Mr. Speaker, Bill C-5 is of paramount importance for the future autonomy of the provinces in the field of health.
With 9,146 full-time-equivalent employees, including 8,833 for the department alone—excluding the health institutes, the Review Commission and the Patented Medicine Prices Review Board—and a budget of $3.35 billion, Health Canada cannot even manage to attend appropriately to its own responsibilities. Yet it is doing its utmost to trespass in the fields for which Quebec and the provinces are responsible. The federal government’s intervention in health should be confined to its areas of responsibility. We are referring among other things to aboriginal people, the armed forces, veterans, approval of new drugs and assessment of toxic products.
Quebec alone is responsible for policies and management relating to the health services and social services available to its population.
The federal government claims that its health mission is to help Canadians maintain and improve the state of their health. In reality, its responsibilities are basically to assist with health funding through transfer payments to the provinces and Quebec, to offer services to certain groups such as aboriginal communities, veterans, military personnel, inmates of federal penitentiaries and the RCMP, and also to exercise control of new drugs. To better impose its vision, however, Health Canada employs more than 9,000 full-time-equivalent employees, and 4,561 of its 9,146 employees are assigned to health protection and promotion, and only 1,529 to aboriginal health.
From 1998-99 to 2002-03, the increase in positions related to aboriginal health was feeble compared with the increase of personnel in fields liable to cause intergovernmental controversy. The most marked increase is in the sector of health promotion and protection, which rose from 506 to 4,561 full-time-equivalent jobs.
Money is spent on aboriginal health, but not enough is being done. The infant mortality rate is twice as high in first nation communities as in the population at large. The life expectancy of registered Indians is seven years less than that of the general population, and their suicide rate is two to seven times as high as that of the general population.
How can they justify phenomenal amounts to promote and protect health when services for first nations are so poor?
In her March 30, 2004 report, the Auditor General of Canada blew the whistle on Health Canada, which does not have a comprehensive program to protect citizens against the risks associated with medical devices. I could mention breast implants, medical devices that proved defective but which had still been approved by Health Canada or that were available even without its approval through its special access to health products program in cases of an emergency or for life-threatening conditions, even though the federal government had promised to institute such a program more than ten years ago.
How can the federal government justify so many intrusions into health when it is incapable of doing a good job on one of the few tasks that really do fall within its jurisdiction in this area. I am speaking of the hospitals under federal jurisdiction.
Health Canada is also in charge of managing three hospitals that serve aboriginal communities.
First there is Norway House Hospital in Manitoba. It is for the Cree and serves 6,000 people. In 2002-03, Health Canada gave it $3,500,429. Apparently $3.5 million is also spent annually on transporting patients to Winnipeg; that is a lot of money for transporting patients. This hospital is in such decline that RDI did a report on it in late 2003. RDI reported that one of the only two physicians working full time in this hospital described it as worthy of a third-world country. That is terrible.
There are also the Percy E. Moore Hospital in Manitoba, which Health Canada gave $3,028,048 for 2002 and 2003, and the Weeneebayko General Hospital in Ontario, which the department gave about $11.5 million for 2002 and 2003. Ontario also funded this hospital to the tune of $3,932,000.
Although Health Canada is in charge of aboriginal health, aboriginals have a smoking rate that is more than twice the Canadian average, an obesity rate that is twice as high as that of Canadians in general, a diabetes rate that is three times as high as that of Canadians 55 years of age or more and six times as high as that of Canadians 35 to 54 years old. In addition, many older members of the first nations do not get the home care services that they need.
What is more, Health Canada does not even manage all the federal hospitals. In fact, some federal government hospitals are managed by Veterans Affairs Canada, National Defence and the Solicitor General. Quebec and the provinces are the only instances with the authority to assess health services needs. Despite this evidence, Health Canada causes duplications and encroaches on the jurisdictions of Quebec and the provinces. The most flagrant example: the Canada Health Act “establishes the criteria and conditions related to insured health care services that the provinces and territories must meet in order to receive the full federal cash transfer contribution under the Canada Health and Social Transfer”.
The federal government appears virtuous by imposing standards when it is not even able to manage properly the few hospitals it has. Let us not forget drug regulation, which is another Health Canada responsibility. Health Canada's approval procedures for new drugs can be quite lengthy. The federal government has often promised to speed up the regulatory process to provide quicker access to drugs. However, Health Canada seems unable to engage in a quick and thorough assessment of the products.
This situation also exists at the Natural Health Products Directorate where more than 12,000 products are currently waiting to be assessed, thereby depriving thousands of people of products that are for the most part inoffensive and could greatly improve their health.
The Patented Medicine Prices Review Board Canada Performance Report for the period ending March 31, 2003, states that only 35 people or “full-time equivalents” are employed with a budget of roughly $4.2 million. That is quite expensive. Nonetheless, Health Canada allocates $802.2 million to its health promotion and protection policy.
The department should do more to address the gaps in approving new drugs instead of putting its energy into interfering in the jurisdictions of Quebec and the provinces.
Despite all these flaws in its own jurisdictions, on December 12, 2003, the Liberal government announced the creation of the Canada Public Health Agency under Health Canada. In the Speech from the Throne on February 2, 2004, the Liberal government said:
The Government will therefore take the lead in establishing a strong and responsive public health system, starting with a new Canada Public Health Agency that will ensure that Canada is linked, both nationally and globally, in a network for disease control and emergency response.
On September 24, 2004, Paul Martin officially inaugurated the Public Health Agency of Canada by appointing Dr. David Butler-Jones as the first Chief Public Health Officer for the agency that had been established in Winnipeg.
The Public Health Agency of Canada is funded out of the $665 million promised in the 2004 budget to strengthen the public health system in Canada and the $404 million provided to the Population and Public Health Branch of Health Canada.
The agency therefore has $100 million for increased front-line public health capacity, $300 million for new vaccine programs, $100 million for improved surveillance systems and $165 million over two years for other federal public health initiatives.
Let us come back to surveillance systems. We have recently heard about this on television.
An English language program did a report on airports in Canada, and more specifically Pearson airport. We saw how easy it was for anyone to get through the security systems with anything. In Canadian airports, you could just as easily get through with anthrax as with a bomb, especially at Pearson airport. If we really want to do surveillance, employees have to be trained to do it properly. Unfortunately, we saw in the past that this was not the case.
The Public Health Agency’s mandate is to focus on more effective efforts to prevent injuries and chronic diseases, like cancer and heart disease, and to respond to public health emergencies and infectious disease outbreaks. The PHAC would also work closely with the provinces and territories to keep Canadians healthy and reduce pressures on the health care system.
And yet as recently as last week the Canadian Cancer Society was telling us that, in its opinion, research was paramount. It is not more bureaucrats that we need, it is money going directly for research, with as few intermediate layers as possible. The more complex the bureaucracy, the less money is used for the purposes for which it is intended.
Ultimately, this agency is to have six coordinating regional offices, including one in Quebec. In Quebec, however, we have had our own public health agency since 1998: the Institut national de santé publique du Québec. In fact, we already have our own action plan for bird flu. In that connection, the government has procured over 9.8 million doses of the antiviral Tamiflu for fighting the disease, and plans to increase its available stock to 11 million doses. We are well aware that this would probably not be enough to fight the bird flu virus if a pandemic were to break out. However, we are aware that we already have more of it than Canada has. We will therefore have a better chance of getting through it. In Quebec, we do things differently, and we want to continue doing them differently.
Because it is the Government of Quebec that has the expertise and that can direct all of the institutions in the Quebec health care network, we believe that it is up to Quebec to set priorities, to develop action plans for Quebec and to ensure that they are consistent with the global objectives developed by organizations like WHO.
The federal government has taken advantage of the fiscal imbalance—which it created itself—and the needs that the fiscal imbalance has created in Quebec and the provinces in their areas of jurisdiction, to multiply its intrusions in those areas by using its spending power. It would appear that the Conservative government is adopting this tactic.
Yet in a speech given as recently as April 21, 2006 in Montreal before a large audience—through which we heard about it—the Prime Minister boasted of his open federalism, saying: “Open federalism means respecting areas of provincial jurisdiction. Open federalism means limiting the use of the federal spending power—”
In the same vein, the Minister of Health said with regard to guaranteed wait times that we have to respect provincial jurisdictions, even if that takes a little more time to get things done.
One has to acknowledge that they are not “walking the talk”. We have always been very aware of the importance of health-related issues, particularly in light of the ageing population and the possibility of easily communicable diseases crossing our borders, as in the SARS episode in Toronto. However we are convinced that the formulation of plans for dealing with serious diseases is one primordial aspect of health care which must remain a provincial responsibility, especially when, as in Quebec, we have our own public health agency.
Furthermore, since the reduction of federal health transfers in 1994, health care has suffered from chronic underfunding. We consider the main problem to be the underfunding as a result of the fiscal imbalance, which deprives Quebec and the provinces of the revenue necessary to meet their responsibilities, thereby making it difficult for them to properly support their public health agencies.
Only the correction of the fiscal imbalance will enable Quebec and the provinces to better develop services to their populations in their fields of jurisdiction, and ensure that citizens have the proper tools to face the new public health challenges.
The Bloc Québécois considers the problems Quebec is experiencing today in its health system to have been caused in large part by the federal government, which effected a massive withdrawal from health starting in 1994-95. Those draconian cuts, of which my colleague was speaking earlier, at a time when Quebec was initiating health care reform, prevented the Government of Quebec from carrying through with its planned improvements and made any intelligent long-term planning to meet the needs of Quebeckers an illusion.
Whatever the party in power, Quebec governments have been denouncing federal intrusions in health for a very long time. I offer you a few striking examples.
According to the second government of Maurice Duplessis, formed by the Union Nationale, which sat from August 30, 1944 to September 7, 1959:
Quebec considers that the following areas are the exclusive jurisdiction of the provinces: natural resources, the establishment, maintenance and administration of hospitals, asylums and charitable institutions, education in all areas including university studies, the regulation of professions, including the entrance requirements to the practice of medicine and relations between patient and physician, social security, health and public hygiene—
Even Robert Bourassa, the leader of the Liberal Party, said the following after the failure of the Meech Lake accord:
Under the Canadian Constitution social affairs and health are irrefutably matters of exclusive provincial jurisdiction. Over the past 25 years, the Government of Quebec has carried out its responsibilities in a remarkable fashion and has provided quality administration in the sectors of health and social affairs. These successes are eloquent proof, and the people of Quebec are convinced of it, that Quebec would gain nothing from a new manner of sharing jurisdictions in these sectors. Up to now, they have been under exclusive provincial jurisdiction and, in the best interest of Quebeckers, will remain so.
Finally, Jean Charest said at a first ministers' meeting:
The first ministers addressed other issues, such as establishing a public health agency that could coordinate a national response to a crisis occasioned by an infections disease such as SARS. The two levels of government will look as well at combining their efforts in the event of a natural disaster. Quebec, warned Jean Charest, has established its own structures in these two areas, which are working. They will work with those put in place, but there is no question of duplication—
We in the Bloc Québécois share these opinions that there is no question of duplication or of setting up another health agency that would employ thousands of people and cost taxpayers millions of dollars for very little in return.
Only correction of the fiscal imbalance will ensure stable funding, enable Quebec and the provinces to further develop services for their inhabitants in their areas of exclusive jurisdiction and ensure that, in matters of health, the public receives proper care.
The government must reiterate its firm commitment to correct the fiscal imbalance. Today's budget must provide a clear indication of the government's intention to resolve the problem by giving the provinces and Quebec an initial portion of the increase needed in transfer payments for post-secondary education and social programs.
In the name of pan-Canadian objectives that negate the Quebec difference, the federal government is confirming that it wishes to interfere further in areas of jurisdiction belonging to Quebec and the provinces. The federal government’s responsibility is to provide adequate health funding, not just to propose new structures, like waiting list indicators, which do not solve the problem of under-funding.
Finally, because the federal government is interfering in the provinces’ areas of jurisdictions with its prevention and surveillance programs, with its Nursing Strategy for Canada, its Canadian Diabetes Strategy, its plan to combat an influenza epidemic and many other unilateral initiatives, health priorities get jostled.