Health Committee on April 30th, 2013

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

Thank you very much.

I would like to follow up on what my colleague Dr. Carrie was saying about self-empowerment. This concerns me a lot as well. First of all, I would mention that I am an MP from a rural region of Quebec, so I am very happy to see that there is a lot of attention being given to rural regions today. Also since I am a general practitioner, prevention is very important to me.

More specifically, I would like to know what role the federal government can play in trying to improve prevention with the help of innovation and technologies. We addressed the question a littler earlier on. I mention this as an example, because oddly enough, the Auditor General published a report today in which he lamented the fact that $100 million was allotted to the Public Health Agency of Canada, Health Canada and the Canadian Institutes of Health Research in order to implement prevention and reduction strategies for diabetes.The government takes this matter seriously and has a role to play in preventing different chronic illnesses, both in urban and rural Canada. At the same time, the Auditor General is saying that no coordination took place.

Therefore, a lot of taxpayers' money was invested in this and with no results to show for it. There was redundancy. I still have the same question: is the solution to add more money that will be poorly administered by some governments, or is it to coordinate our efforts so that people empower themselves?

I will try to finish up my question. I imagine that evolving technology also has negative effects. People with diabetes or high blood pressure think that it's not a big deal, because they figure they can just take medication to solve their problems thanks to advances in the medical field. So they don't think that they need to take responsibility for their own health, do more exercise or eat better. They are happy to take their pill. Before long, it becomes a box of pills per day. I get the impression that on the whole, Canadians don't take their health seriously, or at least they don't want to improve themselves.

[The Chair, Conservative, Joy Smith]

Go ahead, Dr. Norman.

[Dr. Cameron Norman]

There are a lot of different roles that can be played. One of the things to think about, though, is having the right information to make healthy choices. There is also the idea of empowerment, which is important. The federal government could support the education and deployment of technologies that allow people to make informed decisions and organize around them, whether it's through a civil society advocacy mechanism, through creating new business opportunities, or through other means.

For example, with chronic disease, a lot of it has a connection to food. If you are in one of these what we call food deserts—areas where food is not accessible; you're food insecure—being informed about how to eat is somewhat irrelevant. You need to be able to take some type of action, and maybe it's about creating a new opportunity to do that, or something like that. I think there's an ability to create a mechanism to actually help people organize as well as be adaptive, with their health providers and their communities, because it's going to be quite different in different places.

It's one thing to make healthy decisions, but you also have to look at the systemic effects and be able to take action on them as well, simultaneously. I don't think it's an either/or situation; I don't think it works that way. We have way too much diversity in Canada for that to work.

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

Dr. Milne, when you talk about the rural population—

[The Chair, Conservative, Joy Smith]

Mr. Morin, I'm sorry, but Ms. Collins would like to make a comment. Is that okay with you?

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

Sure.

[The Chair, Conservative, Joy Smith]

Ms. Collins.

[Mary Collins]

I want to add one point. There's a lot of innovation going on in the provinces and territories, with the support of provincial governments and NGOs. One of the areas where the federal government can be very helpful is in taking those best practices, scaling them up, and spreading them throughout the country.

The Public Health Agency of Canada has just developed a new approach to partnerships for chronic disease prevention. We're quite pleased to see the kind of approach they're taking. We hope it's going to result in some really good stuff. We don't have to reinvent the wheel on everything. There's a lot of good stuff going on.

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

Dr. Milne, my opinion is that people in rural areas rely on the automobile, as opposed to just walking, as people do in the city. What's your thought on that? How can we make sure rural people walk more?

[Dr. Ken Milne]

They usually drive everywhere because it's so far to get to anywhere, and they're usually on their feet all day doing agricultural stuff. I don't know if it's about getting them to exercise or be more fit that way; I think it's more on the food side of things. That would be my impression. I think they're up and busy.

[The Chair, Conservative, Joy Smith]

Thank you very much. I'm sorry, but I have to go to Dr. Wilks. I just promoted you. You're an MP, a mayor, and now you're a doctor. Okay, Mr. Wilks, you're next.

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

An MP extraordinaire.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you very much, Madam Chair.

[A voice]

Dr. Smith.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Yes, Dr. Smith.

I thank the witnesses for being here.

I'm going to ask my questions quickly, and then you can answer them. That way, I'll keep to my five minutes.

Ms. Collins, you spoke about encouraging innovation that is scientifically validated. I wonder if you could expand on that a bit more for the committee and on how that would fall into a federal component.

Dr. Milne, you spoke about JOG, just out of the gate, and I wonder if you could speak to that a bit more.

Mr. Friesen, I have a different view of smart phones. I think they're a great application that has come about in the last few years, but to the detriment of our kids. They've utilized them for something that might be good in one sense, but I think we're going down a road of obesity and unhealthy kids because of this.

Starting with Ms. Collins, could I get your comments.

[Mary Collins]

First of all, we'd like things to be evidence based. If you're going to be promoting apps or technologies, they should have some evidence behind them that they're actually going to work and that they're effective.

We need to do more in that area. That's where I think the federal government, whether it's through the CIHR or some other mechanism, could be investing more in this area, like the study I mentioned in San Francisco, which was really interesting. I haven't seen too many like that here. That certainly would be one area.

The other would be what we've already talked about: some mechanism by which you would have ongoing evaluation of a lot of these new technologies and apps that would be useful both for the medical community and for the individual consumer.

[David Wilks, Conservative, Kootenay—Columbia, BC]

And on JOG.

[Dr. Ken Milne]

Okay. For JOG, just out of the gate, what we're going to do is take in the critically reviewed relevant information for rural practitioners, who then can say, “Yes, it makes sense in my rural area.” The problem with current medical knowledge translation is that it typically takes 10 years for high-quality and clinically relevant information to reach the patient bedside. Ten years is too long when it comes to information technology, so we're talking dissemination.

It's very cheap to get on iTunes, podcast that information, and tie it into a Twitter feed, a YouTube channel, and a Facebook page. We've already done this successfully with emergency medicine in this last year for the project called the Skeptics Guide to Emergency Medicine. We're going to mirror that, so if you want to see what JOG will look like, go to the Skeptics Guide.

[Dale Friesen]

I think smart phones are here to stay, unfortunately. I agree with you on the negative effect they have on kids. I see my nephews—my kids are small now—stuck in front of them. My angle would be to use them against them.

[Voices]

Oh, oh!

[Dale Friesen]

Let's put smart information on there. Really, we need to educate them, so let's provide that education through their smart phones. It might be that it's a healthy game. Again, that goes back to gamification, so that if the game shuts down for 30 minutes, you have to go and run.

Polar has a device that tracks the activity of kids. I know that a lot of parents we've had in our pilots won't let their kids watch TV until they get 60 minutes on their watch. There are different things that can be used to track their activity and then reward them with the TV or the game they want to play. That's an option as well.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I'll go back to Dr. Milne.

I live in Sparwood, British Columbia. It's a town of 4,000 people. In 2001, the hospital was closed. As a result, we went to our primary health care model. At first I was quite a skeptic—I was the mayor of the town at the time—but over time, it has really worked. What has happened is that it has forced people to educate themselves and to realize that they actually can do things by themselves without a doctor, unless they need to actually go to one.

I know that federally, Madam Chair, health care is not of our volition, as it is provincially, but how can we better educate people and say that primary health care isn't this scary thing that we shouldn't go to? In some places in British Columbia, they're saying, “I want you to tell me what to do, rather than me trying to figure out that, hey, this is not a bad idea.”

[Dr. Ken Milne]

If the federal government provided high-speed Internet access to all of these locations, then they would through telemedicine, through FaceTime, through whatever, be able to have access to those sub-specialties or specialties that they need when they need to. Otherwise, they would be relying on primary care that would be delivered locally, but they need that.

If you guys could build the highway, the infrastructure, that could be the pipeline to the evidence-based content so that everyone in Canada, regardless of where they live, benefits from that information.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you for that answer.

[The Chair, Conservative, Joy Smith]

We'll go to Mr. Kellway.