Health Committee on May 15th, 2014

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

Thank you.

Here is the last question. Resistance to antibiotics is a growing public health issue and falls directly under the responsibility of your ministry. I'd like to ask what action has been taken to protect public health and to monitor this issue.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

There is a lot of action being taken on this issue.

I'd like to turn it over to Dr. Gregory Taylor to make some comments about our AMR strategy—

[The Vice-Chair, NDP, Libby Davies]

We are now over our time, so I think what we might do is come back to this question. It's a very important question, so we'll come back to it.

I'd now like to invite Mr. Wilks to put his questions.

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

Thank you very much, Madam Chair.

Thanks to the minister for being here today. We appreciate it.

During our study on prescription drug abuse, we heard testimony from several witnesses on the need to ensure that Canadian families have the information they need to make informed choices on the medicines they are taking.

With the numerous risks inherent in many drugs, I think everyone around this table can agree that we simply must do better at making people aware. It's imperative that drug safety information be available and accessible for not only overburdened doctors but also parents and families. As a father and grandfather myself, it's critical for me as well to have the information necessary on drug safety, in order to fully understand the risks and benefits of certain medications.

Can you inform this committee on what is being done to ensure that drug safety information is available to those who need it?

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

Thank you very much, and thank you for your good work on the committee.

I appreciate that question because it gives us an opportunity to speak about what I think is very good work that Health Canada is undertaking to become a leader, if it is not already a leader, on transparency. Nowhere, I think, is confidence in transparency more important than in our health system and around the decisions that our regulators make for health, whether it's products or medicines that Canadians take. So I was very pleased. We've done quite a bit of work in the last number of months, and very recently we launched what is a world-leading regulatory transparency and openness framework. So for the first time in Canada, practical and world-leading drug safety review summaries are being posted online, transparently, in an accessible format to Canadians. These summary safety reviews will provide the public with plain language descriptions of Health Canada's findings around drugs and their actions, so that Canadians can make informed decisions about their health.

With this new framework, Canada is now a world leader in a transparent posting of practical drug safety review summaries, ahead of both the United States and the European Union, in fact. Previously, as you know, drug review information like this was only accessible to those who made access to information requests, and I didn't believe that was sufficient.

I would also like to add for clarity that although not many regular Canadians are interested in the full-length technical reviews, a lot of researchers, doctors, and others in the health system and potentially journalists might be, and these are also available on request from Health Canada. On this point, we've also been receiving great feedback. In fact, the CEO of the Canadian Pharmacists Association commended the government for our efforts to increase transparency by making drug safety reviews publicly available. In the development of this framework, we consulted with a wide variety of stakeholders, and I have to say, a number of caucus members on all sides of the House worked on this issue. So I really commend the practical work that parliamentarians do around the issue of transparency.

These full technical documents are not only very exhaustive and complex, but they also range from hundreds to tens of thousands of pages in length. That is why I said while we'll make the practical, understandable summaries available, we'll also have those available on demand. It's also important to note that these steps forward in transparency are only the beginning. I have made that commitment. We will be looking at further steps to ensure that crucial drug safety information is made available to Canadians, and I will ensure that Health Canada continues to find ways to be more open and more transparent with Canadians each and every year.

But the bottom line is that our government is making this issue more relevant. We're making the information around drug safety information more useful and timely than ever before, and I know that it's information that Canadians want. We have a lot of Canadians who seek out this information on our Health Canada website. One of the positive things about the initiative, I think, is that we're engaging Canadians through a portal now, actually asking them for feedback on how much more they'd like to see, or what else we can do to be more transparent, and what kind of information we are lacking and what it is they're looking for. I think that's also a very positive step in the right direction.

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

As you're aware, the court rulings in 2001 have required the government to allow legal access to marijuana for those authorized by a physician. However, the use of marijuana and the system that allowed homegrown ran amok, shall I say, and is contrary to the concerns of doctors and certainly the police community as well. In fact, over the past few weeks, this committee has heard from doctors and researchers on the serious and harmful effects associated with marijuana use. Their testimony has revealed the damaging effects on the developing brain and the harm it inflicts on communities.

As a retired police officer, I'm concerned about the existence of marijuana in our community, and especially its negative effects on young Canadians. Can you please tell the committee what our government is doing to protect the health and safety of Canadian families and communities with regard to this?

[The Vice-Chair, NDP, Libby Davies]

You have a little over a minute.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

Sure.

I think the health committee study that you've done has really articulated the risks to youth well, particularly the health risks to youth. The issue of normalization of smoking marijuana is one that concerns me greatly. I worry about the discussion around legalization because it insinuates that this is a healthy thing to do and it's an acceptable thing to do if and only you're over the age of 18. That's not a great message for kids. It's not a great message for youth. We know that every year more research comes out about the health impacts of smoking marijuana. So there is a concern there.

On the issue of grow ops and the medical marijuana program, we've brought a lot more discipline and rigour to the program in a number of ways, especially bringing in commercial operators that are approved by the RCMP and have a great deal of security around them, and ending home grow ops, which, as you know, were a real problem in a lot of communities.

We did have to make changes to this program. In fact, I will say it was not a well-run program. I'm glad that we have made changes to it. The average approval for a licence for marijuana for an average patient was between 45 and 90 joints a day, which is completely unacceptable. We need to have medical supervision and physician supervision, which is what we're asking for now.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much.

Thank you, Mr. Wilks.

We'll now go to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

Welcome, Minister. I will put a preamble, as my colleague did, in that I have so many questions to ask you, I would really appreciate it if your answers could be short. I'll try to keep my questions short.

The report on plans and priorities identifies about $7.7 million to be allocated to the immunization program at the Public Health Agency of Canada. There are declining rates of vaccination in this country. We know in some areas it's as low as 60%.

I know that you have said, Minister, that you've put on an online system for parents who have vaccinated their kids to keep track of their vaccinations. I don't think that's good enough, because you're preaching to the converted here. I'm wondering if you have a plan with that $7.7 million to find a way to ensure that the vaccination rates go up to the 95% that it used to be—if possible 100%, but we know that's never possible. I think it's really important, because we're only waiting for an accident to happen. Measles outbreaks can kill children.

I think this is a really urgent problem. I want to know what you're going to use that money for and how you're going to address the non-vaccination rates.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

I agree with you completely. It's a very disturbing trend that we're seeing with parents who are refusing to vaccinate their children, making decisions based on misinformation—for instance, that vaccines cause autism, when we know clearly that they do not. Vaccines, in fact, save lives. Just today, in Edmonton, in my hometown, another case was announced, and this was a child who had not been vaccinated.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Do you have a plan, Minister?

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

We have the national immunization strategy. We are reaching out. We work very closely with the public health officers across the country. We work closely with the provinces and territories. We have a coordinated approach to vaccine purchasing, to vaccine education, to leadership in the event of outbreaks or emerging vaccine safety and supply issues.

We are doing everything we can, but I do encourage you to also speak out. All of us need to speak out, because there's a great deal of misinformation out there in this anti-vaccine movement and trend. The more education and awareness we can do, the better. And we are doing that.

[Hedy Fry, Liberal, Vancouver Centre, BC]

The provinces have some tools that they can use, and I hope you will work with the provinces—

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

Yes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

—to make those tools national.

Now, the 2014 budget changed the funding formula for transfers to provinces to a per capita formulation. This means that funds will not only be allocated based on population: it will only be allocated based on population.

We know that demographics are a huge issue in which we could have some provinces with very high costs for seniors, etc. One of the problems we have is that now that you've done this, it will mean, for example, that Alberta gets almost $1 billion in transfers this year when they have a very low seniors population. Yet a place like Nova Scotia gets $17 million; they have very high aging populations in the Atlantic, as they do in my province of British Columbia.

Do you intend to find a way to equalize the transfers based on demographics? If you don't, provinces will in fact not be able to address the needs of their population anymore because you've moved the formula from needs and demographics into a simple per capita basis.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

I think the per capita formula is a fair one. I do think it is.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I disagree with you.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

There are always issues when you decide on a funding formula. But I do believe, when you look at the level of funding in this funding formula, this is a record funding that will reach $40 billion by the end of the decade. Health transfers have increased by almost 50%, and the transfers continue to grow on an escalator of 6% per year over the next three years.

I say that because the good news is that we've seen from the Canadian Institute for Health Information's most recent report that total health spending growth in the provinces is actually starting to slow down. That's a good thing. That means provinces, and those who are responsible for this direct spending of health services in their jurisdictions, are starting to look at ways to create efficiencies and look at sustainability. That's positive.

[Hedy Fry, Liberal, Vancouver Centre, BC]

But health outcomes is not a black and white equation, Minister. Because health spending goes down in the province, it doesn't suddenly mean that quality and timely access to care is being given. I also think this is a gross inequity. I just wondered if you had a plan to fix it, and obviously you don't, because you think it's a good idea.

Now, I want to suggest that the $41.2 billion that was put back into health care over this last decade ending in 2014 was put in by, as you well know, a Liberal government with a 6% escalator clause. That brought up health transfers to the provinces and the federal part of health funding to 20%. The change, when you go to the 3% in 2017, is going to continue now to bring down the health portion of funding so that, as the Parliamentary Budget Officer said, it is going to drop to 13% from 20% in the next 20 years.

This will mean, given that the government continues to say that health is a provincial jurisdiction, that the ability to deliver good care to people will depend on the province in which you live, as we've already heard from the Canadian health reports out of CIHI, etc.

So the question is what are you going to do? This is going to mean that medicare is at risk now. Are you going to take steps to make sure that the funding remains at 20% or at least goes up to 25%? Because the track you are on is going to decrease funding to 13% of the federal share.

[Rona Ambrose, Conservative, Edmonton—Spruce Grove, AB]

Let's be clear; for the next three years, health transfer increases are projected to continue to rise at more than double the rate of spending in the provinces and territories.

I do believe there is a consensus in this country that more money is not going to fix the problem. We have a 6% escalator. We have growing spending rates. Provinces are doing very good work to bring that spending in check, not because they are cutting, but because they know they want a sustainable health system. If we want to address that directly, we need to look at better ways of delivering care and innovative technology. We need to look at innovation in our system. When we look at countries comparable to Canada that are spending less by getting better results, we know that there are inefficiencies in our system that we can address. I'm very optimistic that, working with the provinces and territories, we will find those solutions for better care and more innovative care.

I know those solutions are there and I know my provincial and territorial colleagues have also committed to an innovation framework to ensure that we have a strong and sustainable system.

[Hedy Fry, Liberal, Vancouver Centre, BC]

But your provincial and territorial colleagues have been asking for a meeting with the Prime Minister so that they can look at the innovation that was promised in the 2014 health care accord, which was a whole transformative change. It didn't happen because you walked away from the table.

[The Vice-Chair, NDP, Libby Davies]

Doctor Fry, we are at seven minutes now.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

[The Vice-Chair, NDP, Libby Davies]

The time has run out, so maybe we can come back to it. Thank you.

We'll now turn to Mr. Young.