House Publications

     With respect to chronic cerebrospinal venous insufficiency (CCSVI), the “liberation” procedure, and multiple sclerosis (MS): (a) does Health Canada recognize the International Union of Phebology (IUP), and is Canada a member; (b) does Health Canada recognize the IUP’s Consensus Document on the diagnosis and treatment of venous malformations; (c) will Health Canada be respecting the IUP’s standards regarding diagnosis and treatment of venous malformations; (d) will the government work with the provinces and territories to establish imaging and treatment guidelines for CCSVI and, if so, over what timeline and, if not, why not, (i) what are the benefits and risks associated with imaging and treatment techniques, (ii) what are the costs for each of the identified methods; (e) will the government, in collaboration with the provinces and territories, commit to imaging MS patients for venous malformations, and treating those patients who require interventions and, if not, why not and, if so, (i) over what timeline, (ii) what barriers would have to be overcome; (f) is CCSVI recognized as an official diagnosis and, if so, by what professional medical organizations and how is it defined; (g) what is the cause of narrow veins in the neck or thorax and what methods could possibly be undertaken to reduce their occurrence either in utero, in childhood, or in adulthood; (h) with what medical conditions is CCSVI associated; (i) what are the potential health impacts of CCSVI in the short-term, medium-term and long-term, both with and without treatment; (j) what percentage of MS patients show one or more blocked veins; (k) what veins, other than the jugular veins, are commonly blocked, damaged, or twisted in the human body, (i) what imaging procedures are used to identify the problems, (ii) what interventions are required to address the problems and why, (iii) what are the possible health impacts if left untreated, (iv) are interventions time sensitive, (v) what are the costs of imaging procedures and treatment; (l) what specific methods are used to investigate CCSVI, what costs are associated with each method, and what are the benefits and risks associated with these techniques; (m) where in Canada are these imaging methods available and, for each location, what procedures are offered and how much do they cost; (n) where in the world are private clinics emerging, what are their efficacy and safety records, and what are the imaging and treatment costs; (o) what percentage of MS patients show a reduction in MS attacks and brain lesions following the liberation procedure; (p) what percentage of MS patients with little or mild blockage show improvement following the liberation procedure; (q) what discussions is the government having regarding CCSVI, its imaging, and the possible link with MS; (r) what studies are government scientists conducting to assess the reliability and validity of imaging techniques, the possible association between CCSVI and MS, and to follow-up on patients who have undergone the liberation procedure; (s) how much money has the government allocated to research related to CCSVI, the liberation procedure and MS; (t) what is the estimated number of MS patients in Canada, and what is (i) the percentage who can no longer work, (ii) the percentage who depend on family caregivers, (iii) the percentage who require around-the-clock care from professional caregivers; (u) what is the estimated national annual economic impact of MS on families and healthcare plans; (v) what is the estimated national annual cost of disease-modifying therapies, including Copaxone and Interfon, for families and healthcare plans; (w) what are the projected imaging costs for CCSVI and treatment costs for MS patients who show a vascular abnormality; (x) what are the projected imaging costs for CCSVI and treatment costs for all MS patients; (y) what recommendations regarding CCSVI and imaging are being provided by the government to MS patients, particularly regarding (i) reputable imaging and treatment clinics, (ii) the pros and cons regarding venoplasty and stents, (iii) the need for continuing treatment regimes following any liberation procedure; (z) what steps is the government taking to educate MS patients about blogger patients and sham imaging and treatment centres; and (aa) what is the estimated number of Canadians who have gone overseas for imaging and treatment, and what tracking is being undertaken of their condition following such trips?

    Mr. Speaker, with respect to Health Canada, questions related to the treatment and diagnosis of chronic cerebro-spinal venous insufficiency, CCSVI, are of a clinical nature and are best directed toward the provinces and territories and their respective physician associations. The Canada Health Act requires provincial and territorial health insurance plans to provide medically necessary hospital and physician services to their residents on a prepaid basis, and on uniform terms and conditions. The provincial and territorial governments, in consultation with their respective physician associations, are primarily responsible for determining whether new treatments for CCSVI are medically necessary for health insurance purposes.

    With respect to Canadian Institutes of Health Research, through the CIHR, the government is funding health research on multiple sclerosis, MS. In 2008-09 investments related to MS totalled approximately $5.3 million. CIHR also invested $120.5 million in the larger area of neurosciences research in 2008-2009 and approximately $38 million in stem cell research which is being pursued for the potentially useful therapies it may offer in the treatment of health conditions and diseases such as multiple sclerosis. CIHR also funds a great deal of research related to stroke, much of which focuses on the vascular component of the disease. In 2008/09 CIHR funded approximately $22.9 million in stroke research. All of these investments are building our overall understanding of multiple sclerosis toward more effective treatment and ultimately a cure. CIHR has been consulting with the research community and will be convening, in close collaboration with the MS Society, an international meeting of top scientists to identify research priorities for Canada and accelerate research and innovation on MS.

    CIHR has not funded research on the possible relationship between MS and impaired venous drainage of the central nervous system or CCSVI since no researchers working in this area have applied for funding. However, CIHR is funding Drs. Bruce Pike and Douglas Arnold of McGill University who are working to advance functional magnetic resonance imaging to permit robust and continuous monitoring of cerebral blood flow, volume, and oxygen consumption. While their study is targeted to Alzheimer’s patients, the results will also increase our knowledge of the role that obstructed blood flow may play in MS. Drs. Pike, Arnold and Dr. John Sled are also collaborating on research to develop an MRI technique more able to detect tissue damage than current methods. The research will allow the tissue damage in MS patients to be comprehensively and quantitatively assessed, will lead to increased knowledge on the natural evolution of the disease and will enable the evaluation of new therapies that attempt to slow or stop the progression of this disease.

    It is quite possible that the recent interest in the possible relationship to multiple sclerosis of impaired venous drainage of the central nervous system, or, Chronic cerebrospinal venous insufficiency (CCSVI), will draw more scientists to pursue MS research. CIHR would welcome funding applications through its ongoing programs such as the Open Operating Grants competition. The next competition has a registration deadline date of August 16 and an application deadline date of September 15.

    With respect to Public Health Agency of Canada, estimates from the 2000-2001 Canadian Community Health Survey indicate that approximately 57,600 Canadians aged 12 and older living in private households have been diagnosed with MS by a health professional. This estimate does not include individuals living in institutions. The National Population Health Study on Neurological Conditions announced by the federal Minister of Health on June 5, 2009 will provide additional data by 2013.

    (i) Estimates from the 2000-2001 Canadian Community Health Survey indicate that of individuals aged 15 years to 75 years of age who have MS, 23% reported that they were permanently unable to work. Updated information on labour force participation among individuals with MS will become available with the National Population Health Study on Neurological Conditions.

     (ii) Although the 2000-2001 Canadian Community Health Survey included an optional module on home care, the survey module included too few individuals with MS to report reliable estimates of the percentage of MS patients who depend on family caregivers. The purpose of the 4-year National Population Health Study on Neurological Conditions is to fill gaps in knowledge about individuals with neurological conditions, their families, and caregivers.

    (iii) An estimate of the percentage of MS patients in Canada who require around-the-clock care from professional caregivers is not currently available. A component of the 4-year National Population Health Study on Neurological Conditions will measure the prevalence of selected neurological chronic conditions among the institutionalized population and will provide new estimates on Canadians with neurological conditions, including MS, who are receiving care in nursing homes that provide 24-hour care.

    The Public Health Agency of Canada estimates that the direct health care costs and costs from loss of economic productivity associated with MS in 2000-2001 were $950.5 million. Direct costs associated with MS estimated in 2000-2001 were $139.2 million: $58.4 million for hospital care, $12.1 million for physician care and $68.7 million for drugs. Indirect costs associated with MS estimated in 2000-2001 were $811.3 million: $172.8 million (21.3%) in loss productivity due to premature mortality and $638.45 million (78.7%) in long-term disability costs. Short-term disability costs are not included in the estimates of morbidity costs, and therefore underestimate indirect costs. Source: Canadian Institute for Health Information, The Burden of Neurological Diseases, Disorders and Injuries in Canada (Ottawa: CIHI, 2007). www.cihi.ca

     What is the government’s position with regard to nuclear non-proliferation and disarmament and the development of a new NATO Strategic Concept?

    Mr. Speaker, the current NATO strategic concept review process will provide an opportunity for the NATO Alliance, Alliance, to take stock of developments in the international security situation and make adjustments to NATO nuclear policy, as necessary and appropriate. Canada supports a NATO nuclear policy that balances our strong commitment to non-proliferation, arms control and disarmament and our national security requirements.

    Canada’s longstanding policy objective is the non-proliferation, reduction and elimination of nuclear weapons and other weapons of mass destruction. We continue to work with our allies in NATO toward achieving this goal.

    All NATO allies are party to the Nuclear Non-Proliferation Treaty, and the alliance has repeatedly affirmed its full support and commitment to its implementation. NATO allies have maintained a long-standing commitment to non-proliferation, arms control and disarmament as an integral part of their security policy, and have repeatedly reaffirmed that these objectives will continue to play an important role in the achievement of NATO's security objectives.

    That said, Allied efforts toward disarmament cannot be undertaken blindly, without due regard for Euro-Atlantic security. The continued existence of powerful nuclear forces outside of the alliance as well as the unpredictable nature of the future security environment necessitates the maintenance of a limited nuclear deterrent for the time being. The pursuit of nuclear and general disarmament is intimately intertwined with the global security context. As a NATO ally, Canada agrees that the supreme guarantee of the security of allies is provided by the strategic nuclear forces of the alliance. The role of alliance nuclear forces today is fundamentally political--to preserve peace and prevent coercion and any kind of war--and the alliance consistently reaffirms that the circumstances in which their use might have to be contemplated are extremely remote. Together with NATO’s conventional forces, nuclear forces constitute the means with which the alliance deters any threat of aggression against any NATO member state.

    Although NATO continues to retain a credible nuclear deterrent, its stockpile of nuclear weapons in Europe has been reduced by over 90 percent since the height of the Cold War. The US and UK have also made significant cuts in their own national arsenals.

    Canada supports NATO’s continued commitment to nuclear disarmament and its willingness to adjust its nuclear forces in light of the changing security environment to achieve the collective goal of a nuclear weapon free world. Canada will continue to play an active role in discussions related these issues as we negotiate a new strategic concept for the alliance.

     What steps, if any, will the government take at the upcoming Non-Proliferation Treaty Review Conference to further negotiations on the issues of nuclear non-proliferation and disarmament?

    Mr. Speaker, the Government of Canada aims to reaffirm its collective commitment to the Nuclear Non-Proliferation Treaty, NPT, and to make balanced progress on the three pillars of this important international instrument: disarmament, non-proliferation and peaceful uses of energy.

    On May 3, 2010, the Minister of Foreign Affairs made Canada’s opening statement at the start of the NPT review conference. The minister noted that on nuclear disarmament, states party must strive for implementation of commitments already accepted. In this regard, Canada welcomed the new START agreement, the newly released US nuclear posture review, and US efforts towards ratification of the Comprehensive Nuclear-Test-Ban Treaty (CTBT). Canada calls upon all states party required for the entry-into-force of the CTBT to ratify this essential treaty as soon as possible.

    Regarding the threat of nuclear proliferation, the minister noted that Canada has a long-standing commitment to strengthened national and international efforts to ensure that weapons of mass destruction do not spread to states or terrorists prepared to use them under any circumstances. In this regard, he argued that an important step forward for the review conference would be to recognize that a comprehensive safeguards agreement together with an additional protocol represents the new verification standard.

    With respect to Health Canada’s vitamin D recommendations: (a) does the government plan to update them and, if so, (i) how, (ii) what is the timeline for the update, (iii) what research is Health Canada using in conducting the update; (b) what are the qualifications of the experts who will evaluate and select the research used to support any decision about the adequacy of Health Canada's current vitamin D recommended daily allowances; (c) is there current, accepted evidence to suggest that taking vitamin D in amounts higher than the recommended daily allowance is harmful; (d) what amount of vitamin D, if any, would be harmful to Canadians' health; (e) if there is an amount found to be harmful, what “harm” did the said amount cause; and (f) which studies were used to draw any conclusions found in (e)?

    Mr. Speaker, in reponse to a)i) In late 2008, the Canadian and US governments contracted with the US Institute of Medicine, IOM, to convene a multi-disciplinary panel of Canadian and U.S. experts, the expert committee, to undertake a study to reassess current relevant data and to update as appropriate the dietary reference intakes, DRIs, for vitamin D and calcium, last published in 1997. This will result in the delivery of a detailed report that is peer-reviewed according to the protocols of the Institute of Medicine and the U.S. National Research Council.

    In response to a)ii) The report from IOM is expected to be publicly available in the fall 2010. It is planned that the implementation process for government programs, policies, guidelines and information will take place in 2011.

    In response to a)iii) Health Canada supported the IOM review in a number of ways. Health Canada provided publicly available data on usual distributions of vitamin D intake, based on the 2004 Canadian Community Health Survey. Health Canada also worked jointly with Statistics Canada on a preliminary public release of blood 25-OH vitamin D results from the 2007- 2009 Canadian Health Measures Survey. These results were essential for the IOM expert committee to take into consideration the Canadian vitamin D status in their deliberations. In addition, Health Canada, the Public Health Agency of Canada, the US Office of Dietary Supplements/National Institutes of Health and the US Food and Drug Administration funded the Agency for Healthcare Research and Quality (AHRQ) to prepare the report “Vitamin D and Calcium: A Systematic Review of Health Outcomes”, which was published in August 2009. The purpose of this review was to systematically summarize the evidence on the relationship between vitamin D, calcium, and a combination of both nutrients on a wide range of health outcomes.

    In response to b) The review of DRIs for vitamin D and calcium is being conducted by a 14-member expert committee appointed through standard procedures of the national academies. Expertise includes, but is not necessarily limited to the following areas: nutrition, infant nutrition, reproductive nutrition, pregnancy and lactation, dermatology, gerontology, epidemiology, biostatistics, bone and skeletal health, cardiovascular health, immunology, oncology, cellular metabolism, toxicology, genetics, factors affecting intensity of UVB radiation, and population monitoring methodology.

    In response to c) An AHRQ report published in August 2007 entitled “Effectiveness and Safety of Vitamin D in Relation to Bone Health” did examine the question of whether intakes of vitamin D above current reference intakes lead to toxicities. A total of 22 trials reported data on toxicity-related outcomes, 21 of which used doses above current reference intakes.

    Overall, there was fair evidence from adult trials that vitamin D supplementation above current reference intakes, with or without calcium supplementation, was well tolerated. However, there were challenges in conducting this part of the review because harms are often secondary outcomes and may not be reported completely, especially if they are not significant. Most of the trials were not designed to evaluate harms, were of small sample size, and had short duration of exposure to vitamin D. There is also a lack of data on toxicity outcomes in infants, children, and specific ethnic groups.

    In response to d) As part of its review of the evidence, the IOM expert committee will try to set a tolerable upper intake level, UL, defined as the highest level of daily nutrient intake that is likely to pose no risk of adverse effects for almost all individuals in the general population. The UL is based on an evaluation conducted by using the methodology for risk assessment of nutrients.

    Until the recommendations for vitamin D have been updated, Health Canada continues to recommend that Canadians follow the existing tolerable upper intake level, which for anyone over one year of age is 50 micrograms, 2000 IU, vitamin D per day from all sources, including milk and supplements.

    In response to e) According to the dietary reference intakes, DRIs, for vitamin D and calcium published in 1997, the adverse effects of excess vitamin D are probably largely mediated by increasing calcium levels in the blood, and limited scientific evidence suggests that direct effects of high concentrations of vitamin D may be expressed in various organ systems, including kidney, bone, central nervous system and cardiovascular system. Human case reports of pharmacologic doses of vitamin D over many years describe severe effects at intake levels of 250 to 1250 micrograms per day, 10,000 to 50,000 IU/day.

    The IOM expert committee is looking at more recent clinical scientific data with regard to amounts of vitamin D that may be considered harmful and the indicators of adverse effects.

     In response to f) The full set of studies used will be made available in fall 2010 in the IOM report.

     With respect to the $500 million allotted in the 2009 budget and reallotted in the 2010 budget to Canada Health Infoway: (a) when will the funding be released; (b) how will the funding be targeted; (c) how much of the funding will be focused on acute care facilities; (d) how much of the funding will be focused on physicians and integrated points of service for hospitals, pharmacies, community care facilities and patients; and (e) how much of the funding will be focused on physician electronic medical records?

    Mr. Speaker, Canada Health Infoway, Infoway, is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records (EHRs), telehealth and public health surveillance systems on a pan-Canadian basis. Its corporate members are the 14 federal, provincial and territorial deputy ministers of health. Infoway supports the development and implementation of eHealth technologies on a cost-shared basis with its provincial/territorial partners.

    As part of the Government of Canada’s economic action plan, EAP, budget 2009 included $500 million for Infoway to support the goal of having 50% of Canadians with an EHR by 2010, to speed up the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients. Subsequent to the budget 2009 announcement, the federal government indicated that further due diligence would be conducted before the funds would be released. This included the monitoring of Infoway’s response to the Auditor General of Canada’s fall 2009 report, which contained a chapter on EHRs. Budget 2010 announced the government’s intention to move forward with the transfer of these resources.

    With regard to a) In March 2010, Health Canada and Infoway signed a funding agreement related to the $500 million allocated through budgets 2009 and 2010. Under the new funding agreement, Infoway will periodically draw down on the allocation and is thus required to submit an annual cash flow statement, with supporting details, to access the federal funds. The first cash flow statement to draw-down upon the new funds is due by the end of June 2010. Funding will be disbursed to Infoway within forty-five, 45, days of the receipt and acceptance by the minister of the cash flow statement.

    With regard to b) Through budget 2009/2010, the $500 million funding is intended to continue work on EHRs and to support the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients.

    In this context, Infoway is working to establish corresponding funding strategies. These will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

    With regard to c)d) and e) As noted above, Infoway is working to establish funding programs for the $500 million allocated through budgets 2009 and 2010, which will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

    Since the provinces and territories are responsible for the delivery of health care, they also set their respective priorities and funding allocations for eHealth. Accordingly, within the parameters set out in the annual summary corporate plan, Infoway will work with individual provinces/territories to disburse funds based on jurisdictional priorities.

     With regard to Health Canada’s research on the stress response to aircraft noise: (a) what studies have been conducted; (b) what are their results and conclusions; and (c) what future research is planned?

    Mr. Speaker, in response to a) From 1993 to 1996, Health Canada published three conference papers on the development of a laboratory study of aircraft noise-induced stress on people.

     The only Health Canada published studies with a specific focus on aircraft noise were two reviews of the scientific literature on aircraft noise. One is a peer reviewed journal article in 2007 on aircraft noise-induced sleep disturbance and the other is a 2001 report on aircraft noise, stress and cardiovascular disease.

    Aircraft noise has appeared in other studies by Health Canada, such as a very preliminary field study designed to examine possible relationships between noise annoyance and stress. This was presented in a poster at a 2007 University of Ottawa 4th year honours thesis symposium.

    Aircraft noise was also noted in a national survey of noise annoyance published in a 2002 HealthInsider report, Number 7, and a peer reviewed literature article in 2005.

    Aircraft noise annoyance was also used as an example in a 2008 published analysis of how noise annoyance can be used as a health impact in environmental assessments.

    A study of annoyance and disturbance of daily activities from road traffic noise was also published in 2008 based on a 2005 HealthInsider report (Number 14)

    Health Canada has also published a total of three laboratory studies on the potential for noise-induced stress in either rats, two studies, one published in 2003 and the other in 2005, or people, one published in 2006, using noise sources other than aircraft noise.

    In response to b) Results are listed below from the various published studies that are relevant to the potential for a stress response to aircraft noise.

    In the review of aircraft noise and sleep disturbance, it was found that people living around airports show disturbed sleep in the form of awakenings and increased body movement. Aircraft noise is one reason, but it is responsible for less sleep disturbance than spontaneous awakenings and other indoor noise events.

    The review of the scientific literature on aircraft noise and cardiovascular disease indicated that average blood pressure levels of schoolchildren exposed to aircraft noise were slightly elevated, however there was no conclusive proof that aircraft noise caused chronic stress in children. Also, in adults, although scientific studies have shown that short term exposure to intense noise can cause temporary stress responses such as increases in heart rate and blood pressure, there is no consistent evidence that chronic noise leads to hypertension. Furthermore, it was found that, although there was insufficient evidence to conclude that aircraft noise causes heart disease, some studies suggested that people who live for many years in areas with intense road traffic noise, may face a slight increase in the risk of developing heart disease.

     In the review of the scientific literature on noise annoyance, it was found that there was some evidence to suggest an association between road traffic and neighbourhood noise levels and some stress related adverse effects e.g., hypertension and migraines. It was also found that on average a given long term exposure to aircraft noise makes a greater percentage of a population highly annoyed than would road traffic noise. Furthermore, in a national survey of road traffic noise annoyance in Canada, it was found that people who were highly annoyed by road traffic noise, also thought this annoyance had a negative impact on their health.

    In a laboratory study, exposure of people to noise events during sleep did not appear to create a stress response. It was also inconclusive as to whether there were adverse effects on their sleep.

    In the very preliminary field study where exposure to aircraft noise occurred, the number of subjects was too small to obtain reliable conclusions about any possible relationships between stress hormone responses and annoyance level.

    In response to c) Health Canada plans the following research studies to help assess plausibility of a cause-effect relationship between noise, including that from aircraft, and stress related adverse health effects: i) examination of potential correlations between annoyance to road traffic noise and actual health effects reported in surveys, ii) a study of stress markers in noise exposed rats that are predisposed to hypertension.

     The following future reviews are also planned: (i) for fiscal year 2010-2011, an interim review taking into account recent developments in the scientific literature on the potential for aircraft noise-induced stress-related adverse health effects - to update the Health Canada It’s Your Health document on aircraft noise, (ii) for fiscal year 2011-2012, a comprehensive review paper on the scientific literature on potential links between stress, cardiovascular disease and environmental noise.

     With respect to the New Veterans Charter, does Veterans Affairs Canada experience a cost-savings associated with the granting of the lump-sum Disability Award and Death Benefit, as compared to other longer-term assistance measures such as, but not limited to, the disability pension and health care benefits?

    Mr. Speaker, programs under the new veterans charter were implemented with the objective of changing the focus of Veterans Affairs Canada programming from disability to wellness for Canadian Forces clients and their families. The new design provides an up-front, lump sum payment to recognize the non-economic impacts of service-related disability, as well as ongoing support through rehabilitation and financial benefits to those who need it. This means that those with the greatest need receive the greatest support from Veterans Affairs Canada to aid in their successful transition to civilian life, where possible. Savings are possible in the longer term if the wellness programs of the new veterans charter work as planned to support modern-day Veterans through the transition to civilian life, thereby reducing dependence on pension payments to provide adequate, ongoing income support, a purpose that disability pensions were never intended to have. The object of the new veterans charter is not reducing cost but rather getting better value for money.

    To cover additional front-end costs, government injected $740 million into Veterans Affairs reference levels to cover the first five years of the implementation of the new veterans charter programs. Over time, as the effectiveness of the rehabilitation programming is realized, financial savings are possible, but savings are not a goal of the new veterans charter. This new programming strikes a balance between being financially responsible and accountable to Canadian taxpayers while still providing required benefits and services to meet the needs of our clients. At the time of its development in 2005 and implementation in 2006, the new veterans charter was projected to breakeven by 2025. However, it should be noted that the projection is impacted by the nature of military operations between the date of the forecast and 2025.

     With respect to the new Veterans Charter and the tax-free, lump-sum Disability Award and Death Benefit for fiscal years 2005-2006 to 2008-2009: (a) how many Disability Award or Death Benefit files have been forwarded to the Deputy Minister or Minister of Veterans Affairs' because of problems associated with the lump-sum payment; (b) how many recipients of the lump-sum Disability Award or the Death Benefit filed a complaint with the department about the lump-sum payment; (c) after receiving a lump-sum payment, how many recipients or their dependants have requested additional funds; and (d) has Veterans Affairs Canada reviewed or evaluated the lump-sum Disability Award and Death Benefit programs and, if so, what findings or conclusions have been made?

    Mr. Speaker, in response to a) Veterans Affairs Canada does not have a process to capture this specific information.

     In response to b) Since the start of the new veterans charter program, from April 1, 2006 to March 31, 2009, there have been 1, 234 medical departmental reviews requested specifically for disability awards. This represents approximately 5% of the total number of applications received.

    Of those 1, 234 medical department reviews, 758 have been deemed favourable after applicants provided new evidence. 406 have been deemed unfavourable. There are 70 cases where no decision could be made as it was determined that the department did not have jurisdiction at the time to proceed with the review, for example the Veterans Review and Appeal Board had jurisdiction.

     In response to c) Since the start of the new veterans charter program, April 1, 2006 to March 31, 2009, there have been 6,082 reassessments requested specifically for disability awards.

    In response to d) The new veterans charter was implemented on April 1, 2006. Monitoring is underway and adjustments to new veterans charter programs will be considered accordingly. In addition, Veterans Affairs Canada’s audit and evaluation division is currently conducting a comprehensive evaluation of the new veterans charter. This evaluation is divided into three phases with a report developed for each phase.

    Phase I--focus on the relevance and rationale of the new veterans charter and its programs; Phase II--focus on outreach and the service delivery framework; Phase III--focus on unintended impacts and the success in achieving desired outcome.

    The reporting is scheduled to be completed by December 2010.

    The department also evaluates feedback on the new veterans charter programs, including the disability award and death genefit, as it is received. For example: 1) The department continues to consult with veterans' organizations to hear their concerns. 2) The special needs advisory group, which has been in place since the beginning of the new veterans charter, has submitted four reports, providing observations and recommendations for Veterans Affairs Canada’s consideration with regard to improving the new veterans charter from a special-needs veterans’ perspective. 3) The new veterans charter advisory group has also undertaken a study of new veterans charter programs. Their findings and recommendations were detailed in a report, which was submitted to the department in October. The department will continue to explore and analyse the findings of evaluations/reviews of the new veterans charter, as well as feedback received internally and from clients, to maximize existing authority to the benefit of our clients and to consider if, and where, there might be gaps in that authority.

     With respect to training offered to members of the Department of National Defence and Canadian Forces: (a) what mission-related training is offered on gender; (b) what mission-related training is offered on sexual and gender-based violence; (c) what mission-related training is offered on United Nations Security Council Resolutions 1325, 1820, 1888 and 1889; (d) what mission-related training is offered on the integration of local female civilian, military and police personnel in operations; (e) what mission-related training is offered on strategies to promote the meaningful participation of local women and their national organizations in civil-military relations; and (f) for the types of training mentioned in subquestions (a) to (e), (i) who administers the training, (ii) who has access to the training, (iii) for each course, how many hours of instruction are provided, (iv) which courses are mandatory and which are optional?

    (Return tabled)

     With regard to Canada's transfer of detainees to Afghan authorities, what are the names and positions of individuals who received the originals or copies of the following documents: KANDH-0029; KANDH-0032; IDR-0512; correspondence between Richard Colvin and CEFCOM-J9 and CEFCOM-J3 from August 21 to September 19, 2006; KBGR-0118; KBGR-0121; KBGR-0160; KBGR-0258; "Detainee Diplomatic Contingency Plan", approved by Margaret Bloodworth, National Security Advisor to the Prime Minister, April 2007; KBGR-9261; KBGR-0263; KBGR-0265; KBGR-0267; KBGR-0269; KBGR-0271; May 3, 2007 unnumbered detainee report; May 4, 2007 additional unnumbered detainee report; KBGR-0274; KBGR-0275; KBGR-0291; KBGR-0292; June 21, 2007, KBGR on detainees; KBGR-0302; and KBGR-0321?

    (Return tabled)

     With respect to nutrition in Canada: (a) does the government recognize good nutrition as a basic human right; (b) how is food insecurity defined by the government, and what factors are responsible for it in Canada; (c) what action, if any, has the government taken to address each of the factors as identified in the answer to (b); (d) what action, if any, has the government taken to promote nutrition in Canada and which specific populations have been targeted; (f) does Canada have a comprehensive initiative that aims to reduce undernutrition and hunger at the national scale and, if so, (i) what is it, and if not, (ii) why not; (g) what successes has the current government had in building on effective programs to reduce food insecurity, undernutrition and hunger, and what barriers has it had to overcome; (h) has the government facilitated communications between the provinces and territories concerning the best methods of improving infant, child and adolescent nutrition in Canada and, if so, (i) on what dates and what were the recommendations and, if not, (ii) why not; (i) what are the names of all food security, nutrition, hunger prevention, etc. stakeholders with whom the government meets; (j) what percentage of Canadian families seeks assistance from food banks, and how has this changed over the last 20 years; (k) what percentage of Canadian infants, children and adolescents require assistance from food banks to meet their nutritional needs, and are all their needs met; (l) what action, if any, has the government taken to address in particular the nutrition of pregnant women and children through two years of age; (m) what percentage of Canadian children and adolescents experience food insecurity or hunger, and how does this translate into numbers, how have these data changed over the last 20 years, and for what reasons; (n) has the government considered a national breakfast, lunch or snack program to help ensure that children and adolescents meet their nutritional needs; (o) how does the government define the categories overweight and obese, and what percentage of Canadian infants, children, and adolescents are overweight and obese; (p) how does socio-economic level impact overweight and obesity in Canadian infants, children, and adolescents; (q) what are the medical and psychological complications of child and adolescent overweight and obesity; (r) how has childhood overweight and obesity increased in Canada over the last 20 years, and what action, if any, has the current government taken to address the situation; (s) how has type 2 diabetes increased in Canadian children and adolescents over the last 20 years; (t) how many treatment centres for childhood and adolescent obesity exist in Canada, and has the government increased or decreased funding to these, and by what percentage; (u) what action, if any, has the government taken to expand the number of child obesity treatment centres; (v) what action, if any has the government taken to facilitate communications between the provinces and territories concerning successful overweight and obesity prevention and treatment programs, and replication of what is working well; (w) what action, if any, has the government taken to support research and evaluation of childhood overweight and obesity prevention, including behavioural, dietary, environmental, pharmacological, and physical activity approaches, and treatment initiatives; (x) what analysis, if any, has the government undertaken of nutrition programs in other jurisdictions, such as the United Kingdom and the United States; and (y) what consideration, if any, has been given to the Pennsylvania program that has led to more than 80 supermarkets being set up in unserved areas in the last five years?

    (Return tabled)

     With regard to nuclear disarmament: (a) what official statements has the government made with reference to United Nations Secretary General Ban Ki-Moon’s five point plan for nuclear disarmament; (b) what actions, if any, has the government taken to support this plan; and (c) what actions, if any, will the government take to start the preparatory work necessary for the negotiation of a nuclear weapons convention?

    (Return tabled)

     With regard to the government’s $220 million contribution to the Haiti Earthquake Relief Fund: (a) how much of this money has been committed or spent to date; (b) how much of this money has been committed or sent to Canadian NGOs; (c) will the contributions of $40.92 million to the Canadian Red Cross Society and the International Federation of the Red Cross and Red Crescent Societies, $2 million to Oxfam Quebec, $4.1 million to Save the Children, and $6.8 million to World Vision that the government has announced thus far be coming from the Haiti Earthquake Relief Fund; (d) how much of this money has been committed or sent through bilateral or multilateral aid channels, for example, will the $8 million contribution to the World Bank to help cancel Haiti's debt come from the Haiti Earthquake Relief Fund; (e) how much of the remaining money in the Fund will be made available to Canadian NGOs; (f) how do NGOs access this money; (g) what priorities guide CIDA's use of these funds; (h) how were these priorities established; and (i) did Canadian NGOs have any input in the process of determining these priorities?

    (Return tabled)

     With regard to the Community Futures Program: (a) is Industry Canada still responsible for administering this program and, if so, which section or agency of Industry Canada is responsible for the administration of the program and its support of Community Futures Development Corporations (CFDCs) in Northern Ontario; (b) currently, how many northern CFDCs are there in existence, and how much funding do they each receive; (c) are there any plans for additional northern CFCDs or reductions in the number of northern CFDCs and, if so, how many and where; (d) how many staff at Industry Canada have responsibilities related to the Community Futures Program overall; (e) to what departmental section, division, or agency are they assigned; (f) what is the organizational relationship between the Southern Ontario Development Agency and the Community Futures Program; (g) does the Southern Ontario Development Agency have any responsibilities as concerns northern CFDCs; (h) are there any plans to transfer responsibilities for northern CFDCs from FedNor to the Southern Ontario Development Agency; (i) are there any plans to transfer staff at FedNor, who are currently responsible for the Community Futures Program in Northern Ontario, to the Southern Ontario Development Agency; and (j) will the Community Futures Program be subject to the five per cent budgetary cut announced for Industry Canada and, (i) if so, on what basis would these cuts be made, (ii) if not, will the five per cent cut to Industry Canada's budget have any impact on the Community Futures Program and, if so, what kind of an impact?

    (Return tabled)

     With regard to FedNor: (a) what is the total staff complement for FedNor for each of its programs and in what locations, for the fiscal years 2006-2007 to 2009-2010 and currently; and (b) what are the staffing projections for FedNor for each of its programs, and in what locations, for 2010-2011?

    (Return tabled)