Debates of Jan. 28th, 2015

A motion to adjourn the House under Standing Order 38 deemed to have been moved.

Health

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Mr. Speaker, 19 years ago, maternal health outcomes on Nishnawbe Aski Nation were more in line with the results we see in third world locations. The institution of the mobile ultrasound program has brought those outcomes in line with the successes we enjoy across Canada. The program can be characterized as a real success story and is something we can be proud of.

In November, I raised a question about the program, which was struggling to acquire appropriate equipment that would also have a positive cost benefit. Put another way, we could be getting more bank for our buck. This issue is coming to the forefront, as the current sonographer expects to retire in the next few years, and any replacement will inherit an aging and burdensome system that must be lugged from community to community.

The minister informed me that she would be happy to look into the issue and would get back to me. Officials in her office contacted mine, and we put them in touch with the stakeholders who had flagged the problem with me in the first place. It seemed that there would be movement on the issue, and the ministry would make some headway on a problem that, if addressed, could save taxpayers a significant amount of money over time while ensuring that positive maternal health outcomes were protected in the remote communities of the Nishnawbe Aski Nation.

In December, an official in the minister's office contacted the current sonographer and suggested he contact the director of nursing in Ontario to see if that office could provide funding or had other ideas about where money might come from. I think that is called downloading.

Although it sounded as if everyone was supportive of the project and might be able to access funds through a provincial body, a meeting that was arranged for the period leading up to Christmas was cancelled and was supposed to be rescheduled for some time in January. So far, nothing has happened, and the month is almost done.

While the outcomes have improved, the job of the sonographer is truly taxing. The current and only sonographer to date carries hundreds of pounds of specialized equipment into remote communities to meet with expectant mothers. As I mentioned earlier, this person is planning for his retirement and is attempting to modernize the equipment to create a deeper pool of potential replacements. The equipment used is effective but heavy.

Much has changed in 19 years, including the design of mobile ultrasound equipment. Now it is possible to have two-part machines with a heavier base and detachable computer type components that have been described to me as a brain the sonographer carries from location to location.

The last time the program needed equipment replaced there was a six-month gap during which Health Canada spent half a million dollars moving patients to permanent machines in Sioux Lookout.

The best option may be to equip these communities with the two-part scanners at a one-time cost of $15,000 each. It would allow the program to carry on with a larger pool of eligible replacement sonographers and to maintain the best health outcomes at the same time.

It is a solution that would best protect these communities and our precious tax dollars. Will the Minister of Health decide to save taxpayers money and buy the scanners?

[Eve Adams, Conservative, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I stand in the House today to speak to our government's continued support for sonograph services to ensure better maternal and child health outcomes for first nations in northwestern Ontario.

This year alone our government is investing over $23 million to support healthy child development programming and services in first nation communities in Ontario. The maternal child health program specifically has received $4 million in the 2014-15 fiscal year.

In addition to the maternal child health program, Canada also invests $2 million per year in the Canada prenatal nutrition program for first nations in Ontario. This program focuses on pregnant women and women with infants up to 12 months of age, supporting activities related to nutrition screening, education and counselling, maternal nourishment and breastfeeding promotion and support.

Our government also supports a number of other programs and services related to maternal and child health for first nations in Ontario. These include the aboriginal head start on reserve program, the fetal alcohol spectrum disorder program and the children's oral health initiative.

This support is paying off. Indeed, we are seeing significant improvements in first nation communities with this programming, such as higher proportions of first nation children being breastfed for longer than six months, and increased screening for developmental milestones, prenatal risk factors and existing health conditions.

Specifically on the issue of the provision of ultrasounds, through the maternal child health program, Health Canada funds the Sioux Lookout Meno Ya Win Health Centre to provide ultrasound services to remote communities in northwestern Ontario, including travel for a sonographer to perform the ultrasounds.

In response to the questions posed by the official opposition's deputy critic for aboriginal health, under the arrangement with the health centre, if the current sonographer retires, it is expected that the health centre will undergo a recruitment strategy to ensure continued ultrasound-sonography services.

Further, the deputy critic had concerns over the weight of the equipment, suggesting that it could adversely affect qualified women from being recruited. I understand that the previous mobile unit weighed in excess of 100 pounds. However, Health Canada invested in a new unit in 2013, which weighs approximately 10 to15 pounds.

Regarding concerns about the weight of additional supplies that are also carried from community to community, I understand that it is possible that a stock supply of support items, such as paperwork, ultrasound bags and scan gel, be sent to the communities in advance and that Health Canada's nursing stations are willing to hold these supplies for the sonographer's use exclusively.

I understand that the sonographer must also carry a cart, which holds the ultrasound equipment during a procedure, from community to community. To further reduce the weight burden for the sonographer, my departmental officials will open a dialogue with the Sioux Lookout Meno Ya Win Health Centre to explore options for purchasing sonography carts which can remain on site in high volume communities.

Regarding options other than having the sonographer travel, the option of bringing clients to a central location for scans is not an ideal resolution to this issue. For example, in 2013-14, through funding provided by Health Canada, the sonographer made 35 trips to remote communities in northwestern Ontario and conducted 634 ultrasounds. It would be more cost-effective and efficient for the sonographer to travel than for the clients to travel.

Purchasing ultrasound equipment for each of the remote communities would also not result in actual savings, as a sonographer would still be required to travel to the community to perform the procedure. Moreover, there would be costs associated with maintaining the equipment.

The current system of having the sonographer carry the equipment to the community, even though it may result in overweight baggage charges, is still more cost-effective.

In closing, our Government remains committed to working with our partners to improve the health outcomes for these women.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Mr. Speaker, I have no doubt that the suggestion I made or the sonographer made is a practical solution that most people would like the government to adopt. We recognize that there is a great deal of bureaucracy in this process. However, at the end of the day, the federal government is responsible for the health of aboriginal people and first nations.

The government has spent much money moving patients to permanent scanners, which costs more than this solution does.

Additionally, when the program seeks a replacement sonographer, the pool, as I indicated, will be limited to those who can both perform the specialized work and lug around a couple of hundred pounds of equipment too.

Finally, equipment available today may not be in the future, and costs only go in one direction for highly technical machines.

As I said before, we could be proud of the outcomes we have achieved on the Nishnawbe Aski Nation, but we should also look to achieve those at the best possible price. To have additional machines in these communities is the one that makes more sense, because the more we lug machines around, the more chances there are that something will break.

Will the Minister of Health find a way to address this issue and ensure best maternal health outcomes at the best possible price?

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Mr. Speaker, I would like to clarify that our department will continue to support mobile sonography services to northwestern Ontario.

Through budget 2010, a five-year funding cycle for the maternal child health program was announced. At this stage of the funding cycle, our government is demonstrating strong stewardship in reviewing all the evidence and outcomes from those investments.

This year alone, our government is investing over $23 million to support healthy child development programming and services in first nations in Ontario. This includes approximately $4 million for the maternal child health program in Ontario, and $2 million specifically for the Ontario region first nations and Inuit component of the Canada prenatal nutrition program.

In closing, I assure the member that these programs and services support healthy pregnancies, healthy births, and healthy child development for first nations in Ontario.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, Canada has good drinking water generally, though we do face challenges with emerging contaminants.

That said, not all Canadians enjoy the same quality of drinking water. As we know, there are no enforceable national drinking water standards in Canada. Drinking water quality thus varies by province. Within provincial boundaries, there are problems with drinking water in rural areas, where accessibility to quality drinking water does not match what is available in urban Canada. Rural drinking water advisories are fairly commonplace.

As we know all too well, drinking water quality on first nation reserves is nowhere near what it should be in a country like Canada. Instead of implementing legislation, regulations, and standards that would bring first nations' drinking water to the highest national standards, the government has opened the door to allowing drinking water on reserves to meet only provincial standards, which vary across the country and are not uniformly the highest possible.

My earlier question period intervention, which we are debating this evening, was in response to the 2014 summer Ecojustice report card on the state of Canadian drinking water.

The report begins with the question:

What country is doing the most to ensure its citizens have the safest glass of water?

Australia? Canada? The Netherlands? If you guessed Canada--unfortunately--you're wrong.

That is what the report said.

To quote further from the report:

In dozens of instances, the Canadian Guidelines are weaker than those in other jurisdictions and at risk of falling farther behind. In many more cases, Canada has no standard for substances where other countries do.

What is the government doing, even within the current framework for governing voluntary drinking water standards, to ensure Canada has the best drinking water in the world, nationwide?

[Eve Adams, Conservative, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, safe drinking water is essential to the life and health of every Canadian every day, and our drinking water is among the safest in the world.

While drinking water is primarily an area of provincial and territorial jurisdiction, Health Canada also plays a central role in helping Canadian jurisdictions ensure the safety of drinking water supplies from coast to coast by working in close collaboration with all provinces and territories to establish the guidelines for Canadian drinking water quality. These guidelines are developed to be protective of public health. They are based on robust science and take into consideration the ability to measure and treat the contaminant in drinking water.

The guidelines are developed for specific drinking water contaminants through the federal-provincial-territorial committee on drinking water. They are intended to apply to all drinking water supplies in Canada, whether public or private, from surface or groundwater sources. Provinces and territories use them as a basis to establish their own requirements for drinking water quality and implement them in accordance with their priorities for protecting public health. They are also used as a reference in federal legislation to ensure the safety of drinking water in areas of federal jurisdiction

Health Canada has scientists and other professionals dedicated to the development and review of drinking water guidelines. The process to determine priorities for guideline development is rigorous and includes biannual reviews conducted in collaboration with the provinces and territories. In addition to review of new and emerging science, the priority-setting process takes into consideration the needs of individual jurisdictions and Canadian exposure levels.

The development of drinking water guidelines also relies on international partnerships. Health Canada is a World Health Organization collaborating centre on water quality and has a longstanding partnership with the U.S. Environmental Protection Agency in the area of drinking water quality.

The quality of drinking water depends on the quality of water in the environment. A drinking water contaminant in Australia, for example, is not necessarily a concern in Canada or the United States. This means that the substances that need to be monitored and controlled in drinking water will vary from country to country.

Our approach is to establish guidelines for contaminants that are likely to be found in drinking water supplies at levels that could pose a risk to human health for people living here in Canada. There are other differences that need to be taken into consideration.

While in some cases other jurisdictions may have very stringent standards, it is important to note that they are not necessarily based on scientific evidence. Our government understands the importance of ensuring that critical decisions about the health and safety of Canadians must always be based on the best available science. That is why Health Canada always stays up-to-date on the latest evidence regarding drinking water quality and ensures that our guidelines live up to the highest international standards for safety and quality. We encourage all jurisdictions to do the same and are pleased to partner with countries that also take a science-based approach.

Although the guidelines are considered to be non-regulatory, they are adopted and enforced as standards by all Canadian jurisdictions, either through specific legislation and regulations or through permitting of treatment plants. This collaborative approach respects regional and local differences related to the presence of certain contaminants and provides national consistency and economies of scale while reducing duplication. Our collaborative system also provides the flexibility needed to address emergency situations such as spills or leaks.

Health Canada can develop drinking water screening values for contaminants for which there is no existing drinking water guideline. This is done at the request of a provincial or territorial agency or federal department using the scientific information available at the time of the request. Such screening values can be developed over a period of 24 hours to two weeks, depending on the urgency of the request and the availability of the data. Over the past five years, Health Canada has developed approximately 30 drinking water screening values to address such issues.

The Government of Canada is committed to safe drinking water for all Canadians. Drinking water in Canada is among the safest in the world, and this is built on effective collaboration with all of our provincial and territorial partners.

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, as pointed out in the Ecojustice report and in my question period intervention, there are 189 substances regulated in other countries for which Canada has no standard. It is of concern, for example, that Canada has the weakest standard for the common herbicide 2,4-D, even though long-term exposure can damage the nervous system, liver, and kidneys, and it is considered a possible human carcinogen.

In addition, Canada has no goal, guideline, or standard for styrene, whereas the U.S., Australia, and the World Health Organization have set a maximum allowable limit for this substance in drinking water.

Why is the government not taking these contaminants more seriously? What is lacking? Is it resources, political will, or both?

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Mr. Speaker, the quality and safety of drinking water in Canada cannot be understood by comparing the number of guidelines in a given jurisdiction. It has been stated that there are 189 substances for which Canada has no guideline. However, it is important to note that this number does not take into consideration the number of substances that are not in use, that are banned in Canada, or that are simply not found in our drinking water.

I also note that the same report that identified the 189 substances also indicated that 78 of those substances are not in use in Canada, and that another six are banned.

Our guidelines are protective of health, respect our jurisdictional responsibilities, and are complemented by the flexibility to address emergency situations. We also need to remember that drinking water quality is more than just drinking water guidelines. It also requires the adoption and implementation of multi-barrier approaches to prevent the contamination of drinking water sources in the environment, as promoted by Health Canada.

[The Acting Speaker, Conservative, Bruce Stanton]

The motion that the House do now adjourn is deemed to have been adopted. Accordingly, the House stands adjourned until tomorrow at 10 a.m. pursuant to Standing Order 24(1).

(The House adjourned at 7:28 p.m.)