Public Accounts Committee on March 10th, 2009

[Dr. Gregory Taylor]

Yes, there is.

[The Chair, Liberal, Shawn Murphy]

On the next page, the recommendation in paragraph 5.54 reads:

To ensure that its surveillance systems for HIV, the West Nile virus, and the influenza virus are best meeting the needs of the users, the Public Health Agency of Canada should systematically assess and document the user needs.

That was to be done by December of 2008. Do you have any update?

[Dr. Gregory Taylor]

There has been a user-needs assessment done for one of our HIV reports. Routinely, the user needs assessments in the past have been informal, and these are now formalized, and the plans are to continue going forward using user-needs assessments on an ongoing basis.

So one has been done formally, and the rest informally, but that's changing.

[The Chair, Liberal, Shawn Murphy]

I just have one last area on which I want to get a comment from you. It wasn't part of the audit, but I notice in your departmental performance report that you do work on the whole area of public preventive health, whether it be obesity or diabetes. It's certainly a major issue right across Canada.

At the same time, obviously, there is a jurisdictional issue here. But in the work that you do, are there any specific targets that you undertake with the provinces? Or do you have these targets in your own agency? I ask this because, in my own view, it's wanting, it's needed. I know you're doing some of this, but with your budget, you're not really able to crack the nut, so to speak—but it is something.

Where's this going, Doctor? I guess that's my question, the long and the short of it.

[Dr. David Butler-Jones]

Thanks for the question on something other than infectious disease, because the agency's mandate is across the realm of public health.

We have agreements with the provinces and territories. We provide cooperative funding for healthy living. We have an FPT agreement on a healthy living strategy, as well as targets. Ministers have agreed to targets on physical activity plans for children and adults. And with our counterparts, we're currently developing plans as to how we are going to get there.

You may have heard me say this before, but one of the huge challenges, given the trends in the last 20 years and what's happened with obesity, particularly in children, is that this really could be the first generation of children not to live as long or as healthily as their parents. It's a huge challenge. At one level, it's very simple: the difference between a 10-ounce and a 20-ounce can of pop a day is 10 or 15 pounds a year. At one level, that is very simple, but the issues underlying it are much more complex. Really, it is a whole-of-society issue; it's not even just a public health issue.

[The Chair, Liberal, Shawn Murphy]

Okay. We have a little extra time, if people want to jump in for a two-minute session.

Madame Faille...?

[Meili Faille, Bloc, Vaudreuil—Soulanges, QC]

I believe we have no more time, but I thank you. In fact, I would like to know, given that this is a new agency, whether you necessarily need a source of inspiration somewhere, a model on which you can develop your organization.

Could you tell us what governance model you support? Are there any countries where there are good systems in place, such as the United States or Australia, that you are drawing on?

[Dr. David Butler-Jones]

Every country is different, and my opinion also differs with each country, based on my title, my position, my own role and that of the deputy minister. In the United States, there is a division between the Public Health Service, with the Surgeon General, and the CDC and the Health and Human Services.

What we have done is to align. For example, in the infectious disease world, our units parallel the American units, so it makes interaction between us very simple. So the head of that division can talk to their American counterpart, as opposed to two or three different people.

We did look around the world a bit. We continue to evolve, but every country is different.

[Meili Faille, Bloc, Vaudreuil—Soulanges, QC]

The purpose of my next request is to help us understand the role of the provinces and that of the federal government. You said a little earlier that you had entered into agreements.

Could you provide a list of the agreements reached with the provinces and those that are being reached, or tell us whether there are areas in which there are specific agreements?

One of your challenges will be precisely your ability to adjust, because the disease context is constantly evolving. Consequently, the information you need today may not necessarily be the same in future.

Could you send us a sample MOU that states the rule of the provinces and the agreement on information management, to determine your flexibility in that matter?

[Dr. David Butler-Jones]

A couple of things.

For the Public Health Network, which is joint federal-provincial, that's all laid out in documents, actually, in terms of the role of the network, the kinds of committees, the way we process things, how we make decisions, who's in charge.

In addition, we have various memoranda around healthy living and others with provinces, because we co-share. For example, in Quebec, we jointly agree on projects that we'll fund. It's the same with other jurisdictions. So they're quite varied and across the system in different areas.

Basically, one of the things we did when we set up the agency was recognize the core role of provinces and territories. What is our federal value added to the system? And it's in expertise, it's in coordination, it's in best practices, so not everybody has to figure everything out on their own. We bring specialized capacities to that, and we work to ensure that the system, as a whole, is as effective as it can be and that we're in a position to identify where there are gaps, for example.

[Meili Faille, Bloc, Vaudreuil—Soulanges, QC]

It's that—

[The Chair, Liberal, Shawn Murphy]

Madame Faille, I want to move on.

[Meili Faille, Bloc, Vaudreuil—Soulanges, QC]

All right.

[The Chair, Liberal, Shawn Murphy]

Mr. Weston, you have a question. Then we're going to....

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you.

Dr. Butler-Jones, you've spent an afternoon being challenged by us. I'm going to give you a chance to challenge us in return.

You referred to obesity as being a big challenge to our kids. I've heard Senator Nancy Greene Raine say it's the biggest challenge in a generation. What could we, as parliamentarians, as role models, do to deal with that?

[Dr. David Butler-Jones]

We could have a very long answer, but I think the short answer is that we do take it seriously. We've lost a couple of decades. It isn't that it necessarily needs whacks of money, but it does need thinking through: how we invest, how we make decisions, what we do, and things that support kids to be active, things that support healthier choices as being the easier choices in schools, etc. So it's all levels of the system actually thinking about what's connected to what.

And if you ask kids—there's a recent survey that came out—what they do after school and what they want to do after school, they actually want to be a lot more active, but they don't have an easy, safe place to do it, as a for-instance. And if you're in a neighbourhood that has green space, you're healthier than those who don't have green space--period, end of story.

So it's how we design our communities, how we make our investments. Do we have easy, safe places for people to walk or ride their bike? When you go into the school, is chips and gravy cheaper than an apple?

I'll leave it at that, because there are all kinds of little things. We need to see the connections.

[The Chair, Liberal, Shawn Murphy]

We could go on for another two hours, if we wanted. It is a very important issue.

Anyway, colleagues, on behalf of everyone in the committee, I want to thank you all for being here today.

Dr. Butler-Jones, you have a very challenging and important job. It's a job that is of tremendous interest to all Canadians. Again, I want to thank you very much.

We do have a few minutes, and before we adjourn I want to ask either Mr. Maxwell or Dr. Butler-Jones if they have any closing comments.

Mr. Maxwell, you first.

[Neil Maxwell]

Thank you, Chair. Knowing you have a few minutes, I'll use them.

We were very pleased with the questioning and the interest of the committee on this topic. There are a few things I might highlight.

I think that a lot of the discussion, quite appropriately, was around the action plan and what kinds of actions were being done. This audit was completed almost a year ago now, so I think those were the right kinds of questions.

One of the members I think mentioned two years for following this up. I would think that given the importance, it might be quite important to get periodic updates from the agency. Inevitably, action in the early years is often about systems and process. Some of those improvements being made should generate the kind of information that would actually start showing results when these program evaluations get done.

I think your committee would soon be able to get from the agency some very concrete ideas of the results that are being achieved.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Maxwell.

Dr. Butler-Jones, are there any final comments you want to make?

[Dr. David Butler-Jones]

Thank you very much to the committee, and thank you for your pointed questions. I do take them seriously. As I said at the outset, these are things that are important to us and that we're working on.

I try to speak to the practicalities, but that does not diminish our commitment and effort. I'd be very happy to come back, if you wish, in a year, or to do something in writing to support the committee.

As Neil said, I really appreciate the interest of the committee on this issue. This is important to us.

I must say, having been in public health for 25-plus years, the fact that people even care and take this seriously, even if we don't agree on every aspect, bodes really well for the health and well-being of the public. I really appreciate that.

[David Christopherson, NDP, Hamilton Centre, ON]

Can I have 15 seconds?

[The Chair, Liberal, Shawn Murphy]

Fifteen seconds, Mr. Christopherson. It's yours.

[David Christopherson, NDP, Hamilton Centre, ON]

You commented that you appreciated the interest. I want to comment on how much we appreciate young doctors who decide to go into public health. It is not necessarily where the money and the glory are, as you can well see, but it's so important. It sets a good example for other medical students about this being an area to look at. It's important, too.

So thank you for that.

[Dr. David Butler-Jones]

Thank you.

[The Chair, Liberal, Shawn Murphy]

I am going to remind members to meet on Thursday. We are dealing with chapter 7 of the December 2008 Auditor General's report, “Economy and Efficiency of Services--Correctional Service Canada”.

The meeting is adjourned.