Health Committee on Nov. 25th, 2013

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

That's too bad. I had more—

[The Chair, Conservative, Ben Lobb]

I know. Maybe Ms. Morin....

Mr. Wilks, for five minutes, please.

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

Thanks, Chair.

Thanks to you and all your staff, Minister, for being here.

I'm going to carry on with the conversation that Ms. Fry and Ms. Davies had picked up on. You spoke in your opening remarks about healthy living and said further that protecting Canadians from harm is part of your mandate, as is ensuring that both licit and illicit drugs are dealt with in a manner that is responsible for all Canadians.

Recently, injection sites have been in the spotlight, and specifically how communities should have a say in their placement. As a former police officer, I think it's only fair that people have the right to say whether one is in their community or not. I wonder if you could comment from your perspective on the Respect for Communities Act and what it's trying to accomplish, and then, further to that, on the importance of treatment, recovery, and support.

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

Sure, I'm happy to do that. I appreciate the question.

The legislation you're talking about with regard to supervised injection sites, the Respect for Communities Act, is being debated in the House right now. We introduced it last month.

This legislation will give law enforcement, municipal leaders, and local residents a voice, all of whom have asked for a voice before the permit is actually granted for a supervised drug injection site in the area.

This went to the Supreme Court, and in a 2011 Supreme Court ruling the justices were crystal clear. They ordered that I, or any health minister, must consider specific factors when reviewing applications that grant exemptions under our drug laws. In other words, we must look into specific factors before allowing a permit for a supervised drug injection site.

One of the five factors named in the ruling is expressions of community support or opposition. I do not, nor should I, ignore any of the factors named in the court's ruling. I think it makes good sense. I am required by the Supreme Court to consider community opinions in the process, and that information needs to be made available to me by the organization if it's seeking to build such a site.

I should say that there is no one now seeking to build such a site, but this bill also requires that these organizations submit the relevant scientific information demonstrating the effectiveness of illicit drug treatment at the proposed site as part of their application.

I think that all parties, or at least those with whom we have consulted, agree that this kind of information must be provided to decision-makers when assessing a permit of this kind. This information will be provided along with details about the resources of the proposed site and about how these resources will be used for drug treatment. Knowledge about the level of community support and the treatment options that are available will also help determine the merits of each application.

This is reasonable and it is also mandated by the Supreme Court, so that is what is in the bill. Those stakeholders who have been dealing with this issue for many years deserve a say in where these sites would be if we receive an application for them, so we are moving on this. The Supreme Court has ruled. We believe our communities deserve nothing less than to have a voice in that, and the Supreme Court has agreed.

I do encourage everyone to support the legislation and move it along.

Our government has invested quite a bit of money in drug treatment and recovery. I am of the belief that we spend a lot of time talking about a very small piece of the drug problem when we talk about supervised injection sites. There are literally hundreds of thousands, if not millions, of Canadians across the country who are either in recovery or suffering from addictions. A lot of them feel shame and they don't want to speak openly about their addictions and their need for recovery. We need to speak more about it because they need to feel comfortable about coming forward to seek help and intervention.

That is one of the messages that I bring, as the health minister in my tenure. We need to get people out of addiction, into recovery, and into the right kinds of treatment programs. Sometimes it takes years. Sometimes it takes multiple attempts. People talk about it not working, even after two tries. Sometimes it takes 15. As a police officer, you have seen this first-hand. Eventually, though, people can get up on their own two feet, recover, and lead a productive life.

The message is to not give up on people, any people, particularly those who are most vulnerable.

[The Chair, Conservative, Ben Lobb]

Thank you, Minister.

Next is Ms. Morin.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

I would like to thank the minister for being here today. I quite enjoyed your speech.

You mentioned safe and healthy food for Canadians. You said a great deal about safety, regulation, providing information and communications, but you did not discuss food in and of itself. Yet, in the United States, the Food and Drug Administration has ordered the American food industry to begin to gradually eliminate trans fats from processed food. I think this is a good measure.

In this country however, the government is not listening. Even in your own department, certain experts have recommended the regulation of food processing and ensuring such foods contain less fat and salt. I believe these measures would improve the health of Canadians. I am not talking simply about influencing their food choices. Here in Canada, our cereal contains much more salt than it does in the U.S., and the quantity of trans fats found in processed food is truly unbelievable.

Why have we not followed the U.S. example and that of many other countries by taking similar measures? When will we be able to implement such measures?

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

I don't know what you find, but in speaking to at least my cohort, more and more people want increased amounts of information about what they eat—the food they buy when they go to the store. They want more nutrition labelling, not less. I find that especially parents shopping for kids want to know if there is an allergen in this food, what ingredients are in it. It is even beyond nutritional information. This is why our government has announced in the Speech from the Throne that we will be consulting with Canadians about nutrition labelling. We will be working with CFIA, the Public Health Agency, and Health Canada together, to see what we can do better to support people in making good nutritional decisions.

On trans fats, there has been a lot of movement. Canada, as you know, moved to a voluntary system for trans fats. We've seen a huge improvement—

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

I am sorry to interrupt you, but we do not have much time.

I agree with you. I think transparency in labelling is very important. Furthermore, I also believe we should change the food itself. It is not enough to say that it contains salt. Canada should commit to reducing the amount of salt in these foods.

Unfortunately, most of the people around me would be unable to tell me what the daily maximum dose of salt and trans fats is. However, we could go beyond this and ask the industry to reduce the amount of sodium and trans fats in the food they are producing. This is what we should do. It is not enough to be transparent. We must be proactive and ask that sodium and trans fat levels be reduced.

You yourself must recognize how important this is. In that perspective, when can we expect to see Health Canada take action?

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

It's not only Canada's food guide; there are also incredible amounts of information that we provide to Canadians on www.healthycanadians.gc.ca. We have a nutrition facts education campaign that was launched in 2010 that talks about the nutrition facts table, how to read it and understand it. We've worked with industry to reduce the amount of trans fats in Canadian food and in promoting better labelling.

As a result of that, in a very short period of time we have seen Canadians' intake of trans fats decreased over 60% in just a couple of years. In fact, we know now from ongoing testing that in some segments of our population the intake of trans fats is reduced by almost 90%. So I think we're on a good track.

There are also early signs that decreasing sodium levels in some important food categories is happening. As you know, experts set those levels. What we do is try to disseminate all that information to people so they can make good choices. We literally can't be at the table with people and their salt shaker, but we can advise them on why they should not be using too much salt on their food. We do that widely. Promoting healthy options does get results. We have very good promotional awareness campaigns making sure that physicians have adequate resources to give to patients, nutritionists, and we do disseminate that information. We've seen great results because of that.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

Do you not believe it would be worthwhile to have regulations about salt consumption? You yourself said that we could not sit down with people for every meal. Yet, we know that generally speaking, more educated people will take the time to read nutritional information, unlike less educated people. Should we not help people and improve their health by committing to regulating trans fat and salt levels in food? We know that will allow us to save enormous amounts of money in health care.

[The Chair, Conservative, Ben Lobb]

Thank you, Ms. Morin. I'm sorry, we'll have to get that answer another time because we're up against the clock.

We'll have Mr. Lizon for five minutes, and then that will wrap up our hour with the minister.

Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much, Mr. Chair.

Minister, thank you for coming and meeting with us here today, and all the officials.

Minister, in your previous role as minister responsible for the Status of Women, you were a great and strong advocate for ending all forms of violence against women. As I understand, you continue this in your new capacity and portfolio as Minister of Health through the programs offered in the department in that area. This is very encouraging, since this is an issue that all the parties can agree on and should work together to address.

You highlighted in your opening remarks that the issue of family violence is one that you want to focus on. Can you please provide the committee with an update on the work you are doing with the Ministry of Health to keep the issues of family violence or issues related to family violence at the forefront?

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

I appreciate that comment. Not only in my role as minister for the Status of Women previously, but throughout my whole life I've been involved in this issue, advocating for more awareness around it.

Our government has had an opportunity to bring a more holistic approach to the issue of family violence, whether it's child sexual abuse or intimate partner violence or honour violence. Family violence takes many forms, but the reality is that it is a public health issue. The consequences are far-reaching, both societally and also economically.

I mentioned the Justice Canada report that came out a year ago, which found that just in terms of intimate partner violence, the cost to society is $7.4 billion, and that's just for going to the emergency room with a broken arm or seeking psychological help. Let's remember that most women do not seek medical help, and even more so do not seek psychological help.

I would say that the cost is obviously much higher. We know that aboriginal women are suffering and experiencing violence at a much higher rate than non-aboriginal women—at least 3.5 times higher. They're much more vulnerable to becoming victims of family violence. That of course has profound financial and social impacts on them, their community, and their families.

Not only does it affect physical health; it affects mental health. It puts a huge strain on day-to-day personal activities, but also business activities. It leads to loss of work. All of that affects our communities and our economy, and it obviously has a huge impact on the public health care system.

The Public Health Agency of Canada has a clear mandate in this area, with responsibility for what is called the federal family violence initiative. That coordinates 15 different departments that have a role to play in any family violence. We are working right now to make sure that we're prioritizing all of this and are focusing our priorities in the right way.

I'm glad to say that the Canadian Institutes of Health Research is also now doing research in the area of family violence, with $8.5 million over five years to look at gender-based violence and family violence and its impacts.

So we all have a role to play. I have reached out to the provinces and territories, to the medical community, to physicians, to the Colleges of Physicians and Surgeons, asking all of the stakeholders what we can do together to advance awareness and prevention of family violence. I look forward to working with the committee on this issue and I look forward to the Public Health Agency coming forward with what I know will be some good opportunities to raise awareness on this issue.

You're right in saying that it affects everyone. It's one of those issues that is talked about a lot. It is finally not a private issue, but has become a public policy issue. We still don't do enough to coordinate across the country on this, and we look forward to doing that.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Mr. Chair, if I can—

[The Chair, Conservative, Ben Lobb]

You have 30 seconds.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Maybe quickly I'll ask one of the officials, then, how the collaboration with provinces and territories on this issue is going so far.

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

I would just say one thing. Interestingly, provinces are doing, each in their own capacity, different levels of work in this area. They're encouraged to know that we want to work together on information sharing and whatnot. But I look forward to a better opportunity to see the provinces wanting to engage us on this.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Thank you very much. That should conclude the minister's time. I thank the minister and her staff for being present here for an hour.

I'd also like to thank my colleagues for keeping their questions tight and to the time and for asking them in a respectful manner.

We will suspend for a couple of minutes. Those who need to leave may do so.

When we resume we'll have the departmental staff here to answer questions for about 40 minutes, and then we'll have 10 minutes to go over the supplementary estimates and vote on them.

We are suspended.

We'll call the meeting back to order.

We welcome our colleagues who are here from the various departments throughout Health Canada.

We'll get started in just a few minutes. We're going into our five-minute rounds. Ms. Davies will start off, and then we'll rotate through our regular session.

I'd like to remind my colleagues and anyone in the audience that if you have a mobile phone, please set it to “silent” or “vibrate” so that we don't hear it ringing during the question and answer period. I'd also ask that no pictures be taken with your mobile phones during the committee meeting—just to be clear.

As I said, we'll go till about 5:20, and at that time we'll conclude this portion of our meeting and we'll go through supplementary estimates. I thank you in advance.

Ms. Davies, you have five minutes to start, please.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much to officials who are remaining, because there are obviously a lot more questions that we have.

I actually want to focus my five minutes on the most recent issue of the Canadian Medical Association Journal, where a very strong editorial was written expressing their concern about the fact that RU-486, mifepristone—which is basically a medical abortion pill—has not yet been approved in Canada.

It is registered in 57 countries. It's a pill that provides very safe access for a medical abortion, particularly for women in rural and remote countries.

I think there's a lot of concern, and certainly when we see an editorial in the Canadian Medical Association Journal questioning why it hasn't been approved in Canada and why it's taking so long.... It's very timely that you're here, and hopefully we can get some answers on that.

The subtext of it is that more and more people are very concerned that there is an increasing politicization of medical decisions in Canada. We just had a little back-and-forth about the special access program and the SALOME trial program. There is a lot of concern that this is yet another example where we see the politicization of what should be an expert medical decision. Obviously this pill that's been approved in other countries is extremely important in terms of access and safety for women, so what's the holdup in Canada? Why have we not approved it, and why is it still sitting there to the extent that the Canadian Medical Association Journal now feels compelled to write a very strong editorial about it?

[George Da Pont, Deputy Minister, Department of Health]

The answer is relatively simple. To date, no company has applied to market the product in Canada.

Obviously if we receive such an application, we would study very much the data, the experience in other countries, and we would try to deal with it as quickly as possible.

[Libby Davies, NDP, Vancouver East, BC]

Given that it has been registered in other countries and approved.... I know it's been available in the U.S. since 2000, so it has a history, and it's not a new drug, although, as you point out, it's not yet being used in Canada. How long would that process take if there were an application made?

[George Da Pont]

I can't speculate on how long it would take. It would depend on the application.

But in this case, given widespread use, given lots of data from other countries, I would expect it would go faster than normal applications.

[Libby Davies, NDP, Vancouver East, BC]

Do I still have a little bit more time?

[The Chair, Conservative, Ben Lobb]

Yes.