Health Committee on Oct. 17th, 2011

[Patrick Brown, Conservative, Barrie, ON]

I think members of the committee would be very interested in stuff like that, and if you could send them to the clerk, I'm sure she could distribute them—

[Dr. Frank Molnar]

Absolutely.

[Patrick Brown, Conservative, Barrie, ON]

—because I think one of the hopes we have is to have a study on neurological disorders, and stuff like that would be really interesting.

[Dr. Frank Molnar]

I will be very happy to share it. You have my card, and the box is ready to ship tomorrow. It will be one less thing in my office.

[Patrick Brown, Conservative, Barrie, ON]

You want to read it too, Colin. I know you do.

The other question I want to ask is—

[The Chair, Conservative, Joy Smith]

Can I keep in mind that those articles have to be translated? So if you have the time, Doctor—and I'm sure you have lots of time—it would be great if you could pick through them and choose the ones that are your personal favourites and send them and then we'll get them translated so we'll have an overview. Thanks.

[Patrick Brown, Conservative, Barrie, ON]

One of the things that Rising Tide and a lot of the neurological subgroups talked about was the need for a neurological population study. I know this is ongoing. I think we're two years into it, or two and a half years. What do you hope this $15 million study is going to indicate to Canadians and to Parliament? I know this is something that was urged, that was necessary for Health Canada to support. Do you have any thoughts on what we're going to learn from this in terms of dementia?

[Dr. Frank Molnar]

Is it the CLSA, Canadian Longitudinal Study of Aging, you're referring to?

[Patrick Brown, Conservative, Barrie, ON]

No, it's the National Population Health Study of Neurological Conditions, which is being done by the neurological charities, I think.

[Dr. Frank Molnar]

Yes. I'm a bit of a pessimist and skeptic at heart. I think what we're going to find is all the old boring stuff—people who exercise well, who eat well, who follow their health conditions well, who avoid head injuries, have delayed onset of many of these conditions. So I don't think we're going to find any fantastic breakthroughs. We're probably going to see that a lot of people don't have assessment of their cognitive disorders until a much later stage than we expected, so that screening programs are necessary.

So I think it will reinforce a lot of the old information we already know. I'm not anticipating a major breakthrough.

[The Chair, Conservative, Joy Smith]

Thank you.

Thank you, Mr. Brown.

Ms. Quach.

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

You all touched on integrated care as being the approach the government should take to make primary care more accessible to patients and to prevent chronic diseases. Could you tell me whether you have suggestions for the steps that should be taken first as part of a strategy that promotes prevention and integrated care so that they both become more accessible and universal?

The people from the Canadian Medical Association talked about the public health care system. They also mentioned the importance of following the principles in the Canada Health Act, including the need to improve some services that are not covered under medicare.

So there are a number of parts to the question. First, where should we start in terms of developing a strategy for integrated care? Second, as part of that, how can we continue to rely on the public system for prevention?

[Dr. John Haggie]

That sounds like one for me.

The Canadian Medical Association went out over the last year and spoke to Canadians about what they wanted from their health care system. We spoke to about 2,400 people face-to-face, and we had another 4,000 comments online. We produced a variety of documents as a result of that, and the last one was Voices into Action, which was a kind of narrative of what we'd heard.

The message was very clear from Canadians. They want a system that was free of gaps, free of silos. They don't want this crazy situation, which evolved from the forties and fifties, where we were an acute-based system. We dealt with acute illnesses, and health care was delivered by physicians by and large in institutions. That's how medicare was set up, and that's how it's funded. That's the Canada Health Act.

They suggested this needed to be looked at from several points of view. We distilled down the principles from this, with support from the Canadian Nurses Association and a whole variety of other groups. I think there were 60 other stakeholder groups that signed on with us.

Essentially, they looked at it from the point of view of better value for money, better health care, and a better patient experience. If you actually sit down and say, well, if you've got a chronic illness, what is the system going to look like if you need it, there are lots of good examples scattered around Canada and North America and the globe. The catch is getting that information and measuring it in terms of outcomes.

At the end of the day, it's the outcomes that matter. The difficulty is that we've got a huge outcome gap. We are fifth in spending among OECD countries in terms of percentage of GDP, and if you look at outcomes as they define them, we're 27th or 28th. We've got this huge gap. The question may not be so much about how much we spend as much as how we spend it.

In answer to your question, again, there's no simple answer. But if you start to look at the system from the point of view of a person with chronic disease, it won't take long to find a way of describing a system that doesn't mean 30% of your old people never get to see the doctor because they can't get out of the house—they don't drive, there's no one to get them there—and they wait until they fall over and have to call an ambulance.

You can describe a system because of its faults. What you need to do is say, well, what would happen if there were no faults here? How would you recognize it? That's a very difficult thing to do at a table like this, but if you go to the 85-year-old who can only afford to take her diabetic pills every second day, you can start to see where the holes are, and the holes are sometimes individuals.

[The Chair, Conservative, Joy Smith]

Mr. Wildfong, I think you wanted to make a comment too.

[Don Wildfong]

As a brief comment in support of what Dr. Haggie has just mentioned, we know that the electronic health record is a great answer to some of the many challenges we're facing, both in terms of creating a safer experience for patients and for their experience at each interface across the system. I'm sure we've all heard a lot about this. That's one way that speaks to the integration of information and technology.

I would also say that the past accord has put an emphasis on five wait times—surgical and diagnostic wait times—and we would suggest that those have probably missed the mark and not really addressed the real causes of waiting, the human costs of waiting, which Canadians and their families are dealing with every day.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Mr. Williamson.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you, Madam Chair.

I'm going to follow up a bit, because I'm hearing all kinds of interesting ideas today. Particularly what jumped out is that there's no perfect system. They all have different answers. They all have different problems or challenges.

What I'm trying to sort out is what the paths are for this committee to look at or consider going forward. Collectively you've all touched on different areas that speak to your field, but then you jumped out to talk about education, a lunch program, an arts program for seniors, for example.

At the end of the day, where is the conflict here? You've got 13 jurisdictions delivering health care across the country, all with different challenges from those of the federal government. What's our responsibility, do you think, in terms of setting priorities that lock provinces into areas they might not want to be in, particularly with the comments that the last accord might have missed on a few markers?

If there's no perfect solution, is our approach to encourage provinces to address these and ensure that the funding is stable, and they take up innovation and look around not only Canada, North America, but the world for solutions?

This would probably be a question to the CMA, but I'd be curious to hear from others as well. I'd ask you to keep your answers brief, because we've only got five minutes here.

[Dr. John Haggie]

I think the federal role in health care, which is kind of the message I took from your question, is that it has several. It's the international voice of Canada on the world health stage. It has a responsibility as far as I would see it, on behalf of our members, to provide an even playing field. So if you live in Iqaluit or you live in Goose Bay or you live in downtown Toronto, it is not unreasonable to expect that you would have a broadly similar access to a broadly similar range of a broadly similar standard of health care.

The delivery challenges are certainly acute in more rural areas, but I think on a practical level then, given my understanding of the federal and provincial interaction, you can't have governments held liable or responsible to each other. There's a kind of “first among equals” sort of thing.

I think you look at it from the patient's point of view. If the system is accountable to the patient, then at the end of the day the patient has to have a redress. We talked about a patients' charter, and in actual fact a patients' charter was one of the things that one of my predecessors took out. I think therein lies the nugget of a mechanism by which you can make the system work to the interests of the patient who actually funds it and needs it at the time.

Turning to how you do that, there are various ways you could craft a system like that. But I think at the end of the day you've got to look at it from the patients' point of view—what is equitable? We've heard very clearly across Canada that they wanted an equitable system; they want those kinds of opportunities. How you craft it: a patients' charter may be your answer to that.

That's the short, two-cent version.

[Barb Mildon]

Thank you very much. That's a good question.

One of the things that CNA has been talking about is an accountability framework. We'd be glad to send more information to the committee.

First of all, I want to thank the federal government for the leadership it has influenced in health care, given our constitution and the difficulties that it raises. I'd like to be a bit provocative and talk about, or at least allude to, the example of the HST and the kinds of harmonization issues this has caused in various jurisdictions.

In terms of an accountability framework, it's the ability, then, to grant funds to our jurisdictions with the provision that they demonstrate, for example, how they have harmonized or integrated their multiple governance systems. So does home care have to be separate from acute care? Do there have to be separate entities providing those services? What kind of accountability can we demand in terms of accepting the funding that the federal government's provided to bring to bear?

[The Chair, Conservative, Joy Smith]

Ms. James.

[Roxanne James, Conservative, Scarborough Centre, ON]

Thank you, Madam Chair.

I'd also like to thank each of the witnesses here today. I listened to each of your speeches. I'd like to especially thank Dr. Haggie for acknowledging this government's support of caregivers with our caregiver tax credit. So thank you for that.

I'm just going to touch base on what my colleague Mr. Williamson has mentioned, as well as Dr. Morin across the way. The common theme or thread from each of the speakers seems to be tied into preventive measures. I heard from Ms. Mildon regarding—I actually wrote it down—the ability to fully diagnose hypertension. If you don't, it leads to stroke and cardiac disease. I've heard that the onset of chronic diseases can be delayed if we actually get to younger patients and change their lifestyles. So I want to thank you each for touching on that.

Given that young people—and we all were young at one time, and some of us still may be—tend to see themselves in a different light, that they are invincible, that they're not going to fall into the path of chronic disease or other sorts of ailments, I'm just wondering.... I've heard we should get to the students in schools and so forth, but what age group do you think should be targeted so that later on in life—in our sixties and seventies and so on—chronic disease can be prevented, realistically keeping in mind that young people tend to do what young people are going to do? I'm just curious to know, and I'm not sure who the question should be directed at.

[Dr. Eleanor White]

I would suggest that the age group that should be approached should contain those who are most impressionable, if you want to make an effect. We will be impressionable for various reasons at various ages. But I see no reason why education regarding healthy living shouldn't begin right from the start, in kindergarten.

An American politician was objecting to sex education and sex roles coming out in some kindergarten material, which was meant in a very kindly manner, but he misinterpreted it. Perhaps, if we're going to entrust kindergarten children with that kind of information, we can at least tell them how to eat properly.

As we head into teenage years, another excellent opportunity is what is cool and what isn't. For a long time, when I was a kid, it was smoking, and now it is not. So those changes about what is socially acceptable are particularly important to a teenager, and not so much to a kindergarten participant. It varies with age, but I don't think there is an age that is too young in the schooling system.

[Roxanne James, Conservative, Scarborough Centre, ON]

I understand what you're saying, and I welcome any other answers as well. I agree that nutrition education may be important in the schools. We've certainly been doing that, I guess, in our school systems. But again I know—not necessarily from personal experience—that you go to your doctor, you get your physical and so on, but until you're actually told there is a problem, you don't necessarily listen up.

So how do you see the medical profession getting to a target group before that age when chronic disease sets in? I understand what you're saying about education, but again I think there's got to be some sort of age group where you think people may actually start listening and applying it to themselves.

So is there any other input?

[Dr. John Haggie]

I would suggest that what you're talking about is not education purely and simply; it's actually changing people's behaviours. Education is simply a component of that. The medical profession and the professions that are represented here are simply people who can provide the information. The ability to persuade someone to change or to get a person to alter what they're actually doing isn't one that necessarily resides in any one spot, and therein lies the complexity of the problem. There isn't the Harry Potter spell; you can't just wave your wand and—poof—everybody stops smoking.

It's taken probably more than 60 years to cut smoking down to a level where it now is no longer cool, most people don't, and you can actually go and sit in a restaurant without gasping for air. And it's great. But you go back to the fifties or the time when I was a kid and that was very unusual. You went out to a restaurant and the place was filled with smoke. That's the example, and you see how hard it is to get that change. It's taken 60 years.

So the kind of change you're looking at may not actually occur in a shorter period of time, but the facts of the case are that if you don't make the effort now and start on that first step on what is actually a very long journey.... And it really probably doesn't matter where you start, but kindergarten may be as good a place as any.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Haggie.

We'll now go to Dr. Fry.