Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 6 - Evidence
OTTAWA, Thursday, October 19, 2006
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill C-5, respecting the establishment of the Public Health Agency of Canada and amending certain acts, met this day at 10:46 a.m. to give consideration to the bill.
Senator Art Eggleton (Chairman) in the chair.
[English]
The Chairman: Welcome to this meeting of the Standing Senate Committee on Social Affairs, Science and Technology. This is my first time as chair, so have mercy on me.
We will start off with our study of Bill C-5, which is to re-establish a piece of legislation that was in front of us once before as Bill C-75, that is, the establishment of the Public Health Agency of Canada.
In addition to the committee membership, I welcome Senator Cowan, who is here as what is referred to as the critic of the bill, although in the previous incarnation of this position he was the sponsor. Same bill, different number.
Appearing as witnesses in support of the legislation, we have before us today Mr. Steven Fletcher, Parliamentary Secretary to the Minister of Health; Dr. David Butler-Jones, Chief Public Health Officer; and Jane Allain, General Counsel for the Public Health Agency of Canada.
Steven Fletcher, M.P., Parliamentary Secretary to the Minister of Health: I am pleased to appear before you to discuss Bill C-5. We have heard in the House of Commons that there is strong support for strengthening public health in Canada and for providing a federal focal point to work with the provinces, territories and other public health stakeholders to address public health issues. That is why it is important, in this new parliamentary session, to bring forward enabling legislation for the Public Health Agency of Canada as soon as possible. I am pleased to report that there was broad support for Bill C-5 in the House of Commons and that it passed with no amendments.
In the wake of the 2003 SARS outbreak, there was discussion and debate on the state of public health in Canada. In particular, I would like to acknowledge this committee's report, entitled Reforming Health Protection and Promotion in Canada: Time to Act, chaired by the Honourable Senator Kirby and co-chaired at that time by the Honourable Senator LeBreton. Similarly, I want to acknowledge the work of Dr. David Naylor in his report Learning from SARS — Renewal of Public Health in Canada, completed in October 2003. I would like to thank Senator Kirby for his help throughout in dealing with health in Canada.
Many of the recommendations provided were instrumental in creating the Public Health Agency of Canada and were considered in the development of this legislation. For example, both reports pointed to the need to establish a federal focal point to address public health issues. Specific recommendations include the establishment of the Canadian Public Health Agency and the appointment of the Chief Public Health Officer for Canada.
In response, the Public Health Agency of Canada was created in September 2004 through Order-in-Council. However, the agency currently lacks parliamentary recognition in the form of its own enabling legislation. Bill C-5 is designed to give strong foundation to the agency and authorities through the Chief Public Health Officer of Canada that only an act in Parliament can provide. More specifically, it is important that the Chief Public Health Officer be formally recognized as Canada's lead public health professional with the expertise and authority to communicate directly to the Canadian public in the event of a public health emergency.
As deputy head of the agency, the Chief Public Health Officer would also have the authority to engage with other federal deputies so that the agency can be an integral part of any coordinated emergency response. Additionally, the Public Health Agency of Canada should have the regulation-making authorities for the collection, management and protection of the public health information it needs.
The SARS outbreak clearly showed the importance for the government not only to have accurate information but also to have the ability and the means to access and share that information. By providing a statutory footing for the Public Health Agency of Canada, this legislation gives the agency and the Chief Public Health Officer the parliamentary recognition and tools needed to promote and protect the health of Canadians.
I would like to highlight four key elements of this proposed legislation that collectively will help protect and promote the health of Canadians.
It is important to note that Bill C-5 does not expand existing federal activities related to public health. It creates a statutory foundation for the agency and establishes the position of the Chief Public Health Officer as Canada's lead public health professional. The federal government has a well-established leadership role in public health, working in collaboration with provinces, territories and other levels of government. We intend to continue along this approach and the preamble of Bill C-5 clearly states the federal government's desire to promote cooperation with provincial and territorial governments and to coordinate federal policies and programs.
In establishing a departmental model and in providing a statutory footing for the agency, this legislation continues the strong tradition of leadership, cooperation and collaboration that has been part of Canada's approach to public health for decades. First, the legislation establishes the agency as a departmental entity separate from Health Canada but part of the health portfolio. This will bring greater visibility and prominence to public health issues. As a key player in the federal system, the agency will be able to have greater influence in informing and shaping public policy than it would as an isolated, arm's length body.
Further, a departmental model would give standing to the agency and the Chief Public Health Officer to work with other federal departments to support more a coordinated and integrated approach to addressing public health issues and to prepare for public health emergencies. Also, the federal focal point, the agency, will be able to better engage provinces and territories and link to worldwide efforts in order to provide the best public health advice to Canadians. For example, the agency developed, in collaboration with the provinces and territories, Canada's pandemic influenza plan, which is recognized by the World Health Organization as one of the most comprehensive in the world.
On May 13, Minister Clement met with federal, provincial and territorial ministers of health to discuss pandemic preparedness. At that meeting, ministers agreed that, as part of a broader mutual assistance arrangement being developed with the provincial and territorial governments, they will collaborate to ensure that all First Nations communities are specifically included in these arrangements and that they underscore the equitable access of First Nations, on reserve and Inuit communities to antiviral vaccine equipment and supplies in the event of a pandemic.
A secondary element of the legislation is that it formally establishes the position of the Chief Public Health Officer and recognizes its unique dual role. As deputy head of the agency, the Chief Public Health Officer will be accountable to the Minister of Health for daily operations of the agency and will advise him on public health matters.
The Chief Public Health Officer will also have the authority to engage other federal departments and be able to mobilize the resources of the agency to address public health needs of Canadians. In addition to being the deputy head, the legislation also recognizes that the Chief Public Health Officer will be Canada's lead public health professional with demonstrated expertise and leadership in the field. As such, the Chief Public Health Officer will have the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He will also be required to submit to the Minister of Health, for tabling in Parliament, an annual report on the state of public health in Canada. Stakeholders have made it clear that they want the Chief Public Health Officer to have a credible and trusted voice. Providing the Chief Public Health Officer with authority to speak out on public health matters and ensuring that the Chief Public Health Officer has qualifications in the field of public health will confirm the credibility with stakeholders and with Canadians.
Further, as I indicated previously, the Government of Canada wishes to promote cooperation and consultation in the field of public health with provincial and territorial governments. As co-chair of the Council of the Pan-Canadian Public Health Network, the Chief Public Health Officer can facilitate improved collaboration with the provinces and territories in public health.
Finally, the legislation includes a specific regulation-making authority for the collection, management and protection of public health. The authority will ensure that the agency can receive the health information it needs to fulfil its mandate. With the potential threat of an influenza pandemic, the Public Health Agency of Canada must have clear legal authority to collect, use, disclose and protect information it receives by third parties. This clear legal authority will provide the needed assurance to provinces and territories that they can lawfully share information with the federal government. Thus, the provisions in the agency's enabling legislation and the regulations enacted under them will clarify the agency's authority to gather information while ensuring the protection of confidential information.
By providing a statutory footing for the agency and supporting a dual role for the Chief Public Health Officer, we will demonstrate to Canadians that we have listened to all their calls to establish a permanent federal focal point to better address public health issues and that we are taking the necessary steps to strengthen the public health system as a whole. As we all know, preventing and managing disease and promoting good health is the key to having a healthier population and to reducing the pressures and wait times on the acute health care system. It is important that we have legislation to provide a statutory foundation to the Public Health Agency of Canada and support our collective efforts to strengthen public health in Canada. Clearly, we all have a shared interest in protecting and promoting the health of all Canadians. In providing a statutory footing for the agency, this legislation continues the strong tradition of cooperation and collaboration that has been part of Canada's approach to public health for decades.
Ultimately, this legislation will give the Public Health Agency of Canada a sound legislative footing to assist the Minister of Health to protect and promote the health of Canadians. Thank you very much, Mr. Chairman.
The Chairman: Thank you very much, Mr. Parliamentary Secretary.
Senator Cordy: I think you know that you are speaking to the converted here, since we wrote a report on this and made a recommendation for the agency. The agency has now operated for a little over two years. What difference has the agency made? How have things changed from before we had an agency until October of this year?
Mr. Fletcher: I will defer to the Chief Public Health Officer. However, I will say that this proposed legislation is enabling legislation, so it will ensure that we have parliamentary support for the position of the Chief Public Health Officer. It has helped lay the foundation for preparedness in case of a pandemic. We are much more prepared now than we were when SARS hit. Incidentally, the current Minister of Health was the Minister of Health for Ontario at that time. Therefore we definitely have a lot of expertise in the health department right from the political level onward. This proposed legislation will enable us to react in a more efficient and timely manner.
Perhaps Dr. Butler-Jones would like to elaborate.
Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada: The last time I appeared before your committee was when you prepared your report in the post-SARS era. That was before I held this job, and I never anticipated that I would have to live that down. However, it has been a very interesting couple of years. In addition to the general view and interest in public health, I work with the provinces now, because I sit at the table with the provincial deputies; we are part of the policy development, et cetera. We actually are seeing new investments at the provincial and territory levels, as well as federally.
We now have health goals for Canada that people have dreamed of for many years. Jurisdictions across the country have signed on to them. We have the Pan-Canadian Public Health Network, as the parliamentary secretary mentioned, where we are pulling together a range of activities in public health, both at the policy level and at the program level, which allows joint jurisdictional activity in a way that we did not see before.
We also have a renewed emphasis and interest in chronic disease prevention and other activities, healthy living, addressing issues of obesity and the many challenges. Often attention has focussed on infectious diseases and outbreaks, but really the biggest change will be the foundation for health that the rest of the system builds on.
For me, being part of it and having the privilege of holding this position, it is gratifying to see what progress we have made working with the provinces and territories, other stakeholders, and across government federally. I am a bit biased because I am in the middle of it, but I hear from most people that we are doing many of the things that were dreamed of and we are starting to tick off those boxes in terms of agreements with provinces around information sharing, mutual aid, having plans in place, addressing a range of issues collectively.
While public health issues occur locally and actions are taken locally, if public health bodies are not well-connected nationally and internationally we do not have the resources and expertise to address issues and emergencies. We are definitely making progress, but we are not there yet.
Senator Cordy: We are also a bit biased, then, since you appeared before us and knew what our recommendations would be.
I was interested in your comments about working with the provinces. How is that connectedness working how? How do you deal with jurisdictional matters? When we have written numerous reports on health care we have said let us just get the job done because there is one taxpayer and get on with it. Therefore I am wondering about jurisdictional matters. How do the provinces provide input? Do you have meetings with the deputy ministers? Could you explain to us how it works so that it is a national agency with input from across the country?
Dr. Butler-Jones: In terms of jurisdiction, the bulk of the resources and activities are provincially or territorially funded. They occur locally or are managed locally. Most of the legislation is actually to support local and provincial activities, which we then try to facilitate and coordinate. Plus we have our own responsibilities in the federal jurisdiction.
We work with the provinces and territories around the collective interest. For the agency, what is our value-added to the system? We have specialized laboratories. We bring to the table specialized expertise in chronic disease, infectious disease, health promotion and a range of other issues — expertise that others do not have. As well, we are able to facilitate for smaller jurisdictions access to the expertise they need that they would not otherwise find the way some larger jurisdictions can. Even large jurisdictions, like Ontario, often depend on us. Clearly, it is not very efficient to try to figure out or discover things 14 different times. We can play a role in pulling those efforts together.
In terms of input, we talk about a web. When things happen locally, how do the jurisdictions engage the expertise or the resource needed to address their situations? That works through the regions, the provinces, et cetera. We connect internationally back to them. Within the Pan-Canadian Public Health Network it is a mix.
The council of the network that I co-chair is basically the FPT oversight. That reports to the council of deputies, where I sit, which then reports to the conference of ministers. Policies now have a forum, whereas previously there were a number of advisory committees out there with nowhere to go. Now they are part of the network, so there is a mechanism to get policy advice, recommendations, and so on up to the ministers or deputies. As well, technical cooperation occurs at the committee level, and there is a range of expert committees. The proposed legislation outlines the six functions of public health, and there are committees and expert groups engaged across those functions. They are able to develop guidelines, share information and manage issues. There is also a means by which policy and other advice can come forward.
The system is now much more functional. I get the sense from my deputy colleagues that by and large it is working. It will never be perfect in terms of the federation, but we do try to complement each other rather than compete and we do provide value-added to the system.
Mr. Fletcher: I would like to add to that. In Winnipeg, we are very proud of the virology lab in which Dr. Butler- Jones is very involved. That would be an example of where all the provinces benefit from having a central place where they can send samples and get scientific analysis without having 14 different labs at level 4 containment.
Interestingly, in the House of Commons debate the Bloc asked a similar question, but they seemed to feel that pandemics respect provincial boundaries. Of course, they do not. This is another reason why it is very important to have the Public Health Agency of Canada, because it can play a coordination role that the provinces cannot.
Senator Cochrane: You mentioned new investments in Canada. Could you elaborate on that, please?
Dr. Butler-Jones: The last three federal budgets have contained significant contributions to public health. There were contributions at the outset of the establishment of the agency and then, in the last budget, there was money for chronic disease prevention and healthy living activities, the management of both human and animal disease, and the risk of pandemics. A large chunk was targeted to chronic disease, in particular cancer. Those investments are at the federal level.
Since the establishment of the agency, several provinces now have separate ministers and ministries related to public health in some way. The B.C. Centre for Disease Control existed prior to the agency, as did the counterpart agency in Quebec. Other provinces also now have added ministries and ministers. As well, some are forming their own agencies or parallel agencies to pull together these elements in a focused way.
Part of the irony is that governments started out in public health. It was a public good as part of its public security and the well-being of its citizens. As we have gotten more involved in insurance, we have paid less attention to that first priority. It is interesting to note the lessons of the last few years and the renewed interest of governments and others in that public health foundation. If we do not do well, it is like the building will continue to crack. Finding that balance — and it is a balance; it is not either/or — is really key. We seem at least to be on that road.
Senator Callbeck: Thank you both for coming. Senator Cordy touched on the area I want to ask about. Before the agency was set up there was much consultation with the provinces. Have the major concerns they had been addressed satisfactorily, or are there any still outstanding?
Dr. Butler-Jones: It is a long list. We are slowly ticking off items on the list. The Pan-Canadian Public Health Network is established. Joint work around a number of strategies has been established. We are very close to having agreements on information sharing and other things that underlay some of the challenges in dealing with issues like SARS.
There are still capacity issues in the country. There are still areas we need to continue to develop and focus on, but that cannot be done quickly. There just are not trained people ready to step into place, even if we had the resources.
We need to think five years to 10 years in the future as to what the right balance and the right mix are and how to achieve those. The provinces are obviously very interested in the federal government's engagement in this as a partner in many ways.
Senator Callbeck: Is it fair to say that you feel the procedures are in place for the provinces to have adequate input into these decisions?
Dr. Butler-Jones: Yes. By and large, the mechanisms by which we work collaboratively are now in place. They continue to evolve as we gain experience, but the actual network has been in place for over a year. It is relatively new, as is the agency.
Senator Callbeck: You are the co-chair of the Pan-Canadian Public Health Network. What is the membership on that committee? Does it include deputy ministers?
Dr. Butler-Jones: There are several layers. The council of the network, which is part of the oversight that reports to the conference of deputies where I sit, is co-chaired by myself and Dr. Perry Kendall, who is the chief health officer in British Columbia. That particular council consists of representatives from each of the FPTs. Some are assistant deputy ministers. Some are chief medical officers. It depends on the jurisdiction. They choose whom they send.
Then there is the range of expert committees, which are a mix of professionals, provincial and territorial representatives and a range of experts depending on the committee and the issue.
This FPT council provides oversight to the rest of the network.
Senator Trenholme Counsell: In reading about the preparation for a pandemic, perhaps the most startling and concerning thing that has come to my attention is the reaction at the municipal level, as well as the reaction of professional groups like doctors and nurses. I have read a number of articles in different journals and newspapers that state that the municipalities and the professional groups seem to be indicating they could very likely be overwhelmed and are very much incapable, largely in terms of human resources, of dealing with such a crisis.
At what stage is your thinking on this? How much are you communicating, through the provinces, I assume, with the municipalities and with the professional groups?
Dr. Butler-Jones: Depending on the scale of the pandemic, there is no question it will stretch our capacity. In the big scheme of things, SARS was certainly significant but small numbers of people and only a couple of geographic areas were affected. Yet it affected people's perception of security, economic issues and a range of other matters.
The challenge with regard to a pandemic is that it will occur everywhere. However, it's impact could be as mild as a very bad regular flu year or it could be of a much larger scale. It is unlikely to be as large as that of 1918. There are all kinds of projections.
Depending on the scale, how we respond, how prepared we are and how quickly we move from the crisis to the management of it — and it will not all happen at once — we have a number of measures in place that will assist. I refer to the stockpile for treatment, assuming the antivirals work as treatment. We have a contract with a domestic manufacturer to ensure that if there is a vaccine we can produce it as quickly as possible and provide it to everyone in the country, which again is unique in the world.
There is planning at different levels. The interesting thing is that public health has been planning and preparing and thinking through the issues that need to be addressed for a decade, whereas it is only within the last couple years that people generally have seen it is an issue. Now, everyone wants all the information and everything fixed and in place. That takes a bit of time.
While it is patchy across the country, most areas now have local committees that not only deal with health but also look at other issues in the municipality. We have a committee of deputy ministers from a range of departments within the federal government. It includes a number of committees but also links to the private sector and industry groups in terms of their planning, as well as the Government of Canada's planning, as well as linking back into the provinces and territories, on the emergency preparedness side, the health side and the animal health side and how they relate together.
In my mind, we are making rapid progress. There is still much work to be done. We continue to move the plans along and get the information to businesses, NGOs and others so that they can start thinking about what they can do to minimize the impact.
There are many lessons from SARS. One is that communications is key. Having clear lines and connections is key. Not thinking it is up to any one sector to solve is also very important. If we have a bad pandemic, it will be a society- wide issue. At the municipal level, we cannot think that public health will solve it. There is no capacity for that. Think about the voluntary sector and the private sector. What kinds of things can business do, such as having people work at home to minimize contact? All of those measures must be considered.
We are consulting on a range of issues. At the same time, we are also developing advice with other countries. For example, during SARS, Singapore did not wait for public health to get around to making the contacts. They ensured that principals and business leaders knew what to do if they had someone with a cough and fever in the first stages to prevent infecting other people while waiting for the officials to get around to them.
Quite a range of things can be done, both in learning from prior experience and also as we start to engage with everyone from funeral directors to rink operators. We are not there yet. However, I think the right conversations are taking place.
Senator Trenholme Counsell: I think funeral directors should be at the bottom of the list, if I may say so.
What you are saying is certainly wise and comprehensive. Much of it is theoretical. Are you doing a case study in one city, whether St. John's, Newfoundland, Ottawa or Victoria, to really use that as a model? When I did some work with the emergency measures organization a long time ago there were models.
Is a case study of any city being developed? From that case study, then, is a model being developed?
Dr. Butler-Jones: There are many estimates of what will happen and when, and for the different scenarios there is planning around what to do. At the same time, we are working with health regions and others to share the plans that have been developed in order to facilitate other people's development of plans.
The next part is that you must test it. We have done, at least at the federal level, some paper exercises. Eighty per cent of preparing for a pandemic is like preparing for any other emergency. We are planning for a pandemic, but generically, because we never know whether it will be a natural disaster, a bioterrorism event, an epidemic or some other kind of event to which we need to respond.
An infectious epidemic is not like an earthquake which happens and then we go into emergency and recovery mode. An infectious epidemic happens, it keeps happening, it goes on for weeks or months, and then it might go away for a little while and come back. You have to think a little differently than you would for either a terrorist event or a natural disaster. Very specific elements need to be incorporated into municipal plans and hospital plans and others. However, the basic process is very similar. If we try to plan discretely for bioterrorism and epidemics, we miss it if we are not thinking about all the issues, how society will respond and what each of our roles is in addressing the issue. That is the focus we bring to it, and it will have generic benefit. The next pandemic could be one year from now or 20 years from now. No one knows. I do not think even nature knows at this point. We have to be prepared.
Senator Cowan: I want to commend the government for reintroducing this bill. It was introduced, as Mr. Fletcher said, in the last Parliament by Carolyn Bennett, and it died on the Order Paper when the election was called, so this needed legislative underpinning is longer in coming than it should have been. I spoke in the House in support of this bill and I feel strongly that it is important that we proceed as quickly as possible to get this legislative underpinning in place.
My questions are for Dr. Butler-Jones. My colleagues asked questions about two years in. Your agency was established by Order-in-Council in late 2004?
Dr. Butler-Jones: Yes, in September.
Senator Cowan: We now have two years of experience, so I was interested to hear your response to their questions about the progress that is being made. You have talked about the way you have been handling the jurisdictional issues with respect to the provinces and territories and the way you have been consulting with the provinces and territories and ticking things off the list. Are there any outstanding issues that you see as deal breakers now? Are there any significant issues that you would like to tell us about that require resolution right now?
Dr. Butler-Jones: We are making significant progress. I have been in this business a long time, and in the last two years we have clearly made progress. My fear is that we might think we have done it. If we think we have done it by establishing an agency and do not continue to examine what we need to do, that gives me great concern. We must continue down this road with dialogue at both the provincial-territorial level and the international level.
There is tremendous interest internationally. For example, ministers of health of the G8 met for the very first time, and it was on public health issues. They had never met before.
A number of things are going on. We must continue to build and reinforce. Progress is key. We must not assume that we have done it, because we clearly are not done yet.
Mr. Fletcher: With regard to your initial comments, senator, you are right that the bill died in the dying days of the previous government. You may be interested to know that this bill was brought forward by the current government in its first few months in office, and I believe it was the first substantial legislation that passed through the House. That demonstrates that Canada's new government moves in a quick and expeditious manner on issues dealing with public health. It is great that you will be supporting it.
In my opening remarks I should have acknowledged the tremendous contribution that Senator Keon has made to public health in Canada. The minister and I have relied greatly on Senator Keon's advice on cancer and cardiovascular disease in this bill and many others. It is an honour for me to be here in your presence, senator.
The Chairman: That is a great introduction for Senator Keon.
Senator Keon: Thank you, Steven. I'll pay you tomorrow.
I wanted to congratulate you, Dr. Butler-Jones. You have done a fantastic job in the last two years. You have got everyone onside. You have set up your network without any conflicts. You were smart enough to hire some of my former employees, so you cannot fail. Your accomplishments have been tremendous for such a herculean task.
I want to raise what I think may be the most important issue confronting Canada from the point of view of health point at this time. There is little doubt in my mind that the creation of this agency is the most important step we have taken in health in a very long time. This will have a bigger impact on health status in Canada than anything else. However, if we are going to get back to where we should be — in other words, if we are going to move our health status from 13th in the world back up to where Japan, Switzerland and Scandinavia are — we have to close the loop. I do not think we can close the loop unless we proceed on a population health basis and deal with the kind of issues Senator Cordy raised. We have to close the loop; we have to be able to take the knowledge that you will provide us in your annual reports and get back to the provinces to allow them to eliminate these pockets of disease, because that is what is making us look so bad in the international arena now.
I had the privilege of sitting on two of the three major committees post-SARS, and that reconfirmed my belief that there is a very urgent need for a population health framework so that people like you have the necessary tools to get your job done. I would like to hear your thoughts on that.
Dr. Butler-Jones: Thank you very much for your kind comments. The work of this committee was obviously one of the key instruments in laying out the groundwork for the agency and part of building the goodwill that has allowed us to do the work we have done.
It is too bad that Senator Cowan had to leave, because this relates partly to his question. There is much focus on the infectious disease side, but it is all connected. One lesson of SARS is that those most likely to die are those with underlying chronic disease. The ability of communities to recover and respond, or to avoid illness, is dependent on the other factors that underlie health, which is part of the public health way of thinking and the way government and societies organize.
Getting at the factors that underlie health, not only in terms of understanding them but also in practical ways to address them, is very timely. There is much emphasis on infectious disease. If we do not address chronic diseases, injuries and other fundamental things that underlie health, such as education and how we organize as communities, we will miss opportunities to make the health treatment system more effective and efficient.
The other thing that is timely is an understanding of what makes people healthy and what we need to do to improve that.
I think there is some complimentarity between our interests and those of the Senate in looking at these issues and how we address them. I think we can focus more on that area. I would be very pleased if that were the choice of the committee.
The other area that needs to be addressed is human resources — having skilled, trained, capable people who can step into these activities. For that reason, much of our work is with the universities, provinces and others and is focused on building capacity and a trained, skilled, professional workforce in public health.
Next summer the International Union for Health Promotion and Education will meet in Vancouver. They meet every three years, I think. Again, there will be a focus on the impacts on health in the world.
The World Health Organization will present their commission. We have two Canadian representatives, Stephen Lewis and Monique Bégin. They are not appointed as our government's representatives but as Canadians who have much to offer.
We also support knowledge networks in Canada and some of the work of that commission as they grapple as a world community around these issues. It resonates when the G8 ministers meet and when others have met, in regard to getting these basics of health, because otherwise we will never be able to catch up with the treatment side of the system. Fundamentally, the value of being healthy is good for economies as well.
The Chairman: One issue I am sure was dealt with considerably when the predecessor bill, Bill C-75, was under consideration is the question of arm's length and whether it was enough, as compared to the model that both the previous government and this government decided is the best one, which is the legislative service agency. However, there were people on this committee and in the CMA who also thought it should be more arm's-length.
Mr. Fletcher, you commented today that an agency that is part of the federal system with a department structure reporting to the minister would provide greater influence in forming and shaping public policy than would an isolated arm's-length body. I appreciate that, but I wonder whether there is a concern about politicization, about political interference, particularly with respect to the medical officer of health's ability to inform the public about issues.
Mr. Fletcher: I have four points to make on that subject.
First, the public health issues and threats are growing and of a complex nature. It is important that we have a Chief Public Health Officer. He or she will be integrated into the federal system as a key player in the health portfolio.
Second, the Chief Public Health Officer will also have a great influence in informing and shaping public policy development, perhaps more so than an arm's length body. As the deputy head of the agency, the Chief Public Health Officer will be accountable to the Minister of Health, which will allow the Chief Public Health Officer to work on cross-cutting issues with other federal departments and help support a more integral and coordinated approach to addressing publish health issues and threats.
The third point is that the Chief Public Health Officer is currently providing leadership on pandemic preparedness with deputies of other governments in the country. You have already acknowledged the great work that Dr. Butler- Jones has done in this regard, and this work is made easier due to the Chief Public Health Officer's linkage with the federal system. It would be more difficult if the Chief Public Health Officer were independent of government.
Finally, the bill does recognize the Chief Public Health Officer's unique status within the Government of Canada as the lead public health professional as well as the deputy head of the agency. That unique dual role will allow for response to public health stakeholders and ensure that there is also ministerial accountability, while allowing the Chief Public Health Officer a degree of independence that is needed to have a credible voice in medical and public health communities within Canada and abroad.
Dr. Butler-Jones: I think this strikes quite a good balance. It is fairly unique in the federal government and generally unique as I look around the world in terms of the degree of independence of this position or the expectation of the ability to speak independently of the government, which is necessary to bring a public health perspective. Government may choose to accept, or not, that advice as other jurisdictions may choose.
Being part of government, it is important to be at the deputy table both with provinces and territories and in the federal family. If you are not at the table, it is hard to bring the perspective to the discussions. Public health is not just a system or a way of delivering services; it is a way of thinking about how to get at the underlying issues for the health of populations, which cross over a range of departments and activities as Senator Keon said earlier. There is important value also in being part of the budget process and in being a departmental agency with accountabilities, authorities, and responsibilities for policy, for budget, for other activities of government.
How many issues you take on is a judgment. I can say, having worked regionally, provincially and now federally as the chief medical officer, that there were times, though rare, that someone would try to get me to back off or change my mind. However, never in my 20-year career has a premier or minister said, ``I do not care what you think; you are going to do this.''
At the federal level, I have had conversations and discussions with the previous government and the present government around the political perspective, my public health perspective and policy advice. When it comes to a public health threat, I am going to say so. The government can disagree and we can have that conversation, but I believe my responsibility on that side of my job is actually facilitated by being engaged and having credibility within the federal government and with other governments as someone who does not talk off the top of his head but who understands the process that allows societies and governments to do their work.
[Translation]
Senator Champagne: We now have Bill C-5, respecting the establishment of the Public Health Agency of Canada and amending certain acts.
Before that, we had the Canada Health Protection Act, a proposed legislation that would have replaced the Food and Drug Act, the Hazardous Products Act, the Quarantine Act and the Radiation Emitting Devices Act. What is going to happen to all these other pieces of legislation that have yet to be proclaimed?
For example, Bill C-12 has been introduced to replace the Quarantine Act. This act was adopted and received Royal Assent, but as far as I know, it has not yet been proclaimed in force.
What is going to happen to the Quarantine Act? And have the other acts been included in this proposed legislation? How are hazardous products, radiations and other important issues going to be addressed?
Dr Butler-Jones: All these acts as well as the Quarantine Act fall within the purview of the Public Health Agency of Canada. The Agency experts are reviewing the contents of the Quarantine Act and when this process is completed, the act will be proclaimed.
[English]
Mr. Fletcher: The senator mentioned Bill C-12. That bill is not in force yet. The agency and the Chief Public Health Officer and the Minister of Health are already working within an emergency management framework that is outlined in Bill C-12. The agency and the Chief Public Health Officer and the minister are fulfilling their responsibilities in anticipation of public health emergencies. There has also been discussion with the Minister of Public Safety in regard to Bill C-12.
It is important to say that Bill C-5, the bill on the table today, is just a machinery bill. It is really to provide a statutory framework for Dr. Butler-Jones.
Senator Champagne: Once that is in place, can we return to the other ones?
Mr. Fletcher: Yes.
Dr. Butler-Jones: We are hoping the Quarantine Act will be finalized by December.
Senator Cook: This proposed legislation sets up the agency as an entity separate from Health Canada but part of the Health Canada portfolio. I am looking for reassurance or comfort that there will be adequate funding in the budget to do the job that Dr. Butler-Jones is to do. Will that funding be part of the Health Canada budget, or will it be separate?
Mr. Fletcher: First, let me assure you that the Government of Canada is certainly committed to funding the Public Health Agency of Canada. In fact, in the 2006 budget, $1 billion over five years was committed. That is $1 billion for pandemic preparedness. The proposed legislation is quite clear that the Chief Public Health Officer is the lead spokesperson on issues around pandemics and other things. There is flexibility within the Canada Health Act for the minister to deal with the scope of the agency. The funding is there. I can only speak for this government, but this government is completely committed to the agency and to improving and enhancing the health of Canadians. I can alleviate that fear under a Conservative government. You will have to talk to the Liberals for their guidance, but I do not think you would have anything to worry about there, either.
Senator Cook: Thank you for that information and for indicating the amount of money set aside for SARS.
If you look at this from a wholesome perspective, it is all about wellness, too. If we are to move to keep this country healthy, we must do more than plan for pandemics. Hopefully we never get sick, but we just might. How do we ensure that there is adequate funding for the wellness part of public health?
Mr. Fletcher: Let me reiterate that there is $300 million for a chronic disease strategy. The current government committed $260 million for the Canadian strategy for cancer control, plus in our platform we dealt with cardiovascular and mental health issues. As was mentioned earlier, the agency has four broad categories: emergency preparedness and response, infection disease prevention and control, which you have spoken about, health promotion and chronic disease prevention, and the public health tools and practices.
Certainly the foundation is there. We are just building on it. You are absolutely right: Prevention is the key. Certainly we are committed to that. You can see that with the national diabetes strategy, and the health committee is looking at obesity right now. The Minister of Health and this government are pursuing many initiatives to ensure that as much prevention as possible is being done. Perhaps Dr. Butler-Jones would like to add to that.
Dr. Butler-Jones: To be clear, the agency has its own budget separate from Health Canada's budget. I have my own accountabilities as deputy to the minister and to government. We do all of these things as a departmental agency separate from Health Canada. There are elements that we share and we coordinate as a portfolio, and the deputy in Health Canada has an overall coordination responsibility for the portfolio, but the accountabilities are mine and the budget is ours. It is not rolled into or part of Health Canada's budget. It is very clear in the estimates what belongs to the Public Health Agency of Canada and what does not.
Senator Cook: We realize that you are working with a federation, and I commend you. We welcome your role in that. Just as the provinces do an audit, is there any kind of reporting mechanism to see where we are and what is needed? I heard on the news this morning that most nurses are over 50 years old, and we have to do something about that. I am talking about an audit of human resources and infrastructure. As a Newfoundlander, I am always concerned about that one tertiary care hospital.
Dr. Butler-Jones: Newfoundland has made some moves recently to strengthen public health, and from talking to the deputy and others there I gather there is keen interest, as there is across the country. I am gratified by the interest.
It is not an easy challenge politically when everyone is talking about line-ups, saying ``Yes, but we must do this at the same time, and it does not cost as much.'' In terms of the specifics, through the network with the conference of deputies, part of our task is to look at how better to address public health human resources. Each jurisdiction looks at its own resources, but we also share information to better understand as a country how to address the issues, where the gaps are, what we can contribute to finding solutions, and what provinces and territories can do to make the best use of whatever resources are available at any given time.
Senator Nancy Ruth: This is a more general question about public health, partly because I am new to this committee and to the whole subject.
I remember that 15 years ago in Ontario Dr. Rosalie Bertell was trying to get communities to self-assess a baseline for their community health. I was wondering whether Canada or any provinces have a baseline against which communities can measure their water and all the other criteria that would go into making a public health statement. Is there anything against which to measure change?
Dr. Butler-Jones: That occurs at a number of levels. For example, the National Population Health Survey measures communities across the country. It can be a challenge for very small communities to collect that information, but health regions have it as part of their planning. Public health and, outside of Ontario, the health regions use that information as part of their planning. Often regional medical officers issue regular reports on the health status of populations, the challenges, what is being done about those challenges, the various trends, and so on, using a number of Statistics Canada population health surveys.
In addition, academics bring forward evidence of what works and does not work at the community level, what kinds of organizations seem to work better than others, and what community groups contribute.
Initially it came out in helping provinces and regions dealing with outbreaks, so we have the field epidemiology program. We send in experts to deal with local medical officers, nurses and others to manage an outbreak or better understand it. We also do training around chronic disease and investigation. We provide, for example, special expertise of the health impacts of certain things. It depends on the jurisdiction. Some jurisdictions have more capacity than others. Our involvement depends on their capacity and needs and on their desire for assistance.
Ten or 15 years ago, very few communities actually had medical officers doing regular reports on the health status of the communities. That practice continues to improve and is becoming much more the norm now. It has not spread everywhere, but communities are asking those questions and public health is responding and engaging.
Senator Nancy Ruth: Is there any capacity in Canada for communities to do self-assessment to some extent? As an example, on an Indian reserve in Serpent River, Ontario, many adults and children were getting sick. The community hired someone to test the water and look at other indicators, and it turned out that there were copper tailings in the water coming downriver from a mine quite far away.
Are there any grassroots movements for communities to keep on top of such situations and then feed that information to your medical officers?
Dr. Butler-Jones: A lot depends on the interest of the community and the issues they face. Part of the challenge is the idea that umbrellas cause rain. There are more umbrellas on a rainy day. The association does not mean causation. Increasingly, we have trained epidemiologists and others who can work with communities to assess evidence, what it means and what the possible associations are. That is part of the human resource capacity. Hopefully in the future every community will have access to expertise that would sort through the data and the ideas.
Generally, if a community has an interest they talk to public health and others, and then they develop a way to look at the issue, respond to it and try to figure out whether or not it is meaningful and what evidence is needed, and then they move forward from that.
It is a tremendous challenge for communities to pinpoint the direct cause of a problem, because there so many factors within households and families and with people moving that influence health. Communities have to try to minimize the potential causes.
Senator Fairbairn: Mr. Fletcher, welcome to the committee; it is good to have you here. I note that the word ``communication'' is used several times in your speaking notes as a key part of the whole issue of public health and getting the message out.
This question is for both of you: In the work that you have been doing on the ground to find the right way to get your messages out, have you encountered or have you prepared to deal with adults in this country who have a great deal of difficulty in reading and writing? They are a large group in Canada.
Mr. Fletcher: You are correct; communication is absolutely critical. That is one reason why we have a Chief Public Health Officer: to be able to communicate the science to the public. As political people, many of you know that health ministers come from all sorts of different backgrounds — political backgrounds and not medical backgrounds. That is why it is important to have someone with Dr. Butler-Jones's credentials to be able to communicate in an authoritative way to Canadians.
Obviously there is a strong expectation that the communication will happen in both official languages, and thoroughly. Your point about communicating with adults who cannot read or write is important. In the childhood obesity study, we are looking at how to communicate verbally as well as other issues. If you have a quick solution we would be interested in that at the health committee.
I know that Dr. Butler-Jones and the Minister of Health have communication plans and have prepared emergency responses in each region of the country and the country as a whole.
Dr. Butler-Jones: It is a tremendous challenge. We recognize that many people are not able to read labels, for example.
Senator Fairbairn: That is right.
Dr. Butler-Jones: That is a very practical issue. Much work done has been done in the Public Health Association to develop ways to make information clearer and more understandable for those who are not literate. We are careful in how we communicate. I will not say we always do it well, but it is fundamental. For example, during interactions between a physician, nurse or therapist and a patient, people's comprehension is an important issue. There is still much work to do but we are conscience of this area and focused on it in training.
In emergency situations, there is the important issue of multiple approaches and levels. Not everyone reads papers or listens to the CBC. We have to get messages out in a way that is clear, practical and understandable. We are very conscious of that. There are also the issues of local public health, provinces, and multiple language issues, beyond French and English and different Aboriginal languages.
There are a number of approaches to communication. We can do still better, though we have improved considerably in the past 10 or 20 years.
Senator Fairbairn: You mentioned the issue of people having the ability to read bottles of medication they may have, which is another area that is difficult and involves our seniors.
Dr. Butler-Jones: Yes. I wish to talk about injury and seniors and simple things. As our functions and balance decline, the things that we grew up with, throw rugs and so on, pose a threat. There are simple things we can do to organize our medicine cabinets and our homes to dramatically reduce the risk of injury and hip fractures. Many innovative programs at the community level address those issues. Those are upstream actions that can have tremendous impact downstream and can free the orthopaedic surgeons to deal with other problems.
Senator Cordy: Mr. Fletcher, it is your first time before our committee. May I beg forgiveness of the chair to ask a question that is unrelated to the health agency?
The Chairman: I rather you had not asked me. Go ahead. I will listen to your question.
Senator Cordy: As you know, our committee did the report Out of the Shadows at Last. Our recommendation was for a Canadian mental health commission. Can you update us about when that commission will be established?
Mr. Fletcher: Yes. First, as a preamble, when I was health critic in the previous session for the Conservative Party, I had the pleasure of introducing a motion that dealt with mental health and mental illness. I believe that was the first time there was a substantive debate on the issue. The Conservative Party is aware of the issue and the stigma attached to it. That is also why we had our famous five priorities, one of which was a wait-time guarantee. The second priority in our platform was dealing with the issue of metal health and mental illness. The report has come out, as you have mentioned, and the government is looking at it very seriously.
I met with the Canadian Mental Health Association just this morning. We had a great discussion. They are meeting with the Minister of Finance right now, probably. We are listening to the mental health community and to Canadians, and we are reviewing the report. We will take the appropriate action when the time comes.
Senator Cordy: When would that be?
Mr. Fletcher: That will be after the consultations have taken place.
The Chairman: You are right. It is not in order with Bill C-5, but we are delighted to hear the answer, and we know the parliamentary secretary will be a great champion of this report as the government discussions continue about its implementation.
Thank you Mr. Fletcher, Dr. Butler-Jones and Ms. Allain for coming here today. Ms. Allain did not get too involved, but was there as general counsel to rein the others if needed.
We have a request from two organizations, both of which are Aboriginal organizations, the Assembly of First Nations and the Inuit Tapirisat of Canada. They have asked to speak on Bill C-5, and I have scheduled them for Thursday morning. I would anticipate, depending on the issues they raise and the staff responses we have here at that time, that we might proceed then to the clause-by-clause study and the report out to the Senate on Bill C-5.
The committee adjourned.