Debates of May 13th, 2003

Supply

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Chair, I thank the minister for her speech. It is true that there are those who think that absence makes the heart grow fonder, but this evening affords us the opportunity to ask the minister some questions since she has been a rare sight in the Standing Committee on Health in recent years.

As you know, there is no issue more important than health. This is shown in opinion polls, moreover. It transcends any partisan considerations and reflects a social phenomenon. It is not uncommon for us to meet constituents who are 97, 98, 99 or 100 years old. Now as well as referring to the elderly, we also refer to the old elderly. This will, of course, present a challenge for public administrations in the way they will organize the health care system.

Of course, health care delivery is not a direct federal responsibility, except for the aboriginal people, armed forces personnel and some other specific categories. It is a provincial responsibility.

I have a few questions for the minister. In the last budget, for 2003, $34 billion was announced over five years for health care modernization and reform. If I counted right, the federal government used the occasion to announce—I have re-read the budget documents in the past two days—nine new health care initiatives. This leaves potential for interference, which the Bloc Quebecois will be keeping a close eye on. The minister tends to be somewhat centralist, as she knows.

I will mention each of the funds because our constituents may not know them as well as we do. They may not have had the opportunity to read the budget documents, which can be a source of personal growth if one does not rush through them. I will list the nine funds, and I will ask the minister to specify what the role of these funds is and how much was allocated to Quebec. I would greatly appreciate it if she would be kind enough to send my office a list of the projects approved.

Again, in order to make sure we all have the same information, there are nine funds, nine initiatives that were announced with the $34 billion.

First, there is the health information technology fund, with $600 million. I think that this fund will include telehealth, among other things.

Second, there is $15 million for the Canadian Coordinating Office forHealth Technology Assessment.

Third, there is $20 million for patient security. I do not really understand what the purpose of this is; this would be an opportunity for the minister to provide details.

The fourth initiative is the governance and accountability fund, for $115 million.

Fifth is $15 million for the national immunization strategy. The minister referred to this earlier in connection with aboriginals, but I would like her to clarify.

Sixth is $15 million for the Canadian Health Services Research Foundation. From what I understand, if I read the budget properly, this is only for 2003.

Seventh is $80 million for pharmaceutical management.

There is an issue of great concern to me, so much so that I submitted to the Standing Committee on Health a mandate concerning the whole issue of drug costs. As we know, drug costs are increasing by 15% each year. Even if the Romanow report, on page 203, says that there is no relationship between patents and the cost of drugs, the fact remains that, as parliamentarians, we will have to look into this.

I think that the role of the Patented Medicine Prices Review Board and all the new drugs put on the market which have little therapeutic potential raise issues that will have to be reviewed.

Eighth is $30 million for health planning, coordination and partnerships.

Ninth and last is $89 million in connection with health services provided in official language minority communities. I think that the Minister of Intergovernmental Affairs also intervened in this respect.

My first question is this: could the minister update us on these initiatives and tell us how much of this funding went to Quebec ? If this information is available—I understand that it is rather specialized information—she could send it to me at my office.

I have another question for her. The national HIV/AIDS strategy was implemented under the Conservatives. The annual budget for this strategy is $42.2 million, and it has not been increased in 10 years.

Could the minister tell us what she intends to do about the strategy? I would imagine that she will agree that, in certain major urban centres, AIDS is the primary cause of death among individuals in a certain risk category.

There are my questions for the time being. When I have more time, I will ask more. I would appreciate answers that are both short and to the point.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I take the hon. member's admonition seriously. His first question was not short. Let me deal with the second question first and then I will come back to his lengthier question because that will take me some time if he wants me to go through all the funds.

In relation to HIV-AIDS, the hon. member is absolutely right that our strategy at the moment is an annual amount of $42.2 million. In fact that amount has not been increased over these past number of years. I have gone on record whenever I have met with national or local HIV-AIDS groups, for example from my own province of Alberta and my own city of Edmonton, that there is no question after the evaluation is done, which is ongoing at this very moment, I will be arguing very strenuously with my cabinet colleagues that we must increase the amount of money that goes into our annual national HIV-AIDS strategy.

I simply think that we know more today; science has helped us understand more about pharmaceutical interventions that help people live better lives and help them live longer while suffering with HIV-AIDS. We know there are gaps in our strategy. We know that more research needs to be done. We know that we need to put more emphasis on community support networks and support for families when a family member is suffering from HIV-AIDS.

I do not have to be convinced that more money is needed on an annual basis for the strategy. That is clear. It is a case of making sure that we do the evaluation which is required by Treasury Board, but more important, which is required because the community groups themselves are involved in that evaluation in identifying the gaps and the omissions. We must build on the good work that has been done especially by community based organizations and move forward.

The health committee is looking at this issue. I look forward to any recommendations that its members have for me in relation to how they think the strategy should be enhanced and built upon for the next phase.

The hon. member in his question worked through a number of funds that were identified in the first ministers accord in February. I do not know whether he wants me to go through them all, but I will identify a few and the hon. member can tell me to stop anytime he wants and I can send the information directly to his office.

He mentioned health services and official language minority communities. There is $89 million over five years to implement a training and retention initiative for health professionals and a community networking initiative to improve health services to minority official language communities.

At this point I will take the opportunity to congratulate and thank the chairs of the two committees. Hubert Gauthier from St. Boniface General Hospital in Winnipeg chaired the francophone minority committee on behalf of Health Canada. Eric Maldoff chaired the English speaking minority committee in relation to the provision of health services. Their work and the work of colleagues within the government led to a budget provision that the member has rightly identified to assist both official language minority communities in relation to the areas I have outlined.

The member mentioned pharmaceuticals management. Budget 2003 provides $190 million over the next five years to improve the timeliness of Health Canada's regulatory processes with respect to human drugs as an element of the overall health reform package. Access to safe, effective, new human drugs requires timely, efficient and scientifically rigorous review in all phases of the product cycle, including reviews and approvals by Health Canada.

This is an area to which I personally am very committed. We need to assess our existing drug approval process. We need to figure out how we move forward to ensure we have a globally benchmarked drug approval process that is second to none in the world, not only in terms of timeliness but obviously in terms of effectiveness, safety and cost effectiveness. That $190 million will help us discharge those kinds of obligations.

The hon. member mentioned nine funds. I have details in relation to all nine, but I get the sense that the hon. member does not want me to go through all nine. I would be happy to send the information in writing to the hon. member's office for his consideration.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Chair, I accept the minister's idea, particularly since I asked her a question on the funding for Quebec because she was listing what had been passed in the budget, which we already knew. I know that she meant well by sharing that information with us.

I will, however, raise some other questions because this is such a golden moment, to have a direct contact with a minister who was not know for faithfully attending the health committee. I will ask two more questions, if she is agreeable.

I contacted her about cigarette smuggling. I had received information that this was a common practice in certain parts of Canada, including some reserves. I was on the committee when we revisited the whole matter of mandatory labelling. I presented her with examples of cigarette packaging that did not meet the labelling requirements, as the standing committee required. The minister looked into this, and was suppose to get back to me. Perhaps she could take advantage of this opportunity to bring us up to date and reassure everyone, manufacturers and consumer associations alike, that there will not be two standards, that everyone will be subject to the same laws and regulations.

I have a second question on this aspect. The previous Government of Quebec was one of the best that ever served. I know my good friend, the member for Verdun—Saint-Henri—Saint-Paul—Pointe Saint-Charles, may feel otherwise, but it was a good government. We will judge the new one according to what it comes up with. Can the minister tell us whether she has had representations to indicate whether the new health minister was any more kindly disposed to the reproductive technology bill than the old?

She will recall that, although serving as a go-between is not my style, I forwarded to her a letter in which the Government of Quebec opposed Bill C-13 on reproductive technologies. Has she received any representations that would indicate that the new government is any more in favour of it?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, there are three things.

The hon. member raised the question around Quebec's allocation from various funds. Again, I can send him the details, but let me make it clear for example that the health reform fund of $16 billion over five years is a per capita fund, so it is easy to work out Quebec's allotment. The medical equipment fund is a per capita fund, therefore it is easy to work out Quebec's share of that fund. Some of the other funds or spending items that the hon. member identified are third parties. Canada Health Infoway receives an additional $600 million. That goes to Canada Health Infoway, which is an entity separate and apart from the government, but one where dollars will be spent in the provinces, including Quebec, to build on the good work around things like electronic patient records and telehealth. That is ongoing.

I want the hon. member to be aware that some of the funds are per capita, which are easy to work out. Other items he has mentioned are third party entities. The dollars go there and certainly funding of specific projects will take place in the province of Quebec as in other provinces.

The hon. member referred to the cigarette packages. The member was very wise to bring this to my attention and I thank him very much for doing that.

Just the other day I had the opportunity to see some of the packages and the hon. member is absolutely right. They do not meet the labelling requirements.

After he brought it to my attention some time ago, I asked my department to begin an investigation because there are a host of issues involved with those packages of cigarettes, only one of which is around labelling. Labelling does of course speak to the fact that there are no health warnings on those packages as it relates to the dangers of cigarette smoking. Also, as far as I can tell, there is no indication of the substances; there is no information around what is contained. I think we probably have a safety issue in relation to the tobacco leaf, where it came from, how it was grown, whether it was sprayed with various things.

There are a host of issues that we need to look at in relation to those packages. I have asked my department to follow up on that. I thank the hon. member very much for bringing that to our attention.

The hon. member asked me about the creation of the agency in relation to our assisted human reproduction legislation and the important challenge that many couples, a growing number of couples, face around infertility and their desire to start a family. There will be an agency created as proposed in the legislation. In fact this is the first time there will be any regulatory framework in this area. It is an area that needs some regulatory framework. The agency will be created as proposed in the legislation.

In Quebec, I have not had the opportunity to speak to the new minister of health, Mr. Couillard, in relation to his views around this agency, but I will be meeting with Mr. Couillard tomorrow in Montreal. I will certainly be more than interested in knowing the views of the new minister of health in relation to the creation of this agency.

[Réal Ménard, Bloc, Hochelaga—Maisonneuve, QC]

Mr. Chair, the minister should seek my presence more often. I am easy to work with and I am sure that in these types of discussions, even though I do not pretend to be an expert, I could help. I respect her desire for intimacy with the new minister, and I mean political intimacy, of course.

I would like to go back to the issue of the Krever commission. I think that the minister was not responsible for the Krever report at that time; she was Minister of Justice. You know how important the Krever report was to all parliamentarians, especially the first recommendation contained in the report. This commission of inquiry cost millions of dollars, but it was necessary. We know what happened in blood banks in the late 1980s.

The Krever commission recommended that there be a no fault compensation package. This recommendation created a lot of hope for Quebeckers as well as for Canadians. The former Quebec minister, Pauline Marois, a most endearing woman—who, I should add, knows what the future has in store for her—and the previous provincial government had introduced a compensation package, a fund for those people who were infected through blood transfusions.

If I have had one disappointment in my public life, it was seeing how this government showed no empathy and no consideration for those who were infected. My question to the minister is this: what is she waiting for to follow up on the first recommendation of the Krever report, which calls for a compensation package for all those who were infected, regardless of the chronology of events? It would be a great act of humanity that would enhance her stature as a minister.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, again the hon. member has raised a very serious question, one on which I do believe the government has shown some considerable humanity and compassion to choose his language.

We have committed approximately $1.4 billion for compensating and assisting people infected with hepatitis C through the blood system. We as a federal government have paid $875 million to fulfill our financial obligations to claimants under the 1986 to 1990 hepatitis C settlement agreement. In fact, this all flows directly from Krever.

[An hon. member]

Respond to the question.

[Anne McLellan, Liberal, Edmonton West, AB]

I am responding in terms of what we as a government did. I understand the hon. member wants us to be more sensitive. In essence he is suggesting that our compensation plan has been inadequate. What I am saying is that in fact the government has committed over $1.4 billion by way of compensation and assistance.

Not only have we paid the $875 million to fulfill our financial obligations to claimants under the 1986 to 1990 settlement agreement, we also have put aside some $525 million to provide care and improve blood regulation and surveillance. The $525 million is largely to provide care for those individuals who were infected with hepatitis C before 1986 and after 1990. An important component of that funding is the undertaking agreement which provides a transfer of $300 million to the provinces and territories for health care services to help ensure that individuals infected with hepatitis C do not incur out of pocket expenses.

Our plan is sensible. It is compassionate. It provides care to people living with hepatitis C.

[Svend Robinson, NDP, Burnaby—Douglas, BC]

Mr. Chair, I appreciate this opportunity to ask the minister a number of questions. The challenge for me and my colleagues in the federal New Democrats was to decide on which particular issues we wanted to hone in on this evening because there are so many that we could raise in the course of 20 minutes. What I want to do is to put a number of issues on the table to the minister and then invite her to respond to them.

Before I get to some of the key questions I want to raise, I want to follow up on a question that my friend Mr. Ménard raised, and I believe that as we are in committee it is appropriate to use names.

[The Chair]

Just a moment, please. I just want to be clear that we still must make reference to each other's riding.

[Svend Robinson, NDP, Burnaby—Douglas, BC]

Very well, Mr. Chair.

I want to wish the member for Hochelaga—Maisonneuve bon anniversaire.

The member raised the issue of tobacco and labelling of cigarette packages. I want to ask the minister just to follow up on that, a very specific question.

Some time ago the minister's predecessor, the now Minister of Industry, promised to move ahead on the issue of the deceptive labelling of cigarettes with labels like “light” and “mild”. That was a long time ago, in fact a number of years ago. I am wondering when the Minister of Health will finally honour that commitment and move ahead on this important question.

Why does she allow tobacco companies to continue to market in this deceptive and misleading way, labelling cigarettes as “mild” and “light”, when she knows that this has an adverse impact particularly on younger people? When will she finally take action to put an end to this deceptive marketing practice that her predecessor promised to act on a long time ago?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, the hon. member is right in that my predecessor did indicate that he was going to take a look at the whole question of the “light” and “mild” descriptors on tobacco product packaging. After that, consultations were put in place and research has been done in relation to a number of important areas.

I am going to be quite candid with the hon. member, as he would expect. We want to make sure that when we move in this area, we have the science to back up the decisions we take. Otherwise we know full well that we will be spending a lot of time in court and a lot of taxpayers' dollars. What I would like to do is make sure that we have the science in place and we have done the research so that we have a compelling argument in relation to the descriptors “light” and “mild” and therefore, we can withstand any challenge, including a charter challenge, in relation to these descriptors.

Let me tell the hon. member that I take this issue very seriously. My department takes it very seriously. I would be wrong if I said that the scientific inquiry is over. In fact, we do not have all the answers as a matter of science at this point. I am also looking at the experience of the European Union. It has taken a somewhat different approach in terms of how it has dealt with these descriptors. I am looking at the experience of Brazil. I am looking at the approaches of various countries and then what tobacco companies do--

[Svend Robinson, NDP, Burnaby—Douglas, BC]

Delay, delay, delay.

[Anne McLellan, Liberal, Edmonton West, AB]

No, because then tobacco companies respond to those approaches. What I want to do is narrow the field, so that when we move we move in an effective way that deals with the real problem.

[Svend Robinson, NDP, Burnaby—Douglas, BC]

Mr. Chair, frankly Canadians are appalled at that answer. We do not need endless scientific research to know that these labels are misleading. That is the issue here. We know very well that these labels imply to those who buy those cigarettes, mild or light cigarettes and so on, that somehow they are less hazardous to health than other cigarettes. That is simply not the case. I wonder how much longer it will take for the minister to show the kind of leadership that Canadians are looking for on that.

My first question to the minister is with respect to the issue of the health council that was promised by the first ministers. We were told that it would be in place by May 5 which was over a week ago. Then the minister said that it would be in place by the end of this month. Now I have heard her say a few more weeks.

Could the minister clarify just what the timeline is on that? Just as important, would the minister clarify what her objective is with respect to the composition of this council? Will she assure the House and Canadians that this will not be a body that is dominated by government, but in fact will be a body that is independent of government that can ask the kind of tough questions that have to be asked, for example, around the issue of public funding going into private for profit health care? That is the first question regarding the powers of the health council, the timing of it, and what she sees as the key issues concerning the composition.

I will put the three other questions and then perhaps she can respond to those. The second question is, how does the minister respond to the damning critique this morning of the President of the Canadian Medical Association, Dr. Dana Hanson, with respect to the failure of the government to move ahead on a public health system? Dr. Hanson said:

It has become abundantly clear that Canada's public-health system is ill-prepared to deal with rapidly spreading infectious diseases, let alone the more insidious chronic diseases that lie at the root of most morbidity in our society.Canada's public-health and acute-care systems do not have sufficient disease surveillance capacity to adequately anticipate such events, nor the health-care workforce flexibility to respond to sudden health crises or calamitous occurrences

The auditor general said the same thing to the minister, as she knows, and her predecessor in 1999. How does the minister respond to these criticisms and what will she do to ensure that finally we see some federal leadership in the important issue of establishing a national public health strategy?

The area of medical marijuana is an area in which many Canadians are absolutely disgusted at the fact that the government has recognized that some Canadians in fact do need marijuana for medical purposes and that marijuana actually helps them to relieve the agony and the pain of some illnesses. Yet the government is in many cases forcing these people to obtain their marijuana illegally.

Does the minister not recognize that? I have been contacted by a number of Canadians on this issue. Permits have been issued to allow Canadians to grow their own marijuana for medical purposes, but in many cases people have to obtain the seeds or the plants illegally.

I want to ask the minister very specifically, why has the government not introduced legislation to allow Health Canada to produce safe and legal marijuana with standard THC content for patients that need it or at the very least to allow them to provide patients with seeds or plants so they can produce their own and not have to get it illegally?

The minister knows this is a concern. Some people using medical marijuana actually thought that the marijuana that was being grown in Manitoba would be made available to them. We were told that this was for research purposes, so that was not the case. Therefore they go to the back alleys and to illegal sources for that marijuana. Why is the government not acting on this important issue?

I have two other brief questions, one is on genetically engineered foods. I asked the minister on March 25, why will the government not move ahead and agree to the concerns of over 80% of Canadians who want mandatory labelling? They want to know what is in the food that they are eating. It is time the government stopped shilling for the biotech industry and allowed for mandatory labelling.

In her response to me about genetically engineered food and mandatory labelling this is what the minister said:

In fact, we have voluntary labelling requirements. We were working very hard with the Canadian General Standards Board to see if agreement could be reached around mandatory labelling provisions.

The minister is completely out to lunch there. She said they are working with a board to see if we can get mandatory labelling and that we already have voluntary labelling. Could the minister clear that up and give some indication that she knows what she is talking about on this issue and explain why it is that, given the collapse of the voluntary process and they are trying again this week, she will not move ahead on mandatory labelling?

Finally, there is mental health. It is a scandal that mental health is not a government priority. The minister will know that there are only 10 professionals within Health Canada dealing with the issue of mental health. That is an outrage. Mental health should be a far higher priority. The minister knows that mental health problems result in the second highest hospital admissions after heart diseases and stroke. It is the top billing of general practitioners.

I want to ask the minister, when will she start taking mental health concerns seriously and when will she work with the Canadian Mental Health Association to put mental health issues front and centre in the health agenda in this country. I look forward to the responses.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, as I indicated in my comments, at the request of the minister of health from Ontario, who we all know has been working very hard on the front lines of SARS for these past number of weeks, the health council postponed a scheduled provincial-territorial-federal health minister's conference call to deal with the council.

I spoke with my co-chair, who is from the province of Nova Scotia, and she and I agreed that under the circumstances we wanted to ensure all our colleagues had the opportunity to participate. I would hope that no one would disagree that we should be willing to provide colleagues the opportunity to be prepared to participate in that discussion. That is why the meeting was cancelled from its scheduled time. However, I have made it plain, as has Minister Purves, that we hope to reschedule that conference call and in fact I would like to be able to do that some time next week.

Regarding the composition of the health council, the hon. member is right that we must ensure, as the first ministers' accord indicated, that stakeholders and public experts are represented in relation to the composition of the health council. This cannot be a council that is overburdened with government representatives. It is a council on which we have a wide variety of members representing different perspectives, backgrounds and abilities as it relates to health care in this country. One of the key aspects of whether this body will be credible or not is in terms of who is on this body and we cannot overburden it with so-called government representatives.

I did not read the comments this morning of Dr. Dana Hanson as condemnatory of public health in this country. Dr. Hanson and the CMA have expressed views before as they relate to public health infrastructure, and I take very seriously their constructive input into the public health infrastructure of this country. That is an infrastructure that needs to be national. It is an infrastructure that needs to be built by provinces, territories, local public health authorities, and the federal government. That is why we are working toward and have improved the integration of our public health infrastructure.

For example, since September 11 we have put in $102 million directly into public health programs in order to enhance our capacity to deal with a range of public health measures, not just bioterrorism but other kinds of challenges such as SARS. This funding supports more advanced equipment in our labs, which we saw at work during the SARS outbreak, training for emergency health providers, stockpiles of drugs, vaccines, and emergency supply locations across Canada, and real-time information sharing on disease incidents.

This speaks to what the Auditor General and others have spoken about in terms of enhanced surveillance and how we do that surveillance. It follows that when we get the information from local public health authorities, that information must be shared so that everybody in the public health chain has that information and can work with it, and use it in ways that they see fit.

I also want to point out that coming out of our experience with SARS, I have asked Dr. David Naylor, who is the dean of the faculty of medicine at the University of Toronto, to head up what I describe broadly as a lessons learned exercise. Part of Dr. Naylor's recommendations and his committee's recommendations will be to deal with the public health infrastructure: what works, where the gaps are, and what we need to move forward. I have put in my own two cents worth, which is not unusual for me some would say, in relation to the fact that maybe we need a CDC-like national entity in this country that would become the focal point or the go-to place for a host of health issues, including infectious disease control.

Next is marijuana. I want to clarify this issue because there is a lot of misunderstanding. The hon. member has taken the opportunity to ask me on many occasions whether I and my department are discharging our obligation around drug approvals and medical devices, whether we are making sure we have rigorous clinical trials in place, and whether we are analyzing the results of those clinical trials to determine medicinal benefits and adverse effects.

I would expect the hon. member would demand exactly the same of me in relation to any claim around medicinal marijuana. The clinical trials have not been done to date. I have asked my department to search globally. The clinical trials that we are doing now in Toronto and in Montreal under the auspices of the CIHR, our open clinical trials, will probably be the most comprehensive clinical trials ever done in the world in relation to whether there are medicinal benefits from marijuana. We are the Department of Health. The hon. member would be outraged if we let somebody use some product for an alleged medicinal purpose without the clinical trials.

I will not be criticized for doing clinical trials to determine the medicinal benefits. In the clinical trials, both closed, in Toronto and Montreal, being run at McGill in the case of Montreal, marijuana is provided to those who are participating in the closed trials. The open trials can involve anyone who has an exemption under our regulatory regime. If they wish to participate in the open trials, marijuana will be provided to them so they do not need to worry about source of supply. Anyone who has an exemption, applied for and granted, can receive to participate in that open trial marijuana provided by us and marijuana, might I add, that has been tested and standardized so we know exactly the product with which we are dealing. We will be able to draw medically sound and scientifically based conclusions from those open trials.

I do apologize to the hon. member. I got my mandatory and my voluntary mixed up in the answer. Let me clarify for the hon. member and anyone else. We are working with the Standards Board in relation to voluntary labelling, and the hon. member says it is a failure. I and my colleague, the Minister of Agriculture, are not ready to throw in the towel. We have asked, and my colleague, the Minister of Agriculture, has even provided additional resources for the work to continue to see if we can reach some agreement around voluntary labelling. However I understand that this is an important issue and I just want to reassure the hon. member that Health Canada, along with the CFIA, has a rigorous process in place for evaluating the safety of foods derived from biotechnology. We are not waiting for labelling to do that. That is part of our obligation.

Our regulations require that these products be reviewed by Health Canada prior to being sold in our country to ensure that there are no safety concerns. We will continue to examine our review processes for biotechnology derived products.

[Svend Robinson, NDP, Burnaby—Douglas, BC]

What about mental health?

[Anne McLellan, Liberal, Edmonton West, AB]

The hon. member is probably aware that we participated in a fact finding exercise which recently resulted in the report on mental illnesses in Canada. This is the first statistical overview of mental illness in Canada and I would be the first to agree with the hon. member that this is a very serious question. Some people call it the orphan of the health care system. We are not different. It is true in other countries as well. That is no justification. We all realize that we need to ensure that mental health is integrated as a key component of our health care system.

I take heart from the fact that for example in my own province of Alberta, mental health is now integrated into the health regions so they can develop an integrated approach to both physical and mental health. Obviously that will be something interesting for us all to look at.

Let me also point out that the Canadian Institutes of Health Research dedicated over $30 million in the past fiscal year to fund research projects in universities, research institutes and teaching hospitals across our country that ultimately aim to improve the mental health of Canadians.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Chair, I was going to say it is a great treat to have the Minister of Health in the House tonight, and I suppose there are other words I could have used as well to be generous, but to have the parliamentary secretary, my colleague from New Brunswick, and her officials here is even better. I hope I can keep my questions short for the minister so I can get a few of them in. I think this one will start out in sort of a generous tone.

One thing suggested by Romanow was vesting more transparency in the transfer of moneys from the federal government to the province. To be honest, the provinces try to minimize that amount of money, the federal government tries to maximize it and there are all kinds of smoke screens all over the place. One of them is this idea of tax points. I guess in all honesty many of us, health officials included, have a hard time identifying exactly how much money flows to the provinces and when.

As evidence of that, one of the most confusing answers ever given on the floor of the House of Commons was to me by the Prime Minister in question period in February, after the agreement with the provinces, about old money, new money, so on and so forth. I will not quote the Prime Minister because it is quite confusing and I would not want to confuse the Chair.

The fact is we can do a lot to improve that. Does she agree with Romanow? I want to remind the minister that one of the suggestions we had in the last federal campaign was to include that sixth principle of health care. If we are to have another principle of health care, it should be full transparency so we could eliminate those types of petty arguments that really do nothing to help fix the system. Could the minister respond to that?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, the hon. member raises a very important question. That is why, starting in 2004, we will have a Canadian health transfer, CHT, which will make absolutely plain to Canadians and to each of the provinces and territories how much money the federal taxpayer is sending to the provinces. That Canadian health transfer will include both the cash and the value of the tax points so it will be absolutely clear to Canadians, as it relates to those two components which have made up heretofore the Canadian health and social transfer, the amount of money either in cash or tax points being transferred to the provinces.

For fiscal 2003-04 that amount of money, including and reflecting the increase through the health reform fund and the cash increase, will be $38.8 billion. That includes the tax transfer, the cash and the new money for this coming fiscal year, which flowed out of the health reform agreement.

However the hon. member raises a really good point. Canadians want to know how many of their federal tax dollars, be it cash or tax points, are going to support health care. We are going to create a health transfer. It will be completely transparent and Canadians will know and be able to say to the provinces that this is how much cash they have and this is the value of theirs tax points. They then will be able to ask the provinces how much is their total health care expenditures, how much of it is federal and how much of it is provincial tax dollars and what are Canadians getting for that?

The federal government is putting in more money every year. “Am I getting better health outcomes” is the kind of question to which expanded reporting will provide an answer. Canadians have a right to those answers. Canadians want those answers. Things like the Health Council will help provide those answers and analyze where the money goes and whether we getting better health outcomes for the dollars that are spent.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Chair, my colleague from Burnaby--Douglas mentioned the article that appeared in the Ottawa Citizen today by Dr. Dana Hanson. Dr. Dana Hanson is my doctor and he is from New Brunswick. He is now the president of the Canadian Medical Association. He was somewhat critical of the government in terms of how it acted in light of the SARS crisis, and I think I can use the word crisis without raising too much ire, and suggested that the government could do a better job. The member was right in raising the fact that he was somewhat critical.

There is a lot of uneasiness in the country in terms of how the minister responded to that. This is one of the occasions where we can look eyeball to eyeball and talk honestly without the normal interruptions in question period. I think some people were disappointed in how the minister responded to that. I know it is easy to be critical but the fact is some of her own cabinet colleagues criticized the minister on her being invisible on the file in terms of leadership.

That leads me to the point that Dr. Hanson made today. We know we have made some mistakes. I would like the minister to at least stand in her place and admit some of the shortcomings because there were some. He has suggested ways that we can be prepared for the next crisis which will occur. In fact we may be looking one in the face now and not recognizing it, and that is the West Nile virus. We are coming into the summer season. In a sense the minister will have a second chance because that could be a crisis, although we hope it will not.

What has the minister and the department learned in terms of responding with their provincial colleagues to prepare us for that next potential crisis, whatever it might be?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, first let me say in relation to a comment the hon. member made that I know what my job is and my job is not useless photo ops. My job is letting front line responders do what they know how to do and my job is making sure my department is working with the Ministry of Health in Ontario and front line public health responders to make sure we have all the resources on the ground integrated in a way that controls and contains, in this case SARS, to protect the public health of Torontonians and Canadians. Forget the photo ops, boys, this is too serious. What we do is make sure that we are fulfilling our obligations as a federal department of health as it relates to the public health of Canadians.

The other thing I would say is that I find it very interesting that in spite of Dana Hanson's column, and I have the greatest respect for Dana Hanson, centres like the Centers for Disease Control in Atlanta have nothing but praise for the work that Canada did, for the way the three levels of government worked together. In fact it indicated that it wants to work with us in relation to our national strategy and thinks that it would be very useful to participate with us and have a North American strategy.

Again, Dr. David Heymann, who heads up the communicable diseases division of WHO, although I do not have his quote directly in front of me, said something to the effect of how Canada did everything right.

That does not mean that it was not a public health challenge. Of course it was. That does not mean that there are not lessons to be learned, because of course there are, which is why I asked Dr. David Naylor to put in place a lessons learned exercise.

The hon. member raises an important question about what we do learn for the future, because we know there will be new public health challenges whether it is West Nile or some re-emerging infection or disease or some new disease such as SARS, which eight weeks ago we knew nothing about. But today, because of the state of our public health infrastructure, scientific and otherwise, and those of some other countries, we know an awful lot, we know about control and containment, we know what works and we can share that with the rest of the world. Dr. Naylor will help us build for the future, which is what is important.

And yes, I think there is not a country in the world that would not say we learn from every one of these public health challenges and it is our obligation to learn and build for the future, just as we learned after September 11, a bioterrorim challenge. It spoke to our public health infrastructure. I am sorry: September 11 was a terrorist situation, not a bioterroism situation. We learn from that. We see what works, what we need to integrate, where the omissions are. That is why we spent $102 million since September 11 doing just that: to enhance our capacity to deal with a range of public health measures, not just bioterrorism. As I indicated earlier, a lot of the things we have done, and that $102 million, help us deal with things like SARS and will help us deal with West Nile.

One of the most important things we have done is that we have upgraded our labs. We have put more advanced equipment in our labs so that we are able to deal with things like the epidemiology of SARS. We are able to deal with things like the confirmatory test that is done in relation to West Nile virus. We are able to share those results with the rest of the world. We are able to work on a diagnostic test and we are able to work on vaccines in partnership with researchers in Canada's great universities like UBC and elsewhere.

I would say that I have great respect for Dr. Hanson's point of view. I take his message as being that one learns from every public health challenge. We learn where the gaps are, where we can integrate and where we need new resources. It is our obligation to learn those lessons and build for the future and that is what we will do.

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Chair, the minister is prepared and she has her officials here, but I still disagree with some of what she said.

Following September 11, the Americans passed what they called the public health security bioterrorism response act. Having that passed was one of the reasons that the Centers for Disease Control was able to come to Canada and assist us; it was simply because the United States passed that act in a speedy fashion. Here in this place, still languishing in Parliament, as the article in the National Post tells me, we have the Canadian public safety act, which would allow us to deal with bioterrorism or diseases like SARS in the same capacity that the United States can, will and does.

As evidence of how inconsistent the government is on this and where the message still does not appear to have come through, I am looking at page 30 of the minister's own estimates for the year 2003-04. I would like the minister to take a look at it and respond. It is under the heading in section 4, “Priority: Protect the health of Canadians by enhancing emergency preparedness and response capability”.

That is pretty clear, is it not? Let us look at the budget for that. This year, 2003-04, it is $432.9 million. I believe we are talking millions. In this world of ours is it not something to think that we have come from the pipeline debate when C.D. Howe was in trouble in this place for saying “what's a million” to now saying what is a billion? We are looking in this case at $432.9 million. It is interesting with this plan that the minister has in the making that it appears as if the department in the year 2004-05 is going to be spending less, not more, and in the year 2005-06 less still, at $307 million.

How can the minister stand in her place and tell us that we are going to be doing more when she has less money to do the very thing that she is talking about under the heading of emergency preparedness? Can she explain that one?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Speaker, first let me indicate to the hon. member, because he is referring to some article that appeared in the National Post today, that we have all the legal authorities necessary to--

[Greg Thompson, Progressive Conservative, New Brunswick Southwest, NB]

Mr. Chair, on a question of clarification, I did use one particular quote but no, it is not out of the National Post . It is established fact. I did refer to one line out of that when I paragraphed that line, but that is common fact in terms of what happened in the United States. We are not just taking the word of a reporter. That is a fact. That was passed in the U.S. legislature, in Congress, and we have not done the same thing here. That is the point.