House of Commons Hansard #182 of the 41st Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was report.
HealthCommittees of the HouseRoutine Proceedings
The Speaker Andrew Scheer
The hon. parliamentary secretary is correct, the chief government whip was standing and speaking. However, I recognized the hon. member for Beaches—East York and the first point of order I heard was from the hon. member for Dartmouth—Cole Harbour. I recognized him, he has moved his motion and now the House shall decide.
Shall the member for Saint-Bruno—Saint-Hubert be heard?
HealthCommittees of the HouseRoutine Proceedings
HealthCommittees of the HouseRoutine Proceedings
HealthCommittees of the HouseRoutine Proceedings
The Speaker Andrew Scheer
In my opinion the nays have it.
And five or more members having risen:
Call in the members.
Committees of the HouseRoutine Proceedings
The Speaker Andrew Scheer
I declare the motion defeated.
It is my duty pursuant to Standing Order 38 to inform the House that the questions to be raised tonight at the time of adjournment are as follows: the hon. member for Western Arctic, Parks Canada; the hon. member for Abitibi—Témiscamingue, National Defence.
Resuming debate, the hon. member for Beaches—East York.
Matthew Kellway NDP Beaches—East York, ON
Mr. Speaker, the results of that vote confirm the wisdom of my colleagues.
As a member of the Standing Committee on Health, I am happy to stand and support the motion. One cannot underestimate the timeliness of the subject matter before us. The study that was before the committee was long overdue. The solutions that the issue demands are also long overdue. This was crystal clear from the attention this issue received in Canada and internationally and it was confirmed beyond a doubt by the evidence received at health committee. I confess I was not there to hear all the evidence in person, having only been assigned to the health committee in time for the drafting of the report. That process did afford me the opportunity to familiarize myself with the evidence that came before committee.
The evidence was quite stunning. It opened up not only to me but to all members of committee the scope of the challenges we faced with the issue of chronic disease. It opened up as well the opportunities that were before us for tackling these challenges. We need to ensure that the response we make to these challenges is commensurate with those challenges.
Unfortunately that is not the case before us today in the report. We heard the evidence and we could not reconcile that with the recommendations in the body of the report. This is why the House will find attached to the report a dissenting opinion from the NDP members of the standing committee.
Before getting to the issue of the recommendations, let me take a moment to scope out the issue of chronic diseases.
Let me begin with the fact that this is not just a Canadian problem. It is international in scope and it is a problem of such importance and scale that it caused the United Nations to convene a “high level meeting” of the General Assembly in an effort to shake the international agenda on this issue. This was only the second time in the history of the UN that the General Assembly met on a health issue, the other one being the issue of AIDS. According to the World Health Organization, the purpose of this high level meeting was for “countries to adopt a concise, action-oriented outcome document that will shape the global agendas for generations to come”.
I would like to quote from the declaration that emerged from that high level meeting in September 2011. It said:
We, Heads of State and Government and representatives of States and Governments, assembled at the United Nations on 19 and 20 September 2011, to address the prevention and control of non-communicable diseases worldwide, with a particular focus on developmental and other challenges and social and economic impacts, particularly for developing countries...
This includes Canada as well.
It goes on to describe the issue as “A challenge of epidemic proportions in its socio-economic and developmental impacts”.
It notes:
—with profound concern that according the WHO in 2008, an estimated 36 million of the 57 million global deaths were due to non-communicable diseases, principally: cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, including about 9 million deaths before the age of 60, and that Nearly 80 per cent of these deaths occurred in developing countries.
To be clear, this is not an issue that is just recognized by the World Health Organization and it is not just an issue of developing countries. This issue is recognized by countries and political jurisdictions around the world.
What one notes from the evidence and research available to the public on this issue is that there is considerable discussion on the incidence of chronic disease both related to the issue of aging but also across the population in general.
A central preoccupation of the evidence before the committee and in the public realm is the fiscal and economic burden of chronic disease. Going outside of Canada, the Centres for Disease Control in the United States estimates that 75% of health care costs in the U.S. are related to heart disease, cancer, diabetes, arthritis and obesity. The Canadian Medical Association told us at the committee that there was no reason to believe Canada was any different.
In fact, we heard at committee from the Public Health Agency of Canada that cost to Canada of chronic disease related to aging but also across the population was $190 billion, $90 billion for the treatment of those diseases and another $100 billion incurred in economic costs to Canada in the form of lost productivity. The Public Health Agency's estimates that is equivalent to 67% of all direct health care costs in Canada.
It should be noted that numerous studies within provincial jurisdictions come up with numbers of the same order. That is to say that chronic disease is responsible for a very high percentage of very high costs.
According to the UN declaration, and all sorts of evidence before the committee as well as research in the public realm, and I quote from the UN declaration, that “with profound concern, non-communicable diseases are among the leading causes of preventable morbidity and of related disability”.
I want to focus on the word “preventable”. The common risk factors are well known and controllable. Tobacco use, harmful use of alcohol, unhealthy diet and lack of physical exercise rank among the top of these.
However, the report further recognizes the role that social determinants play with these diseases, such as the conditions in which people live and their lifestyles. These are also contributing factors to the rising incidence and prevalence of these diseases. For example, poverty, uneven distribution of wealth, lack of education and a number of factors that go into these social determinants are known as “contributing factors”.
I will cite some of the evidence that made it into the report. Right upfront, there was a lot of discussion about healthy eating, obesity and physical activity levels. The committee heard that the burden of chronic disease was related to dietary patterns as well as rates of overweight and obesity and the level of physical activity of Canadians.
Witnesses stated that healthy eating reduced the risk of developing chronic diseases. It was suggested that 90% of type 2 diabetes, 80% of coronary heart disease and one-third of cancers could be prevented by healthy eating, regular exercise and by not smoking. Members were also told that as many as 48,000 deaths per year in Canada were related to poor nutrition.
Of particular concern is the issue of childhood obesity. These rates have quadrupled in the past three decades.
There is much more to discuss about this. I think the numbers that I have shown tell us that this is an issue of great importance and scope and that this report deserves further study in particular, as well as the government's response, the minister's response and the dissenting report of the NDP members of the committee.
Pursuant to Standing Order 60, I move:
That the House do now adjourn.
Committees of the HouseRoutine Proceedings
The Acting Speaker Bruce Stanton
The question is on the motion. Is it the pleasure of the House to adopt the motion?
Committees of the HouseRoutine Proceedings
Committees of the HouseRoutine Proceedings
Committees of the HouseRoutine Proceedings
The Acting Speaker Bruce Stanton
In my opinion the nays have it.
And five or more members having risen:
Call in the members.
Committees of the HouseRoutine Proceedings
Robert Chisholm NDP Dartmouth—Cole Harbour, NS
Mr. Speaker, while I had some hesitation about the member giving a speech, he showed me very quickly that he had an incredible grasp of the subject. I am glad that the members opposite voted to support him, because I certainly enjoyed listening to what he had to say.
I would like to ask the member if he would comment on the fact that provinces like Nova Scotia, in 2016, are going to be subject to a change in how health care is going to be funded, which would have quite a dynamic and negative impact on the ability of that province to fund health care in any equitable way in relation to other provinces in this country. I wonder if the member would please comment on why it is wrong that the government is heading in this direction.
Matthew Kellway NDP Beaches—East York, ON
Mr. Speaker, I think the record will show that it was in hesitation that my colleague from Dartmouth—Cole Harbour actually voted against me.
Yes, the government will take about $31 billion to $36 billion out of health care transfers beginning in 2016, which is contrary to its pre-election promise of a 6% escalator in health care.
I have seen studies on the issue of chronic disease coming out of Nova Scotia. Nova Scotia, like a number of other jurisdictions in Canada, has studied this issue and its estimates of the cost to the health care system in terms of direct costs for treatment, as well as costs to the economic productivity of that jurisdiction, are in line with all the other estimates that other jurisdictions in Canada, and, frankly, in North America, have performed. I anticipate that Nova Scotia, like other jurisdictions in Canada, will have problems providing health care to its citizens.
Kevin Lamoureux Liberal Winnipeg North, MB
Mr. Speaker, chronic disease and aging are very serious issues in Canada for which there should be federal and national leadership. However, there is a huge vacuum in that respect. Whether it is on chronic disease and aging or other issues like child obesity, for example, the government has been very lacking. The Liberal Party has talked about it for a great deal of time over the years. It is something that needs to be recognized.
From our perspective, we need to not only increase the amount of debate on the issue but, more important, we need to start working with our provincial counterparts and demonstrate some leadership to ensure we are able to tackle this issue from a national perspective. We can only do that if we co-operate and provide leadership with the provinces.
Would my colleague agree with those comments?
Matthew Kellway NDP Beaches—East York, ON
Yes, Mr. Speaker, I do agree with my colleague's comments.
The fundamental root cause of the issue here is that the government disavows any responsibility for health care in this country. It is right there in the second paragraph of the report. It reads:
In undertaking this study, the Committee recognized that the administration and delivery of health care services is the responsibility of each province or territory. Guided by the provisions of the Canada Health Act, the provinces and territories fund these services with assistance from the federal government in the form of fiscal transfers.
The government limits its responsibility for health care to the issue of fiscal transfers. However, the issue of chronic disease in Canada is a national issue that requires a national response. As I said in my speech, it has been tagged by the Public Health Agency of Canada as a $190 billion health care problem for Canada. It is incumbent upon our federal government to show leadership on this issue in supporting treatment and preventive means to limit chronic disease in Canada.
Hedy Fry Liberal Vancouver Centre, BC
Mr. Speaker, the reason we are discussing this report in the House today and debating this issue is that time and again we have heard the government make statements about what it is doing to prevent, protect and ensure that Canadians are safe and have good health care but the facts do not support any of that. When we discuss issues as important and urgent as this one, the whole parliamentary tradition of debating these issues at committee and bringing in expert witnesses to speak on these issues, we find that this is all short-circuited at committee. The government does not listen to witnesses and continues to ignore them.
This report is a glorified toothless report. It says nothing, does nothing and only pats the government on the back. The government did not listen to any of the recommendations that any of the witnesses made.
The Liberals put forward a dissenting report. We listened to the witnesses and heard what they had to say. They were experts, not only in health, chronic diseases or aging, but they were also people who talked about the other factors that we need to take action on to deal with this problem.
When we look at the demographics of the aging population, the problems they face and the costs to the system providing health care and medications, we see this as a really important problem. The problem is that it was given short shrift. The report does not reflect what the committee heard, which is why we felt a need to bring forward a dissenting report. Debating the issue brings this to the attention of the public and ensures that parliamentarians understand the nature of the issue of chronic disease and aging.
Demographics tell us that we will have an enormous increase in our aging population. With the first set of baby boomers entering retirement in 2011, we are looking at an enormous number of people who will become aged and who will be suffering from chronic diseases.
We heard from witnesses at the committee who said that chronic disease was not a natural component of aging. We heard that for many seniors who have chronic diseases today, it is because enough is not being done to prevent disease and to promote health in Canadians starting from the early stages. We now find that we have an epidemic of one in four children being obese and who are at risk of having type 2 diabetes or heart disease. We know that but we do nothing about it.
I heard an echo across the floor from someone who said that we all know that. Well, if the member knows it, why is the government not doing anything about it when it has the power to do something?
Sixty per cent of diseases are preventable. They are not only caused by viruses, bacteria and the breaking down of organs. They are also caused by poverty. Poverty is the greatest indicator of ill health. Many seniors live in substandard housing or have no access to housing. Nutrition and the ability to have good food is important. The ability to look at how people eat and how they are housed are not things that we look at in the budgets that are presented in House. These massive budgets are also never given the opportunity to be debated or discussed at any length in committee or to have recommendations that are meaningful and accepted. None of this happens. It is all a whitewash that goes on around here.
Under her mandate, the Minister of Health has the responsibility for health promotion and disease prevention for all Canadians, but, specifically, to deliver health services to the first nations, the Inuit, the RCMP, the armed forces and veterans. Nothing is being done to help them.
We never hear about housing in any of the budgets. In the last two budgets, the word “housing” was not even mentioned and yet substandard housing is one of the things that all witnesses invoked as a major cause of ill health. It definitely stems from poverty.
We also heard that the ability to look at regulating foods was important.
We know that the biggest cause of chronic disease right now is cardiovascular disease. We know that the biggest cause of chronic disease in aging is diabetes. We know that those are all preventable.
The minister has the ability to regulate. All the indications given to the federal Minister of Health from all of the experts, not only within her department but by a committee of experts who advise the minister on these issues, were that she must regulate trans fats in food but she has refused to do so. She has been advised to regulate energy drinks, which are now causing serious arrhythmia and other problems, and even death in young people under the age of 18, but she has refused to do it. We know about the amount of sodium in foods. This is evidence-based stuff. The minister has been advised to take steps to regulate these things but she does not do it. The minister is abdicating her role. The government pats itself on the back for what it is doing to promote health and disease prevention but it is doing very little.
We also know that the cost to medicare will be very high because one in four people will depend on pharmaceuticals as he or she ages. One in four seniors depends on prescription drugs right now. Seniors cannot afford the costs because of something that was mentioned but was never responded to by the Conservative government and the minister. What are we going to do about the cost of drugs for chronic diseases? People who cannot afford their medications buy their medications until they feel a little better and then go without for a couple of months but then they get sick again. Then they take it for another month or two because that is all they can afford. That is not how to treat people who are ill.
In fact, this is something that was recognized by the premiers and the health ministers of the provinces and territories and by the federal government when the 2004 health accord was signed. Everyone from the government loved to ask what it mean. Into that accord was put $41.2 billion over a period of 10 years. That money had a 6% escalator clause attached to it. The government continues to say that it is increasing transfer payments by 6%. Well it was a signed document for 10 years. There was nothing the government could do to stop the 6% escalator. However, it is promising that as soon as the 2004 accord sunsets it will start slashing the transfers within two years by 50%. The federal government is even walking away from the work that was going to be done by the accord and the work that the provinces need to do to deal with the aging demographics.
This is what we heard at committee. This is what witnesses continue to tell us, and they had some solutions. Going back to the accord, it said that there were five things that people needed to do to ensure that Canadians got the health care they needed when they needed it and that Canadians remained as healthy as they could. We have seen that Canadians today have reached a longevity of 80.9 years. That is now sliding. The longevity rates are going down. In other words, people are becoming ill as they age. They are dying sooner. They are disabled more often. We see a rise in mental disease. We see a rise in depression among seniors. We see a rise in Alzheimer's disease. We see a rise in stroke and in cardiovascular disease.
The accord suggested five objectives that were agreed on by the premiers. One of them was to look at how one deals with chronic disease in terms of delivery of health care. The provinces agreed that they would work with the federal government and that there would be a flexible jurisdiction. That is written in the accord. I would advise anyone in this House to go on line and read the accord. It was agreed by the provinces and the federal government that they would look at a shared jurisdictional responsibility to deal with an aging population, the rising cost of health care and the appropriate need for drugs. The current government walked away, in 2006, from working on anything that would deliver chronic disease care in the community and in the home, as opposed to in the hospital, which is a costly and inappropriate way of doing it.
That was one of the objectives, and the second was to look at a pharmacare strategy to deal with the cost of drugs for people who are chronically ill and cannot afford them. That was agreed to in the accord and signed. Nothing has been done. The government walked away from that segment of the table.
We have a farce of a report being written that pays absolutely no attention to what the witnesses said. We have a government that pays absolutely no attention to what was signed and agreed to in a health accord with Prime Minister Martin at the time, when the premiers and provinces all agreed to look at key issues of how and when we deliver care, and to whom. The government wants to abdicate its role, although the money is there and the 6% escalator clause is there. The government is doing diddly-squat because we know it does not really care about medicare and would love to see it go away and become fragmented, with every province and territory trying to do its own thing. That, we know, would be impossible because many provinces cannot afford it.
The government is actually going to penalize provinces even further. I understand the need for cuts, but we have to talk about what is going to happen to people who really need care, especially with chronic disease and aging.
This document that we are debating does not reflect anything that we heard at committee. While it provides the data, it follows that up with recommendations that say and do nothing. That is why both opposition parties agreed to write their own dissenting reports to echo what they heard. It is a farce when witnesses come to committee and speak with expertise and knowledge, presenting demographics and evidence, and are actually ignored. When none of their recommendations are listened to or taken into account, it becomes a joke.
I suppose the hidden agenda of the government is probably to do away with parliamentary committees altogether. Then no one would tell the government what to do, which would further its dictatorship and its lack of responsibility for people. Even if it does not want to take responsibility for the health of Canadians, it has a fiduciary responsibility for the health of aboriginal people, which is getting worse. We know that.
We see what is happening, but the government has done absolutely nothing to deal with the issues of health promotion and disease prevention. Saying that it is doing something is not good enough. The witnesses gave concrete recommendations, all of which are not only doable but would also prevent disease, promote health and consider issues of affordable drugs and the delivery of chronic disease care in communities, which is cheaper and more cost effective, with better outcomes than anything else. All of this is based on data; it is evidence. This is not something people are making up as they go along, but the government refuses to act on it. The Minister of Health refuses to take any kind of concrete action whatsoever. The government is looking at cutting transfer payments to the provinces down the road, and the latter will not even have the ability to take care of Canadians as a result.
This report is worthy of debate. It is a pity that government members do not see the need to debate it here, because they have fast forwarded and rubber stamped whatever they had originally started with. The original position of government members has not changed regardless of what they heard. It did not influence them in any way. The moving stories, the ability to come up with real concrete action, none of it swayed the government.
As a physician, I know that we could do better. I know that there are things we need to implement. Government members continue to use the mantra, “Don't look at us, it's a provincial jurisdiction”, while they sit and do nothing as the fifth largest provider of health care services in the country to the RCMP, the armed forces, aboriginal and Inuit people and veterans. They continue to fall down on the job. Veterans have had to take them to court to deal with their chronic problems, such as mental illnesses and post traumatic stress disorders, and their access to housing and good burial services when they die and have no money.
Why does the government have to be forced to do this? The mantra that the government has no role to play in the lives of these people is a joke. Why do the Conservatives want to form government if they have nothing to do and do not believe they have any role to play in the lives of Canadians? This is worthy of debate. It is a pity that the government does not debate it. It is a pity that the government continues to use all sorts of nice words and to present shiny objects for people to look at, but does nothing with any teeth to change it. This is going to get worse and Canadians will suffer.
Committees of the HouseRoutine Proceedings
The Acting Speaker Bruce Stanton
The hon. member for Vancouver Centre will have six minutes remaining in her speech when the House resumes debate on the motion and the usual 10 minutes for questions and comments.
It is my duty to interrupt the proceedings on the motion at this time. Accordingly, the debate on the motion will be rescheduled for another sitting.