Kirsty Duncan

[Questions Passed as Orders for Returns, November 20th, 2024]

With regard to performance-enhancing drugs (PEDs) in international sport and in Canada up to 1990: (a) what specific actions did Sport Canada (SC) take to combat the use of PEDs after (i) the International Olympic Committee’s (IOC) establishment of the Medical Commission in 1967, (ii) the Council of Europe’s resolution on drug abuse in sport in 1967, (iii) testing for stimulants and narcotics at the 1968 Grenoble Olympic Games and Mexico City Olympic Games, (iv) the first large-scale drug testing at the 1972 Munich Olympic Games, (v) the International Association of Athletics Federations’ (IAAF) and IOC Medical Commission’s ban on the use of anabolic steroids in 1974, (vi) a positive test by a Canadian at the 1975 Pan American Games in Mexico City, (vii) the Sport Medicine Council of Canada’s establishment in 1978, (viii) two disqualifications of Canadians at the 1983 Pan American Games in Caracas, (ix) the acceptance of the European Anti-Doping Charter of the Council of Europe’s Committee of Sports Ministers in 1984;

(b) what specific actions did SC take to combat the use of PEDs after anti-doping legislation was enacted in (i) Belgium and France (1965), (ii) Ireland (1966), (iii) Italy and Turkey (1971), (iv) Greece (1976), (v) Portugal (1979); (c) in what year did Canada introduce an anti-doping policy; (d) why were only 15% of specimens at the 1976 Montreal Olympics tested for anabolic steroids; (e) in what year were PEDs first identified in any Canadian sport, and what (i) was the specific sport, (ii) were all the drugs reported to be used at that time; (f) what actions have been taken by SC on PEDs from its first action through to 1990, and on what date was each action taken; (g) what specific actions did SC take to address steroid use in sport after the editor of Track and Field News called anabolic steroids the “breakfast of champions” in 1969; (h) what specific action did SC take in 1976 to prevent the use of PEDs at the Montreal Olympics and Toronto Paralympics;

(i) what specific actions did SC take to address steroid use in sport after the first edition of The Underground Steroid Handbook appeared in 1981, and what action, if any, did SC take to address the use of human growth hormone in sport, which was included in the handbook, before randomized, double-blind, controlled trials were published; (j) what specific actions did SC take to address steroid use in sport after the Sport Medicine Council of Canada surveyed 1,500 athletes, coaches, and medical and para-medical practitioners about doping in 1982 and found that “fewer than five percent of athletes” stated they used or had previously used PEDs; (k) what specific actions did SC take to address steroid use in sport after the publication of “The Practical Use of Anabolic Steroids with Athletes” in 1982; (l) in what year did testing for PEDs begin at the Canada Summer Games, how did SC decide what sports to test, what specific sports were tested at each Games since testing began until 1990, and what PEDs were tested for at each Games since testing began until 1990;

(m) in what year did testing for PEDs begin at the Canada Winter Games, how did SC decide which sports to test, what specific sports were tested at each Games since testing began until 1990, and what PEDs were tested for at each Games since testing began until 1990; (n) in what year did the Canadian Olympic Committee first act to address PEDs, what specific actions did it take, and, for each action, on what date was it taken; (o) in what year did the Canadian Paralympic Committee first act to address PEDs, what specific actions did it take, and, for each action, on what date was it taken; (p) in what year did each national sport organization in Canada (i) begin testing for PEDs at competitions, (ii) begin announced testing for PEDs between competitions, (iii) begin unannounced testing for PEDs between competitions; (q) in five-year increments from 1970 to 1990, how many athletes were found to have used PEDs in Canada, broken down by sport, and what specific PEDs were being used, broken down by sport;

(r) in five-year increments from 1970 to 1990, and for each identified PED, was the drug approved for veterinary use in Canada, what clinical trials did the drug pass for use in humans, was the drug approved for human use in Canada, for what specific medical use was the drug approved in Canada, what specific medical dosages were approved in Canada, was off-label use of the drug approved in Canada, what side-effects, if any, did the drug have, and what long-term impacts, if any, might the drug have had; (s) what are the details of all Olympic and Paralympic team physicians from 1968 to 1988, including, for each, (i) the dates they served, (ii) who, if anybody, raised concerns about PED use among athletes to SC and the date of the report to SC; (t) what investigation, if any, has SC undertaken to look at health impacts of anabolic steroids when (i) doses used were much higher than the recommended doses, (ii) there was simultaneous use of oral and injectable steroids, (iii) they were possibly used with human growth hormone;

(u) what investigation, if any, has SC undertaken to look at morbidity and mortality of athletes who used PEDs during the 1970s and 1980s; (v) in five-year increments from 1970 to 1990, if an athlete was sanctioned in any way for use of a PED, what investigation, if any, was undertaken of any (i) coaches, (ii) medical personnel, (iii) other members of an athlete’s team, and what are the details of the investigation process; (w) in five-year increments from 1970 to 1990, how many athletes, broken down by sport, were sanctioned for any kind of drug infraction, and, for each identified infraction, were any (i) coaches, (ii) medical personnel, (iii) other members of an athlete’s team, sanctioned; and (x) in five-year increments from 1970 to 1990, how many (i) coaches, (ii) medical personnel, (iii) other members of an athlete’s team, were sanctioned?

[Questions on the Order Paper, November 20th, 2024]

With regard to the use of drugs and banned practices intended to increase athletic performance: does Sport Canada acknowledge that, prior to the Commission of Inquiry into the Use of Drugs and Banned Practices Intended to Increase Athletic Performance, (i) drug use in sport extends back to the 19th century, (ii) coaches, doctors, scientists, trainers, and the International Olympic Committee (IOC) failed to address the use of performance enhancing drugs (PEDs) for decades, (iii) anabolic steroid use in sport extends back to at least the 1950s, (iv) coaches, doctors, scientists, and the IOC failed to address the use of anabolic steroids for over a decade, (v) athletes acquired knowledge about PEDs through the sport system,

(vi) some coaches, doctors, pharmacists, and sports federations were complicit in athlete steroid use, (vii) power imbalances existed in sport between authority figures (e.g., coach, doctor, trainer) and athletes, (viii) deference to authority and obedience existed in sport, (ix) in some cases, authority figures controlled workouts, diet, sleep, and those with whom an athlete could associate, (x) athletes who were approached by authority figures in sport to try steroids were often racialized and young, (xi) authority figures in sport did not approach parents and ask for their permission to give their child PEDs, (xii) athletes could be bullied, lied to, or persuaded to follow a steroid plan or risk losing their place in a club or on a team,

(xiii) authority figures in sport sometimes persuaded an athlete to use steroids by saying everyone else was using in competition, steroid use was levelling the playing field, steroid use was the only way to win, and the side-effects of steroid use were minimal, (xiv) in some cases, authority figures in sport were experimenting on athletes with a veterinary product, injectable and oral steroids, human growth hormone, with a combination of the previous two, with unknown short-term health impacts and unknown long-term health impacts, (xv) authority figures experimented on athletes who were often racialized and young,

(xvi) authority figures instructed athletes to stay silent about PED use, (xvii) authority figures instructed athletes to deny use of PEDs if they tested positive, (xviii) before the internet and cell phones, athletes lacked the knowledge and means on their own to access anabolic steroids, determine what doses and combinations to use, determine the doping regimen, and taper in order to test negative before a competition, (xix) before the internet and cell phones, male athletes lacked the knowledge and means on their own to urinate to empty their bladders of tainted urine and then insert needles into their bladders with clean urine so that they could test negative for steroid use,

(xx) before the internet and cell phones, female athletes lacked the knowledge and means on their own to create a fake bladder, fill it with clean urine, and insert it inside themselves so that they could test negative for steroid use, (xxi) in some cases, authority figures instructed and groomed younger athletes to inject senior athletes with steroids between the toes, (xxii) athletes became part of a sport culture or club that normalized illegal drug abuse, (xxiii) a “pact of ignorance” and “conspiracy of silence” surrounded drug use among sport organizations?

[Eric Lidell, November 20th, 2024]

Mr. Speaker, here is an epic story to inspire us all. It is about compassion, passion and integrity immortalized in the movie Chariots of Fire, with an important Canadian connection. One hundred years ago at the 1924 Paris Olympics, Scottish sprinter Eric Liddell, son of missionaries, refused to run on a Sunday to compete in his signature race, the 100-metre sprint. Instead he ran the 200-metre and 400-metre events, winning bronze and gold, the gold in world record time. Liddell exemplified the very best of athletics, and his faith and sport gave him a platform to help others.

A year after winning Olympic glory, he returned to China as a missionary, teacher and mentor. When war approached, he sent his wife, Florence, and daughters back to Canada. He never saw them again. Liddell died in a Japanese internment camp, aged 43. We join his family in Canada to celebrate his life. His legacy endures.

[Support for the Fight Against Cancer, October 21st, 2024]

Mr. Speaker, I am grateful to be with friends and colleagues and am thankful for the support so many of them have shown me. I am looking forward to being back with everyone. I am especially grateful to doctors, scientists and health care professionals for their medicine, research and caring, which have allowed me to work every day for the community I love, through multiple surgeries, radiation and ongoing chemotherapy.

I know there are people on the Hill who have gone through cancer or are going through it now. My heart is with them. Cancer touches all of us, and it is hard. Sometimes the fight is week by week; sometimes it is hour by hour. It can be lonely despite having the best support system.

Those who are hurting should know they have one more person in their corner. I understand and support them and I walk beside them and their families as they climb every hill.

[Questions Passed as Orders for Returns, June 12th, 2024]

With regard to duty of care of athletes and athlete accidents, injuries, concussions, eating disorders and mental health challenges: (a) does Canada have a duty of care to carded athletes, and, if so, what is the policy; (b) do (i) coaches, (ii) medical personnel, (iii) other individuals on an athlete’s team, have a duty of care to carded athletes, and, if so, what is the policy; (c) do any of the provinces and territories recognize a duty of care to (i) young people participating in organized sport in school, (ii) athletes and young people participating in organized sport outside of school, and, if so, which provinces and territories, and what are their respective policies; (d) does Canada have a duty to report any abuse of athletes, and, if so, what are the details, including, (i) is it immediate, (ii) is it direct, (iii) is it ongoing, (iv) does it address confidentiality, (v) does it require documenting action, (vi) what is the policy; (e) do any of the provinces and territories have a duty to report any abuse of children participating in organized sport in school, and, if so, what are the details, including (i) is it immediate, (ii) is it direct, (iii) is it ongoing, (iv) does it address confidentiality, (v) does it require documenting action, (vi) what are any policies; (f) do any of the provinces and territories have a duty to report any abuse of athletes and young people participating in organized sport outside of school, and, if so, what are the details, including (i) is it immediate, (ii) is it direct, (iii) is it ongoing, (iv) does it address confidentiality, (v) does it require documenting action, (vi) what are any policies;

(g) does a registry of athlete accidents and injuries in Canada, for carded athletes, exist, and, if so, what are the details, including, (i) the physical and mental health injuries being tracked, (ii) the period for which injuries are tracked, (iii) the number of injuries, broken down by sport, (iv) the time lost from training, (v) the time lost from education, (vi) the time lost from work, (vii) the treatments required, (viii) whether the full cost of necessary treatment is covered, and by whom, (ix) any cost to the athlete for treatment, (x) long-term health impacts, if any; (h) do registries of athlete accidents and injuries in Canada exist at the provincial or territorial level, and, if so, what are the details, including, the (i) physical and mental health injuries being tracked, (ii) period for which injuries are tracked, (iii) number of injuries, broken down by sport, (iv) time lost from training, (v) time lost from education, (vi) time lost from work, (vii) treatments required, (viii) long-term health impacts, if any; (i) have any sport deaths occurred in Canada, and, if so, what are the details, including, (i) the number of deaths, (ii) the year, (iii) the sport, (iv) the cause of death, (v) was there an investigation, (vi) were there recommendations to prevent similar accidents in the future; (j) have any sport paralysis cases occurred in Canada, and, if so, what are the details, including, (i) the number of cases, (ii) the year, (iii) the sport, (iv) the cause of paralysis, (v) was there an investigation, (vi) were there recommendations to prevent similar accidents in the future;

(k) have any severe brain injury cases occurred in Canada because of sport, and, if so, what are the details, including, (i) the number of cases, (ii) the year, (iii) the sport, (iv) the cause of the brain injury, (v) was there an investigation, (vi) were there recommendations to prevent a similar accident in the future, (vii) were there long-term health impacts, and, if so, what were they; (l) does a registry of concussions for carded athletes exist, and, if so, what are the details, including, (i) the concussion rate among carded athletes, broken down by sport, (ii) whether the concussion rate is increasing or decreasing, broken down by sport, (iii) in which sports are concussions most prevalent; (m) how is “safe” defined with respect to head injuries; (n) are head injury protocols designed to be safe, broken down by sport; (o) how is “reasonable action” defined with respect to head injuries; (p) what National Sport Organizations (NSOs) take reasonable action to protect athletes from permanent injury caused by repetitive concussive and sub-concussive blows; (q) which, if any, NSOs have a policy regarding subclinical hits; (r) which, if any, NSOs have a policy regarding (i) head injury education, (ii) prevention of head injury, (iii) injury assessment, (iv) injury management; (s) do preventive head injury protocols exist, and, if so, what are the details, including (i) the sport, (ii) the protocol, (iii) how it reflects the best available science;

(t) what, if any, certification, and training is required of (i) coaches, (ii) trainers, (iii) members of an athlete’s team, regarding mental health; (u) what, if any, work is being done to look at the mental health of carded athletes, including, but not limited to, (i) the creation of safe spaces, (ii) the consideration of stress, anxiety and depression, (iii) the consideration of cumulative impacts of injury, overtraining and uncertain futures, (iv), support before, during and after major competitions, (v) recognition of athletes’ efforts; (v) what, if any, certification and training is required of (i) coaches, (ii) trainers, (iii) members of an athlete’s team, on physical development, including basic needs, cognitive development, social development, risk, and resilience; and (w) is any tracking done regarding disordered eating rates among carded athletes, and, if so, what are the details, including (i) the rates, broken down by sport, (ii) whether eating disorders are increasing or decreasing, (iii) what, if any, work is being done regarding power dynamics and culture of dietary practices, (iv) who has the medical training to provide nutritional advice, (v) what, if any, work is being done regarding body shaming, (vi) what, if any, work is being done regarding reducing stigma?

[Questions Passed as Orders for Returns, May 29th, 2024]

With regard to cancer in Canada: (a) what are the top 10 cancers annually since 2010, broken down by province and territory, and, for each cancer, what is the (i) morbidity rate, (ii) mortality rate, (iii) five-year net survival rate; (b) how do the rates in (a)(i), (a)(ii), (a)(iii) compare to the United States; (c) for the rates in (a)(i) and (a)(ii), what is the (i) number of people affected, (ii) cost to the health care system, (iii) total investment compared to the United States; (d) are there any types of cancer on the rise in Canada, and, if so, what are they, broken down by province and territory; (e) what percentage of new patients are offered a diagnostic molecular test in Canada; (f) what percentage of patients are offered a clinical trial in Canada; (g) what percentage of patients are enrolled in a clinical trial in Canada; (h) how many clinical trials have been initiated in Canada annually since 2010; (i) what cancer prevention programs, by cancer type, are funded by the government; (j) how much has the government invested since 2010 in the top 10 cancers, broken down by (i) cancer diagnosis, (ii) treatment, (iii) research, (iv) prevention, (v) federal transfers, and the specific amount, (vi) direct investment in cancer programs, and the specific amount, (vii) research funding, and how does the total investment compare to the United States;

(k) how much has the government annually invested since 2010 in pediatric cancer, broken down by (i) diagnosis, (ii) treatment, (iii) research, (iv) prevention, (v) federal transfers, and the specific amount, (vi) direct investment in cancer programs, and the specific amount, (vii) research funding, and how does the total investment compare to the United States; (l) how much has the government invested since 2010 in rare cancer, broken down by (i) diagnosis, (ii) treatment, (iii) research, (iv) prevention, (v) federal transfers, and the specific amount, (vi) direct investment in cancer programs, and the specific amount, (vii) research funding, and how does the total investment compare to the United States; (m) does the Scientific Advisory Committee on Oncology Therapies still exist, and, if so, (i) what is its membership, (ii) when did it last meet, (iii) what was on the agenda of all meetings since 2019; (n) what is the average approval time for phased clinical trials for the top 10 cancers in Canada, broken down by (i) phase I clinical trials, (ii) phase II clinical trials, (iii) phase III clinical trials, (iv) phase IV clinical trials, and how do the approval times in (i), (ii), (iii) and (iv) compare to the United States; (o) what percentage of Canadian children undergoing cancer treatment have access to a clinical trial; (p) what is the average approval time for phased clinical trials for rare cancers in Canada, broken down by (i) phase I clinical trials, (ii) phase II clinical trials, (iii) phase III clinical trials, (iv) phase IV clinical trials, and how do the approval times in (i), (ii), (iii) and (iv) compare to the United States;

(q) how many new cancer treatments has Health Canada (HC) approved since 2010 and what percentage have been precision treatments; (r) what are all cancer drugs approved in Canada, and the dates of approval since 2010, broken down by the (i) date the drug was approved in the United States, (ii) provinces and territories where the drug is available, (iii) provinces and territories covering the entire drug cost, (iv) provinces and territories requiring patient payment, (v) additional cost per treatment; (s) how many new cancer treatments has HC approved since 2010 for the top 10 cancers, what percentage have been precision treatments and how do the approval rates and times compare to those in the United States; (t) how many new pediatric cancer treatments has HC approved since 2010 and what percentage have been precision treatments; (u) how many new rare cancer treatments has HC approved since 2010 and what percentage have been precision treatments; (v) on what date was the special access program for drugs first put in place, (i) how many applications have been made for chemotherapy drugs since its creation, (ii) how many times have approvals been made for chemotherapy drugs since its creation, (iii) what is the average approval wait time for a chemotherapy drug, (iv) is there a process for re-application, and, if so, what is the average approval time for re-application of a chemotherapy drug;

(w) what are the top 10 pediatric cancers since 2010 annually, broken down by province and territory, and, for each cancer, what is the (i) morbidity rate, (ii) mortality rate, (iii) five-year survival rate by stage, (iv) cost to the healthcare system; (x) for each rate in (w)(i) and (ii), what is the number of people affected; (y) what is the list of all rare cancers in Canada, how many people are affected by rare cancers, and what investments has the government made in their research; (z) what is the process for a clinician to access off-label chemotherapy options for a patient with a rare cancer, including (i) the average approval time, (ii) the re-approval process, and, if any, the average re-approval wait time, (iii) the approval success rate for application, (iv) if relevant, the approval success rate for re-application, (v) the approval success rate when a drug is already approved for use in another country; (aa) what is the average time to diagnosis for each of the (i) top 10 cancers, (ii) pediatric cancers, (iii) rare cancers, and what is the average cancer stage at diagnosis and the cost to the healthcare system, since 2010, broken down by province and territory; (bb) what was the average time to diagnosis for each of the (i) top 10 cancers, (ii) pediatric cancers, (iii) rare cancers, and what is the average cancer stage at diagnosis and the cost to the healthcare system, broken down by province and territory, and annually from 2019 to 2023;

(cc) how many people had to seek diagnosis outside of Canada due to either wait time or lack of diagnostic technology or procedure, and what was the cost to the healthcare system, broken down by province and territory annually since 2010; (dd) how many people had to seek treatment outside of Canada due to either wait time or lack of treatment that was available elsewhere, and what was the cost to the healthcare system, broken down by province and territory annually since 2010; (ee) how many people could not get a recommended chemotherapy because (i) they did not have health insurance, (ii) their health coverage did not cover a chemotherapy drug, (iii) their insurance covered only part of the drug cost, broken down by province and territory; (ff) broken down by province and territory, how many times has the federal special access program been accessed since its inception, (i) how many approvals have been made since its inception, (ii) what is the average approval time, (iii) is there a process for re-application, and, if so, what is the average approval time for re-application; (gg) what has each government invested in cancer treatment since 2010, broken down by province and territory; and (hh) how much has the Canadian Institutes of Health Research invested annually in cancer research since 2010, and specifically what has been invested in (i) the top 10 cancers, (ii) pediatric cancers, (iii) rare cancers, and how does this annual total investment compare to the United States?

[Questions Passed as Orders for Returns, May 29th, 2024]

With regard to women’s health in Canada and clinical research funded by the Canadian Institutes of Health Research (CIHR): (a) how much did the government invest in women’s health annually, from 2010 to present, and specifically, for the same time period, how much was invested in (i) aging, (ii) cardiovascular conditions, (iii) neurological conditions, and how did these investments compare to that of the United States; (b) how much did the CIHR invest in women’s health annually, from 2010 to present, and specifically, for the same time period, how much was invested in (i) aging, (ii) cardiovascular conditions, (iii) neurological conditions, and how did these investments compare to that of the National Institutes of Health (NIH); (c) broken down by all common female-specific conditions, including, but not limited to, endometriosis, fibroid tumours, pelvic inflammatory disease, and polycystic ovary syndrome, (i) what are the number of women impacted, (ii) what is the cost to the healthcare system, (iii) what are the effective diagnostics, if any, (iv) what are the effective treatments, if any, (v) is the condition under-researched, (vi) what is the annual investment since 2010, (vii) how does investment compare to that of the United States, (viii) what is the annual investment by CIHR since 2010, (ix) how does investment compare to that of the NIH;

(d) what annual investment has the government made since 2010 in (i) fertility, (ii) pregnancy, (iii) maternal health, (iv) reducing maternal morbidity and mortality, (v) breastfeeding, and how does investment compare to that of the United States; (e) what annual investment has the CIHR made since 2010 in (i) fertility, (ii) pregnancy, (iii) maternal health, (iv) reducing maternal morbidity and mortality, (v) breastfeeding, and how does investment compare to that of the NIH; (f) broken down by all specific female cancers including, but not limited to, cervical cancer, ovarian cancer, uterine cancer, vaginal cancer, (i) what is the number of women impacted, (ii) what is the cost to the healthcare system, (iii) what are the effective diagnostics, if any, (iv) what are the effective treatments, if any, (v) what is the average cancer stage at diagnosis, (vi) what is the annual investment by the government since 2010, (vii) how does investment compare to that of the United States, (viii) what is the annual investment by the CIHR since 2010, (ix) how does the investment compare with that of the NIH; (g) broken down by all specific conditions that disproportionately affect women including, but not limited to, autoimmune diseases, chronic pain, Alzheimer’s disease, osteoporosis, and specific cancers, (i) what is the number of women affected, (ii) what is the cost to the health care system, (iii) what is the annual investment by the government since 2010, (iv) how does the investment compare to that of the United States, (v) what is the investment in research by the CIHR annually since 2010, (vi) how does the investment compare to that of the NIH; (h) what percentage of CIHR’s budget is invested in the gender and health institute, and how does this percentage compare to each of the remaining institutes;

(i) does CIHR have a policy regarding the sex of animals used in pre-clinical research, and, if so, what are the details of the policy, including the date it came into effect; (j) does all CIHR-supported pre-clinical research require the use of female and male animals; (k) what percentage of CIHR’s pre-clinical research uses female animals, and how is that percentage measured; (l) what percentage of CIHR’s pre-clinical research reports on the sex of animal subjects, and how is it measured; (m) is it mandated that all CIHR-supported clinical research include women, and, if so, what (i) is the date of the mandate, (ii) is the policy, (iii) are the exceptions, (iv) are any requirements for analysis to include sex, gender, and intersectionality, (v) are any requirements for reporting on sex, gender, and intersectionality; (n) how specifically does CIHR track whether clinical research includes women, what are all questions on grant applications, and what questions and formulae are used to calculate the percentage of CIHR-supported clinical research involving women; (o) what percentage of CIHR-supported clinical research involves women; (p) what percentage of CIHR-funded research examines (i) sex, (ii) gender, (iii) intersectionality, and how are these measured; (q) what specific policies has CIHR put in place to ensure women of all ages and backgrounds are included in clinical research populations; (r) does CIHR provide support for research specifically focused on populations of women historically (i) under-represented, (ii) under-researched, (iii) under-reported, in clinical research, and, if so, what specific investment is made for each?

[Questions Passed as Orders for Returns, May 29th, 2024]

With regard to healthcare in Canada: (a) what is specifically included under universal health services; (b) has the scope of services included under universal health services changed since first implemented and, if so, (i) what are the changes, (ii) on what dates did these changes take place; (c) what are the specific services that are (i) funded publicly, (ii) not fully publicly funded; (d) what was the annual total health spending in Canada, broken down by year from 2010 to present; (e) what was the private total health spending in Canada since 2010 to present; (f) what, if any, publicly insured services are being offered for out-of-pocket pay, and, if relevant, what is the annual spending since 2010; (g) what was the annual per capita spending on health since 2010, and how does per capita spending compare to that of Organisation for Economic Co-operation and Development (OECD) countries; (h) what was the private annual per capita spending on health since 2010; (i) what was the investment in homecare since 2010, and, for each investment, (i) how many more people were served, (ii) what was the average wait time from approval to service delivery, (iii) has the wait time from approval to service delivery changed; (j) what, if any, mechanisms have existed to hold provinces and territories accountable on how they spend the health transfer, and, if relevant, what is (i) the accountability mechanism, (ii) the date;

(k) for each province and territory, what is the annual funding compared to the age-adjusted population growth since 2010; (l) for each province and territory, what is specifically included under universal health services; (m) for each province and territory, has the scope of services changed since universal health services were first implemented, and, if so, what are (i) the changes, (ii) the dates of the changes; (n) for each province and territory, what are the specific services that are (i) funded publicly, (ii) not fully publicly funded; (o) for each province and territory, what (i) is the percentage increase in healthcare service costs since the last health transfer, (ii) is the new negotiated health transfer, (iii) new services will the transfer buy for Canadians; (p) where does Canada rank with respect to amenable mortality among comparator countries, and (i) where have there been improvements, (ii) where specifically has there been a lack of improvement; (q) what does Canada spend on pharmaceuticals, and how does Canada rank among the OECD; (r) what are all of the pan-Canadian health benchmarks, and what is the target for each benchmark;

(s) for each benchmark, what is the percentage of patients receiving care within each of the pan-Canadian benchmarks, broken down by province and territory; (t) what is the percentage of patients receiving care within the benchmarks for (i) cataract removal, (ii) hip fracture repair, (iii) hip replacement, (iv) knee replacement, broken down by province and territory; (u) how does Canada rank with respect to service wait times for comparator countries, specifically to (i) see a general practitioner, (ii) see a specialist, (iii) be treated in an emergency department, (iv) receive advanced diagnostics, (v) receive elected surgical care; (v) what is the average wait time to (i) see a general practitioner, (ii) see a specialist, (iii) be treated in an emergency department, (iv) receive advanced diagnostics, (v) receive elected surgical care, in each province and territory; (w) how many people left an emergency department in 2022-23 without ever having been seen, broken down by province and territory; (x) what is the health and social services sector vacancy rate in each province and territory; (y) what is the physician supply gap in each province and territory and how does Canada rank against comparator countries; (z) in each province and territory, (i) what is the vacancy rate for nurses, (ii) what discipline has the highest vacancy rate;

(aa) broken down by province and territory, what percentage of Canadians lack a primary care provider; (bb) how does Canada rank on inequality in healthcare by income compared to other countries; (cc) what groups of Canadians have difficulty accessing primary care, and, for each group identified, how (i) is access to a general practitioner, (ii) is prescription use, (iii) is access to a specialist, (iv) are diagnostics, (v) is treatment, (vi) is morbidity, (vii) is mortality, impacted; (dd) in each province and territory, what percentage of cost is covered for prescription drugs outside (i) the hospital, (ii) homecare, (iii) non-physician mental health care; (ee) what percentage of income do Canadians in the lowest income quintile spend on their healthcare; (ff) what percentage of income do Canadians in the highest income quintile spend on their healthcare; (gg) broken down by province and territory, (i) how many more people were served with respect to long-term care since 2010 by each federal health transfer, (ii) what was the average wait time from approval to service delivery, (iii) has the wait time from approval to service delivery changed; (hh) broken down by province and territory, what percentage of hospital-bed days is designated to those awaiting long-term care; (ii) how does Canada rank with respect to comparator countries on (i) health outcome measures, (ii) patient-reported experience;

(jj) what specific data is collected at the federal level on medical errors, including, but not limited to, (i) patient harm, (ii) a foreign body left in after a procedure, (iii) obstetric trauma, (iv) postoperative pulmonary embolism after a hip replacement, (v) postoperative pulmonary embolism after a knee replacement, and how does this data compare internationally; (kk) what specific data is collected at the provincial and territorial level on (i) medical errors, (ii) patient harm; (ll) how does Canada rank with respect to comparator countries on (i) dental coverage, (ii) non-physician mental health care, (iii) vision?

[Questions Passed as Orders for Returns, March 18th, 2024]

With regard to international charters, conferences, consensus statements, declarations, policy, and national reports regarding sport and abuse, discrimination, and harassment: (a) following the UNESCO International Charter of Physical Education and Sport in 1978, and with respect to the statement that “sport practiced by all must be protected against any abuse”, what, if any, (i) actions were taken against abuse in sport, (ii) new requirements were adopted as a result of the Charter with respect to “appropriate qualifications”, “training”, and “further training” for each of those in administration, coaching, teaching, and volunteering, and on which dates between 1978 and 1988; (b) following the UNESCO International Charter of Physical Education and Sport in 1978, and with respect to the statement that “it is crucial that the fight against doping should win the support of national and international authorities”, what, if any, actions did Canada take, and on which dates between 1978 and 1988; (c) following the 1990 release of the Commission of Inquiry into the Use of Drugs and Banned Practices Intended to Increase Athletic Performance and with respect to the recommendation “that individuals and organizations in receipt of government funding meet the ethical standards as well as the performance standards required for funding”, what actions, if any, did Canada take in response to the recommendation for individuals and organizations, and on which dates; (d) following the 1990 release of the Commission of Inquiry into the Use of Drugs and Banned Practices Intended to Increase Athletic Performance, and with respect to the recommendation “that those involved in the health, care, and training of athletes are qualified to be so ethically as well as technically”, what actions, if any, did Canada take regarding ethical qualifications for all those involved in the health, care, and training of athletes, and on which dates; (e) following the 1990 release of the Commission of Inquiry into the Use of Drugs and Banned Practices Intended to Increase Athletic Performance, and with respect to the recommendation that “the measure of success of government funding be linked not to medal count, but to the degree to which it has met the social, educational, and national goals of government for sport”, what actions, if any, did Canada take to (i) disentangle medal count from funding, (ii) tie medal count to funding, and on which dates; (f) following the International Olympic Committee’s adoption of a Consensus Statement on Sexual Harassment and Abuse in Sport in 2007, what actions, if any, has Canada undertaken with respect to (i) developing “policies and procedures for the prevention of sexual harassment and abuse”, (ii) monitoring “the implementation of these policies and procedures”, (iii) evaluating “the impact of these policies in identifying and reducing sexual harassment and abuse”, (iv) developing “an education and training program on sexual harassment and abuse in their sport(s)”, (v) fostering “strong partnerships with parents in the prevention of sexual harassment and abuse”, (vi) promoting and supporting scientific research on these issues, and on which dates; (g) did any representatives of Canada attend the 5th International Conference of Ministers and Senior Officials Responsible for Physical Education and Sport in 2013, and, if so, what were the names of positions of all those who attended; (h) following the 2013 Declaration of Berlin, what actions, if any, has Canada taken with respect to Article 1.4 of the Declaration “recognizing that an inclusive environment free of violence, sexual harassment, racism and other forms of discrimination is fundamental to quality physical education and sport”, and on which dates; (i) following the revised International Charter of Physical Education, Physical Activity and Sport in 2015, what actions, if any, has Canada taken with respect to (i) “safety and management of risk”, (ii) Article 10.1 which states that, “All forms of physical education, physical activity and sport must be protected from abuse”, (iii) any identified harms, (iv) “bullying”, (v) “deprivation of education”, (vi) “discrimination”, (vii) “excessive training of children”, (viii) “homophobia”, (ix) “racism”, (x) “sexual exploitation”, (xi) “violence”, (xii) “potential risks, especially for children, of dangerous or inappropriate training methods and competition, and psychological pressures of any kind”, and on which dates were these actions taken; (j) following the issue of the Policy on Non-Accidental Violence and Abuse in Sport of the International Paralympic Committee in 2016, what actions, if any, were taken by Canada with respect to violations of human rights, including, but not limited to, (i) “bullying and emotional abuse”, (ii) “child exploitation”, (iii) “hazing”, (iv) “neglect”, (v) “physical abuse”, (vi) “sexual abuse and assault”, and on which dates; (k) did Canada attend the Sixth International Conference of Ministers and Senior Officials Responsible for Physical Education and Sport in 2017, and, if so, what were the positions of all those who attended; and (l) following the Kazan Action Plan, what actions, if any, did Canada undertake with respect to (i) “protecting the integrity of sport”, (ii) “III.1 Safeguard athletes, spectators, workers and other groups involved”, (iii) “III.2 Protect children, youth and other vulnerable groups”, and on which dates?

[Questions Passed as Orders for Returns, March 18th, 2024]

With regard to the Red Deer Declaration signed in 2019: (a) how many federal, provincial and territorial sport ministerial meetings have been held, and, for each meeting, what were the details, including (i) the date, (ii) the agenda, (iii) whether safety and integrity in sport were on the agenda, (iv) what specifically was discussed regarding safety in sport; (b) how many federal, provincial and territorial sport ministerial conference calls have been held, and, for each, what were the details, including (i) the date, (ii) the agenda, (iii) whether safety and integrity in sport were on the agenda, (iv) what specifically was discussed regarding safety in sport in each of the conference calls; (c) what intergovernmental goals have been developed to address abuse, discrimination and harassment in sport in the areas of (i) awareness, (ii) policy, (iii) prevention, (iv) reporting, (v) management, (vi) monitoring; (d) what intergovernmental actions have been taken in the areas of (i) awareness, (ii) policy, (iii) prevention, (iv) reporting, (v) management, (vi) monitoring; (e) what progress has been made on mechanisms to report and monitor incidents of abuse, discrimination, and harassment (i) federally, (ii) by each province and territory; and (f) what outcomes have been achieved as a result of signing the declaration?