Evidence of meeting #28 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

George Da Pont  Deputy Minister, Department of Health
Alain Beaudet  President, Canadian Institutes of Health Research
Krista Outhwaite  Acting Deputy Head and Associate Deputy Minister, Public Health Agency of Canada
Gregory Taylor  Deputy Chief Public Health Officer, Public Health Agency of Canada
Bruce Archibald  President, Canadian Food Inspection Agency

8:45 a.m.

NDP

The Vice-Chair NDP Libby Davies

We'll call the meeting to order.

We're very delighted to welcome the Minister of Health here at our committee.

Welcome, Minister Ambrose. We're here to deal with the main estimates today, and we look forward to hearing you. I believe you're staying for an hour. If you can stay longer, we'd be very delighted, because then we can ask you more questions. I know that your officials will be here for the two hours.

I'd like to call vote 1, which means that we now invite the minister to make her remarks.

Thank you.

May 15th, 2014 / 8:45 a.m.

Conservative

The Honourable Rona Ambrose Conservative Rona Ambrose

Thank you, Madam Chair, and good morning to all the committee members. It's a pleasure to be here with you.

Thank you for the invitation to discuss the main estimates for Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research and the Canadian Food Inspection Agency.

I'm joined by George Da Pont from Health Canada, our deputy minister; Krista Outwaite and Dr. Greg Taylor from the Public Health Agency of Canada; Dr. Alain Beaudet, who is here from the Canadian Institutes of Health Research; and Dr. Bruce Archibald from the Canadian Food Inspection Agency.

You're right, Madam Chair; after I depart you'll be in good hands with the officials. I'm sure they'll be happy to take more questions from the committee.

Before I begin my remarks on the main estimates, I would like to take a moment to commend this committee on the great work you've done recently. I know right now you're undertaking a current study on the health risks and harms from marijuana. I have a particular interest around the concerns of the health risks associated with children. I also want to thank you for the work you've done on prescription drug abuse. It's not an emerging issue; this issue has arrived. It is very much a public health issue here in Canada and in the United States. You've heard from many health officials across the border. I thank you for your recommendations. I know we've already acted on some of them. I look forward to acting on others.

On the current study you're doing right now, obviously as Minister of Health I am very concerned about the health risks associated with smoking marijuana, but particularly for our children and youth. I think it's important to know that Health Canada does not endorse the use of marijuana, nor has it approved it as a drug or medicine. I think that's an important message to send and for kids to understand.

When we have discussions around medicinal marijuana, it's important for young people to understand that while there is a program in place, this program has been put in place to respond to a court decision. Health Canada does not endorse the use of marijuana, nor is it approved as a drug in Canada, or as a medicine. This is an important message to counter the normalization around the use of it and some of the misperceptions that kids have. I understand you've heard from them.

I have been pleased that you've invited a number of organizations to your session, including the Canadian Medical Association and others who are raising similar concerns around the health risks. I've been reassured to hear that you've been seeking advice from very well-informed and credible medical experts—Michel Perron, who is the head of the Canadian Centre on Substance Abuse, and others, including researchers, in particular from the University of Ottawa and elsewhere, have also been speaking out about these well-established health risks.

So I thank you for that good work. I think what's coming out of this committee is important because it's credible evidence from those who are close to this issue and dealing with young people. I think that informs some of the work we do going forward.

I will now briefly go to the main estimates, and my priorities for the health portfolio, before answering questions. As Minister of Health, I'm very focused on improving Canadians' health and working with all partners to ensure that Canadians can continue to access the health services and products they need in a safe way. The department is providing services that are important to Canadians, such as stronger safety systems for health products and food, continued support for mental health research, and improved access to quality health services to first nations and Inuit.

Health Canada's main estimates for 2014-15 outline $3.66 billion in spending, which is designed to help Canadians maintain and improve their health. This represents a net increase of $365 million over last year. The increase is due mainly to the stabilization of first nations and Inuit health program funding, which accounts for $311 million, as well as the implementation of the very successful B.C. tripartite framework, which accounts for $63 million.

However, as members of the committee know well, main estimates do not reflect our recent budget investments, and economic action plan 2014 has several important investments that do continue to deliver on our government's commitment to the health and safety of Canadians. In fact this year's budget announced almost $400 million to strengthen Canada's food safety system and better protect Canadian families.

These investments will support the hiring of over 200 additional inspectors with CFIA and other staff, improve our systems to detect and respond to risks, and continue programming that keeps our country free of dangerous animal diseases that affect human health.

I was of course thrilled to hear the leader of the opposition say that this was good news in the budget with regard to food safety and that this was a good idea. Of course, I couldn't agree more.

Since I last appeared before you, I've also held round tables to hear what Canadians have to say about nutrition information. I raise this because there's a lot of discussion and interest in this from members and from the media around nutrition information and healthy eating.

We've also launched a regulatory transparency and openness framework for Health Canada so Canadians can easily find relevant drug facts and information about medicines that have been approved in Canada.

Working with the CFIA, I have also announced the healthy and safe food for Canadians framework. This framework describes how the government is working to inform consumers about healthy and safe food choices, minimizing food safety risks, and protecting Canadians when unsafe foods enter the marketplace, with our ability, of course, to recall them quickly.

I'd also like to spend a few moments talking about Canada's health care system, the pressures that it's facing, and the action we are taking.

Canadians are among the healthiest people in the world, living longer and enjoying more quality years in good health than ever before. And we are living in a time and place of remarkable progress in healthcare.

And indeed our government is providing the highest recorded health transfer dollars in history to provinces and territories. This record funding will reach $40 billion annually by the end of the decade and provide stability and predictability to the system. In fact, since we formed government, health care transfers have increased to the provinces by almost 50%, but there are also important issues that we need to continue to address. We simply must do more to ensure that our health care system is innovative and delivers the care that Canadians need and want, and ensure our system is sustainable for the long term.

Since my appointment, I have had the privilege to meet and hear from Canadians across the country about our healthcare system.

I've also met front-line staff workers and even had a chance to work with residents for a day in Toronto at St. Joe's Health Centre to understand the important work they do and the challenges they face.

I've heard from Canadians that they feel that the system needs to adapt to changing economic, demographic, and technological pressures. They need to know that we are working to improve the health system and ensure its sustainability, not just for themselves but for generations to come.

These concerns reinforce the most critical challenge facing Canada's health care system, and that is its long-term sustainability. The reality is that more money is not going to fix the inefficiencies in our health system. Currently we spend 11.2% of our GDP on health care, significantly more than many other countries, and, left unchecked, some experts like David Dodge suggest that by 2031, public and private spending on health care could be 15% of our GDP, or higher.

I believe the key to the long-term sustainability of our health system is innovation. We need to make better use of our existing resources and target best practices. This means breaking down barriers, tapping into creative minds, and working collaboratively to improve the productivity, efficiency, and responsiveness of the health care system.

To that end, a few months ago I announced the creation of an expert panel to find the most promising innovations in health care, not just here but abroad, whether they are technologies or models of care. This panel will focus on finding innovative solutions to these challenges and informing our future policy decisions. It will also identify promising innovations within Canada and abroad, as I've said, that have the potential to reduce growth in health spending while improving care, and it will recommend ways the federal government can better align its efforts to support such innovations.

I look forward to the advice of this panel. It will be invaluable in guiding us toward a sustainable and responsible health care system that meets the needs of Canadians now and to the future. I look forward to announcing more details about the panel to you very soon.

All jurisdictions in Canada are starting to focus on innovation within the healthcare system, and we are making progress.

Our government plays a key role in these efforts. On the research front, we invest almost $1 billion annually to support Canada's best health researchers and trainees through the Canadian Institutes of Health Research. I am particularly pleased with our investments in Canada's strategy for patient-oriented research.

SPOR, as we call it, in which the CIHR plays a key leadership role, is a coalition of federal, provincial, and territorial partners, patients, researchers, and industry, all dedicated to ensuring that the right patient receives the right intervention at the right time.

I was pleased that in budget 2014 we committed to ongoing support of this initiative when we increased its investment by $15 million. This will help support the expansion of SPOR as well as the creation of the Canadian Consortium on Neurodegeneration in Aging and other health research priorities.

Of course, building partnerships among governments, industry and others in the private sector, the health care community, and academia will be critical going forward. We've extended a challenge to the private sector to partner with us and the non-profit sector to invest in public health objectives specifically and to co-create initiatives that help make Canadian society and workplaces healthier. l am pleased to say that we've had a great response from non-profits and from the corporate sector to step up for this challenge.

Examples of this would be that through our partnership with Air Miles for Social Change and the YMCA, gym members receive Air Miles reward miles if they reach certain physical activity milestones on a weekly basis. We're testing whether this incentive-based approach leads to longer-term behaviour change.

We've also partnered with Canadian Tire, LIFT Philanthropy Partners, and the CBC for what we're calling The Play Exchange in order to appeal directly to Canadians themselves for healthy living ideas that we want to put into action. That's because we know that Canadians are among the most resourceful and innovative people in the world, so we're tapping into their ingenuity as well. We had a chance to launch this initiative during the Winter Olympic Games and we have seen great participation so far.

By joining forces with both the public and private sector, we are fostering innovation, making the most of our resources, amplifying the impact on our communities, and creating environments that help make the healthier choice the easier choice.

Madam Chair, I'll end my comments there. I am happy to take any questions from members.

8:55 a.m.

NDP

The Vice-Chair NDP Libby Davies

Thank you very much, Minister Ambrose, for your comments. I'm sure there will be lots of good questions from the committee.

We'll begin our first round, which is a seven-minute round, with Dr. Morin.

8:55 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you very much, Madam Chair.

I also thank the minister for joining us. I would like to ask her to give brief replies to all my questions, given that I have a number of questions to ask.

If, unfortunately, the answers are not very short, I will have to cut her off, and I don't want to do that.

My first question for you, Minister, is this. When we had government officials before the committee in November, they mistakenly said that no application for mifepristone had been made, but in fact it had been submitted to Health Canada for over a year.

The drug is approved in 57 countries, including the U.S.A. The medical community even calls it the gold standard of care.

Considering that safe access to abortion is a fundamental right in Canada, could the minister confirm that Health Canada's approval process for mifepristone will be fully independent and be based on science alone?

8:55 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

Yes, I'd be happy to answer that question. Of course, I do understand that the last time officials were here, that information was there; I know that the deputy minister addressed that issue to the committee.

In terms of drug approval processes, this drug like every other is under an approval process whereby decisions are made by scientists within Health Canada, not by politicians or ministers. Under the Food and Drugs Act and its regulations, manufacturers submit applications for the approval of drugs to Health Canada, and the timing of the reviews for drug submissions varies depending on the information provided by the manufacturer.

8:55 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

So it will be independent?

8:55 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

Yes.

8:55 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you so much.

My next question is this. The main library at Health Canada has been closed, and the library's physical collection has been moved. Can the minister confirm that she is aware that understaffed and under-resourced libraries present a liability for the department, putting the health of Canadians in danger?

8:55 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

What I can tell you is that I've been reassured by the department that the change to digitize our library services means that more Health Canada officials and bureaucrats will be able to access those documents, and so they see it as very positive. All of the documents are accessible and available to employees through our library services.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Well, in fact managers at Health Canada admitted that changes to the departmental library services would lead to risks to the department's credibility and its ability to produce evidence-based decisions. Was the minister aware of these concerns?

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

As I said, I've been reassured by the department that employees maintain free access on a broad electronic database of publications and can request any item that is not yet available electronically.

You should know that the entire library collection remains accessible to all Health Canada employees, whether through loan request or electronically via the National Research Council.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

But before, I believe, there were 40 researchers working at the library, and now there are only six of them. Do you honestly believe that they will be able to produce more research and make it more available, with so many fewer people on staff?

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

I appreciate your comments, but officials have reassured me that this is a good decision, because more people will be able to access the documentation.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Okay, then. Thank you for the answer.

Here is my next question. Canada's first nations and Inuit face significant barriers when accessing dental care, and they experience much higher rates of dental disease, but we have heard of significant concerns with the rules and requirements of the program responsible for ensuring their dental care, the non-insured health benefits program. These rules can cause delays in treatment and increases in transportation costs and can deter follow-up treatment. All of these effects have direct impacts upon patients' health.

Can you confirm that you plan to have a joint review for the non-insured health benefits program to ensure that it is meeting its goals and is meeting the needs of first nations and Inuit people in Canada?

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

Yes, I can confirm that we're in discussions related to a review.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Do you have a timetable for when that study will start and when it should be complete?

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

No. I discussed this a number of weeks ago with Chief Atleo, and we made a commitment to him and to the AFN for this review. In fact, the review was already something we were looking forward to doing.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Do you believe that this joint review will start before the election?

9 a.m.

George Da Pont Deputy Minister, Department of Health

Perhaps I can add a few comments on timing.

AFN is in the process of finalizing its own internal views on the review. I understand they will do it over the summer, and then we would be in a position to start the process after that.

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Thank you very much.

My next question is to the minister again. As you must know, the problem of drug shortages has gotten worse. Doctors and pharmacists say they are spending more and more of their time scrambling to make up for drugs in short supply and to find substitutes.

What actions have you taken as this problem has continued to spiral out of control? Give me a short answer, please.

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

Sure.

We all worry about drug shortages, obviously. Drug shortages are not just an issue in Canada; they are a global problem, which we take very seriously.

We established a stakeholder steering committee on drug shortages. It is co-chaired by us and the Province of Alberta, with all provinces and territories as part of it. As part of that committee, we're working with drug companies. We have a pan-Canadian strategy to manage and prevent shortages and reduce their impact.

We have seen real progress and we have announced increased communication strategies. Plus, as you know, if the drug companies see a drug shortage coming, they alert us. We put it—

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

But it is not mandatory.

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

It is not mandatory,

9 a.m.

NDP

Dany Morin NDP Chicoutimi—Le Fjord, QC

Should it be?

9 a.m.

Conservative

Rona Ambrose Conservative Edmonton—Spruce Grove, AB

I have said many times that if it's not working, we will make it mandatory. I have told the provinces that; I have signalled that to industry. We are obviously keeping a close eye on this, and if we feel that it is not sufficient....

It was an agreement among the multi-stakeholder committee that this would be a voluntary approach, but I've told everyone very clearly that from the federal point of view, if it is not working effectively we will move to a mandatory system. I can tell you that we have already begun formal consultations.