Mr. Speaker, I am pleased to rise in the House today to speak to Bill C-5. As many of us in the House are aware, the Public Health Agency has been in operation for some time, and this is the enabling legislation.
In the context of dealing with the Public Health Agency of Canada, I went to the Public Health Agency's website and reviewed some information that is important for the context of the debate in the House.
The mission for the Public Health Agency is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. As many members have noted, the Public Health Agency is responsible for a number of different aspects of public health. In part, it is mandated to respond to public health emergencies and infectious disease outbreaks. Specifically, there are a number of branches that have been set up to deal with this issue. I will address two of those branches in my speech today.
One is the branch for infectious diseases and emergency preparedness. I have a quote from the website. It states:
The Branch enables the prevention and control of infectious diseases and improvement in the health of those infected. Staff prepare for and are ready to respond to public health emergencies, 365 days a year. Examples of specific challenges are HIV/AIDS, pandemic influenza preparedness, health-care acquired infections such as C-difficile...
I will speak specifically about infectious diseases.
The other is the branch for health promotion and chronic disease prevention. Again, on its website, it states:
The Branch works with stakeholders at all levels to: provide national and international leadership in health promotion, chronic disease prevention and control; coordinate the surveillance of chronic diseases and their risk factors and early disease detection; create and evaluate/measure programs addressing common risk factors and specialized issues focussing on special populations (seniors, children)...
In the context of several things that have happened in Canada over the past years, it is important to talk specifically about pandemics.
I want to hearken back to SARS and what happened in Toronto and how that terrible event impacted so heavily on so many people, the workers, businesses, and the tragedy for families who lost loved ones. As a result of that, an inquiry was commissioned and it resulted in something that we all refer to as the Naylor report. I want to go back to the conclusions of the Naylor report and the specific recommendations that were made.
The summary of the Naylor report talks about the fact that SARS killed 44 Canadians, caused illness to hundreds more, paralyzed a major segment of Ontario's health care system for weeks and saw in excess of 25,000 residents of the GTA placed in quarantine. Those impacts still reverberate in that community. The report went on to talk about the fact that the national advisory committee on SARS and public health had found that there was much to learn from the outbreak of SARS in Canada, in large part because too many earlier lessons were ignored. The report states:
A key requirement for dealing successfully with future public health crises is a truly collaborative framework and ethos among different levels of government. The rules and norms for a seamless public health system must be sorted out with a shared commitment to protecting and promoting the health of Canadians.
On and on it goes. Toward the end of the report, it states:
Until now, there have been no federal transfers earmarked for local and P/T public health activities. Public health has instead been competing against personal health services for health dollars in provincial budgets, even as the federal government has increasingly earmarked its health transfers for personal health service priorities.
In that context, one would have hoped that there would have been significant movement. Instead last year, on November 3, 2005, the public health officials came before the health committee to talk about a couple of issues, one I will address shortly when I talk specifically about first nations and public health.
In the context of pandemics let me refer to something that Dr. David Butler-Jones brought forward to the committee. In part it was in response to a question that I asked about the fact that there were challenges in light of communication, capacity and the federal plan specifically had earmarked timeframes around vaccinating all Canadians in four months, in two waves.
The question I had put to Dr. Butler-Jones was whether we had the ability to obtain a domestic supply of a vaccine if one is developed, because it does depend on the strain, and whether we had the physical capacity in communities to vaccinate all Canadians in four months. Keep in mind that we had the SARS crisis that talked about coordination in response. Dr. Butler-Jones in 2005 said, “In terms of capacity, it is very variable in this country. But it is something the public health network and working with my colleagues, the deputies in the provinces and the ministers to ministers, in terms of how we can continue to build that capacity”. He talked about the money that was allocated in the budget. This is not that we were able to do this, but he talked about continuing to work with the provinces and territories in terms of rebuilding the capacity that was lost at the local level over the last decade, as we had been so focused on hospitals and less on the public good of public health.
That was in the fall of 2005. We still have gaps in our capacity to respond to a pandemic in this country. In the context of sending the bill to committee, I urge that this information be addressed.
In the past year we were able to go through a flu season without needing that kind of response in place, but it is a ticking time bomb. We need to have the capacity in this country to address that situation.
I also want to speak about chronic disease and disease prevention specifically in terms of aboriginal communities. There is an aboriginal peoples round table report on the Public Health Agency website which contains a number of recommendations. Regarding operational strategies for a public health agency, it states that an agency should consider:
The need to avoid a melting pot approach to aboriginal issues which might disregard distinctions between aboriginal peoples.
Agency needs to be sensitive to cultural differences in public health, which means that some approaches can seem foreign or counter-cultural.
The importance of engaging aboriginal women as leaders in community public health issues. Aboriginal women should be consulted on the formation of good models of health delivery.
Strategies to address the public health issues of aboriginal peoples who live off reserve.
The report goes on to talk about specific investments that are required:
The need for training nurses and public health professionals to serve northern and remote communities -- particularly Inuit who would like to become nurses;
The need for cross-cultural training for nurses who are often unable to take such training because of the demands of their work;
The need for investments in capacity so that first nations communities are better able to respond to outbreaks of infectious disease; and
The need for support to address public health crises in many communities, including mould in housing and potable drinking water.
There were other public health issues that were specifically raised. Participants also raised concerns about specific public health issues, including that Inuit need help facing particular public health concerns relating to lower life expectancy, mental health, tuberculosis, and the challenges of keeping health care providers, such as nurses, in the communities. They also indicated that first nations communities need help addressing problems such as the prevalence of diabetes among first nations people and the high rate of suicide in communities such as those in northern Ontario.
In talking about suicide, after I was elected for the very first time, my first official duty in my community on July 1, instead of celebrating what a great country this is, was attending the funeral of a first nations youth who had committed suicide a couple of days before. He was 19. This is a crisis in many first nations communities.
In terms of a public health framework for first nations communities, the First Nations Health Bulletin, Winter-Spring 2006 talked about work that the Assembly of First Nations is doing in the context of many communities across Canada. It is raising a number of issues including some of what we call the social determinants of health. We must not just talk about health promotion. We must talk about the social determinants of health. The bulletin refers to high rates of unemployment, lower educational opportunities, poor housing and overcrowding, lack of basic amenities such as running water and indoor toilets. These are but a few of the social issues that contribute to the poor health in first nations communities.
The bulletin stated that it is essential that a community have access to information about itself. We know that knowledge is often power. When we do not have adequate information to talk about the health in communities, then we do not have the tools to help us develop the appropriate public policy to address these issues. That is not available in many circumstances, largely due to the dysfunctional surveillance systems for first nations health.
It goes on to say that the recommendations proposed in the public health framework take into consideration the distinct communities that first nations represent across Canada. This points to the fact that we cannot have a one size fits all approach to public health in first nations and aboriginal communities from coast to coast to coast.
The Assembly of First Nations put out a bulletin on May 3, 2006. I will quote from this because I think the words should come from the people it directly affects. The headline is “Federal Budget Ignores Health Crisis in First Nations Communities” and it states, “Assembly of First Nations National Chief Phil Fontaine said it is alarming to see a complete absence of funding in the federal budget to address urgent health crises faced by first nations communities such as those faced by Garden Hill First Nation in Manitoba and Kashechewan First Nation in Ontario. It is ironic that the first government saw fit to invest in epidemics of tuberculosis, HIV-AIDS in developing countries, while many first nations are living with these diseases and there is no new assistance for them”.
To give a little more context, this is Canada. This is not a developing country where sometimes, sad but true, people come to expect high rates of infant mortality, tuberculosis, HIV-AIDs and diabetes. Let us talk about the reality in first nations communities.
In 2000 the life expectancy at birth for first nations populations was estimated at 68.9 years for men and 76.6 years for women. That represents a gap of 7.4 years and 5.2 years respectively with Canadian populations. The gap in the potential years of life lost between first nations and Canadians was estimated in 1999 to be three times greater on injuries, almost double on endocrine diseases, such as diabetes, and more than double for mental illness. In 1999 the first nations suicide rate was 27.9 deaths per 100,000. The Canadian suicide rate was 13.2 deaths per 100,000. There is a litany of these pieces of information. It is shameful that we need to talk about them today in the context of a country as wealthy as Canada.
I will briefly touch on pandemics as I know I will run out of time and I still want to speak about tuberculosis and diabetes. Pandemic readiness in first nations communities is not where it needs to be. In a paper by Dr. Gideon for the Assembly of First Nations, she specifically talks about the fact that there are gaps in the training plans, that many first nations communities have had the opportunity to develop these plans, but have had no ability to test the plans, that there is still inadequate training around drinking water and sewage plant management, and that there are still no formal discussions or written protocols between Health Canada and the provinces and territories where much of that action will need to happen.
I need to turn my attention in the time I have remaining to the crises around tuberculosis and diabetes within first nations communities in this country. I want to talk about Garden Hill specifically. In 2001 the incidence of tuberculosis disease in first nations communities was on average 10 times higher than that of the Canadian population as a whole.
Between 1975 and 2002 there was a significant decline in the number of cases and incidence of TB among first nations. The most positive impact was achieved by 1992. This is despite the first nations insured health benefits branch tuberculosis elimination strategy implemented in 1992 with the goal of reducing incidence of TB disease in the first nations on reserve population to one per 100,000 by the year 2010. Over the last 10 years there has been limited improvement in further reducing the incidence of TB among first nations, especially in western provinces.
This is in the context of the first nations community, the Garden Hill Reserve, with 3,500 where only 4% have access to running water. There are 20 cases that have been reported in the area. The first case went undiagnosed for eight months. There was a critical need to move on clean drinking water, on sewage, on adequate health care resources in the community.
The community is calling for community-wide testing. We must act. This is Canada. People should not be facing the spread of tuberculosis in their communities in this day and age.
I want to turn now to diabetes. Friday, May 5 marks National Aboriginal Diabetes Awareness Day. Diabetes walks are being held in my own community to attempt to shine the light of attention on this crisis.
I am going to quote from a press release by Chief Phil Fontaine who said, “Diabetes has become a disabling and deadly disease for many Canadians but first nations continue to suffer with a level that is three to five times higher. In order to better come to grips with understanding and treating this epidemic, the Assembly of First Nations is in the process of completing a three part first nations diabetes report card based on the Canadian Diabetes Association model. The report card will assess the current state of diabetes supports available to first nations people focusing on six areas: prevention; treatment; education; policy development; research; and surveillance. The first part of the report card will be released next month.”
The great tragedy of diabetes is that it can be easily prevented or regulated through diet and exercise, but when people live in poverty, making healthy choices is not an option when there is no access to affordable foods and safe drinking water.The press release goes on to talk about how in some communities entire families, from toddlers to grandparents, have diabetes.
This year the first nations regional health survey revealed that the average age of diagnosis among youth is 11 years, but there are also many adults who go undiagnosed and untreated until they suffer serious complications, such as blindness or loss of limb. The risk of developing type 2 diabetes can be reduced through healthy nutrition, healthy weight and regular physical activity. There are success stories in some first nations communities but there are also many tragedies.
The release goes on to say, “The great tragedy of diabetes is that it can be easily prevented or regulated through diet and exercise, but when you live in poverty, making healthy choices is not an option when there is no access to affordable foods and safe drinking water”.
There is a litany of information. For many decades first nations communities across this country have continued to plea with governments to ensure that the social determinants of health that are impacting on the health and well-being of aboriginal communities is addressed.
We have developed drinking water strategies and housing strategies and yet we still do not see a significant improvement in many aboriginal communities. What is the loss to this country in terms of people's ability to participate fully in their community life? What is the loss to the economic well-being of the community? What is the loss to the cultural vibrancy of the community when many elders and young people are contracting a disease that is entirely preventable?
Diabetes can be addressed through a comprehensive program that ensures there are adequate health resources in the community and adequate educational resources. These tools must be developed in conjunction with aboriginal communities to make sure they are culturally relevant and appropriate to the first nations community, because it is a diverse community from coast to coast to coast. These things must be put in place to address this crisis.
We saw events unfold in Kashechewan last year when the community was faced with a drinking water crisis. We are seeing an emerging situation in Garden Hill with a tuberculosis outbreak. I believe there are currently 79 boil water advisories in place in first nations communities.
This bill provides us with an opportunity to highlight some of these very serious issues facing first nations, Inuit and Métis communities, both on and off reserve. I would urge the committee to examine these issues in a very serious way and put forward some meaningful proposals developed in conjunction with aboriginal communities and their leadership.
It is critical that we make sure that access is available for all. We consider ourselves an equality country so let us make sure equality is in place. The time for action is now.