Debates of Nov. 23rd, 2004

Supply

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, with respect to prostate cancer in particular, I understand that CIHR in fact has taken up the slack and has provided $8 million for research in that particular area.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Chair, with all due respect to the minister, he is acting like a crown prosecutor. He did not answer my question.

I asked him whether his government intends to keep money earmarked for certain pathologies, such as prostate cancer or diabetes, or whether he wants to have a comprehensive approach to public health.

I was told that some officials from his department were pressuring him to have a comprehensive strategy for public health, without funding reserved for certain pathologies. I believe this would be a mistake.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, there is no question that we are discussing the possibility of a coordinated integrated chronic disease strategy. I think I said that to the hon. member in one of my earlier remarks. We want to make sure that we actually arrive at that because I believe that many of these diseases have similar issues relating to them. There are underlying diseases that happen for the same reasons and their treatment, cure and prevention sometimes take the same kinds of approaches to deal with them.

There is no question that we will be looking at that, but I believe that for HIV-AIDS and the like, very special kinds of diseases, we support specific strategies.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Chair, I will try to keep my questions brief so that the minister can answer.

First, with respect to the questions that he has already been asked about the hep C announcement today, the minister quite rightly pointed out how difficult this issue is with lawyers, class action suits, et cetera. Would he not agree that things would be less difficult if the government would say at the same time as it said what it said today that it would be willing to put more money on the table should it be required in order to meet the needs of all the victims who exist outside that window? That would certainly make things a lot less difficult.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, the member obviously raises an important question that perhaps can be answered, but I have said very clearly that we are looking at all options. No option is foreclosed. Lawyers have been given a mandate to look at and discuss all available options for financial compensation to those from the pre-1986 and post-1990 class.

I believe it is important, if we want to have discussions with the lawyers from all the classes and the justice lawyers, that we not interfere in those discussions by holding negotiations in public.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Chair, it is not a question of negotiation. It is a question of the federal government making it clear that it would be willing to put more money on the table if that is what it takes to solve the problem and meet all the needs that are identified. The minister said this is a question that can be answered, but then he went on not to answer it. If it can be answered, perhaps he could give it another try.

I want to ask the minister a second question. Of course he can respond to my commentary on his first answer and I realize that. It has to do with something that the member for Hochelaga also brought up and it has to do with the national strategy against diabetes.

The Canadian Diabetes Association was on the Hill today meeting with members of Parliament. The NDP caucus had a meeting with its representatives. I am sure they met with other members. They are concerned that the funding for the national diabetes strategy as it is now constituted will run out on March 31, 2005.

The minister said he hopes to maybe integrate a national diabetes strategy into the 10 year health accord, but if that did not happen, he would be concerned that the money not run out. I am wondering why he does not just get up and say that if it does not get integrated into the 10 year health accord, there will be $50 million which the Canadian Diabetes Association is looking for, not for itself but for Health Canada. The association is not asking that the $50 million be given to it. It is saying to give Health Canada $50 million to implement this particular strategy.

Can the minister make that commitment this evening?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, let me address the earlier part of the hon. member's remarks with respect to the hepatitis C issue. Yes, the question can be answered, but at the risk of vitiating the discussions that are taking place. That is why I want to say all of the issues that members have raised on the floor of the House are wrapped up in the mandate that has been provided to the lawyers to have discussions and look at all available options for financial compensation.

With respect to the issue on diabetes, if I were able to say what the hon. member wants me to say, I would be pre-empting the Minister of Finance for next year's budget. The budgetary process is not complete. We will of course fight to make sure that the health budget is protected. It is the top priority of the government. I am assuming it would be protected. I remain hopeful that we will be able to integrate the strategies into one common chronic disease strategy across the country, with ample and sufficient funding. That is very important for me.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Chair, I offered the minister the opportunity to make a pre-emptive strike on the budget and he turned it down, but pre-emptive strikes are popular in other forms of geopolitical activity so I thought that maybe within the Liberal Party that might have been appropriate as well.

I wonder if the minister could tell us whether, since becoming the Minister of Health, he has made himself aware of all the various problems that have arisen around the Virginia Fontaine centre in Manitoba. I actually was the first one to raise this on the floor of the House of Commons a number of years ago.

Many things have happened, but it seems to me that this is a case which has had many, many ramifications. I wonder whether the minister is in a position to say whether he is just going to allow this thing to drag on in a piecemeal fashion or whether he is prepared to hold the kind of inquiry, public, judicial or otherwise, that would be necessary to finally determine exactly what all went wrong and how something run by Health Canada could be so badly mismanaged.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, let me first say I understand from the information I have been able to glean from the pages I have been able to access and read that Health Canada has made many changes in its processes to ensure that this kind of thing does not happen again. We also know that the matter is before the courts. We also know it was Health Canada that actually alerted the RCMP with respect to an investigation.

I think the questions of an inquiry are premature. As a former attorney general, I can tell the member one ought not to even think about an inquiry while there are criminal proceedings under way. At the end of those criminal proceedings, as a result, and if we can look at what Health Canada has done and what the results of the criminal proceedings are, in the end if the hon. member is still dissatisfied I will be happy to take that question from him and answer it more fully.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Chair, we have had some discussion tonight about the cost of drugs in Canada. It came up in earlier questions. I have a couple of questions related to drug policy.

The first has to do with the practice of evergreening. I do not know if the minister is aware there is a private member's bill, Bill C-274 in the name of my colleague from Windsor West, which, if it were to come to a vote and then be passed, would eliminate this practice that has the effect of increasing the price of drugs, unnecessarily in our view. I know it is a private member's bill, but does the minister look favourably upon this proposed legislation or not?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, the hon. member raises a very important issue. In fact, this was one of the first couple of issues that came to my attention when I became minister. We are currently in the process of developing and concluding development of regulations to deal with evergreening. Hopefully we would not need the private member's bill, but if we do I would be happy to take a look at it and tell the hon. member at that time whether or not I support it.

But I do support dealing with the issue of evergreening. It is a serious issue. It is a matter of balance. We want pharmaceutical companies to have drugs approved in this country and to manufacture drugs in this country. We also want to make sure that they do not unnecessarily delay the entry of generics into the market.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Again with respect to drugs, Mr. Chair, I wonder if the minister could tell us about it. There has been a lot of controversy of late about it, and I heard the minister say earlier that part of the plan that the federal government and the provinces are looking at is a national formulary and bulk buying and this sort of thing and also speedier approval of new drugs.

I understand the reason for that, yet at the same time we are in a context now where we see that many drugs have been approved--I do not know whether they have been approved speedily or not but they were approved--and then we find out sometime down the road that they are not all they are cracked up to be or they have side effects that are quite serious. Vioxx comes to mind, as do certain anti-depressants that have been identified with suicide. Just today Depo-Provera was identified as causing osteoporosis, I think.

I recall actually raising the issue of Depo-Provera in the early 1980s in the House when I was the NDP health critic, in another century, and at that time I raised it because they were experimenting with Depo-Provera on women in third world countries. We asked the Canadian government to oppose that at the WHO.

We did not succeed and of course after the experiment on third world women we have now had the experiment on first world women, and now we finally have the results of that experiment.

Could the minister tell us what is the government's intention with the drug approval process? There are obviously some problems. What is the government's plan to deal with the inadequacies in that particular process?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, obviously it is very important that we keep and maintain the robust drug approval process that we have. In terms of speedier drug approvals, I only meant to say that we have provided resources, starting last year with $190 million over five years, I believe, to make sure that we have the resources to be able to approve drugs within about 300 to 350 days rather than drugs having to wait over a couple of years to be approved. We want to make sure that business comes to Canada and they actually apply to have their drugs approved here. It is important for us.

But it is also important to ensure as rigorous a process as there is for pre-approval. There ought to be a rigorous process for post-approval in terms of the surveillance. That is missing at this point. I have been talking to my own department for the last several weeks to make sure that we add post-approval requirements for the drug companies to report to us any information and data they collect, and that we also have some surveillance ability and opportunity to be able to see how those drugs are doing after they have been approved, so that we do not have a situation of a drug being utilized over 10 years and finding out after 10 years that people have been having problems from year one.

It is important. I have actually been discussing that with my own department to make sure that we get there.

[Bill Blaikie, NDP, Elmwood—Transcona, MB]

Mr. Chair, it seems to me that the minister or the federal government would have a lot more control and a lot more influence over many issues having to do with drugs if in fact the government had proceeded with its own election promise and responded to the proposal by the premiers for a national pharmacare program.

Earlier the minister raised questions about Internet pharmacies. If the federal government was in charge of pharmacare in this country and if that Liberal promise had been kept, or if the premiers' proposal had been responded to, does the minister not think he would be in a much better position to deal with this than he is now, having to deal at several arms' lengths with this issue?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I will stand corrected if I am wrong, but I do not think having a national pharmacare program would make much difference in terms of how we are able to deal with the issue of drug prescriptions, because they are prescribed by doctors and filled by pharmacists and both of those bodies of professionals are obviously governed by provincial legislation.

Yes, export of drugs is dealt with by the federal government in any event, even now, but we are trying to deal with the issue of Internet pharmacies by using the definition of practitioner, because we believe that is the simplest way of dealing with it rather than a cumbersome export permit method that might be available.

On the other issue of national pharmacare, the hon. member suggests that the approach would have been better. Here is what we are trying to do with the national pharmaceutical strategy. The Prime Minister said this one day at Penticton, I believe, if I remember correctly, and I have said this several times. What we are trying to do is put in place building blocks that may over time lead us to a national pharmacare plan.

A national pharmaceutical strategy would include catastrophic drug coverage, speedier drug trials and common drug review. It would include perhaps a common formulary. It would include bulk purchasing. Once we have been able to put all of these things in place, we may not be far away from the idea of a national pharmacare plan even though it still may be run by the provinces in their own jurisdictions.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, I am glad for the opportunity to congratulate the minister on the leadership he has shown in a very complex portfolio.

Much of the discussion this evening has been centred on our health care system and what our government will be doing to improve it. This is important, no doubt, as health care is the number one priority for all Canadians.

As a chiropractor who has owned multidisciplinary clinics, I had the chance firsthand to see the challenges we face in our health care system. I have also seen the benefits of various health care professionals working together in one team to provide patients with high quality care. More important, I have had the chance to experience the benefits of empowering patients with knowledge about their health.

I strongly believe that it is imperative that we as a government move forward on our health care file with an agenda that incorporates both prevention and promotion of a healthy lifestyle activity. Be it physical fitness, genetic factors or social and economic conditions, the health of our air, our water or the rest of our environment, these are all factors which are critical and crucial to the health of Canadians.

Some of these factors are well outside the mandate of our hon. minister. However they are areas in which our minister can play a significant role in promoting and educating Canadians that healthy choices do equal healthy lifestyles and good health. Much research has shown that people who exercise, eat right and live a healthy lifestyle are less likely to require health care services. In an era when resources are limited and the needs are many, we must look at effective strategies that encourage Canadians to lead these healthy lifestyles.

I am sure many members in this House have heard the saying, “An apple a day keeps the doctor away” or “An ounce of prevention is worth a pound of cure”. I am sure that these were not invented because they sound nice. These sayings are instrumental in promoting the mindset that we as a government must encourage.

We must look at healthy living in two different perspectives. We must first forecast and acknowledge the social implications of our aging demographic but we also must be proactive in articulating the importance of healthy living to our younger generation.

As an example, it is well-known that we as a nation are seeing an increase in obesity. The percentage of Canadian adults who would be defined as obese has more than doubled between 1985 and 1998. In 1985 the rate for obesity was 5.6%. and in 1998 the rate changed to 14.8%.

We also can talk about childhood obesity. In 1981 the rate was 2% and in 1996, 9% of young girls and 10% of young boys were overweight . Today, eight years later, in 2004, obesity in children has dramatically increased.

As a nation, I strongly believe that we must do more. We must take initiatives to promote healthy living. We must promote promotion and population health. We, as a nation, must make it our responsibility to reach out to children in schools and promote physical activity and exercise. It will be this increase in physical activity that will help the very cause that leads to obesity.

We, as a government, must reach out to Canadians and promote healthy eating habits. Encouraging better eating habits will produce a reduction in the rates of obesity in our country.

It is evident that prevention and promotion of healthy lifestyles will assist in the reduction of the $1.8 billion per year that our health care system spends on the problem of obesity.

I am a firm believer that as we move forward into the next generation, our health care investments need to focus on population health, on prevention and on promotion.

In light of all of these factors, how do these estimates that the minister has provided today support effective action to encourage healthy living?

[Carolyn Bennett, Liberal, Minister of State (Public Health)]

Mr. Chair, it has been a time of renaissance in terms of the kind of understanding the member shows on the importance of health promotion and disease prevention in terms of the ultimate sustainability of our health care system.

It was inspirational to see the Prime Minister and all first ministers make the kind of commitment they did in the first ministers' meeting to both disease prevention and health promotion. It was extraordinarily important for them to outline for all of us to do everything we can around choosing the health goals for Canadians as well as some targets, to be able to move, as the minister said, on these integrated disease strategies understanding how important the common risks to all of these diseases around cancer, heart disease and diabetes can be.

As the member so rightly pointed out, there was the importance of school health and the commitment that all governments made to a school health consortium and program that the Minister of Health was able to shepherd at the health ministers' meeting in September in Vancouver.

It is an exciting time but I probably would not have my job if it had not been for SARS. However, as we have had to deal with the threats of infectious diseases, we have been able to tuck in behind that the other epidemics of diabetes, cancer and heart disease.

We have been able to move forward on setting up a public health agency with the kind of real money that was invested in the 2004 budget and the $165 million that the finance minister was able to find for us. We are now able to do a much better job on disease surveillance, on health risk assessments and on the kinds of things we want to do around the determinants of health in the collaborating centre in Atlantic Canada and in the other collaborating centres.

The $300 million commitment that was made to the provinces for immunization and the $100 million commitment to enhance local public health was also important. As members know, officials are working hard every day with their local voluntary organizations to help do exactly as the member suggested in terms of disease prevention and health promotion.

As I think the member knows, we actually do need the data to support the surveillance that we need to do on both the health status of Canadians and particularly our aboriginal people. We were thrilled to give $100 million to the Canada Health Infoway to begin incorporating the good work it is doing on the electronic health record into proper surveillance on public health.

We will need the support of members as we go into the next budget cycle to make sure we have the dollars we need to do the shared goal of keeping as many Canadians healthy for as long as possible.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, I take the opportunity to congratulate the Minister of State for Public Health for doing a wonderful job in her role. She has reached out to a tremendous number of Canadians. I know, from my background in health care and in working in a multidisciplinary environment, that providing and promoting healthy lifestyles are definitely the keys to the success of the health care of Canadians.

I was wondering whether the Minister of State for Public Health could provide me with some insight into the role that our public health officer will be playing for the lifestyles of Canadians and how that fits into the estimates.

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

Mr. Chair, the chief public health officer is an important position. As the Minister of Health has said, the appointment of Dr. David Butler-Jones has provided his network with respect with regard to his relationship with the chief medical officers of health throughout the country in terms of their shared work.

We had a fabulous lunch with the Chief Medical Officer of Health and the chief medical officers for the provinces and the territories. They have an unbelievable understanding of the social determinants of health and the common risks. We need not only ministers of health across the country but we need ministers of all departments to put a health lens on healthy public policy. Whether it has to do with smog days or whether it has to with the percentage of families spending more than 50% of their income on rent, it must be a response by this government and indeed the whole country.

I hope we arrive at the day when we will see that the sustainability of our health care system is actually the shared goal of keeping people well.

We look forward to the efforts of all members of Parliament who have become real champions in their areas with their various networks across the country. This is really a shared goal and vision of all parliamentarians. We thank them all for their help.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, I thank the minister for her insight into the role that our public health officer will to play. I think all parliamentarians share a collective vision of wellness for all Canadians.

Could the Minister of Health perhaps elaborate on the significant and historic deal we signed in September 2004 with the federal government working in significant partnership with all the provinces and highlight or outline the direction the health of our nation will take for the next 10 years?

The substantial issue that was in the health care accord, which was signed at the first ministers meeting, was the reduction in waiting times that many Canadians experience across the country. It is nice to see that our federal government has finally taken a great initiative to reduce that waiting time.

Could the minister perhaps elaborate on the waiting time strategy contained in the health care accord that was signed in September 2004?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I believe that the wait times across the country in different areas of health care have become almost the litmus test for health care. Even though people may not have been in direct contact with health care recently, when they look at the waiting times they believe that health care may not be available for them when they need it.

There is a high degree of satisfaction with our health care system among Canadians, particularly among those who have been in touch with the system, because it was there for them.

However there is a real problem with wait times. The Prime Minister recognized that in the last election and made it a national issue. With the assistance and cooperation of the first ministers from across the country, we signed an agreement in mid-September of this year which will provide $41 billion in additional money over the next 10 years for health care. It was agreed that all the provinces would establish evidence-based benchmarks and multi-year targets to achieve those benchmarks, and would have comparable indicators to arrive at those wait times and to reduce them.

The Prime Minister selected four areas on which all the first ministers agreed: sight restoration, joint replacement, cardiac and diagnostic. If some provinces felt that their priority lay in some other area or that they had wait times that were more problematic in other areas, there was flexibility in the four that they could choose. These four were not etched in stone.

It is important that all jurisdictions report by March 31, 2007 significant reductions in wait times across the country. It is important that we re-inject that sense of public confidence into our public health care system. Regardless of the difficulties we may be having now with our health care system we must remember that 40 years ago we rejected the private system where a person's wallet was checked before the person's pulse.

It is important that we maintain, strengthen and enhance our public health care system, an institution that is cherished, loved and supported by Canada, so that health care is available for all of us. It defines our sense of shared values to look after each other as Canadians.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I have some questions for the minister and I am pleased that he could join us tonight.

I want to correct what was said earlier. It is not on his initiative that he is here; it is on ours, the official opposition. We are the ones who asked him here because health care is a number one priority for us and we had some serious questions that we wanted to put to him with regard to it. Therefore, I thank him for giving us his time and opportunity.

The Auditor General is held with a tremendous amount of respect by all Canadians and all members of the House. In her report today it states:

--we found that the government is paying tens of millions of dollars more than necessary each year because it does not take advantage of some well-known cost-saving measures...This is the third time we have raised this with Health Canada. I am disappointed that these issues have not been resolved.

There are many issues that we deal with in the House, some on the liberty of Canadians, some on the actual dollars and how their money is spent, and some on actual life and death situations. This one happens to be on money and life and death.

I would like to ask the minister point blank, how come it has taken three times? This is the fourth time. What assurance can he give us that this is not going to happen the fifth time?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I said earlier on in the House and I also said it outside to the media, we fully accept the Auditor General's recommendations.

I met with her. We had a conversation about these issues. In fact, I will direct my department, as we make the changes to meet the recommendations that she has given and implement those recommendations, to consult her from time to time.

There are, as I said earlier, issues of consent and privacy. There are also issues as to whether or not we can bulk purchase these drugs for first nations people. The federal government delivers health care to 750,000 first nations individuals. There are thousands of pharmacies that actually provide those prescriptions to those 750,000 individuals. There are medical practitioners who deal with those issues.

Therefore, it is impossible for the federal government to bulk purchase those drugs that are given at the pharmacies by private practitioners, private pharmacists, and prescribed by private medical practitioners.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I want to get this straight. Is the minister saying that it could not have been fixed when the Auditor General addressed it the first time? When she addressed it, it was pretty specific. She is saying that just one drug alone cost $17 million, when it should have cost $4 million in one year. That was just to change the buying practice of one drug. Is the minister telling us that she was wrong the first time she addressed this issue?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Chair, I am saying no such thing. I have said very clearly that we accept the recommendations of the Auditor General. We will implement them. I am simply trying to deal with some of the complexities and difficulties. The Department of Health has tried to deal with the drug abuse situation which is not the question that the hon. member is raising and I recognize that.

There is the question of privacy and consent. The aboriginal leadership just issued a press release today to highlight that issue of consent.

The issue of bulk purchasing and the federal government being able to purchase in bulk some of those drugs directly is just not feasible at this time. We may be able to do that, but we have over 1,000 pharmacies prescribing those drugs to individuals. We have medical practitioners giving them the prescriptions. If we were a province and actually owned the pharmacies, and had the doctors under our control, we would be able to do that.

I want Health Canada to sit with the Auditor General and perhaps she can advise us as to how she thinks we can do that.