Health Committee on Dec. 6th, 2018

[The Chair, Liberal, Bill Casey]

I call the meeting to order.

Welcome, everybody, to the 128th meeting of the Standing Committee on Health. Welcome to our guests.

We have a full house today and lots of questions, and I'm sure we'll have lots of answers.

First of all, I want to welcome the Honourable Ginette Petitpas Taylor, Minister of Health and my neighbour in New Brunswick.

Welcome to our committee.

I want to welcome the officials here.

From the Department of Health, we have Simon Kennedy, deputy minister. From the Canadian Food Inspection Agency, we have Paul Glover, president. From the Canadian Institutes of Health Research, we have Michel Perron, executive vice-president. From Patented Medicine Prices Review Board, we have Douglas Clark, executive director. From the Public Health Agency of Canada, we have Siddika Mithani, president, and Theresa Tam, chief public health officer.

My understanding is the minister has to leave at 9:45 or thereabouts. Is that correct?

[Ginette Petitpas Taylor, Liberal, Minister of Health]

I have to open the House, yes. I've been told.

[The Chair, Liberal, Bill Casey]

I urge everybody to keep the questions succinct and the answers succinct. We'll get through this and get as much information as we can. We're going to have one seven-minute round and one five-minute round, and by then I believe the minister will have to leave and the officials will stay and answer questions if we need them to.

Minister Petitpas Taylor, would you like to open with a 10-minute statement?

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

Thank you very much, Mr. Chair.

Good morning, everyone, and thank you so much for inviting me to the Standing Committee on Health.

It's truly important for me to be here today to discuss with you the supplementary estimates (A) for the year 2018-19. I always welcome this opportunity to highlight some of the priorities and to discuss our efforts to keep Canadians healthy and safe. As always, I'm grateful to the committee members for your contributions to discussions, and I look forward to answering your questions.

Before I begin, I would also like to thank my officials who are accompanying me today.

They are Mr. Simon Kennedy, deputy minister of health; Dr. Siddika Mithani, president of the Public Health Agency of Canada; Dr. Theresa Tam, chief public health officer and from the Public Health Agency of Canada; Monsieur Michel Perron, vice-president of external affairs and business development at the Canadian Institutes of Health Research; and last but not least, Mr. Paul Glover, the president of the Canadian Food Inspection Agency.

They are masters in their fields and I am always happy when they accompany me at committee here. Also, I may turn to them for details with respect to some of the questions.

First, I would like to speak to Health Canada's authorities. Through the supplementary estimates (A), we are asking for an increase of $33.5 million. This would raise Health Canada's total authorities to just under $2.4 billion. This increase in funding would allow us to deliver on key priorities of the Government of Canada. I will describe these for you now, starting with opioids.

As Minister of Health, the first file that I was briefed on as Canada's health minister was the opioid crisis.

Since 2016 this crisis has claimed the lives of over 8,000 Canadians. This is a national tragedy that must be stopped, and it's why our government has taken action to save lives and to turn the tide on this national public health crisis.

So far we have restored harm reduction to the core of our approach and opened more than 25 supervised consumption sites. We have implemented the emergency treatment fund through budget 2018, and we are working to reduce stigma, which is a barrier to health and social services for people who use drugs, through public education.

Nevertheless, the opioid crisis continues to take lives and devastate communities. We must do more, and we will do more. These enhanced efforts include Health Canada's substance use and addictions program, which provides more than $28 million annually to support initiatives that work to prevent, treat and reduce all forms of harm from problematic substance use.

As a part of these estimates, this program has realigned $7.3 million to help address the opioid crisis.

Let's turn now to cannabis.

To support the legalization and regulation of cannabis, Health Canada received an additional $500,000 for operating expenditures from the central advertising fund as a part of these estimates for the cannabis pre-legalization advertising campaign.

This funding is a part of our government's significant investment of $108.5 million over six years to support cannabis public education, awareness and surveillance activities. We know that it's essential to invest in public education efforts surrounding the health and safety facts of cannabis, specifically targeting youth, in advance of the Cannabis Act coming into force.

These campaigns began long before legalization. They're intended to give Canadians, especially youth, the honest facts about cannabis, and to put them in a position to make informed, responsible and healthy choices. While healthy choices are the most important part of maintaining good health, environmental factors also have an impact.

Now let's turn to the new impact assessment and regulatory processes.

As you know, our government is renewing the federal impact assessment and regulatory system. The enhanced system will better protect Canadians' health, as well as our environment, fish and waterways. It will also rebuild public trust in how decisions about resource development are made.

This system will apply to all projects that are subject to federal assessment, such as mines, dams, pipelines and marine terminals.

Health Canada is the key federal department positioned to provide expertise on human health impacts of projects like these.

As such, we are requesting $5 million to help transition to the new impact assessment and regulatory processes.

Let's turn now to pay administration. I would now like to turn to an important administrative issue.

As you know, the Phoenix pay system continues to pose challenges for the public service, including employees of Health Canada and its portfolio organizations. For this reason, we are requesting $1.3 million in additional funds to address the issues in pay administration and to help ensure that our employees are paid properly and on time.

I will now speak in more detail about our portfolio organizations, their priorities and their specific requests for funding.

The Public Health Agency of Canada, PHAC, is asking for a net increase of $6.7 million to its authorities. This would bring the total authorities for 2018-2019 to $687.2 million.

This increase includes nearly $5.5 million to support the Aboriginal Head Start in Urban and Northern Communities Program.

This program funds indigenous community-based organizations in urban and northern areas to develop programs that promote healthy development of indigenous preschool children.

The increase we are requesting also includes $1 million to support PHAC's childhood vaccination campaign. This advertising campaign will raise awareness of the importance, safety and effectiveness of vaccination.

As a part of the health portfolio, the Canadian Food Inspection Agency, also known as CFIA, works to uphold a strong and reliable food-safety system.

The supplementary estimates we are presenting today reflect an increase of $9.4 million for CFIA for specific time-limited activities, bringing its total authorities for 2018-2019 to $762 million.

The specific time-limited activities include funding for the Canadian Food Safety Information Network. This network will strengthen Canada's ability to detect and respond to food hazards by connecting and coordinating food safety and public health authorities.

The Canadian Institutes of Health Research, or CIHR, is Canada's health research investment agency. It provides $1 million per year to support Canada's health scientists.

Through these supplementary estimates, CIHR is seeking an increase of $0.4 million, for a total of approximately $1.1 billion in available authorities. This increase will support the creation of new scientific knowledge—knowledge that will lead to improved health, more effective health services and products, and a stronger Canadian health care system.

In conclusion, Health Canada, and indeed all five organizations in the health portfolio, is committed to spending funds responsibly, efficiently and effectively. The work I have outlined today will be instrumental in helping us achieve our mandate to protect the health and safety of all Canadians.

Thank you for this opportunity to speak about our work and to explain our budgetary priorities.

I am now pleased to take your questions.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Our first questioner will be Ms. Sidhu, for seven minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you, Minister, and all the officials, for being here today.

My first question is to the minister.

Minister, as you know, I introduced a motion to the committee to study diabetes and its impact on the health of Canadians. Part of the study was around what the government can do to help those living with diabetes, as well as how we can prevent it.

I know that healthy eating is part of diabetes prevention, and thank you for taking a great initiative on that.

I would like to know what our government is doing to help Canadians understand the risk factors and to motivate them to make lifestyle changes to prevent chronic diseases such as diabetes. Also, are you aware of Diabetes Canada's 360° strategy? What are your thoughts on that?

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

Thank you very much, Ms. Sidhu, for the question. I want to take this opportunity to thank you for the leadership that you've shown with respect to the area of diabetes and also for the work that you've done on the all-party caucus on diabetes, and thank you for bringing forward the motion to ensure that the HESA committee could study this very important issue.

We certainly recognize that many Canadians live with diabetes, either type 1 or type 2 diabetes, and we certainly recognize that there are many contributing risk factors as to why people live with diabetes. Our government is deeply concerned with this area, and that's why we've made significant investments there.

I was very pleased that in budget 2016-17, an investment of $47 million was made in the area of diabetes research. We've also been able to partner with the JDRF, and we were able to collaboratively invest $30 million in the research component of type 1 diabetes. We still have some work to do with respect to that investment, but the money continues to roll out.

Also, I have to say that I was very pleased that over the past several months, I've been able to meet with officials from Diabetes Canada, and they've been able to provide me with a snapshot of the good work that is being done.

I was very pleased to hear about the Diabetes 360° program that they have brought forward. Just a few weeks ago—and I think I saw many of you there that day—they had their mobile unit here on the Hill, and many of us were able to stop in. I think that several members of the health committee were there, as I'm looking around the table. Many of you had your health checks and had your report cards that looked at the risk factors associated with diabetes. Again, we certainly are pleased with the work that Diabetes Canada is doing.

Finally, I think that as a government, we've certainly done a lot of work in addressing the risk factors for diabetes. We recognize that diabetes is a serious, chronic disease, and, as I indicated at the very beginning, we recognize that it affects millions of people and that investments made at the front end can certainly prevent people from living with and suffering from diabetes.

More work needs to be done in the area of research with respect to treatment and prevention. I know that as health minister, I'm extremely pleased with the investments that we've made and the strategies that we've brought forward, such as the healthy eating strategy and the tobacco strategy. We certainly recognize that education also needs to be done to ensure that Canadians are aware of the risk factors associated with diabetes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Canada's health care system is a source of pride and a defining value for Canadians, and our government has been working collaboratively with provinces and territories to improve access to home care and mental health services for Canadians. Budget 2017 provided, as you said, $11 billion in new funding over 10 years to provinces and territories.

In August 2017, provinces and territories endorsed a common statement of principles of shared health priorities that set out pan-Canadian objectives for home care and mental health funding. Could you provide the committee with an update on the ongoing work with the provinces and territories to ensure that this funding meets the needs of Canadians?

I'm also a great advocate for national pharmacare. Can you give us an update on ongoing work on that? When Canadians living with diseases cannot afford their medical supplies and equipment, something has to change. Please give us an update on ongoing work on that.

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

With respect to investments made in additional funding for mental health care and home care, to give you a snapshot as to where we're at, in budget 2017, as you've indicated, we were pleased that we saw an investment of $11 billion in those two areas. We've certainly heard from Canadians that the areas of home care and mental health were two priority areas, and I was extremely pleased that in budget 2017, targeted investments were made in those two areas.

As a result, over the past year and a half we've been in negotiations with the provinces and territories to finalize the bilateral agreements with provinces and territories. At this point in time, I'm pleased to announce that nine provinces and territories have finalized and have signed their agreements, and as for the other remaining four provinces, we are almost at the end of the negotiations, and either by the end of this year or in early 2019 those negotiations, those bilaterals, will be completed, and the monies will be flowing.

I also have to say that even before the bilateral agreements have been signed, money has been going to provinces and territories. We certainly want to make sure that people have access to the funding that's required, but those bilateral agreements are really key, because we want to make sure that the money is going where it's supposed to be going.

As per your question with respect to pharmacare—I think there was that component as well—as you're all aware, in budget 2018 we announced the creation of an advisory council on the implementation of a national pharmacare program. Work continues to be under way with respect to that. We are very pleased that Dr. Eric Hoskins and a group of fine Canadians have agreed to sit on this committee, and they've been having a national conversation with Canadians with respect to what a national pharmacare program can look like. I look forward to receiving the report in the spring of 2019 with some recommendations of possible options as we move forward. We recognize that the work that's been done in this area by the advisory council is key, and I truly look forward to receiving the report with recommended options and a path to move forward.

[The Chair, Liberal, Bill Casey]

Okay, your time's up.

Ms. Gladu is next.

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

Thank you, Chair.

Thank you to the minister for being here today and to all of the departmental representatives as well.

I want to start by thanking the minister personally. I see she tabled in the House of Commons the framework on palliative care, of which I am passionately a fan. I see that all of the elements that we heard in consultations across the country were captured, and I look forward to working with her to see us accelerate palliative care for all Canadians. Thank you for that.

My first question has to do with thalidomide. In budget 2018, there was an intent to resolve the remaining claims in the thalidomide area. Could you give us an update as to whether those claims are resolved?

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

Thank you very much, Ms. Gladu, for your question.

Once again, congratulations on your private member's bill. We were extremely pleased that we were able to table the bill. I look forward to seeing the progression of the work that needs to be done and that will be done with respect to an action plan. I'm looking forward to continuing to work with you on that.

With respect to your question on thalidomide survivors, soon after I was named Minister of Health, I was privileged to meet with many thalidomide survivors in Ottawa, one of whom was Fiona Sampson. I also had the privilege of meeting with TVAC, which is the Thalidomide Victims Association of Canada.

These individuals shared with me the challenges they face, day in and day out as they age, in living with thalidomide. We also heard from some individuals who were concerned because they had not been identified as part of the compensation program.

I was extremely pleased that budget 2018 committed to addressing concerns regarding thalidomide survivors. Within the very near future—within the coming months—we will be announcing steps to move forward with respect to this program.

I certainly want to make sure—and I stress to the committee—that individuals who are thalidomide victims or who feel they are possible victims will have another opportunity to apply for this program. As I've indicated, within the coming months we'll be able to do a formal announcement. I look forward to being able to share that information with all of you.

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

That's very good.

I see that we are expecting the Hoskins report in the spring of 2019. Will the report be made public before the election?

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

First and foremost, with respect to the report, we have to recognize that Dr. Hoskins and his group of officials have been working diligently in having a conversation with all Canadians from coast to coast to coast. I haven't had an update with respect to the work that's been done thus far, but I do follow through with the secretariat, and they're telling me that they're hard at work.

With respect to the report's findings, I absolutely feel that the report will be made public. I'm not sure of the exact date of the tabling of the report or of our making the report public, but like many of you, I look forward to seeing the findings of that report, as we certainly recognize that it will be a key pillar as we move forward in the decision on what a potential pharmacare program could look like for Canadians.

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

That's very good.

My next question has to do with the competitiveness of Canadians and with some of the things that have been introduced by Health Canada. I would like to offer some examples.

One is pesticides that Canadian producers will not be able to use anymore that don't necessarily have replacements. When we receive food from other countries that do use those same pesticides, that disadvantages us. Also, the front-of-pack labelling will be something that Canadian businesses and industries will have the expense of putting in place, but there are many exemptions given to materials coming from other countries so that they don't need to have that.

Could you make a comment on why, when we put these programs in place, we're punishing Canadian businesses, as opposed to making these requirements for all?

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

First and foremost, protecting the health and safety of Canadians is my number one priority as Canada's health minister.

There are two components to your question there. Perhaps I'll start off with the second component of your question with respect to the front-of-pack labelling.

We recognize, as I indicated earlier, that the issue of chronic disease is on the rise in this country. We recognize that we spend approximately $28 billion to $30 billion in addressing chronic disease. Our eating habits, either healthy or unhealthy, as well as our sedentary lifestyle, certainly contribute to that.

When it comes to front-of-pack labelling, we want to make sure that we make the healthy choice the easier choice for Canadians. That's why we're moving forward with this initiative of front-of-pack labelling. As you're probably aware, it's to make sure that Canadians are aware that the foods they purchase may be high in sugars, fat or salt.

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

Sure. I'm familiar with the program, but will all other countries have to put on Canadian front-of-pack labelling in order to sell products in Canada?

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

If the products are entering Canada, they are going to be bound to ensure that front-of-pack labelling will also have to be on the products. That is a part of the process for sure.

In no way are we penalizing Canadian companies. We want to make sure we can provide Canadians with easy access to information regarding the food choices they make.

We recognize that Canadians are extremely busy. I know that when I'm in the grocery store—and I'm sure it's the same for you, Marilyn—I just put things in my shopping basket very quickly. We just want to make sure that Canadians have a quick reference guide to allow them to make the healthy choice the easier choice.

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

Sure.

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

With respect to pesticides as well, once again that's a regulatory process—the reviews that we go through on a regular basis—and we want to make sure that pesticide safety is considered.

Perhaps I'm going to turn it over to you, Simon, if you could perhaps elaborate a bit on that process.

[Simon Kennedy, Deputy Minister, Department of Health]

Sure.

I think as the member may know, under the Pest Control Products Act, there's a requirement every 15 years to go back and kind of re-examine the chemical that's been approved to make sure that there haven't been updates on the science or on the use that might suggest an issue.

We're now 15 years past the passage of that legislation, so one of the things we're seeing as a department is that a lot of the chemicals that had been approved 15 years ago are now coming back in for re-evaluation. I know that some members question why these chemicals are being looked at again and why the PMRA is undertaking this. It's a statutory requirement, and we're doing our best to fulfill the requirements of the legislation.

When we do the review, we do try to engage as extensively as possible with various stakeholders, obviously, including the agriculture sector. It's very important for PMRA, the pest management agency, to understand the usage patterns. There is a real issue of talking to the industry and to the manufacturers to have an understanding of how this stuff is used and to make sure that if restrictions are put in, it's done in a way that's obviously as sensitive as possible to how the product is actually used in the marketplace.

Often an initial proposal, which might call for more extensive restriction, actually will be amended through the consultation process because we get better data from the agriculture sector on usage. I just wanted to make that clear.

The second thing I would say is that we are very well aware that often there may be a lack of alternatives. As a result, when there are restrictions that have to be put in place, there is work to determine an appropriate phase-out schedule so that a transition period is available. The statute really does put an emphasis on health protection and the environment. That's obviously what we follow as a regulator.

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

Very good. Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Mr. Davies is next.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Minister, at present 32% of Canadians have no dental insurance at all and approximately six million Canadians avoid visiting the dentist every year due to cost. Canada's most vulnerable people have the highest rates of dental decay and disease, but the worst access to this much-needed health service exists among people with low income.

Given these stark disparities, what steps is your government taking to ensure that all Canadians can access medically necessary dental care?

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

We look at the Canada Health Act, Mr. Davies. We recognize that the Canada Health Act covers medically necessary services. With respect to dental care, we recognize that it's not covered under the Canada Health Act. Just recently I appeared at the seniors caucus committee here—our seniors caucus—and that was an issue that came up, an area that people wanted to look into.

I would encourage the committee to possibly even do some work in this area. At this point in time, with respect to investments in that area, no federal investments are being made.