Debates of June 7th, 2005

Supply

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Speaker, I do not know why the member opposite is so upset at my mention of the fact that I am engaged in a personal struggle on these issues. It is important that all Canadians participate. That is why we want to have a Canadian healthy living and chronic disease strategy.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Mr. Speaker, I rise on a point of order. There have been discussions among the parties and I believe if you seek it, you would find unanimous consent in the House to allow me to move the following friendly amendment to the motion we are now considering. The amendment reads, “That after the word 'provinces', the words 'territories and municipalities' be added”.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Speaker, I rise on a point of order. Contrary to what our colleague from the NDP is suggesting, there is no agreement between the parties, since the Bloc Québécois is not in favour of this amendment.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Mr. Speaker, not to get into a debate on this, but I have spoken to the Bloc Québécois. That party did give its consent.

[The Acting Speaker (Mr. Marcel Proulx)]

Does the hon. member have the unanimous consent of the House to move the motion?

[Some hon. members]

Agreed.

[Some hon. members]

No.

[The Acting Speaker (Mr. Marcel Proulx)]

There is no consent.

We are moving on with questions and comments. The hon. member for Hochelaga.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Speaker, I know that time is running out. I simply want to ask the minister a question. Later my colleague from Laval will have the chance to explain why we are not in favour of this proposal by the Conservatives.

Is the root of the problem not a problem in and of itself? The situation would perhaps be less problematic in a much more functional political system than the one we have had for the past few years. The federal government has the resources but the provinces have great needs, in health especially. Health is the most inflationary item for any government.

From 1994 to 1999, the government unilaterally and substantially cut transfer payments. To achieve the objectives being proposed by our Conservative colleagues, would it not be easier to considerably increase the transfer payments and allow the provinces to define their own strategies for fighting cancer and preventing mental illness and heart disease?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Mr. Speaker, we did just that last September. We added an additional $42 billion over the next 10 years to those transfer payments. Now, with that money going to the provinces, the amount of money being provided far exceeds the recommendations made by the Hon. Roy Romanow in his report.

I believe that in addition to providing more transfers, we have an obligation in terms of education and awareness on prevention and promotion of public health across the country. The $300 million integrated disease strategy and healthy living strategy is part of that compliance with respect to our own obligations to Canadians.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Speaker, I am pleased to speak on this official opposition day.

First, I want to pay tribute to volunteers in communities throughout Quebec and English Canada who help those afflicted by cancer, mental illness or cardiovascular disease. Often, caregivers are the ones making such commitments, and this demonstrates tremendous solidarity within our communities.

I will try to make my remarks as detailed as possible. I would not want to give the impression that mental health, cancer and cardiovascular disease are unimportant to the Bloc Québécois.

In the near future, one in five Canadians will likely develop a mental health problem. Obviously, the seriousness of these problems can vary; nonetheless, one in five individuals is at risk.

Currently, every eight minutes, a Canadian is diagnosed with cancer—be it breast cancer, colon cancer or another cancer. It is quite scary and a cause for concern, but that is the reality.

Cardiovascular disease is, clearly, also a problem. If every MP who has lost a loved one to cardiovascular disease raised their hand, there would be a big show of hands. I am certain that most of us know someone who has died from this disease.

However, I believe that our Conservative friends used faulty logic to identify this problem. I respectfully submit that what the Conservatives are proposing will not allow us to truly resolve the real problems.

First, I want to re-read the motion for those just tuning in. Then, I will explain why the Bloc Québécois will not be able to support this motion. This motion has been moved by the member for Charleswood—St. James—Assiniboia, my colleague, the Conservative health critic, an MP from Manitoba, a monarchist and a fascinating fellow. That is how I tend to describe him.

It reads:

That, given a national strategy is needed now to reduce the growing human and economic costs of cancer, heart disease and mental illness; the House call on the government to fully fund and implement the Canadian Strategy for Cancer Control in collaboration with the provinces and all stakeholders, and given that Canada is one of the few developed countries without a national action plan for effectively addressing mental illness and heart disease, the government should immediately develop and initiate a comprehensive national strategy on mental illness, mental health and heart disease.

I must begin by saying that the motion is certainly well-meant. We do, of course, live in a time when chronic diseases are wreaking havoc in terms of productivity and morbidity. I cannot, however, resist pointing out that the word “national” appears four times in the 10-line motion. When the member for Charleswood—St. James—Assiniboia uses that term, he is, of course, referring to Canada. One might therefore legitimately ask the following question. Does the type of strategy the member is calling for have to be driven from Ottawa?

I think there is no doubt in the minds of the Bloc Québécois that this strategy cannot be federally driven.

If our colleague had proposed increasing transfer payments and encouraging the provinces to set aside funds for cancer, mental illness and, of course, the whole area of cardiovascular disease, the Bloc Québécois would obviously have been a staunch supporter of this motion. I believe, however, that it must be acknowledged that such is not the case.

I had the pleasure earlier of an impromptu conversation with spokespersons for the Canadian Strategy for Cancer Control and the Canadian Mental Health Association. What they had to say was a bit different.

If the intended objective had been to create a co-ordinating point where representatives of all provinces and territories could sit around the same table and exchange information on diagnostic tools, preventive approaches and available therapies, then the Bloc Québécois could not be opposed, out of good common sense and a degree of generosity. That is, however, not what we are dealing with here; this is about implementation of a national strategy.

It is really about giving the federal government a bigger role in health. In any case, the motion before us cannot be isolated from the national issue. This is really the main point the Bloc Québécois is making. One cannot claim, on the one hand, to respect the prerogatives of the provinces, and on the other, ask the federal government to have a national strategy. They are irreconcilable. There is a kind of paradox or contradiction.

I know that the Conservatives like to say that they support provincial rights in the 19th century tradition and want to respect the jurisdictions of the provinces. I only wish I could believe them. But reading the motion before us, I can hardly believe that this is a sign or demonstration of a desire to respect the provinces and their jurisdictions.

That is the general background that leads us to vote against this motion. I would like to tell you about a little experience I had a few years ago. I am obviously not 20 years old any more. I have been in this House since 1993 and have been health critic since 1999. In fact I think that I am the dean of the health critics. I do not think that anyone in the other parties has been on the Standing Committee on Health longer than I have.

I do not claim to be the incarnation of stability within the Bloc Québécois during what are shaping up to be some interesting times. But that is another debate, and we do not want to get off track.

This being said, a few years ago the Health Minister at the time, Allan Rock—the member for Etobicoke Centre, which whom you yourself sat, Mr. Speaker—was appointed, in a non-partisan gesture by the Government of Canada, to be the Canadian representative to the UN. You will remember him. Allan Rock was a lawyer, not a bad person, and he appeared before the Standing Committee on Health. At that time, Mr. Charbonneau, the member for Anjou—Rivière-des-Prairies—a riding that has now been renamed Honoré-Mercier — was appointed to UNESCO by the government in another non-partisan gesture. Mr. Charbonneau was the parliamentary secretary to the Health Minister—Mr. Rock at the time — and he had asked the Standing Committee on Health to study the whole issue of mental illness.

It is obvious that these illnesses are a major problem and will even be one of our most important concerns over the next few years. If it is true that one in five of our fellow citizens will have mental health problems over the next few years, ranging from slight depression to more serious illnesses, this is obviously something that we need to be concerned about.

So I was opposed to the motion.

The Standing Committee on Health began its work and heard witnesses from Health Canada. Are members aware how many Health Canada officials could talk to us about the department's mental health initiatives? In all, in a full committee, there were three officials who had the expertise and who had done full-time research into mental health.

Why am I saying this? It is not because the officials were not competent or not doing their job to the best of their ability. However, do they seriously think that the federal government, which does not have responsibility in this, can be a motive force in connection with problems as serious as mental illness, heart disease or cancer?

Those who provide care, make the diagnoses, are familiar with drug therapies and are working on detection technologies in hospitals are all part of a strategy.

It is fine with me to talk about strategy, but what is this strategy about? A strategy has to include prevention first off. Prevention has to do with the factors affecting health, including the environment, food, physical activity, recreation and stress management. The responses to all these variables are to be found in provincial jurisdictions.

A national strategy, if there has to be one, begins with prevention. None of the major factors in prevention is connected with an area of federal jurisdiction.

Diagnosis follows prevention. From a sampling of the population, those in whom the three diseases I referred to are either active or dormant have to be identified. But who is responsible for prevention? First, a CLSC, then a long term care centre, an emergency room or a hospital. How can the federal government be useful in prevention or detection?

Further along in the strategy, after prevention and detection, comes cure. If care is required, where can it be obtained? In a hospital, of course. How is this care provided? It is provided by health care professionals. Who accredits the health professionals through the professional bodies? The provinces. Who makes the medication available? I will come back later on to the federal government's strategy to create a national drug formulary. Formularies exist already for available therapies.

The Quebec government and the official opposition are considering this issue. I want to take a few moments to wish best of luck to Louise Harel, the MNA for Hochelaga-Maisonneuve, now leader of the opposition in the National Assembly. She is the first woman occupy this position. I do not want to get off topic, but I mention Ms. Harel because she is the PQ's health critic. The National Assembly's social affairs commission is currently considering a drug policy. However, who decides what medications to include on the formulary? Certainly not the federal government.

So we see the subtle inconsistency from which the Conservatives are unfortunately—and temporarily, I hope—suffering. They are intimating that the House could implement a national strategy. However, none of the major components of such a strategy, from prevention to detection, from therapies to hospitalization, gives us reason to believe that the federal government could make a difference here.

The best thing the federal government could do would be to increase the transfer payments.

Earlier, the Minister of Health—I was going to record him, but I understand this could bring him bad luck—said that, over the next 10 years, federal funding will increase to $42 billion. Bravo! We are not afraid of saluting this initiative. The more money there is for health care, the better for everyone. However, even with this investment, the federal contribution to the health care system is less than 25%.

I want to remind everyone that, no matter what their political stripe—and there have been Conservatives, New Democrats, sovereignists and Liberals— whenever all the premiers have met, since 2001, they have called for the federal contribution to health care to reach 25%.

Such is the insidious nature of Canadian federalism. Every government uses themes to promote nation building. Health is a top priority for our constituents. Naturally, it is on everyone's mind. These days, we cannot simply talk about old age, we have to talk about very old age. It is no longer unusual in our communities to meet people who are 80 or 85 or 90 years old who are seem younger. They are in great shape and active in their community.

We have examples in our own caucus, such as the member for Champlain. He is a senior, but an extremely dynamic man, who is energetic and in good health. Why? Because he watches what he eats, he avoids excesses and he manages his stress level. That is the secret of getting to old age, Mr. Speaker.

In short, we cannot support the Conservative motion, even if it is well intentioned. We are of course concerned about the whole issue of chronic disease. And, yes, cancer, mental illness and cardiovascular disease are prevention, research and treatment priorities. These areas were identified in the 2004 agreement. However, we do not think the federal government should be the motive force.

I remind you that, in recent years, the federal government has been using health for nation building. What is the federal government's inspiration? Not just that. I have to say, with regret, in this regard that my NDP colleagues, so progressive in other areas, have latched on to the federal government and the Romanow report. What is the federal government's bible? It is the Romanow report. What does the report recommend? It is as plain as day. The report advocates putting an end to ten health care systems and having only one.

It is even true that the report has pushed audacity to the new height of calling for a single drug recognition system with one formulary for all of Canada. Is that not insidious?

In closing, because I see my time is running out, I say that we cannot support the Conservative motion. We ask them to take the logic of respect for the provinces to its conclusion and not ask the federal government to take the lead with a national strategy, when it is not the competent player to do so.

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

Mr. Speaker, from one health critic to the other, I am not sure whether the member took a breath during his speech and I must say that air is good for people and he should use it. The member may have misunderstood what is happening here.

This national strategy, particularly the cancer strategy, is not a Conservative Party document. This document has been put together by all the major stakeholders in the cancer community, including members from Quebec. The strategy brings together expert advice. It is an arm's length council of experts. It allows provinces to opt in and opt out as the case may be, and it respects the autonomy of provincial governments in health care delivery. It focuses on outcomes and results and is managed, in most cases, locally.

The strategy is not a program out of Ottawa and will not be run by the federal government. We are asking the federal government to provide the money for the program but that the stakeholders, the people, the council would implement it. It is quite different from what the member has described.

It is a small “n” national strategy. The fact is that we are in this together. We share a lot of the same challenges. The fact that the member is in the House today indicates that there are many common concerns between people who live in Quebec, Ontario, Manitoba or Alberta and cancer is one of them.

The point I am making is that the federal government will not really be involved in the strategy other than in the funding of it. The bureaucracy has shown that it is unable to implement a national strategy. The fact is the Liberal government has shown contempt for the stakeholders in the cancer community by rejecting the strategy.

I wonder if the member would reconsider given that the strategy would be arm's length, that there would be provincial autonomy and that it would be for the greater good. This strategy will save lives, the lives of his constituents, the people who vote for him. I am sure he does not want to lose his voters.

I would ask the member to please reconsider and help us implement the strategy because it will help everyone.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Speaker, I thank my colleague for his question. I can reassure him that I am not in any danger of running out of air; I am fine. My health is good. I thank him for his concern.

Words do have meaning, however. The motion can be amended if he likes. It refers to “a national strategy to reduce the growing human...costs” and calls upon the government to “fully fund and implement”, adding “with... all stakeholders”. As the motion is worded, the initial principle is that the leadership and implementation of this strategy would come primarily from the federal government. This I think must be acknowledged.

Our colleague says the provinces will be the ones responsible for running the whole thing. The motion can be amended to indicate that. If the motion called upon the federal government to restore transfer payments so that the provinces, exercising their own jurisdiction, could develop strategies on cancer, mental illness and heart disease, then we would have been in favour.

I would like to ask our colleague whether he obtained the support of the National Assembly. I do not think the Jean Charest government, the Parti Québecois or the ADQ would support such a motion. As an MP from Quebec, I consider myself the spokesperson for the consensus in the National Assembly. I call for full respect of jurisdictions, particularly the sacrosanct ones, such as education and health. I would be extremely surprised if the National Assembly would give its support to anything worded in this way.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Mr. Speaker, I know members on this side find it disappointing that our colleagues from the Bloc are not willing to support this initiative for a national cancer strategy.

I want to ask the member a question in another direction. He mentioned the former minister of health, Alan Rock, and the parliamentary secretary of the day, Mr. Charbonneau, who introduced a motion at the time to look at mental illness. That is a subject that a lot of us are concerned about and we are talking about that as part of a national strategy.

The member, who is a longstanding member of the health committee, is aware that the health committee has a bill before it right now dealing with the way we regulate natural health products. I know a lot of Canadians who are having trouble understanding Health Canada's response to an initiative that came out of Alberta showing great promise in treating people with mental illness, a vitamin and mineral product called Empowerplus.

It was showing such promise that four peer review studies were published. The Alberta government put over half a million dollars into that study. People were being relieved particularly from bi-polar disease when Health Canada authorities moved in to shut down the study at the University of Calgary that was producing the evidence of effectiveness.

The RCMP were sent in to raid this little company in Raymond, Alberta, steal its computers and contact 3,000 Canadians who were benefiting from the product and who had actually recovered their mental health. Those people were told to get back on their psychiatric drugs under the care of their doctors and to have proper psychiatric management when in fact they were actually doing very well, many of them with the support of their doctors.

Whether it is mental health with Empowerplus or whether it is heart disease and folic acid, which we now know is one of the main defence mechanisms against one of the highest risk factors in heart disease, the homocysteine which damages the lining of the vessels, and yet because of the antiquated sections in the Food and Drugs Act, subsections 3(1) and 3(2), and parts of schedule A, we are not allowed to tell Canadians about the benefits of simple, non-patentable, low risk products that would help them lower the risk.

In establishing a national strategy would the member agree that it is important that we look at all possible avenues of advancing health and prevention and in promoting wellness in any strategy to promote national wellness in these areas?

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Speaker, I agree with our colleague that in the range of options available to consumers, there are some natural products that can be very beneficial. However, with all due respect, there were a few problems with the wording of the bill.

Nevertheless, let us use this as an example. For several months, we considered the bill of another colleague—not the bill on natural food products and natural health products—on fetal alcohol syndrome. We had the same reaction.

At the committee table, people called for a national strategy for fetal alcohol syndrome. When we looked at the elements of this strategy, we realized that the responsibility and expertise of the federal government hardly went beyond information.

They printed off pamphlets and sent them to various professional bodies. These pamphlets contained information on preventing the syndrome. However, beyond that, when you go to a doctor's office for a prescription or a healing strategy, the federal government cannot help.

I think it is no different for fetal alcohol syndrome than it is for mental illness, cardiovascular disease or cancer. The federal government might be able to invite people to come to the table to exchange information, but we do not need a national strategy for that.

The best system and the best service the federal government could provide is to increase transfer payments, just as all the provinces have been asking it to do for almost 10 years.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, the NDP will be supporting the motion and I thank the member for Charleswood St. James—Assiniboia for bringing it to the attention of the House and for some very vigorous debate around an issue that is very important to Canadians.

I will not read the whole motion but I will read the last part which states:

--the government should immediately develop and initiate a comprehensive national strategy on mental illness, mental health and heart disease.

Earlier in the motion it talks about the need for a national strategy on cancer.

The member referred to the coalition of a number of organizations that have been working very actively and very vigorously for a number of years on this very initiative. In a document entitled Establishing the Framework for a Comprehensive Canadian Strategy for Cancer Control, it lays out a number of factors that are critical in looking at a national strategy. These include prevention, screening, diagnosis, treatment, supportive care and palliative care.

I know a number of other members will be talking about various aspects of this national strategy but I would like to focus on prevention and wellness.

In the document it is stated:

True cancer control aspires not only to treat and hopefully cure the disease, but to prevent it, and to increase the survival rates and quality of life among those who develop it. The process encompasses interventions aimed at both individuals and populations.

This is a very critical statement in this document.

After looking at this initiative and after speaking with a number of advocates in the cancer community, one of the things that dismayed me was that this conversation has been going on for years and years. In 2005 one would hope that we would not be in the position of having to spend an entire day of members' time talking about this very important issue and instead we should be talking about the success of a national cancer strategy.

In preparation for the debate today I pulled out a document called Cancer Care in Canada, the voice of the Cancer Advocacy Coalition of Canada. I talked earlier about being dismayed. The coalition produced a report called report card 2003. One of the lead in statements in the report card says:

Since the year 2000, the Cancer Advocacy Coalition of Canada...has been asking for hard facts on the issues that matter most to the country’s cancer patients. Year by year, our mantra has been, “We cannot manage what we cannot measure.

This group did a report card on the provinces throughout Canada. It looked at a number of measures: mortality, which provided rankings for the provinces; 2002 waiting times; per capita funding; rates of funding increases; and transparency and accountability.

When we take a look at a factor such as waiting times, we are looking at a range that goes from unacceptable, borderline, to acceptable. Throughout the provinces we have no consistent way of looking at waiting times, of gathering the information or of reporting the information back to Canadians. What the organization pointed out in this document was that often we were talking about apples and oranges.

My favourite topics are transparency and accountability both at the federal level on how federal dollars are spent on health care, but also at the provincial levels in how they report back to the federal government on how dollars are spent.

The analysis on how provinces reported out information went from unacceptable to borderline to accessible, to actually one case of outstanding. It talked about the fact that the transparency and accountability in the province of Ontario was outstanding. Unfortunately, in my own province of British Columbia it was merely acceptable.

One of the challenges we have when we are talking about cancer control and prevention is that often we do not know what we are measuring, we do not know how to gather the information and we have no consistent framework to talk about this.

Before I go on to talk about prevention and wellness, my good friend from the Bloc referenced the Romanow report and implied that the federal government had actually been working progressively on the Romanow report. I must beg to differ.

The federal government has talked about the fact that it has closed the Romanow gap by allocating some funds over the next 10 years to health care. The only Romanow gap that it has closed is by making a commitment to funding, but when we talk about many of the other initiatives that were addressed in the Romanow report, we are talking about inertia and inattention.

The final report from the commission on the future of health care in Canada specifically talked about prevention and wellness and this is a very good context in which we can speak about the cancer prevention strategy. One of the things the report talked about was anticipating an aging population. We know that age is a factor when we talk about cancer. The demographic trends show that the proportion of Canadians 60 years and older is expected to grow from 17% to 28.5% by the year 2031.

When we talk about the need for a national strategy, the fact is that not only are we seeing cancers identified in people under the age of 60, but we have a very serious demographic bulge that is going to happen over the next few years. If we are not out in front in developing a strategy to address this, it is going to present some serious challenges for our medical system.

The Romanow report goes on to say that much of the international evidence indicated that modest growth in economics should ensure that most countries are able to manage the growth in their elderly populations and increase health care spending in the future. It is worth remembering that there are countries which already have larger elderly populations than Canada, spend significantly less, and achieve similar health outcomes in comparison to Canada.

Romanow also addressed the issues of needs and sustainability. He talked about the fact that Canada's health outcomes compare favourably with other countries. Evidence suggests we are doing a good job of addressing factors that affect the overall health of Canadians. There are, however, areas where there is room for improvement and there are serious disparities in both access to health care and health outcomes in some parts of Canada.

Clearly, more needs to be done to reduce these disparities and address a number of factors that affect the health of Canadians, such as tobacco use, obesity and inactivity. In a few moments I am going to talk a bit more about those determinants of health.

Romanow made some very specific recommendations to strengthen the role of prevention. Recommendation 22 stated:

Prevention of illness and injury, and promotion of good health should be strengthened with the initial objective of making Canada a world leader in reducing tobacco use and obesity

Recommendation 23 stated:

All governments should adopt and implement the strategy developed by the Federal, Provincial and Territorial Ministers Responsible for Sport, Recreation and Fitness to improve physical activity in Canada.

When we talk about promoting good health, we know that many of the factors that lead people into acute care systems and requiring treatment for cancer are directly related to other factors such as lifestyle. In the report Romanow talked about the fact that over 90% of lung cancer deaths and 30% of all other cancer deaths could be prevented in a tobacco free society. Those numbers are from Statistics Canada. They are not made up, pie in the sky numbers.

We are certainly taking steps and I applaud many of the non-profit groups, like Physicians for a Smoke-Free Canada, on their vigorous pursuit of making Canada a tobacco free society. Clearly, there are many issues in prevention that need to be incorporated in the pan-Canadian strategy. I must add that the coalition has advocated for that.

He goes on to say that the impact of determinants of health and lifestyle choices is well known to government and health organizations. Unfortunately, the key problem lies in turning the understanding into concrete actions that impact on individual Canadians and communities. That has been a huge challenge in seeing that translation from talk into action.

Canadians are losing an appetite for more reports. Canadians are losing an appetite for more promises that do not actually result in concrete action.

There are more facts about smoking and again these are addressing the leading major causes of health problems. The Romanow report said:

Estimates are that smoking costs our economy more than $16 billion each year, including $2.4 billion in health care costs and $13.6 billion due to lost productivity through sick days and early death.

Surely if we developed a national strategy, we would be talking about these factors and incorporating these into these factors.

I am going to come back to the coalition specifically because it has done some good work on developing a cancer prevention system for Canada. A report was produced by the Canadian Strategy for Cancer Control: Prevention Working Group in January 2002 . It outlined some important principles regarding a cancer prevention system for Canada. I want to talk about some of the principles that it outlined because these would be important factors to include in a national strategy. It stated:

A cancer prevention system should embody the following principles:

1. Population-Based Public Health Approach that takes into consideration the Determinants of Health

The risk factors for cancer are widespread and have an early onset. Public health is our best vehicle for reaching healthy people in their communities with interventions designed to decrease these risk factors.

1. Integrated and Coordinated

The risk factors for cancer are common to many other major non-communicable diseases. Collaborative action is cost effective and increases the opportunities for learning. There are many stakeholder organizations in cancer control and coordination among them is needed to enhance effectiveness and create synergy.

1. Focus on Community Capacity Building with Strong Linkages

The most promising interventions have multiple interventions in multiple settings at the community level with supportive action at provincial and national levels.

1. Accountability

Funding is needed to bring partners to the table but this must be done in a responsible way that requires participants to meet the performance of set standards in order to receive funding. Standardized data collection is needed to measure the impact that activities are having on established short-term goals.

1. Sustainability

It will take time and committed effort to establish a system. An implementation body with clear responsibilities and adequate resources is needed to provide strong leadership.

These are critical principles to guide the development of this national strategy. They have been developed by pan-Canadian consultation and by not only health care providers and practitioners but by advocates in the cancer community. These five key principles would go a long way to addressing many of the things that need to be addressed at the community level, for example.

We know that many of these strategies and ideas come out at the national level and are developed at the provincial level, but the impact is felt at the community level. I was pleased to see that part of the principles in this strategy focus on community capacity building because it is there that we need to develop our strength.

There is one other element in this document that is really important. Under the case for a cancer prevention system, it lays out the fact that:

Estimates range but most experts agree that at least 50% of cancer cases and deaths can be prevented through healthier lifestyle choices. These include: reducing exposure to tobacco, a diet that is high in vegetable and fruit consumption, protection from overexposure to the sun, adequate physical activity to maintain a healthy body weight, and reducing environmental/occupational exposure to carcinogens.

When we hear this kind of information coming out of prevention that says 50% of cancer deaths and cancer cases could be prevented by paying attention to some of this front-end information, it makes me wonder, in this day and age, why we have not addressed these factors.

I talked a little bit about tobacco earlier, but this document also focuses on tobacco because it is one of the contributors.

I talked a little bit about tobacco earlier, but this document also focused on tobacco because it was one of the contributors. It said that simply educating people about a healthier lifestyle was not enough to effect change. It is not adequate to educate children in school about the hazards of tobacco if they go home and their parents are smoking, or they go to their local sports facility and public smoking is tolerated, or if the price of cigarettes is too low to discourage uptake. The social environment, including public policy, needs to support healthy choices.

Clearly, many good minds have come together to talk about the fact that we need to not only look at treatment, and it is very much a part of this cancer strategy, but we must look at prevention. We must look at lifestyle factors. We must concentrate on educating Canadians and health care providers and practitioners about the necessary factor of prevention.

I am going to shift gears a bit here, from talking specifically about prevention, to talk about some of the challenges that we have when we talk about information systems that would support a national strategy. Although this is broader than the cancer strategy, there was an interim report put together called “No more time to wait--Toward benchmarks and best practices in wait time management” by Wait Time Alliance for timely access to Health Care. Of course, when we are talking about timely access to health care, we are talking about people who have cancer as well as a number of other issues that bring them into the health care system.

The report talks about principles for medically acceptable wait time benchmarks. One of the challenges that we have come across as we look at many of these issues is that we do not do an adequate job of gathering information. We do not do an adequate job of analyzing the information that we do gather and we are often talking about factors that are not gathered in the same way from coast to coast to coast, so we cannot even do comparative studies across the country.

When we talked many months ago about Bill C-39, we talked about accountability in the health care system. One of the critical factors of accountability is that we must have information. When we are talking about programs and services, we talk about what we measure. Well, if we do not even know what we are measuring, how do we know what we are getting? The report talks about medically acceptable wait time benchmarks and I am going to paraphrase from the report.

It talks about the fact that benchmarks need to be pan-Canadian in approach, so that we avoid things like duplication of effort. We want to maximize economies of scale. It talks about the fact that wait time benchmarks need to be derived from an ongoing process. Life is not static in Canada, so it needs to be an ongoing process in order to review the benchmarks and talk about their significance.

There needs to be ongoing and meaningful input of the practice in community and many of us talk about the fact that we all do the statistics around policy. It is great to have policy developed in Ottawa, but we need the ongoing community practitioners and the community residents to be involved in these kinds of initiatives. Public accountability and transparency are exceedingly important and I am going to read this part:

--Canadians must see tangible results in terms of reduced waiting times for health services in the 5 priority areas.

We keep talking about accountability and transparency. Yet, we continue to see an opaque veil drawn over the operations in Health Canada and other government departments as was demonstrated a couple of weeks ago by journalists across Canada about accessing information. Transparency and accountability are fundamental to ensuring that we are getting what we want out of the money that we are spending. Wait time benchmarks and provincial targets to reduce wait times must be sustainable.

Mental health is a critical issue and in the statement of issues that the Mental Health Association put together, it talked about things like affordable housing.

In conclusion, we support this motion before the House and I urge all members to support it. I have an amendment to the motion that I would like to put forward. Following consultation with my colleague, the member for Charleswood—St. James—Assiniboia, I move:

That after the word “provinces” the words “territories and municipalities” be added.

[The Acting Speaker (Mr. Marcel Proulx)]

Does the member for Charleswood—St. James—Assiniboia accept the amendment?

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

I agree.

[The Acting Speaker (Mr. Marcel Proulx)]

Questions and comments.

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

Mr. Speaker, I would like to thank the NDP for its support of this motion.

Earlier today we heard the Minister of Health say that disease specific strategies were not the way to go, yet the government does have a disease specific strategy when it comes to diabetes. Also, it has been demonstrated throughout the developed world that disease specific strategies are very important. The minister also talked about the $300 million for chronic disease, of which $90 million is already designated for another specific disease, so that leaves only a small pittance for this strategy.

I wonder if the NDP member could share with the House why she believes that the Liberals seem to dodge this issue and why they have not implemented this strategy. Quite frankly, it is a great strategy. The work is already done. It just needs to be implemented. The Liberals have had many years to do it and they have not, and they make claims, as we have heard this morning, that are simply not true.

Could the member share with the House why she thinks the Liberals are not straightforward with Canadians on these national strategies?

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, the member's question does get right to the heart of the issue.

It is interesting when we are talking about a disease specific strategy to focus on what this strategy would actually do, particularly when we are looking at the prevention aspect. I will focus on prevention again and say that it is very difficult to see how a comprehensive, disease specific strategy dealing with particular lifestyle factors would actually not benefit us in regard to a number of other diseases.

If we could find a way to make this particular disease specific strategy a leader in Canada, I would suggest that we would be probably be able to impact on a number of other factors. Not only would it end up saving costs in the health care system and benefiting us around economic productivity, but we could become a national leader in developing strategies, research and other tools for dealing with this strategy.

Why are we not there? That is a very good question. Over the last several months, we have heard a number of times about how good work has been done on any number of issues, and certainly the cancer prevention strategy is a very good example of significant amounts of work that have been done. We have seen this in other areas such as employment equity and violence against women, where we have the studies and the reports and we have done the consultation. What is lacking is the political will and a commitment to moving some of these initiatives forward.

Many people are becoming quite cynical about hearing things announced in budgets and throne speeches yet not actually seeing any real action as a result. This would be a chance to have some real action.

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

Mr. Speaker, contrary to what the member for Charleswood St. James—Assiniboia earlier said in inviting me to change my position on this, I do not know that he has to because I do not know if I oppose his position.

I think this is the ideal type of debate that the House should have. I thank the member for her comments and her speech. I think we can have different opinions or different ways of looking at how we achieve the same thing, have a good debate on it, bring forward different ideas that feed the process, and hopefully come to a good resolution.

Let me ask the member about this. Let us look at the question of the integrated strategy, the $300 million on healthy living and chronic disease prevention, which seem to be the common points that lead to the three specific diseases that the member's motion refers to, those being cancer, cardiopulmonary disease, and mental health, to a different extent. It also touches on a lot of other diseases that we often deal with. Whether it is diabetes or questions of vision, hearing, juvenile diabetes, MS, MD, and many more, they need a lot of research money.

If we have disease specific strategies and we know that we are competing with limited funds, do we risk in certain instances, for example, repetitive work being done in all of these individual strategies rather than being done on a common point? Or do we risk having limited resources available through competitive funding, like the Canadian Institutes of Health Research, for diseases that might not get as much attention in the media or might not get our attention at all, but where we have a possibility of coming to resolutions on some cures or better treatments with proper research funded on a competitive peer-reviewed basis, as is done in CIHR and its institutes? They of course include cancer, cardiac disease and all of those others.

Once again, I thank the member for her points and I ask her those specific questions.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, this is the case of the cart or the horse and which comes first. We have had so much talk over a number of years about developing an integrated strategy and about issues around public health and how important they are for Canadians, yet we are not really seeing the results.

Therefore, why not go with a disease specific strategy that actually can provide a framework for dealing with some of the other issues facing our health care system? An innovative strategy could benefit other disease specific strategies like diabetes or mental health. That kind of framework could demonstrate that leadership. There could be synergies as a result of developing a specific strategy; we could see some spinoffs in the health care system that would be of benefit to us.

I spoke earlier about innovative research and economic development. Perhaps we need a model that would help us work through some of these other issues.

[Don Boudria, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Speaker, I support the main motion and the amendment. However, I do want to raise another point. We cannot conclude today's debate without talking what I consider to be a major problem in western society: being overweight.

Being overweight is a very important determinant of cardiovascular disease and some cancers too. However, it is not a determining factor in other diseases. We know there is a link between the rates of cancer—such as prostate cancer—in men and being overweight. This is not always the case, of course, and I am not claiming otherwise. Whatever the case may be, there is a direct link between being overweight and diabetes, although not juvenile diabetes.

In my opinion, any debate on health must consider the problems associated with being overweight or obese, a problem afflicting western nations, particularly Canada. We eat a lot of fast food. This issue deserves consideration.

I invite my colleague to respond to the following proposal. In the past, advertising campaigns, particularly the ones from ParticipAction, encouraged Canadians to be physically active. To some degree, we have turned our attention elsewhere lately. I think we need to focus on this again. The health of Canadians depends on it.

[Jean Crowder, NDP, Nanaimo—Cowichan, BC]

Mr. Speaker, if we are going to talk about obesity and weight control, it seems timely to remind members that the NDP brought forward the motion on trans fats, which is one factor in dealing with things like diet.

I would agree with the member that this is a critical factor. I ran out of time so I was not able to talk about the social determinants of health in a broader way, but we need to deal with some of these lifestyle factors that are contributing to ill health in Canadians, not just around cancer but, as the member rightly pointed out, around diabetes, although not juvenile diabetes.

When we are talking about programs like Participaction, what a strategy allows us to do is develop a vision and the specific goals underneath that vision and then make sure that whatever we are doing comes back against that vision and those goals.

We would need a comprehensive 360 degree look at what would be included in that kind of strategy. Things like Participaction and other healthy lifestyle initiatives would be part of that strategy, and we must make sure that everything else we are doing is supporting those kinds of initiatives.