Health Committee on June 7th, 2018

[The Chair, Liberal, Bill Casey]

We'll bring our meeting to order.

Welcome, everybody.

This is meeting 109 of the Standing Committee on Health, and today we welcome the Honourable Ginette Petitpas Taylor, Minister of Health.

I wanted to point out to you, Minister, that we put out a red carpet for you and some flags just to make sure you were welcome. That's in appreciation of your coming so early in the morning.

Along with the minister, we have, from the Canadian Institutes of Health Research, Adrian Mota, Associate Vice-President; from the Department of Health, Mr. Simon Kennedy, Deputy Minister; from the Canadian Food Inspection Agency, Mr. Paul Glover, President; and from the Public Health Agency of Canada, Dr. Theresa Tam.

Welcome back.

There's just one small change. The Liberals have asked if they could shorten their questions a little. Their first two questions will be shortened to five minutes so that Ms. Sonia Sidhu could have an opportunity to ask some questions, but they'll still have the same amount of time as before, and I'll make sure they keep in line.

Welcome to the committee, Minister, and if you have an opening statement, we'd be glad to hear it.

[Ginette Petitpas Taylor, Liberal, Minister of Health]

Thank you very much, Mr. Chair.

Thank you to each and every one of you for coming in bright and early this morning. I know it's perhaps a bit of an odd time to come in, but we certainly wanted to make sure that we had an opportunity to respond to some of your questions and to appear for the main estimates.

Hello, Mr. Chair and members of the Standing Committee on Health.

Thank you for inviting me to speak to you about the votes in the 2018-19 Main Estimates for Health Canada and some of its priorities.

First of all, I would like to congratulate the committee on its work and accomplishments. The government and I value its expertise on health matters.

All standing committees work hard, but I have to say that the Standing Committee on Health does outstanding work.

First, I wanted to introduce my colleagues, but you've done that already, so I will pass along and continue with my comments.

Over the next few minutes, I would like to highlight some of the portfolio's key proposed expenditures for the 2018-19 fiscal year. I would also like to discuss our actions on some of the issues that this committee will address in its work over the coming months. I will then be pleased to take some of your questions.

Let me begin by giving you an overview of Health Canada's planned initiatives.

The department is seeking $2.2 billion in spending authority for 2018-19. This funding will enable Health Canada to continue to protect the health and safety of Canadians. As you know, the budget no longer includes the First Nations and Inuit Health Branch, which has been transferred to Indigenous Services Canada.

I will now outline some of the government's priorities for health and describe what Health Canada is doing to follow through on them.

Let's start with Canada's actions on the opioid crisis. As you all know, this crisis is certainly unprecedented, and the effects are truly heartbreaking. One of the first trips I made as Health Minister was to Vancouver, where I toured the Downtown Eastside to visit treatment centres and supervised consumption sites. It was very moving.

I was proud that our government is taking action. We have restored harm reduction as a key pillar in our strategy. We have approved more than 25 supervised consumption sites and passed the Good Samaritan Drug Overdose Act. We have supported national treatment guidelines for opioid use disorder, and we've made it easier for health professionals to provide access to methadone and prescription-grade heroin as treatment options.

Continued federal actions combined with reduced barriers to treatment will help us mitigate the opioid crisis.

I will now turn to cannabis.

As you know, the government wants to protect Canadians and minimize the harmful effects of cannabis consumption. That is why it introduced Bill C-45, which is currently being considered in the other house.

In these estimates, we are seeking $65.1 million for the implementation and application of a federal framework to strictly regulate cannabis. In addition to developing a regulatory framework, the government has made public education a cornerstone of its approach to cannabis, the ultimate focus of which is public health.

We want to give Canadians the information they need to make informed choices.

Another priority for our government is ensuring that Canadians have access to the health care services they need. That is why our government is working with the provinces and territories to ensure that health care systems continue to respond to the needs of Canadians. In the 2018-19 main estimates, we are requesting $850 million in funding to support provincial and territorial investments in home care and mental health care.

As you know, last summer, provincial and territorial governments agreed to a common statement of principles on shared health priorities with the Government of Canada. Now, Health Canada is establishing bilateral agreements with each province and territory to determine how they will use the federal funding included in these estimates to improve access to home care and mental health services.

We are also making great strides on another important issue, pharmacare.

In the 2018-19 Main Estimates, we are seeking $17.9 million to improve the affordability and appropriate use of prescription drugs and medical devices. This amount will allow us to strengthen regulations on the price of patented drugs and modernize the way we regulate prescription drugs and medical instruments.

We also want to protect Canadians, governments, and private insurance companies against exorbitant drug costs, while ensuring that patients have access to the drugs they need. These efforts are in line with and contribute to the key measures announced in Budget 2018, in particular the creation of an advisory council on the implementation of a national pharmacare program.

Mr. Chair, in April you tabled the committee's report entitled “Pharmacare Now: Prescription Medicine Coverage for all Canadians”. I would like to thank you and the committee members for all the work that went into producing this excellent report. I am confident that it will be helpful to the advisory council.

Today, I also want to highlight the progress made by the agencies of the health portfolio. Let me begin with the Canadian Food Inspection Agency.

Overall, the estimates for this agency have decreased marginally over the last year. Beyond these estimates, budget 2018 provides $47 million to maintain CFIA's efforts to improve food safety. Specifically, this funding will support activities to address food safety risks before Canadian consumers are affected.

This includes improving risk intelligence and oversight, developing offshore prevention activities, and improving business compliance with food safety regulations. Budget 2018 also provides $29 million for continued support for CFIA's activities related to the negotiations of export conditions and the certification of Canadian exports against the import requirements of other countries.

I will now turn to the Public Health Agency of Canada.

The votes for the Public Health Agency of Canada in the 2018-19 Main Estimates represent an increase of $17.2 million, bringing its total budget to $589.2 million. This increase is primarily for the creation of the Harm Reduction Fund, which will support community projects to help reduce rates of infectious diseases, such as HIV and hepatitis C, among people who use drugs, and provide new funding for the effects of climate change on public health.

As you know, one of the government's key priorities is to understand and mitigate the health effects of climate change. The funding requested in the main estimates reflect this priority.

The Canadian Institutes of Health Research, also known as CIHR, supports world-class health research in Canada. CIHR's proposed spending on health research for 2018-19 is approximately $1.1 billion, an increase of $16.8 million over the 2017-18 main estimates. These estimates will help provide the evidence needed to make better health care decisions and ultimately improve health outcomes for Canadians. By supporting the Canada 150 research chairs program, this funding will enhance Canada's performance and reputation as a global centre for science, research, and innovation excellence.

In closing, I would like to say that I am confident that the measures outlined today will help Health Canada carry out its mandate, which is to maintain and improve the health of Canadians. This is a very broad mandate and we face headwinds at times, so it is essential for us to have clearly defined priorities with targeted measures.

The commitments announced in the main estimates reflect our most pressing health priorities. They show that we are taking action. They reassure Canadians that we will continue to protect and improve our health system.

Once again, I want to thank the committee for the opportunity to provide comments, and I will be pleased to take some of your questions. I have my officials with me, so I may rely on them for a bit of assistance if your questions get technical.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

That's quite a list of issues you're dealing with. It's amazing.

We'll go to our question period now, starting with Dr. Eyolfson for five minutes.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you, Minister, for coming before the committee at this early hour. We appreciate the accommodation.

As you know, we've spent a lot of time over the past couple of years preparing the report on pharmacare. One of the biggest items in the discussion is the numbers involved.

We had the Parliamentary Budget Officer report, and we had information from the Canadian Institutes of Health Research. I was concerned about some of the information in the dissenting report by the opposition party, claiming that, according to the Canadian Institutes of Health Research, $39.8 billion a year is spent on prescription drugs. In fact, this figure of $39.8 billion includes prescription and non-prescription drugs. As we've said, we weren't thinking of covering non-prescription drugs under a national pharmacare program.

Again, at committee, the PBO analyst, citing Canadian Institute for Health Information data, said that “public spending on prescription drugs accounts for roughly 43% of total prescription drug spending in Canada”. “The total spending on prescription drugs”, according to that PBO testimony, “is just over $29 billion”, as opposed to the $39.8 billion.

It appears that this dissenting report has a lot of incorrect information. Has it impacted any of your decisions on implementing a pharmacare program, or the advisory committee by Dr. Hoskins?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

As we've indicated very clearly, our government certainly recognizes that Canadians pay too much for drugs. That's why we were extremely pleased to see the announcement in budget 2018 that we were creating an advisory council on the implementation of a national pharmacare program.

I also want to take this opportunity to thank the health committee for the wonderful work they have done and for really looking into this issue. They have done tremendous work in this area, and I have to say that the advisory council's first work will probably be to review the report. I know that Dr. Hoskins has already done so, but we certainly want to make sure the council builds on the good work that's already been started by this committee.

We have made it very clear that we want Dr. Hoskins and the advisory council to present us with options with respect to a national pharmacare program, and also with an implementation plan for moving forward. We have no preconceived ideas with respect to what this pharmacare program will potentially look like. We certainly want to serve the needs of Canadians.

As I've indicated, we recognize that Canadians pay too much for drugs and that many Canadians have to make choices between food and drugs, or heating their home and drugs. Having been a front-line social worker for a number of years before I entered politics, working with many individuals who did not have access to a drug plan, I've certainly seen the realities first-hand. We Canadians are proud of our publicly funded health system, but we certainly recognize that we can do better. The implementation of a pharmacare program would certainly make things better for Canadians.

I'm looking forward to the work the advisory council is going to be doing, and to receiving their report by the spring of 2019.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

To further elaborate on this, of course, there's sometimes a public perception, with this number of $33.9 billion a year going out, that the federal government would somehow need to find an extra $33.9 billion a year. However, according to our testimony as well, $12.9 billion a year is already being paid by provincial taxpayers through their different systems. From the PBO report, there would be an additional savings of $4.5 billion just through a national drug-buying program. National pharmacare would also basically make a number of other expenses obsolete. If you're paying for medications, tax credits cost the federal government $2.5 billion a year, which would likewise be unnecessary, if people weren't paying for medications.

What would be your comments on this being a much more sustainable program, given all these savings that have been mentioned in the report?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Again, that is why we're putting in place an advisory council. As I've said, they can really build on the work this committee has done, in order to provide us with information with on an implementation model.

We also have to recognize that the Government of Canada has taken some steps to reduce the price of drugs within this country. If I look at the investments that have been made in budget 2017, we have invested over $140 million over five years to provide Health Canada agencies with the tools they need to reduce the price of drugs. We've also joined provinces and territories, as members of the pan-Canadian Pharmaceutical Alliance, in which we have been able to bulk purchase drugs together to lower the price. As a result, over the past year, jointly we've saved approximately $1.3 billion—the provinces, territories, and federal government together—so we are taking some steps to make sure that the prices of drugs certainly come down. Also, we're in the process of modernizing the Patented Medicine Prices Review Board.

Once again, we are doing some work before we look at a national pharmacare program, because we certainly want to make sure that it will be affordable, but our priority is also to make sure that drugs are affordable and accessible to all Canadians. That is truly why we are moving forward and have taken the steps we did, but are also now looking forward to the work to be done by the advisory council.

With respect to the advisory council, we're just in the process of finalizing the membership of the council members. I'm looking forward to being able to make those announcements in the very near future. To look at the complement of the membership, we really want to make sure that we have individuals from different backgrounds to provide us with the proper information and advice we need for implementation.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now, we go to Ms. Gladu.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Chair, and thank you to the minister and her staff for appearing today.

My first question is in memory of the late Gord Brown, who passed away recently and who we all know was a passionate advocate for thalidomide survivors.

In budget 2018, the government committed to addressing these remaining thalidomide claims. Could the minister update us on what action has been taken to resolve those?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Thank you very much, Ms. Gladu. I truly appreciate the question.

When I became the health minister, I had the privilege and the opportunity to meet some of the recognized victims of the thalidomide compensation package that was provided, and I certainly was able to see and to hear first-hand the challenges these individuals have to go through day in and day out. Our heart certainly goes out to these survivors. Also, I had an opportunity to meet with some individuals in my riding, who have not been named survivors for the lack of a better word.

In budget 2018, I was pleased that an amount of money has been put forward to ensure that we can expand the eligibility criteria for the program. We are in the process of working on that and, within the next weeks and months, I'm truly looking forward to making an announcement on the next steps forward with the expansion of the eligibility criteria for that program.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Good. We hope to hear how many people are remaining and how many will actually receive their compensation.

The second question I have is about palliative care because, as you know, I'm a passionate advocate of palliative care. How much is in this year's budget to address the need for consistent access to palliative care for all Canadians?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Once again, Ms. Gladu, we were very pleased, as the government, to be able to support your bill, Bill C-277, and we're very keen to move forward on its implementation and the work that needs to be done in that area.

We certainly recognize that all Canadians want to stay home as long as they can, but to do so, we certainly need to make sure they have the quality care and necessary care they need to live the rest of their days in comfort. Those support services are absolutely critical. We are very pleased, as I've indicated, to support Bill C-277 and to work on the development of a framework that promotes palliative care.

I was also very pleased that we were able to make some announcements this year, and I believe you were with me for the funding announcement of $6 million for Pallium Canada. Those monies were put in place to expand existing services, called the learning essential approaches to palliative care program. That money will go specifically to front-line service providers, like ambulance attendants or EMTs, to provide them with the training they need so that when they go to homes, especially in rural areas where they can provide direct services to people at home, they will be able to provide people with the additional quality services they need so they won't have to go to community centres or hospitals to receive those services. We're certainly moving forward in that direction and making sure that investments are made in that area.

I was also pleased that we've invested $184.6 million over the next five years to improve home palliative care for indigenous communities. We recognize that an awful lot of work needs to be done in that area, and we certainly recognize that those investments will help moving forward.

Finally, we recognize as well that research is key in this area, so we're investing over $2.8 million over the next four years to support two research teams, which I'm sure you're probably well aware of. We certainly want to generate high-quality research and evidence to inform professionals in health care with respect to best policies as we move forward in end-of-life care and the policies that we need to put in place.

Finally, Mr. Chair, with respect to the investments that we've made in home care in budget 2017, $6 billion has been put aside, and I'm in the process right now of completing bilateral agreements with provinces and territories. In the ones that I have seen thus far, palliative care services are absolutely mentioned in those, as well. They may not be a line item in the budget, but we certainly know that provinces and territories, especially with our aging population, and people who want to make sure they expand palliative care services see it as a priority.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Excellent.

[The Chair, Liberal, Bill Casey]

Do you want to split your time with Mr. Lobb?

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you very much.

Thank you, Minister, for appearing.

I have a document here. It's a request that Health Canada sent out. It's the cost-benefit analysis survey that you've sent out to food processors. In it, your department asked, as per Treasury Board guidelines, that they provide a cost-benefit analysis, which I think would amount to Bill S-228. In there you're asking many, many questions that I think industry is very uncomfortable with, and one of them is that the cited costs not include costs related to the reformulating of food.

I'm just curious. If you're asking industry to provide a cost-benefit analysis of marketing, etc., shouldn't the cost of reformulating their goods also be included in the cost-benefit analysis? My understanding is that it costs the industry almost $2 billion to do this, and I'm just wondering if you could provide some comment as to why your department would do this.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

I have to start by indicating that our healthy eating strategy was launched in 2016, which is the part—

[Ben Lobb, Conservative, Huron—Bruce, ON]

I am aware of that. It's specifically the cost-benefit analysis question I am interested in.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

With respect to the issue of marketing to kids, that is certainly a priority of our government. It's one of our pillars when we look at our healthy eating strategy. I would be more than happy to ask one of my officials to perhaps provide a bit more information on the details.

[Simon Kennedy, Deputy Minister, Department of Health]

The Treasury Board sets out fairly detailed guidance on how these cost-benefit assessments are to be conducted—

[Ben Lobb, Conservative, Huron—Bruce, ON]

I understand. I'm asking specifically, though, about the reformulating of food, because that is going to be a massive cost to industry.

[Simon Kennedy]

My sense on that—and I'll have to get back to the committee formally—is that the decision on whether or not to reformulate in order to avoid the restrictions is a business decision. There's no requirement in the new marketing rules that would require a business to reformulate. That decision is entirely within the discretion of the management of the firm, and so it's not a cost you can calculate as part of the cost-benefit analysis.

[Ben Lobb, Conservative, Huron—Bruce, ON]

If you change the rules for a company that manufactures food, and a large—

[Simon Kennedy]

Mr. Chair, the rules are not with respect to the formulation of the food. The rules are with respect to what can and can't be marketed.

If a firm decides that it wishes to reformulate its product so that it can continue to market, that's a business decision. That's not a requirement of the regulations.

[The Chair, Liberal, Bill Casey]

Okay.

We have to move on to Mr. Davies now.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you, Minister and staff, for being here at this early hour.

Minister, of course you know that, after two years of study and hearing from almost 100 witnesses and receiving more than 30 written submissions, this committee released our final report, called “Pharmacare now: prescription medicine coverage for all Canadians” on April 18.

After consideration of many different policy proposals, this committee concluded that the best way to move forward is by expanding the Canada Health Act to include prescription drugs dispensed outside hospitals as an insured service under the act—in other words, to make pharmaceuticals part of our single-payer public system. That was the considered recommendation after two years of study at this committee.

I'm interested if, as health minister, you agree with that recommendation.