Mr. Speaker, I rise with great pleasure to speak in support of Bill C-95, a bill to create Canada's Department of Health.
I want to say a word about the referendum this week. Like many members of this House, I am pleased with the result, but I do not want to downplay the challenges that lie ahead of us. This government came into power with an agenda for change that it will
implement appropriately to improve efficiencies and to create better bottom up management that recognizes the regional differences and specific needs of this vast country of ours. We remain committed to change, for Quebec and for all of Canada.
Since taking office, we have embarked on reforms to make the country work better, to eliminate duplication and top heavy administration and to ensure that services are delivered by the level of government that is most appropriate and best able to do the job. Let me talk about some of these changes.
We have signed agreements with nine provinces to reduce federal-provincial duplications. We have signed agreements with all provinces to end internal trade barriers in Canada and to promote efficient movement of goods and services across the country.
In keeping with our commitment to forge partnerships with all levels of government and the private sector, an unprecedented team Canada trade mission with nine premiers and many municipal leaders went to China. The team brought home more than $8 billion in deals for Canadian businesses that benefited every province.
We have eliminated unnecessary boards and committees making government leaner. We have eliminated subsidies to businesses and other groups in order to make government relevant and less intrusive. We have turned over the management of many programs to local authorities, streamlining and removing duplication and inefficiencies. It is in keeping with this move toward efficiency and relevance that we introduced the legislation before us.
Bill C-95 is a milestone in the evolution of a health system that is the envy of countries around the world. Over more than two generations, Canadians from across this great country under the leadership of Liberal prime ministers and ministers of health have built Canada's health system with great care and courage, foresight and compassion. We are proud and honoured to carry the torch of their vision forward, unaltered, while at the same time responding to the need and the challenge for finding new ways to implement the goals.
The bill will change the name of the federal department to give it a more focused mandate. It will confirm and strengthen the raison d'être of the Department of Health, which is to promote and preserve the health of Canadians. It will reaffirm its mission of helping the people of Canada maintain and improve their health status. It will continue to fulfil these objectives through medicare and public health initiatives, through research and investigation, through education and awareness, and through the monitoring and investigation of food, drugs, devices and products that would compromise the safety of Canadians.
However the social assistance and income support programs of the government once contained within the Department of National Health and Welfare have been turned over to the Department of Human Resources Development, and for good reason. As we move into the 21st century issues such as poverty, unemployment and social welfare have become inextricably linked with the notion of empowerment through creation of opportunity via skills, training and education, all aimed at developing the human resource potential.
Bill C-95 addresses the need for a clear and proactive focus on Canada's primary resource, its people, and on ensuring that their quality of life and health status are balanced, enhanced and improved. It allows us to concentrate on the broader spectrum of issues that affect the health of Canadians today, the challenge and enticements to come to terms with and to explore the complex new discoveries, drugs and technologies that spring up with such dizzying rapidity in the world of biomedical science.
These innovations have on the one hand presented us with exciting new opportunities for prevention, diagnosis and treatment of disease and alleviation of suffering and on the other hand raised conflicting issues of safety, cost effectiveness, ethics and evaluation of social values.
The act will allow our department to create a vision for the future and at the same time to renew and strengthen our commitment to co-operation, co-ordination and partnership with all Canadian jurisdictions, provinces, territories, organizations and communities. In keeping with this evolution, the bill brings about the change that is the promised mandate of the government.
There is more to renaming the Department of Health than a mere change of name. There is a clarification of focus and an opportunity to formulate a new vision of the future that will improve greatly the health status of Canadians and make innovations that will enhance and strengthen what is already one of the best national health care systems in the world.
This is no more clearly spelled out than in the portion of the act that declares the health aspects of social well-being are the responsibility of the Department of Health. We all know that social well-being is multifactoral in its linkages and that it concerns in an interlocking manner the policy makers of every government department and every minister. Social well-being is interrelated with the economy, with justice, with employment, with poverty or wealth, with cultural and spiritual issues, with gender and ethnicity, and with the environment. The new health definition is more than just the absence of disease. It has to do with the quality of the individual's life and ability to cope with disability.
In the case of Health Canada this responsibility, which has always been implicit in its mandate, is now being explicitly acknowledged. The context of the words in the bill make it clear that the department's scope to exercise this broad definition of health is confined to matters over which the health minister has jurisdiction. It obviously does not give the Minister of Health the mandate to infringe on other ministers' responsibilities. By using the specific words in the bill, Canada has declared its commitment to the definition of health used by the World Health Organization
which says that there is more to health than health care. It says that health means much more than the absence of disease.
Health is the complete state of physical, mental, spiritual and social well-being. This is what the new department aspires to for every Canadian. Its renewed commitment to a long and glorious tradition has inspired Liberal governments, politicians of every party and Canadian people over many years, indeed over many decades.
Many eminent Canadians have been intimately associated with the growth of Canada's health system: the hon. Judy LaMarsh, the hon. Paul Martin, Senior, Mr. Justice Emmett Hall, the hon. Marc Lalonde, the hon. Monique Bégin and the late hon. Tommy Douglas. I mention only a few. We can see how the vision of health has known no political boundaries in the past. Though members of the third party as we well know have tried to challenge it in the present, we can trace the evolution of the commitment to social well-being through the contributions of each of these people.
In particular it was foreshadowed just over 10 years ago when Parliament debated and unanimously passed the Canada Health Act under the direction of the hon. Monique Bégin, the federal Liberal Minister of Health at the time. This major milestone, the Canada Health Act, contained a preamble that called for an assault on the social, environmental and occupational causes of disease. The idea that shaped that statement was a growing awareness of the importance of nutrition, stress management, physical fitness, safety in the workplace and the environment generally. These concepts deal with health, not sickness. These are concepts the hon. Marc Lalonde, another federal Liberal Minister of Health, created and championed. This definition has since been taken up by many other countries of the world and is now considered indisputable fact.
These concepts of health deal with prevention and promotion, not only cure, as the strategy for achieving health. It is a strategy that speaks of long term planning, not only reactivity. It represents the real health care revolution in the country.
Inherent in Bill C-59 most emphatically the concentrated focus on health statement does not mean that our vision of the future of health is intrusive or limiting. Clause 12 of the bill like the act it replaces makes it clear that nothing in the act gives the Minister of Health or any Health Canada official authority to exercise any jurisdiction or control over any provincial health authority. As I have just related in detail, it certainly defines health in its newest and broadest terms.
The bill confirms and strengthens the national interest of the federal government in health and answers those who would Balkanize health care. We know that health care is primarily local in nature. People who become sick are generally treated close to home by their own medical practitioners. If necessary, they are taken to hospitals in or near their town or city. It is well accepted colloquially and constitutionally that the managerial and administrative aspects of Canada's health system fall under the jurisdiction of the provinces.
But Canada's intrinsic values, beliefs and ideals are not local in nature. They define who we are as a people and what we stand for. These values and beliefs are reflected in the principles of the Canada Health Act.
While the federal government's financial contributions to the provinces and territories subsidize a substantial share of the cost of health care, the role and contribution of the Government of Canada in the area of health extend well beyond its funding responsibilities.
The work of the Department of Health touches the life of every Canadian every day. It monitors the safety of the foods we eat, the medication we take, the consumer products we buy for our families. In effect it is the watchdog of consumer safety. Health Canada identifies the health risks we should avoid and undertakes the research programs that improve the health of children, women, seniors and all other segments of society. It is a machine of proactive care.
The protection aspects of health care begin long before health interventions for the sick. It extends more broadly than mere treatment of illness. It is in the national interest that systemic examination of disease trends and health risks be in a single accessible place where public health intelligence from within Canada and around the world can be assembled and evaluated and that there be a centre where population health strategies can develop and where national health status benchmarks can be set.
To this end the laboratory centre for disease control located in the department is dedicated to programs preventing, controlling and reducing the impact of chronic and communicable diseases in Canada.
There is a national interest in working with other countries to combat and control health threats that know no borders. The Government of Canada supports international collaboration against the common threat of disease. It is in the national interest that research into the causes and treatments of disease be carried out.
The federal government spends many hundreds of millions of dollars a year on health research. The results of research are available to all provinces, all hospitals and all doctors throughout Canada. The outcome of research benefits all Canadians. It saves the lives of all Canadians. Health Canada's role as co-ordinator, database gatherer and clearinghouse is clearly invaluable.
It is in the national interest that drugs and medical devices be evaluated to ensure that regardless of where they are purchased and used they are safe for public use and they do what the manufacturers claim they do. The Department of Health analyses pharmaceuticals that are submitted by manufacturers and certifies their effectiveness and safety. The Department of Health works to assure Canadians that their food supply is safe, nutritious and of high quality. It is in the national interest that the Department of Health does these things. It is also in the national interest that standards are set and enforced so Canadians can be ensured of comparable health care services no matter what province they reside in or visit.
It has been well documented by many surveys that Canadians want a national vision for health and social well-being. Poll after poll has found that the health care system is in first place as one of the things that binds Canadians together. They see it as a defining aspect of Canadian values.
The latest Canada Health monitor findings show that 89 per cent of Canadians support the principles of the Canada Health Act. The third party across the way that seeks to trample on those principles should get in touch with the people of Canada.
Health Canada has a clear role to play in public awareness and education on health issues as well as a responsibility to protect those who are disadvantaged. The government is proud of the measures it has taken on behalf of groups with special needs whose health status is more compromised such as First Nations persons, children, seniors and other disadvantaged groups. At the same time, because the health status of First Nations people requires concentrated ongoing efforts we have expanded and enhanced health programs for First Nations and Inuit people.
For instance, last year the Minister of Health announced the building healthy communities strategy. In consultation with First Nations and Inuit leaders we will implement the strategy to strengthen efforts in three critical areas: solvent abuse, mental health and home care nursing.
We are well aware that health programs designed and delivered within First Nations communities are often more successful than those delivered by outside agencies. I have proof of this not only from my own experience as a physician working with aboriginal communities to improve their health but more recently as I travelled with the Standing Committee on Health across Canada visiting native communities and seeing firsthand what worked and what did not work.
We are working with the First Nations to increase their control over their own resources. We have helped many bands to move through the transition that will eventually culminate in full control of management and administrative powers that will enable self-government.
It would take too much time to tell the House of all the initiatives now under way to empower Canadians who are least able to help themselves, those disadvantaged by need or by neglect. However with the indulgence of the House I will mention only a few. An example is our seniors. We currently support research into alternatives for care that promote independence and allow the elderly to stay in their homes, close to friends, family and familiar surrounding. We do this by funding groups that provide community programs for seniors. This is what we mean by health status encompassing quality of life objectives.
For our children Health Canada is a key player in a network of government programs designed to improve the life chances for children at risk. The clear understanding is that the future of children depends on critical inputs during the first years of life. The federal government administers a number of programs for Canadian children and their families to help improve access to the best opportunities for health and development. The department directly supports a wide range of strategic programs targeted at children at risk of abuse or injury, social or physical disease.
What about women? For too long, women have taken second place on the health agenda. Our government has taken dramatic steps to correct this grave inequity. We have given strong support to the Canadian breast cancer research initiative. We have introduced gender specific elements into health promotion programs such as Canada's drug strategy and the tobacco reduction demand strategy, working with community groups to ensure that women get help at the local level.
Statistics Canada showed that the prenatal death rate in this country climbed in 1993. As a physician, I know that good nutrition in pregnancy is a key factor in decreasing the rate of low birth weight babies, who are at highest risk for chronic disease and disability. Health Canada's prenatal nutrition program for low income and other at risk mothers was a red book response to this tragic occurrence. I am proud to say that this simple and effective program would benefit many at risk babies in the future.
The hon. members of the third party with tunnel vision may rest assured that spending on these health programs does not fly in the face of the debt reduction priority of this government. Each dollar that goes to prevent ill health saves tens and hundreds of dollars in health care and treatment costs.
I turn now to the specifics of the bill before the House. As I have said, essentially it renames the department to conform to its new singular focus on health. Hon. members will find that most of what is in the bill carries over from the previous legislation. There are a few new items included in order to clarify the mandate of the
department and to extend its abilities to discharge its mandate. I will deal with some of these very briefly.
The bill defines the minister's powers in clause 4 as the promotion and preservation of the physical, mental, and social well-being of the people of Canada. Hon. members will understand the meaning of social well-being in light of my earlier comments in the context of this bill. We are concerned solely with the health aspect of social well-being, because health is more than just health care. It involves the total environment in which the organism lives and develops, in which human babies are born, youth develops, and seniors find quality of life. Health is based in the social order of the community.
We speak then of the social well-being of Canadians in the same breath as we speak of their physical, mental, and spiritual well-being. Not only does this wording reflect the reality of human existence, it echoes the wording and usage of the World Health Organization of the United Nations.
A subclause of this section confirms the department's responsibility for the safety of consumer products and workplace equipment, which is a transfer from the former Department of Consumer and Corporate Affairs.
By virtue of clause 5, Health Canada officials will gain the same powers to inspect possible disease carrying agents entering the country as they now have to enforce the Food and Drug Act.
Clause 6 authorizes the minister, under the supervision of Treasury Board, to recover the cost of services provided to business. I hasten to explain to the third party that for medically necessary care this does not apply to user fees and they should never confuse it. Members know that we remain unalterably opposed in this government to any user fees.
What we really refer to under cost recovery is the cost recovery of charges to businesses for the cost of government services that have commercial value, such as evaluation of drugs, devices, pesticides, et cetera, which we all agree taxpayers should not subsidize.
I would like to reassure hon. members and the Canadian public of one overriding truth, the clear mandate and mission of Health Canada. Our mission will continue to be to help the people of Canada maintain and improve their health. We will continue to enforce the Canada Health Act so that all Canadians will have universal access to a comprehensive range of medically necessary quality health services. Our objective as a Liberal government has historically been to ensure that the health care system remains accessible to Canadians when they need it.
In this vein, hon. members are aware that the Minister of Health has given the provinces until October 15 to disallow user charges for medically necessary services in private clinics or experience reductions in transfer payments. The message is clear and simple: we will do what is required to stop user charges in their tracks, to push them back wherever they have crept forward, and to prevent the development of a two tiered system of health care, a system which contradicts every one of the five principles of medicare, to which Canadians have stated full commitment.
We do not oppose the use of private clinics. They can be a creative, cost effective way to deliver services, and they can do so without contravening the Canada Health Act if they are set with clear, well defined criteria.
We are committed to consulting openly and thoroughly with our provincial colleagues. We have shown our commitment to working with them to resolve outstanding issues and renew their health care system-indeed as they must-in a way that preserves and respects the underlying principles and values of the Canada Health Act. However, the bottom line remains fixed: no Canadian will suffer financial hardship because of illness in this country. This principle has not changed since Emmett Hall's report and since Liberal Prime Minister Lester Pearson enacted medicare. It will not change in the future as long as there is a Liberal government in Canada.
We will continue our wide range of activities aimed at preventing disease and promoting health. We know this is the best investment in the health status of Canadians that we can possibly make.
We know that 60 per cent of disease is preventable. We know that early screening, public information and awareness, research, and healthy public policy can make a remarkable difference to the lives of Canadians, even in diseases where there is no known cure. So we have instituted a breast cancer information exchange. We have implemented strategies to reduce tobacco use, to counter family violence, and we have introduced a prenatal nutrition program to improve prospects for newborns at identifiable risk. We have announced an aboriginal health head start program to address the needs of aboriginal children living in urban centres and large northern communities. We have embraced the axiom that good health is the result of proper exercise and diet. My department provides guidelines on nutrition and financial support for physical fitness and active living.
Nobody wants to spend more money than is necessary on health. We want to get the maximum value from every dollar. The road to this objective passes through the prevention of illness and the promotion of health through the development and support of healthy communities.
Dr. Brock Chisholm, former deputy minister in Canada and first director general of the World Health Organization, once recast the age-old saying that an ounce of prevention is worth a pound of cure. Dr. Chisholm said "You can only cure retail, but you can prevent wholesale". We subscribe to that.
The new Department of Health will continue all the essential work that has helped Canada reach and maintain its place on top of the world rankings in health. However, as I said at the outset, we intend to do far more than maintain hallowed traditions. We intend to be a dynamic player in a world filled with new challenges and innovative and creative opportunities for health and health care.
We will be open to exciting visions of the future that take full account of the discontinuities and uncertainties of fast changing times. We look to the national forum on health to help develop this new vision for Canada's health system in the 21st century. We believe the forum is an appropriate vehicle, one that respects the rights of Canadians to be consulted on this matter of primary importance. It brings expert opinion from many areas to bear. It promotes dialogue with all segments of the public. It respects the established and effective conference of federal-provincial health ministers. The personal involvement of the Prime Minister as its chair reflects the importance this government assigns to its deliberations.
The national forum on health, which will maintain a dialogue with Canadians, is a unique and important milestone in the evolution of Canada's health care system. It also makes good on a promise the Liberal Party made when it sought and received the support of Canadians in the last election, a promise to strengthen partnerships, to open doors to public input. The forum would bring in for the first time in a meaningful and practical way the third player on the health care team, the consumer.
I point out to hon. members that significant progress has been made on the health commitments of the red book. Consider the forum, aboriginal head start, prenatal nutrition, centres of excellence for women's health, and on and on. Health is everybody's business. It is an investment in the Canadian economy. Health is an economic resource. Healthy people work, play, and are active consumers.
Studies done by many economic think tanks have shown the loss to the economy through illness. So it is important to understand that Canada's financial commitment to health care provides considerable value for every dollar spent.
In 1972, when our health insurance system was completed, Canada and the United States were spending approximately the same level of gross domestic product on health, at 8.4 per cent of gross domestic product. Since then we have done a far better job of controlling spending. Last year Americans spent more than 14 per cent of GDP on health, with 35 million citizens still uninsured, while we spent about 9.7 per cent of gross domestic product on a universal, comprehensive system where every Canadian has full access, regardless of income level. This translates to $30 billion a year in savings on health compared with the U.S. spending levels.
What about outcomes? OECD and WHO statistics show that Canada ranks in the top three and sometimes is second in health outcomes, while the United States still ranks between 15 and 17. I say to the third party that more money does not mean better care.
Who gains from these savings? Canadian employers. Who has high overhead costs to insure their employees against basic health risks? Not Canadian businesses. We are among the big winners. In fact major American companies have admitted that this is one important reason to invest in Canada. Moreover, Canada's labour market is more flexible and more mobile because problems with health insurance do not deter workers from changing jobs.
This Canadian health dividend is not simply in the delivery of health care services. It is sometimes unfairly alleged that medicare is bureaucratic and eats up funds in administration and red tape. The truth is quite the opposite. Health care administration costs about $272 per person in Canada. In the United States it is about 250 per cent higher, at $615 U.S. per person.
Public administration, as one of the five principles of health care, works. We only spend about 5 per cent of our health care dollars on administration. The United States spends 25 per cent. It was once decided by the United States Department of General Accounting that if that 25 per cent spent on administration in the United States were put into health care services, the 35 million Americans who are not insured would be insured.
We are committed to managing effectively and prudently in difficult financial times. There are many management strategies in health care that are innovative, save dollars, and still ensure quality, such as evidence based care, appropriate acute care, community care, and assessment of technologies. But this all means working in close co-operation with provinces and territories. This government has taken great care to avoid duplication of programs and services. If the provinces can administer a program better, and in many cases they can, we let them do it. Our aim is to co-operate and be flexible with the provinces in ways that ensure there is no wasteful overlap. We consult widely within the field and among all Canadians before we act.
I have spoken about the record of the health department that has been its history and portends well for its future. It has been the instrument for promoting high quality health care and improved health status for Canadians at reasonable cost. It has earned and maintained an international reputation for its efforts on health promotion and disease prevention.
I am therefore proud to sponsor this bill to create Canada's new Department of Health. I urge all hon. members of the House to afford it swift passage through Parliament.
