Debates of May 2nd, 2006

Public Health Agency of Canada Act

[Guy André, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, I have a question for the hon. member.

In Quebec we have the Institut national de santé publique du Québec. This institute specializes in research on various health problems. We have an entire organized health network: CLSCs, hospitals and so forth. Many services are organized to provide the public with appropriate health care.

I read an article recently that said the universities were getting deeper in debt. However, researchers just want to research.

My question for the hon. member is on the fiscal imbalance. During the election campaign the Conservative government said it absolutely wanted to respect provincial jurisdictions, especially those in Quebec with a view to independence. In Canada, a bigger budget is allocated to research. Could some research mandates be given to the Institut national de santé publique du Québec and some to the universities? That way Quebec's jurisdictions would be more respected. Furthermore, that is what the Conservative government promised to do during the last election campaign.

[Dave Batters, Conservative, Palliser, SK]

Mr. Speaker, Quebec has a number of high quality universities, as there are throughout the country, and federal dollars do flow down through the provinces to these universities for such research. This type of activity is something the government would encourage.

As the member knows, some very important work happens within the private sector in terms of research and development in the field of health care. However the member is absolutely right when he says that more work could be done in the universities in Quebec and throughout Canada.

It certainly is not the intention of the government, in introducing this legislation, to infringe in any way upon the provincial control or the provincial responsibility for health care. Clearly, that responsibility is well defined in our Constitution. What we are trying to do with the bill is to follow up on the recommendations of Dr. Naylor and Senator Kirby to provide some federal role which these individuals believe would benefit the health care of Canadians.

[Dennis Bevington, NDP, Western Arctic, NT]

Mr. Speaker, coming from the north, as I do, and being familiar with the conditions of health care in the northern regions, it is an overriding concern that crosses the country. In many cases, people in small communities and on reserves face very difficult health conditions and very limited resources to deal with them.

Having said that, I am interested in the Public Health Agency as a federal responsibility and how it will work. In our perusal of the legislation, it seems to indicate that the chief health officer would not have jurisdiction over aboriginal reserves or perhaps even over self-government arrangements that are constitutionally given through the federal government.

How does the member see the bill improving the life of aboriginal people on and off reserves? The chief health officer represents a very significant service that one would receive if one were under provincial jurisdiction. How does the member see that fitting with the federal responsibilities on reserves?

[Dave Batters, Conservative, Palliser, SK]

Mr. Speaker, I know the hon. member is a new member and I want to welcome him to the House.

I sat here this morning and listened to the member from the Bloc Québécois talk about the significant number of individuals working within the Public Health Agency of Canada who are devoted to the health care of our first nations peoples. That is a very positive step. Perhaps the member could look into those figures. I believe it was in a neighbourhood of 1,500 to 1,700 employees dedicated to first nation health and certainly a lot of work will be done both on and off reserves.

The member is concerned that the Chief Public Health Officer would not have standing or authority on reserves. In fact, the Chief Public Health Officer, under this bill, would be a deputy answering to the Minister of Health. I will give the member perhaps a couple of different scenarios.

Ultimately, the Minister of Health will have responsibility for what happens in terms of health care on reserves, such as in the case of an emergency, quarantines or containing a pandemic. The Minister of Health would do that, I would guess, in cooperation with the Minister of Indian Affairs and Northern Development. The Chief Public Health Officer, as a deputy, would work with other deputies within the Department of Indian Affairs and Northern Development to address the health care concerns of our first nations people.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Mr. Speaker, the act to establish a Public Health Agency of Canada is a good first step. Health promotion, disease and injury prevention, and public health emergency preparedness response is a federal responsibility and a Public Health Agency is long overdue.

This agency would collect data, issue reports and coordinate various efforts. One of the goals of the Chief Public Health Officer is to identify and reduce public health risk factors.

We know that when children are overweight, they are likely to develop more health problems and illnesses. We know that when children grow up not knowing drownproofing, they could be in trouble if they are near water. We know that there is a public health risk when the environment is polluted. We know that there are ways to prevent and reduce the risks of cancer.

After collecting data, after consulting everyone, and after reports, annual reports and various reports, a Canada Public Health Agency must have the mandate to act. After knowing what the health risks are, the new Public Health Agency must also have spending power. Let me give an example. Children need good health and we know that it comes from food, for example. Right now there is a CAPC program that delivers some kind of food program to kids across Canada, but it is very much underfunded, not well understood and not well appreciated. Canada is one of the very few countries that does not have a national food policy.

Some 72,000 children in Toronto have nutritious snacks, hot breakfasts or lunches in community centres, schools and church programs. The federal government used to be a small partner with the Department of Health, but throughout the years the percentage of contribution has declined. There is absolutely no reason why a child in Montreal or Vancouver or Halifax should also not enjoy such a program.

We see that preliminary research, primarily from the United States, has found associations between households classified as food insecure and the health of young children in those homes. These associations included poor health child status; lack of iron; more frequent hospitalizations, which by the way costs taxpayers money; stomach aches; headaches; lower physical functions, including problems--now this is for children--with walking, running, doing chores; low energy levels, and we are talking about low energy levels in young kids; impaired social interaction skills; and emotional status.

A study of 21,000 U.S. children found that if there was food insecurity among kindergarten children, even if the kids were not from poor families, it hurt their academic performance in reading and math for boys and girls and there was a decline in social skills among boys when followed to grade 3. Those of us who are worried about bullying and safety, all of those issues, we must first think about the public health risk when kids do not have the right food to eat.

The study also looked at older children from 6 to 12 years of age and noticed that there was anxiety, aggression, psychological dysfunction, and difficulty getting along with other children. The parents had poor physical health, feelings of anxiety, loss of control, family dysfunction and psychological impairment, regardless of income status. A feeling of shame or embarrassment about not being able to feed oneself or one's children can also promote social exclusion, a feeling of isolation from neighbours and the community at large.

The British House of Commons, through the public health agency's promotion, is debating a children's food bill, as we speak, which would legislate a number of changes to optimize a child's diet, nutrition and health. It has widespread support and the endorsement of 150 national organizations in England.

A Canadian child's food bill, coming from the recommendation of the Public Health Agency, could support and implement visions proclaimed by many federal charters and conventions that we have declared in the past.

I notice that the former Minister of Health has joined us. We talked about a national plan that would see all children in grade 3 learning drownproofing. The same principle of public health applies. After all, Canada is surrounded by water. We have tragic drownings of Canadian children and young people. That can be prevented if they knew how to swim or, as a bare minimum, knew drownproofing.

After all the studies, reports and gathering of data, a national government has the responsibility to establish a general plan with standards and provide funding, so local community organizations and municipalities or provinces could cooperate and deliver programs. No, we should not be delivering programs, but certainly community agencies from the grassroots up should be provided the kind of support, so they can take the data from the Public Health Agency and do something with the annual reports.

Approximately 68,000 people in Canada will die this year from cancer. It is estimated that one in three will be diagnosed with the disease during their lifetime. We know that some cancers are caused by pollution and environment depredation. Sarnia, Ontario residents, for example, have higher rates of cancer. That is because of the local activities of petrochemical companies. My colleague from Windsor tells me that local residents have a high rate of thyroid disease and cancer, which occurs because of environmental depredation.

Environmental health activists point to the fact that about 500 new chemicals are being used in commercial processes each year, on which no or minimal information is available to consumers. As our ecosystem becomes more permeated with chemicals from agriculture, industrial and residential uses, so do our human systems, especially that of our children. I hope the Public Health Agency would disclose information on products and the contents in food to consumers, so that we can regulate food safety.

At the turn of the century, a public health agency noticed that polluted water leads to bad health. As a result, purification systems were set up. It was also a public health agency which noted that kids grow up with bad teeth if they do not lead very productive lives. As a result, in my city of Toronto, there are dental clinics for kids and seniors who cannot afford to have their teeth fixed privately.

It is very important that as we set up this Public Health Agency, with a Chief Medical Officer, that the agency be given the responsibility to act.

Lastly, I want to echo what my colleague said earlier, that the SARS crisis illustrated that we must have a clear protocol and a place where all the data can be stored. Information available in Vancouver should also be available in Toronto or Montreal. We must expand the mandate of the agency, so it would cover airports and rail lines because we live in a global environment and the transportation corridors are extremely important. It is very important that the Public Health Agency have a mandate over airports and rail lines.

I look forward to working with the Public Health Officer and hope that some of the areas that we already know about could be prevented and that the bad health of Canadians can be acted upon. If not, setting up the agency will really be just a paper exercise. We will have many reports and a lot of coordination, but no real action.

[Brian Masse, NDP, Windsor West, ON]

Mr. Speaker, I want to ask my colleague a question regarding Bill C-5.

One of the things she mentioned in her speech was the environmental contaminants issue. In this chamber in 2002, I presented a motion on environmental contaminants and human health. It looked to create an investigative body that would go to hot spots where we know that cancer rates, for example, or other contaminant issues that are linked to environmental pollution are problematic for those communities. It would look at ways to take remedial action and investigations as well as introduce some best practices to lower the actual percentages of either the cancer rates or other types of illnesses.

In my area, we have respiratory diseases. We have a significant pollution problem from the United States and from our own industries that cause health problems. We actually have some benefits that could be introduced through remedial action.

It is important to add a prevention element to this as well because some of the issues that we deal with, related to disease as well as contaminants, could be done in the forefront by preventing those things in the first place. My question to the member is, how should that envisioned role be part of public health in terms of lowering our costs and, most important, improving the lives of our citizens on a daily basis in order to extend their lives?

[Olivia Chow, NDP, Trinity—Spadina, ON]

Mr. Speaker, one of the goals that is identified in Bill C-5 is very clear and it is in writing. It says that the Chief Public Health Officer will “identify and reduce public health risk factors”.

There have been many reports that connect environmental depredation with a higher risk of cancer, whether it is asbestos, pollutants, airborne pollutants or substances that are in the food or water. Those really have health risks.

It is critically important that we label our food. Many European countries do that, but Canada does not. We do not know what is in some of our health care products or beauty products that we use. I know there are other products that kids are exposed to that have chemical ingredients that are a cancer risk.

I certainly hope that this Public Health Officer would have the power to say to the government that we know this is a risk and that is why we must take action.

[Rod Bruinooge, Conservative, Parliamentary Secretary to the Minister of Indian Affairs and Northern Development and Federal Interlocutor for Métis and Non-Status Indians]

Mr. Speaker, some of the member's points are well taken. I can speak specifically for the aboriginal community in relation to food and diet. There are clear specific issues throughout the north and throughout Canada concerning diabetes.

However, I will not insinuate perhaps the direction she might be thinking in terms of how to mitigate the circumstances of diet. I would offer that there is a certain degree of government overaction in some areas. I know there needs to be education. I will use smoking as an example. Clearly we know that second hand smoke is something that is very detrimental to people in the immediate vicinity of smokers. That was the biggest reason why there has been such an initiative across Canada to bring about the regulation of smoking. However, in terms of diet, I think education is the right approach.

I would ask the member, what would be her intention in terms of her party and herself in helping to mitigate this issue?

[Olivia Chow, NDP, Trinity—Spadina, ON]

Mr. Speaker, I have seen food programs in schools in very depressed neighbourhoods where there is a lot of food insecurity and low academic performance. With a small investment at the local level and from the businesses in the neighbourhood through fundraising efforts, but also from the government, a CAPC program was initiated, which again is a federal program, and I have seen the academic performance of children rise dramatically.

Do not take my word for it. Take the word of principals, teachers and parents. As the parents come together to cook and provide a decent hot breakfast for their kids, they learn life skills. As the kids learn to eat proper food, rather than all the junk food they see on television, and which is more expensive by the way, they are able to have much higher productivity in life.

As a result, the families do a lot better. I know that in some of the aboriginal communities there is a lot of depression and a teenage suicide problem. I cannot help but wonder whether a program that is run by the elders working together and financially supported by the government would have dramatic results.

I certainly have seen it in some communities. I know that it is not a top down solution. It should be done by the people themselves. We only have to present a general guideline and leave it alone, and allow the communities to come up with the program because every community is different. It should come from the grassroots up and should be organized by the people themselves. I have seen dramatic improvements in the health of children and the health of the entire community, including their families.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Mr. Speaker, I want to congratulate my colleague on her presentation. In her comments she spoke a lot about programs on smoking and food programs in schools.

I am from Quebec where CLSCs, or local community service centres, have been set up. These centres have a truly local approach to dispensing services to deal with tobacco addiction, AIDS prevention, nutrition, child care and much more. I have a hard time understanding why the federal government is giving itself the responsibility of designing prevention programs. This is one of Quebec's jurisdictions.

I would like to know what the hon. member has to say about that.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Mr. Speaker, I have no intention of saying that the federal government should take charge of these programs. Absolutely not. I do not believe it should take charge of these programs. The federal government has the responsibility to look at the health results. Also, the federal government has the responsibility to have the funding available so that the Quebec government can then, through transfers to the health agencies or the community organizations, provide this kind of support. Quebec already has very good programs that are community based. The last thing we need is the federal government meddling in them.

However, I know that a lot of those agencies are struggling for funding. I know that they do a lot of fundraising with the private sector, which is good too, because it brings the community together, but they are struggling for funds. That is what I am talking about. I am not talking about jurisdiction or a top-down solution, because we have seen it messing up programs that work very well. A top-down solution does not work because it is not the closest level of government.

This does not mean that the federal government should not have the responsibility of public health. It does not mean that it should not provide funding for the Quebec government to provide the kind of funding that is working quite well in Quebec and hopefully in many other parts of the country outside of Quebec.

[Larry Bagnell, Liberal, Yukon, YT]

Mr. Speaker, I have a very short question. The member mentioned carcinogens in chemicals. I wonder what her views are on the recent and fairly famous program by Wendy Mesley which suggested that the Canadian Cancer Society and others were spending far too many resources on prevention and not enough on fighting the government's allowing of carcinogens in all sorts of products in society.

[Olivia Chow, NDP, Trinity—Spadina, ON]

Mr. Speaker, I have seen that program, several times in fact. The program also mentioned that a lot of the beauty products in Europe, for example, are labelled with what is in the products and that some of the products we use on ourselves cause cancer.

We need to have that information. Some of those chemicals should be banned. I think we all have a role in preventing cancer rate increases, especially among young people. Taking those steps would be extremely important. We need labelling so the public knows. Also, we know that some products cause cancer. Some of them should be banned.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, this is my first opportunity to speak in the House in this new session. I want to say again just how much of an honour and privilege it is for me to represent the wonderful people of Yellowhead. I cannot acknowledge it enough. I am always in awe of the awesome responsibility they have given me and the honour I feel in representing them, so I stand to proudly represent them.

I also want to say how important today's piece of legislation is. As we are speaking about it today, I want to lend my voice to some of the consideration of the legislation as it goes through the House. I want to talk about why I think it is important.

I have talked about this. We have seen exactly what has been going on with regard to this legislation. It has been an order in council since 2004 and now we are actually bringing it into the House in order to put it into legislation. It comes out of Canada's SARS experience. As well, I will talk a bit about the possible pandemic of the avian flu and whether it is or is not.

Let us get to the agency itself and what we are really talking about. We are basically talking about prevention and how we prevent health crisis situations from happening. In Canada in the last 40 years, our experience has been more about looking at crisis intervention. When there is a health crisis, people usually go to hospitals or doctors and try to find an intervention to somehow alleviate the crisis. This is not necessarily about doing that. This is about doing something before that happens.

Not only do we have to look at public health with regard to a potential pandemic or something like a SARS infection, but we have to do that in all of our health considerations, whether it is cancer, heart, diabetes or arthritis. There has been tremendous advancement in the things we can do in the area of prevention before we get into a crisis situation. If we are going to sustain our health care system in the 21st century, we are going to have to begin to be very serious about being far-sighted with regard to the health of ordinary individuals in Canada.

When it comes to this agency and protecting the public health side of things in Canada, we go through monitoring, testing, analyzing, intervening, informing, promoting and preventing until something actually happens unexpectedly, just as we saw recently in Toronto and Vancouver with the SARS situation. When we realize that a good part of what actually happened there could be prevented and that it can be very costly if it is not prevented or dealt with, then we realize that we in the House have a responsibility to do everything we possibly can on behalf of Canadians to prepare them for those situations.

This was brought home with what happened after SARS. The Kirby report talked about it, and many have talked about the Kirby report, its implications and what it recommended. It was also followed with Dr. Naylor's report, a national advisory committee report on SARS that specifically talked about what we could learn from that disease. This is what has come out of that. It is a recommendation that we actually do something with regard to prevention so that not only can we talk about the federal government and its responsibilities, but we can also understand the responsibilities that provinces and territories have with regard to this whole area of preventing individuals from getting into these crisis situations and what we can do to protect ourselves and prepare ourselves for what might be coming.

I want to spend a minute or two talking about the SARS situation, because there is a lot we can learn from what has actually happened. I want to discuss it because the Naylor report talked a lot about what the province did and what the federal government did not do. I would like to explain a little of what the government's responsibility was at the time and what perhaps did not happen.

Before SARS happened, it was Canada that actually exposed it to the world when it realized what was happening. The virus was present in Asia, in China in particular, and it was actually Canada's surveillance that alerted the World Health Organization to the problem.

It is interesting to note that Canada alerted the World Health Organization, and yet when there were two cases of SARS, one in Vancouver and the other in Toronto, they were handled completely differently and had completely different results. Officials were alerted to the case in Vancouver because the individual came from Hong Kong. All hospitals in Canada were supposedly aware of this infectious disease. In Vancouver, it instantly was treated as an infectious disease. Because of that, there was not one death, because of the way the hospitals handled it and intervened at that time.

I am not blaming the medical people at all for what happened in Toronto. I understand full well what happened. The point is this. When SARS was diagnosed in the Toronto hospital, it took medical staff 24 hours before they really understood what they were dealing with. With everything that flowed out of that 24 hour period of time, there were 44 deaths in the Toronto area. The World Health Organization put a travel advisory on the Toronto area and as a result of individuals refusing to travel to that city it suffered an economic loss of $2 billion. That was the fallout.

We can see that the timing and the way we prepared in those two cases was absolutely critical to the fallout with what actually happened with regard to human deaths and economic costs.

So why is it so important to show leadership? Because, in regard to leadership, one area reacted differently from the other. I am not blaming anyone. I am not saying that anyone was at fault. I am saying that what we should do is learn from the experience and, in this agency, understand that preventing this from happening again is critical. We should be aware of the fact that many experts around the world claim that another SARS or another pandemic is going to happen in the future. This is very valuable. What we are doing prior to this is actually critical.

No country in the world should be more prepared and more understanding of what is actually going to happen than Canada. After all, we had SARS in our country. It left another nation and came into our country. Because of that, we saw a human toll and an economic disaster. It was when the World Health Organization recognized that we were also actually guilty that we realized Canadians could have potentially transported this virus to the United States, Australia and perhaps other countries in Europe, so the World Health Organization had no option but to put out a travel advisory.

What was our responsibility in the House at that time? Our responsibility was where our jurisdictions lay. First of all, importing and exporting and individuals arriving in Canada or leaving Canada fall under federal jurisdiction. At the time of the SARS outbreak, I had the privilege of being the senior health critic for my party. I have always seen health care as a non-partisan issue. We should approach it in a non-partisan way. We can go and play politics with other issues, but when it comes to health care, we should not. We cannot afford the time. We cannot afford the economic costs. We certainly cannot afford the political fallout from it.

In that case, I wanted the then minister of health to understand the importance of SARS and to take an aggressive approach in dealing with it. Before question period, I told the minister what actual question I was going to ask her in the House. I wanted her to reply in a way that would throw some light on the situation and push her toward a leadership position. I have never done that since, and it was the first time I did. I did it because SARS breached all political party lines. I was disappointed with the results I got when I saw what the provinces were doing.

The member for Parry Sound--Muskoka, now the Minister of Health, was the Ontario minister of health when the SARS outbreak occurred. He took the lead on SARS. When the travel advisory was put out for the city of Toronto, he actually went to Geneva to fight it, to say that the travel advisory should not have been put on Toronto, and actually, the travel advisory was placed on Toronto after SARS had been contained and controlled in the Toronto area.

As it was not the federal minister of health who acted in an aggressive way, in a quarterback way, we saw the disconnect between the federal responsibility role and the provincial responsibility role. Therein lies the reason that we absolutely need to get the lines of communication straight. We need to do everything we possibly can to ensure the Public Health Agency and the Chief Public Health Officer have clear directions and guidelines set out as to what should happen and who should be in charge if this were ever to take place again. We know that it probably will. It is just a matter of time.

I mentioned earlier the avian flu. We had some experience with what we thought might be the avian flu in the lower B.C. mainland, in the Fraser Valley area where we had to eliminate a number of poultry because of it.

There is good news and bad news on the avian flu side of it. The bad news is that in 2005 we had 95 cases worldwide and 41 deaths. However, since January 2006, and we are only a third of the way into the year, we have had 61 cases and 37 deaths worldwide. We have seen the avian flu actually spread into Europe, into Africa and into Asia Minor. Most of the world has experienced some of what is potential in this virus. The experts are telling us that we are very close to receiving it here in North America. We know it is spreading.

What we do not know is whether the virus will mutate into a pandemic. The experts are divided on that. It has been around for a couple of years. Some of them say that a virus never sits stagnate. It is always mutating and when it is mutating it could easily trigger to mutate between human to human contact. If that were to happen we would be sitting in a potential pandemic situation. That potential is always there and it is escalating as times goes on.

Another group of scientists are saying that the longer this virus is out there and it has not mutated the less chance it actually will mutate.

I am not trying to raise alarms, other than to say that there are things we know and there are things we do not know. The thing we know is that it is spreading. The thing we do not know is whether it will be the next pandemic. However we had better be prepared in either case. Therein lies why it is so important for the bill to pass. We can debate it in the House and try to fine tune it as much as we possibly can so that we are prepared for whatever might happen.

A perfect example of this happened in the health committee last year. Some of my colleagues who sat on that same committee are here in the House. It was when the avian flu and the pandemic began that the Tamiflu was said to be the anti-viral that could help prevent and actually cure individuals with avian flu and we had a glut internationally of wanting to acquire the Tamiflu. The pharmaceutical officials came to the committee and we talked about Tamiflu and whether we were prepared. The Chief Public Health Officer was there and we were able to discern whether or not we were doing the appropriate thing. At least we had some experts who we could go to be able to discern as parliamentarians whether we were as prepared as we could be for what might or might not be transpiring.

As it has turned out, we have some Tamiflu in Canada. Whether we have enough or not we could still debate, but whether it is actually a product that can do the job if the virus mutates is another question. We know that if the virus mutates, the Tamiflu may not work at all.

Nonetheless, we have a professional, the Chief Public Health Office, in case something like this happens. The number one advantage of having a medical officer who is an expert is that he is not a politician. The last thing we want in a crisis situation is anyone who has a political bent. In saying that, we must understand that the responsibility of the federal minister of health is to be able to deal with the situation and deal with the agency.

It is important to have someone who is a professional in the health field because it puts the public's mind at rest knowing that a professional, whose area of expertise is medicine and not politics, is dealing with a potential pandemic. It gives me comfort knowing we have Dr. David Butler-Jones who has his mandate to follow this internationally and nationally, is able to educate our doctors and front line nurses, and is able to make teams of individuals prepared and ready to deal with a pandemic if and when such an event were to happen.

The agency would do more than just prepare us for any kind of a potential pandemic. It also would be looking at chronic diseases of all kinds. We now realize that chronic disease is the number one cause of death and disability in Canada. We need to do whatever we can to prevent and stop the progress of these chronic diseases. This leads us into the physical environment in which individuals are involved. We know that 60% of the determinants of the health of the population relate to physical environment as well as the social and economic environment. These are areas that we should not overlook and the agency will have the mandate to deal with them.

We could get into the specifics of the agency and talk about whether it should be inside or outside Health Canada but what we need to have is an agency that is focussed on its mandate. We do not want to take a shotgun approach or water it down in any way, shape or form. It is a wise way for the legislation to go forward, which is for the agency to be outside of Health Canada, that it deal with its mandate and, specifically, that it be able to communicate with the population in case of a very serious situation. I am very much in favour with the way this has been drafted. It is the right way to go.

It is important that the agency report directly to the minister. I look forward to annual reports coming back to the Department of Health because it is important for this body and the politicians who are here to have public responsibility and public reporting of what that agency is actually doing and whether we are preparing the country for what may or may not be happening.

The legislation is long overdue. SARS hit in 2003, a long time ago, and, thank goodness, it was not the pandemic and that we have not had one since. We have had some time but there is a striking difference between the past government and what we are seeing in how we actually bring this forward because it is all about leadership.

Later today we will be introducing our first budget but this legislation that is now on the floor will be driven through very quickly. I am looking forward to committee where we will be able to flesh this out to see if there are any problems with it in any other way and then to move it on and enact it as soon as possible, giving our confidence to Dr. Butler-Jones, our Chief Public Health officer, because this is very important for us to do. It is important for us to do everything we possibly can to ensure that we and all Canadians are prepared and this legislation would do all of that and more. This is the beginning of an exciting chapter in the history of Canada and it prepares us well for the 21st century and beyond.

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

Mr. Speaker, I remember SARS and I remember the response that we were able to give as a government in terms of appointing the first ever minister of state for public health and appointing Dr. David Butler-Jones as the Chief Public Health Officer for Canada.

My question for the member concerns the response we have had over the past few months in terms of the insecurity that our first nations Inuit and Métis people are feeling in terms of their responsibility in preparing for a pandemic or a potential SARS outbreak on reserve. Could we prove that germs do not respect borders and could we put in place a public health network for the 13 jurisdictions? The reason people on reserves are feeling so insecure is that no one seems to know whether it is the First Nations Inuit Health Branch or the Public Health Agency that will be helping plan for a pandemic on reserve.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, I have the greatest of confidence in Dr. Butler-Jones. I think my hon. colleague was very instrumental in choosing him. Not only did we have great respect for him when he appeared before committee, but some of the best conversations I have had with him were actually at the airport because we fly an awful lot and we usually sit and chat for a half hour or more when we get to the airport. I believe he is doing a very credible job.

My argument is: Why did it take so long? It was almost a year and a half after the SARS outbreak before the actual appointment of a chief medical officer.

With regard to the first nations, they do have serious problems. We have $9 billion to $12 billion a year of federal money going to reserves where we have third world conditions. I believe this gets to some of the root of the problem. It is leadership. Somebody has to play quarterback, not only in a SARS situation, where we saw no federal leadership at the time of SARS, but the same sort of thing has to happen with first nations. I believe we need some strong leadership on and off reserve to ensure we streamline the activity with preparedness for any kind of a pandemic or potential pandemic on those reserves.

I cannot answer directly what is actually happening at this specific time. I just know that there has to be some strong leadership. I have a great amount of trust in not only our Minister of Health but also our Minister of Indian Affairs and Northern Development to give that leadership and to ensure things are being dealt with on reserve. I have a lot of confidence that is going to take place.

Dr. Butler-Jones would have to be the person who answers the question as to exactly what is happening on those reserves with regard to public health, as he does with preparing front line workers, nurses and doctors right across the country. I am assuming that is being done. I am looking forward to the health committee starting so we can have reports, ask those exact questions and get more thorough answers.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Thank you, Mr. Speaker.

In its report on federal transfers to the provinces, the commission on fiscal imbalance said that the federal contribution, proportional to social spending in Quebec, ought to decrease from 20.4% in 1993-94 to 13.9% in 2005-06, representing a reduction of nearly seven percentage points in just over seven years.

My question is for the hon. member. Instead of encroaching shamelessly on fields of provincial jurisdiction, should the Conservative Party not act on its commitment and restore the transfer to the 1994-95 level, giving the money to federal granting agencies in Quebec and the provinces? They could then conduct their own health research through their universities and their own research institutes.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, I have heard the Bloc member ask that question of other members on this side with regard to jurisdiction. I would suggest to him that it is not the province of Quebec, the province of Ontario or any other province that has the jurisdiction to deal with airports. Importing and exporting people to and from Canada comes under federal jurisdiction, which is why the Quarantine Act is federal legislation.

One of the problems we had in dealing with SARS was when it came to jurisdictions in dealing with a pandemic or potential pandemic. It is not that we should be threatening or that a province should feel any threat that its jurisdiction is being trampled upon. The bill does not do that at all. It actually complements what is happening in the provinces. It would help them to prepare, deal, train and monitor what is actually happening in the province so that there can be a seamless system and a system that is dealt with, not only at the airports and the public health agencies within the provinces, but that they are all working together as a team.

That is the Canada that I believe in, the Canada I believe we need and that is the way we need to deal with a pandemic, whether it is nationally or internationally. I would encourage my colleague to not be so protective or so phobic about provincial jurisdiction because I do not believe the bill or the agency would contravene anything that is happening in the provinces.

[Bill Siksay, NDP, Burnaby—Douglas, BC]

Mr. Speaker, I enjoyed listening to the remarks of the member. We are debating establishing the mandate for the Public Health Agency and the Chief Public Health Officer of Canada, but there are concerns about whether there are enough financial and human resources to fulfill that mandate as set out in the bill. The Canadian Medical Association and other key stakeholders have raised concerns about the resources that are available to do this important work. Could the member comment on that?

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, I have seen the comments from the Canadian Medical Association. They come at it from a human resources perspective. Whether there is ever enough money for human resources, I do not know when enough is enough. They may be valid to some degree because we have a human resources crunch in medicine, not only in Canada but around the globe. It is very important that we understand that. I have never heard from Dr. David Butler-Jones or anyone from the agency.

The questions of the shortage of our resources with regard to the mandate of the agency are good questions to bring up in committee. We can ask those questions in due course, but I have not sensed that is a consideration at this time.

[Steven Fletcher, Conservative, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, the people of Yellowhead are very fortunate to have such an excellent member of Parliament. As the member mentioned, he was the health critic of our party at the time of SARS and did an outstanding job in that role.

It is interesting that the government has brought forward the legislation even before bringing forward its budget, particularly when it took so long for the previous government to act. Would the member comment on his experience with the commitment of the previous government on this legislation? Why did this government act so swiftly when the other government seemed to dilly-dally.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Speaker, as I mentioned in my speech, it is all about leadership, or the lack of leadership. That was the problem with the last government. It led by polls and not by directive. I think Canadians are starting to understand that this government is very directive and solid on leadership. That is why the legislation is in the House before the budget. It is important legislation and it should have been done two or three years ago.

It is now before the House. Let us get it to committee and get it enacted. That is what needs to be done, and I believe we will make that happen. It is refreshing to see a government that has this kind of initiative.

[Nicole Demers, Bloc, Laval, QC]

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.

[Steven Fletcher, Conservative, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I think the member may in part misunderstand what this bill is doing. First, it is not infringing on any jurisdiction. It is a machinery bill that organizes the responsibility that the health minister already has. In fact, in the area of public health there is some overlap in jurisdiction, particularly when it comes to peace, order and good government. Part of it is if there ever is a pandemic, there needs to be coordinated role.

The member talked a lot about Quebec in isolation of the world. I do not think Quebeckers or Canadians would accept that Quebec somehow would be isolated from a pandemic. This is why this bill is very important. It provides for a Chief Public Health Officer who is not a politician but someone who has expertise in public health matters, who would be able to address the concerns of all Canadians, including Quebeckers, when such a pandemic occurred. Quebec is only 100 metres away from where we are speaking today and to suggest that it is somehow isolated is incorrect.

Will the member accept that Quebec is not an island unto itself and there are circumstances where the provinces need to work together to ensure the protection of all their citizens? The Public Health Agency of Canada will do that without creating additional cost to bureaucracy but actually will streamline the government's response to a public health crisis. Would the member agree?

[Nicole Demers, Bloc, Laval, QC]

Mr. Speaker, although I have often agreed with my honourable colleague on the Standing Committee on Health, I find myself forced to say no right now because, by instituting this agency, the federal government is displaying its arrogance towards the powers of Quebec and the provinces.

Also, we repeat that Quebec already has had its own Institut national de santé publique since 1998, and that this institution does not need a federal agency to do the same thing. We already take care of this, ourselves, in Quebec. Furthermore, it is not true that we are isolated.

We do things directly in Quebec. We do things differently. We do things by taking into account the aging population and the children we have. We do things because we are concerned about people in Quebec. We do things because perhaps our way of thinking is a bit more social than conservative, but we do things well.