Evidence of meeting #5 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was money.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Alain Beaudet  President, Canadian Institutes of Health Research
Siddika Mithani  President, Public Health Agency of Canada
Gregory Taylor  Chief Public Health Officer, Public Health Agency of Canada
Simon Kennedy  Deputy Minister, Department of Health

3:35 p.m.

Liberal

The Chair Liberal Bill Casey

I call the meeting to order.

This is our fifth meeting of the Standing Committee on Health, and we have some very distinguished witnesses today. Just briefly, we have the Honourable Dr. Jane Philpott, Minister of Health, and Simon Kennedy, who is a career civil servant who has held important positions with the Privy Council and the Department of International Trade. He has also worked in public relations at Mount Saint Vincent University.

We have Siddika Mithani, who's on her first day on the job here today, so we're going to be especially hard on her. She is president of the Public Health Agency of Canada.

Congratulations on your new position.

We also have Dr. Gregory Taylor, chief public health officer for Canada; Alain Beaudet, president of the Canadian Institutes of Health Research; and Bruce Archibald, president of the Canadian Food Inspection Agency. I hope I didn't miss anybody.

There are more of you than there are of us. Anyway, I certainly welcome you.

Pursuant to Standing Order 108(2), we are studying the mandate of the Minister of Health. Pursuant to Standing Order 81(4), we are also dealing with the main estimates for 2016-17. I'm not going to detail those, but for now I'm going to call vote 1 under the Canadian Food Inspection Agency.

Minister Philpott, welcome to you and your officials. You have the floor.

3:35 p.m.

Markham—Stouffville Ontario

Liberal

Jane Philpott LiberalMinister of Health

Thank you very much, Mr. Chair, for this wonderful opportunity to be with you. Good afternoon to all of the members of the committee. It's a real pleasure for me to be here at the Standing Committee on Health as the new federal Minister of Health.

First of all, Mr. Chair, I want to congratulate you on your appointment as chair of this committee.

3:35 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you.

April 11th, 2016 / 3:35 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

The Standing Committee on Health, as you know, is proud of its achievements in times gone by and currently. It has a lot of experience when it comes to working on difficult and important issues for Canadians. I have no doubt that the work you will do around this table and others like it will be good for Canada over the next few years as we address health issues that could actually redefine public policies in the field of health for generations to come.

In many ways, as you know, working as a doctor for the last 30 years has helped to prepare me for this role and I'm deeply honoured to be in this position and to have this opportunity. I have practised medicine here in Ontario for many years, and I've also had the privilege of working in a number of countries in sub-Saharan Africa including living and practising medicine in West Africa for almost a decade. Those were some of the most satisfying years of my life.

The harsh realities of health and living conditions in some of the world's poorest countries have taught me a great deal about social determinants of health, what it is that keeps people healthy. It has shaped my vision for how we can improve health outcomes, both here and internationally.

Helping people benefit from and enjoy healthy and fulfilling lives is a matter of more than just providing the right drugs. It is also a matter of ensuring sound governance and having a system tailored to all the necessary objectives.

Before I continue, I want to also thank my colleagues who have gathered around me today. They've already been introduced, but I would like to say again, thank you to Simon Kennedy, my deputy minister of health, and to Siddika, who has joined us. We're absolutely delighted to have a new president of the Public Health Agency of Canada. I also want to thank Dr. Greg Taylor, Dr. Alain Beaudet, and Bruce Archibald. I believe we also have Barbara Jordan here. Is that correct? She's with us at the back, and she's the vice-president of policy and programs for the Canadian Food Inspection Agency.

Today, in the next few minutes, it's my aim to provide you with an update on the activities of the health portfolio and to talk about some of the key issues that this committee is going to address in its work over the coming months. Afterwards I'd be very pleased to answer any questions that you may have.

Canada's publicly funded health care system is a source of pride, and it's a defining value, as you know, for Canadians who rely on it for timely access to universal and high-quality services based on need and not based on the ability to pay. However, while Canada's health care system has served Canadians well, we would agree I believe that it must be strengthened in order to better meet the needs of patients as Canada changes in its demographics and disease patterns, as new technologies emerge and continue to shape the delivery of care, and as we try increasingly to move the delivery of care into homes and communities.

Canadians will be pleased to know that our budget has provided immediate investments that will support pan-Canadian progress on a number of priorities in the form of innovations within the health care system. In addition, budget 2016, as you may be aware, has announced initiatives that will help Canadians maintain and improve their health, including expanding access to nutritious food in the north, expanding food safety and enhancing those mechanisms, providing funding for specific men's and women's health initiatives, improving vaccine uptake and coverage, and investing in concussion protocols.

As members know, our government is committed to helping Canadians maintain and improve their health.

Our health care system is a source of national pride, but the gaps are widening. Transforming the way that health care in this country is delivered is one of my top priorities.

In January, as I suspect you know, I sat down with my provincial and territorial colleagues, the health ministers across the country, to begin working out a new vision for health care. We discussed and agreed upon a number of shared health priorities that will resonate with Canadians. These priorities put us on a solid footing to move forward with the development of a new health accord, one that will help provinces and territories accelerate their work in transforming care for Canadians, and I'll have a bit more to say about that accord in a few moments.

I wanted to comment a little regarding the main estimates and the supplementary estimates (C). I want to outline for you where they fit within the portfolio. Health Canada's main estimates, as you have seen, outline $3.75 billion in spending authorities for 2016-17. This represents a net increase of $97.8 million over the spending in 2015-16.

There are funding increases of $249 million for 2016-17 that relate primarily to first nations and Inuit health programming, and funding for the Canadian Foundation for Healthcare Improvement. You will note there is a decrease in the program of $151 million. That is mainly due to the sunsetting of some program funding, and I'd be happy to respond to your questions about that as we go along.

The Canadian Institutes of Health Research main estimates outline just over $1 billion in spending authorities for 2016-17, and this represents a net increase of $17 million over 2015-16. The net funding increase consists primarily of contributions to projects funded under the Canada first research excellence fund and the Canadian centres of excellence for commercialization and research program.

The Public Health Agency's main estimates outline $589.7 million, which represents an increase of $22.5 million over 2015-16 main estimates, which were $567 million. The major factors contributing to this net increase include new funding for medical countermeasures for smallpox and anthrax preparedness, as well as the reprofiling of the Ebola preparedness funding and response initiative in 2016-17. The agency's funding increase of $13.7 million in the 2015-16 supplementary estimates (C) consists primarily of new funding for the aboriginal head start in urban and northern communities program. It also includes funding for responding to the Syrian refugee crisis and for establishing the Canadian Centre for Aging and Brain Health Innovation.

The main estimates spending authorities for the Canadian Food Inspection Agency for 2016-17 are $739.7 million and that's a net increase of $41.5 million over 2015-16.

The main elements of this funding include the federal infrastructure initiative, which will help renew and upgrade CFIA assets and infrastructure. The funding includes continued work under the electronic service delivery platform, which will make tools and technologies available to industry, trade and international partners, as well as inspectors and CFIA staff. In addition, the funding will be used to improve food safety oversight in Canada.

This proposed spending is going to ensure that the government can contribute to and focus on important health priorities that are designed to result in better health outcomes for all Canadians.

Now, as this is my first appearance before this committee, I want to take a few moments to outline other priorities within the health portfolio.

In terms of health care transformation, you and I know that high-quality universally accessible and publicly financed health care is an essential foundation for a strong and prosperous Canada, but it had been more than a decade since health ministers from across this country sat down together to map out a plan to improve health care for Canadians. Restoring the federal government's role as a vital partner in supporting a more adaptable, innovative, and affordable health system is critical.

I believe that, if we work together, we can bring about real change in the health care system, so that Canadians can continue to enjoy high-quality and sustainable health care.

To that end, I met with provincial and territorial health ministers in Vancouver this past January to kick off discussions around a new long-term health accord.

We discussed a plan to work collaboratively and to support health care transformation and health system transformation that would enable a more accessible, patient-centred, and responsive care for Canadians. As an important first step at the meeting, we agreed to the key priority areas where transformation actions will bring about real change. We're going to be looking for ways to make sure that drugs are more affordable and accessible. We will explore approaches to making sure we move more health services from institutions into the community, including both home care and palliative care. We will look at how we can improve access to high-quality mental health care across the country. We're also going to look at how promising and proven innovations in the organization and delivery of health care services can be adopted and spread across the country.

The work to support this is going to be a focus of considerable activity in my department—in fact, it already has been—as we work with provinces and territories to develop the best approaches to address these issues. Although, as you know, health care delivery is largely in provincial and territorial jurisdictions, there are a number of things the federal government can do to support provinces and territories in their efforts to transform the health care system, and we're going to carefully study how federal activities and levers can help to accelerate progress in these areas of shared priorities.

By that I mean, for example, how our role in regulating drugs and our support for pan-Canadian health organizations can accelerate progress. We're going to explore how the federal commitment to invest $3 billion in the next few years in home care can be implemented to the best effect. I'm excited about the opportunities this work holds, and I look forward to working with my provincial and territorial colleagues on our health priorities.

At the beginning of the summer, I will meet with them again to see how progress is coming along. My hope is that we can ultimately find common ground so that we can work towards a plan that will transform and strengthen our nationally funded health care system.

We already know, on the matter of research, what needs to be done to improve our health care system. Health research has been essential in improving the quality of care and ensuring that Canadians get good value for the money that's spent.

The Government of Canada has made significant investments in health research to broaden its knowledge of health matters. That expertise shapes best practices and leads to improvements in the health care system.

This builds on an existing collaboration with our provincial and territorial partners on efforts such as Canada's strategy for patient-oriented research, otherwise known as SPOR. You may know that SPOR is a national coalition that's committed to health care innovation across Canada. Its goal is to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care.

On the matter of indigenous health, those of us who are parents know that we want our children, for example, to have the best opportunities in life. Those kinds of great opportunities involve having access to a good education, access to nutritious food, access to clean water, a roof over our heads, and access to quality health care. These are the basics that every Canadian child should expect.

There is no doubt that health conditions in many first nations and Inuit communities across Canada are deplorable and must be fixed. It has taken generations, though, for these problems to develop, and they're not going to be solved overnight. I find it deeply troubling as a physician, parent, and Canadian that these conditions should exist in a nation as affluent as ours.

History has shown that a top-down approach does nothing to address gaps. To do that, we need to build partnerships with first nations and Inuit leaders, a process that will require respect and an attentive ear.

In its throne speech, our government reaffirmed its commitment to building a nation-to-nation relationship with aboriginals. Moved by that spirit of partnership, I am committed to working with first nations, the provinces and territories, as well as front-line health care providers.

Already, as you may know, our department is investing more than $2.5 billion each year in first nations and Inuit health. However, truly embracing wellness will require uniting the physical, mental, emotional, and spiritual aspects of health to help change health outcomes. Also, implementing the calls to action of the Truth and Reconciliation Commission is going to be an important part of that healing process. I believe that by working together we can close those gaps in health status. As Minister of Health, I am personally committed to beginning this change now and to ensuring that these actions are sustained over the long term.

Next is the matter of healthy living and healthy eating.

Physical inactivity, poor diet, and injury remain major concerns. As a result of these problems, an increasing number of Canadians visit the doctor or a hospital every year.

Promoting an active and healthy lifestyle and preventing injury and illness remain at the heart of the federal government's efforts to help Canadians—

3:50 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

I have a point of order, Mr. Chairman.

Mr. Chairman, I'm sorry, with great respect for the minister, the standing orders of this committee give every witness 10 minutes to make their opening statement. That applies to everybody, whether you're a minister or not. Out of respect for the minister, we've allowed her 15 minutes so far, but I see by the pages coming that we could be looking at significantly more, and that will cut into the time that we have to ask questions, which is the purpose of this meeting. I respectfully request that the minister wrap up her comments.

3:50 p.m.

Liberal

The Chair Liberal Bill Casey

Yes, if that's possible. We're very interested in them but we're also very interested in asking questions. If you could finish up, we'd appreciate it.

3:50 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Thank you very much. I will do so and be happy to provide further comments.

The two other areas I was going to touch on were the matter of responsible drug policy—and feel free to ask me questions about that—and physician-assisted dying and legal reforms.

I did want to make just a few personal comments at the end. Would you permit me to make those? Apart from my prepared notes, I wanted to tell you what I am committed to doing in terms of my relationship with this committee and what I would request of you in return.

I would like to make a commitment to three things. One is that when it comes to my relationship with the health committee, I commit to be honest with you. There will be times, even today, that I won't have the answers to your questions. I will look for those answers. I will let you know the direction that we're taking, but I commit to being open and transparent.

Two is accountability. The Prime Minister made it very clear to me that I as a minister am accountable to you. That's the way the lines of accountability flow, so I will uphold the direction of the Prime Minister and make sure that I remain accountable to you.

Three, I commit to being fair in responding to the needs of Canadians and responding to the needs of the health committee and responding to you as colleagues in the House of Commons. I intend to always uphold fairness.

My three requests of you would be these. Number one is pragmatism. I ask you in your efforts as a committee to be practical, to look for what we can actually get done. I will be depending on you to get some very important work done in the years ahead.

Number two is to be collaborative. I am delighted that this is a representation of all members of the House of Commons, and I encourage you to collaborate with one another to be effective in your work and to think about the legacy of this committee.

This is a tremendous opportunity. The work that I know you're already considering is of profound importance. What will matter is not necessarily whether you're going to have your name written down in a book as having been a member of this committee over this period of time, but the legacy this committee is going to leave behind. How will Canada and Canadians be different, how will they be healthier, as a result of the work you have done here? I encourage you to think about that, and I'll be happy to respond to any questions.

3:50 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much.

I would just like to add a little personal note too. I read with great interest the article in The Globe and Mail about you and some of your endeavours. I certainly gained new respect and admiration for you, and I'm sure that you'll do a good job.

On your request of this committee on pragmatism, we are a pragmatic group I can assure you. We are collaborative. We don't always agree on everything but we have mutual respect all around, and I don't know if we have a legacy or not. That remains to be seen. Thank you very much for your comments and your work.

We're going to open up the questions with Mr. Kang, and we're going to start with seven minutes.

3:55 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Thank you, Mr. Chair. Thank you, Minister.

In your opening statements, you were talking about palliative care. It is very important to Canadians who require it. What actions are being taken to assist in the access to palliative care and how do you plan on improving the current palliative care options that patients have? How do you plan on working with the provinces to encourage access and options for patients requiring it?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Thank you very much for that very important question.

I believe the matter of palliative care is something Canadians are very interested in. I certainly look forward to hearing the thoughts of the committee and your recommendations in that regard.

This is something that came up in the meeting with provincial and territorial health ministers when we met in January. There was a tremendous amount of interest in palliative care, and I think it's safe to say that part of that interest has been spurred on by the fact that, as you well know, we are in the process of, in the very near future, tabling legislation associated with medical assistance in dying. I think that's highlighted for us as Canadians the fact that we have, as a country, not done as well as we could have. In fact, Canadians don't have access, in many cases, to the high quality of palliative care that they need.

I intend—and I think my colleagues in the provinces and territories are prepared to do so, as well—to direct a significant portion of our attention in the health accord discussions to palliative care. I think it's a very excellent vehicle for being able to make this happen. You know that we've committed to an additional $3 billion in home care, and a good portion of that money may, in fact, go to palliative care. I would look forward to your comments on that.

Going forward I think, as you know, the delivery of health care is in the hands of provinces and territories, but one of the things we are committed to doing as a federal government is responding to the innovative ideas across the country. I know that across the country there are a number of places where palliative care is being done well. We will make investments to make sure those good ideas are spread across the country.

3:55 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Has any study been done? You touched on home care. Have there been any studies done? I'm sure it's going to cut wait times in hospitals. Has any study been done on how effective home care and palliative care will be in cutting down those wait times?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

That's a fantastic question.

I would actually encourage every member of the committee, if they haven't already done so, to read an outstanding book by Dr. Atul Gawande called Being Mortal. That's one of the most accessible ways to think about the matter of palliative care. He talks, in that book, about the evidence.

There's lots of other academic evidence, and perhaps Dr. Beaudet could refer to that. But there is a lot of evidence that, in fact, introducing palliative care costs less, makes patients happier, makes patients more comfortable, and guess what? It often extends life. When people decide to stop trying to live longer, when they accept the fact that they want to be kept comfortable, when they sometimes take measures to stop direct treatment of their cancer, for instance, they actually live longer, which is very interesting data.

I don't know whether you want to comment further on that, Alain.

3:55 p.m.

Dr. Alain Beaudet President, Canadian Institutes of Health Research

Only that at CIHR we are investing in palliative care research and looking at a number of issues associated with palliative care. We have, in particular, with a number of partners, recently invested $16.5 million in an initiative called “palliative and end-of-life care initiative", to look exactly at these issues.

The outcomes of these investments are really making a difference in the health care system. For example, research by Dr. Kirk and Dr. Lau on the palliative performance scale has now informed new eligibility criteria for the British Columbia palliative care benefits program.

3:55 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Thank you, sir.

My next question, very quickly, is about first nations. Can you elaborate on the nutrition north program that is taking place within our northern communities. How are you planning to expand that program?

3:55 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

This is an area that, as you know, was part of our platform commitment. It's something that I will be working on in collaboration with Minister Bennett from Indigenous and Northern Affairs.

The idea here is to address the costs of getting adequate nutrition to northern communities. We have made some investments in that, and we'll continue to invest in that area.

Are you comfortable commenting on that at all, Siddika, in terms of nutrition north?

4 p.m.

Dr. Siddika Mithani President, Public Health Agency of Canada

No, Minister, not at the moment, but we can certainly get back to you about further details on what this entails.

Greg, do you—

4 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

Do you want to add something, Greg?

4 p.m.

Dr. Gregory Taylor Chief Public Health Officer, Public Health Agency of Canada

Just that it's extremely important from a public health perspective, obviously, because of the distance, and the agency would be able to play a supportive role.

4 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Are you going to give us more information on how you are expanding it?

4 p.m.

Simon Kennedy Deputy Minister, Department of Health

Maybe just to clarify, Mr. Chair, the main delivery of the program is actually INAC, and Health Canada has a small portion. We provide the policy advice, the content about what should be covered, what constitutes nutritious food, that sort of thing.

In the budget we received a small portion of the money, because we're a participant. But the main program is actually run by Indigenous and Northern Affairs.

4 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

Have you consulted with our northern communities on this?

4 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

We had some early discussions on a number of topics with indigenous leaders in the country. The topic of nutrition has come up to a certain extent. As you know there are a huge number of health problems in indigenous communities across the country. When it comes to things like the nutrition program, as the deputy minister has said, some of that falls under Minister Bennett's jurisdiction, but obviously the topic of getting access to great food is extremely important to maintaining good health.

4 p.m.

Liberal

Darshan Singh Kang Liberal Calgary Skyview, AB

My next question is about mental health. Could the nutrition program be related to mental health as well? Do you believe the services for mental health in the remote areas are adequate? What improvements, if any, can be made to mental health services in remote communities?

4 p.m.

Liberal

Jane Philpott Liberal Markham—Stouffville, ON

That's a very important question and obviously very timely in terms of some of the things that you've probably been reading in the media recently. You asked whether or not I felt that access to mental health services was adequate in remote communities. I would argue that access to good, high-quality mental health services is not adequate in very many regions in the country, if anywhere. If fact, mental health is one of our real gaps in health care. There is a tremendous need to improve that if for no other reason than.... Obviously we want it for our own happiness and well-being, but when people look at the world from an economic perspective I think it's argued that something like 10 billion dollars' worth of lost productivity in the workplace each year is due to mental illness. So for all kinds of reasons we need to do better.

In indigenous communities in particular this is most widely seen, and I think it's very interesting you commented about the fact that even something like how well people can eat has an impact on their mental health. There are all kinds of other things that you'll hear in some of the remote communities, like kids not having access to recreational facilities. Many of these towns, depending on the time of year if there's no arena, no swimming pool, or there's nothing else to do, it has a huge impact on mental health. The mental health of remote communities is probably one of our most pressing health needs in the country. Whether we wanted to or not, it is pressed upon us as an urgent matter that we have to address.

We will be doing that obviously in a whole-of-government way, but mental health as I alluded to earlier is going to also be a big part of our health accord. We have some really interesting ideas about how we can improve access to mental health care. We're going to be putting together an advisory panel on mental health. This is such an important issue and you guys around this room are all smart people and have great ideas. If you have great ideas about mental health in particular, or if that's something the committee's going to be looking at, please let me know, please reach out to me with your good ideas. There are few things that are as important to us as a country as getting this right.

4 p.m.

Liberal

The Chair Liberal Bill Casey

Mr. Carrie, you have the floor.