Debates of May 13th, 2003

Supply

[Anne McLellan, Liberal, Edmonton West, AB]

We do not need that legislation, Mr. Chair, because we have all the legal authorities now required in existing legislation to do the things which that legislation speaks to. I guess we could pass legislation that is redundant, but I do not think everybody on the other side would be very keen on that.

In relation to the money being spent, the hon. member is right that the fiscal profile as it appears here goes down, because in fact for the numbers in the lead-up, for example, plan spending in 2003-04 includes a one time expenditure for the procurement of smallpox vaccine. We do not intend to carry that forward in 2004-05 or 2005-06. They are one time expenditures that do appear, for example, in 2003-04. The other thing I want to point out to the hon. member, for example, is new equipment in labs. Again, it is a one time expenditure and therefore as we ramp up one may see the numbers go up as we make those one time expenditures, but they are not continued in the fiscal profile further out.

The other thing I would say is that if Dr. David Naylor and others decide and we agree, for example, that one wants to move to a kind of national, CDC-like, public health go-to focal point, then clearly I would be going back to cabinet and I would be talking to cabinet about that. I would be talking to cabinet about the resource implications. Then it would be up to the government to decide whether or not it wished to proceed in that way and provide me with the additional resources.

I am sure, and I will be quite candid, and I have no doubt that I will be going back to cabinet after Dr. Naylor's recommendations and seeking additional resources to enhance our public health infrastructure. I think that will probably happen. Whether it is a CDC-like entity or something else, that will then be reflected in the out years.

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

Mr. Chair, everyone in this place disagrees with the minister, including people outside of this place, such as the Auditor General. If we go through the Auditor General's report of September 2002, we see that she steps through this in chapter 2, line and verse, where the federal government is completely lacking in resources and the ability to respond to a crisis. If we look at that report from September 2002, we see that it is almost as if the Auditor General could see an issue like SARS coming down the road and was suggesting that the government was not capable of dealing with it.

The jury has already come in on this one. As a result of how the government handled this, last month for the first time in how many years we had 19,000 job losses in this country. Last Friday when I put the question to the Minister of Finance, it was answered by the Minister of Industry who admitted that yes, SARS did take a toll on the Canadian economy and that in fact we lost jobs. He admitted that we lost jobs. We lost 19,000 jobs and are still counting. Many experts are suggesting that because of the way the government handled this there are more job losses to come.

The fact is that we are ill-prepared to deal with the next emergency that may or may not be around the corner and the fact is that the minister's answer is simply not good enough because the record speaks for itself. The government was unprepared, she was caught flat-footed and it cost Canada 19,000 jobs and 24 lives.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, nothing could be further from the truth. I guess the hon. member will say what he wants.

What is really interesting is that when SARS came here nobody knew anything about the disease. In terms of infectious disease control, it is remarkable how quickly everybody put in place the public health control and containment measures to succeed.

It is people like him who create the problem. They talk of failure, whereas everybody else in the world talks about the success story. This disease, which no one had control over and which no one knew anything about, landed here and within weeks we had it under control and contained. We are a model to the rest of the world. People, such Dr. David Heymann, have said that Canada did everything right, including the screening of passengers as they left.

He can talk about failure and he can denigrate all the work that everybody did at all three levels of government but the rest of the world is not with him. The rest of the world, the CDC, the WHO and others, are saying that in a terrible, tragic situation of a new disease nobody knew anything about that we were amazingly successful in relation to control and containment.

Yes, tragically some people lost their lives. However no one is perfect and we will learn important lessons and build for the future.

However, because of the degree of readiness and the degree of co-operation among the three levels of government, we are able to say that only 24 people died. Those 24 deaths are a tragedy but, thank goodness, more people did not die because of the level of preparedness and the ability to put in place a plan to control and contain the disease.

[Bob Speller, Liberal, Haldimand—Norfolk—Brant, ON]

Mr. Chair, it is real pleasure to speak this evening to an issue of importance to the people in my riding of Haldimand—Norfolk—Brant. I am speaking about first nations health care.

The minister is well aware of the significance and the importance of health care to the communities in both the rural and remote portions of Canada and the important role that Health Canada plays in delivering health care services to these communities.

The hon. member across the way said that it was substandard health care. Frankly, I would agree that our aboriginal communities have many difficult problems and one of those problems is in the area of health care. I also believe that the Government of Canada can and should do more in this area.

We on this side are continuing to dialogue with the minister and the department to make sure that the proper resources are brought forward in this area, which I think we in Canada have been lacking for a number of years. However the hon. minister will know that there are success stories.

Before I go on I must inform the Chair that I will be splitting my time with the member for Mississauga South.

First nations and Inuit health care is provided by the Department of Health through Canada's first nations and Inuit health care branch. It tries to improve the health outcomes of first nations and Inuit. It also tries to ensure availability and accessibility of quality health services and support a greater control of the health system by building partnerships, which I believe is critical.

As the hon. member across the way said, there are challenges. We on the government side recognize those challenges. I know the department and the minister are working very hard to make sure the health services provided to the aboriginal and first nations communities are at a standard that is expected in other parts of this country.

As I said earlier, I think much more effort needs to be made. I know the Minister of Health agrees with me in that area. In fact, the population that Health Canada serves includes 721,000 status Indians, eligible Innu and Inuit residing here in Canada. Of those, about 397,000 are living on reserves or in Inuit communities.

Our challenge is to ensure that those others, those who live outside the communities that are the responsibility of the provincial departments of health, are still provided those services and have access to those services.

It is important to note some of the unique characteristics of the services that we do give to our aboriginal clients. For instance, the population of first nations is growing at a rate of about 2.2% a year. This is more than 2.5 times the Canadian rate. The aboriginal population is also on average younger.

In addition, 70% of first nations and Inuit live in communities with populations of less than 1,000. In fact, some have less than 500 people. These are small communities in remote parts of the country. As I have said, there are challenges in these communities.

However, despite these demographic statistics, the general health of our aboriginal people is better today than it was 50 years ago or even 10 years ago. These overall improvements, I believe, have been attributed to the noticeable improvements in their living conditions and in investments in disease prevention, but more particular, the importance of investing in public health in these communities.

Canadians still need to recognize that there is a significant gap in health status between our first nations and Inuit compared to the broader population. As I have said again and again, I believe much more needs to be done.

To address this gap Health Canada's first nations and Inuit branch has undertaken an extensive analysis of the situation and the services needed in these communities. Results from this analysis noted that rising drug costs and a shortage of health care professionals are specific challenges being faced by these communities. It is not a challenge that is unlike other parts of rural Canada, but it is particularly significant in the remote parts of this country where it is hard to get a health care provider to provide the service. We talk about distance learning and distance medicine and I know there are things we can do to help deal with these problems. Health Canada, in partnership with other departments, is looking at unique ways in which we can deal with the situation of the remote parts of the country.

It is such factors that really challenge Canadians today and challenge Health Canada in its ability to provide effective health programs and services to our first nations people. However I believe that the important groundwork has been laid.

When the premiers and the Prime Minister came together for the recent 2003 health accord, which was endorsed by all of them, they looked at health care for Canadians and particularly our aboriginal peoples. It constituted an important milestone in recognizing that there are specific aboriginal health care needs. It should be noted that the first ministers understood that they needed to work together to address the gap in health care services between aboriginal and non-aboriginal Canadians.

It is also critically important to know that Health Canada is committed to continuing this collaboration, particularly with first nations people themselves. Who knows better about their communities and the people within their communities than the first nations themselves?

Mr. Chair, coming from the same part of Ontario that I come from and representing the largest native reserve in the country, the people of the Sixth Nations, the Grand River or the New Credit, I am sure you know how important it is to dialogue with the people of our first nations in order to understand better those things we can do to help improve the livelihood of these aboriginal communities. Health Canada needs to continue to support a collaborative approach to health care across this country. There are important aspects of what is needed to be done that is known among first nations and Inuit people themselves.

On behalf of my constituents I will continue to dialogue with the minister and work with her departmental officials to make sure that all Canadians, not only in my communities but all communities across this country, rural and remote, have equal access to the health care services that the Government of Canada can provide along with the provincial departments, and make sure that first nations' voices are heard within this dialogue.

[Paul Szabo, Liberal, Mississauga South, ON]

Mr. Chair, I am pleased to participate tonight in this dialogue with the Minister of Health on the estimates and thereby on a broad range of matters.

I specifically want to address an issue relating to fetal alcohol syndrome. In the middle of 2000 a national advisory committee on fetal alcohol syndrome was struck. There is a little bit of background to it and I hope the minister will be able to enlighten the House as to where we have been and where we are right now.

Fetal alcohol syndrome and fetal alcohol effects are probably one of the least known impacts on children. In fact when I became a member of Parliament I had never heard of fetal alcohol syndrome. I am an educated person and have spent nine years on the board of a hospital and I have three children. I thought that we would have had every opportunity in a vibrant community to have been apprised of this, but I was not. When I came here one of the first things I asked was that I be put on the health committee, because I wanted to know more about the very critical area of sustaining Canada's health care system.

When I joined the committee I looked at some of the past reports of the health committee. One of them was “Fetal Alcohol Syndrome: A Preventable Tragedy”. When I read it, it just sold me. It just took my heart. I have been working on this issue for some time and I continue to work on it.

Fetal alcohol syndrome has been talked about by many of the NGOs and by Health Canada. The line they have been using for so long in their documents is that fetal alcohol syndrome is the leading known cause of mental retardation in children. FAS is the leading known cause. It struck me one day that fetal alcohol syndrome is not the cause of anything; it is in fact the result of drinking during pregnancy. However we do not want to say that as it is not politically correct. It would stigmatize women who drink during pregnancy and who have an FAS child, so we say that fetal alcohol syndrome is the problem.

I did some research and I wrote a little monograph. I made some suggestions. At one point real progress was being made. The suggestion was made that we have a national advisory committee on fetal alcohol syndrome. The then minister of health asked for my review of the specifications for this national advisory committee. It was the traditional one person from every province and territory with a balance of gender, aboriginals and people who knew about FAS, et cetera. I had seen this time and time again. I was so alarmed that I wrote a letter on April 13, 2000 to the special assistant to the Minister of Health saying “I have to let you know that I have a big problem with this. We need people who can deliver solutions”.

I laid out a three point program. The first aspect was to develop an information package on fetal alcohol syndrome so that everybody across Canada would be singing from the same song sheet.

The second aspect was to establish within the group those who were problem solvers, those who would develop a comprehensive strategy directed at the prevention of fetal alcohol syndrome and fetal alcohol effects.

The third aspect was to determine how to handle those who had the problem already. After someone has the problem, what do we do in our social program system, our criminal justice system, our health system and throughout all of society, because people with FAS and FAE are an integral part of our community.

The minister went ahead to establish the national advisory committee on fetal alcohol syndrome. I said in the letter that we needed targets and we needed to have deliverables, otherwise we would have another false start. My fear is that we have had another false start.

I suggest to the minister that this is an issue where we cannot allow any more false starts. We have to pick up the ball and recognize the significant impact this has on all Canadians, not just those who have children who suffer from FAS. All of us can be part of the solution. I hope that in the remaining time the minister will have some words of wisdom for the House.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I acknowledge the member's longstanding interest in fetal alcohol syndrome and fetal alcohol effects. He has done a tremendous amount of work and research in the area. He has really increased the level of awareness certainly in our own caucus in relation to the causes of FAS-FAE and the devastating effects not only for the children born with FAS-FAE but also for their families and the larger community.

The hon. member is right in that Health Canada did strike a national advisory committee. The committee is to provide independent strategic advice and expertise to Health Canada on FAS-FAE and promote collaboration and partnerships across disciplines and sectors. As I understand it, the committee consists of 18 members representing those sectors, including health, addictions, corrections, education and research, and it has representation from first nations and Inuit.

The hon. member is probably right that we need to do more and we need to do better. I must also give credit to my colleague the Minister of Labour, who has taken up this issue because she sees its effects in relation to homelessness which she deals with. When dealing with homelessness we look at the people who are on the streets, who are homeless either temporarily or unfortunately, more permanently. Many of them have mental health issues. Many of those mental health issues are related to FAS-FAE. My colleague the Minister of Labour and I have been talking about this, and she deserves credit for pulling together across government a range of interested departments to talk about how we can do a better job of integrating our responses.

For example, there is additional funding to deal with FAS-FAE on reserve. We received new funding of $10 million in 2002-03 and $15 million on an ongoing basis has been approved to expand FAS-FAE programming for first nations on reserve. We need to work more effectively with those communities to understand what the exact needs are and how we reach those people, how we reach people who may become pregnant and if they are pregnant to reach them and tell them they cannot drink or do drugs once they know they are pregnant.

We also know that the problem extends well beyond the aboriginal community. Recent studies would indicate that the fastest growing group of people who are a challenge to us in relation to this are middle class women in their mid-twenties to mid-thirties where perhaps social drinking is a part of their lives. We need to get the message out to them that one drink is one drink too many if they are pregnant.

The hon. member has raised some very important issues in terms of how we as a federal government can get our house in order and then how we link to the provinces, to communities and to grassroots organizations that are on the front lines. If the Minister of Labour were here she would say that the money has to get to the front lines; the money has to get to the grassroots community based organizations that know what is happening in those communities, that know who their client groups are. I could not agree more.

The hon. member also probably agrees that we have to rethink what we are doing in this area. While we are getting new resources, are we actually getting better results? Those are very serious questions. I would be the first to say that we have to do better; everybody has to do better.

I applaud the three prairie provinces for the prairie network on FAS-FAE. We are linked into that in certain respects but again we need to work more closely with those kinds of networks that are closer to the grassroots and the communities.

There is a whole lot we could be doing to re-order the way we all work in meeting the challenge of FAS-FAE.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, I would like to ask for a ruling from you. The last time we participated in a debate such as this, there was a convention that the question, if it were about a minute, the response would be about a minute. If the question was very short and technical, some latitude would be given.

Could you rule as to whether we are dealing under the same circumstances tonight?

[The Chair]

The Chair does not want to sound evasive, but it is very difficult and I do not think members would want the Chair to decide as to the technical merits of a question in terms of what length of reply would be suitable. As members themselves have heard earlier this evening, some members have chosen to ask several questions and have allowed the minister to answer them. Certainly if it is one question for one answer, I will monitor the situation. Thus far I am satisfied that the questions and answers have been somewhat reasonable.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, let me give the minister a little test and see if she can respond to that.

Does the minister agree with the labelling of alcoholic bottles to prevent FAS, yes or no?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I wish life were as simple as yes and no. It would be easy to say yes, but my goal is to determine what the most effective strategies are in this regard. Some work has been done in other countries that would indicate that labelling does not get at the real problem.

The hon. member for Winnipeg North Centre raised this issue when she had a private member's bill in relation to this. My department is working in relation to this question. What I have to decide is whether that is the most effective way to deal with the FAS-FAE challenge. Maybe it is, but so far we have not made that decision and so far, evidence is fairly inconclusive in terms of what the benefits are in relation to that labelling.

As I have said before, I am open to continuing to look at this issue. The only thing I am interested in is what are the most effective strategies. Let us not pat ourselves on the back and say “We have put labels on something so we can all go home now because we have discharged our societal obligation”. No. I think we have to decide what the most effective strategies are.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, I would like to return to the issue of the former finance minister and his speech about the health accord. I am going to read a quote from that individual. He stated “In terms of health care, we have not dealt with waiting lists. I think we have to deal with that”. This was talking specifically about the accord.

I want to know from the minister in relatively short terms, does she agree with that statement that the accord does not deal with waiting lists?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I do not agree with that statement.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, that response was terse and straightforward and I thank the minister.

Let me change subjects for a moment. Joanne Meyer, an individual that the minister's predecessor hired, was hired in suspicious circumstances. We had a report from the minister that did not answer the central question. I would like to ask her now, why was Joanne Meyer not hired under her own company instead of being hired under a car restoration firm?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, as I indicated to the hon. member some time ago, we did a full review. In fact, the hon. member felt that it was taking too long and I certainly understand his frustration in that regard, but one of the reasons it took the time it did is that we did a fulsome review of all the contractual relations of this named employee in relation to the Department of Health.

The review found that all services contracted for were provided. The companies involved, and I think this gets at the member's point, had the legal authority to enter into contracts for the services required and they had the capacity to provide those services. I think that at least in part answers the question.

Our question was in terms of the entities that entered into the contracts. Did they have the legal capacity to enter into those contracts and were the services contracted for provided? The answer to both of those questions is yes.

[Grant Hill, Canadian Alliance, Macleod, AB]

With respect, Mr. Chair, that does not answer my question, so let me ask it again. The report did not answer the central question and it leaves some Canadians suspicious.

I will ask again, why was this individual not hired, as she was once, under JM Enterprises, her firm, her name, her corporation? Why was she hired under three different contracts with three different companies?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, honestly I cannot speak to motivation in this context. All I can do is what we did, which was review the record of contractual services and determine whether there were illegalities or deficiencies in relation to those contracting procedures. We determined that the companies involved had the legal authority to enter into the contracts for the services required. They had the capacity as legal entities to provide those services. There was a determination that all services contracted for were provided.

I know that it is probably somewhat unsatisfactory to the hon. member but I cannot determine or speculate in relation to anyone's motivations. What we do know is that the legal capacity was there and the services were provided.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, let me reinforce the fact that response still does not answer my question. I did not ask her to speculate, I asked her to find out why. She has not done that.

We talk about deficiencies, per diem rates paid above the maximum rates payable. We also talk from an administrative point of view about deficiencies in the contract files. This has done nothing other than to raise more suspicions.

Since I cannot get any further with that particular question, let me turn now to hepatitis C. One point one billion dollars was set aside for the victims between 1986 and 1990. That grew to $1.4 billion with interest. How much of that money has been spent on the victims between 1986 and 1990?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, as of March 2002, the latest date figures were reported by the administrator, approximately $220 million had been paid to claimants in benefits. As I have indicated, the settlement agreement is administered at arm's length from government by an independent court appointed administrator responsible for deciding claims.

As of June 2002, approximately $900 million was left in the fund but this is not a surplus. The funds belong to the beneficiaries of the trust. One of the things people have to understand is that payments out of the fund may continue up to 70 years. This is a progressive illness and people may, not in all cases, get progressively worse in terms of being sicker. Payments can continue in relation to the health of an individual claimant and those payments could continue for some significant time.

Therefore, as of March 2002, which I believe are the latest reported number from the administrator, $220 million has been paid out to the claimants. The first actuarial report on the sufficiency of the fund was assessed by the courts in June 2002, and I think everything was found to be in order.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, on the same subject, from that $220 million, how many victims have been compensated?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, the first payments were issued to claimants June 20, 2000. In a report issued by the joint committee after the administrator's second year of operation, as of March 31, 2002, over 7,300 claims had been received. As of March 31, 2002, 5,400 claims had been paid, and 1,900 are in process awaiting the submission of further information or the completion of trace back searches.

These numbers refer to claims, not claimants. One claimant may have more than one claim.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, those numbers equate very well with what victims' groups have said. Many provinces compensated all victims of tainted blood with hepatitis C; in other words more than just those between 1986 to 1990.

Does the minister think that those provinces are right or wrong to have done what they did?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I am not going to comment on the correctness or not of that which provinces choose to do. That is clearly within their domain.

I can however indicate that what we did was the right thing to do. We were interested in ensuring provinces had the means to provide care to those people infected pre-1986 and post-1990. I think we all remember the phrase became care not cash.

Provinces can take whatever approach they want in relation to those particular claimants. Our approach was to transfer some $300 million to the provinces and territories for health care services to help ensure that individuals infected in those two periods identified did not incur out of pocket expenses.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, carrying on with that same subject, how many victims outside the 1986 to 1990 time frame are there? We were told during this debate that there were between 40,000 and 50,000 victims. I will not lead the minister but I would like to know how many she thinks are outside the 1986 to 1990 period.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I do not have the number of people who have made claims pre-1986 and post-1990. We would probably have to get that information from the provinces, which I can undertake with my provincial colleagues because the funds were transferred to them. It is their obligation to provide care and that would be on the basis of identification within the provincial health care system.

Therefore I could ask the provinces for those numbers.

[Grant Hill, Canadian Alliance, Macleod, AB]

That will not be necessary, Mr. Chair, because the number is between 5,000 and 6,000 people.

If we take the 7,300 which the minister has identified between 1986 and 1990'90 and take those 5,000 to 6,000, it is easy to see that the numbers of victims totally in Canada are somewhere between 10,000 and 12,000.

There is $900 million left in the compensation fund. The minister says that the disease may get worse in the future and that is true for a small proportion of people. However $900 million will take care of plenty of those problems.

Could not that money or a large portion of it be used to compensate those outside 1986 to 1990?