Evidence of meeting #11 for Veterans Affairs in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was recommendations.
A recording is available from Parliament.
11:05 a.m.
Conservative
The Chair Conservative David Sweet
Meeting number 11 is now in session.
Good morning, Mr. Marshall. We'll move to you in a second.
I understand there was a member--I believe it was Mr. Oliphant--who asked if we could handle some business. Is that correct, Mr. Oliphant?
11:05 a.m.
Liberal
Rob Oliphant Liberal Don Valley West, ON
Yes, but could we do it at the end? Judy is not here, and I know that she was the one--
11:05 a.m.
Conservative
The Chair Conservative David Sweet
Yes, we could. It's always risky to hold it until the end. On that note also, we have witnesses who might be late for the second half. So we'll keep it for the end. But let's try to be crisp on it, because it's going to jam the business portion of it.
Do I have consensus on that? Shall I keep the business for the end?
11:05 a.m.
Some hon. members
Agreed.
11:05 a.m.
Conservative
The Chair Conservative David Sweet
Welcome, Mr. Marshall. You were in front of the committee twice in the 39th Parliament?
11:05 a.m.
Conservative
The Chair Conservative David Sweet
We appreciate your expertise from the Gerontological Advisory Council. Do you have some opening remarks?
11:05 a.m.
Conservative
11:05 a.m.
Chair, Gerontological Advisory Council
They're probably right on 10 minutes--I tried.
11:05 a.m.
Conservative
The Chair Conservative David Sweet
Okay, that's fine, then.
Please begin. When you've finished, we'll go with our regular routine rotation.
11:05 a.m.
Chair, Gerontological Advisory Council
Thank you, Mr. Chairperson and the standing committee, for giving me this opportunity to come before you once again.
As you know, I have served as the chair of the Gerontological Advisory Council since its inception in the fall of 1997. I'm sure you've all read and digested GAC's report, Keeping the Promise, which we released in 2006. I appeared before this committee in April 2007 to discuss it.
Over the past 13 years, I've also attended meetings of other VAC advisory groups, and I was a member of the new Veterans Charter advisory group as well, which of course released its report in October 2009, Honouring Our Commitment.
I know that you're primarily interested in the new Veterans Charter, as it continues to be a living and therefore changing and changeable charter. While Keeping the Promise focused on the concerns of DVA for the traditional veterans of World War I--there were four alive at that time, and of course none now--and World War II and Korea, in that report we suggested that the basic principles advocated for the traditional veterans should really be applicable to all veterans.
The Gerontological Advisory Council works largely through consensus and only rarely votes on motions. However, GAC, at its last meeting, formally and unanimously endorsed the report of the new Veterans Charter advisory group. As you know, that report also endorsed the basic principles in Keeping the Promise. So there's a real synergy between these two reports. That's really the theme I have for you today.
I want to speak to some of these general principles of, if you will, consistency or agreement across those reports, and then take some questions from you.
Any recommendation that the Gerontological Advisory Council made had to pass three tests, basically. It had to meet the needs of the veterans groups, as they see it, to be acceptable to them. It had to be realistic in terms of the clinical and health care experience of the providers. And it had to pass the scientific criteria so important to the academic members of the council, who are really interested in evidence-based practice. These same principles, which I can translate as realism, pragmatism, and scientific validity, also governed the new Veterans Charter advisory group in its deliberations. I really don't think you can do better as a way to formulate policy advice.
I think the most useful thing I can do is to highlight the congruence between these two reports. The basis of this congruence is that both reports place the veteran in a life course context. The life course context is widely accepted by social scientists and employed by the policy research initiative of the Canadian government. It maintains that in order to understand people in the later years, you really have to understand what they have been through all of their lives, and also in relation to the way they encountered history. For example, research shows that psychological damage occasioned by operational stress injuries does not necessarily emerge immediately, but may only have effects later in life, sometimes much later in life. For that matter, the same can be said for musculoskeletal injuries. That makes it difficult, if not impossible, to link the veteran's needs to a specific service-related incident that may have occurred years or even decades earlier.
Another principle enunciated in Keeping the Promise and further developed in Honouring Our Commitment is the emphasis on the social determinants of health. That concept is very Canadian, in fact. It dates back to the famous Lalonde report and also to what is colloquially referred to as the Epp report--after the then minister, Jake Epp--Achieving Health For All. These are charter documents in the field. Their approach has been adopted by the World Health Organization and very much influences thinking among the National Institutes of Health in the United States, CDC, and the Canadian Institutes for Health Research in Canada.
Social epidemiologists maintain that social determinants of health other than medical care, which is one of the social determinants, account for more variation in health status than does health care itself. The emphasis on policies to address not only medical care but also other social determinants of health, such as economic conditions, I take to be a major strength of the Honouring Our Commitment recommendations.
The big example for me in that report is in terms of economic well-being and the importance of taking a life course perspective, as reflected in recommendation 2.2: “Ensure disabled veterans receive a fair, equitable income consistent with a normal military career.” It's a good thing to index disability benefits to the cost of living. However, if the base salary remains that of a private, these benefits will not fairly reflect what the individual would have been able to realize had they been able to stay in active service and live out a normal military career with its attendant promotions.
I know there are concerns about the issue of lump sum payments. This is a complex area, and I am not an economist; I am merely a sociologist. But my major area of research in aging, in fact, has been in the sociology of the life course and the changing transition from work to retirement. My reading of the literature on people's anticipations and planning for retirement suggest that lump sum payments may have disadvantages from the perspective of the veteran.
I recently summarized for my aging class at the University of North Carolina at Chapel Hill--where I am a professor--the data related to income security in later years. There are four basic points. Most people think they're saving more than they are. People think they have more pension coverage than they do. Most people don't know--this is in the U.S.--that the social security retirement age is rising from 65 to 67, and people expect to work longer than they actually end up working.
This is all evidence-based knowledge in the U.S., and I assume it applies to Canada. The new Veterans Charter would do well then to provide predictable economic support that does not change drastically when one reaches the conventional retirement age of 65 or the normative actual retirement age of about 63 or 64 in Canada.
Some people who receive lump sum benefits as compensation for pain and suffering are likely to spend them rather than use them wisely over the remainder of their life course. Lump sum benefits may be less costly to the department, but they can be very costly to the economic and social well-being of our veterans.
The recommendations in Honouring Our Commitment, I think, present a reasonable set of proposals in this area. An ecological perspective is another plank in the platforms of both reports--advocated in the Gerontological Advisory Council as well--which places the veteran in the context of his or her family and community and urges the provision of care programs close to home.
Keeping the Promise promoted the principle of family based services, and this approach is reflected in the new Veterans Charter advisory group recommendations regarding the family. In fact, it's the very first recommendation in that report, to strengthen family support services in five different areas.
A program based on needs rather than on complex service-based eligibility requirements was central to recommendations in Keeping the Promise. We maintain that it is neither feasible nor necessary to relate a current health condition in the later years to a specific war or conflict-related event. Moving to needs-based criteria with careful screening of needs could save a lot of administrative dollars and reduce the complexity and the time of the appeals process that many veterans go through.
To address veterans' needs--I know Muriel Westmorland has emphasized this to you--rehabilitation has to be stepped up greatly as a Veterans Affairs Canada service component. While doing so is costly, I'd like to suggest to you that it's also an investment, because active rehabilitation early in life is going to enhance the veteran's ability to remain in the workforce, to attain economic security, and to remain healthy longer.
Putting all this together, we in the Gerontological Advisory Council saw the need for a new way to organize comprehensive, integrated health and social services. We continue to think this has a wider applicability through the new Veterans Charter evolution to address as well the needs of the Canadian Forces veterans. All members of the Gerontological Advisory Council think Keeping the Promise articulates a clear set of principles for the reform of health and social services for all of Canada's veterans.
We are all delighted that the May 2008 report of this committee called Keeping the Promise is a bold new approach to health programs and services, and your first and second recommendations were that the DVA redesign its programs for both classes of veterans, as recommended by the department's Gerontological Advisory Council in Keeping the Promise.
I will tell you frankly that neither I nor other members of the Gerontological Advisory Council, which I chair, are particularly happy that the legislative authorities to act on this advice are not in place. My impression is that the Department of Veterans Affairs values the policy advice in Keeping the Promise greatly, and at its request we have been giving the department advice as to how to move as far as we can in the direction we've advocated, sticking within existing legislative authorities.
So here's where the advice of the new Veterans Charter advisory group I think is useful, because it rests on the same general set of principles. We think the recommendations in Honouring our Commitment meet those three tests that I mentioned earlier: they meet the needs of veterans; they are realistic in terms of providers; and they are consistent with research-based evidence about the health and social service delivery and economic support mechanisms that are needed.
My message to you, then, is a ringing endorsement of that report, and I hope you'll recommend the necessary changes to legislative authority.
Thank you.
11:15 a.m.
Conservative
The Chair Conservative David Sweet
Thank you, Mr. Marshall.
This is just a reminder that we have a second set of witnesses, so we will have barely enough time—probably not enough—for two full rounds. Please share your time with your colleagues appropriately.
Also, maybe just because of the last meeting, let's try to stay focused on what's under the charter so that we have enough material for our analysts to finish the report.
Now we'll move on to Mr. Oliphant for seven minutes.
11:15 a.m.
Liberal
Rob Oliphant Liberal Don Valley West, ON
Thank you, Mr. Marshall, and thank you for coming back repeatedly to this committee. You may end up being an example of gerontological forbearance, in the end, if we don't get moving on this.
I am still a relatively new committee member. Just so I get it in my head, in 2005, the study was commissioned and a group was put together. Your report came out in the fall of 2006, so we're at almost four years. Your principal recommendation was the integration of programs that related to health care for what we call traditional veterans.
11:15 a.m.
Chair, Gerontological Advisory Council
That's correct. We also had recommendations for jacked-up health promotion—
11:15 a.m.
Chair, Gerontological Advisory Council
—and integrated services, under our determinants of health framework.
11:15 a.m.
Liberal
Rob Oliphant Liberal Don Valley West, ON
I've read the report. I think it's excellent.
Has your group continued meeting in these last four years?
11:15 a.m.
Chair, Gerontological Advisory Council
Oh, yes, it has, but we have almost certainly had our last meeting, because there is a move afoot to come up with an integrated advisory council, which will bring together a number of the people who are on the Gerontological Advisory Council now and then the people from the new Veterans Charter advisory group and representatives from the mental health advisory committee, although that will remain a separate committee.
So we'll continue--and maybe I'm speaking out of turn--but this is not finalized. This is what we are actively discussing now. And then I would actually remain on and chair a committee focusing on the traditional veterans within this broader event.
We held our last meeting last fall, but we're still doing a bit of committee work.
11:15 a.m.
Liberal
Rob Oliphant Liberal Don Valley West, ON
Okay.
In these four years, has anything changed in Veterans Affairs as a result of your study? Your principal recommendation has not been accepted by the government.
11:15 a.m.
Chair, Gerontological Advisory Council
That's correct. And I've written the minister--not the current minister--twice expressing our unhappiness.
11:15 a.m.
Liberal
Rob Oliphant Liberal Don Valley West, ON
Okay. We're now into this sort of strange world of our new veterans now becoming senior citizens. The reality is that even in these five years there's been a shift, so that many Cold War veterans, peacekeepers, and other veterans are now close to being or are senior citizens, and some of them are actually quite aged persons.
Are your findings still hopeful or valid for new veterans under the charter? Is there some work that can be done to bridge that gap?
11:15 a.m.
Chair, Gerontological Advisory Council
Just to preface my remarks on this, I would like to say that I think our report had a significant impact within the VAC bureaucracy, if you will, in helping to move the culture in the direction of our recommendations. We think the bureaucrats in Veterans Affairs--the ones we deal with at, least--seem very supportive of all of this.