Debates of Nov. 23rd, 2004

Supply

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I think the minister is saying that the Auditor General was wrong the first time she addressed it because she said that with different buying practices alone this could be saved. This is the third time she said how disappointed she was that it was not addressed the last two times.

If that was the case, the minister is saying he respects the Auditor General's report. Does that mean you did not respect it the last--

[The Chair]

I remind the hon. member to address his comments through the Chair. The hon. Minister of Health.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, there is no question, we respect the recommendations that were made. We will abide by them. We will implement them. In fact, I have directed my department to consult with her on an ongoing basis as it implements the recommendations.

I am simply telling the hon. member what the difficulties have been. If the hon. member is talking about the drugs that are purchased and used by the Department of National Defence, it can do bulk purchases because it is delivering to a population that is controlled by it within its pharmacies.

It may be difficult, if not impossible, to do the same with 750,000 first nations people across the country with 1,000 pharmacies and with medical practitioners unless we get into the business of actually providing pharmacies ourselves across the country.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, the minister is trying to fudge what the Auditor General has said with regard to this issue. That is just on the dollars and cents that could have been saved. If we were to multiply that over a number of years, it would be tens of millions of dollars a year. That is what she said. That is a lot of money.

Then we go to what she said with regard to human life. She said that there are a number of these drugs. We have seven or more doctors prescribing to seven or more different pharmacists different drugs, and that becomes a health and safety issue. How many lives are at risk because of the lack of information from Health Canada, from the government, to those doctors and pharmacists? That becomes a much more serious issue than even the money and that is what she is addressing. I would like the minister's comments on that.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I would be less than candid if I did not tell the House that the Department of Health has been trying very hard to deal with a very thorny and difficult issue of consent and privacy with respect to overuse of drugs, abuse of drugs and multiple prescriptions. That is a complex issue. The Auditor General has a view on it. It is very clear to me. That is why I have told Health Canada that we will be following her instructions and from time to time will consult her as we implement her strategies.

Life is very important. I know that the Standing Committee on Health had raised these issues perhaps a year ago. I have looked at the transcript. I recognize the severity and the gravity of this issue. That is why, in an overall way, I can tell the hon. member that we respect the recommendations made by the Auditor General. We will abide by them. We will implement them at the earliest possible--

[The Chair]

The hon. member for Yellowhead.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, the minister is right. We did look at this over a year ago in the health committee. In fact, we had the actual consent forms that were being asked for. We said that there was no way that first nations were going to fill them out, they were so complex. We would not fill them out for ourselves and yet we were asking our first nations to do it, so there was no surprise about that.

That was over a year and a half ago. We recommended changing those forms so that the compliance would be there. That is another issue. I do not want to spend all 15 minutes on this issue, but I am rather upset. The Auditor General is bang on. The government and the minister had better do something about it.

However, let us get on to another issue that is related to it. The report came out this spring. Actually, it was in the middle of the election. There were 24,000 deaths because of adverse events in our acute care hospitals in the year 2000 and probably more since. That was what the report suggested. We have to believe it is true because it was reflected with another study in the United States saying exactly the same sort of numbers. That does not count for the ones in the nursing homes. That does not count for the ones who die outside of hospital because of adverse events from drug reaction.

I brought in a motion that was passed by the House, this spring, saying mandatory reporting had to take place. I would like to ask the minister, what are you doing with that and what are you doing to deal with the issues that are addressed in that report?

[The Chair]

I remind the member to address his comments through the Chair. The hon. Minister of Health.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I understand that there has been a Canadian Patient Safety Institute created. We are working on this issue.

When I appeared before the standing committee, this is one of the first issues that caught my eye when I became the Minister of Health. I have asked the Department of Health to take a look at whether or not we can actually begin to receive the results of a mandatory reporting system for adverse drug reactions and adverse incidents. I think that is important.

I am told that there are five or six centres at this time for voluntary reporting across the country. There is one in British Columbia, Saskatchewan, Ontario, Quebec, and there is one for the Atlantic. That is well and good, but the issue that the member raises, as I said to him in committee, is very important and we are looking at it. I am in favour of the mandatory reporting of adverse drug reactions. Even if it saves one life or two lives, that is one more life saved. It is important that we do that.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I would suggest it will save not one or two lives, but thousands and maybe tens of thousands of lives if the numbers that I see are accurate, and the numbers that were reflected in that report.

However, I want to stay on the issue of drugs for one more quick question because it is very important. We talked about this in committee the other day with regard to the catastrophic drug coverage. According to the minister's report and his information to committee, the 2003 accord said that the catastrophic drug coverage would happen, that it would be in place by 2006.

That is what the provinces and the federal government were working toward, by the end of that year. Now we see that the accord that was struck here a couple of months ago is saying that we are first going to get a report near the end of 2006. So, the actual catastrophic drug coverage in essence is going to be put back one, two, or three years? How many years? Give us a date? What is the proposal?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I would be hazarding a guess if I said when, but let me answer the question with the best information that I have.

I understand there was an accord in 2003. All of us know there was. We also know that not much progress happened, whether in terms of home care or catastrophic drug coverage, both of which were to be done by the provinces. None of that happened and they had been given the money.

Now, in this accord, we have given an additional $500 million a year for home care and for catastrophic drug coverage. We have placed deadlines that we have to come back as ministers of health to the first ministers and report on a national pharmaceutical strategy, including catastrophic drug coverage, by 2006. We must report at least the elements of the strategy and then begin to put it in place.

We also have home care and the two week period--

[The Chair]

The hon. member for Yellowhead.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, that is not giving us a date. The minister is saying a report is going to happen. He has confirmed what I have just said. When can we expect catastrophic drug coverage for Canadians? That is really what the average guy on the street wants to know.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, if and when we have the national pharmaceutical strategy report back to the first ministers, which would be hopefully early 2006 if I had my way. That report would then be available to the provinces and they could implement it overnight.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, that will be interesting to see. We will wait with bated breath for that one.

I would like to get on to hepatitis C because the announcement was just made. It was something that was worked on by the health committee. We brought forward a motion in committee. We got a unanimous decision and brought it to the House. This minister actually shut down debate in the House when his own members wanted to debate this issue.

He says it is a complex issue. It is a complex issue. It is not really complex as far as the issue goes. The issue is very clear. The government either compensates or it does not compensate. That is the issue. How we do it is a little complex, fair enough, but there was a debate that was supposed to take place in the House. It was asked for twice and the minister shut it down. There were 400 individuals who should have been compensated outside that window who are no longer alive today because the minister and the government decided that it would not compensate.

Would the minister explain why he shut down debate and when will these victims begin getting the cash? That is really what it means.

[Robert Thibault, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Chair, I would like to indicate to the member that the minister was not in the House at the time of the debate. As parliamentary secretary, I was. We had a full debate. A lot of members from the government's side--

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, on a point of order, this is committee of the whole and I addressed my question to the minister.

[The Chair]

Yes, but any minister or parliamentary secretary can answer a question. It is just like a question period. Any minister or parliamentary secretary can answer the question on behalf of the government.

Another point of order, the hon. member for Charleswood--St. James--Assiniboia.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Mr. Chair, the minister was in the House.

[The Chair]

We do not normally comment on whether the minister was in the House or not. Perhaps it is a point of debate, but the parliamentary secretary has the floor and he is just going to finish up his answer.

[Robert Thibault, Liberal, West Nova, NS]

Mr. Chair, the minister was in the House at the beginning of the debate. He did not stay throughout the debate because he had other duties. As parliamentary secretary, I stayed, as is quite regular. We debated with members of the opposition until the end of the allotted time, as is usual.

On the question of hepatitis C, if the opposition members were not blinded by their partisanship, they would congratulate the minister for what he has accomplished. The Prime Minister mentioned during the election campaign that he would look at this. The minister, in six short months, took it on.

[The Chair]

I am sorry, but the time for debate is over. We are all enjoying the spirited debate, and now we will go to the member for Dartmouth—Cole Harbour for some more.

[Michael John Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Chair, it is always wonderful to join a debate when it is getting good. I will be splitting my time. I have two questions, which I figure will take 10 minutes maximum of my 15 minutes, and I will cede my last 5 minutes to my charming colleague from Thornhill.

My first question, although I will leave to the discretion of the minister, I would suggest is for the Minister of State for Public Health. It follows on a discussion that the member for Brampton—Springdale had asked on the issue of health promotion. I would not suggest that the Minister of State for Public Health does anything but provide concise answers, but I want to get to my second question as well.

I want to talk about chronic and preventable disease. We have a public health department and I think all Canadians have great confidence in the minister and that department. However, it is very important that we not forget, while we get consumed by SARS and West Nile and the issues that come up in public health, that chronic disease is the biggest killer by far in Canada, such as cardiovascular disease, cerebrovascular disease, arthritis, diabetes, which I think people would concede is virtually epidemic, emphysema. They all contribute to many of the cancers.

I want to talk about one specific idea that I have. I think the country is ready to move to action on chronic disease. We need a test market and I have the perfect test market in the province of Nova Scotia. Let me explain why.

We have a department of health promotion that involves Dr. Hamm, our premier, Dr. Tom Ward, our former deputy minister of health, who we unfortunately lost but who was a pioneer in many aspects of health, and Scott Logan, who heads the department in Nova Scotia. We have a very good team working on health promotion, and I believe we are the first health promotion specific department of government in Canada.

It would not be the first time either that Nova Scotia has been used as a test market. There is a famous study, called ICONS, which is improving cardiovascular outcomes in Nova Scotia. It used Nova Scotia as a test market for it about seven or eight years ago. We also have a high incidence of chronic disease. We have a nice round number of people, around a million. We have a nice mix of urban and rural. We have a university presence. We have strong research.

We also have strong stakeholders in the community. We have the Heart and Stroke Foundation, the Canadian Cancer Society and a number of other organizations that are very involved in the promotion of healthy living in Nova Scotia. As well, being part of Atlantic Canada, we have among the highest incidence of chronic disease in Canada.

On April 15 of this year I had the opportunity to invite the Prime Minister to a round table meeting in my constituency, held at Cole Harbour Place. Stakeholders from across the breadth of the health promotion community were present, such as the Heart and Stroke Foundation, the Cancer Society, the Canadian Diabetes Association, the Lung Association, the provincial department of health promotion, the regional health board, the community officer from the local health board, Recreation Nova Scotia, Sport Nova Scotia, representatives from a number of physical activity organizations like the Sportsplex and Cole Harbour Place and consultants in health promotion.

After the meeting, the Prime Minister indicated to me how much he thought the meeting was useful. He also indicated it was the first time he had been in a specific meeting in a community that talked only about health promotion. He said that he had found it refreshing as well as enlightening. Nova Scotia would be the perfect place to do a pilot project on health promotion.

I know my hon. colleague from West Nova, who is a perfect example of community health in action, would support me in this. We need to get the schools involved. We need to get child care facilities, hospitals, sports organizations, recreation groups, coaching associations, non-profit health charities, universities and researchers involved. Some great work is being done through CIHR in Nova Scotia on rural health and on all aspects of population health. We need to get public health nurses involved.

People in Nova Scotia know this minister very well and have great faith in her. She has been down on a number of occasions.

Federal, provincial and municipal governments, with non-profit charitable organizations and stakeholder groups, need to set some standards and achieve some outcomes on nutrition, physical activity in school, smoking, alcohol abuse and stress management. We could do it through education, programs, incentives and regulations. We could set some timeframes. We could set some checkpoints.

I have had the opportunity to talk directly with Scott Logan of the department of health promotion in Nova Scotia. I am sure that he would be very interested in being involved in this type of project.

We have great community leaders in health promotion in Nova Scotia; Jane Farquharson, Bill VanGorder, Dawn Stegen of Recreation Nova Scotia, Mike Lagarde, Anne Cogdon. I think we need a test market for a real attempt to measure and set targets to improve the health of Canadians. I believe we can start it in Nova Scotia. That is my short preamble.

Would the Minister of State for Public Health consider this a reasonable idea? Specifically and more generally could she talk a little about the benchmarks or targets that she thinks are important to consider in the promotion of healthy living?

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

Mr. Chair, I look forward to having further conversations with him about his idea. I remember hearing about the Prime Minister attending the round table in Cole Harbour and how inspired he was with what happened when a group of people from all walks of life with various approaches to keeping Canadians healthy, or a well-being initiatives, got together. I also think the member knows that some of the best work on indicators was done by Ron Coleman's group, GPI. I think there are all kinds of good things.

I had round tables both at Dalhousie and Acadia before the launching of the agency, and there was such a huge interest. I think the people of Nova Scotia and in Atlantic Canada, more generally, know that the health status of their citizens is of the worst in the country, and it is extraordinarily important. As we were building the case for each of the six collaborating centres across the country, it was not surprising that Atlantic Canada was asked to deal with the collaborating centre on determinants of health.

It will be extremely interesting, as we develop the collaborating centres, that each of the collaborating centres will be the glue in the region. They will begin to get together with local and provincial public health officials, federal agency officials, the stakeholders, as have been described, and academia. Citizens will be an extraordinarily important part of how we do the next step of identifying best practices, using community laboratories to find out what works and what does not work in the joint project of keeping people well.

The whole longitudinal approach, as the member described, from maternal child and infant to child care, to schools, to youth and sports, to families and healthy places for families to seniors is very exciting. In the whole life cycle approach, as we move forward, we will have to work with great people like Ron Coleman and with people in all aspects of health and health care.

We also have to work with all departments on how we choose health goals for Canada and how we pick some realistic and meaningful targets that people will buy into in the real approach of a strong common purpose, keeping as many Canadians healthy for as long as possible while at the same time respecting local wisdom and local knowledge to get it done.

I am look forward to working with the member and all members of Parliament and with all governments. The first ministers have asked us to work with them in picking these goals and targets. At the same time we have to understand, as the member has described, that there has to be goals around the health determinants, poverty, violence, the environment, shelter and equity as well as the goals around the kinds of choices people make, such as exercise, eating, drugs, alcohol and sexual health. We also have to look at specific outcomes in other epidemics of heart disease, diabetes, cancer, mental illness and lung disease. How do we move forward in picking those targets and how do we--

[The Deputy Chair]

Resuming debate.