[Recorded by Electronic Apparatus]
Thursday, April 25, 1996
.0907 
[English]
The Vice-Chair (Mrs. Gaffney): Attention, please. I'd like to start moving on with the agenda, although our chair is not here. He is on his way. I think because we have quorum, we can start. Our witnesses are all here and we do have a very constrained time frame, so I think it's important that we do get underway.
Welcome, committee and welcome to the first set of witnesses who are here today. I will have you introduce yourselves rather than me running down this list. I welcome you and we're looking forward to hearing what you have to say. I know we all have good questions for you.
Mr. Cochrane, are you the official leader of the group?
Mr. Paul Cochrane (Assistant Deputy Minister, Medical Services Branch, Health Canada): Yes, I am.
The Vice-Chair (Mrs. Gaffney): Good morning.
Mr. Cochrane: Good morning, Madam chairperson.
My name is Paul Cochrane and currently I'm the Assistant Deputy Minister of Medical Services Branch. With me this morning is Phil Martin, who takes care of our expenditures in Medical Services. I'm sure by now you know Mr. Orvel Marquardt.
As you've indicated, the committee staff have provided us with a list of some areas of particular interest. Before we get into a question and answer session, I'd like to take a couple of moments to set a context.
As you would be aware, recent federal budgets have established an Indian health budget envelope in which all departmental expenditures for first nations programs must fit. This budget set the growth rate at 3% for 1996-97 and 1997-98, with approximately 1% available for 1998-99. If we are to work together to achieve these targets, it is evident that the growth of the non-insured health benefits program must be contained.
At present, the non-insured health benefits program represents about half of all the expenditures within the Indian health envelope. We want to ensure that it does not consume a larger portion of the envelope at the expense of community-based programs. In fact, we would like to increase the resources in community-based programs. These programs, which include Brighter Futures and Building Healthy Communities, fund communities to take action on behalf of children and actions that are community-based.
.0910
Nurses who work for Medical Services Branch, and at an ever-increasing rate band nurses and community health representatives, run well-baby clinics, prenatal classes and immunization clinics, and provide parenting skills to first nations peoples. Services focus on pre-school and school-age children, and include an innovative dental therapy program.
In addition, much of the focus is on mental health programs. As we are all too aware, the problem of adolescent suicide and self-destructive behaviour is at times a serious factor in first nations communities. In addition, we run a solvent abuse program that provides prevention and treatment.
As we move forward in working with first nations, our strategic direction is to ensure that they control their own programs. To date, 65% of first nations are at some stage in the transfer process in taking control of their own programs. This represents transfer agreements with some 141 first nations. Transfer is a major pillar in improving the health of first nations.
As I said at the beginning, we want to ensure our efforts are directed at funding programs at the community level, and to the largest degree possible, containing the growth of non-insured. If we can work with first nations and provide them with additional resources, these resources will be directed most effectively to address their health priorities and thus build healthy individuals, healthy communities and healthy first nations. Thank you.
The Vice-Chair (Mrs. Gaffney): Thank you.
Was anyone else speaking, Mr. Cochrane?
Mr. Cochrane: No.
The Vice-Chair (Mrs. Gaffney): Thanks very much. You're really to the point. We were going to give you five minutes, but I think you're under your five minutes, so that's perfect.
Mr. Cochrane: I'm operating on Newfoundland time, so that's why.
The Vice-Chair (Mrs. Gaffney): Mr. Dubé, you're the lead-off person for the Bloc Québécois.
[Translation]
Mr. Dubé (Lévis): I am new on this Committee and I am still involved with the Standing Committee on Human Resources Development. Therefore, I will have to base my questions mostly on the document prepared by the Library.
Page 2-10 of the Estimates indicates an increase of $25.7 million over 1995-96 funding for the Child Development Initiative. Then, on another page, I see that there will be an increase of $36 million over 1995-96 for the same Initiative.
Could you explain the difference? Could you tell us what part of those increases will be allocated to programs implemented by your Branch? Is it new money that is additional to the original $500 million allocated to the Child Development Initiative?
[English]
Mr. Cochrane: The increase is to two different programs. Under the program that you will hear about from my colleague, Kay Stanley, the child development initiative, there has been a decrease of approximately $10.3 million. But under the Medical Services Branch portion of the program, for which I'm responsible, there has been an increase of $36 million. So the net effect within the departmental allocation for the program is an increase of $25.7 million. So the $25.7 million you referred to in your question is a net of an increase of $36 million in the first nations program, and a decrease of $10.3 million in the rest of the program.
.0915
[Translation]
Mr. Dubé: Do you have an explanation for the $36 million increase I have referred to?
[English]
Mr. Cochrane: Yes.
[Translation]
The amount of $36 million relates to the budget increase over our program for the Aboriginals. For the department as a whole, there is a total of $25.7 million because the program of my colleague, Kay Stanley, will be cut by $10.3 million.
Mr. Dubé: Can I continue?
[English]
The Vice-Chair (Mrs. Gaffney): You can continue, sure.
[Translation]
Mr. Dubé: Pages 2-171 and 2-172 of the Estimates provides a general list of grants and contributions.
Could you provide a more detailed breakdown for the Committee of the grants and contributions? Could you provide a list of HPPB programs currently falling under each component of the Child Development Initiative? How much money is designated for each of the components of the CDI for the year 1996-97?
[English]
Mr. Orvel Marquardt (Director General, Departmental Planning and Financial Administration Directorate, Corporate Services Branch, Health Canada): I am sorry, but we don't have the details behind all of the grants and contributions listed on those pages. A list of that type would consist of of about 5,000 projects for the department and would be quite a mass of paper. If there are any particular projects within one of those programs, we could respond to that, perhaps.
Mr. Cochrane: I could highlight the types of programs that are represented by those expenditures.
On page 2-156 for the Indian health program, two-thirds of the way down the page, it says Medical Services and Indian and Northern Health Services. The programs for which we in Medical Services have responsibility are broken out into several main categories.
The first category is called contributions for integrated Indian and Inuit community-based services. These programs represent the NNADAP program, the Brighter Futures program, Building Healthy Communities, and Health Services. These programs are now called integrated because they are managed by first nations.
The next group is called control and provision of health services. Those programs are transferred to first nations, and they have the resources and can make the decisions about how the funds are spent. That represents an additional $75 million.
If you continue you will see special initiatives, which represent slightly more than $9 million. Those are the initiatives for AIDS, the drug strategy and the green plan. Moving on to non-insured health benefits, those are the contribution funds that first nations manage, largely for transportation within their communities to access health services.
The next group is called control and provision of non-insured health benefits - $10 million. Those are innovative pilot projects, some 30 across the country, which are allowing first nations to demonstrate different ways of using those resources to meet their health needs.
The next one is for health facilities - that's about $17 million. That constructs nursing stations and health centres on reserves.
.0920
This next one is health careers, which is $2.4 million. That provides two sources of funding, scholarships and bursaries, to first nations individuals and it also provides money for bridging programs. For example, in northern Manitoba and in Saskatchewan there are bridging programs with universities that allow first nations individuals to upgrade their skills prior to entering into nursing programs, medical programs, and dental programs. It's money that is used to work with universities for bridging.
The next amount of money is an agreement with the province of Newfoundland and the aboriginal people of Labrador, which provides them with services over and above those provided by the province.
The next amount is for consultation. These are moneys we provide to organizations such as the Assembly of First Nations and the Assembly of Manitoba Chiefs, to allow them to consult with their first nations and gather information about health needs. Then when they sit down at the table with us, it's an informed dialogue where they have the opportunity certainly to put forward their positions and their aspirations.
The last one is a very specific contribution to the Government of Yukon. It's the last and final payment for the federal contribution toward the replacement of the Whitehorse General Hospital. That contribution will be made this year and will be the last in a series of contributions that total $45 million to the Government of Yukon for the replacement of that particular facility.
The Vice-Chair (Mrs. Gaffney): There's still a minute and a half left of his time. Madam Picard, would you like to use the rest of his time and then I can come back to you on the second round? Okay.
Mr. Szabo.
Mr. Szabo (Mississauga South): As a result of the aboriginal health study the committee did last year, it was quite an education for members. I want to dwell on the aboriginal concentration here.
Do we have figures that first of all give us an idea across the first nations groups of what proportion of the first nations live on reserve versus off reserve? While we're looking that up, what proportion would you classify as remote locations versus generally settled locations?
Mr. Cochrane: Do you mean accessible locations?
Mr. Szabo: Yes.
Mr. Cochrane: We're responsible for first nations, not aboriginals. In terms of the status population, where we focus our attention, at the end of last year that population was about 604,000 across the country. Of that total population, approximately 325,000 resided on reserves, so just in excess of 50% resided on reserves. Of the remainder, as you probably saw in your travels, there are some predominant concentrations in places like Kenora and Thunder Bay and there are large aboriginal communities in Winnipeg, Regina, and Calgary.
Of the population, I certainly don't have the figure, Mr. Szabo, of how many actually would be in isolated locations. But just from my experience, I would suggest that of the 604,000 status Indians, and if you take 50% of them on reserves, about 60% of those first nations individuals live in communities that would either be considered remote or isolated.
Mr. Szabo: Is that 60% of the 50%?
Mr. Cochrane: Yes, that's right, 60% of the 50%.
Mr. Szabo: That would be about a third.
Mr. Cochrane: That would be about 180,000 who actually live in remote northern locations. The others live, as you saw, in many communities in Alberta, for example, some of them next to Calgary, which are certainly road accessible.
It is the same thing in southern Ontario, where there are major communities like Akwesasne, Tyendinaga, Six Nations Reserve. Our Six Nations Reserve is very close to Brantford; Akwesasne is located just south of Ottawa contiguous with Cornwall and upstate New York; and Tyendinaga is in the Belleville area. So you have a wide distribution of communities that I guess very much represent a microcosm, in some sense, of the Canadian population.
.0925
Mr. Szabo: Okay.
The non-insured health benefits, a major component of this, really have to do with remote problems - transport and the like - to get reasonable quality services out there. The cost of that is not in question; you have to do it. It's simply a commitment that's made by Canada.
If we could take out the cost associated with being a remote community from all that we provide to the first nations people - and knowing that for instance alcohol problems are quite a bit higher than they are in the rest of non-aboriginal populations and similarly for some problems in terms of health - do you get any indication of the cost per capita of providing health care to first nations versus non-first nations people?
Mr. Cochrane: Certainly the way you phrase the question is extremely difficult to subtract, for example, transportation within our non-insured health benefits budget. About $140 million is spent on transportation.
Mr. Volpe (Eglinton - Lawrence): I'd say get our own airlines.
Mr. Cochrane: That represents transportation all the way from Conne River in Newfoundland to Alert Bay in B.C.
It's quite expensive to travel, as any members from the north would recognize. It's almost impossible to sort of subtract out what you're suggesting, but in terms of comparisons let me give you a couple of comparisons we have.
We've done a comparison on the per capita cost for first nations under our drug benefit program, comparing it to the per capita cost for the Ontario drug benefit program. If we use that as a comparison then the per capita cost for first nations, in terms of the drug benefit program, is anywhere from 10% to 20% less per capita than through the Ontario drug benefit program.
What that tells us is that while some people suggest that drug benefits are more readily available or accessible to first nations, if you use that one comparison - and that's not perfect - the first nations' utilization is actually less.
Mr. Szabo: I think this is very helpful, because this is the kind of bias or misinformation that I've heard from others about the first nations getting overfunded on the health care thing. If you really stripped it down, there is some pretty substantive evidence that in fact first nations people do not get a disproportionate amount of health care funding.
I think I'm satisfied on that, and I hope you will help us get that kind of information so that we don't fall into those traps.
There is one last thing I want to ask, if I may. As you know, we're doing some work with regard to preventative strategies for the good health of children. Do you have any information? Because we have such a young population within the first nations; its average 14 years of age and under accounts for almost half the population.
Mr. Cochrane: It is 40% of the population. In fact under age 14 represents 31% of the population and under age 24 represents 50% of the population.
Mr. Szabo: So we have a very young population. I don't know what that means in terms of the quality of health care or parental care, or whatever, that was given during those periods, but there must be a body of knowledge developing that indicates some of the factors that have affected the health of these young people. How healthy are they? Are they healthier or less healthy than non-first-nations children in terms of their outcomes? Do we have any indication or have we any opportunity to figure out what it was?
I keep hearing that issues such as bonding and parental closeness in a generic sense is probably one of the major contributors to secure healthy attachments, etc. I'm very interested. I know you can't do our work for us, but if you can, I would like to at least have an indication from you as to whether this is an area we should look at to see whether we can learn something from the experience of the first nations people.
.0930
Mr. Cochrane: You've certainly pinpointed an area that is of interest to first nations communities and into which we put a lot of our resources. There has been improvement in the health status of first nations and first nations children. Infant mortality rates, for example, have decreased significantly over the years, but they still remain somewhat higher than in the Canadian population. The rates have gone down from 28 per hundred thousand in the early 1980s to about 12 per hundred thousand. So the rates have gone down.
What you'll find with the population you're focusing on is that the population is going to be very vulnerable to several factors. If there's a baby boom in first nations communities, it's about 20 years behind the overall population. There's a very large number of first nations children who are moving into a very at-risk area. That is the group of children who are moving into the adolescent stage - 13 to 19. All of the statistics will demonstrate that it puts these children most at risk for suicide, for self-destructive behaviour, for issues of abuse, etc.
Unfortunately, what first nations communities are facing - and you talk about bonding - is that there is a generation that has an absence of really good parenting skills. You will ask why that is. We're still working through the generation of people who largely were taken out of their communities to residential schools. This group of people, who are now parents, didn't have the luxury or the privilege of staying in their communities and learning parenting skills from their parents and their grandparents. So there is this absence of really good parenting skills in that group. Now the children of that group, as I say, are becoming very much at risk, and parents are having difficulties dealing with that. So there's a greater need for the overall community to try to deal with it and for us to work with them to try to deal with it. That's an area of significant interest.
The Vice-Chair (Mrs. Gaffney): I might have to -
Mr. Cochrane: Madam Chair, I understand, and I'll move on. Just for the committee, this sounds like an area we should -
The Vice-Chair (Mrs. Gaffney): Explore further.
Mr. Cochrane: I hope we'll have an opportunity to carry on.
The Vice-Chair (Mrs. Gaffney): Thank you. It's very interesting. I'm sorry that I have to cut you off, but I must move to Madam Picard.
[Translation]
Mrs. Picard (Drummond): The Child Development Initiative Program is reaching its final year. On page 2-43 of the Estimates, it is noted that final evaluations were carried out in 1995-96. Have the programs been evaluated separately and, if so, can you provide a copy of those evaluations?
[English]
Mr. Cochrane: Yes. The programs were reviewed, but not necessarily separately. There was a review of the initiatives, and we can provide you with that information. What I can tell you in general is that the evaluation that was conducted addressed factors like relevance, the success rates, and the cost effectiveness.
In general, in talking to communities and in talking to providers, it was found that the community-based approach that was used was deemed to be a successful strategy in terms of allowing communities to develop solutions, because we didn't construct a model that communities had to use. What we did was allocate resources across the country. In virtually every one of our regions, a first nations group of individuals established a committee. They decided the priorities for the program, and they decided the funding proportions, if you will, for the program. Now we see communities developing innovative child care programs and innovative child care practices in the community.
.0935
You said it's the last year of funding; that's not the case. It's the last year for a new increment of funding. The program now has a base of about $56 million a year. That $56 million remains in our A base, and remains available to those communities for this type of program.
[Translation]
Mrs. Picard: Last year, in his report, the auditor-general stated that it is very difficult to evaluate the programs established for the aboriginal people. I am not saying that the Aboriginals do not need those programs since it is obvious that they face some very specific problems. Therefore, it is important to help them as much as possible. However, we see that the budgets increase each year but we find that it is very difficult to evaluate the programs and we do not know if they are really effective. How can you make sure that the programs are really set-up on the basis of the real needs of aboriginal people? How can you make sure that the evaluations are really relevant and useful?
I wonder if you could make some suggestions to the auditor-general in order to allow him to provide the right answers in his report, at the very time that you increase the funding of those programs.
When we were dealing with our report on aboriginal wellness, many witnesses came to tell us "often" - one has to be careful about this - that cheques issued to fund some programs were sent to band chiefs but that the persons responsible for implementing the programs did not see a cent of that money. Can you answer that criticism?
[English]
Mr. Cochrane: There are really two issues here: are the programs meeting the needs, and is there efficacy in the way the money is spent?
In terms of meeting the needs, we certainly have found that trying to devise solutions that fit the predominant culture, as we basically know it, has not been terribly successful in terms of first nations communities. For those of you who travelled last year, you will see the uniqueness of the communities culturally, linguistically, etc. So to the largest degree possible, we try not to second-guess the communities.
What we do is work with the communities, provide them with advice and professional assistance, either from our resources or from other health care providers, and let them design a program that fits a community like, for example, Big Trout Lake in Ontario or Montreal Lake in Saskatchewan. We found that -
The Vice-Chair (Mrs. Gaffney): Mr. Cochrane, let me just interrupt you for a minute. This is a very important answer, but Madam Picard's preamble was long. We're five minutes into our second round. Is there some way we can be concise? Because the five minutes are up, yet I want to hear the answer, as does Madam Picard. I don't know.
Mr. Cochrane: Well, it's hard to answer a question like that by saying yes or no.
The Vice-Chair (Mrs. Gaffney): Right. With the indulgence of the committee then, can we have Mr. Cochrane's answer?
Some hon. members: Agreed.
The Vice-Chair (Mrs. Gaffney): Thank you.
Mr. Volpe: I want to see how close he gets to the answer.
Mr. Cochrane: Probably not very close, because it's not black and white.
.0940
So we've let the communities design the programs to suit their needs. That's the answer to the first question: how do we work to ensure effective programming.
On the side of resources, there's a fine line to walk between first nations control and authority and accountability both back to the minister and to Parliament. That is a very fine line.
In my experience - and I've worked in this program for 20-some years - I find that the bad news stories attract far more attention than the good news stories. There is no doubt that from time to time there are first nations communities that have funding difficulties. In some cases one may even say that they're deficit financing in first nations communities.
But again, in my experience, most communities make decisions that are generally sound financially, because they have an accountability to the community. And can you say that it's perfection; it is not. Can you say that mistakes are made; there are mistakes made. But we work with those communities.
If we identify a deficiency in funding or some abnormal use of funding, we'll do an audit on a regular basis, and we'll put follow-up plans into place. So we do protect the integrity of the dollars, but try to allow as much community decision-making as possible on how the dollars should be spent.
The Vice-Chair (Mrs. Gaffney): Thank you. Mr. Volpe.
Mr. Volpe: Very briefly... And this is another one of those yes and no questions. I was intrigued by your response earlier to Mr. Szabo that we're dealing with a blip in the population that's really deficient in parenting skills. Presumably that means you believe that the cohesion and health of the first nations communities is dependent in part on a good solid family structure -
Mr. Cochrane: Absolutely
Mr. Volpe: - especially in remote or isolated areas.
If you have a deficiency of those parenting skills, and you're dealing with a population, 50% of whom are under of the age of 25, 31% of whom are under the age of 14, do you get some strategies in place that are going to resolve the problem that you see in terms of parenting and social skills?
Secondly, do you have a projection of the costs, as you see them, that are consistent with the approaches you're using today, as that group under 14 and yet under 25 moves into its own parenting mode?
Mr. Cochrane: The answer to the latter question is no. We haven't done any costing models as that group moves through the system. But we have done something in the last three to five years. Virtually all the incremental resources that the government and Parliament saw fit to allocate to the program have been moved into those areas in the communities, working with children, working with parents.
So we've focused whatever incremental resources possible at the community level, and tried to work with communities at targeting the problem. But we don't have a model as yet that suggests the costs as they move through the system.
Mr. Volpe: I realize this supplementary might be a little unfair, and I'll acknowledge that before I ask it. But in view of the fact that the most troublesome - if I may use that word - group in the communities is that group that was removed from the communities and given a set of values that was inconsistent with the experience from which they came and into which they've re-entered, are the strategies you have in place dependent on the same type of value system, or are they there to regenerate what was there before you intervened?
Mr. Cochrane: Well, I'm not willing, I don't think, to say that was I was an intervener, which -
Mr. Volpe: I'm sorry, let me use the corporate ``you''.
Mr. Cochrane: - disrupted the balance, but yes indeed, we do.
.0945
What we find in working with communities who have this gap - and I don't think I'm saying anything that you wouldn't hear if you went to Big Trout Lake or Pikangikum yourself.... I don't like to speak on behalf of first nations, but sometimes you have to paint the picture. The first nations culture, particularly in the north.... In the south there wasn't the same loss of culture; the culture remained much stronger on a general basis. But in the north there was a great loss of culture, and that is what first nations communities are now using, in terms of their own teachings, their own language, far greater use of the elders, and in terms of passing back those skills we talked about.
As you may know, aboriginal culture is largely a non-written culture. It is largely dependent on the linguistic, and stories and traditions are passed on that way. So there's a real - I would call it - rebirth of culture, of the recognition of the role of culture in these communities. In health, for example, the medicine wheel concept is now far more prevalent in communities for teaching about holistic health than it was in northern Ontario or northern Manitoba 15 years ago.
I think first nations had their own plan. What we're trying to do is assist them to utilize these resources, because some communities are far better equipped to deal with this situation than others. Rather than bring in an expert from Toronto to help a community like Big Trout Lake, it's far better to bring in another elder, a respected leader from Sandy Lake or Pikangikum to work with the community. That's what we find communities are doing now. They're putting together their own support networks to fill the void. We're helping to provide the resources, so they can do that.
The Vice-Chair (Mrs. Gaffney): Thank you very much.
We have time for one more question before we end this part of the session. Madam Picard, did you have another question?
[Translation]
Mrs. Picard: Last year, Mr. Cochrane, in the summer of 1995, the Committee produced a study titled Towards Holistic Wellness: The Aboriginal Peoples. When we prepared that report, we certainly did not expect - as we told the various program directors - that it would be shelved.
On April 18, 1996, the Committee received a two-page letter from the minister acknowledging the report. None of the specific recommendations were addressed in detail. The letter referred to "work with the national aboriginal associations on the Red Book commitment to initiate a comprehensive health policy, designed by and for Aboriginal peoples."
Could you tell the Committee whether your Branch had a role in preparing the requested response? Could you provide the Committee with some details about the work on the comprehensive Aboriginal Health Policy?
[English]
Mr. Cochrane: Yes indeed, we certainly participated in the review of the report. In fact Health Canada was the lead department with other departments that participated in the review.
There are a number of recommendations in the report. The report certainly reinforced very strongly community involvement, community solutions, community answers, which we've talked about.
As I indicated in my brief opening comments, currently we have 141 first nations communities that are in transfer. We have an equal number that are considering transfer. The report strongly reinforced that policy direction. In a sense, there was no necessity for a new policy direction, but the report certainly reinforced that, and gave us another source of validation for that approach.
.0950
In terms of the recommendations concerning a national look at this particular problem, last year we funded the five major national organizations to begin the process of developing an aboriginal health policy. Those five organizations have now prepared preliminary reports. We will be having a round table with those organizations very shortly to discuss how we can move together with those organizations to the next step of the process.
If there is an approach that can be compatible for all organizations, it is intended to provide them with additional resources this year to have a more extensive input into the process. At the end of the day, hopefully they will agree on a consistent and comprehensive aboriginal health policy. So we are proceeding with that. We are working with those organizations and we hope more substantive progress will be made this year.
The Vice-Chair (Mrs. Gaffney): Thank you.
[Translation]
Mrs. Picard: I am extremely disappointed because we had invested lots of time on this issue and we had promised the Aboriginal communities that the report would lead to some specific measures. As a representative of the Bloc québécois, I am very disappointed by your answer because you have just told us that our recommendations were only confirming the direction that you had already taken, whereas we had been looking at this issue for six months. We invested a lot of time and money in that.
[English]
The Vice-Chair (Mrs. Gaffney): A brief response, please.
Mr. Cochrane: I could appreciate your concern if we weren't moving in the direction the report reinforces, if we had a policy position in health that was at odds with the report. But the report, along with other reports such as the forthcoming report from the Royal Commission on Aboriginal Peoples, together form a cohesive and consistent set of recommendations that will guide our further policy development in this area.
The Vice-Chair (Mrs. Gaffney): Thank you.
This concludes the first part. Thank you for coming in. Obviously the Medical Services Branch is a big branch with a lot of responsibility. We've only managed to touch on a small part of that in the one hour we've had here, which is unfortunate, but this is the way of committees. Perhaps sometime in the future we will have the opportunity to call you back to further question you on it.
Mr. Cochrane: I'd be pleased to provide you with information, come back to see you, or brief individual committee members in gaining a fuller understanding of the program.
The Vice-Chair (Mrs. Gaffney): Committee members might wish to do that, and I hope they do. Thanks again for coming in.
Mr. Cochrane: Thank you, Madam Chairman.
The Vice-Chair (Mrs. Gaffney): I'm going to turn the chair over to our official chair.
.0954
.0958
The Chairman: Order.
My apologies to the committee and to the earlier set of witnesses for not being here at 9 a.m. A couple of us were at the national prayer breakfast, maybe because we need prayer more than the rest of you. It ran on a little longer than we thought, so here we are.
We're going to get a bell at some point in the next few minutes, so we are going to ask the witnesses to sit there for a moment while we deal with an item of business that we cannot delay. The subcommittee on HIV-AIDS needs some money, so it needs a decision from this committee.
We've circulated two documents. Deal with the one labelled ``committees and parliamentary associations directorate''. It's a travel cost estimate for the subcommittee on AIDS to go to Vancouver. The requested amount is $10,599.34. This has come to us from the subcommittee on AIDS, on which all parties are represented, so I would suggest that there is not a lot of need for discussion.
.1000
Mrs. Hayes (Port Moody - Coquitlam): I want some clarification. My understanding was that our motion was for one MP and one researcher. Oh, I guess that's the two fees.
The Chairman: Yes. If you look on page 1, about halfway down, it says exactly that - one MP and one staff.
Mrs. Hayes: Okay.
Another point I'd like to make.... If this is an outside amount or if this is.... For instance, we did comment in our committee meeting that the $285 per night accommodation estimate was high. I'm certainly from that area. Even if the area is full as stated, I think we could possibly lower that fee if we looked closely.
The Chairman: Nancy Hall.
The Clerk of the Committee: My understanding from speaking to the conference organizers is that most of the hotel rooms in the Vancouver area are booked. The only rooms that we could find available are at that cost. We can try to get rooms that are cheaper than that, but the problem is that there are thousands of people descending upon Vancouver for that conference. That is the outside cost. That is the maximum we would have to pay. The other factor is that once this budget leaves here, it has to go to the budget subcommittee of the liaison committee, so that process could take a number of weeks as well. We may find that's the price we have to pay to get a hotel room.
Mrs. Hayes: Could a reservation be done now in light of...? I ask that because usually there's not a -
The Clerk: In this situation we've already tried to do that, and they require confirmation at this point. So they need an advance payment at this point to make a final booking.
Mrs. Hayes: A credit card won't do?
The Chairman: I need a motion.
Mrs. Gaffney: I so move.
The Chairman: Beryl has moved that we approve the requested amount from the subcommittee for travel purposes. Are you ready for the question?
[Translation]
Mr. Dubé: I had understood that it would be only one member on behalf of the Committee?
[English]
The Chairman: You just saw the reverse of the NIMBY syndrome. If it's in my backyard, it's okay.
Some hon. members: Oh, oh!
Motion agreed to
The Chairman: Would you look at the other piece of paper, which is labelled at the top summary - sommaire. Nancy Hall, talk me through this one.
[Translation]
Mr. Dubé: If a member wanted to use his points and pay his own expenses to go to the conference, could he do so?
The Chairman: Yes.
Mr. Dubé: Thank you.
[English]
The Clerk: The summary you have on the front page shows these are operating cost expenses. As the committee is aware, we receive at the beginning of every fiscal year $10,000 as start-up costs. On each project, we then have to go to the budget subcommittee of the liaison committee for approval. This summary shows the costs for the child health study from now until June. It also includes two budgets that have been approved by the subcommittee on Bill C-222 for its operating costs. As well, the subcommittee on HIV/AIDS has approved a budget that you will see here for its costs anticipated between now and June. So the amount you see at the bottom shows the total cost less the $10,000 received on April 1. The total combined supplementary request for the standing committee and the two subcommittees would be $35,300, and that's to carry the committee and the subcommittee through until June.
The Chairman: I need a motion to adopt the supplementary budget request.
Mr. Murphy (Annapolis Valley - Hants): I so move.
Motion agreed to
The Chairman: Thank you very much for that. We needed to get that out of the way.
We're trying very hard in this committee to get on with the study we've told ourselves we're going to do on strategies for healthy children. The problem is that we have other obligations as a committee, including the vetting of the estimates, which we're in the process of doing today, and some legislation, which Beryl's committee is looking after at the moment. So there are other issues we have to keep dealing with.
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So I say that in the context of an apology to the witnesses. You're going to be given short shrift here this morning. It's going to be sweet and to the point, I tell you, because the bell is going to go. The bell we just heard was to convene the House. There's going to be another bell shortly to call us to a vote. Once that bell goes, we'll have about half an hour to get ourselves over there.
It's not practical to try to reconvene after, because of the availability of the room and other people's schedules. It would be fully 11:30 a.m. before we get back here. So that's why we're going to have to be short and sweet.
I'm going to welcome our good friends from the department, Kay Stanley and her colleagues, including our ongoing presence, Orvel. I call him Krazy Glue. He appears to be what keeps that crowd together over there. Every group that shows up has Orvel with it. We make light of it every year, but we're delighted to have you again, Orvel.
Kay, would you introduce your team, give us the briefest of opening statements, then we'll have some questions?
Ms Kay Stanley (Assistant Deputy Minister, Health Promotion and Programs Branch, Department of Health): Thank you, Mr. Chair. Yes, he is the glue that sort of keeps us together and makes sure that what we say is consistent with the record.
I am joined by Catherine Lane, director general of the population health directorate in the Health Promotion and Programs Branch, and by Diane Kirkpatrick, director general of the systems for health directorate. Kathy Stewart and Hervé Leblanc, from the branch, are also with us this morning.
I will not give an opening statement. I think the members of the committee have received a draft of it, so I don't want to take up the time of the committee. I know this is a key time for questions.
I do want to just say a couple of words in context, though, Mr. Chair, in the sense that I think the last time I appeared before the committee, we had another name. It was Health Programs and Services Branch, and now it's Health Promotion and Programs Branch.
This is because we really do want to flag the importance of health promotion to the federal mandate for health, which is of course to assist Canadians in maintaining and improving their health. This branch, or my branch, is centred on health promotion and disease prevention, support for health system renewal and health research, of course, which is carried out through the department's national health research and development program.
The other comment I want to flag for the attention of the members of the committee is that our activities support Health Canada's four business lines.
There's a tendency I think to see us in the context of one, but we really have a role to play in health system support and renewal, and health services to first nations. Of course, you heard my colleague, Paul Cochrane, in the first hour this morning on the management of risks to health, which is predominantly an activity centred in the Health Protection Branch, but in which we have a key role. And, of course, there's population health.
This latter business line has been, and will increasingly be, the focus for our branch. We have reprofiled some of our resources to ensure that they are targeted to population health priorities.
So with those few words, Mr. Chair, I'd be quite ready now, in light of the time, to turn the questions over to the members of your committee.
The Chairman: Pauline.
[Translation]
Mrs. Picard: I see on page 2-1o of the Estimates an increase of $25.7 billion over 1995-96 funding for the Child Development Initiative.
Can you explain this increase? Is it new money that is additional to the original $500 million? Can you tell the Committee how these funds will be spent? Will they be provided to individuals, to groups or to organizations?
Could you provide the Committee with a list of HPPB programs currently falling under each designated area or component of the Child Development Initiative?
Ms Stanley: Thank you, Mrs. Picard.
[English]
My colleague answered, I think, the first part of your question in the first session. The additional resources, the $25 million, was an increase to the Medical Services Branch. I think Mr. Cochrane dealt with that aspect when he answered your question in the first session.
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Let me spend a few moments talking about the purpose of the Child Development Initiative, because it is designed to promote the health and well-being of children at risk, especially those children who experience or are likely to experience a higher than normal incidence of poor health and nutrition - we are referring here to those with mental health problems, developmental problems, disability or injury and abuse and neglect. This program is run with grants and contributions, both of which support projects through appropriate non-governmental organizations and not-for-profit organizations, and also support research.
We have three granted contribution programs under the Child Development Initiative. Many members of Parliament will be familiar with this. The health promotion contribution program, often referred to as Brighter Futures, is a national program that increases the public's participation in health promotion programs, policies and strategies related to children's health. We are speaking in areas of preconception health, pregnancy, healthy babies, breast feeding and reducing the incidence of childhood injuries. In 1996-97 there's $560,000 in that particular program.
We have the children's mental health strategies. Grants and contributions are delivered in both program development and research, and the amount for 1996-97 in that area is $538,052.
The largest component is the community action program for children. This funds community groups to establish and deliver services that address the developmental needs of children at risk. These are long-term financial assistance programs provided through contributions. In 1996-97 there's $48.4 million in CAPC, and in subsequent years funding will level off at about the $32 million to $33 million level.
In addition to the activities that are focused on children, we have the community support program of Canada's drug strategy. A sizeable amount of that is spent on areas of concern to children, as well as the tobacco demand reduction strategy, which has a focus on children and youth. Under our national health research development program we're funding research into areas such as childhood injuries, low birth weight infants, childhood diseases and illness, paediatric aids and interactions between parents and child. I took note of the interest of the committee members in terms of things we're doing in the department to strengthen family relations, and some of this research will assist in that area.
[Translation]
Mrs. Picard: Ms Stanley, when you decide to increase the budget of a program such as the Child Development Initiative, I suppose that you have already carried out the relevant studies and that you have evaluated the need for such an increase.
You know that the Committee is on the verge of studying the health and wellness of children. Could you give us some help on this? Is there any specific issue that the Committee should review? Do you think that the results of this study could help you in your work?
[English]
Ms Stanley: I think we had a discussion on evaluation at the time I appeared before the committee studying strategies for healthy children. The Child Development Initiative involves six federal departments, and Health Canada is responsible for the majority of those programs under the CDI. We recently completed an evaluation, which should be available to members of the committee by the end of June. This evaluation focuses on the 26 programs - there are a total of 33 programs in the Child Development Initiative - in our department. The evaluation that I will make available to the committee members through the minister in June focuses on Health Canada's programs with respect to their continuing relevance, how successful they've been and their cost-effectiveness.
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We have a second evaluation under way in the form of a contract with Price Waterhouse. This is an interdepartmental evaluation that deals with all 33 aspects of the Child Development Initiative. We expect that evaluation will be completed and available in July of this year. As has been our practice in the past, we will make that available to the clerk of the committee for the discussion of the members of the standing committee.
The Chairman: Mrs. Hayes and then Mr. Murphy.
Mrs. Hayes: Thank you, Mr. Chairman. As this session is shorter, Mr. Chairman, will we have an opportunity to question these witnesses at another time?
The Chairman: That's a committee decision. This morning I was just pointing out the impracticality of trying to return here after the vote because of the unavailability of the room and that kind of thing. If the committee feels the need to recall some of the witnesses, we can do so at another time.
Mrs. Hayes: Okay.
The Chairman: But my advice is that you treat the witnesses as though this is the last time you're going to see them until next year.
Some hon. members: Oh, oh!
Mrs. Hayes: I want to pursue two topics. I think both fall within your purview, so I'll have to be very short and hopefully you will be too.
The first question comes from our discussions with MRC the other day and some of the questions I had there. You are probably aware of that if you've been reviewing the discussions. It specifically has to do with the centres of excellence and the naming of these places. I may have missed it, but as I look through the estimates I see no indication as to what, who and where the responsibility lies for this vague network of.... It isn't the network of centres of excellence, we've determined, it is another network with the same name. Maybe network is not the right word, but there are several places in Canada called centres of excellence. Where are these, what are they, who do they report to and what is their budget? If there is a substantial difference in how they operate, what about their accountability?
Ms Stanley: To clarify, Mrs. Hayes, are you talking about the centres of excellence for women's health?
Mrs. Hayes: That is one of them, and there's one on AIDS and there are others.
Ms Stanley: Yes.
Mrs. Hayes: I don't know where to track these down.
Ms Stanley: Maybe I can be helpful. I would ask Diane or Catherine to jump in if I leave out something.
You're right, there is a network of centres of excellence. I think the definition of what constitutes a centre of excellence varies, depending on the issue.
To put aside the emerging one or the ones that are about to come on the scene - the centre of excellence for women's health - the minister will be dealing with the results of an extensive peer review exercise that's been under way. This is the responsibility of my colleague, André Juneau, the ADM of Policy and Consultation Branch, because the centres of excellence for women's health fall under the purview of the Women's Health Bureau. Discussions with respect to the focus of the centres of excellence for women's health are best directed to the Policy and Consultation Branch. However, all of us, certainly in our branch, work on this file because issues of women's health traverse the department.
The centres of excellence on health promotion have been around for some time. I may ask Catherine to comment on that. Some are assisted by government, while others are not. They're adjuncts of universities. Certainly the centres of excellence on AIDS are part and parcel of some of the work that falls under the umbrella of the national AIDS strategy. I am responsible for the national AIDS strategy.
Catherine, did you want to say anything about health promotion?
Ms Catherine Lane (Director General, Population Health Directorate, Health Canada): There are six health promotion centres across the country that are funded under the National Health Research and Development Program. They started their funding in 1993. It was a five-year funding. So they fall under NHRDP. They would not be separately allocated. They would fall within the overall allocation of NHRDP. So there wouldn't be a separate line object.
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There are seven other health promotion centres that are not funded by the federal government, as Kay has said. They are funded as adjuncts of the university or through other methods - their own research cost recovery, etc.
I don't know, and I don't know whether I'm straying outside of the question, but some of what you may be referring to are what are called WHO collaborating centres. I believe LCDC is a WHO collaborating centre for AIDS. The University of Toronto health promotion centre is a WHO collaborating centre for health promotion. It's not funded by us. These collaborating centres go through a fairly rigorous screening process before WHO designates them as such. That means that they share in an international network and are recognized for their excellence. Diane just reminded me that there is one on disease prevention in her area that has been recognized as a WHO collaborating centre.
Mrs. Hayes: I think these all are called centres of excellence, except for the collaborating centres, but they're all called the same thing.
I'll go specifically to an issue because of the lack of time. With respect to the funding and the use of the funds, specifically with the AIDS centre of excellence, my understanding is that approximately 80% of its budget goes to funding drugs for AIDS patients. When you say each of them has a different mandate and so on, I've had some feedback on other catastrophic diseases and funding of their medical expenses having to fall to the individual and so on and so forth. Is there a centre of excellence for cancer, for instance, of that kind? If so, how does it operate? I'm trying to determine who it is that decides how the money is spent and who's accountable for that money, specifically towards the centre of excellence for AIDS in B.C.
Ms Stanley: I certainly am aware of the work that's done in British Columbia and the centre of excellence for AIDS. I will have to, though, in terms of.... Certainly the work that Dr. Michael O'Shaughnessy does.... The link between the research and how that research guides our decision-making with respect to AIDS care and treatment, etc. is a very strong one. Also, of course, we do have AIDS research scholars we fund and who work in centres across the country, not specifically the one in Vancouver.
I would have to, with the permission of the chair, do a little more work - unless Orvel has a sheet there that I don't have - for you, Ms Hayes, on that, because we are only one player in that centre. St. Paul's Hospital, of course, is intimately involved, and there are a number of players in that centre of excellence for AIDS. I think we could probably, without too much difficulty, find the information.
Catherine.
Ms Lane: I would just like to ask whether we could have a conversation afterwards so we can get some specifics to be able to answer your specific questions, because I'm not clear. We also have the clinical trials network, which may be part of what you are talking about. It doesn't fund drugs or drug research, but it funds a network of people who are involved in clinical trials. There's a lot, so maybe if we could have....
Mrs. Hayes: Okay.
Coming from the round table last year - and actually I have from Dr. O'Shaughnessy, talking about the drugs.... This is drugs across the board, not just clinical trial drugs. He says there's no deductible. If a person is eligible to receive any of the 20 drugs on the program, they get that drug free of charge without a deductible. I believe that makes up, as I say, about 80% of the budget of that facility.
Ms Lane: Again, we do not fund drugs and we do not fund the cost of drugs, so I think that's why we need to have a conversation about what we're getting at.
Mrs. Hayes: Possibly not directly, but it seems that through the funding of this program it may be the case.
Ms Lane: I would doubt it very much.
The Chairman: I'll have to cut you off right there for now. Because of the bell, we have time for three quick questions in this order: John, Beryl, and Joe.
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Mr. Murphy: My question is concerning the smoking reduction strategy. I would like to hear - if we don't have time now, I'd like to hear after - explicit results from your strategy, the outcome studies that have been done. I'd like to know who in fact is doing the outcome studies and the costing of your program. Is there a differential in the budget item from last year to this year?
Ms Stanley: Well, first of all, we're still in the midst of our tobacco demand reduction strategy. As you will recall, it was a three-year strategy, so 1996-97 is the third year of that strategy.
Yes to the question with respect to.... That strategy has taken a significant reduction in terms of the work that is conducted in my particular branch. But there is a significant amount of activity at the community level still under way during the third year of the strategy. So there's activity right across the country in terms of cessation programs, trying to work with young adolescent women, who, all the data shows, are the ones where the prevalence of smoking is very high.
The focus of the strategy is now starting to shift toward the blueprint document, of which members of the committee will be familiar, and the implementation of the blueprint once we move into a legislative mode with respect to the whole area of advertising, promotion and tobacco control.
It was always a three-year strategy, although the work we do in trying to reduce tobacco demand will continue in the department. Just because the strategy ends doesn't mean we walk away from this absolutely crucial issue. We are in the early stages of developing a population health strategy, which will look at the life cycle and decide, based on the evidence, where it's best to make our investments.
All the research at this time points to the fact that if we get to the young people early enough with our interventions with respect to not taking up smoking, this is a sound place for our investment. So we will continue to work on the tobacco file, but more under the umbrella of the emerging population health strategy.
A lot of the research is now complete. We had a number of studies relating to the follow-up surrounding the development of the blueprint. I know that information will be available within weeks in terms of confirming the positions that are in the discussion paper, called the blueprint.
Mr. Murphy: Are there no studies to date with any results? Is that what you're telling me?
Ms Stanley: Well, we have results, and we were engaged in this activity long before the decision was made in 1994 to have a tobacco demand reduction strategy.
My branch and the health promotion area have been working for years with non-governmental organizations and provincial and territorial colleagues. We have the surveys and the studies that show us where we need to put our emphasis.
The recent three tobacco ads we ran on national TV were specifically targeted at environmental tobacco smoke and at young people.
So that research is pointing the direction our program should go.
Mr. Murphy: I guess I'm really looking forward to it making a difference.
Ms Stanley: Well, this is the perennial question then. Members of the committee and I have debated this before.
Some of it is so long term. We're still in the early days. We do know that the overall prevalence of smoking in the country has gone down, but not with youth. So we're still looking for some good news on that.
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I'm optimistic that the combination of measures we have been able to initiate under the strategy is starting to pay return dividends, but it's not -
Mr. Murphy: Should I be concerned that the shift -
The Chairman: That's all, for God's sake. Now, come on, we have two more people, and we have ten minutes. Come on.
Mr. Murphy: All right.
The Chairman: Beryl.
Mrs. Gaffney (Nepean): Thank you, Mr. Chair, and thank you, John.
Ms Stanley, I want to mention ME and FM. ME is better known as chronic fatigue syndrome and FM is fibromyalgia. We know that it is a major debilitating illness in this country, yet we do not appear to have any type of research on those two illnesses here in Canada.
We know the Americans are doing it out of the Disease Control Centre in Georgia, and we know that they have moved it from third to first priority. In other words, they're recognizing that it is a major illness. Yet I do not believe that the medical profession in Canada is reporting any direct input from them to health services, to your branch. Shouldn't we be doing that? Should we not be examining the causes of this illness? What can these people do? Even in terms of diagnosing it, it's very difficult to diagnose.
I don't know whether you're going to have time to respond to this, but I really need to have some answers. Maybe it could be through a private meeting, I don't know. At least 20,000 people in Canada need to have some answers. I don't have them for them, and they don't seem to be forthcoming from Health Canada.
Ms Stanley: I'm going to ask my colleague, Diane Kirkpatrick, to respond, Ms Gaffney.
First of all, remember that in the department, the Laboratory Centre for Disease Control in the Health Protection Branch is one of the sort of radar scans when an issue and the epidemiology start to show that we need to take some action. Our research is either extramural research, or our people working out in the regions start to report back to us anecdotally that there is a condition or a situation that merits our attention. There's no clear way that all of a sudden the light bulb goes on and we say, aha, we have a problem here.
Diane, I'd ask you to respond to some of the technical aspects of Mrs. Gaffney's question.
Ms Diane Kirkpatrick (Director General, Systems for Health Directorate, Health Promotion and Programs Branch, Health Canada): In fact we have had contact and have been working with a group in this country that deals with these particular conditions at the national level and through our national voluntary health organizations program. Through that group they solicit and leverage funds through corporate and public donations that are then put towards research. They also serve in the capacity of providing information to the public.
So perhaps we could put together a little package for you, and provide that information as a starting point.
Mrs. Gaffney: Okay, that's a good start. Thank you.
The Chairman: Joe.
Mr. Volpe: If I could go back to the question of tobacco, I noticed that under national health research and development programs and tobacco, over the course of the last four or five years you've gone from $50,000, $67,000 to $274,000 forecast in 1995. For 1996 you went to $1.3 million. Does that have anything to do with the addictiveness of tobacco?
Ms Stanley: I have a note in here, and if the parliamentary secretary would allow me to find it -
Mr. Volpe: Of course.
Ms Stanley: - I would respond to it.
Perhaps, Catherine, until I dig it out, you could....
Ms Lane: Just on a very base level, Mr. Volpe, the major increase is due to the fact that some of the tobacco demand reduction strategy funds, the special three-year funding, went into NHRDP, and it just started to kick in in terms of the expenditure amount. So that's the really basic answer on why there is this increase.
Mr. Volpe: But that was for research into the chemical qualities of tobacco and its addictive characteristics?
Ms Lane: No. It's mostly socio-economic research, so it would be trying to get a handle on why people take up smoking, on the economic costs of smoking, on the linkage between smoking uptake...and I think we have one on smoking and schizophrenia. So it's more the socio-economic than the kind of research that would be done within our Health Protection Branch.
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Mr. Volpe: Excuse me for interrupting.
Ms Lane: That's fine.
Mr. Volpe: There's little Roger's heavy hand behind me.
A voice: Oh, oh.
Mr. Volpe: Would that be forming the basis for your strategy on a reduction in smoking?
Ms Lane: It would be forming part of it in terms of the blueprints, the legislation, to whichMs Stanley was referring. The base research for that is going on within the Health Protection Branch, not through NHRDP.
Mr. Volpe: So it's a standard against which you've measured the success of a lot of your publicity and advertising campaigns?
Ms Lane: No, not that research. That research is not evaluating our campaigns or the effectiveness of our programs. It's research that helps us decide the kinds of things we should be doing on health promotion in the health promotion area.
Ms Stanley: But we do tracking following an ad, and measure retention, influence on certain groups. We've had some very good stats on the last two sets of anti-tobacco ads we've run to show where we have had the greatest impact.
Mr. Volpe: Would you share that with the committee, please?
Ms Stanley: Yes.
Mr. Volpe: Just on the news wire, four Toronto area smokers are trying to launch the biggest class action suit in Canadian history. They've filed statements of claim accusing Canada's big three tobacco companies of hiding their own research that shows smoking is additive. Do you have any research that would either substantiate that, contest that, or give us an indication that the nicotine component of tobacco would in fact substantiate this kind of claim?
Ms Stanley: With respect, Mr. Chairman, I'd like to defer on that question, because it is the Health Protection Branch that is responsible for the tobacco control division. Perhaps that's a question the parliamentary secretary might like to raise with the minister because of the focus that is now coming forward on the blueprint.
Mr. Volpe: What's that guy's name? Jaromir Jagr?
Voices: Oh, oh!
Ms Lane: Could I just point out that last year - I can't remember the date, but I think it was December, January, or maybe November - there was a study done with the Health Protection Branch on the nicotine content of cigarettes. We can certainly make that available to you.
Ms Stanley: The problem is there's nicotine in the smoke as well as in the cigarette, and it's a lot more complicated subject than we can deal with in the context of this meeting.
Mr. Volpe: Unfortunately.
Ms Stanley: I would just like to have the scientists close by to make -
The Chairman: All right, I thank Kay and our witnesses for coming. I thank Beryl for chairing the first part of the session.
The meeting is adjourned.