Evidence of meeting #108 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was food.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Gerry Gallagher  Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
Valerie Gideon  Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada
Alfred Aziz  Chief, Nutrition Regulations and Standards Division, Department of Health
Jennette Toews  Chief, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
Roslynn Baird  Chair, National Aboriginal Diabetes Association
Agnes Coutinho  Past Chair, National Aboriginal Diabetes Association
Melanie Henderson  Pediatric endocrinologist and Associate Professor, Centre hospitalier universitaire Sainte-Justine

3:30 p.m.

Conservative

The Vice-Chair Conservative Marilyn Gladu

Good afternoon. Welcome to meeting number 108 of the health committee. Today we are going to be studying diabetes strategies in Canada and abroad.

I want to take the opportunity to welcome Terry Beech and Peter Fragiskatos, who have joined our committee members today.

We have some excellent witnesses with us. From the Public Health Agency of Canada, we have Gerry Gallagher, executive director of the centre for chronic disease prevention and health equity, health promotion and chronic disease prevention branch; and Jennette Toews, chief, centre for surveillance and applied research, health promotion and chronic disease prevention branch.

Along with them we have Alfred Aziz, chief, nutrition regulations and standards division, Department of Health; and Valerie Gideon, senior assistant deputy minister, first nations and Inuit health branch, Department of Indigenous Services Canada.

The Public Health Agency of Canada and the Department of Indigenous Services will each have seven minutes to present to the committee.

We'll begin with Gerry Gallagher.

3:30 p.m.

Gerry Gallagher Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Thank you for the opportunity, Madam Chair, to address the standing committee with regard to the Public Health Agency of Canada's role in addressing diabetes and other chronic diseases in Canada.

Our role is threefold: to obtain data to better understand the patterns and trends related to chronic diseases; to gather, generate, and share evidence to inform policies and programs; and to design, test, and scale up innovative interventions to prevent chronic disease. We do this in collaboration with partners from within and outside the health sector.

Diabetes, as you know, is a chronic condition that affects Canadians of all ages. Each year, close to 200,000 Canadians are newly diagnosed with diabetes, and approximately 90% of those have type 2. Currently, about three million Canadians are living with diagnosed diabetes, and with the growth and aging of the Canadian population, the number of Canadians living with diabetes is expected to continue to increase in the coming years.

Some Canadians are at increased risk of diabetes, such as first nations, Métis peoples, and immigrants. There are higher rates of diabetes among Canadians with lower incomes and education. For example, if the prevalence of diabetes among adults who have not completed high school were as low as that of university graduates, we would see 180,500 fewer cases of diabetes in Canada.

Diabetes and many other chronic diseases, such as cancer, cardiovascular disease, and chronic respiratory diseases, are largely preventable. Scientific evidence demonstrates that by eating healthier, increasing physical activity, not smoking, and moderating alcohol use, the onset of many chronic diseases can be prevented or delayed. That is why the Public Health Agency of Canada takes an integrated approach to promote healthy living and prevent chronic disease.

Through our health surveillance function, we are able to better understand the impact of chronic diseases and risk and protective factors. For instance, in collaboration with all provinces and territories, we conduct national surveillance of diabetes and 20 other chronic conditions to support the planning and evaluation of related policies and programs.

The Pan-Canadian Health Inequalities Reporting Initiative includes new insights into how diabetes impacts different groups of Canadians in different contexts. Products include an interactive online data pool and a narrative report on key health inequalities in Canada. This initiative is a partnership between the Public Health Agency of Canada, the provinces and territories, Statistics Canada, the Canadian Institute for Health Information and the First Nations Information Governance Centre.

We recognize that innovative solutions and partnerships with health and other sectors are needed to better address the complex challenges of chronic disease prevention. The Canadian Task Force on Preventive Health Care develops evidence-based clinical practice guidelines to support Canadian primary care providers. The Task Force published recommendations on screening for type 2 diabetes in 2012. The Public Health Agency of Canada funds and provides scientific support to this independent arms-length body.

To help Canadians understand their risk factors and motivate them to make lifestyle changes to prevent diabetes, the Public Health Agency of Canada has developed CANRISK. It is a questionnaire that provides an individual risk score and guidance on how to reduce risk for diabetes. CANRISK is accessible to Canadians through partnerships with Diabetes Canada as well as with Shoppers Drug Mart, Pharmasave, Rexall, Loblaws and others.

Since its launch in 2013, our multisectoral partnerships approach to promote healthy living and prevent chronic disease has invested $73 million and leveraged another $57 million in non-government sources to support innovative interventions that address the common risk factors that underlie major chronic diseases, including diabetes.

For example, Play for Prevention is a Right to Play and Maple Leaf Sports Entertainment Foundation project, which uses an activity-based approach to youth empowerment to address diabetes prevention in urban indigenous peoples. Trained community mentors plan and lead events that have engaged over 1,000 children and youth in 16 cities across Ontario, Alberta, and British Columbia in helping active lifestyle programming.

The healthy weights initiative is a culturally adapted community-specific partnership with Alliance Wellness and Rehabilitation Inc., the YMCA, and the University of Saskatchewan. It is an evidence-based program for adults, which includes physical activity support, nutrition education, and social supports. It has demonstrated significant improvements to address unhealthy weights and encourage a healthier lifestyle.

In addition, budget 2018 proposed to provide an additional $25 million over five years, starting in 2018-19, for Participaction to increase participation in daily physical activity among Canadians.

The Public Health Agency of Canada works closely with Government of Canada partners such as Health Canada and Indigenous Services Canada.

Scientific research has established again and again that poor diet is a primary risk factor for these conditions. This is why Health Canada launched the comprehensive Healthy Eating Strategy in October 2016. This is made up of complementary mutually-reinforcing initiatives which will make it easier for Canadians to make healthier choices for themselves and for their families. The strategy includes important mandate commitments to promote public health by restricting the marketing of unhealthy foods to children, eliminating trans fat and reducing salt, and improving labelling on packaged foods, including front-of-pack labelling initiatives.

The Public Health Agency of Canada also collaborates with federal, provincial and territorial partners. For example, since the endorsement by ministers of the Declaration on Prevention and Promotion in 2010, we have partnered on initiatives to promote healthy weights and curb childhood obesity.

We are now working towards a common vision and collaborative approaches to support Canadians to move more and sit less.

In addition, we collaborate globally, contributing to and learning from the global evidence base, as a World Health Organization collaborating centre on non-communicable disease policy.

In closing, I want to thank the Standing Committee on Health for examining diabetes strategies in Canada and abroad. Through data, evidence, tools, innovation, and partnerships, the Public Health Agency of Canada is advancing our collective efforts to prevent diabetes and other chronic conditions among Canadians.

We'd be pleased to answer any questions you may have and look forward to reading your report.

3:35 p.m.

Conservative

The Vice-Chair Conservative Marilyn Gladu

Thank you very much.

Now, we go to the Department of Indigenous Services Canada.

3:35 p.m.

Valerie Gideon Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada

I'd like to start by acknowledging that we're on unceded Algonquin territory today. As a member of the Micmac Nation of Gesgapegiag First Nation in the region of Quebec, I am pleased to have been asked to speak to you today about diabetes and other chronic diseases among indigenous peoples across Canada.

I'll begin by sharing some statistics with you on the prevalence of diabetes among indigenous peoples. Diabetes rates are three to four times higher among first nations than among the general Canadian population and all indigenous peoples are at increased risk of developing diabetes. Results from the last three cycles of the first nations regional health survey indicate that the prevalence of diabetes among first nations adults has remained steady, at approximately 19% to 20% over the past 14 years.

To help reduce the prevalence of type 2 diabetes, Indigenous Services Canada provides funding of $44.5 million annually for the aboriginal diabetes initiative to support community-based health promotion and disease prevention services in over 400 first nations and Inuit communities. First nations communities in British Columbia also receive these services, through support from the B.C. First Nations Health Authority, which took over our regional health-specific operations in 2013.

Indigenous Services Canada recognizes that food security is a critical issue for indigenous peoples and that it significantly impacts the health and well-being of individuals, families, and communities. As part of nutrition north Canada, Indigenous Services Canada and the Public Health Agency of Canada fund and support culturally appropriate community-based nutrition education activities in 111 eligible first nations and Inuit communities. Budget 2017 announced $828.2 million over five years to address key long-standing program gaps and improve health outcomes for first nations and Inuit, in areas such as primary care, home and community care, mental wellness, and many other areas.

As a concrete example, in fall 2017, the Government of Canada provided $19 million over four years to support first nation-led basic foot care services in all Manitoba first nations communities. In partnership with regional leadership councils, the first nations' basic food care program was developed to help clients in 63 Manitoba first nations communities to maintain their health and lower their risks from diabetes-related foot complications.

One significant advancement in the management of chronic disease prevention more generally is the development of a specific framework for indigenous peoples related to the prevention of chronic disease. The framework provides broad direction and identifies opportunities to improve access for individuals, families, and communities to appropriate, culturally relevant services and supports based on their needs at any point along the health continuum.

This framework was mirrored by Inuit Tapiriit Kanatami, which developed a specific framework to address the specific needs of Inuit in Canada.

Indigenous Services Canada has many mechanisms in place to ensure the engagement of partners. For example, engagement protocols were developed with the Assembly of First Nations and the Inuit Tapiriit Kanatami to advance a culture of respect, transparency and reciprocal accountability in support of the First Nations and Inuit Health Strategic Plan. These have been valuable tools for building and maintaining relationships.

There are also partnership tables with first nations and Inuit in every region to support joint planning and priority setting. These tables include bilateral tables, as well as trilateral tables with provincial and territorial governments.

Indigenous Services Canada values a collaborative approach with external indigenous and other organizations to advance health initiatives for first nations and Inuit. For example, in Saskatchewan we've partnered with the Dieticians of Canada on a six-month pilot project for the operation of a dietician call centre, which will provide free access to trusted food and nutrition advice via telephone or email to all first nations communities in Saskatchewan, including more isolated and remote communities.

Through our non-insured health benefits program, a number of diabetes treatment supports are offered.

First, a total of 12 diabetes medications to date are covered, with additional medications pending decision, and are aligned with the Canadian Agency for Drugs and Technologies in Health's recommendations and other public drug plans.

Blood glucose test strips are an open benefit under the NIHB program. As well, a range of medical supplies and equipment is available to support clients facing complications from diabetes, such as wound-care supplies, mobility devices, and prosthetic devices.

Lastly, the non-insured health benefits program provides medical transportation coverage, including accommodations and meals, so that clients can access health services not available to them in the community where they live.

Indigenous Services Canada is working collaboratively with provinces, territories, other federal departments, and with indigenous partners to ensure that data linkages are supported where possible and that health survey data are available to inform health care planning.

More specifically, over the past 17 years, the first nations information governance centre's regional health survey has provided national, on-reserve, and Yukon first nations' prevalence rates of health status and lifestyle risk behaviours.

Through budget 2018, the federal government announced $82 million over 10 years, with $6 million per year ongoing, for the co-creation of a permanent Inuit health survey.

In summary, Indigenous Services Canada is committed to reducing the prevalence of type 2 diabetes and related complications in first nations and Inuit communities across Canada.

While progress has been made, we are committed to continuing to work in partnership with indigenous peoples to address diabetes and its risk factors.

Thank you. Wela'lin.

3:40 p.m.

Conservative

The Vice-Chair Conservative Marilyn Gladu

Thank you very much.

We'll now go to our rounds of questions, beginning with my colleague Mr. McKinnon for seven minutes.

3:40 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Thank you, Chair.

The witnesses may be aware that our committee recently released a report on national pharmacare. We know that part of proper diabetes treatment is the medications that Canadians rely on to reduce their blood glucose levels, and we know that it's essential for diabetics to take their medication.

This is a question for the Public Health Agency to start with. Can you tell us if modern diabetes medications are included across all formularies in Canada and what gaps might exist in diabetes medicine coverage across Canada?

3:40 p.m.

Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Gerry Gallagher

The department responsible for addressing your question is Health Canada.

Dr. Aziz, do you want to address that?

3:40 p.m.

Dr. Alfred Aziz Chief, Nutrition Regulations and Standards Division, Department of Health

I think we can take that to the department, but I want to just make sure that I communicate that Health Canada is responsible for the approval of medications for the treatment of diabetes, and for the review of their safety and efficacy. Anything potentially related to formularies is within provincial jurisdiction. I will take this question back to my department and we'll provide further answers.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Thank you.

I guess I'll pass that question along, as well, to the Department of Indigenous Services.

Under the non-insured health benefits plan, are there any significant gaps? Does it encompass everything it needs to do to provide good coverage for people?

3:45 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada

Valerie Gideon

Yes, that would be our assessment. We follow CADTH recommendations, and we align ourselves with other public insurance plans across the country.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Are you aware of any gaps in public services elsewhere that we might need to know about?

May 28th, 2018 / 3:45 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada

Valerie Gideon

We do have experts in our department who could answer that question in about five seconds, but I apologize that I don't have the comparison of all the PT drug formularies. However, it is information we have and could provide.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

I'm going to stay with you. You mentioned the higher rate of diabetes among indigenous populations. You mentioned it is three to four times higher on reserve than general population, and I have information here that says urban indigenous people have double the incidence of the regular population.

Do you have anything you can correlate that to? What is the cause of that? Is it a genetic predisposition, or is it because this is poorest demographic we have in Canada, or...? What would you suggest is the cause of that?

3:45 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada

Valerie Gideon

Well, I would certainly say that the research has demonstrated that we see more acute health care conditions—through hospitalization data, for instance—from first nations who are living in remote or isolated communities. Diabetes screening, early screening, and prevention are extremely important in those circumstances.

Why has there not been a decline, with respect to prevalence, over the number of years we have been gathering data? We don't have anything conclusive that I can provide to you, but I will say we do believe that the social determinants of health—poverty, food security, the displacement of families, and intergenerational impacts—all would likely contribute to that answer. We don't have conclusive research evidence to provide to you at this time.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

It would suggest, I think, because the incidence is different for urban indigenous people versus those on reserve, that the conditions on the reserve are not generally amenable to improving their health outcomes in this respect. Would that be appropriate?

3:45 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Indigenous Services Canada

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Thank you.

Ms. Gallagher, you mentioned that you expect the incidence of diabetes to be increasing in the coming years. To what do you attribute that increase?

3:45 p.m.

Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Gerry Gallagher

I'll turn to Jennette Toews for our assessment on that issue.

3:45 p.m.

Jennette Toews Chief, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

The prevalence of diabetes is increasing. That's the number of Canadians who are living with diabetes in Canada. However, we are finding that the incidence rate is dropping. In the last 10 years, from 2006 to 2014, there has been a decline in the number of new cases of diagnosed diabetes. We don't know at this point, though, what is behind the drop in incidence.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

To clarify, you're saying that the number of cases is going up, but the incidence is going down. That's because we have a growing population; is that it?

3:45 p.m.

Chief, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Jennette Toews

Yes, it's due to the growing population, our aging population, and the fact that people living with diabetes are living longer.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Okay.

Ms. Gallagher, you spoke of an online data tool to report on various aspects. Could you elaborate on that a bit?

3:45 p.m.

Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Gerry Gallagher

Yes, the pan-Canadian health inequalities reporting initiative has two dimensions. One is an online data tool that looks at more than 70 indicators of health inequality—health behaviours, as well as broader determinants of health. That was made available last year. It's possible to pull up data specific to diabetes in different subpopulations. Just today, there is a release of a narrative report that tells more of the narrative around the top inequalities in Canada, of which diabetes is one. That's something that may be of interest to this table.

3:45 p.m.

Liberal

Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC

Who would use this tool? Is this for the general public, physicians, or medical practitioners?

3:45 p.m.

Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada

Gerry Gallagher

It is a tool that's available, certainly, for planners and health professionals. It is also user-friendly in the sense that it is quite an easy tool to get basic information with several clicks, as far as looking at a condition is concerned or looking at a subpopulation of interest. We also offer webinars to professionals so they better understand how to use this data accordingly.