Health Committee on Oct. 19th, 2011

[Christopher Wilson]

Obviously, as you've mentioned, it isn't the role of the federal government to deliver health care services, but we feel there is an important role and it's a role that the federal government has fortunately been playing. First of all, there are obviously areas of direct federal jurisdiction that are critical and have to be attended to, with first nations health being one them. We think there's an important role for the federal government in helping to pilot innovative initiatives that can really make a difference.

I'll speak from the perspective of lung health. To take the example I brought up, it's a wonderful thing that Dr. Jean Bourbeau and his team have done in Quebec. The results are very impressive. It's a little dismaying that after some years of this being well known and recognized, it hasn't extended beyond the boundaries of Quebec. We think there is an important role to catalyze the situation, identify these best practices, and assist in their dissemination. It's not to create federal programs but to see that these best practices are adopted.

There's similarly a serious problem with lung disease. Physicians and other health professionals are not fully aware of the clinical guidelines for treating the disease. I have a very good friend who's in the care of a physician. She has COPD and it's plain to me that her disease is not being properly managed because the physician simply doesn't know what to do. She's resisting treatment because she's independent. No one has told her that if she wants to stay independent, the important thing is to manage her disease properly. It's the key to independence.

This is where best practices such as respiratory, asthma, and COPD educators can have a role. I think there's a role for the federal government in helping to develop and disseminate these best practices. It's one of the things that's happening through the national lung health framework.

[Jessica Hill]

Perhaps I could comment as well about the model we use, which is really a collaborative model with jurisdictions to advance the adoption of best practices, and it's very much as has been raised.

For instance, we have a repository of guidelines on our portal cancerview.ca, and that repository can be shared with all the clinicians in the country. In addition, we have a capacity for collaborative spaces on the portal whereby clinicians from across the country can actually work together in a secure space to discuss the guidelines and their application. That would be available to anyone in the strategies we're discussing, because in fact it's a way of leveraging the investment the federal government's already made to increase collaboration in the country.

We are having a forum on lung cancer screening in November, where we're really looking at some new evidence of the ability to screen, and really asking questions with the provinces about what might be the best use of this technology.

Just to build on the previous witness's comment, we believe collaboration is absolutely critical in this country. It's a huge country with quite a small capacity, and we're going to get much further if we work together on some of these conditions and diseases.

Our coalitions very much focus on the full range of prevention efforts. In this first round of our coalitions, we are looking at how clinicians, physicians, can actually better counsel patients around these risk factors--this is through a joint effort in Ontario and Alberta. We'll learn how that goes, because some of it is really trying to learn how to actually effect change in many of these areas and it's not always clear. We might have the tools, but we don't seem to be having an impact, so how can we do better?

The fundamental part of it is to work with the jurisdictions, the clinicians, the charities, and the patient groups, actually working together to create solutions, implement them, evaluate them and learn from them.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Fry.

Did someone else want to...?

Mr. Arango.

[Manuel Arango]

I have just one quick comment.

The member mentioned the federal tobacco control strategy. That strategy was extended for one year last March and it's up for renewal again this coming March. We're hoping for a five-year extension, and that's what the government is looking into. It's really key. Without investments in tobacco control you just can't get those rates down and keep them going down.

I would point to two particular initiatives under the umbrella of the federal tobacco control strategy we really need to continue investing in. One is mass media support and funding. It's been a few years since there's been any investment in mass media, a public awareness campaign, so re-funding that part of the strategy is really critical. It was funded to the tune of approximately $25 million several years ago. We need investment back there again.

The other piece is with respect to tobacco taxation. It's one of the most important measures in tobacco control to keep smoking rates down. The tobacco industry has been using the contraband situation as a lever to justify and call for cuts to tobacco taxation. That was done in the early nineties. It didn't quite work. When taxes were cut for a short period of time, rates did go up. So we've got to ensure that we keep taxes up. It's a critical measure.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Arango.

Now we will go to Mr. Gill.

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

Thank you, Madam Chair.

I'd like to thank all the witnesses, first of all, for taking the time out to be here with us today. I also want to thank you for your hard work and your commitment in terms of helping Canadians.

I'm wondering if each of the organizations can actually share their experience on what they found to be the most effective way to educate the elderly patient and in regard to prevention or management and treatment of some of these chronic diseases.

[The Chair, Conservative, Joy Smith]

Who would like to take that?

Ms. Holmes, do you want to? Go ahead, please.

[Rosario Holmes]

Thank you for the question. It's very important and I think it's part of the question we had before.

In the Lung Association's case, the most effective way to help our patients is through education. We started in groups, but now we do it one on one. When patients understand their illness--what has happened, where it came from, what the triggers and components are, how to use the medication and all that--we see enormous change in the patients, including they don't have to visit a hospital, even for years.

This has been my experience since I started working especially with COPD and asthma patients. I'm also working with patients going for a transplant. Again, it's helping them understand the disease and where that disease comes from. Then the other part is to just go naturally, because when the patients understand what will happen in their bodies if they smoke—we'd show them all the damage—it's easier for them to stop smoking.

For me, I would say one-on-one education is the best.

[Aileen Leo]

Thank you very much for the question. It's very important, because basically self-management rests on how you engage with people living with chronic disease, and the longer you can keep them healthy, the less costs will increase and the less human misery will result as a result of living with a disease.

Like our colleague, we feel that direct education with those living with a disease is the optimal way to educate people, including people over the age of 65. Our presentation referenced that in terms of direct interventions in working with elderly Canadians. We've seen that with what are commonly called high-risk groups, in particular with aboriginal groups through the aboriginal diabetes initiative. They employ community health care workers who live in those communities who can engage directly on a one-to-one basis with people living with diabetes. Other high-risk groups--for example, African Canadians, Southeast Asian Canadians, South Asian Canadians--all have higher rates of diabetes, and peer support workers work very well in those communities as well.

It's important to note that there are diabetes education programs that exist across Canada, but there is actually no set standard for accreditation of those programs. So we strongly support one-to-one diabetes education programs or education in small groups, but there have to be standards underlying those interventions. We've developed those standards, and one of the things we're trying to do is get all provinces and territories to adopt those standards.

[The Chair, Conservative, Joy Smith]

Go ahead, Ms. Kitchen Clarke.

[Leanne Kitchen Clarke, Vice-President, Public Affairs, Canadian Partnership Against Cancer]

Thank you.

It is an important question that you raise, and there probably isn't one perfect solution. I certainly agree with the other witnesses that one-to-one education is key. That's certainly something that Partnership Against Cancer would support through its interactions with the health system, in particular, cancer centres that deliver care directly to the patients but also consider that the families are part of that care team and can also be very important facilitators and advocates for elderly parents or their own spouses.

We do, through Cancer View Canada and the portal, have a number of resources available. There is a significant number of the elderly or aging population that is online and quite active. So in addition to the education programs at direct point of care, there is an ability for people to access information through online tools, trusted information, and certainly a number of the organizations represented today have very trusted and credible information available online.

We also support partnerships where information exists. In the Canadian Virtual Hospice, for example, a website that provides information to caregivers, particularly around end-of-life issues, there is certainly a point around self-management being the key to good wellness and prevention and ongoing good health for those who suffer from a chronic disease. But many diseases are life-limiting and life-threatening, and we have to address the palliative end-of-life care needs.

The other piece related to our first nations, Inuit, and Métis communities is it is extremely important that the information and resources made available in those communities are culturally appropriate and relevant. It is not a one-size-fits-all solution for rural or remote and far northern communities. Similar to the diabetes educators, there are community health workers in first nations communities who also look at cancer prevention and cancer screening, and we have to recognize the limitations and capacities in those communities. So disease-by-disease solutions are often going to be very difficult for them to implement, given that they are addressing so much burden within the communities also related to social determinants of health, which have been raised here today.

Those are some of the key things that need to be addressed.

[The Chair, Conservative, Joy Smith]

Dr. Sharma.

[Dr. Mike Sharma]

I have a brief comment, if I may.

We have some experience with this in a number of facets. I'll stick to one example, and that is with regard to sodium. When we looked at the impact of sodium on blood pressure, stroke, and dementia, we wanted to communicate to people what is the best amount of sodium to take.

The sodium we take in in our diets is in prepared foods. Less than 20% is what you add at the table with your salt shaker. If you read the labels on prepared foods, they can be quite difficult to interpret. It's given as a percentage of recommended daily allowance, and if you try to juggle in your head all the percentages you've consumed in a day, it's quite a feat if you manage it.

The first thing we did—and I think this is one critical principle—is we translated the information into something that was usable. We developed a technique to translate it into a number of milligrams and put that on the website. You may point out that a lot of individuals we are trying to target who suffer from these conditions are elderly, and it is true that there is a smaller rate of penetration of Internet information in that age group. However, their children are very well versed in this. We found that was very helpful to get the families involved.

The second key element, in addition to translating that, was to make it easier to make the right choice. In terms of prevention, we found that if we also took that same information and put it on little cards that could go into your wallet or purse when you're shopping, or on fridge magnets, it suddenly became very easy to get the right things.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go into our second round. It's a five-minute round of questions and answers, and we'll begin with Dr. Morin.

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

Since I have several questions, could you please make your answers short?

Thank you very much for doing all the good work you do with the Canadian population.

Do you feel that your charitable tax status inhibits your ability to advocate on Parliament Hill for improvements within the health care system?

[The Chair, Conservative, Joy Smith]

Who would like to take that one?

[Christopher Wilson]

Everybody would like to answer that question, I'm sure, but I'll be brave here and say that it can be an inhibition.

Frankly, I think for the level of national charity that is addressing you today, that's less of an issue for the simple reason that the budgets are so large. There's so much programming going on that you'd have to be very politically focused to break the 10% rule.

However, having spent most of my life working for non-profit organizations, I can tell you that the problem you are raising is a very real one for smaller non-profit organizations. Some of the coalitions that exist on mental health and other issues, by their nature, are not offering programs—their affiliates are—but they need to do advocacy work, and it is an inhibition. That's all I'll say.

[The Chair, Conservative, Joy Smith]

Mr. Arango.

[Manuel Arango]

Yes, I have just a very quick comment. I can't speak specifically to the tax status, but here is a related issue.

A coalition called Imagine Canada, which deals with non-profit organizations in the country, as well as the Health Charities Coalition of Canada, which deals with charities and is a coalition as well, are interested in the promotion of the stretch tax credit.

I can't speak much to it, but I know that this issue has been raised in the past at the finance committee. I would just flag that for you. The stretch tax credit is something you could look into.

[The Chair, Conservative, Joy Smith]

Ms. Leo.

[Aileen Leo]

Very briefly, to respect the time limit, we also support the stretch tax credit and have made that recommendation to the finance committee.

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

Thank you very much.

My next question is for the representatives from the Canadian Lung Association.

You mentioned earlier that overcrowded conditions in the aboriginal community increase—

[The Chair, Conservative, Joy Smith]

Could I just interrupt you? Could people take their BlackBerrys away from their microphones? Then we won't have choice words.

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

Thank you.

Yes, you mentioned that overcrowded conditions in the aboriginal reserves increase lung problems, medical problems. I don't get why. I understand they smoke more than the general population, but why are the overcrowded conditions a risk factor?

[Christopher Wilson]

If I may respond, it's a combination of things. You've identified one of the factors, which is cigarette smoke. Overcrowding is also often connected with poor ventilation, so there's general poor indoor air quality, and that often is associated with mould growth and—