Health Committee on May 28th, 2018

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Is this for acquiring data about the circumstances out there, or is this for disseminating information about diabetes in the community?

[Gerry Gallagher]

This is a tool intended to understand at a baseline level the large range of health inequalities in Canada. As I said, diabetes is one of those conditions that can be.... Data from a variety of sources is gathered in that tool. As far as tools for Canadians are concerned, there are a number of things that complement that. One is a guide for Canadians on diabetes, and this is available. It describes the different types of diabetes and risk factors for that.

The other thing that I would refer to is called CANRISK, which is an early detection tool available in most pharmacies across the country. I mentioned that in my remarks.

[The Vice-Chair, Conservative, Marilyn Gladu]

Thank you.

Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Madam Chair.

Also, thank you, Madam Sidhu, for bringing this important issue on diabetes to our committee.

I had the honour a number of years ago, when my hair was a bit darker, to serve as the aboriginal relations minister in Alberta. I knew the prevalence of diabetes back then was extremely high, and it continues to be.

Ms. Gideon, you talked about some of the treatments that are offered to on-reserve indigenous people, things like test strips, medical supplies, and 12 types of diabetes medications. Are insulin pumps offered to the aboriginal indigenous communities as well? Are they also offered to people who are off-reserve?

[Valerie Gideon]

Yes.

Anybody who is a registered first nation or recognized in it, regardless of where they live and regardless of their income, receives coverage under the non-insured health benefits program.

[Len Webber, Conservative, Calgary Confederation, AB]

Do you have any idea of the cost of an insulin pump for an individual?

[Valerie Gideon]

I don't know but we can follow up for sure.

[Len Webber, Conservative, Calgary Confederation, AB]

I'm just curious about that.

That's for on-reserve indigenous first nations, and off-reserve as well.

[Valerie Gideon]

Yes, it's for off-reserve as well. But it's for registered first nations and recognized Inuit.

[Len Webber, Conservative, Calgary Confederation, AB]

This is a question to anyone else here on the panel who can answer this with regard to insulin pumps throughout the country. Are they offered now? I know back then they weren't. We worked hard in Alberta to get that coverage. Are insulin pumps, along with test strips, covered right now throughout the country?

[Dr. Alfred Aziz]

I wouldn't know the answer to that question. I know that we are responsible at Health Canada for approval of these types of products under medical devices, for example. Their availability around the country depends, first of all, on their approval. I'll get back to you on that. In terms of whether they are available in the provinces and where they are available, etc., that would be under provincial jurisdiction.

[Len Webber, Conservative, Calgary Confederation, AB]

Yes, it's under provincial jurisdiction. That's right. I thought maybe you might have known.

To continue with Ms. Gideon, you also talked about transportation and accommodation for on-reserve indigenous individuals to go into a centre to seek treatment. Is it quite a popular item that indigenous people certainly take advantage of? Is it something that would require more funding than what's there now, or are things working okay with that?

[Valerie Gideon]

In the last budget 2018, we were able to rebase the non-insured health benefits program and also allow for growth to accommodate growing demand and need. It is a needs-based program so it's very difficult as it's not capped. The government has accommodated that growth at this time. Medical transportation is an extremely large benefit. It's the second-largest benefit that we offer. It is very highly utilized; however, the unfortunate piece of that is that where the provincial health systems there has been a centralization of certain services within urban centres, it means that community members unfortunately have to travel farther distances. We always try to encourage joint planning between indigenous peoples and provincial health care systems so that they can talk about where the services could be located. More and more, first nations are interested in creating their own health authorities or bringing services closer to home. Dialysis, as an example, is a service that can really disconnect family members from their families and from their communities and can be a significant hardship for families. While we would offer medical transportation and accommodation in urban centres, it's definitely not the best solution. The best solution is to offer as many services as possible close to home for those clients who have chronic disease.

[Len Webber, Conservative, Calgary Confederation, AB]

Great.

A number of our panellists at the last meeting talked about a national diabetes strategy and how important it is to have a strategy.

Ms. Gideon, what should be the key elements for a national diabetes strategy for indigenous Canadians? What would you throw in there?

[Valerie Gideon]

That's a big question.

I will humbly say that in the past, the chronic disease prevention framework that was developed with the first nations—now the Inuit have their own, really, and copies of that could be provided to the committee—essentially was a program-by-program approach in communities and health care systems. People would get lost if they weren't caught by one program or another, so this is about creating a continuum of services along a lifespan, with culture as the foundation. Indigenous people certainly share that aspect of it.

It's also about looking at that connection to the social determinants of health. For instance, if a mom is pregnant and gets a prenatal visit, there is also education provided to her about healthy living for herself; planning for the family to have healthy nutrition; preparing for baby to come; continuing that follow-up when baby comes; and, making sure she's attending public health sessions with respect to healthy living and doing it within that context. Then, when her child goes to an aboriginal head start program, there's nutrition education in the program, so that when they're at the preschool level, kids are informed about what types of healthy foods are available to them and how they should seek out the connection to oral health. There's a connection between nutrition and oral health as well; we have the children's oral health initiative.

Really, it's not so much a diabetes strategy. People have moved away from one disease-specific or illness-specific western medical model of strategy development and more into this holistic framework approach. We have one for mental wellness. It's the same concept with chronic disease.

[Len Webber, Conservative, Calgary Confederation, AB]

That's excellent.

Again, Ms. Gideon, with respect to culturally relevant treatment, can you give me some examples?

[Valerie Gideon]

Well, in the language, in the indigenous language for sure, and also in having more of a verbal type of relationship versus a written one, in telling stories in nutrition education, and in having community sessions that connect and bring elders and youth together and doing that on the land. Those are some examples.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you.

[The Vice-Chair, Conservative, Marilyn Gladu]

We'll go now to my colleague Don Davies for seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, witnesses, for being here. You've already had a positive impact. It's the first meeting I've been to where there are no cookies. I've never seen such healthy snacks.

[Voices]

Oh, oh!

[Don Davies, NDP, Vancouver Kingsway, BC]

At the last meeting, we heard from some witnesses from Diabetes Canada. The word that was used there for the 2013 Auditor General's report regarding the underperformance of the diabetes strategy was “scathing”. I'm going to quote from the report from 2013. It says:

While the Public Health Agency of Canada has collaborated with the provinces and territories to address common risk factors for chronic diseases, such as childhood obesity, its management practices for delivering programs and activities under the Canadian Diabetes Strategy are weak. It has not defined a strategy, priorities, performance measures, deliverables, timelines, and expected results to effectively deliver programs and activities. Furthermore, the Agency has not coordinated its diabetes activities internally. As a result, the Agency does not know whether its activities have had an impact on the well-being of people who live with diabetes or who are at risk of developing the disease.

I'd like to fast-forward to 2018. How successful have we been in addressing those concerns? Where are we at today?

[Gerry Gallagher]

I can begin.

What I can say is that over the last number of years, starting in 2010, there has been a real shift towards a more integrated approach for chronic disease prevention. Valerie spoke to that earlier. A number of changes were under way in that time period. We have seen a much stronger emphasis on performance management and reporting, with very clear indicators. Looking at our grants and contributions program as an example, we're looking at the number of participants and what we're seeing in terms of concrete behavioural changes when looking at physical activity and healthy eating. We also have much more rigorous processes in place in terms of where those funds are allocated so that we can track it over time.

As far as the issue of coordination goes, we work closely with Health Canada, Indigenous Services Canada, and the provinces and territories. We have also made great strides in working outside the health sector. This is consistent with where the global direction is going, which is to move away from disease-specific strategies into looking more at the risk factors that are common to the major chronic diseases, or what we call the “four-by-four”. In particular, the agency focuses on three of those, which are unhealthy eating, physical inactivity and sedentary behaviour, and tobacco reduction.

[Don Davies, NDP, Vancouver Kingsway, BC]

Could you give me some sort of sense of where we are? If 2013 were ground zero in terms of all those criticisms, where are you today? Are you halfway there, three-quarters of the way there, 25% of the way to where you want to be? Give me a sense of the progress that has been made since that report.

[Gerry Gallagher]

On each of the dimensions of the report, there has been significant progress made. As I mentioned, from the perspective of strategy development, we use an integrated strategy for healthy living and prevention of chronic disease. That is articulated.

As far as the coordination of efforts, we do have mechanisms in place. There were some recommendations around surveillance and how we collect that data. There have been good gains made in that area.

The other area was around information to the public. I talked earlier about CANRISK. I talked about “Your Guide to Diabetes”. We've talked about the guidance to practitioners in primary care settings.