older Canadians into the planning and design of their own communities to create healthy, safe, and supportive environments where they can live and thrive.

The approach is being received enthusiastically across the country and internationally. Since it was first introduced in Canada in 2006, over 560 communities have taken steps to make their communities age-friendly, meaning more accessible for seniors, safer for seniors, and putting seniors at the centre of policy discussions around how we design communities for aging.

Another important step we're taking to address chronic diseases in aging is filling critical knowledge gaps by investing in research that's solving real world problems that are facing individuals, families, and communities. As one example, we've invested $15 million over four years on a national population health study of neurological conditions. This study involves 18 neurological health charities that have come together under an umbrella, Neurological Health Charities Canada. They are working together with the Government of Canada in a partnership to understand neurological conditions in this country. It may surprise you to learn that we in fact don't have good information on how many Canadians have neurological conditions. This study is about getting that information. But it's not just about counting people. It's about looking at the impact of neurological conditions on Canadians in their homes and communities and at what their families and caregivers need to improve the quality of care and the quality of life they are enabling among Canadians suffering from neurological conditions.

Certainly Alzheimer's disease and other dementias related to Alzheimer's disease are an important part of that, as are Parkinson's disease, epilepsy, and the myriad of other neurological conditions that often are hidden in communities. But when you bring neurological health charities together and they start to share experiences about what the impact is of these neurological conditions at the grassroots level, you start to understand the commonalities of impacts. You start to understand what needs are occurring in communities that governments working in partnership with health charities and business communities can actually start to solve.

This study is now in its third year of operation. The amount of research talent that's been brought to bear on this and the amount of community involvement that's been included in this study, in my view, is unprecedented. What we are going to know at the end of this study is going to allow us to look very precisely at where we need to make investments to improve the quality of life of Canadians living with neurological conditions. When we think about Alzheimer's and other dementias and about the aging of the population, we know that we're going to need this information very soon to prepare for those needs.

The Canadian Institutes of Health Research, our premier health research funding agency, is leading the Canadian longitudinal study on aging, which is another really important part of our toolkit in terms of understanding the health, social, and economic issues of Canadians age 45 to 85 over the next 20 years. Information from this cohort of Canadians will inform future decisions and activities related to prevention, health care, and social support.

While we're working to fill these knowledge gaps through the important research that's under way, we're also working with a range of partners to promote healthy aging and to prevent chronic disease. To promote health, we've supported the Canadian Coalition for Seniors' Mental Health. They're developing national evidence-based guidelines for practitioners, making an important contribution to the assessment, diagnosis, and treatment of mental health problems, including the prevention of suicide among seniors. By bringing these issues to the fore and by providing tools for practitioners who are on the ground, we're able to make great strides in prevention, better treatment, and better understanding of the conditions facing our seniors.

We're investing in partnerships that promote the development of conditions for healthy aging. That includes social inclusion, keeping seniors independent, improving their quality of life, helping them understand what they need to do to prevent chronic diseases or to delay their onset, and keeping them connected in their communities.

At a national level, there are a number of important strategies under way to meet these objectives. These include the Canadian partnership against cancer, the Mental Health Commission of Canada, the Canadian diabetes strategy, the Canadian heart health strategy, and the national lung health framework.

Let me mention briefly the work of the Canadian Partnership Against Cancer. Although this partnership is focused on cancer, it's really addressing chronic diseases more broadly. It's a partnership that's uniquely Canadian, and it's being watched around the world because of the approach it's taking. The Government of Canada is providing $250 million, over five years, to support the work of this important partnership.

It's really about mobilizing. I'm sure you see in your communities and your travels that there are nuggets of innovation everywhere across this country. I'm sure you think, if only this were happening at a more national level, wouldn't it be wonderful to see the impacts we could make with these initiatives?

That's what the partnership is doing. It's identifying these islands of innovation, as they're sometimes called, and it's mobilizing partnerships to introduce these innovations on a broader scale. Because the partnership is working directly with provincial and territorial governments, it's bringing those governments that have jurisdictional responsibility for providing services into the early thinking about what will work in their jurisdictions and how we can raise the bar on all of these services so Canadians from coast to coast are benefiting from the innovations happening in some communities across the country.

I encourage you to watch the work of the Canadian Partnership Against Cancer. It's already making a difference. I think we're going to see much more from it in the coming years, as it embarks on some interesting research projects. It's forming the largest Canadian cohort to study risk factors for chronic disease going forward. It's joining up the social care system with the health care system with communities, under new and important projects around innovation and prevention. It's boosting the policy discussion around end-of-life and palliative care.

In our view, public health, in the context of an aging population, provides an opportunity for action. A whole-of-society approach is really what we need. I know that sounds like jargon, but it's true. At the recent United Nations meeting on chronic disease prevention and control, which happened two or three weeks ago, the world talked about chronic disease prevention. World leaders—and our health minister was there at the table—talked about how they can work together and how countries can learn from each other to prevent chronic disease.

Developing countries talked about the double burden of malnutrition and obesity that they're facing. It was quite emotional to hear the issues that developing countries are struggling with around access to affordable medicines, prevention in the context of trying to feed their population, but also seeing their children becoming obese because of unhealthy eating.

This UN meeting put a focus on the action of many sectors that need to come together to address this societal problem. I stress again, it's not a health sector problem. The health sector is part of it, but it's our whole-of-society approach to staying healthy, helping each other stay healthy, and putting in place the programs to support the conditions for good health. This is a norm we have to start to think about.

While we've had success in extending the life expectancy of aging Canadians, it's important to remember that it's not just how long we live, but how well we live. Through working with partners to promote healthy aging and delay the onset of chronic disease, we will continue to take steps toward improving the health and well-being of Canadian seniors.

I'm going to stop there and thank you for listening. I'm looking forward to the discussion that's going to follow and the ideas you are going to put on the table.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you so much, Kim. That was an insightful presentation and a real springboard to start this study. You've given us many ideas, as you've spoken.

We'll start with our first round of seven minutes. Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

First of all, thank you very much to the director general for coming today. Many of us are new on the health committee, so it's really helpful to get this kind of overview and snapshot of what you're doing. I really appreciate it, and I feel as if you've spoken very frankly to us and given us a lot of information.

I think my questions and comments are going to focus not so much on the chronic diseases and conditions themselves but on what goes on around them. I was very struck by your figure of $190 billion annually for medical treatment and the impact on the Canadian economy. I know that a number of us met last week with the Neurological Health Charities of Canada and had some very good discussions, and the thing that really struck me when we're talking about these chronic conditions, to take Alzheimer's for an example, is just the impact on caregivers.

So much of our attention is focused on the acute care situation, it seems to me, like the hospital costs and all of that, but these other costs and what we're not doing is just so significant. So it's very alarming to hear that figure of $190 billion. But when you think of what you call informal caregiving, like family members who are having to give up work to provide care to aging parents—the so-called sandwich generation—it's a huge issue in our society. I just wonder, as part of this longitudinal study you're talking about, whether or not there are any particular elements that actually look at this question. What are these associated costs in terms of our not having adequate long-term care, our not having adequate drug coverage, and our being so focused on the acute care situation? What is that actually costing us?

I know that the outgoing president of the Canadian Medical Association, who's here at the Ottawa Hospital, Dr. Turnbull, made a very stark comparison of the cost of an acute care bed and a long-term-care bed—not even a senior at home any more, but someone who's needing to go into a facility.

I'm interested in whether that longitudinal study is looking at that. How often does it report out? If it's over 20 years, there must be regular report-outs. When can we expect the next one?

The other thing I would raise with you is do you have an example of a country that you think is doing a pretty good job on chronic diseases, that you look to and say, wow, that's where we should be trying to get to?

[Kim Elmslie]

Thank you very much for those excellent questions. I think we're all struggling with the issues you've talked about.

Let me address the neurological health population study and what it can tell us. The study will look at impact and will project impact out over the next 20 years. Within that context, it will look at the economic issues associated with living with neurological diseases.

One of the studies--and I brought the list of studies with me--that's happening out of Dalhousie University is looking at the everyday experience of living with and managing a neurological condition. I'm really looking forward to that particular study, because it will look, at a very practical level, at the health, the social, and the economic side of living with a neurological condition.

In answer to your question on whether we are going to be getting information to help us understand the impact on the economy, both at the level of the workforce and at the level of what they call the macro-economy, yes, we are going to be getting that information. The researchers come together annually to report out on what they're learning. Their next meeting will be in January 2012. It would be great to involve as many of you as could possibly be there to understand what these researchers are finding, because we're just starting to drill down on some of those tough questions on this issue. So there's more to come on that, but I'm happy to share with you the program of research so that you can see with more depth what these folks will be studying and understand how the economic impacts are going to play into that.

On the issue of other countries we can look to, when I look around the world I look at models that are being developed in the United Kingdom, in Australia, and in some of the Scandinavian countries. The Scandinavian countries have had a lot of success in the heart health arena, in reducing cardiovascular disease and cardiovascular disease outcomes, so I think we can go there to learn how to take a population approach to these things.

In terms of the health care system transformations, the U.K. is doing a great deal of work in that area. I think we can learn a lot there. But nobody has this one solved: there's no one country that I would point to and say, boy, they really know how to do this. Of course, that's because our contexts are so different and the way we deliver care is so different, as are the ways in which we deliver prevention and how we've adopted prevention in our various countries.

But the collaborations that are happening in research across the world are really starting to help us identify what we can apply in our own country, based on what is being learned in other countries, and I'm excited about that, especially in the area.... I'll point out Alzheimer's disease because it relates to the topic today, and also because it's just such an important area for us as a country to get our heads around in regard to how we're going to deal with this as our population ages.

[The Chair, Conservative, Joy Smith]

I just want you to keep in mind that you only have a couple of seconds left. We want each person to have their full seven minutes as it's just so interesting, but the next person could pick up on that. To help you out, I'll give you a signal when there's a minute left, if that's okay.

[Kim Elmslie]

That would be great. Thank you so much.

[The Chair, Conservative, Joy Smith]

All right. We've gone over for this particular one, so we'll go on to the next one.

Mr. Gill.

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

Thank you, Madam Chair.

I also want to thank the witnesses for coming out and providing this very valuable information.

In your mission statement, there's a mention of surveillance of these conditions. What surveillance systems are currently in place, and how are they impacting patient care and disease prevention or control?

[Kim Elmslie]

For chronic disease we have a number of surveillance systems in place. We have paid a lot of attention to them in terms of integrating them so that we get information on not only the disease outcomes themselves but also the risk factors for the disease and some of the conditions that are important to developing disease as well.

Our major surveillance program for chronic disease is called the Canadian chronic disease surveillance system. It's a surveillance system that allows us to work with provincial and territorial governments and gather information from their health systems around risk factors for chronic disease and trends in chronic disease over time.

That's a core function that we play. Each year we produce in-depth reports on various aspects of chronic disease to feed back to provincial and territorial governments and to national health organizations, as well as to our own government, so that we can use this information to make decisions. For example, next month we'll be issuing the first comprehensive report on diabetes in Canada. It will look at the full range of diabetes from the perspective of the factors that influence its development--obesity, poor nutrition, physical inactivity--as well as what's happening in the care system around diabetes control and management.

These surveillance products are widely distributed. We use them extensively to inform and target policies and programs. Provincial and territorial governments are the main users of our products, but non-governmental organizations, such as the Canadian Diabetes Association, also use these products to help them understand where they need to be investing their resources, what areas across the country are most vulnerable. For instance, we know our first nations, our aboriginal populations, are highly vulnerable to diabetes and other chronic diseases. We use those surveillance reports to shine a light on where the real problem areas are and how we can best address them.

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

That's great.

Would you be able to tell us how Canada compares with other countries when it comes to the rate of chronic disease?

[Kim Elmslie]

It's hard to make comparisons with other countries, because oftentimes the way we count chronic diseases will differ. Generally speaking, however, our rates of chronic diseases are comparable with other developed countries, such as the U.S., the U.K., and Australia.

We don't know what the rates of chronic diseases are like in developing countries, because they don't have the infrastructure to do surveillance at all, but in general the developing countries are seeing rates grow at about the same pace.

When you think about the causes, it's not surprising. We're all dealing with rising rates of physical inactivity and rising rates of unhealthy eating. We're all seeing rising rates of obesity. The fact that people are overweight and obese is a major driver of increasing chronic disease rates in our population. Those rates are similar in developed countries.

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

In your assessment, how do we really fare as a country? Are we above average, are we below average?

[Kim Elmslie]

I would say we are about average if we compare with World Health Organization statistics. Again, comparisons are difficult to make, because people count these things differently.

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

Would you be able to describe some of the initiatives being taken in terms of prevention and promotion around chronic disease?

[Kim Elmslie]

At the federal level, we have the integrated strategy on healthy living and chronic disease. That strategy addresses healthy living across the lifespan. It includes a specific emphasis on seniors--for instance, in the area of falls prevention. It focuses on cancer, diabetes, and cardiovascular disease, these illnesses being the major causes of death and disability, and it focuses on addressing risk factors like physical inactivity, poor nutrition, overweight and obesity, and smoking. We also focus through that strategy on Alzheimer's disease and the work we're doing with the neurological health charities.

So how do we do these things that we're doing through these strategies? First of all, we're looking at what's common among them so that we can join up the things that make sense and do them in an integrated fashion.

Prevention and management really require that we take action at the national level, at the provincial-territorial level, and at the local level. Good data are what drive good programs. We've all heard the old adage that you can't manage what you can't measure. We spend a lot of our time measuring and providing data and analysis to provincial and territorial governments, communities, and others so that they can take those data and use them to make change in their own local communities or at the provincial-territorial government level.

Federally, we've created a centre of expertise in surveillance, so people rely on us to do that for them. That's the value-added that we bring. We also focus on effective practices and effective interventions in understanding what works and why.

Many of our strategies provide communities with funding so they can test out interventions. Those interventions then can be shared more broadly to be used by others. We call that initiative the “Canadian Best Practices Initiative”. It involves a huge number of community organizations focusing on specific aspects that are of relevance in their own communities, so that we can learn from them and scale them up as appropriate across the country.

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

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you. You're right on time. How did you do that, Mr. Gill?

We'll now go to Ms. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair. It's really lovely to be here.

Thank you so much for coming.

I am going to ask about neurological disease. I think everyone knows that the brain is the most vital organ of the human body and that if it doesn't work properly every aspect of life is compromised. One in three--or 10 million--Canadians will be affected by a neurological disease or a psychiatric disease disorder injury at some point in their life. There are no cures for ALS, MS, Alzheimer's or Parkinson's disease and no treatment that consistently slows or stops the course of these devastating neurological diseases.

In the last Parliament we had a subcommittee on neurological disease. I hope they're going to bring it back and I hope the report is going to come back.

I have a very simple question, a yes or no one: Will the government, or Health Canada, or CIHR commit to the national brain strategy that the neurological health charities have been asking for?

[Kim Elmslie]

It's a simple question with a not so simple answer. What I would say is that about five years ago, the neurological health charities came to us at the Public Health Agency of Canada and said “We really need information. We really need this neurological longitudinal study to understand what's happening in Canada and to understand what we need to be doing going forward.”

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So are we waiting for the results of the study? Is that what you're saying?