Debates of May 13th, 2003

Supply

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, no, it cannot under the terms of the court settlement. Those moneys were set aside for a very specific and agreed to purpose, for those between 1986 and 1990.

I want to go back and reiterate for people that while it seems as if there is a large amount of money remaining in the fund, no one should think of these funds as a surplus. Payments to claimants out of the fund may continue for as much as 70 years, either to new claimants who have until 2010 to apply or for new or continuing payments to those who have already qualified. Some claimants will be receiving loss of income payments for a very long time from the settlement agreement. Other claimants can make claims for additional compensation as their disease progresses.

Therefore the $900 million is there by court order and agreement of all the parties, and it is there to be disbursed over a number of decades in the future.

[Grant Hill, Canadian Alliance, Macleod, AB]

Mr. Chair, of course that was a political decision that was made by government, not by other parties.

I will change the subject one more time. The Romanow commission was followed by many participants in the health care system with interest. Romanow suggested raising the federal share of health care to 25%.

Does the minister agree with that proposal?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, we as a government feel that we put on the table a large amount of new money through the first ministers accord reached in February. I think $34.8 billion over the next five years is a significant amount of money to help transform our health care system, to stabilize it and to sustain it well into the future.

I am less interested in percentages. There are different ways we can arrive at those numbers. I have great respect for Mr. Romanow but there are others in the provinces for example who would disagree with the formula that he put in play in terms of 25% on what.

Therefore for me it is more important to think about the health care system and what that system needs to renew itself and sustain itself and to ensure that the federal government is doing its fair share. That is important to me and that is something which needs to be assessed on an ongoing basis.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, I would like to ask a question with regard to the estimates on the Romanow report. I think the 2000-01 estimates showed $7 million for the cost of the Romanow study.

Could the minister tell us what it accumulated to in the final analysis and how much Canadian taxpayer money went into that report?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, the total amount that was set aside for the Romanow commission was approximately $15 million. It is my clear understanding that Mr. Romanow brought his process in under budget. The exact number I could get for the member. I do not have it here this evening. However he brought it in, as I understand, under budget.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, it is nice to say that but we are talking about estimates here tonight and I would have thought that we would have that information. Could the minister get that for us? I would certainly appreciate that.

I would like to shift to one other topic since my time is very short. I want to get into the SARS situation, but before that there is a smallpox situation. I think the Americans are working aggressively to vaccinate some of their frontline workers. We are in a process of doing that as well. I think there were 500 frontline workers who we were attempting to vaccinate but we pulled back on that I understand, and I am not exactly sure why. What I hear is it is because of liability and we are not sure whether we will stand between them and a bad reaction.

Is that in reality what is happening? Could the minister enlighten us as to why we are not vaccinating frontline workers?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, with respect to not vaccinating frontline workers, we would and will vaccinate frontline workers. There were a very small number of Department of Foreign Affairs employees offshore in certain parts of the world who were offered on a voluntary basis, and obviously it is always voluntary, the opportunity to be vaccinated, and in fact a very small number of them I believe were.

In terms of frontline responders, it is still our intention to make the vaccination available to frontline responders on a voluntary basis. We have some of those within the federal government. The provinces and territories actually have the vast majority of frontline responders. They will need to identify those responders for us and then the vaccination will be offered to them on a voluntary basis. That is the approach that we are taking.

I talked to my colleague Tommy Thompson, the secretary of health in the United States. Mr. Thompson and the government of the United States had a very ambitious plan to vaccinate large numbers of so-called first line responders. There was very limited take-up in relation to that plan. Part of the issue was the possibility of an adverse reaction. The other problem was in terms of a compensation scheme for those who suffered from an adverse reaction. The United States government has moved to look at the kind of compensation scheme which could be put in place to deal with that situation.

Clearly, we are looking at the same kind of issues. Whether we reach the same resolution is something that has not been decided. However we are aware of the small number of people who are adversely affected and therefore we want to do our homework. Right now--

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

It was a very short question.

[Anne McLellan, Liberal, Edmonton West, AB]

No, actually, it is quite a complex question.

[The Chair]

I will borrow from a suggestion from the hon. member for Macleod earlier. I will allow a final question of one minute and an equal response time for the minister.

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

Mr. Chair, it will not take me a minute to ask the question, and I appreciate the Chair's indulgence. It is really a very important one.

Whether we vaccinate frontline workers is not as quite as important as whether we actually have the vaccine available to us. I know the minister was looking at putting it out to tender and purchasing 10 million doses.

Could the minister inform Canadians as to exactly where we are with that and why the delay? I think this was supposed to be done last January.

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, there is no delay. The vaccine is being produced right now. I believe we will have more than the 10 million doses because of arrangements worked out with the manufacturer.

We are in a position, if required, to vaccinate frontline responders right now because DND has a stockpile of smallpox vaccination that would be made available to, among others, frontline responders if a situation presented itself.

However, the procurement is over. The company is producing the smallpox and we will--

[Rob Merrifield, Canadian Alliance, Yellowhead, AB]

How about the antidote?

[Anne McLellan, Liberal, Edmonton West, AB]

And VIG, which is the antidote that goes with the smallpox vaccine. We will have both and it is being produced right now.

[John Maloney, Liberal, Erie—Lincoln, ON]

Mr. Chair, I will be sharing my time tonight with the member for Winnipeg South Centre.

I would like to take the opportunity this evening to report on the contribution that Health Canada's Pest Management Regulatory Agency is making to increase the pest control options that are available to Canada minor use crop producers, contributions for which the tender fruit producers, grape growers and vegetable growers in my riding of Erie—Lincoln are most appreciative.

The Pest Management Regulatory Agency, PMRA, is responsible for administering the Pest Control Products Act in order to ensure that human health and the environment are protected by minimizing the risks associated with pest control products while enabling access to pest management tools, namely, these products and sustainable pest management strategies.

Minor use pesticide products are those used in such small quantities that manufacturers find the sales potential is not sufficient to seek a registration in Canada. This is a challenge to the growers of minor use crops who consequently have access to a limited number of products registered for their crops. Growers of similar crops in the United States have access to a wider variety of newer, reduced risk technologies to control pests, which gives them a competitive advantage in the global agricultural market. Canadian growers are demanding access to the same products as their American neighbours to level the playing field.

Health Canada and Agriculture and Agri-Food Canada are working together to meet the needs of Canadian growers and to reduce the risks of pesticide use. The government's initiatives are centred around making more reduced risk and minor use pesticides available and collaborating to develop strategies to reduce reliance on pesticide use, thus reducing health and environmental risks.

The intent of the reduced risk and minor use registration programs is to encourage pesticide manufacturers to file submissions for registration of these products in Canada, particularly if they are registered in the United States. The PMRA and the Environmental Protection Agency, EPA, currently have joint review programs for reduced risk chemical and biopesticide products that have been in place since 1996.

This program was designed to encourage manufacturers to submit products for registration in Canada and the United States at the same time. The U.S. EPA and the PMRA review these submissions jointly and share the evaluation work.

To encourage the availability in Canada of reduced risk products already available in the U.S., the EPA criteria and designation for reduced risk are now accepted in Canada. In addition, as an incentive for making such reduced risk products available in Canada, the PMRA has shortened the timelines for review for these products.

New funding initiatives have also been announced to meet the needs of Canadian farmers for minor use pesticides. In May 2002, the Ministers of Health and Agriculture and Agri-Food announced $7.3 million in new funding aimed at reducing the risks of pesticides through the re-evaluation of older products and introducing new, lower risk pesticides. The agency is using funds to collaborate with AAFC to develop and implement commodity based integrated pest management strategies aimed at reducing reliance on pesticides and, in turn, reducing risks.

Furthermore, in June 2002 a further $54.5 million in funding over six years was announced to allow AAFC and PMRA to give Canadian growers better access to minor use and reduced risk pesticides. AAFC will develop a minor use pesticides program, similar to the U.S. Department of Agriculture's interregional research project number 4, or IR-4. As part of AAFC's new program, a minor use pesticide centre will be established to work with stakeholders, generate data for pesticide evaluations in conjunction with the U.S. IR-4 program and prepare submissions for review by the PMRA.

The PMRA's funds from this announcement will be used to ensure that the agency has the resources required for the timely review of these new minor use and reduced risk submissions. All of these activities are essential in providing growers with faster access to a broad range of safer minor use pesticides.

The PMRA appointed a minor use adviser-ombudsperson to facilitate the registration of minor use pesticides in Canada. Her role is to liaise with growers, the AAFC, the U.S. EPA and IR-4 to encourage harmonization with the U.S. regarding products for minor use. The minor use adviser position at the PMRA is modelled after the very successful minor crop adviser position in the EPA, in that she reports directly to the executive director of the PMRA.

One of the most important functions of the minor use adviser is to serve as a liaison between the PMRA and Canadian growers and to bring their concerns to the attention of PMRA's management. The minor use advisor has met with many grower groups across Canada to obtain information about their crops and to provide them with information on the minor use pesticide registration process.

Her meetings with growers and provincial minor use coordinators have also assisted in developing a process whereby their needs are identified and priorities for data generation are set. AAFC can then generate the field trial data necessary to get priority minor use products registered and into the hands of Canadian growers.

Since the announcement of significant investments for minor use pesticides in 2002, I am pleased to announce the results of our efforts. In fiscal year 2002-03, the PMRA approved more than 754 minor uses, of which 385 were specifically for agricultural crops.

Harmonization with the U.S. EPA is also important in ensuring that reduced risk and minor use products are available in Canada. Previous pesticide harmonization efforts with the U.S. EPA, such as the joint review program, have been quite successful. Currently, more than 50% of submissions received for new active ingredients are reviewed jointly or work shared with the U.S. As of October 30, 2002, 32 registrations were completed through the joint review program, and there are currently more than 24 submissions in process.

Thanks to this program, the number of submissions each year increases as more pesticide manufacturers develop their products for joint entry into Canada and the United States. This ensures that products, including those used on minor crops, become available to Canadian and U.S. growers at the same time. This is a considerable improvement over the past, when there have been significant delays before industry filed submissions for registration in Canada for products already registered in the U.S.

The PMRA looks forward to continuing to improve the situation for Canadian growers and for Canadian consumers in making available more minor use and reduced risk pesticides. PMRA will continue to work with growers, provincial minor use coordinators, AAFC, the U.S. EPA and IR-4 to achieve this goal.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Mr. Chair, it is my pleasure to take the opportunity this evening to discuss some of the initiatives the Government of Canada, through the Department of Health, is taking to ensure that the health system is more responsive to the health needs of women and ultimately to improving the health status of all women in Canada.

The Government of Canada established the Centres of Excellence for Women's Health and the Canadian Women's Health Network, funded through Health Canada, to provide easier access to health information, resources and research, to promote and develop links to information and action networks, to produce user friendly materials and resources, to provide forums for critical debate, to act as a watchdog on emerging issues and trends affecting women's health, to encourage community based participatory research, and to promote women's involvement in health research. The Women's Health Network works with the centres of excellence to increase communication, information sharing and interaction among all interested groups and individuals. These relationships ensure that women are present and involved at the grassroots level.

How much does gender really affect health? This is indeed a provocative and very important question. The centres are generating significant research which explores the social determinants of health and which will serve researchers, policy makers, and women themselves. Many studies demonstrate the connection between income and health. And as one researcher, Patricia Kaufert, has said, “locating health in the social condition of people's lives is an idea which can be dated back to the origins of the public health movement”.

Gender is indeed a critical lens by which to examine health trends in the broader population. In addition, it permits important questions to be asked. I want to bring to the attention of the House the important study done by the Women's Health Clinic in Winnipeg. It is called “Poverty is Hazardous to Women's Health”. The study explores the many ways in which poverty can lead to ill health, including lack of access to affordable housing, transportation, food and non-insured health benefits such as medication.

Recently in the consultation process undertaken by the Commission on the Future of Health Care in Canada, the synergy and initiative of these collaborative efforts was evident. Women came to the table and shed light on issues that affected them as women most dearly. The circumstances of women as caregivers were presented. Home care from the perspective of the person receiving the care and home care from the perspective of informal caregivers were subjects of research that was presented. The enormous challenges of home care, both social and economic, were highlighted by the commission's report and recognized by the following:

Many informal caregivers are more than happy to provide care and support their loved ones, but the reality is that care giving is becoming an increasing burden on many in our society, especially women.

Turning to other initiatives, Health Canada focuses on a number of initiatives ensuring that pregnant women and women with babies and young children are getting the help they need to ensure good health. There is a folic acid awareness campaign to encourage women of child-bearing years to be aware and an initiative to support postpartum parents.

The Canada prenatal nutrition program enjoys widespread success across the country. The CPNP funds community groups to develop or enhance programs for vulnerable pregnant women. Through a community development approach, the CPNP aims to reduce the incidence of unhealthy birth weights, improve the health of both infants and mothers and encourage breastfeeding. CPNP enhances access to services and strengthens inter-sectoral collaboration to support the needs of pregnant women facing conditions of risk. As a comprehensive program, the services provided include food supplements, nutrition counselling, support, education, referral and counselling on health and lifestyle issues.

Based on the enhancement from the 1999 federal budget, the budget for the non-reserve portion of CPNP is $30.8 million as of 2002-03. Of this, $27 million goes directly to communities in the form of grants and contributions.

There are currently 350 CPNP projects funded by PPHB, serving over 2,000 communities across Canada. In addition, over 550 of these projects are funded in Inuit and on-reserve first nations communities.

There are many other initiatives that have been undertaken by the government that will affect the health of women. In this year's federal budget we saw a $16 billion investment over the next five years to provinces and territories for a health reform fund targeted to primary health care, home care, and catastrophic drug coverage.

We saw the budget invest $5.5 billion over five years in health initiatives, including diagnostic medical equipment, health information technology, and the creation of a six week compassionate family care leave benefit, a very important initiative.

There is the $45 million investment over five years to assist in the national immunization strategy which will result in the improved safety and effectiveness of vaccines, and the efficient procurement and better information on immunization coverage rates. Immunization provides one of the most important preventative health measures.

Finally, we saw an increased investment in the budget for research and innovation. In the next five years $925 million has been tagged for this purpose. An additional $55 million annually will be provided to the Canadian Institutes of Health Research to advance health research in Canada through its network of 13 virtual institutes.

It has been said that life is for doing, learning and enjoying. A prerequisite for that is good health. I am pleased that the government is working in collaboration with all stakeholders to ensure that women from all corners of the country, regardless of their background or circumstance, have access to quality care in a timely, responsive manner.

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

Mr. Chair, for those watching us at home, we are now engaged in a process that has us sitting as committee of the whole; we are not examining a bill. A little earlier, some people from outside asked me this question. What we are doing this evening is examining the funds allocated to the Department of Health, which amount to just over $2 billion, of which $1.4 billion will go to aboriginal peoples.

I will have five questions to ask of the minister and I will ask them all at once to give her time to reply.

In the last budget, for 2002-05 it was planned that an additional $8.2 billion would be invested in health initiatives, of which $6.5 billion would go directly to the provinces.

There was one interesting point. The budget said that there would be an additional $2 billion in 2003-04 if the financial situation was positive. I would like the minister to tell us if she is optimistic that, in addition to the amounts budgeted, the provinces could have the $2 billion that the Minister of Finance and member for Ottawa South promised to reserve for the provinces. Is the minister optimistic today?

My second question is this: 50% of the budget allocations we as members are voting on will go to the first nations. I understand that the federal government has a fiduciary responsibility for the first nations.

Thirty years ago, when the Laurendeau-Dunton commission report was released, you could see that those who were in poor health, those whose lifestyle factors ranked them at the bottom of the development scale, were the aboriginal peoples. We may wonder; this is quite a lot: 50% of the budget of the federal health department goes to the first nations. When we look at the first nations, when their spokespersons appear before us—the parliamentary secretary will remember that we had the opportunity to discuss dental health among first nations people—one does not have the impression that the situation is improving in proportion to the energy expended and the desires expressed by the hon. members. We all hope that the first nations will be able to achieve a much better quality of life than they have now.

There is, of course, the bill on first nations governance that should not be forgotten. That is a very, very bad bill. It absolutely does not permit the tools of development to be given to the first nations, but that is not this minister's fault, despite cabinet solidarity. I saw her applauding in Edmonton when the former Minister of Finance said he was not in favour of the bill.

It was quite a display for the minister in contrast to the stoicism and self-control she has been used to in her profession, as a lawyer. I saw her applauding like crazy in Edmonton when the former Minister of Finance announced he would not implement this legislation.

I want the hon. minister to know that I will not give up on this issue. I would like her to update us on her understanding of her department's role as far as the first nations are concerned. This is very important; half of the budget concerns the first nations. There is much catching up to do, as I said. At the time of the Laurendeau-Dunton Commission, the first nations ranked last in terms of development, and I do not think that they are faring much better today.

Allow me to digress to say hello to constable Baronette and his spouse, Nicole Sabourin. Make sure he gets a warm welcome home tonight because he is working hard here. He is on duty on the hill, and he is a little tired. We may be sitting until midnight, and all constables deserve our friendship in these difficult times.

This brings me to my third question. I have a little criticism for the minister on another topic besides aboriginal health and the contingency reserve, to which I hope the extra $2 billion promised to the provinces, if the economic conditions permit, will go. As everyone knows, as part of our work as members of Parliament we make representations to the federal government. Sadly, I have a case to submit to the minister without getting into the details, for her to take under advisement.

I am talking about the case of Dupuis-Magna Cosmétiques, which has been asking for the past seven years for a new drug to be approved.

As a member, I have been trying to talk to a public servant for the past two months, and I have not yet been able to do so. I will not get into the details, because I do not want to cause trouble for anyone. But I find it strange that someone has been trying for seven years to obtain approval to market a product available in Germany and the United States. Unfortunately, I get the feeling that Health Canada's bureaucracy is causing problems for this individual. I hope that the minister will also provide guidelines so that all parliamentarians have access to public servants. It is not normal that, as a member, I have been trying for two months to speak to someone, and I still have not been able to do so.

I am coming to my final question. It concerns the Romanow report. I want to say a few things about this. This report was criticized by several provincial governments, including the Quebec government, which had created the Clair commission.

It would be interesting to know one thing. Can the minister tell us something? In the Romanow report, there is a presumption that the provinces are not accountable, that they are not responsible and that they are mismanaging the health care system. It is difficult to understand how the federal government, which is not an expert in health care, except when it comes to aboriginals, the armed forces, research and epidemics, could be demanding a greater role and how it could have more expertise than the provinces.

I want to ask the minister the following question. Each province, in my opinion, has accountability mechanisms in place. There are parliamentary commissions and question periods in each legislature. I want the minister to give us a list. Were many violations of the Canada Health Act by the provinces brought to her attention? Could she enlighten us in this regard?

Should she not distance herself from the Romanow report, which is a tool in nation building? Should she not say that, as Minister of Health, those who know the most about health care are the provincial governments and not the federal government?

Does the minister recall that when the hospital insurance system was created in the 1960s, the federal government contributed half of health care spending? Today, the federal government contributes 14 cents of every dollar spent on health. Can the minister distance herself from the Romanow report, and commit to respecting the 50-50 ratio and stop trying to use the health care system for nation building?

[Anne McLellan, Liberal, Edmonton West, AB]

Mr. Chair, I thank my hon. colleague for that series of questions.

I want to clarify one thing first. My hon. colleague from Yellowhead took umbrage with the fact that I did not know in relation to the main estimates the dollar amounts in relation to the Romanow commission. It has been pointed out to me by my hard working officials that the Romanow commission is in PCO's estimates and not in my department's estimates.

Therefore, it would be unreasonable to expect us to have that documentation, but I stand by what I said earlier. It is my clear understanding he brought the commission in under budget.

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

But that is not my question.

[Anne McLellan, Liberal, Edmonton West, AB]

The member asked a question concerning the additional $2 million. That is contingent upon there being a surplus in January 2004 and then a decision being made between the finance minister and the Prime Minister as to whether or not we would be in a position to provide those additional dollars.

That was made very plain to the first ministers at the time of the agreement. Obviously we are looking at some nine months down the road. We have done a remarkable job in terms of the economic state of this country, but it is not for me to say eight months away from the date whether or not it is likely to happen. As the Minister of Health I hope that it does happen.

The member also raised the issue of aboriginal health. The total expenditures for 2003-04 in the main estimates are $1,588,000,000. The hon. member is right. It is a substantial part of the federal Department of Health's budget. The Government of Canada is strongly committed to the well-being of aboriginal Canadians and we know that aboriginal Canadians too often suffer from poor health. They are among Canadians who have some of the worst health. This is an issue we all need to take very seriously, the health committee does, and it is an issue that we all need to address.

I am pleased to say that we have received in budget 2003 an additional $1.2 billion over the next number of years to help us in terms of delivering health care to Canada's first nations and Inuit people.

The hon. member asked why a significant number of aboriginal people suffer from bad health, for example, chronic diseases such as diabetes. Adult diabetes is increasing at an alarming rate in our aboriginal communities. Part of it is the predetermination of health. Part of it is in terms of healthy living, good nutrition, physical activity, healthy body weight, and ensuring that kids have good nutrition, start healthy eating and good living habits at an early age. Part of it is education and information. And let us face it, part of it is poverty.

We know that the better off people are, the better their health will be. We must deal with these determinants of health. We must understand that until we deal with the social and economic conditions of poverty, it will be harder for aboriginal peoples to enjoy the same quality of health that other Canadians enjoy.

I want to reiterate the fact that we take our commitment to working with aboriginal peoples in improving their health very seriously. This is not just a health issue. It is also a predetermination of health issue. This means we must work across a broad range of federal departments including our provincial colleagues and local communities themselves.

I will look into the member's specific complaint in relation to the medical device which he outlined. I believe it is classified as a medical device within our department. I will certainly look into that for him. I apologize if he or his constituent have not received a timely response. I will take the matter up right away.

In terms of the provinces mismanaging the health care system, I do not think Mr. Romanow said that the provinces mismanaged the health care system. Mr. Romanow talks more positively, as we all do, about the importance of accountability on the part of all of us, whether it is the federal government, the provincial or territorial governments in ensuring Canadians know how much money is being spent on health care, where it is going, how it is divided between physicians, hospitals, and so on, and what we are getting for it. Are we getting better health outcomes for those dollars?

Mr. Romanow is encouraging all of us to do better in that regard. In fact, some of the provinces have been leaders in areas like the PIRC process and prediction indicators, where we are able to compare apples to apples across provinces and within provinces.

CIHI is a collaborative endeavour where information is provided to residents of provinces so they can make assessments concerning their health care system. The provinces are working very diligently in relation to accountability. Mr. Romanow is suggesting that we build on the good work that is being done to ensure that we are even more transparent and accountable.

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

Madam Chair, I enjoy listening to the minister. It is always an experience in personal growth. She is a font of information. Even though she may wander in her comments, she can always be brought back to the subject at hand.

The Romanow report takes the position that the federal government is best placed to come up with initiatives in health, but we believe that the provinces are better able to do so. The best test of this is that we believe, as does the National Assembly, in the five principles of the Canada Health Act, with a few subtle differences on the issue of portability.

I would like the minster to give us an update on this. Have there been any violations by the provinces that she could share with us? Second, does the minister agree that there is a paradox in Canadian federalism, in that the money is in Ottawa, the provinces have needs, but the federal government is cutting back in terms of its commitment?

Those who saw the public health care system being set up recall the commitment made by the federal government to pay 50% of the costs. Today, it pays 14 cents for every dollar spent on health care. Yes, there has been some increase, but it is not 50-50.

Can the minister make a true commitment and say that she will work very hard to convince her cabinet colleagues so that, in the not too distant future, the 50-50 funding will be restored, which was the objective of those who built our public health care system? I would appreciate short, meaningful, precise and honest answers.

[Anne McLellan, Liberal, Edmonton West, AB]

Madam Chair, the hon. member asked me a question concerning compliance and monitoring infractions. He also asked me a question regarding funding. I categorically reject the 14¢ argument of the provinces. If the hon. member for Hochelaga—Maisonneuve goes to the Department of Finance or the Department of Health website, but I direct him to the Department of Finance website, he will find there our presentation of the federal government's total contribution to the funding of health care in this country. It is not 14¢. The range could be anywhere between 36¢ and 42¢ of every dollar for health care.

The hon. member asked, is that fifty-fifty? He must understand the nature of the original arrangement. It was not fifty-fifty in terms of all those things on which the provinces spend money today. That was never the original understanding. We must go back to first principles and understand what the original cost share agreement was about and what it applied to. Mr. Romanow sets that out very clearly in his report.

The hon. member was kind enough to raise this question. He was talking about the provinces and monitoring. I want to make it plain to everyone here this evening that Health Canada's approach to resolving possible non-compliance issues emphasizes transparency, consultation and dialogue. Issues are resolved through consultation and discussion, based on a thorough examination of the facts.

It seems to me that it makes a lot more sense as opposed to becoming confrontational with provinces. It should not be necessary to withhold dollars, as we have had to in certain circumstances, and thereby deny provinces money. The approach we would like to take is to work with a province in a collegial and consultative fashion, determine whether the allegations of problems are real and if so work with the province to investigate and determine how the problem can be dealt with. However, if at the end of that a province does not cooperate or if we think there is still a problem, we will withhold dollars. We are withholding dollars right now, for example, in the case of Nova Scotia. We have withheld dollars in relation to other provinces at other times.

I worked with my provincial and territorial colleagues on a dispute avoidance and resolution mechanism. This mechanism can be used in situations where a province and the federal government cannot agree through negotiation and consultation. That dispute resolution mechanism can be put in place to resolve a dispute with a panel of third party experts. It is a tribute to how well we all work together that the dispute resolution mechanism has not been used to date.

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

Madam Chair, I would ask my friend, the Minister of Health, to whom I wish all the best, if she can undertake to table, for the benefit of all members of this House, the original agreement.

I maintain that, for hospital and medical services, it was 50-50. I am thinking here of the position of the member for Saint-Laurent—Cartierville and of all government members. There is someone here who is unwittingly misleading the House. Personally, I maintain that the funding was 50-50.

I am asking the minister in a friendly way to show intellectual rigour and to table the agreement. We will read the agreement because all premiers, including the Conservatives, the Bolsheviks and the sovereignists, said that it was 50-50. The federal government is the only one saying that the original agreement was not 50-50.

Since I know that the minister does not want to mislead the House, what she has to do is to table the original agreement. I do not know if she has it in her briefcase. If not, she can go to her office to get it and table it tonight. I will bet her a beer that it was 50-50.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Madam Chair, it is always a good time to look at health estimates and I think it is a good time for us to remind Canadians that we are ever vigilant in terms of getting value for their money when it comes to health. It has been an exciting year in terms of Canadians having an opportunity to speak and I think it was important for us to listen in the way we did. It really was about core Canadian values.

I think there are mainly four questions that will come out of this year of the cottage industry of commissions, particularly the Romanow commission. I think we understand that it is going to be extraordinarily important to understand that pieces of legislation will never protect the Canadian badge of honour in terms of our most treasured social program, that only when Canadians can have confidence in the system will they then be able to relax and not demand to pay.

What would be the strategy to restore the trust in the public system? I think we also then want to know what the strategy is to ensure that governments are accountable to Canadians. Do they know where the money is going? Do they know what value they are getting from the money? Are they getting healthier? Is the system getting fairer? As the minister knows, this is where we were dinged by the WHO in terms of the gap. Are we learning and investing in innovation to get a better system? Are we striking the right balance between treatment and prevention?

I think there is a third question Canadians have. How do we keep listening to them? If we do not want to have a commission every two years, how do we make sure that Canadians know that we will continue to listen to them, that we will continue to understand the trade-offs that they know must be made and that we will be able to continue to listen to their priorities and follow with a system that is relevant and responsive to their needs?

I think their fourth question is this: How do we keep more Canadians healthier longer?

In being able to answer that, I think the minister began tremendous work in her original work on the social union framework agreement. When the minister was in charge of it, I think all of us were thrilled with what came out of it in terms of transparency, accountability, asking citizens to set priorities and the ability to report to Canadians in a regular way. I think the first ministers accord then underlined how we would continue to do that.

Out of the first ministers accord, there are four areas that I think need to be interpreted and strengthened. On the minister's behalf, I would like to help her interpret them in the way I think that would be. In the recommendations, I think that this idea of Quebec council's on health and welfare with a new mandate would collaborate with the health council, but obviously I would hope that the minister, following the Quebec election, will now be able to re-engage the Quebec government with the ability to actually be full partners in the health council, including reporting on the performance of its health care system and health care in a pan-Canadian way that includes Quebec.

We want to make sure that in its statement the accord and the council would monitor and make annual public reports. We hope that means the council is free to report on anything relevant to the health of Canadians, not only that which is explicitly mentioned in the health accord.

We also are interpreting that publicly reporting through the FPT ministers of health obviously means that the council would be truly independent and a trustworthy council which reports publicly, leaving the governments the dissemination of the information to their constituents, but it must be a report that is transparent to all Canadians. Also, in including representatives of both orders of government, experts and the public, we assume that in the accord this means that although governments will select their representatives they will not be government officials, elected or non-elected; they will be government nominees who will act independently and are faithful to the terms of reference of the council, as the council of maritime premiers chooses its regional appointees.

I think that what Canadians expect from this council is an independent, trusted body that advises Canadians on the state of their health and on the performance of their health care system. The council must earn its moral authority by celebrating excellence, pointing out the opportunities for improvement and telling the truth. It must make recommendations, not policy. It has to be more than our collective conscience and the council must ask for good quality data and encourage a learning and collaborative culture that promotes ongoing dialogue.

We hope that what will be supported is a council that uses information of the same quality and reputation as that of Statistics Canada, that it will interpret that data with the rigour of the Auditor General and that it will make recommendations as important as those of the Bank of Canada. We think Canadians must see that the health council of Canada has an important mediating effect on the previous intersectoral tensions that have hindered the progress toward an integrated system of health maintenance and care in which the public good and cost effective, world class results are paramount. We think that the data coming from CIHI is good as it is, but we hope that the council will be able to commission the new data it will require and the research that is not currently available from places like the CIHR.

What we hope is that the collaborative culture that we have seen in this recent SARS outbreak could be practically bottled, such that we would never again see the spectacle that came out of that first ministers meeting where people actually were calling to deal with the next prime minister, those kinds of absolutely inflammatory statements. It has to be an ongoing relationship.

As we have discussed, we would love to think that we could move the fed-prov relationships into something like the VISA model, where feuding financial institutions are able to come together on a common IT program, a common governance and even decide what colour the card is. It is amazing to think that if feuding financial institutions can do this we are unable to do this as a country.

It is important that the federal government go to the table, as the minister said, as the fifth biggest provider of health care in this country, with our own problems in aboriginal health, the military, veterans and correctional services, and we go there to share best practices and to learn from one another. The council is not to be big brother. It is not to be a watchdog. It is to be a place where positive--

[The Assistant Deputy Chair]

The hon. member for St. Albert.