Veterans Affairs Committee on Jan. 31st, 2008

[Claude Rocan]

Yes, it's in February; in fact, next week.

[Roger Valley, Liberal, Kenora, ON]

Where does Canada sit in the world? Are we leaders in some of this work? Is that why we're presenting to the UN? Can you place us in the world? You mentioned some provinces that are ahead, but place Canada in the world and tell us how we're fitting in.

[Claude Rocan]

Thank you for that opportunity.

Yes, in fact, we are very highly regarded in the world for the work we've done. The work related to age-friendly cities is something on which we've worked very closely with the World Health Organization.

It's been really pioneering work. Through it, we've developed a guide that is being used around the world. There are now, I think, 33 cities involved in that particular initiative. It's largely due to Canada's leadership, I think I can say, that this initiative has taken place. I think we've done a very significant job. We received an award from Help the Aged in the U.K. for the work we've done in this area.

The other area I would mention is the area of seniors in emergency situations. Again we've been the leader in that area. We hosted a workshop in Winnipeg last year, the results of which will be discussed and presented to the United Nations next week on February 8. We'll be following that up with a second workshop in March that will bring together a number of experts from around the world.

I think very fairly we can say that Canada has been the leader in the world in this area.

[Roger Valley, Liberal, Kenora, ON]

I was fortunate enough to travel to Chile some time ago, where I recognized the value the world was putting on Canada's contributions.

You mentioned the workshop coming up in March. Can you give us a flavour of some of the countries around the world that are, I guess, coming out of respect for the work Canada is doing?

[Claude Rocan]

I'll ask John to speak to that, if you don't mind.

[John Cox]

Thank you.

We expect about 130 participants. It's a combined Canadian and international experience. Some of the countries will include Japan, Australia, Lebanon, and South America. I think we sent an invitation to people from Peru, for example, who have been very active with seniors on the ground in preparing for disasters or emergency situations. Probably 20 different countries or states will send experts or representatives to this meeting in Halifax in March.

[Roger Valley, Liberal, Kenora, ON]

Thank you very much.

[The Chair, Conservative, Rob Anders]

I now give Mr. Gaudet the floor. You have five minutes.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you, Mr. Chairman.

Good afternoon, everyone. My mother is 98 years old, and I hope I'll live at home as long as she has, and she's still living at home. I wonder what Health Canada is doing for her. It's my sister who takes care of her. My mother is in perfect health, and she goes out every Sunday and even two or three times a week. What does Health Canada do to help people keep seniors at home? The help we've had so far comes from the CLSC nurse, who comes and washes her once or twice a week. The rest of the time, she goes out with us every week. Last Sunday, I went and had lunch with her. She's in great shape.

We would like her to die at home. My father died at home 25 years ago. We were 11 children at the time. Only 10 are left now, and we take of our mother.

What does Health Canada do to help people stay at home with their children?

[Claude Rocan]

I must say your mother is very lucky.

Health care is a provincial jurisdiction, and we don't interfere in it directly. Perhaps Nancy can talk about some of our initiatives.

As I mentioned in my presentation, we're mainly concerned with knowledge development. We're trying to share our knowledge. We're working with the other provincial and territorial governments in Canada. We're trying to work strategically with those governments and with non-profit organizations, research institutes and universities, to gain a clearer understanding of what it is to age in good health and a better understanding of the practices that can contribute to that.

[Roger Gaudet, Bloc, Montcalm, QC]

I understand your viewpoint. However, I don't want to talk to you about provincial jurisdictions because that's not the point of my question. Earlier Ms. Hinton talked about physicians. There's a shortage of physicians. There's a shortage not only in Quebec, but in Ontario as well. Quebec physicians are leaving for Ontario, Alberta and elsewhere.

Couldn't Health Canada tell the government to give the provinces more money for education? That would make it possible to have more physicians. People don't study medicine because it's very costly. Canada could give more money to the provinces and the universities. Perhaps that would be a solution.

If you hold meetings with all the departments in the world, you will only find problems. I was mayor for 13 years and we always had the same problems. We held meetings. Today, thanks to computers, we can find solutions that would be suited to all Canadians. Let's stop holding meetings to find out the problems because we know them. We need solutions.

Even if you went to the UN, you wouldn't solve the problems. Let's take the example of Cuba. A number of Canadians and Quebeckers go to Cuba for operations. How is it that they can be operated on in Cuba? There are doctors on every street corner. In Canada, a supposedly rich and democratic country, we can't get doctors. There's a problem.

Canada currently generates surpluses of $11 to $12 billion a year. A portion of that money should be given to the universities and provinces to help people. If we don't have physicians, we can't help people. Without physicians, no one will be able to solve life's problems.

Those were my comments. Now I'd like to hear yours.

[Nancy Milroy-Swainson]

As I've already said, it's really a problem everywhere in the country and in the world. The government is working with the provinces and territories and granting them money to increase the number of physicians and other health professionals, particularly nurses and psychologists, to name only a few. However, there are other ways to improve access to health services. For example, to assist the provinces and territories, we're working in the primary care field to create teams. The goal is for professionals to be able to work together and meet the needs of people, particularly those coping with chronic diseases, those who need home care or palliative care.

The fact that people work in teams means better access to somewhat specialized services. We're working closely with the provinces and territories and with other partners to create an environment and tools to work in teams. For example, we give money to Canada Health Infoway, an organization that is working to establish a common electronic health record across the country. This tool is to enable professionals to work together and individuals to obtain information on their own health so that they can take care of it.

Canada Health Infoway is also working to create Telehealth programs. The objective is to improve the quality and accessibility of home care, for example, in the case of individuals suffering from heart problems or chronic diseases. The number of professionals is not the only important factor; there is also the way in which these professionals are organized and the way they are supported so that they can meet people's needs. We're working together with our partners to improve those conditions.

[Roger Gaudet, Bloc, Montcalm, QC]

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you.

Now we're going over to Mr. Shipley, who I know would have loved to have picked up on the tail end of Mrs. Hinton, but he now has his own five minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you, Mr. Chairman.

Thank you to the folks coming in today.

Ms. Mealing, I was just taking a peak in the book here, the Canadian Institutes of Health Research's aging biennial report. If you go to page 8 there's some disturbing news in the report. One of the things is helping seniors stay on their medications safely...new emerging teams. It talks about in 2006 we spent $25 billion on medications, the second largest share of health care expenditures. That says that if you're between the ages of 60 and 79, you have an average of 39 prescriptions per year, and that goes up to 74 as you reach ages 80 and over. If we aren't actually concerned about those numbers, we should be concerned about them.

Mr. Rocan, in your comments on page 9 you talk about health promotion. It seems to me that we're running in two directions in terms of health promotion. Is there a direct relationship to the amount of medication we give people in terms of how we measure promotion of health? We talk about health, up to 70%...90% for diabetes, 50% of strokes are preventable. Are you talking about more preventable because of the drugs that we give them, or more preventable because we encourage them to actually do healthy activities?

[Claude Rocan]

I would say it's more the latter. We are working very hard to encourage people to undertake healthy activities in a number of ways, as I've expressed, in a number of different levels. The area of health promotion is extremely broad. It does deal with individual behaviours, but it also deals in a broader sense in policies that governments take that can have an impact on health. What we try to do is to have a broader impact on public policy on a number of different levels. Yes, ultimately what we are trying to do is to have an impact on human behaviour and to encourage healthier human behaviour so that people can avoid problems, including problems that require medications and so forth.

Linda, did you want to add a comment?

[Dr. Linda Mealing]

I think that's the research also--that you have 39 prescriptions--but I think it's eight different medications when you're over 65. I think that's perhaps a culture of the physician who has very limited time, because sometimes physiotherapy or some other kind of therapy could reduce the need for medication. It's also the behaviour of the patient wanting medication and perhaps seeing more than one doctor.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I don't think the patient should be the one who determines whether they get medication or not. Do you?

[Dr. Linda Mealing]

No, you're right.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Do your agencies actually try to promote good health rather than medicated health?

[Dr. Linda Mealing]

Yes, definitely.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Do you think you are very successful ?

[Claude Rocan]

That's a very interesting question. I think that leads to the challenging issue of evaluation in the area of health promotion. We are definitely working very hard in that area. We put a number of resources into it. I think methodologies related to evaluation continue to evolve. Some are challenging in the sense that we need longitudinal studies to track the impact that we're having. I think that we can certainly show the results of shorter-term interventions and indicate the impact that we're having in that way. But it's hard to develop those causal links between our interventions and the actual change in health outcomes. We continue to try to do that, but it's challenging.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

This is not a hit. I'm just concerned, because when you go on to page 14, we talk about prevention of falls. In terms of medications that we have, I don't know if the medications sometimes get the credit for the accidents they cause, because people have mixed medications. We've all heard of times when we as parents, or as siblings of parents, say “no more”, pull back, and some miraculous thing happens to the health of those we're caring about because they've got all these medications that over time have just been building, and they create incoordinations.

I encourage you, as we look at the falls, and this is what we're trying to do.... This is about veterans also. I don't know if these are your studies, but does there seem to be more of a concern for veterans--because of their background of being in the armed forces--that they will tend to have higher medication than others, and are they as susceptible to the health promotion factors you talked about? Are they more accepting of that than other Canadians?

[John Cox]

I think part of the question that you're asking is what is the difference between a veterans population as it's known and identified and the general population. I think we obviously suffer to the extent that finding data and having enough data about older persons generally, and the specific sub-populations--whether it's veterans or some of the other sub-groups that we've mentioned in conversation today--is quite a challenge as well. I guess the short answer would be I don't think there is a great deal of information that sets out those comparisons.

I think perhaps David Pedlar of the Department of Veterans Affairs would have the best handle on some of those things from his position as a researcher and gerontologist, in terms of what he's been able to identify with veterans populations.

Did you have something, Linda?