Thank you very much for inviting me to address this special committee.
I'll make some brief remarks. I'm quite sure I won't take 20 minutes, and then I'll be happy to answer any questions you might have.
I thought you might, in the first place, wonder why you're speaking with someone from Chapel Hill, North Carolina, so I'd just like to give you a little background on myself.
I am a Canadian. I was born and raised in Calgary—Calgary West riding, by the way. While pursuing my BA at the University of Alberta, Calgary, as it was called at the time--that was the last graduating class before it became the University of Calgary—I was in the reserve officer training program of the Royal Canadian Navy Reserve, so that's the UNTD, or the University Naval Training Division. I was commissioned in the naval reserve, but I went on the inactive list when I went off to the United States to do my PhD. Then I returned to Canada for an academic career, first at McMaster University for eight years and then at the University of Toronto for twenty years. It was during that period, in fact ten years ago, that I was appointed chair of the Gerontological Advisory Council of Veterans Affairs Canada. In 1999 I moved here to the University of North Carolina, where I direct its Institute on Aging, but I have continued to be asked to chair the Gerontological Advisory Council, and it's frankly an honour and a privilege to do so.
I want to begin by telling you a bit about the Gerontological Advisory Council and its mandate, and how this led to the report that we issued last November called Keeping the Promise. I'll then highlight the main principles and features of the report before turning it back to you for questions.
The Gerontological Advisory Council will celebrate its tenth anniversary in July. Its members include representatives of the three veterans associations that are focused on the traditional veterans: those from World War I, World War II, and Korea; people from the health care sector who provide services to these veterans or who otherwise have experience with long-term care; and the leading Canadian researchers in aging and health.
Veterans Affairs Canada asked us for advice, and I am pleased to say our advice has been, for the most part, taken, and we think it's had an impact. From an academic point of view, I can tell you that's rare, and we're pleased about that.
Our mandate is formally restricted to the traditional war veterans from World War I, World War II, and Korea. As I'm sure you all well know, the average age of the World War II veterans is now about 83 years old, and that of the Korean veterans is 73 years old. That's why we're a gerontological advisory council. A few years after we were established, a Canadian Forces advisory council was established for the remaining veterans. As chair of the Gerontological Advisory Council, I sat as an observer with that council, the Canadian Forces Advisory Council. Its chair, Dr. Peter Neary, sits as an observer on our council as well.
We're an arm's-length council, and our mandate is specifically limited to giving advice when we are asked for it. I do confess that from time to time, we have exceeded our mandate by giving advice not specifically asked for, but we're really not supposed to do that. In no way do we speak for Veterans Affairs Canada.
About two years ago, we were asked by the department to give an assessment of their services to the traditional veterans and our best advice as to how to improve these services. Any recommendation that we make has to pass three tests, in a sense, given the nature of the council. It has to meet the needs of the veterans' groups, as they see them. It has to be realistic in terms of the clinical and health care experience of the providers, and it has pass the scientific criteria that are so important for the academic researchers on the council. I believe it's fair to say that the recommendations in Keeping the Promise have passed these three tests and are therefore recommendations for reform, based on what is known as evidence-based practice.
Building on the momentum of the Veterans Charter, which focused on the Canadian Forces veterans and drew on recommendations from the Canadian Forces Advisory Council, we reviewed existing arrangements for the traditional veterans and developed a framework outlining the best ways to support health, wellness, and quality of life for the estimated 234,000 war service veterans.
In Keeping the Promise, then, we have outlined some basic principles. Currently, 40% of war service veterans receive Veterans Affairs Canada health benefits, and we take the position that all war service veterans who could benefit from VAC services should be eligible. In other words, a vet is a vet is a vet.
We wanted to start from first principles. We commend the department. It's made a lot of great progress and innovations in serving veterans, but we wanted to look at the state of the art in gerontology and geriatrics. What is today's wisdom about the best way to provide services for an aging population? We also adopt a social determinants of health perspective, which is very Canadian in its origin. Health, wealth, and social integration are seen as the major factors leading to well-being in later life. This builds on a framework adopted both by Health Canada and by the World Health Organization in its active aging framework. We also adopt a life-course perspective, which is very common in the field of social gerontology, but it means that to understand people in the later years, you have to understand where they've been over their lives. If you want to influence what happens to people in later years, it doesn't hurt to start early.
Early life events can produce delayed adverse health outcomes, as the general PTSD literature and also the Australian research on Korean War veterans that we cite in our report, attest. This implies that health promotion and disease prevention should be an important component of VAC services. That recommendation would be consistent with the federal health program review recommendations. We also take an ecological perspective. A chart on page 9 very graphically shows this. This places a veteran in the context of his or her family and community. It rests on the principle of trying to provide care programs close to home. I think most importantly we advocate for a program based on needs rather than on the complex service-based eligibility requirements that now exist.
We maintain it is neither feasible nor necessary to relate a current health condition in the later years to a specific war service related event. I might say that when all the university professors and experts on aging came on the council, they were truly astonished looking at the complexity of the table of eligibility. We couldn't believe it was that complex. The state of the art and thinking about the delivery of health and social services is to move as much as possible to needs-based criteria with carefully developed screening.
When putting all this together, we saw the need for a new way to organize a comprehensive integrated health and social services system for Canadian veterans. We sketched a plan based on two well-evaluated service delivery systems from Quebec. We developed this plan with the idea of getting to veterans early; that is, before serious frailty or disability occurs. With the average age of World War II veterans at 83 and Korean veterans at 73, it's impossible to be too late. It's almost too late to be early with this population. But experts in health promotion and disease prevention stress that it's never too late as well as never too early to initiate health promotion strategies that will produce positive results and be cost-effective.
The recommendations we made are in the report, and they're summarized in nine bullets. I want to highlight the three key recommendations for you. The first is that Veterans Affairs Canada should combine its current three health and social programs into one called Veterans Integrated Services. Second is that services be available to all veterans who served in the Canadian Forces during World War I, World War II, and Korea. A vet is a vet is a vet. Third is that services be expanded to include early intervention and health promotion services, more extensive home supports, and a wider range of residential choices.
I think Keeping the Promise is an important report showing how to go beyond the new Veterans Charter that was implemented in April 2003 and targeted at reforms and services for Canadian Forces veterans.
We are well aware that the Canadian Forces veterans are themselves aging. The average age of the Canadian Forces clients of Veterans Affairs Canada is actually 53. Particularly in the health promotion area, our recommendations could be very useful to guide services for these veterans as well, and frankly, while our mandate is to give advice regarding the traditional veterans, we quite deliberately and explicitly in the report suggested that the program we're outlining could have many benefits for services for the Canadian Forces veterans as well.
The current initiative—the health care review—will be drawing on this report, and in fact we've established two committees to assist in implementing our recommendations so that they could be helpful in this regard.
One of these committees is in the critical area of health promotion. The other will deal with the development of a screening instrument that can be used to direct veteran clients to appropriate levels of care.
When we formally released Keeping the Promise last November, I was proud to have standing beside me representatives of every one of the veterans organizations. They have all endorsed Keeping the Promise, and needless to say, the council hopes that government will be sympathetic to our recommendations.
That concludes my remarks.
Thank you.