Proceedings of the Subcommittee on Population Health
Issue 4 - Evidence, May 16, 2007
OTTAWA, Wednesday, May 16, 2007
The Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:17 p.m. to examine and report upon the impact of the multiple factors and conditions that contribute to the health of Canada's population — known collectively as the social determinants of health.
Senator Wilbert J. Keon (Chairman) in the chair.
[English]
The Chairman: Good afternoon and welcome. Our first witness is Margaret Gillis, Director of the Division of Ageing and Seniors at the new Public Health Agency of Canada, which is doing a tremendous job in all dimensions. We have had representation from them already, but we are looking forward to what Ms. Gillis has to say specifically on aging.
Margaret Gillis, Director, Public Health Agency of Canada — Division of Aging and Seniors: I am delighted to be here today on behalf of the Public Health Agency of Canada, PHAC, to speak about the social determinants of health in the context of seniors' health. Since you mentioned you have previously heard from the agency, I will not review its mission, vision and mandate. However, I will emphasize that the agency is committed to addressing the health needs of seniors, to improving their health outcomes and to promoting healthy aging.
The social determinants or the population health approach provides the needed flexibility to focus on the entire range of individual and collective factors and conditions and their interactions that affect health. Health promotion activities are an important and effective way for governments, non-governmental organizations and the Public Health Agency of Canada to influence social determinants.
At the federal, provincial and territorial levels, both the ministers of health and the ministers responsible for seniors are supportive of policies related to population aging and healthy aging. I will give a couple of examples of that. In 1994, the document called ``Strategies for Population Health: Investing in the Health of Canadians'' was approved by all health ministers. In 1998, the National Framework on Aging was endorsed by ministers responsible for seniors; and in 2002, ``Planning for Canada's Aging Population — A Framework'' was also developed to guide governments across Canada in developing policies and programs for aging.
Currently, jurisdiction officials in Canada are working to advise ministers responsible for seniors on initiatives and opportunities that contribute to thinking strategically about healthy aging, some of which you may also hear from my colleague from Nova Scotia, Ms. White.
To set the context, by 2015, seniors will outnumber children under the age of 15 in Canada; and by 2041, one fourth of the population of Canada will be over the age of 65. Seniors currently comprise 13 per cent of our population — about 4 million people — and account for 44 per cent of health care expenditures.
The 65 years and older age group presents considerable diversity in terms of life experiences, economic status, health status and resources for independent living. An increasing number of Canadians are now living in better physical and mental health, but the increased incidence of diseases such as diabetes and the higher rates of obesity could change that picture.
The major risk factors for poor health are low income — especially for many unattached older women — low education and literacy, and social isolation. Healthy aging is not simply about individual choices or biology. Seniors with low education and income are more likely to have chronic conditions or long-term activity limitations. Other subgroups of seniors at risk include the oldest old, seniors living in institutions, seniors who are also caregivers, seniors living in rural or isolated communities and those from minority ethnocultural backgrounds.
A recent discussion brief endorsed by the federal, provincial and territorial ministers responsible for seniors points out that there are real environmental, systemic and social barriers to adopting better health practices. Some relate to inactivity as a result of gender, culture, ability, income, geography, ageism and living situations. Through a combination of political will, public support and personal effort, healthy aging is within the reach of Canadians.
There is a growing body of evidence supporting investment in healthy aging to improve the quality of life for seniors, even for the oldest seniors. It has been shown that only 33 per cent of seniors function at their optimum potential. Therefore, it stands to reason that any programs aimed at disease prevention and health promotion can help improve their health status and quality of life and reduce the use of health services.
Evidence also shows that older adults can live longer, healthier lives by increasing their physical activity, eating healthy foods, taking measures to reduce falls, minimizing the use of alcohol, not smoking and staying socially connected.
We know that health promotion can realize significant gains for older adults in the short and medium term. These gains can be made with a reduction in the dependence on chronic care as a result of maintaining and restoring physical ability. However, currently our health care system focuses primarily on cure rather than on health promotion and disease prevention.
Seniors and aging issues are horizontal issues that are a fundamental part of the federal agenda. The agency works closely with a number of federal partners, such as the human resources department, with the provinces and territories and with international governments and nongovernmental organizations. Within the agency, our work is focused on health promotion, the prevention of chronic diseases such as diabetes and cardiovascular disease, infectious diseases, injury prevention and emergency preparedness.
Within the health portfolio, we collaborate on seniors' issues related to primary, home and continuing care and with the Institute of Aging at the Canadian Institutes of Health Research. Finally, we work in tandem with seniors' organizations, researchers, gerontologists, geriatricians and academics. This inter-sectoral collaboration is mandatory in order for us to have effective policies.
Let me tell you about our work on seniors. It revolves around four pillars: healthy aging; falls prevention; seniors and emergency preparedness; and mental health. I will give you a few examples of how our work addresses the health needs of seniors in the context of the social determinants of health, starting with falls prevention.
Injuries resulting from falls can have a disastrous impact on the health and autonomy of seniors. It is estimated that falls-related injuries in Canada among those 65 and older cost the economy about $2.8 billion a year. In the agency's 2005 Report on Seniors' falls in Canada, we estimated that a reduction in falls by 20 per cent could result in fewer hospitalizations and fewer permanently disabled seniors, as well as national savings of about $138 million annually.
According to a province of British Columbia report, the study of the social determinants of health has repeatedly shown that one's income, education, housing and social connectedness all bear a strong relationship to one's health, level of disability and longevity. People with low income, low education, inadequate housing, lack of social support or lack of access to appropriate health or social services are all at greater risk for the chronic conditions that are, in turn, risk factors for falls.
The role that social and economic factors play in falls is not completely understood and is an area for which we require more research. However, contributing factors may include poor literacy, resulting in the inability to benefit from printed resources on strategies for preventing falls, or muscle weakness or ill health due to lack of funds for a nutritional diet.
Seniors have indicated that it is important for them to have access to the services and programs to maintain and improve their health and to stay connected to their community and family. The agency and the World Health Organization are collaborating on the Global Age-Friendly Cities project in which 33 cities in 23 countries are involved. This was partially funded through the population health fund at the Public Health Agency. In Canada, the participating cities are Saanich, British Columbia; Portage la Prairie, Manitoba; Halifax, Nova Scotia; and Sherbrooke, Quebec. They are conducting focus groups to identify age-friendly assets and barriers within their cities.
An age-friendly city is a city in which policies, services and structures related to the physical and social environments are designed to support and enable older people to age actively — that is, to live in security, enjoy good health and continue to participate in society. Some examples of the issues being dealt with in age-friendly cities include appropriate and accessible public and private transportation, places and programs for active leisure and socialization, hazard-free streets and buildings and support for caregivers. As you can see, this initiative is built around the social determinants of health by looking at factors such as social support networks, social and physical environment and accesses to health services, just to name a few.
One third of Canadian seniors live in rural areas. Access to health services and social isolation have been raised as concerns by seniors living in rural and remote communities. Building upon the Global Age-Friendly Cities project, the federal-provincial-territorial working group on healthy aging and wellness, which is co-chaired by me at the Public Health Agency of Canada and the Province of Manitoba, is working on a parallel project in rural and remote areas of Canada. Ten communities in eight provinces are exploring age-friendly factors in communities and populations under 5,000 people. The findings will be synthesized into a practical guide that rural and remote communities across Canada can use to identify common barriers and to foster dialogue and action that support the development of age-friendly communities.
Canadian and global events have demonstrated the special risks faced by seniors as a vulnerable population during catastrophic events. In 2005, PHAC's Centre for Health Promotion along with the Centre for Emergency Preparedness and Response began the development of policy, research, awareness and action regarding seniors and emergency preparedness in terms of their vulnerability and their acknowledged capacity to contribute to the planning, response and recovery of their communities during emergencies.
Important partnerships have been developed with the World Health Organization, the United Nations, Help the Aged in the U.K., various government administrations at the local, provincial, federal and international levels, emergency organizations and seniors' groups.
Our work on emergency preparedness addresses a number of determinants including social and physical environments, education and personal health practices and coping skills. Culture, income and social status play important roles as well.
In closing, the agency is yet another important capacity created to bring about healthier Canadians and healthier communities. During the past two years we have forged strong partnerships, both domestically and internationally, to address the social determinants of health through a population health approach in dealing with seniors and aging issues. The agency's leadership in this area has been recognized both domestically and internationally. However, much work remains to be done.
The Chairman: Thank you. I want to get your help in focusing. We have a meeting with Sir Michael Marmot in the next couple of weeks and then some of us will be going to Vancouver to the world health meeting there.
I have been trying to develop a theme that I hope will come out in our report. It is a new concept of health delivery systems that will build on a population health basis, will build on a public health basis, will build on a prevention basis and will build on health promotion basis. I believe that the only way that this can be done is to build a network of community health and social service resources, which I think is the missing link in our health system in Canada at the present time.
Some things are starting to happen, but we have poured all the money into large hospitals and tertiary care centres. I was guilty of this for 35 years of my life, bleeding the health system for all I could get for the heart institute and not thinking enough of the community resources that were needed to do the things we are talking about now.
Senator Eggleton will be next on the list and he is very interested in the cities, but even in the rural communities, we just do not have the community resources, in other words the community health and social service centres, that can link public health and health promotion and prevention and health care delivery.
Can you comment on that and do you see any light with your new agency? You guys have got quite a bit of cash.
Ms. Gillis: Some of us do. Yes, there is light. It is an interesting question. It is very complex because of the various agencies and groups that are involved. I think some of the work that we have started to do, including the Global Age- Friendly Cities project and the Age-Friendly Rural/Remote Communities Initiative, is trying to establish from seniors themselves the sorts of situations they are finding themselves in cities and in the rural communities based on the determinants of health. In fact, the nine questions the seniors are asked are all based on the determinants of health. We will have, right from the communities, a guide that we can use in other communities.
We have enough preliminary information now to know that in Canada it is harder to access health care services in remote communities. Children often move to cities, so seniors living in small rural towns often do not have their families there to support them the way families traditionally did. I expect we will see issues here that both we and the provinces who are our partners on that will have to start thinking about how to address.
I guess the short answer to your question is yes, there is a lot of work to be done at the community level and I think we have some ways in. The interesting pieces will be as we gather information how we move some of that out, and some thinking has been done on that.
The Chairman: Speaking of your information gathering, Glenda Yeates will be coming before us from the Canadian Institute for Health Information, CIHI, as soon as she can get her troops ready and we can arrange it. What are your formal links with CIHI right now?
Ms. Gillis: My links are not as tight with CIHI as they are with the Institute of Aging at the Canadian Institutes of Health Research, CIHR. We do a lot of work with CIHR. We are quite connected with them because they work on some of the priorities I named for you, mental health, Alzheimer's disease. We are working with them on age-friendly cities and on falls. We have been trying to strengthen the research policy link between ourselves and CIHR.
Senator Eggleton: Regarding the Global Age-Friendly Cities project, I note that 33 cities and 23 countries are participating, but I see only one Canadian city here that would qualify as one of our top ten cities in terms of population, and that is Halifax and even it is right down at the bottom of the list of most populous Canadian cities. The cities that represent virtually half or more of the population of the country are not in here, and yet the risks, dangers and hazards that occur for seniors in big cities certainly need a lot of attention.
How is it decided what cities go into this project and who pays for that? Does the World Health Organization pay or does the Government of Canada?
Ms. Gillis: Let me answer your first question about the size of the cities and how they were chosen. We asked the provinces to assist us in choosing cities. They indicated their interest and the cities that they were wished to have involved. Your question is interesting because the World Health Organization asked a similar one when we first became involved.
We are talking to some larger cities for the next phase. We will have the age-friendly indicators launched on October 1, 2007, and then we will be starting to look at ways to implement them. I will not name them yet because they have just indicated interest, but we hope a few of the larger Canadian cities will implement the guide when we release the information.
Senator Eggleton: It is largely the provinces, then. Ontario did not put any city forward.
Ms. Gillis: No, but we had a stronger participation in the rural and remote areas. Most of the provinces put them in, but it was sort of the beginning of the project.
Senator Eggleton: I hope we can get some of the big cities into this.
Ms. Gillis: The international ones are quite big, for example London and Rio.
Senator Eggleton: Toronto, Montreal and Vancouver should be here.
Senator Pépin: We have Montreal.
Senator Eggleton: You have Sherbrooke in here.
The next question comes as a result of my being educated by Senator Fairbairn to perk up my ears every time I hear the word ``literacy.'' I believe I heard it three times in your presentation. I am trying to get a handle on more characteristics of people who have a literacy problem, because that helps us to shape programs that will help them.
I would suspect a lot of literacy difficulties for seniors might relate to language. Many people came here from different countries at an advanced age and either went into an industry, if they still had employable years, where they spoke the language from their home country or their roots. We all know about the construction workers, for example. Others who come over as sponsored parents or grandparents do not get sufficient command of English or French, I suppose, because they are more involved with their own families and communities in their traditional language. Does that account for most of the literacy problems among seniors, or are there also people who might have been considered literate at one time but who now either have a failing memory or are faced with advances of technology beyond what they saw when they were in the workforce? I am trying to get more information about the characteristics of the seniors who have literacy difficulties.
Ms. Gillis: I do not know if the breakdown gives you that much information. I could check into that. I would expect that that sort of detail would probably be handled by the Department of Human Resources and Social Development Canada, which has the literacy agenda, but I can check and get more information for you.
Senator Eggleton: Maybe Senator Fairbairn will know the answer to that. You mentioned it, so I thought I would ask.
Senator Callbeck: You referred to an age-friendly cities project being undertaken by the agency in Manitoba on rural and remote areas of Canada. I am from a rural area in Prince Edward Island. Is my province involved in that project?
Ms. Gillis: I believe your province is involved, but I do not remember the community. I can get that for you.
Senator Callbeck: When was that project started? How long has it been in existence?
Ms. Gillis: We started first with the cities project about a year ago. Just to clarify, I co-chair with Manitoba the FPT committee on health, and that is the Manitoba link. A number of provinces are involved in the Age-Friendly Rural/ Remote Communities Initiative piece. It would have started about six months ago, but the funding did not come through until relatively recently because it involves pulling together researchers to go out and have discussions with older people. It has to be done statistically and soundly, so it took us a while to collaborate. We put in provincial and federal money.
Senator Callbeck: When do you anticipate the results of the projects?
Ms. Gillis: The guide for rural and remote should be ready in November and the one for cities in October.
Senator Callbeck: You talked about the agency working closely with the provinces. What determinants are you working on now with the provinces from Atlantic Canada?
Ms. Gillis: I have the list of questions we are asking on the age-friendly cities project based on determinants, and maybe I can hand that over.
Senator Callbeck: Are there other projects that you are involved with in Atlantic Canada?
Ms. Gillis: The main ones are the age-friendly city projects. We are working with the provinces as well on emergency preparedness. That one is interesting. We had a meeting in Winnipeg in February where we brought both domestic and international partners together to look at nine or ten issues from a senior's perspective with recommendations on what governments and communities need to do to ensure the safety of older people. That is another project that is quite broad.
The active aging work that is starting involves all of the provinces and is done at the federal-provincial-territorial table as well with federal, provincial and territorial ministers responsible for seniors. Much of the work with the provinces happens around the FPT table on seniors.
Senator Callbeck: Would the active aging area have the ministers of all the provinces coming together?
Ms. Gillis: Yes, there is a table of ministers responsible for seniors, and the agency participates in the health piece on that.
Senator Callbeck: Do you take the initiative on any of these things?
Ms. Gillis: We took the initiative on age-friendly cities and on emergency preparedness. The initiative on active aging has been a long-standing one. Mental health has not been linked as much to provinces. There is probably work to do on mental health and Alzheimer's disease.
Senator Callbeck: You say there is one place in Prince Edward Island. How is that carried out there?
Ms. Gillis: Researchers were hired, and they used a set of questions established by the World Health Organization on nine determinants of health, everything from transportation to housing. They pull groups of seniors together, ask them the questions and record their responses to those health determinants questions in the two projects. The idea was that we would ask seniors what their life is like with respect to the nine determinants of health.
Our next step was to create a guideline of what cities or communities need to have for seniors to age healthily and happily based on determinants of health. Those are being compiled now through the sessions with seniors.
Senator Callbeck: What percentage of seniors do you hope to have input from?
Ms. Gillis: Do you mean percentage of a province?
Senator Callbeck: No, let us say that area in Prince Edward Island, if it is 5,000 people.
Ms. Gillis: I do not recall the numbers offhand. I know a little more about the cities project because I was more closely involved in the discussions, and I went to some of the sessions with the seniors.
They are done statistically through the academics who are working on this, and they determine the percentage of people. In the cities project, for example, there are eight different groups they talk to and they make sure they have men and women, different incomes, different social ethnic backgrounds, and so on. There are a number of criteria the academics use to determine the participants.
In the smaller communities it is tougher. From the discussions that I had in the provinces, I know they had to loosen up some of the restrictions of the cities piece because of the numbers in the rural communities.
Senator Fairbairn: All of us, as we move along, have experiences, and I am certain that all of you have daily experiences with the individuals with whom you work and whom you are trying to help. As I have worked with older members of my family, I have been startled and almost enchanted by their ability to make their own decisions. Also, in spite of all the good will of everyone who might swirl around them, they are very keen on being able to maintain control over what they want to do.
There are many seniors' centres in Canada and they are just great. In my hometown of Lethbridge, they are probably the biggest activists in the community. In your work, do you deal closely with organizations like the CNIB, the Canadian National Institute for the Blind, which has in large and small communities some of the most extraordinary efforts that almost go through the whole lexicon of health and aging? They bring in the talking books, although they do much more than that now; they create ways of moving around a house that will enable older people to stay in their homes without having someone at their elbow all the time telling them what to do.
Ms. Gillis: We work with them in two ways. We do a number of brochures and information packages for older people, and we always work with the CNIB or, depending on the issue, a number of different groups.
We also have a phone line and a computer service, where we assist seniors to link up in their community. Any senior across the country can call 1-800-O-Canada. We will assist them if they are trying to find out where in their community they can go to get information on hearing or if they want the stay in their house and need assistance getting Meals on Wheels; we will assist seniors in doing that. That is a long-standing program that has been in the Division of Aging and Seniors for many years.
Senator Fairbairn: The word ``literacy'' has popped up. It pops up at every age, but I think with seniors it is particularly important because reading is a large part of their lives — even more so than television, to a point. If you do not have that skill, and a great many do not, then all of the things that are at the centre of your daily life — whether cooking, getting a newspaper through the door or taking your medication — can be difficult to deal with. Sometimes the person is too stubborn to tell anybody they cannot do it or do not know something. Do you run into that often?
Ms. Gillis: I think you have been talking to my mother.
Senator Fairbairn: No, I was talking to mine.
Ms. Gillis: Do we hear about these things directly at the Public Health Agency? Probably less so, but you have raised some interesting issues, such as medication use. That has huge links to falls and capacity, particularly if medication is badly used.
A whole wealth of work could be done around those issues. They touch on a number of negative things in seniors' lives. Interestingly, when you are talking about someone who is off by themselves, the main point is the question of social isolation. As we were discussing earlier in the context of rural and remote communities, seniors who do not have family members or a support system close by can become marginalized and their health deteriorates. Therefore, I think social isolation is a key issue every time.
Senator Nancy Ruth: I am always interested in how the federal government is able to have any influence on municipalities and their building codes — their designs for sidewalks, kitchens, window openings, light switches that are not at the right height and all that kind of stuff. I have the impression that the federal government wants to stay away from putting any pressure of that nature on cities and I think it is a huge mistake.
Ms. Gillis: That is a great point. We will probably see some of that coming out of the studies on age-friendly cities when we talk about the built environment. I think our winters are very difficult for older people in terms of mobility.
With respect to what the federal government is doing on falls, at the end of 2005 we released what we almost refer to as the grizzly statistics, which I am more than happy to share with you, in Report on Seniors' Falls in Canada. The report shows that hospital stays for falls are double the time of just about everything else. Falls ruin seniors' lives; they lose their independence. It is about $1 billion in direct health care costs to deal with falls. I think it is the second leading cause of injury, after motor vehicles, for the entire population.
We know that falls are a huge issue for Canadian seniors. Falls also lead to social isolation because often after a fall you are afraid to go out again. Those of you who have elderly parents or relatives who have fallen will know that often you find that it creates in them a fear of leaving the house again. There are issues around how not only to stop falls but also to assist people after a fall to regain their capacity to engage.
We did that report. Also, through the population health fund we have funded different studies and we have a lot of knowledge about why falls occur. I think the interesting piece is the next step, which is how do we intervene, working with the provinces — because some of this is social services and federal-provincial-territorial pieces. We have some ideas around that.
I do not know whether we can affect things like road construction and those kinds of decisions, but I am hoping that as a beginning, because the provinces are so interested in the age-friendly work that we are doing, which will include accessibility, some of those questions will come up.
We have quite a bit of knowledge of the systems that work in interventions on falls. For instance, the Ministry of Health in B.C. has a chart that shows that as they increased their falls prevention programs they saw a decrease in hospitalizations because of falls. In terms of health promotion, you do not get statistics like that very often that show you how effective you can be by intervening.
I go back to my final comment, which is that I think a lot of work can be done on that. We are very interested in working with the provinces on that issue.
Just as an aside, the report on falls, which is a great document, led to the World Health Organization asking to work with us to do a report on falls globally. We funded that through the population health fund and they are working on it now. We have had a number of international meetings and domestic meetings with experts to talk about how to move some of the issues out.
Senator Nancy Ruth: The report you spoke of is really —
Ms. Gillis: It is statistics.
Senator Nancy Ruth: You send it on to the province, not on to the city.
Ms. Gillis: It is available to everyone; it is a public document.
Senator Nancy Ruth: You do not actually work with them; there is no transition of funds.
Ms. Gillis: Not specifically, no; we do so more anecdotally, through different projects.
Senator Cochrane: What is your relationship with the provinces? How do you communicate with them? How do you assess all the things that are happening? For instance, you said that only 33 per cent of seniors function at their optimal potential. Where did that number come from? What is the role of the provinces here?
Ms. Gillis: We work through the provinces in a couple of ways. As I mentioned, there is the FPT meeting of ministers responsible for seniors.
Senator Cochrane: How often does that happen?
Ms. Gillis: That happens a couple of times a year — once a year for the ministers, but the officials meet frequently. I would say at least once a month I am on the phone with the provinces with respect to the FPT table's work on healthy aging; we are fairly connected that way.
The agency also has regional offices, which work closely with the different provinces; also, they can use part of the population health fund in order to address population issues specific to their province. Those are the two main ways.
We also do a lot of bilateral meetings because we know the people in the field; we have been working on aging issues for a long time, and as a result we have contacts around the country.
Senator Cochrane: Does any one province stand out in anything you have done?
Ms. Gillis: B.C. does great work on falls prevention. They are ahead probably, although a few other provinces are working on that.
Senator Cochrane: Can you tell me why B.C. is doing well?
Ms. Gillis: They put a lot of money into their seniors' programs.
Senator Cochrane: Provincial?
Ms. Gillis: Yes, provincially they have. I will let Ms. White talk about her experience in her province, which has also done some great work. We have partnered with Nova Scotia on just about all of the projects I have mentioned to you today, and with Ontario. We have partnered basically with all of the provinces.
Senator Cochrane: You mentioned evidence that older adults can live longer. You mentioned that staying socially connected is important. I am familiar with the New Horizons for Seniors program. It is fabulous; they have buses of seniors going from one community to another, they have social events, they make friends, they have dinners, they dance. It is amazing what the New Horizons for Seniors programs are doing. Have you seen an impact?
Ms. Gillis: New Horizons for Seniors used to be at Health Canada; they are now funded out of HRSDC. We work with them. We have a close connection with HRSDC. In fact, I spoke to all of their workers from across the country and we were talking about health issues, because they get many requests for funding for health issues like falls. We were talking about how we could be more effective in some of those programs in terms of sharing knowledge.
Senator Cochrane: That is a good program to share information.
Ms. Gillis: Absolutely.
Senator Cochrane: That is what they do when they get together.
Ms. Gillis: It is a good one for sure.
[Translation]
Senator Pépin: You are talking about physical health programs, but when we think about seniors, we also think about isolation. That is one of the problems that has to be solved. Even if they live in seniors' homes, we know that it is very common for some people not to have enough visitors, or not to be involved in enough activities. Do you have any statistics about this?
Ms. Gillis: Not a lot. Is your question in relation to falls, or is it a general question?
Senator Pépin: Do you have statistics on isolation?
[English]
Is there any specific program?
Ms. Gillis: No.
Senator Pépin: I believe it is one of the major problems.
[Translation]
Ms. Gillis: That is a problem. This is under provincial jurisdiction. It is difficult for the federal government to play a role. At the same time, I think there will be options under new programs. The agencies are very important in emergency situations. After Hurricane Katrina, the statistics were terrible, and that is one of the reasons why we decided to work on issues involving seniors in emergency situations. When we studied the subject, we found that the global statistics were tragic.
[English]
The Chairman: Unfortunately, Ms. Gillis, we have run a little over time and we have to move on to the next group of witness. Thank you very much for coming.
We now have three expert witnesses before us. We will hear from all three, and then we will have a period of questions. The first witness is Professor Mark Rosenberg, a member of the executive of the Canadian Association on Gerontology. He is Editor-in-Chief of the Canadian Journal on Aging, which is the official journal of the association and actually Canada's only interdisciplinary journal on aging. He is also co-author of Growing Old in Canada: demographic and geographic perspectives.
In addition to Professor Rosenberg, we have Valerie White, Executive Director, Seniors' Secretariat, Nova Scotia Department of Health. The secretariat is the provincial government agency responsible for seniors. In 2005 the secretariat published Strategy for Positive Aging in Nova Scotia, which proposed a framework for government and community action based on social determinants of health.
Then we have Dr. André Davignon, the founder of the Observatory on Ageing and Society. Founded in 2003, this organization seeks to help seniors age well by supporting individual and collective reflection and decision making about the challenges posed by an aging population and its impacts on society.
Mark Rosenberg, Professor, Queen's University, Canadian Association on Gerontology: On behalf of the Canadian Association on Gerontology, as a member of the executive board and as editor-in-chief of the Canadian Journal on Aging, it is an honour to present this brief to the Subcommittee on Population Health of the Standing Senate Committee on Social Affairs, Science and Technology.
Population health can now be seen as a mature conceptual framework for understanding the health of the Canadian population or segments of the Canadian population. Why does the Canadian Association on Gerontology, CAG describe it this way? First, as you know, the Public Health Agency of Canada traces the intellectual development of the population health approach back to Mark Lalonde's groundbreaking report: A New Perspective on the Health of Canadians. Since that time, a series of meetings and seminal reports have fleshed out population health as a framework. In other words, population health as a framework has been developed and refined over a period of more than 30 years.
Second, while much of the early emphasis of the population health approach in Canada focused on early childhood development, the population health approach was a major organizing framework for many of the 96 projects funded between 1991 and 1995 through the Seniors Independence Program, the Ventures In Independence program, and the New Horizons: Partners in Aging program.
In Toward Healthy-Aging Communities: A Population Health Approach, a report prepared in 1997 for the Division of Aging, Health Canada, Linda Macleod and Associates identified a number of issues relevant to Canada's seniors using a health approach. I will not spend time going through all of the issues, as many of them have been raised and they are in our written brief.
Third, in talking about population health as a mature approach, linkages have been drawn between population health as an approach for the identification and analysis of issues, and the key factors underlying them and health promotion strategies. One can see these linkages in publications of the CAG, such as Abuse & Neglect of Older Canadians: Strategies for Change and National Forum — Closing the Care Gap, which we sponsored and in which we produced these reports.
We would like to draw to the attention of the subcommittee three significant drawbacks to the population health framework. First, the framework is essentially static. It has provided valuable research in identifying social determinants of health at a given point in time, depending on who and what was the focus of the research. We do not have many examples of research that employs a population health framework in a dynamic or longitudinal context to show how changes in the determinants of health and health care lead to changes in health status and the need for more and different types of care.
Second, the population health framework does not easily embrace the growing diversity of the Canadian population in general and the growing diversity of Canada's elderly population. In the coming decades, an increasing proportion of Canadian seniors will come from visible minorities, the gay and lesbian communities and, later in the century, the Aboriginal peoples of Canada.
Third, the population health framework does not take easily into account the complexity of local geographies. The determinants of health for seniors are likely to be different in rural Canada in contrast to urban Canada and in those parts of Canada where the costs of living are rising rapidly, for example Vancouver, Calgary and Toronto, and also in boom communities like Fort McMurray. That is not to say there is no research that addresses the latter two issues, but most of the research tends to be small-scale case studies.
How can these limitations to the population health framework be addressed? First, the Canadian government needs to invest in the tools required for dynamic, longitudinal research. Currently, CIHR through the Institute of Aging is developing the Canadian Longitudinal Survey on Aging, CLSA. More funding is required to launch it, and a long-term funding commitment will be required to maintain the survey for a minimum of 20 years to provide the data required to understand how the determinants of health are changing within a population health framework.
Second, Statistics Canada supports the Canadian Community Health Survey, CCHS, and the regional data centres for remote access to Statistics Canada surveys. Both of these programs deserve additional funding support to make CCHS even more inclusive of both the diversity and the small-scale geographies embedded within CCHS.
Third, it has been more than 10 years since Health Canada funded a major health program in the form of the Seniors Independence Program. To take the next step in understanding population health within a dynamic and longitudinal framework and to support a new generation of research and young researchers who want to understand how the determinants of health and health care are changing as Canada's seniors are changing, we need a funded program of research that will link population health policy and programs.
I have emphasized these topics because the Canadian Association on Gerontology is essentially a multidisciplinary association of researchers, practitioners and people who are concerned about seniors, but foremost amongst our mandates is research. For the research to take the next step, these are the three key issues that we would like to bring to your attention.
I would like to thank you for your time and understanding, and I have brought copies of the Canadian Journal on Aging for each of you.
Valerie J. White, Executive Director, Seniors' Secretariat, Nova Scotia Department of Health: Honourable senators, thank you for this opportunity; it is a pleasure to be here to talk about Nova Scotia's Strategy for Positive Aging and to assist in any way I can with the complex but important task that you have undertaken.
I have been asked to speak about the following: our Strategy for Positive Aging as a useful example of an inter- sectoral government strategy; the preparation of the strategy; the contents of the strategy; and our implementation process. Because it directly relates to your work, I will also highlight how our strategy positions the social determinants of health.
First, our strategy demonstrates an inter-sectoral approach. The unique structure of the Seniors' Secretariat makes us ideal for this type of work. We are governed by a committee of seven cabinet ministers chaired by the Minister of Seniors. This means that cross-government collaboration is more than an activity for us: it is also the way we operate. Although the secretariat will soon become the department of seniors, the cabinet committee will remain in place.
In keeping with this collaborative approach, the strategy is a long-term guide for helping all sectors create senior- friendly communities and prepare for Nova Scotia's aging population.
The strategy released in December of 2005 was the first of its kind in Canada. British Columbia followed with a similar report late last year, and Newfoundland and Labrador is currently creating its framework. Needless to say, in Nova Scotia we are learning as we go. There are few jurisdictions we can look to for advice.
Preparation of the strategy involved an extensive consultation process, and a 22-member advisory committee guided the process, including creating a discussion paper which provided a draft framework. In total, more than 1,000 Nova Scotians were engaged in editing the framework through attendance at 34 public meetings and 11 stakeholder forums and through written submissions. Also, a comprehensive literature review involved about 400 reports and books representing provincial, national and international perspectives.
The main section of the strategy is the framework, which includes guiding principles, a vision, nine goals, and 190 societal actions. The strategy also contains the context and background to informed decision making and a section that highlights innovative initiatives being undertaken in other jurisdictions. The intent is to stimulate creative thinking and encourage fresh approaches.
The implementation phase is where the secretariat, as the lead agency, must also demonstrate creativity and find fresh approaches. This past year we have focused on communication activities. We knew that before wide ranges of sectors could use the strategy for their own planning, they first have to know it exists. We have had great success with this approach. Many NGOs have aligned their strategic plans with the strategy, including the Gerontology Association of Nova Scotia, the South Shore District Health Authority and other groups.
The strategy has also informed the work of other departments, such as the Department of Health's Continuing Care Strategy, the Department of Education's demographics study and a caregiver strategy currently being developed, another first in Canada. The secretariat has also seen a dramatic increase in requests for speaking engagements and invitations to participate in multi-stakeholder committees. This tells us that many people want to be part of implementing the strategy. The secretariat has developed a template for monitoring progress. We have used a wide variety of sources to capture many of the activities going on across the province.
The secretariat is also leading the creation of the provincial government's Action Plan for Positive Aging. The first meeting of the interdepartmental working group was held two weeks ago, and we hope to have a draft completed by April 2008. The group is currently updating the progress template to ensure it fully captures the work of government since the strategy's release, and they are reviewing the 190 societal actions to identify which are the responsibility of the provincial government and for which others the government might be able to play a role in advancing. We also asked them to prioritize government actions based on cost savings, ease of implementation, ability to improve independence and well-being, ability to reduce projected demand on government, and potential for collaboration.
Before diving into the action plan, we intend to involve the group in scenario planning. This has been done only once in the Nova Scotia government — around the topic of energy and the economy. It proved successful by giving participants a thorough understanding of the many drivers that influence change and by enabling them to focus on what is within their power to control. Coincidentally, after we decided to do scenario planning around population aging, we discovered that Scotland did it last year as part of creating a discussion paper called Growing Older and Wiser together.
As I said, we are learning as we go. To date, an unresolved part of implementing the strategy has been creating a mechanism to engage non-government sectors.
Looking again to Scotland, we see they recently created a national forum on aging to provide advice and assistance to all sectors in developing their responses to a strategy in a document called All Our Futures: Planning for a Scotland with an Ageing Population, which was released two months ago. We are looking closely at this, and just last week our Minister of Seniors attended a conference in Scotland and met with officials there to discuss their approach.
Finally, the secretariat itself has identified several areas where we are ideally suited to lead the development of initiatives that will see progress on a large number of actions.
I will wrap up now with a few words on how the strategy positions the social determinants of health. As these are represented throughout the strategy, we decided to include them as an overarching theme. However, we soon discovered that Nova Scotia lacked an agreed-upon definition and other definitions, including those used by Health Canada, lacked important elements that the strategy addresses. We dug deeper and found a description developed by the World Health Organization. We were pleased with how well this fit with our strategy. We were also impressed that they included transportation, which was the most talked about issue at consultation meetings. We liked that this description expands understanding around the issue of income by moving away from poor versus rich to talk about social gradient.
In conclusion, I want to note that Nova Scotia is in the unenviable place of being the second-oldest population in Canada and having among the highest chronic disease rates in the country. Because of this, our province is ideally positioned to pilot innovations and try new approaches. We hope the Strategy for Positive Aging is helping to lead the way. We invite everyone to work with us to advance our vision of an inclusive society of caring communities that supports the well-being of seniors and values their contributions.
I hope that as we chat I can focus on some of the actions that have already taken place and some of the initiatives we are working on in this coming year.
The Chairman: Thank you very much, Ms. White. The great thing about Canada is the fact that we have the large and small provinces and the large and small cities, and models that cannot be put together in some of the large provinces get put together in the small ones, and you are a classic example.
[Translation]
Dr. André Davignon, founder, Observatory on Ageing and Society (OAS): Mr. Chairman, I would like to thank you on behalf of the Observatory on Ageing and Society for the opportunity to appear before this prestigious committee, whose mandate is to study social determinants, which is exactly the mandate that the Observatory on Ageing and Society has adopted. We are a federally incorporated non-profit organization, and so we are entirely independent. We are able to speak freely.
Second, I can also speak freely because I am the oldest person here. I have lived as a retired senior, and I have experienced it all.
[English]
I will give you just a few anecdotes to wake up everybody. One day I was walking in my new hospital, which is a hospital for old people, and in the corridor a nurse stopped and asked, ``Are you looking for your bed?'' No. ``Then you must be looking for admissions?'' No. ``Then I am sure you are looking for your wife's bed?'' No. She said, ``What are you doing here?'' I told her, ``I am in research; I have an office here.''
A few months later I got in the elevator followed by a technician. I punched floor four, and she punched floor four, and when the door opened she looked at me and said, ``The fourth floor is exactly here, take care, straight ahead, right in front of you.''
Here is an even worse story. My close friend, age 73, was putting shingles on his roof. He fell down and broke a bone in his neck and his neck started to swell. He was choking. His wife called 9-1-1 and we brought him to the emergency of a large hospital. They intubated him. The young resident looked at the chart and said to the anaesthetist, ``He is 73 years old; why do we not let him go?'' I am reporting real facts.
All this is our manifestation of something I call ageism. I was looking for a common denominator, and it is ageism. I have suffered ageism, and I have heard of others suffering the same. At our lookout post, the observatory, that is the common complaint right now.
[Translation]
What are the social determinants of health? Certainly they include psychological determinants. A person who enjoys good social health will be happy to be alive, to be here, to do exercises and take his or her medications. If a person is not depressed, his or her immune system will be stronger and the person will therefore live longer and be happier. It is therefore fundamentally important that people be happy.
Unfortunately, our society tends to devalue seniors. It is absolutely necessary that all governments, at all levels, tackle the social stereotypes that are used against seniors and perpetuated by the media. A 70-year-old man has an accident, and immediately the newspapers are asking whether 70-year-olds should be allowed to drive.
Those are some of the social stereotypes. We are expensive. We are going to ruin federal programs, the federal government and the provincial government as well. I have read this. Our pension funds will be bankrupted. We are ruining society. We are useless. We consume 44 per cent of prescription drugs even though we are only 12 per cent of the population. We not particularly competent at work. We learn less. We are incapable of learning new techniques. We are a danger to the public on the roads. Seniors are not a new visible minority. These days, there is a tendency to designate seniors the way racism, ageism and feminism were designated in the past. I get the feeling, as a senior, that we too often have fingers pointed at us, and I do not like it.
How can we combat these stereotypes? I have a few points to make on that. Seniors must be given a feeling of social belonging, or be given that feeling back; they must be shown that they are not useless. Someone who feels socially useless will die, that is a certainty. The first thing is that they have to be asked for their opinions. Not much is said about asking seniors for their opinions. It is essential that they be consulted. That is the urgent message we hear on all sides: ``Consult us and ask us what we want.'' The decision-makers decide, and the people who carry out the decisions carry them out, and seniors live with the consequences.
The value of their social contribution has to be recognized. Seniors have a fantastic social contribution to make, if we think about the arts, cultural heritage, the work world. Take volunteer work — billions of dollars worth of volunteer work is done by seniors.
Should we consider tax credits or other approaches to encourage volunteer work? Seniors can play a fantastic role in finance. The wealthiest people in Canada are seniors. They still have something to contribute. I am thinking of Mr. Desmarais, for example. We have to recognize the value of their social contribution, and provide them with security.
Given the ageism that exists, seniors have to be provided with security by making it possible for them to keep working. As our review of teaching showed, seniors are capable of learning. Programs have to be designed to teach seniors the techniques that will enable them to stay in the workplace. They have to be given assistance to combat isolation. Social isolation is the big problem for seniors.
We have not talked a lot about intergenerational relationships. This is a very important aspect.
Health problems are also a matter of concern for seniors. We have to give them ready access to medications and to catastrophic health insurance. It is appalling to learn that a person is not covered by federal social programs when a catastrophic health event occurs. There is no room in the hospitals. Private hospital care costs a fortune, sometimes $5,000 to $10,000 a month. These costs can ruin a family. There should be federal or provincial programs to provide these people with insurance.
Then we have legal assistance. Seniors are victimized by all sorts of exploitive legal scams. A major association has just joined the OAS: the National Institute of Law, Policy and Aging. The purpose of that organization will be to offer free legal advice to seniors. Obviously, this will all require an evaluation and research.
Last spring, a regional report was prepared by the Atelier régional des aînés du Québec on research done by the CIHR. You have undoubtedly received a copy. They ask that social research be prioritized, not at the expense of other research, but that it be encouraged. This will have a positive effect on seniors' psychological health.
To keep seniors in good social health, we have to listen to them, recognize the value of their contributions, use their skills and provide them with security.
Senator Pépin: Dr. Davignon, we are pleased to have you with us today.
You have highlighted the most important points involved in maintaining seniors' social health: listening to them, recognizing the value of their contributions, using their skills and providing them with security. What are the main barriers to achieving those objectives?
Dr. Davignon: The first thing we have to do is consult seniors. Quebec has an extraordinary structure that does not exist elsewhere in Canada, to my knowledge.
There are 5,000 or 6,000 seniors' associations in Quebec that are organized into regional coordinating bodies. There are 17 of those, one association per administrative region. They in turn belong to a regional conference, in which the OAS is a leading partner. The president and executive of the conference speak directly to the minister on behalf of 1.1 million people.
The goal is to listen. No matter what message seniors want to send, it goes directly to the government.
Let me quote a passage from a speech given by Jean Charest on May 9:
As the population ages, we are seeing the emergence of a new phenomenon. A growing number of active seniors who are still in good health are wanting to keep working, at their own pace.
I want to recognize their contribution. They have experience and wisdom. We are going to facilitate gradual retirement for them. Discussions are already underway with the federal government to organize the tax rules that will apply.
There you have one approach to solving the problem.
Where did Mr. Charest get this idea? I do not want to say that it was from me, but it comes in part from the OAS. I do not know how to answer your questions in any greater detail.
Senator Pépin: Perhaps the Quebec model could be used in the other provinces?
Dr. Davignon: Absolutely.
Senator Pépin: You told us that they are consulted regularly.
Dr. Davignon: The federal government should encourage seniors' associations to organize themselves into umbrella groups. That way, they would be speaking with one voice, for each province.
Do you know how much this project cost in Quebec? Ms. Marois told the thousands of associations to organize themselves into coordinating bodies and gave them $15,000 a year, per administrative region. The amount has gone up to $20,000 a year today, per administrative region. The system works very well.
Senator Pépin: You have talked about the most important things. But let us come back to isolation.
People who are living in their own homes or in an institution will feel isolated. Could you tell us what the most important factors in relation to our seniors' mental health are, that could be remedied? We need to consult them.
Dr. Davignon: Less than 5 per cent of the population suffers from isolation in institutions.
Senator Pépin: Seniors living in apartments are often isolated.
Dr. Davignon: The main problem is isolation in their own homes. That phenomenon takes all sorts of forms in Quebec.
These days, we often talk about the importance of intergenerational relationships. Grandchildren going to see their grandparents. We want to encourage family relationships and recognize the role of natural helpers.
I had to have an operation. I was told to go to the hospital. The surgeon discharged me one day later and told me that I would need home help. That was no problem for me, because my sister-in-law came in. If I had been all alone, I would not have been able to do it. My sister-in-law has financial resources. That is not always the case, however. We have to support natural helpers by compensating them for lost time, giving them tax credits or some kind of financial assistance so that they are able to provide this help.
Senator Pépin: Yesterday, we received a document stating that a $500 tax reduction is going to be offered to helpers and volunteers looking after seniors or people who are sick.
Dr. Davignon: I agree, but that provision does not apply to parents. Certainly a wife has a responsibility to take care of her husband. Parents and maybe even cousins should be included. But we need to define who a natural helper is, and I hope that the regulations will do that.
[English]
Senator Cochrane: Dr. Davignon, thank you for coming. I am very glad to have you all here. I have heard many times about how medical personnel feel about treating seniors.
Dr. Davignon: Pardon?
Senator Cochrane: About how medical personnel feel about seniors.
Dr. Davignon: We were doctors, yes.
Senator Cochrane: I have heard the same story you told us about this gentleman who was 73 years old and how they felt about him. I have heard stories like that many times, and sometimes I question myself: Is this for real? Is it true?
Dr. Davignon: It is for real.
Senator Cochrane: How can we change that? Do you have any ideas?
Dr. Davignon: Through medical education, medical minds.
I will give you another anecdote. A friend of mine, a nice lady from Outremont, is 80 years old. She was driving and she felt palpitations so she went to the hospital. The young intern started examining her and said, ``Madam, do you want to be resuscitated if your heart stops?'' She said, ``What the hell, why?'' He said, ``Because the policy of this institution is that after age 80 we do not resuscitate and we do not tell the patient, but you look quite lucid so I will do something if something happens.''
There was an article about this in a Canadian medical journal about four years ago. Did you know that in Cartierville you only have to be 75 and that at another hospital in Montreal there is no age? The people know: go there and they will help you. It is a joke, black humour, but it exists. You have to change the mentality.
Senator Cochrane: Terrible.
Dr. Davignon: We are not done; I do not feel like we are done.
Senator Cochrane: Ms. White, within the strategies you are developing, do you have seniors involved? I am sure that many of my senator friends know that no matter what topic we are talking about, whether autism, seniors or whatever, my philosophy is that I want the individuals involved in the decision making. Tell me, do you have them involved in your strategy?
Ms. White: We have them involved in more than our strategy; they advise the secretariat. There are nine provincial seniors' organizations in Nova Scotia and those organizations also relate to similar national organizations or bodies. We bring them together on a monthly basis to talk about a wide range of issues. They are at the policy table and they advise the Minister of Health on two specific areas, pharmacare and long-term care. There are two people from each organization and when they meet we cover the costs to bring them together.
Of the 22 members on the planning committee for the strategy, I would say the majority of people were in the retired age range, and then we had other people with professional skills and so on.
I agree with you that if seniors are not at the policy table then you are missing the boat.
Senator Cochrane: I am glad to hear that.
The Chairman: By the way, Dr. Davignon, the next questioner is Senator Nancy Ruth; she is a doctor also.
Senator Nancy Ruth: There is a new federal ministry of seniors and a new minister appointed. You said you have seven ministers overseeing your work. Have any of you had links to the new ministry and, if so, have they been reaching out to you? What is happening?
Ms. White: It is my understanding that that is a fairly recent announcement. Maybe Ms. Gillis can speak to that better.
We work closely with the federal government in a number of ways, with the federal-province-territorial work that we do with health development and with the Public Health Agency of Canada, so it will be interesting to see what this new announcement will mean. We absolutely have to and would want to work closely together.
Senator Nancy Ruth: Are you doing anything to push the agenda for the federal minister?
Ms. White: Yes, we are. At the FPT level there are a number of areas we are pushing, and this also relates to a previous question about the barriers to encouraging older people to work. Pension reform is at the top of the list. Without pension reform, where do you build in the incentives for people to work beyond retirement if they wish to work? That is a key issue on the FPT agenda.
We are also working together on a number of other issues: falls prevention; elder abuse prevention strategies; and healthy, active living, looking at the prevention side. Those are all joint initiatives where we are working closely with the federal government and all the other ministers responsible for seniors.
Senator Nancy Ruth: Have you heard anything from the minister or the new ministry?
Mr. Rosenberg: My understanding is that the president of the Canadian Association on Gerontology, Sandra Hirst, is to sit on the new panel, but as far as I understand they are just ramping up their activities.
I think the positive point from our perspective is the fact that we will be at the table and will have the opportunity to promote research on Canada's aging population.
Ms. Gillis: Senator Marjory LeBreton is now the secretary of state responsible for seniors. The department that assists her in that role is HRSDC, with Minister Solberg, the Minister of Human Resources and Social Development. This work is happening through the creation of the new National Seniors Council with Mr. Soulière as the chair, which was announced last month. Mr. Soulière is also the head of the Congress of National Seniors' Organizations.
The council's inaugural meeting with the first eight members will be May 24 and 25. The council will be working day to day with Senator LeBreton and will be looking at a number of seniors' issues across the broad spectrum of the federal government and making recommendations to the ministers. The council reports directly to the Minister of Health and the Minister of Human Resources and Social Development, but the day-to-day operation reports to Senator LeBreton in her role as being responsible for seniors. That is how it is coming about.
Senator Nancy Ruth: What is she supposed to do with those reports?
Ms. Gillis: She will be working with those committees and then bringing the reports to the ministers with recommendations.
Senator Fairbairn: This has been an uplifting panel and I think it is an uplifting subject.
I have spent my working years here and through friends have spent a lot of time in Nova Scotia, especially in Cape Breton. There always seem to be an awful lot of older people in Cape Breton and they are constantly on the move. They walk endlessly; they are out at ceilidhs dancing; they are out with the boats — it is breathtaking really, especially if you are well behind them when all of this is going on.
There is much I see that is different, but in many ways it is the same as in my own area in Lethbridge. More than in any part of our society, there seems to be a spirit, a determination and a real interest still in learning. In my area, they are all over the computers that are available to them through seniors' organizations. They are taught and they can do things that young people would not even know how to do because they have the time to do it.
Sometimes people try to stereotype this particular group of great citizens and get strange ideas about what they cannot or should not do, as the good doctor has indicated to us. However, whenever you turn around and give a chance and open a door, they are among the finest volunteers in this country.
I think this panel is just a delight because there are so many people in our society who still feel sorry for seniors. They think seniors just need a television set and to be visited once a week. It is not that way and there is no reason that it should be. It is very elevating to hear all of you talk about it.
Do the people in the various other groups in which you are involved tend to have a vigorous attitude toward people who are in their older years, as opposed to an attitude of patting them on the head or reading them a book? In the various groups that you work with across this country, is there an attitude that seniors are probably more fit than we are and should be included rather than put off in a corner? Seniors are very much a part of everything, and I am wondering whether that is the attitude that you run into, or whether you run into the other side, where people are sort of worried about them and almost segregating them. Anybody can answer those questions.
Ms. White: I have worked in this field for 28 years and I have seen tremendous change around the images of aging and the attitudes toward people who are retired. In our province — and I know it is the same across the country — volunteers are the backbone of our communities and seniors continue to volunteer well into their later years. However, I think we also have to provide more opportunities for engagement.
For instance, seniors will say they want to exercise, they want to be more active, but in our community, we do not have a safe place to walk on the side of the road because of the logging trucks. Many do not have the transportation to go out and participate in civic affairs. There is a real positive attitude of people who work with seniors, but there is much more that we can do to support the people who work with seniors to create even more opportunities for involvement and activity.
Dr. Davignon: Can we make seniors work with seniors? We always speak of people working with seniors, young and old, but seniors have to work with seniors.
Mr. Rosenberg: The members of our organization, as researchers and practioners, are dedicated to working with seniors as their partners. Many of our projects have seniors as active partners in them. I would like to reinforce the message that it would be a real advance if the kind of program research funding we had in the early 1990s, which encouraged this kind of partnership, could be reinvented in the coming years.
Considering how much the elderly population will grow in the coming decades, it is shocking that we are still discounting where we need the most research done, which is on the elderly population. If we want a new generation of researchers to work with seniors in answering the questions that I have heard raised over the last hour or so, we need to invest in a new generation of researchers who can work with seniors as their partners in solving these problems.
Dr. Davignon: I hope you mean work with seniors and not using seniors, because every week when I walk in my hospital, I see a young girl doing her thesis on cognitive impairment in old people. She says, would you become one of my subjects? She is cute so I say yes, but this is not what I call work; I am a guinea pig.
She does not ask me what I think of her project. I have 200 publications; I have hundreds of thousands in research funds, but she never asks me that. You understand what I mean.
Ms. White: I support the need for more research and ongoing research, but I would also like to pick up on something you mentioned earlier about social development. From my perspective, that is an area that has been neglected for a long time — funds for community development at the grassroots level. Municipalities and communities are struggling with wanting to do things in that area, but often they do not have the funds or someone to work with them, to maybe take the lead or provide them with tools or seed money. There is a huge need in that area, and it is something that we build into our budget, stemming from our strategy.
Senator Fairbairn: This is very encouraging. My colleagues may disagree with me, but we are seniors and the caricature of the Senate — if ever you see a cartoon — is of a place where there are extremely elderly men, many of them puffing away on a cigar or sipping a glass of port or, on the other hand, being helped out of the chamber by an assistant. Generally, we are all thought of as being as being very old and we are not — not in years and not in spirit.
It is good that we are doing this study. We and all our colleagues do as much going out into the communities and working with our people there as do our friends in the House of Commons. It is really quite an honour to that when we are doing it with seniors who are reaching out and who are eager to be involved in almost anything. I think you have been very uplifting for us today.
[Translation]
We know that women seniors are the poorest, have accidents the most often and have slightly more chronic problems than men.
What are the determinants of health that relate more specifically to senior women, as compared to other groups?
As well, what are the limitations of a public health approach when it comes to senior women?
[English]
Ms. White: It has concerned me for many years, especially that age group of 55 to 65 who have been homemakers. If they have worked outside the home, they may have worked very little. That can be compounded if they have had a divorce.
I have seen people just counting the days and weeks and months until they turn 65 to get the old age security pension. In most cases, they have lived on a very low income and that has an impact on so many determinants of health — the education they have, the nutrition they have, the social involvements that they have. They have lived a poor life; and as they get old and the health complications start to increase, it is a real double whammy to be a woman and have low income and not have the wherewithal to do anything about it.
There is a huge need to look at women and maybe this is where even more research comes in, to develop programs that will bring their income up to a level where they can be involved and make the changes in their life around work or volunteerism, whatever, that gives them a good sense of lifestyle and a better future. It is complicated, but income, education and nutrition all play a huge role.
[Translation]
Dr. Davignon: Absolutely, the common denominator is money. This is the generation of women who sacrificed, and they have no money. There is a hospital that shall remain nameless, in a Canadian province, where it was observed that in the last few days of the month, women were coming in to emergency rooms because they had no money to buy their medications. They were given their medications. Otherwise, they would have had no medications and would have gone into a diabetic coma, for example. They have to be given financial assistance, this is crucially important.
Senator Pépin: Are there other specific determinants you can mention?
[English]
Mr. Rosenberg: I am not sure I can add much to what has already been said. All of these factors are key. The other key factor is that we really do not understand well the transitions that take place from one situation to another. We know, for example, what the problems of low-income women are. We know the problems of women when they become single and isolated, but we do not know how the transitions take place from being a low-income woman to being a low- income woman living alone and in isolation.
That is why the next generation of research needs to look at these transitions and the dynamics that will take place. These dynamics will be further complicated by the changing nature of the diversity of elderly women. There will be more visible minority women, more Aboriginal women who are elderly and more women who come from a lesbian lifestyle. All of these factors must be taken into account. It is so important that we focus on these complex transitions.
Senator Callbeck: Dr. Davignon, you founded the Observatory on Ageing and Society. You gave us a list of all conferences you hold and the other things that you do, and it is a lot of work. How is that work financed?
Dr. Davignon: I do not know how it is financed. Every day is a struggle. I wrote to 25 agencies in the federal government and I got lost somewhere. I got $5,000 from the IRC. Then I went to see the financial person. I arrived there, and I said, ``Please help me. I will not sell you more insurance. You will not sell more insurance. I went to see Pfizer and they said, ``How much more Viagra do you want?'' I said, ``No, no!'' After one month, I got a call, ``We have a program for humanity work and we do not need you to advertise us. We will help you.'' They gave us a sum of money.
I would say most of the work is volunteer work. I have a private driver here, who is a retired man working. He is a volunteer working for me. He is a young man, 10 years younger. He volunteered to drive me here. This is volunteer work.
I would like to refer you to the motto on our brochure:
Ageing gracefully is ageing with one's heart,
No remorse, no regret, ignoring the flight of time,
Always moving forward, without fear,
Because happiness is part of each period of life.
An 85-year-old man wrote that. Therefore, 85-year-old people are not stupid.
Senator Fairbairn: That is excellent.
Senator Callbeck: Ms. White, you mentioned initiatives that you are working on this coming year. Perhaps you could talk about that.
Ms. White: I will be brief. Ms. Gillis mentioned that we are working on the age-friendly cities and the rural and remote communities initiatives. The latter will provide a stimulus and a guidebook to be a tool for other rural communities in our province or in the world that want to take a look at their community and start that process. The same is true of the cities project.
We will be hosting a conference called Silver Economy around labour force issues and how to encourage people to be in the workplace if they want to be, and also looking at the economic position of our governments. Silver Economy is a movement taking place in Europe. The two-day conference here will bring together businesses and all levels of government as well as not-for-profit and higher learning sectors to explore opportunities for economic and social gains that are inherent in our aging population.
It is very exciting, and I encourage you to Google Silver Economy. In Germany, they can look at one area of their country and, using a scientific approach, say how many other workers they would have if they created more friendly workplaces, opportunities, linkages for people to be retrained and have an opportunity to work if they wish to. That is a very exciting piece for us.
We will be working with our federal, provincial and territorial colleagues on pension reform. Without that, it will be hard to do the other piece.
Two of our community health boards are piloting a unique approach to volunteerism, with a focus on encouraging an emphasis on seniors helping seniors and looking at credits for the things you do in a volunteer capacity.
We are also working with the residential construction industry and other key stakeholders to identify and eliminate barriers and to promote incentives so that we can have more seniors' housing. We are hearing from developers that they would put up the capital funds but the zoning laws have to be changed. As Ontario and B.C. did, we are looking at changing the Nova Scotia Human Rights Act so that we can have seniors' housing. Right now, legally, we cannot.
Our lieutenant governor wanted to create an award for seniors and also wanted to do something with seniors. We suggested that there be an intergenerational award. This year, the work has been done on that. In October there will be three awards: one for a young person who has created and worked on something that helps and supports seniors and one for seniors that involved doing something for seniors.
I went to the rotary club I belong to for funds, and they will provide monies for a specific program.
We are rolling out our elder abuse strategy and developing networks across the province on that and also developing networks within local areas on falls prevention.
Those are some of the things we are already taking action on from our strategy. There are many more to come.
Senator Callbeck: You have a full agenda.
Ms. White: We do.
Senator Callbeck: I have other questions but I will have to pass because of time.
Professor Rosenberg, you mentioned the importance of more research, and you said that you would like the Canadian Community Health Survey to be more inclusive. What would you like to have in the survey that is not there?
Mr. Rosenberg: I could add that this is individual research, but the problem with the survey — and unfortunately this is the nature of Statistics Canada surveys — is that to be representative of the whole population, the sampling of seniors is actually relatively small. What we need, as an association that is interested and my members who are interested in doing research on seniors, is over-sampling of the senior population. With over-sampling, we will capture the diversity of the senior population in a way that we can then do research and make findings representative of all seniors. That is what we really need.
The Chairman: I had wanted to raise the question of measuring outcomes in your research, both Dr. Rosenberg and Ms. White, because you have a structural framework to do it, but we will have to do it another day.
Dr. Davignon, it was great to see you. We enjoyed you tremendously. Thank you to all of our witnesses.
The committee adjourned.