Health Committee on May 7th, 2015

[The Chair, Conservative, Ben Lobb]

Mr. Rankin, we are out of time. We're at seven minutes and 20 seconds.

To be fair to everybody, Ms. McLeod, go ahead.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Chair.

Thank you, both to the minister and to all the officials who are here today. It's always a nice opportunity, and really an important opportunity, as we talk about the main estimates.

I think one of the things that is critically important, of course, is the transfers that we do to the provinces. It's certainly an enormous part of our support for the health care system in Canada. Over the last number of months, I've had a lot of constituents writing to me and suggesting that there has been a cut in terms of the transfers to the provinces, which, Minister, as you're probably aware, is totally inaccurate. I believe that the misinformation should be, and I'm trying to ensure that it is, corrected.

We can certainly see in the budget document where the trajectory has gone in terms of these transfer payments. I understand that our government is going to be increasing payments to the provinces by over $27 billion over the next five years. We have done significant measures in terms of trying to support additional physicians coming into Canada.

I would appreciate if you could set the record straight in terms of the transfers to the provinces and where we're going, and where our commitment is as a government to what is very important in terms of the provinces being able to deliver health care.

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

Yes, absolutely.

When Finance Minister Jim Flaherty renewed our commitment to the provinces and territories at the end of the health accord, he renewed, for the next 10 years, record-level funding. Of course, that includes an escalator of 6% up to 2016, and after that a 3% escalator for the provinces. That means that by the end of the decade that amount will reach $40 billion annually. That's a 70% increase in federal transfers, just for health care, since 2006.

That is very important to the provinces and territories because it has allowed them to plan their own budgets in a much more predictable way, and it's probably the area in which they are struggling the most when they think about the impact on other parts of their own provincial budgets. Let's remember that health care takes up a great deal of the federal budget, but it takes a great deal, if not 50%, of most provincial budgets, so they are struggling with figuring out ways to curb costs at the provincial level, because otherwise they're going to have to look at the impact it has on other services.

I think one of the things we should think about is the latest information out of the Canadian Institute of Health Information. Since the year 2000 health spending by provinces and territories grew by less than 5%, and since 2010, spending by provinces grew by less than 3%. So if you think about that and the amount of increase and the escalator we're applying to the funding we give to provinces and territories every year, that means that for the next three years, with a 6% escalator, our transfer increases are projected to continue to rise at more than double the rate of health spending increases by the provinces. We are well in line with providing them with the appropriate amount necessary.

However, I think the other part of the discussion has to be around money, because while health transfers are at record levels, the truth is that provinces are trying to find ways to curb their costs, because if you look 20 years out and if we continue down the track we're on, it would basically take up the entire budget of every province, and that's completely unsustainable.

That's why we're focused on innovation. That's why we're focused on working on the recommendations that come out of the panel in June, with the provinces and territories, to look at what we can do to innovate our health care system. If we don't do that, I think we're letting Canadians down, because we invest heavily per capita in health care, but we don't have the best health care system in the world. I like to brag about this health care system, but there are areas in which we can improve, and I think only through innovation will that happen.

We are making those investments in innovation and we'll continue to have that conversation with the provinces about supporting them in areas, such as the strategic patient-oriented research partnership we have with the provinces, and other investments we made recently in the budget.

This is a good time to have this conversation because we have money on the table for the next 10 years in health care. Let's talk about the smart way to spend it, and the best way to get the best possible outcomes for Canadians. I think that's what our government is focused on now with the provinces, and I think it will benefit the health care system.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you.

I certainly appreciate your comments about innovation. I think we've all seen things that we know will work very well. They improve quality of life and of course are very cost-effective. I think that shift in terms of supporting innovation is going to be essential, and this leads me into my next question and my thoughts.

Certainly, I would expect every person at this table, whether parents or constituents... Of course, the bulge, in terms of the senior population, is going to create some extraordinary challenges over the next few years. Could you highlight some of the things that you're planning on looking at in terms of supporting health of seniors? I think it will be something that's very prominent over the next number of years.

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

Yes, I think you're right. I couldn't agree more that a focus on the health of seniors is incredibly important. I think that provinces are seized with that as well in their delivery of health care and trying to figure out how to reorganize their models of care so they can address what is a huge demographic challenge coming down the line.

We're doing our part to address those issues. In the budget I was very pleased to see significant funding for the creation of the Canadian centre for aging and brain health innovation. Really, if you're interested in these kinds of issues, everything right now is a conversation around brain health, and the government has made incredible investments in brain health, whether it's through our investments in neuroscience or our investments in dementia or Alzheimer's. This specific centre will be based in Toronto, at the Baycrest Health Sciences centre, and will support new research and also develop, importantly, new services to address the particular health challenges we face as we age.

That, I think, will provide good data evidence and support to the provinces as they try to figure out how to deal with this big challenge.

[The Chair, Conservative, Ben Lobb]

Thank you, Minister.

Ms. Fry, go ahead.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I want to thank the minister for coming today. I'm going to ask the minister a series of questions. I'm looking for short answers because I have quite a few questions I want to ask you.

With regard to innovation, I notice that the CIHR has been cut. It's a decrease of $4.5 million from the estimates to date in 2014-15 and knowing that the Naylor report on innovation is coming out, how would the CIHR deal with this if you don't increase the budget for CIHR to fund further research into innovation of the health care system?

The second piece is that we know that currently the agencies that are doing research are having to find a fairly large amount of money, $8.5 million, for these groups that don't have anywhere to raise the money to be able to do that little transition for three months each year for the last two years. This cut means they're going to have to.... Nobody knows what they're going to do because there's no way to be able to get that transition money from CIHR, because CIHR is going to have to be cutting certain things. That's about CIHR.

I also wondered why.... For instance, we looked at the fact that the budget for first nations and Inuit primary health care has been cut by a fairly large amount, $45 million, from 2014-15, and $59 million.... That's going to leave us with a real shortfall at a time when we see that the Auditor General has been talking about the quality of care and outcomes and the number of nurses and the ability to deliver care in the north and to Inuit and first nations populations.

We see the increase in infectious diseases, in obesity, in type 2 diabetes. We see rickets in the north, which I only learned about in medical school as a historical fact. Nobody has seen rickets here for, I don't know, almost a century, and we're seeing this in the north. The nutrition is no longer good. We're seeing overcrowding. We're watching tuberculosis increasing. We're watching this kind of falling happening, and I know the minister will say that this cut has come about because of the sunsetting of the water and waste water action plan.

Since February of this year we've had 139 drinking water advisories in first nations communities, so the water isn't safe and it's getting worse. In three months we've had 139 advisories. Why are we cutting such essential programs for a group of Canadians who have the worst health outcomes in the world as seen in the last UNICEF report that was done here?

There is one last piece I wanted to ask you about as well because I think that's all I'll fit, so I'm putting these three on the table. One of them has to do with the CFIA. It's receiving $107 million less than it did in 2013-14. We're also seeing that there is a plan in your planning and priorities for 2015-16 for 271 full-time employees to be eliminated for the meat and poultry subprogram of the food safety enhancement program.

We also know that we're hearing about E. coli in beef and we want to know how many meat inspectors were employed in 2013, 2014, and 2015. Were any positions left unfilled? Have the number and frequency of inspections been cut back at any plant, and if so, which plant and why? How many times a year are general sanitation inspections done at ready-to-eat food plants, like Maple Leaf Foods or raw food plants, such as beef and poultry, etc.

Why would there be a cut in something that is so essential and which has had really bad outcomes for the last three years?

The minister said in the House that she would get inspectors to inspect inspectors because of the bad results that have been happening. What is the quality and the level of the training of the inspectors there? Do they have any requirements for their training if they allow such huge problems to occur?

I'm going to leave those three questions on the table and I'm hoping to get every piece of them answered. That's why I was so specific.

[The Chair, Conservative, Ben Lobb]

Minister, you have two and a half minutes.

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

Great.

There have been no cuts to CIHR. In fact, there are increases. I'll leave it to Michel Perron in the second hour to elaborate on all of those.

To aboriginal health there have been no cuts whatsoever. Anything in the estimates that shows a decrease is because those we're sunsetting. We've approved and renewed those, so you'll see them come back. There are no cuts to aboriginal health.

There are no cuts to CFIA. In fact, there was $400 million extra in the budget last year. I'll let Bruce explain to you the specifics around that.

In terms of aboriginal health, I want to say how committed our government is to the $2.5 billion we invest every single year and the 24-7 access to essential nursing services we have in 80 communities.

Let's remember, no matter where you are, if you're an aboriginal Canadian we will provide emergency evacuation for something as simple as a regular appointment, no matter where someone is. If they live in an area where there are no roads, we will provide emergency evacuation transportation to get people to a hospital, to a doctor, to wherever they need to make sure they have access to care. We spend over $200 million a year just on evacuation and transportation for medical purposes for aboriginal Canadians.

Of course, we have coverage, whether it's medical transport, dental care, or prescription drugs. We provide a very comprehensive care for aboriginal Canadians on first nations when it comes to health care. We've now increased our support for aboriginal health by 31% since 2006. We will continue to work with all of our aboriginal partners in the now 734 health facilities across Canada that are on aboriginal first nations that we support.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I have another 30 seconds, Minister. You have said there are no cuts, but there are. I've been looking since 2013, and I'm looking at what was removed that was not replaced.

The point about the whole thing is that if everything is so wonderful, how come the outcomes are becoming worse and worse? I think that if one is spending on any particular program in any particular way and people have pointed out the problems, we should see, over the course of a three-year cycle—just three years going from 2013—and be able to say there is improvement. There has been no improvement in any single one of those three areas I've brought forward.

There is a cut, Minister, to CIHR. Adding new money is—

[The Chair, Conservative, Ben Lobb]

Ms. Fry....

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

Ms. Fry, Canada's now considered the best country in the world when it comes to food safety. That's a Conference Board of Canada report. In the entire OECD, we're number one, even better than the U.S., and we should be proud of that. We should never fearmonger Canadians about our food safety. Our food safety system is incredibly effective and very safe.

[The Chair, Conservative, Ben Lobb]

Thank you very much—right on time.

Mr. Wilks, go ahead, sir.

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

Thanks, Mr. Chair.

Thanks, Minister, for being here. I was happy to hear you talk about addiction recovery. It's a passion of mine, as you know, as someone who is in long-term recovery. As a result of that I wanted to bring two specific questions to you, and they revolve around illegal substances in Canada: one being marijuana and one being heroin.

As you know, Minister, this committee undertook its own study on the serious health risks and harms of smoking marijuana. We recommended that a public awareness campaign be undertaken, given that we heard clearly from doctors and researchers about the serious and harmful effects of smoking marijuana, especially on teens' developing brains and the unborn child.

The recent health campaign that was launched was an excellent way to educate families about the health risks of marijuana. I find it very concerning that the leader of the Liberal Party proposes to legalize and normalize marijuana. I think it's completely irresponsible. In that case, I think our progress in this has been crucial.

First, I'd like you to speak about the government's efforts to stop kids from smoking marijuana.

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

Sure. Thank you, and I want to congratulate you on your private member's bill, on your personal recovery, and on your advocacy of that in supporting those who are working so hard to live drug free.

Obviously, as health minister, I'm very concerned about the impacts of marijuana smoking on kids in Canada, and you know, from the committee study that you did, the severe health impacts. Marijuana is an illegal drug for a reason. It's illegal because it's very harmful and it does have serious health effects on youth. This committee heard that loud and clear, and when I had an opportunity to bring together health stakeholders from the mental health and addictions field, they talked about their concerns around the proliferation of marijuana and how many young people were exposed to it who didn't know enough about how this could harm them. I asked, “What is the one thing I could do to help you in the work that you do?” They said, “We want a smoking cessation campaign, a national campaign.”

What we committed to doing was an ad campaign so that we could get to parents and kids, get that information to them. That's what we did, and we targeted the issue of marijuana and prescription drug abuse. It was very effective because a lot of parents said, “You're kidding. I didn't know that this stuff that's out on the streets is something like 500 times stronger than it was when I was a kid”, and there are all of these health impacts, whether it's the early onset of psychosis or schizophrenia, obviously decreased IQ, and many of the things that you heard from the committee study.

We know that especially in youth the evidence is irrefutable, so we have to get that information out there. I would quote the current Canadian Medical Association president who said, “Any effort to highlight the dangers, harm and potential side effects of consuming marijuana is welcome”.

We'll continue to do that.

What do I think of Mr. Trudeau's idea of legalizing marijuana? I don't like it. I've seen what's happening in Vancouver where pot dispensaries are selling pot to kids, well, to a 15-year-old the other day who ended up very sick and overdosed. I think making a harmful drug more accessible and normalizing it by selling it in storefronts is a very bad idea. I don't know how, as health minister, I could think in any other way. This has a serious health impact on young people. I think parents need to educate themselves and think very clearly about what kind of city they want to live in, and make that known to those who are making these decisions. I think it's irresponsible.

We clearly have heard from communities and parents across Canada that home grow ops pose a public health issue, but more so a public safety issue, so we have fought to shut those down. We've passed regulations to shut down home grow ops. Of course, we're now fighting the courts because the courts have put an injunction in place, and we'll continue to fight that in court. We don't think home grow ops are a good idea. We've heard from the police, from the firefighters, and from parents in neighbourhoods that they don't want marijuana grow ops in their neighbourhoods, and we'll continue to fight that fight.

We know that a UNICEF report a few years ago said that Canadian youth were the number one users of marijuana in the world per capita, and that was very concerning. We have really made an effort in schools and in other ways to reach out to young people in our ad campaign. I was very pleased about a recent report that, according to the Canadian Centre on Substance Abuse, there is a decrease, from what I understand, in the number of kids using marijuana, so that's a good thing. The strategy is working. This idea that, if we make it legal, somehow kids will use less, makes absolutely no sense to me. I think we have to keep warning kids about the dangers of it and parents as well so that they have that conversation with their kids and keep it away from them.

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

Quickly, Minister, another passion of mine with regard to addiction is that I was adamantly and I continue to be adamantly opposed with regard to drug injection sites. I think in my humble opinion, we're enabling and we're not dealing with the problem, which is getting them off of the drug and providing addiction recovery services to them.

I wonder if you could just speak to that bill with regard to injection sites. It's moving through the Senate right now. It's having some difficulties with the opposition opposing it, and I wonder if you could just speak to that for a few minutes.

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

Sure. I actually had a good meeting with the Senate yesterday. Most members, Liberal and Conservative, thought the bill was a good idea, so I find it odd that in the House of Commons the opposition is not willing to support a bill that is in line with the framework we have created to respect the ruling of the Supreme Court in relation to injection sites.

At the end of the day, when people ask why you would not support Justin Trudeau's idea of opening injection houses across the country without having to consult with people, I say, “What is this?” It is an exception under the Controlled Drugs and Substances Act to allow illegal heroin that's brought in off the street to be injected in a location. Let's remember what that means. That means the police need to think about what kind of criminality might occur around that site. We need to have municipalities prepared to deal with any issues that might happen around a site like that. We need parents to know about it. We need the neighbourhood to support it. We need the province and the public health authorities to be ready to deal with it and to actually put resources around supporting those who are addicted. Prevention—we want them to have treatment available and safe options available other than using heroin. There are so many things that go into that, and that's the framework we have put in place.

The most important thing is public consultations. I don't understand why the other parties are opposed to publicly consulting with neighbourhoods, police, public health authorities, provinces, around the location of an injection site.

[The Chair, Conservative, Ben Lobb]

Thank you, Minister. We're a little over time.

Ms. Morin, go ahead,

you have five minutes.

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

Okay. Thank you, Mr. Chair.

I'd like to talk about the Canadian Food Inspection Agency. In April, a slew of articles came out about the shortage of inspectors.

Minister, you told us that the funding had not been reduced but, in fact, raised slightly. In your presentation, you mentioned that a secure Web platform would be used to share information. That's a positive measure. But does the government also intend to hire more inspectors?

According to Bob Kingston, the president of the Agriculture Union, which represents federal inspectors, the government is really cutting corners when it comes to food safety. More and more, the responsibility for food inspection is falling on companies. In Montreal and throughout Quebec, a minimum of 45 inspectors are needed, but there are only 30. Overall, 10 inspectors are lacking when it comes to satisfying the required minimum number of inspectors at a number of meat-processing plants. Has any money been set aside to hire new inspectors? This is, after all, an issue that has a tremendous impact on Canadians.

My understanding is that meat intended for export to the U.S. is inspected on a daily basis, while meat for Canadian consumption is inspected just three times a week.

I'd like to know the reason for the double standard. Why, under the budget, is meat for Canadian consumption subject to less inspection than that intended for U.S. consumption?

Are there plans in the budget to do away with that double standard?

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

Thank you.

First of all, I reiterate the fact that Canada has the safest food system in the world, and that includes putting it up against the United States. In terms of investments, there are absolutely no cuts.

I understand the head of a union has made the claim that there are cuts, but the president of the CFIA has said there are none. So while Mr. Kingston wants to grandstand, I would just refer him to the actual budgetary numbers and he'll see there are absolutely no cuts. In fact, we have now invested almost $1 billion—

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

Actually, he hasn't necessarily said that there are cuts but, rather, that there aren't enough inspectors.

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

Again, he's wrong. He said there were cuts. We've invested almost $1 billion. In the last budget we invested $400 million that will result in CFIA hiring over 200 more front-line food safety inspectors. Again, as another opportunity for making sure that our food safety system is strong, we've also—

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

There's a processing plant—

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

Can I answer your question?

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

Yes, but I want to give you a real-life example. There is a processing plant in Montreal West.