Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 12 - Evidence - November 23, 2016
OTTAWA, Wednesday, November 23, 2016
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:24 p.m. to study the mandate letters of various ministers.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee, and I'm going to ask my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
Senator Merchant: Pana Merchant, a senator from Saskatchewan.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Seidman: Judith Seidman, from Montreal, Quebec.
Senator Neufeld: Richard Neufeld, British Columbia.
The Chair: I'm particularly delighted to welcome Minister Philpott here today.
It's really a pleasure to have you, minister. Thank you so much for being willing to join us.
We have the absolute power centre of the health ministry with us, which is a great privilege as well. We recognize the Deputy Minister, Simon Kennedy. We have Alain Beaudet from CIHR. We asked for more money for you, Alain, in our most recent report. And from the Public Health Agency of Canada we have Dr. Gregory Taylor, who is Chief Public Health Officer, and in his new role, someone who has appeared before us in other capacities, we welcome Paul Glover, President of the Canadian Food Inspection Agency.
For the benefit of the committee, there are other officials in the audience. When the minister has to leave, the officials will be available to assist as the folks at the table decide is appropriate, depending on the questions.
Minister, the format we would like to use is to give you the opportunity to say whatever you would like to say to us and then I will open up the floor to questions from my colleagues.
Colleagues, given that it is Wednesday afternoon, we do not know what games may be going on in various chambers at this point, though ours has finished its games for today. I'm going to use the one question per senator per round and hope you will focus your questions because it's rare to get a minister here with us for this particular view. We want to get as many questions in as we can.
With that, minister, the floor is yours.
Hon. Jane Philpott, P.C., M.P., Minister of Health: Thank you very much, Mr. Chair and honourable senators. It's a pleasure to be with you here this afternoon. I get to spend my afternoon with senators, which is a good thing, and I just enjoyed the lovely period of being grilled in the Senate just now.
I want to say that this is a committee that has done incredibly important work over the years. I want you to know that long before I even thought about running as a politician I used to read reports of this particular committee, so you're serving on a committee that is held in high regard and is looked to by health care providers and health policy- makers in the country for the good advice that has come out of the work that has been done here. I know you're continuing that legacy with this particular constellation of senators that are on the committee.
I think you've already introduced my colleagues who are here, so I won't go into details on that.
I will make fairly brief opening remarks because I want to get to your questions as quickly as possible. I'm very happy to talk to you about the issues in my mandate, which are obviously important to me. I have a commitment to the Prime Minister to deliver on those and I look forward to your feedback on those.
The areas I will highlight in my opening remarks are a little bit around the health accord negotiations, which I suspect will be of interest to you and in fact it's something that I know has been looked at by this committee in the past. I want to discuss also the matter of indigenous health and my responsibilities related to the health of indigenous peoples, and was going to refer to some of the regulatory work we're doing on matters of health, which I thought might also be of interest to you.
On the health accord, I think that you'll have seen in my work to date that we've been very much engaged in restoring the federal role as it relates to health in this country and making sure we have a sustainable, innovative health system that will meet the needs of Canadians. I think the response to that has been positive to date.
As you know, there's a large part of health care that is within provincial and territorial jurisdiction, so obviously we work very closely with them. Certainly, the federal government has an important role and we have been trying to respond to some of the pressing needs, things like the aging population, which I know you have discussed, the tremendous growth in chronic diseases and the rapidly changing landscape as it relates to technology in health care.
My mandate letter has laid out a number of areas within the health accord around home care, mental health, price of prescription drugs and health innovation. We've added to that the matter of indigenous health as part of the discussion.
I will be happy to answer questions. I won't go into any more detail on the health accord. If that's something you're interested in, I would be happy to take those questions.
I want to touch briefly on indigenous health. That's an area I'm quite concerned about. As you know, our Prime Minister has said that no relationship is more important to him and to Canadians than our relationship with indigenous peoples.
We have a big investment, in the order of $2.5 billion annually, in our portfolio for indigenous health through the First Nations and Inuit Health Branch, but I'm particularly aggrieved by the tremendous gaps that exist in indigenous health outcomes. We can go into some of those in detail.
We have made some progress to date. We had a big investment on mental wellness. We've got a new mobile crisis line up 24/7 across the country expanding mental wellness teams, mental health crisis teams. We've done I think very good work in responding to Jordan's Principle and I think now up to 1,000 children have been assessed to make sure that their care needs are met. There's a lot of work to be done in that area.
The last area I was going to talk about was some of the regulatory actions. I won't go into specifics, but just to highlight some of the areas where we are doing some regulatory work around healthy eating and healthy living. I know that's been an interest of this committee and of other senators as well, for example, on healthy eating, looking at Canada's food guide, improving labelling requirements around processed foods.
We've had a number of consultations around how we can make sure we reduce salts and trans fats in processed foods. So that may be an area you want to talk about. I can't help but mention that in the Senate yesterday a bill was tabled by Senator Petitclerc on a new tobacco and vaping products bill. I'm very pleased that Senator Petitclerc has sponsored that bill and that may be something you're interested in discussing.
I think it's a very important move for Canadians to address the ongoing realities of smoking, the fact that every 14 minutes a Canadian dies of smoking-related illness is something to pay attention to.
I'm happy to discuss many other issues: marijuana, mental health, opioids. There is no shortage of topics.
Rather than take up the time with my formal prepared remarks, I will just say I'm very pleased to work with you. Thank you for your interest in the matters of health.
The Chair: Thank you very much, minister. I'm going to start with Senator Eggleton.
Senator Eggleton: There are tons of questions we could ask. I'm going to go to the health accord. I am really delighted you're talking about re-engagement in all aspects of this and with the provinces and helping to develop a new multi-year health agreement. We did a study back in 2012 on this subject. We did a review and came up with a whole lot of recommendations, one of which was a national pharmacare program, recommendation 28.
Anyway, the recommendation that we put right on top, the very first recommendation I want to ask you about, it says that the committed annual increase in funding transferred from the federal government to the provinces and territories through the Canada Health Transfer be used by governments in great part to establish incentives for change that focus on transforming health care systems in a manner that reflects the recommendations that are outlined in the report.
The whole point of this is that if there's going to be additional money put into the system, it's time to update it. It needs change. It is not in accordance with the realities that exist in this country today.
You can call this a change kind of recommendation, but is the government prepared to press that at the table with the provinces in terms of getting change reforms in the system?
Dr. Philpott: First, thank you for that report, which I've read through on numerous occasions. It's an excellent report. I know that you and Senator Ogilvie and I have discussed this in the past.
Your report, from four years ago now, I think still has tremendous relevance today because many of the things you recommended have not necessarily been followed up on.
I am wholeheartedly with you on the matter of investments in health going to transformative change in the system. I thank you for your support around the federal role in health. I think it's something that's been underemphasized in recent years and absolutely the federal government through its spending powers and through other mechanisms has a very important role to play.
As you've probably heard through conversations in the media, where you get to have a glimpse at what's going on in those federal-provincial-territorial negotiations, that's been the messaging I've been trying to deliver to my counterparts in the provinces and territories.
There's some reluctance, obviously, and we respect the role that they have, but I think there's general agreement around the table that, for instance, in the matter of home care, they need support to be able to expand home care initially because it does cause increased costs. You know better than I do that in the end we will serve Canadians better and will actually have a more efficient health care system if we can push a system towards delivering care in the home and community.
You folks showed that years ago. It's been known for a long time. Somehow we've never been able to get there.
Our hope is, and the details are not yet hammered out, but we've made a commitment to investing in home care. We hope that the provinces and territories will agree to follow along some metrics that will allow them to see that that happens and that that will be transformative in terms of nudging the system into getting people to get that care in the home, which costs a lot less and keeps a whole lot of people happier.
Thank you for supporting that approach. It's the approach that I would like to see in other areas, like mental health as well. There is still work to be done with my counterparts.
The Chair: Minister, to follow up on that, in your reference to things oozing out into the press with regard to your discussions with the provinces, one very encouraging ooze was the idea that you want to put accountability on specific tranches of funding that are identified in clear areas, and to follow up on Senator Eggleton's question, that was an absolutely essential part of our recommendations. We don't believe a thing will change unless accountability comes with specific funding.
I would just interject to say, whatever our weight is worth, it is entirely behind that particular aspect.
Senator Stewart Olsen: I want to talk about basic health care, especially in rural areas. I'm from New Brunswick. We're very big on rural areas there. You have probably seen the news reports today that the wait times have increased so drastically. I can attest to that. Have you given any thought at all to maybe bringing the hammer down on the provinces in the provision of basic health care?
We spend, at the federal level, a lot of money, and I think we're past the point where we can say you're doing a great job. This comes into accountability, but I think that there have to be some pointed initiatives that the provinces must do to discuss things like a year's wait for a hip transplant, two years' wait for a hernia repair. These are not acceptable by any means in a country that spends as much as we do on health care.
Just give me a bit of a flavour of what you think about that.
Dr. Philpott: Thank you for the question. I have to say I've had very good conversations with my colleagues in the Atlantic provinces, and certainly both New Brunswick and Nova Scotia, in particular. I've spoken to the premiers in both of those provinces about the real challenges they are facing in health care.
I think that pressure is driving a desire for change, and in fact I think there is some really creative work being done in those provinces.
The big pressure that they are feeling is the aging population. There's a lot of panic around what that will mean. My perspective is that I don't think we should be panicked about it but we should realize that that's why the system needs to transform. We need to change the way that we do care.
On the things that you talked about, like wait times, the reality is $1,000 a day on average for a person to be in a hospital bed. The data shows that 15 per cent of hospital beds in the country are occupied by somebody who doesn't need to be there, who could be cared for at home in the community. Initially it's going to cost money for the provinces to move those people out of the hospital bed and provide the home care, but what it does is directly addresses that wait time by then opening up those beds and allowing somebody to be able to move in.
I think there's a real willingness on the provinces to do that. I think the health accord is a great mechanism to encourage provinces and territories to do what everybody knows, has known for a long time needs to be done, and with the support of folks like yourselves, I think there is an appetite for seeing that happen.
The other thing I'm seeing happening in the Atlantic provinces, which I think is encouraging, is a move towards using technological solutions to do a lot better job on care.
For those of you who've been involved in health care in the past, we have a terribly siloed system. It drives health- care providers crazy because nobody knows what anybody else is doing, and there's a crazy amount of duplication of services.
I'm seeing, for instance, in Nova Scotia — I was there this summer — they are starting to really expand their platforms. We've invested a lot in Canada Health Infoway and hope to invest more, and Infoway has managed to work in Nova Scotia. Nova Scotia is working on trying to get better, more seamless systems so that we are not wasting all kinds of money and all kinds of people's time by redoing work.
I don't know whether that totally answers your question. You sound like you really want us to put the pressure on. I don't like to think of bringing hammers down. My approach tends to be as collaborative as possible, but I appreciate the sense of urgency that your question brings.
Senator Merchant: Thank you, minister. You highlighted the importance that your government, the Prime Minister, is putting on Nutrition North and issues that relate to Northern communities. We have heard from our colleagues in the Senate — and we know from news reports, and you know it too — that healthy food, fresh food is unaffordable in Northern areas. Specifically, regarding this program, can you tell us what progress you have made and when you're going to announce specifics about this program, please?
Dr. Philpott: Thank you for the question. You're from Saskatchewan, right?
Senator Merchant: Yes.
Dr. Philpott: So I know some of the challenges, even in northern Saskatchewan, are significant in terms of being able to address the needs of communities that are often quite remote.
Nutrition North has had some challenges along the way but has played an effective role in helping to get some of these healthier foods in more affordable ways. We did make some progress — and this is something that I worked with my colleague the Minister for Indigenous and Northern Affairs on to expand the program. I think it's 37 new communities that now have, as of October, services from Nutrition North. That's the Minister for Indigenous Affairs that has done that.
The total investment in Budget 2016 was $65 million to assist in the delivery of Nutrition North. The other part that we play in the Nutrition North program is expanding the educational part of it so that people also learn more about healthy food choices. I know that there's a lot of emphasis in terms of people also using some more traditional foods, which are healthier for them than, for instance, processed foods that are often cheaper, unfortunately, and not necessarily the choice that people would go to.
Did you want to expand on that?
Simon Kennedy, Deputy Minister, Health Canada: Just very briefly to supplement what the minister said, the actual delivery of the program is through Indigenous and Northern Affairs, but Health Canada has a component around nutrition education. In the expanded program — it's being expanded to other communities — we're, in a sense, expanding our nutrition education work as well, as the minister noted.
Senator Seidman: Minister, thank you for being with us, almost all afternoon.
Now that you've answered the question on transformative change and the move from delivering health care from acute care facilities into the community, I would like to come back to that on the second round because I'd like to get another question in here with respect to mental health.
I know that your mandate letter states that a new Health Accord should make high quality mental health services more available to Canadians who need them. I'd like to ask you about a specific problem about anti-depressant and anti-psychotic dispensing rates in Canada. We just saw, recently, an article in the papers.
Although anti-depressant and anti-psychotic drugs are valuable medications in the treatment of psychiatric disorders, the recent focus has shifted to the question of the balance of risks and benefits of these drugs, particularly among our youth. A recent study of prescription transactions revealed an increase of 33 per cent in national pediatric anti-psychotic dispensing rates between 2010 and 2013. Anti-depressant rates skyrocketed to 63 per cent in that same period.
My home province of Quebec has the highest pediatric anti-psychotic dispensing rate in the country, with 253 prescriptions filled for every 1,000 youth under 18. That's triple the number of prescriptions filled in Nova Scotia, the province with the lowest rate nationwide.
This overuse might be the result of prescribing attitudes, standards of care, even lack of access to mental health treatment options. Of course, we must also treat this data with caution because of the lack of national standardization in the types of data collected to measure medication use.
All that to ask you, accurate data is necessary, both to understand the potential problems in the health delivery system and any changes that must be made to policy. So how can the federal government tackle this critical problem?
Dr. Philpott: Thank you for that question, and thank you for your interest. I know health issues have been important to you, and we had some good discussions together around the bill related to medical assistance in dying. I thank you for your work on that.
Mental health is one of our priority issues, and you're absolutely right that it's going to be one of the things that I want to see. In fact, the Prime Minister insisted in my mandate letter that I make sure that we have better access to mental health services in the country. So it's a big issue overall.
Your question related specifically around anti-psychotics, which I think is a fascinating question. I, like you, have been following some of these interesting reports recently.
There is some good news on some of those reports. There are a couple of groups that I'll draw your attention to that I think have done very good work. One is the Canadian Foundation for Healthcare Improvement. One of its highlight projects was a de-prescribing program that they have actually had good success in, and it has rolled out in a couple of provinces.
Mr. Kennedy: That was use of benzodiazepines in old age homes, I think.
Dr. Philpott: Right, so it's had some work in that area. There is another group called Choosing Wisely, which is not a federally supported organization, but it's one that we work closely with. They've actually also had some success in de- prescribing.
One of the areas that you have talked about is, "Why is this the case?'' Actually, I think that's a very interesting question. My personal sense — and I think there's data to support this — is that one of the reasons why people go to medication is exactly as you've implied, that often there are no other publicly funded resources for mental health care. In a system where doctors are one of the only health care providers and, in the most circumstances, are funded under our public system, for doctors who are short on time and don't have the benefit of a social worker or psychologist working with them, except in exceptional cases, there's evidence to show that that's one of the pressure points that leads to prescription being an earlier choice.
I am very interested, and I hope that my provincial and territorial counterparts will agree that we should actually look at better publicly funded mental health care services.
In fact, there's a report that came out of this committee, I think in 2002. I believe it was led by Senator Kirby, and I'm not sure whether there was a co-author. Was anybody around in 2002 on this committee? I think I have the date right. It was around publicly funded support for things like cognitive behavioural therapy and counselling services and whatnot and some evidence to suggest that that would be a good investment.
Those are some of the things that I'm literally in the midst of discussions on with my colleagues. I think that that may help around the medication, and it may be, again, one of those places where a little bit of investment up front can actually save a whole lot of money to society and a lot of grief to society in the long run as well.
Appropriate prescribing use: My deputy is always available to help me remember the things that I might have forgotten to say. The part of my mandate letter on prescription drugs is that they need to be accessible, affordable and appropriately prescribed. So that's definitely a part of the mandate.
Senator Nancy Ruth: Minister, I want to talk about the new multi-year Health Accord and gender-based analysis. The accord is to include, among other things, better home-care services, more access to high quality in-home caregivers, financial supports for family care and, when necessary, palliative care.
Since September 2016, both the Privy Council and Treasury Board Secretariat required that GBA be done for all new initiatives. And since no GBA was made public for Bill C-14 — and we had this discussion in the chamber at the time regarding medically assisted dying — how will your department conduct GBA on the health accord and its components, and how will you undertake to make it available to parliamentarians and the public before the accord is finalized?
Dr. Philpott: Thank you for an excellent question.
I think I told you this when we talked in the Senate before about this that I appreciate your fantastic advocacy on this issue. We have a Minister for Status of Women who is just relentless to her colleagues in the cabinet.
Senator Nancy Ruth: I'm interested in the health ministry's outcomes on this issue.
Dr. Philpott: I want you to know I have regular reminders of the absolute necessity of GBA. In fact, I insisted that the entire political team in my office go through a course that is offered on-line for —
Senator Nancy Ruth: It's not about a course, minister; it's about outcomes.
Dr. Philpott: Absolutely. These are some of the pieces that are contributing to the fact that strong gender-based analysis will be essential on the health accord negotiations and their outcome. Many of the pieces like home care have huge gender-based implications, because we know that caregivers are more often women than men in many circumstances and that women have a large burden of care. I would be very open to hearing your particular recommendations if there are specific areas that you're concerned about in terms of the health accord.
Senator Nancy Ruth: No, but I would like to hear from your deputy about what on earth is happening in terms of the accord. How do you do it?
Mr. Kennedy: Senator, there are a number of things we are trying to do to advance this as a priority. For some time we have had — and we're working to beef it up — a unit in the department that does gender-based analysis. Actually, it's broader. I guess they call it GBA-plus. It does analysis on this. I am certainly not satisfied that that is sufficient. I think the government has laid out that they want to put a priority on this.
Senator Nancy Ruth: Could you explain to me what the unit does? Do policies go to it and they respond? How does it work?
Mr. Kennedy: Well, senator, it has a number of functions. One of them is to act as a centre of expertise for the various units in the department, such as the folks doing drug approvals and reviewing clinical trial data packages from drug companies. They can rely on the gender-based analysis centre of expertise in the department to get advice on taking sex and gender issues into account in the drug approval process and in the work they do. They provide that kind of centre of expertise for other parts of the organization.
They are also the group that whenever a memo is going to cabinet or whenever we're developing a policy, there are processes that require that all of those go through gender-based analysis. They perform that function, too, which to scrutinize policy and make sure that whether it is the Privy Council Office or the minister's office or others, we are able to attest that there has been that assessment.
The last thing I can say, Mr. Chair, is we're not necessarily satisfied that that is sufficient. We know that the government has made this a priority. So we have actually been working with the Institute of Gender and Health at the CIHR to develop what we hope to be a pretty significant — it's not for external partners — bit of a summit inside Health Canada, which we aim to have take place in the first half of next year. What we would like to do is get the senior management team to partner up with researchers from the Institute on Gender and Health to figure out how we can drive GBA further into the operations of the department.
I would characterize right now that I think we're doing an okay job, but it's not perhaps as anchored into the organization as it could be. Alain Beaudet's folks have been helpful in that regard. We are working with the research community to figure out whether there are ways we can build some of this into our everyday processes. The minister and I haven't spent lot of time talking about that, but a lot of work is going on in the organization to try to push this ahead.
The Chair: Thank you very much.
Senator McIntyre: Thank you, minister, for being with us this afternoon.
In the Senate you spoke about the five-point action plan that you have implemented to address opioid misuse. That said, the House of Commons Standing Committee on Health recently tabled a report on the issue. My understanding is that it called on the federal government to declare a national public health emergency. Is there precedence for declaring a national public health emergency in Canada? Could you give an explanation on that? If not, is there a legal basis for doing so?
Dr. Philpott: Thank you. That's an excellent question. I'll respond first, and then I may ask my colleague from the Public Health Agency, the chief medical health officer, to respond as well.
Yes, we received the excellent report from the Health Committee. It has a number of really important recommendations. The very first one was related to the declaration of a national emergency. I think part of what was behind that was because British Columbia declared an emergency within their province, which they deemed to be necessary and helpful because it unleashed some of their powers to be able to do better surveillance, and real-time surveillance.
The situation is a little different at the federal government level. The current Emergencies Act is a follow-up on what was previously the War Measures Act. The War Measures Act apparently was enacted three times in Canadian history: the First World War, the Second World War and the October Crisis.
To date, the Emergencies Act has never actually been used as a tool to declare a national emergency. It is intended to be used when all other tools are deemed to be exhausted, including the powers of the provinces to be able to respond to an issue. I think that helps to give a little bit of perspective.
This issue was raised with me a number of times when we had our conference and summit over the last couple of days. I obviously raised this with my officials to make sure that we were looking at this from the right perspective, because it is absolutely a serious and growing crisis. I wanted to know what declaring a national emergency would do. Would it unlock any particular mechanisms for me that I don't already have access to in terms of making decisions that are actually going to have an impact on this crisis?
To date, the advice that I have been given is that we are literally using every tool available at our disposal to respond to the crisis, and that the declaration of a national emergency wouldn't give us any abilities that we don't already have. But it's obviously something that we will continue to monitor.
Dr. Taylor may want to respond to that as well.
Dr. Gregory Taylor, Chief Public Health Officer, Public Health Agency of Canada: You gave an excellent explanation. In particular, it gives no extra authority to the CPHO.
Even between the provinces, the legislation is a little different. When B.C. declared, I called Perry Kendall, the chief health officer, and said, "Why are you doing this?'' He basically gave two reasons: first, to get the visibility it needed; and, second, he could require information from some of the alternate sources so he could do better surveillance.
I talked to David Williams in Ontario. They don't need that at this time. It really varies from jurisdiction to jurisdiction.
From a medical or an outbreak perspective, it has never happened in Canada. We went through Ebola. We went through the pandemic. There was no need to declare that.
Senator Raine: As you know, I have legislation going through the Senate, but I don't want to talk about that today.
I have had some people give me their concerns. Many Canadians purchase natural health products as part of their own personal health plan. Health Canada launched a public consultation on that. It began on September 7 and closed on October 24. When I looked at that, I saw that it was on the regulation of self-care products, including natural health products, over-the-counter medication and cosmetics. My fear is that we're going to lump these all into one body to control them, and yet each one of those products is so separate. In particular, I note that national health products have gone through a very extensive change over quite a few years now to come up with a good national health product labelling system and control system. It seems to be working very well.
There is a lot of concern that, somehow, this is all going to change. First of all, I would like to ask you: How was the consultation communicated to Canadians? Are there any preliminary results at this time, and what concerns caused the consultation?
Dr. Philpott: Thank you. You surprised me. I thought you were going to ask me about marketing to kids. Since I have the opportunity, let me let you know that I look forward to meeting with you to discuss that. This is something that I know is really important to you and we're really pleased to work with you on that matter.
In terms of the self-care framework, I think what is most helpful is to understand the latter part of your question, which was why we initiated this in the first place. There are two large reasons that I will give to you, although there are some sub-reasons. I'll ask my deputy to comment in terms of the feedback of the consultation so far.
One of the things that I heard early on in my mandate was that even though, yes, to some extent, the current regulatory structure has been perceived to be helpful by many, there is a lot of confusion around it because of the fact that there are three separate regulatory structures that might actually apply to the same product.
For example, you might find a tube of cream that, in one sense, could be deemed a cosmetic depending on how you label it and which structure you want to apply to it. You might be able to ask for that very same tube of cream to fall into the framework of the natural health products if you claim it reduces wrinkles or something like that. Or you may decide that you want it to go in under the over-the-counter medication and that you felt it fit into that structure if you made some particular health claims and thought it would be associated with that.
Our goal is essentially to simplify the structure so that there is not confusion over which particular piece of the regulatory framework it fits into, and not to have too onerous a set of regulatory requirements for products that simply don't face a lot of risk. A tube of lipstick that might want to say that it has a sun protection factor on it is a very low level of risk, and therefore shouldn't necessarily be forced to apply through a strict regulatory framework.
The other piece that really is a driver for me in this, as somebody who is a previous health care provider, is that, of course, we want Canadians to have access to a whole range of products. It's important to me as health minister that, when people go into a pharmacy or a convenience store and buy a product for themselves, first of all, obviously we want the products to be safe. We also want to make sure that if it has a claim related to it — that it, for instance, will decrease wrinkles, cure cancer or prevent infection — that Canadians will have confidence that those health claims on those labels can be trusted. We know the heartache that happens when people believe that a product will do something that there isn't good scientific evidence for it to do.
I know that's a controversial issue, but it's something that I think is important. Do you want to give some further details in terms of the consultation on that?
Mr. Kennedy: Sure. I can think of two things to add to what the minister said. We have these three different sets of regulations: the cosmetics regulations, the non-prescription drug rules and the natural health products regulations. As the minister noted, there are plenty of products, whether it's toothpaste or hand cream, et cetera, where very minor differences in the formulation will cause that product to fall into one of these three regimes.
We actually have companies that manufacture hand creams and they are all made in the same factory with slightly different formulations. Each one has to go through a different regulatory process and the rules vary substantially. For example, if you have a hand cream that has a sun protection factor in it, we consider that to be a non-prescription drug. We do an inspection of the factory, you pay a fee and it can be a very long process to even get approval to sell that product.
If it has no SPF in it, we consider it a cosmetic and you don't even need an inspection. There is really not that kind of onerous oversight. If it happens to have some natural ingredients in it, we might consider it to be a natural health product and then, again, it has a different regime. The idea is to bring a little bit of common sense to this.
We have had concerns raised that this is potentially a way to regulate natural health products as drugs and that we will be applying more onerous requirements. We have been very clear in trying to explain that. There is material on our website to say there is no intention to regulate natural health products as drugs. Certainly, under the proposed approach, there will be a lot of products that will actually get to market faster because we actually think that some of these products have a level of oversight now that is probably not appropriate.
We will be publishing a document outlining what we heard that will try to provide the sense of the feedback we have received from the public consultations. I do not remember, senator, whether it was January or February, but we will certainly put that out publicly in the first little bit of next year.
Senator Neufeld: Thank you, minister, for being here.
I live in a part of British Columbia which is called Northeast B.C. It's about a quarter of the land mass of British Columbia, with about 70,000 people. It goes on record that we birth more babies per capita in northeastern B.C. than they do anywhere else in British Columbia. We have a problem with an aging population in all of British Columbia because people want to come from much of Canada and settle in the lower mainland when they retire. That causes some problems; I'm sure you have heard that from our minister.
I applaud you for embarking on home care. We need to do that. I'm not one to say we should bring a hammer down on provinces, having been spent eight years as part of a government just eight years ago. I know how hard our ministers of health work — because they burn out quite regularly — to try to spend their dollars as wisely as they can. I would rather see a co-operative approach, as you spoke about, working with different regions in different provinces on how you bring those programs forward.
One of the big problems we have is retaining doctors and nurse specialists. It's almost impossible. I remember, last summer, people lining up at the one walk-in clinic we had for a couple of hours ahead of time with their babies to actually get in to try to see a doctor. But the line gets cut off at a certain time, so is it any wonder that we don't get hips, knees and those kind of things done? I have lived in the North pretty well all my life. I'm used to a lot of the South African doctors that we used to get. We don't seem to see them so regularly anymore. I know there are some reasons for that.
Is there something that the federal government can do to actually help us get specialists, nurses and doctors even just for a while? We were so short of doctors that you could wait two or, maybe, three months before you might get in for a sore throat. Well, by then it's done.
Is there something that is being done that I'm maybe not aware of? I would have to speak to Terry Lake about that. Is there something that is happening within your department that you can help us a little bit with actually getting those kind of people centred in some of these regions?
It's not because we have old facilities. We have a brand new hospital in Fort St. John that's five or eight years old. The facilities are all there. The problem is to get and retain doctors and specialists.
Dr. Philpott: Thank you for the question. It's actually a topic that I'm tremendously interested in, the matter of human resources for health. It's not something that the federal government has typically played a large role in, although there is a small group within Health Canada that is involved in human resources for health. It's something I think that, again, the federal government and the provinces can work on together in terms of health ministers gathering to share solutions, of which I see some happening when we gather at federal-provincial and territorial meetings to discuss these things.
I will share with you a couple of thoughts; two things that I think are within the federal role in that.
One is a bit more from the policy point of view. One of the ways that we'll do better in this country in delivering care and addressing things like the wait times that you brought up earlier is in this whole transformation of health systems. One of the most important pieces of the transformation is the use of inter-professional teams. Around the world there is a lot of interesting work being done in what is called task shifting or task sharing, to make sure that the right health care provider is delivering the right care, at the right time, in the right place.
Some of the work that I know is being done in some of the provinces is around making sure there is more access to nurse practitioners. Quite a bit of this work is done within the First Nations Inuit Health branch to try to find alternate health care providers when doctors can't do it.
Some of our work in the Health Accord, as we support home care and mental health, there may be opportunities to find ways that — again, within publicly funded structures, historically, according to the Canada Health Act, we have provided coverage for doctors and hospitals, which has meant that we use some of the most expensive delivery mechanisms, which are doctors and hospitals. If care can get into the communities so it can be delivered at home and provided by nurses, nurse practitioners and personal support workers, if we can help resource some of that, it can offload quite effectively from doctors and make them available to do the things only doctors can do.
I think a really interesting piece of the solution that you're talking about in areas that are maybe more remote is the technological solutions on health care delivery. There is some really interesting work being done. Within our First Nation and Inuit Health branch, there are increasing opportunities to deliver care through Telemedicine, and some very creative work being done in some provinces, including Saskatchewan, some great work out of the University of Saskatchewan around the use of technology. The doctor doesn't necessarily need to be in the same place as the patient. I'm hoping, through some of our innovation investments as a federal government, this is something I have put on the table and shared with the Minister of Innovation, saying that we need to be supporting these people that have fantastic solutions.
Because the solutions we can find to remote care delivery in this country could have potential to be exported around the world. Canada is a great place to innovate on how we can better deliver remote care.
Those are a few ideas, not specifically within my mandate, but it's a very important topic.
Senator Munson: Minister, it's really nice see you. I will tell you why. I just missed the cut this afternoon in asking a question. We have rules as well. I went back to my office, and my assistant said that you are appearing at Social Affairs, Science and Technology. So here I am. Like you, I am a guest. I was a member of this committee for 10 years, but I'm no longer a member. Thank you, chair, for giving me the opportunity.
Now that I have a second chance and another lifeline, this committee had a report called Pay Now Or Pay Later: Autism Families In Crisis. I'm like a dog with a bone; I'm not going to let this go.
The previous government has implemented some of the things we had in our report. We know there have been extensive consultations and work over the past year on the Canadian Autism Partnership, and a business plan has been presented to you. I want to ask you publicly, can I count, can this committee count, can the autism community count on your support to address this critical initiative soon, perhaps in the budget or otherwise, and we'll finally address many of the complex needs for individuals and families in this country living with autism?
I understand there are big issues. This is an issue which, in my life at least, and others in this country, is extremely important.
Dr. Philpott: Thank you for the question. You have been an amazing advocate on this issue for a very long time. It's made a big difference. I know that the community most affected by autism is very appreciative of your work. I know you worked with some of my colleagues from the House of Commons as well who are real advocates around this.
I had a meeting on my agenda this week that got deferred until next week to meet with the CASDA group, which is the Canadian Autism Spectrum Disorders Alliance, who is working on this particular project. We are expecting a report back.
I don't know whether you have details on that, Greg? No? Okay. I would say this is something that we recognize to be a challenge. A business plan is going to be presented to me next week by CASDA. It was supposed to be this week, and I had to reschedule them.
Can I get back to you as to how that meeting goes and what our response will be on the business plan? I need to hear it.
Senator Munson: You do believe in a partnership that is going to work?
Dr. Philpott: It's a hugely important problem. There are some real challenges around figuring out what the right response is on specific categories, and this is one of those areas where a lot of the more broad horizontal work that we're doing as a government is important in terms of helping people with autism and autism spectrum disorder in terms of issues like housing, jobs and all the other issues faced by people with autism.
The specific role of where the Public Health Agency and the government will be involved in this and how much they will be able to support, I'll be able to answer better after I have had my meeting next week.
Senator Munson: I'll keep my fingers crossed.
The Chair: Minister, I would love to ask you about innovation in the health care system, but the parameters there are critical, large, and that would take too much time.
I want your quick comment on the issue of an electronic health record. This country has spent billions of dollars. To this point, we only have pockets of examples where an electronic health record is operating for relatively small parts of the country.
When we look at the incredible cost of health care delivery, and we look at the idea of innovation in health care delivery, and we look at delivering health care remotely, an electronic health record is absolutely critical. It is a fundamental, underlying piece of infrastructure.
If you're going to bring down a hammer, I would urge you to bring it down hard on those who are charged with it and to ensure that the RFP you send out does not make the requirements for privacy so strict there is no way it can be dealt with, and that billions of dollars have been spent trying to deliver something that is absolutely impossible.
Minister, with regard to an electronic health care record, where are we and where are you?
Dr. Philpott: I can certainly tell you where I am. There will be no stronger advocate than me on the matter of the importance of electronic medical records and electronic health records.
I remember saying at a meeting soon after I became health minister that electronic medical records changed my life. It's not a stretch to say that, because I first started working with an electronic medical record in 2008, as a family doctor. It was absolutely transformative. Everyone who has used one will tell you they would never go back. It's absolutely essential for patients' safety, for quality of care, for reaching targets and for a whole variety of reasons.
We have made progress in recent years. Part of that has come through investments with the Canada Health Infoway. It's one of the things that the provinces and territories love the most about how we support them.
I will not say there haven't been mistakes made in terms of how this has rolled out over the years. I will be with you on — maybe not a hammer, because that's not my style — but let me tell you, when I met not so long ago with the folks at Canada Health Infoway, I said this is absolutely one of the keys to unlocking transformation in this country. I want to every Canadian to know there is a patient-centred medical record. It should be rooted in primary care, where the patient can book appointments and see what their lab results are, communicate with their health care provider, and that same record is linked to the hospital, the home care provider, and has a direct link to the lab and pharmacy. We need seamless systems of electronic records that are focused on the patient in this country.
It's going to take a lot of pressure. I told that message to the Canada Health Infoway board when I met with them recently. I said that I will be counting on them. I'm going to be very demanding, because there is no time to waste. There is absolutely no excuse for wasting money on this, because it's one of the keys to the success of the future. I will advocate hard.
The Chair: I will exert pressure strongly in lieu of a hammer.
I will say to you that with regard to transformative change, it's essential and every review of every sector of health since then continues to emphasize the need for that.
Minister, thank you so much for being with us today. You have an incredibly important portfolio. We like many of the things we hear in the language oozing out of some of these areas, and we will be tremendously supportive of directions you take that really will bring about change and benefit. The change will bring benefit to Canadians and we are wholly with you in that objective.
Dr. Philpott: I thank you very much. I gather I'm leaving officials to carry on.
The Chair: Yes.
Dr. Philpott: They know what I think about a lot of things so I'm sure they will be able to answer your questions.
Thank you for your work. I look forward to more opportunities to meet.
The Chair: Colleagues, we are pleased to have Kimberly Elmslie, Assistant Deputy Minister, Health Promotion and Chronic Disease Prevention Branch, join us.
Senator Eggleton: Earlier this year we put out another report, as you know, on obesity. We did get a response that the minister agreed in principle and pointed out that there are a number of items related to the issue of obesity and disease that arises from it in the mandate letter.
We went on to make a number of recommendations on it, everything from a national campaign to a revision to the food guide, particularly emphasizing fresh whole foods as compared to highly processed foods. We were alarmed at the degree of highly processed foods that are being used.
In fact, we are alarmed in general about obesity. The numbers over the last number of years have been growing in epidemic proportions.
So we talked about the need for a new food guide, the emphasis, as I said, on whole foods as opposed to processed foods, the front-of-package labelling to make it easier for people and the tax on sugary drinks was also in there as well. That might be a political hot potato for you.
Regarding the Nutrition North program that Senator Merchant raised earlier, I've certainly heard that not only was the subsidy of the program not getting to people to the degree it should but also nutritious food. A lot of it is highly processed food, again.
Those are just some of the concerns that were among our 21 recommendations.
Because of the alarming rates of obesity and I should mention, of course, advertising to children, which we recommended be prohibited following the guidelines in Quebec, and Senator Raine has now put a bill into the Senate on that issue.
All of that to say that we'd like an update on how this is coming along, because it's alarming. We have to do something about this.
Mr. Kennedy: Maybe I could start, and then I could ask colleagues from the Public Health Agency to add their comments as well, because there's work going on on both sides.
As you may be aware, the minister recently announced her Vision for a Healthy Canada strategy, and there's a range of measures in there. A lot of those are led by Health Canada, so I could talk to those and then we could turn to the Public Health Agency.
We recently released the evidence base for a revision to the food guide and we're out in the field now doing consultations. They were launched, I believe, in October. We are going to be revising the food guide. While I don't want to get ahead of where our scientists and experts in this area may come to, we certainly are mindful that, in other jurisdictions that have similar products like that for healthy eating guidance, they have a more modern approach than we have tended to take. They have different versions for vegetarian diets and different kinds of lifestyles and simplified materials that can be available on your phone and tablet, that sort of thing.
We're looking at whether we can transform our food guide into a more modern pallet of products that will have better uptake. That work is under way right now.
We have also, as you know, launched work and have a number of white papers that are out for consultation on advancing the government's objective to make improvements in the food supply. We are out actively talking about the proposal to eliminate industrial trans fats from the food supply.
We have a proposal that is now being discussed around front-of-package labelling for things like salt, sugar and trans fats. There are a number of other jurisdictions in Europe, South America and elsewhere that have employed this front-of-package labelling. There is evidence that it actually encourages the food industry to up its game and to improve the quality of the food offering, but also to help consumers make informed choices.
We're looking at helping to advance the government's agenda in those areas through some of those measures.
Then, of course, we also are working to advance the conversation about restricting marketing to children. There is the legislation that is now before Parliament and we're very optimistic about making progress on that, certainly, in this mandate.
I'd be happy to elaborate. Maybe I could have Kimberly Elmslie to talk about what the Public Health Agency is doing.
Kimberly Elmslie, Assistant Deputy Minister, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada: Thanks very much, deputy, I'd be glad to. From the public health perspective, as you will all know around this table, work at the community level to create the conditions for good health is something that we spend much of our time working on.
You will know, for instance, that Participaction, one of our important partners, is working with us to raise awareness of physical activity and the importance of healthy living, overall, across the country. Participaction, because of its brand and reach, plays a particularly powerful role when it works with public health people because they can take our message and bring it into communities across the country in a very persuasive and highly impactful way. That's what they're doing.
The other thing I want you to know is that the federal, provincial and territorial governments, through sport, physical activity and recreation ministers, have agreed to develop a new physical activity framework for the country. What we are doing is taking all of the work that has been done over the last number of years, through sport and recreational organizations, as well as through the public health tables through our own work on curbing childhood obesity, and we are developing a new framework that will guide our collaboration as we work as governments to really move this agenda forward.
The importance of that is that stuff is fragmented in the country and we're trying to bring it all together in a new way of talking about physical activity and healthy eating, not only as important lifestyle choices, but as something that we as governments have to be looking at supporting from the ground up.
The other area I wanted to talk to you about is sedentary behaviour. We should be standing up: You may have heard from the recent conference in Bangkok on physical activity that governments around the world are very concerned about just getting people to move more. We have very evidence-based physical activity guidelines that are being used across this country, but the focus is now on getting people out of their chairs, standing up and walking around their offices a bit more.
You're going to hear more from us in public health and in the Public Health Agency on how to start to nudge Canadians to get them out of their current practices of sedentary behaviour. When you're not sedentary, you're also not so much in the world of eating unhealthy foods or smoking. These things are all related, which is why the portfolio is working so closely together in all of these areas.
The final thing I want to say is that we're advancing in the built environment, with our colleagues at the Canadian Institutes of Health Research. So we are working with researchers to say: How do built environments have to change in order to give Canadians the conditions that they need to find healthy foods close to them but also to be able to move around?
Over the coming months, under the minister's Vision for a Healthy Canada, you and Canadians will start to see more and more of this kind of project that brings healthy eating, physical activity, mental health and not smoking all together in a way that we talk to Canadians.
Alain Beaudet, President, Canadian Institutes of Health Research: To re-emphasize what Kim has said, we are working together on this. I would like to add two things. I remind senators that we are spending over $35 million a year in research on obesity, the cause of obesity and how we deal with this.
There are two new areas of research that I think will prove fascinating in the coming years. One is the developmental origins of obesity, the critical role of nutrition and exercise, not only during the lifespan but from conception, during pregnancy and during the first two years of life.
The nutrition and weight gain of the mother during pregnancy is now proving absolutely critical, and the nutrition of the kid for the first two years is absolutely critical.
Linked to that, most probably, are the fascinating data that are emerging on the microbiome. As you know, about 97 per cent of our genome is from bacteria that live in our gut. As it happens, it seems that the composition of this microbiome really starts at birth. You have different compositions if you're born naturally or through Caesarean section, just because of the bacteria that you're exposed to. This will have a critical influence on your capacity to absorb nutrients, your capacity to deal with the nutrition that you're exposed to and, of course, in the course of life, obesity.
These are two areas that are extraordinarily important, and we're pushing research in those areas because that will help us, I think, to better understand what's behind the obesity epidemic and how we deal with this.
The Chair: Just to finish that off, we would hope that, in your review for the new food guide, you will look at our recommendation with regard to your advisory group and ensure that those with a vested interest in production are not on that final committee. That committee can consult broadly, of course, but we don't think that they should be on the committee that will recommend to the minister.
Mr. Kennedy: Mr. Chair, just to add, actually, we've taken very careful note of that. In the minister's announcement around moving ahead on the food guide, actually, we put in place measures to ensure transparency. Anytime we get a letter in on this, frankly, if it's from industry or somebody else, when we get correspondence in, when there are meetings, all of that will be made publicly available, that that's happened. There has been a commitment that the group that is developing this will not have meetings with industry with a vested interest in the development of this.
We've tried to take some of those recommendations on board.
Senator Eggleton: Will we get a new food guide next year?
Mr. Kennedy: Senator, I'll have to get back to you on that. I'm not hedging; I just don't quite remember what the timeline was for the rollout. But we aim to go as fast as we can.
The Chair: Mr. Kennedy, thank you very much for that comment. We really appreciate that.
In the meantime, you can just take the orange juice picture out of your current food guide.
Senator Stewart Olsen: Just to continue on my questioning, I think that, for every component that you're looking at, I'd like to see a rural aspect to it because Canada is mostly rural.
I see all kinds of wonderful programs happening in major metropolitan areas, but people in rural areas still have enormous wait times. Even the basic tests are not being done.
I think what Senator Eggleton was saying was a re-look at everything and a rethinking of everything. I hear what the senator is saying: It's not that the health ministers in the provinces don't work very hard. They all do, but I think maybe it's gone a little bit further from what they can actually do. We don't seem to gather areas of excellence, you're right. Everything is fragmented. An enormous help for provinces, I think, would be to bring together areas of excellence and assist with that rather than leaving them out on their own, trying to solve these problems that perhaps someone else has solved. But every single thing that you come up with should have a rural component. With the food guide, do a rural component. All of these kinds of things I think we're going to have to look at. I don't know, perhaps you are already.
Mr. Kennedy: Thank you very much for the comment. I think it's a very helpful reminder for us in the work we do.
Certainly, in the development of the Health Accord, as an example, I think there's an acute awareness that we want the same objectives across the country in the sense that we want to have better health outcomes, a better functioning health system in the area of mental health, fewer suicides, those sorts of things.
In our vision of the way we've been discussing this with the provinces and territories, we've been discussing the idea of an overarching agreement where we have those common objectives, but, at the same time, we've also been talking to them about having bilateral annexes, where we figure out, for each jurisdiction, "How is it going to work for you?'' I think part of that is an acknowledgment that the reality in, say, Ontario might be very different than the reality in Nova Scotia and New Brunswick.
That's actually built into the kind of conversation we're having. My wife is from New Brunswick, so I know a lot about the reality of rural New Brunswick. Obviously, that's going to be a very different situation than if you're talking about the Golden Horseshoe in Ontario. We're trying to take that into account.
Senator Merchant: My question also relates to the report and the study we did on obesity and many of the things that the senator has mentioned.
Just looking forward, shopping patterns of people have changed. Now, a lot of shopping is not done by people who go to the grocery store, or it won't be forever. It's changing. We've talked about labelling and that people should look at every can in the shop and decide which soup they want or which cereal they want. What is going to happen, how are you going to address the problems that will arise, when people just go on the Internet and order their groceries, and those groceries are delivered maybe that afternoon or the next day? What are the challenges that we're going to face as we look forward to the years ahead instead of just looking back and saying that there are things that we have not paid attention to such as understanding labels. Will those labels now be available to people? How is that going to work?
Mr. Kennedy: We're certainly trying to be mindful of technology, and I would say that that's as true with food labelling as it is for drugs, for example. There are innovative ways now where you can scan a bottle and can get the information on your smartphone. I think we're trying to be conscious of that in developing our policies.
When I talked about the food guide, as an example, we are thinking through quite actively. We're probably not going to have a booklet where we print 10 million copies and hand it out to everybody. We'll continue to have a paper booklet, but there is going to be a lot of consumption happening online.
When we've been looking at the issue of labelling, I'm not sure, senator, that this will fully answer your question, but I think we're trying to be mindful that the different policies we have will interact with each other. This has been one of the problems to date, for example. We're going to be trying to improve the labelling on the side of the box, but not everybody looks at the side of the box. A lot of decisions are made on impulse, which is the reason why we're also out consulting about the possibility of front-of-pack labelling. For example, we are going to be moving forward very soon to do a final promulgation of regulations around the nutrition facts table, nutrition regulation. This is a project that's been under way for several years, and that change in the labelling is going to give much better information about sugar.
In the past, when you looked at the list of ingredients, you might have maple syrup and corn syrup and brown sugar and this and that. Now, they all have to be grouped together. It's going to be much clearer. Again, a lot of people don't look at the side of the box. The front-of-pack labelling is designed to ensure that, if that product is high in sugar, that's going to be starkly visible on the front of the package.
We're also looking at modernizing the kinds of claims that can be made because if you have a product where, if you look at the ingredients, it kind of is not so great on a whole range of measures, the fact that you can have this claim on the front of the box may be a bit incongruent with the reality of that product. So we're also looking at claims and what kind of claims are allowed. We're hoping all of that will come together in a way that's rational and will give the consumer better information.
I will readily admit to you that I'm not entirely sure about the details of the plans we may have for a world where people are doing things mostly online, but it sounds like my colleague Paul can speak to that.
Paul Glover, President, Canadian Food Inspection Agency: Mr. Chair, in terms of the senator's question, I would add that we're acutely aware of the two points you've raised. One of the changes happening in food is portion sizes. People are moving to single servings and buying smaller. The challenge that is creating now is that the amount of information on the label and the amount of real estate to put all that information on is getting smaller and smaller. The fonts are getting to the point where they're really difficult to read.
I frankly don't think the CFIA plays a role in food labelling. We're going to change those requirements and consumers are going to want more information. So as we move to online technology and shopping, that actually presents opportunities where we're currently constrained by the real estate available on a smaller package, to actually make sure that additional information when you click on it is presented to the consumer so that they are informed. We are working with a number of partners that are really very forward looking.
This isn't going to change tomorrow, but we are trying to understand where the industry is going, where it may change, the implications that may have for us and the opportunities in that space for us moving forward. We're very much aware of the issues you have raised and are trying to prepare the regulatory systems to be able to respond.
Senator Seidman: I'm not sure who to address my question to, but I'm sure you'll figure it out amongst yourselves.
One of the items in the minister's mandate letter that relates specifically to the health accord and its renewal is to "improve access to necessary prescription medications.'' If I read from the letter, it says:
This will include joining with provincial and territorial governments to buy drugs in bulk, reducing the cost Canadian governments pay for these drugs, making them more affordable for Canadians, and exploring the need for a national formulary; . . . .
What progress, if any, has been made on this?
I'd like to ask you specifically about something that isn't mentioned, and that's the role of the Patented Medicine Prices Review Board. It is mandated to regulate the wholesale price charged for patented medicines, which it does by comparing the price charged in Canada to the price charged in comparative countries for medicines. There's a list of comparative countries, one of which is the United States. If we're trying to reduce the cost that Canadian governments pay for these drugs, I wonder why the United States would be a comparative country.
I'll leave that out there and ask if I could have some feedback on where we are with improving access to necessary prescription medicine.
Mr. Kennedy: I can speak to that. Health Canada is largely leading the work on this with the provinces and territories.
We're very bullish on this agenda in terms of our ability to make progress. We've had excellent collaboration and a lot of engagement from our provincial and territorial colleagues. They are very keen to move in this direction. We have a working group of very senior people that has been working on those and other priorities in the pharmaceutical area.
When ministers first got together after the election in January of this year, this was one of the items when they came out with their communiqué and spoke about this. This is an area where they clearly indicated there was a lot of synergy and they thought they could make progress. We have been working ever since.
We have joined the pan-Canadian Pharmaceutical Alliance. The federal government is a member of the bulk purchasing consortium. In that consortium — and this is my layperson's explanation — we basically divide up the work. We've taken on the responsibility of negotiating some of the product listing agreements that lead to the savings.
We're negotiating with some drug companies for some products, and other provinces are part of the consortium and are negotiating as well. I can tell you here on the record that we have produced real savings by negotiating these kinds of product listing agreements amounting to millions of dollars a year. It's just a start, but we have actually made progress on the bulk purchasing issue.
You mentioned the Patented Medicine Prices Review Board. I wouldn't want to speak directly for my colleagues. They are an independent, arm's-length organization. What I will say is that we're working very closely with them. They have just finished a round of consultations on their guidelines. I think we are very well aligned with them in a view that more can be done both with respect to the guidelines but potentially with respect to the regulations to actually make their operations more effective.
You noted, for example, the basket of comparative countries. That was established at a time when Canada was hoping to emulate the United States and countries in Europe that were not just countries with perhaps slightly higher prices but also countries that have a very large native pharmaceutical manufacturing industry. Of course, we do not have the sort of industry the way the United States or Switzerland or Germany have. So a lot of questions have been asked about the basket of countries, and that is being actively looked at.
I would also say that there's serious work going on within Health Canada looking at the way in which we do regulatory approvals and how that lines up with the needs of the health care system but also with the other actors in the health care system. I'll give you one example, because we could spend all day on this.
When Health Canada receives a package of material from a pharmaceutical company wishing to get approval for their drug, we do the analysis and then make a decision whether or not to provide an approval.
Generally speaking, the Canadian Agency for Drugs and Technologies in Health, their cost effectiveness assessment starts when our decision is rendered. We basically take a year and say yes or no. When we have a decision on a drug, then through the common drug review process run by CADTH, they take their time to decide on the cost effectiveness. That might come eight months or a year later. The result is that a lot of private insurance plans across the country have listed a drug which CADTH later determines should not be reimbursed at the suggested price or perhaps is not cost effective.
We think there may be opportunities to do a better alignment of the cost effectiveness assessment and the drug review so that when we give approval, to give you one example, all of the purchases around the country — not just the provinces, private insurance plans — actually have evidence-based material to suggest what that drug is worth to them, what the reimbursement price should be, et cetera. This is what many other countries do, and so we're looking at whether we could try to re-jig our system to do that. Good progress is being made on that.
The Chair: There are some suggestions that the pCPA is perhaps having a significant negative impact on some aspects of the pharmaceutical industry. Issues are arising with regard to approval times, removal of research effort in Canada and so on. Unintended consequences are another aspect of what you're dealing with. We won't go down that road in more detail today, but nothing comes without consequences in this area.
Since we've got Dr. Beaudet here, I'm going to move to a question on our dementia report. He knows that our study did not delve into the research base of the issue except in terms of identifying it. It's not that we didn't recognize its importance. We did recognize its importance, but that area was not the primary focus of our investigation. However, we did conclude on its importance to us and have made a recommendation that Canada would move to roughly 1 per cent of the actual health care cost of dementia in research funding, which would take it to about $100 million a year from the $41 million I believe you're now enjoying.
Dr. Beaudet, as a leader in neurodegeneration and aging, which covers of course dementia, could you give our committee a brief synopsis of where you think the research level is with regard to moving towards the ability to slow down the progression of the disease and with regard to significant treatments of the specific causes of the disease?
Dr. Beaudet: As you know, senator, the brain is the last frontier. The real solution to this real problem — and a problem that is growing with the aging of the population — is an understanding of the brain, understanding of brain connectivity, understanding of brain metabolism in this context in particular. Why is it that neurons degenerate? Why do they degenerate in specific areas of the brain?
I would say that there are really three areas of research that the CCNA, which you are very familiar with, the Canadian Consortium on Neurodegeneration in Aging, is tackling. First thing is understanding the basic mechanism underlying the process of neurodegeneration. What is happening at the neuronal level? Why are we losing cells? What causes that loss that you see of course in Alzheimer's disease but you also see in other types of neurodegenerative diseases such as Parkinson's?
The second area is how do you slow down the mechanisms of neurodegeneration, and particularly the cognitive aspects? As you know, a number of studies actually are starting to give some positive results on things that can be done to slow down the neurodegeneration process and slow down the loss in cognition, and some are just cognitive stimulation and psychological exercises to slow down the loss of cognition.
The link to that is being able to diagnose dementia earlier. That's absolutely critical because it means that (a) you can start taking measures to slow down the mechanism of neurodegeneration early enough that it is not too late; and (b) hopefully it will allow us to intervene pharmacologically to slow down those mechanisms, for instance, as you know, working on preventing the accumulation of amyloid in the brain. If you do that and you have lost half your neurons, it is just too late. You have to be able to intervene early enough. For that, you need to diagnose early enough. A lot of our focus is on early diagnosis through biomarkers, through imaging, through psychological testing, a huge focus. Also, there has been quite a bit of progress in that area.
Finally, these things happen, and for now we cannot totally cure dementia. How do we take better care of patients with dementia? How do we keep them at home for a longer period of time? How do we decrease the cost to society and our system, but also to the dignity of patients? So there is a whole focus of the research we support through the CCNA, but also through other programs in CIHR that are focused on health services research and on mechanisms to better support patients and their caregivers, because they also play critical roles in helping the patients through these very difficult years.
So these are the three major areas where we are focusing our efforts. I would say that the progress is encouraging, particularly in the last two, and in the first one, which is understanding the molecular biology of the brain, we still have a little way to go.
The Chair: I understand there is some indication that some have claimed the ability to distinguish between different types of Alzheimer's. There are I understand a number of forms of Alzheimer's and that some are claiming now they can actually distinguish at least up to five different forms of Alzheimer's. Is that something that shows some promise?
Dr. Beaudet: I have to follow up on this. I think you know more than I do on this topic, senator. I would be happy certainly to look into it and send you the information.
The Chair: I'm not trying to put you on the spot. Thank you, Dr. Beaudet. It's very good to have you here again. Thank you very much for that.
Senator Nancy Ruth: I want to ask a question about abortion and the new drug for medical abortion.
The organization Action Canada for Sexual Health and Rights in its 2017 pre-budget proposals has called upon the renewed health accord to improve access to women for abortion services, particularly in rural and Northern Canada, and to the new drug for medical abortion, which has strict access conditions here in Canada. Action Canada has made other important recommendations. I want to know, I assume you're aware of them, you can tell me if you are, what kind of actions are you taking in response to the recommendations?
Mr. Kennedy: As I think, senator, you and others would know that Health Canada had given approval to a drug known as Mifegymiso, a drug combination commonly known as RU-486 in popular language. The company is still working to bring that to market, but they have an approval from Health Canada to do so. There were a number of conditions that were placed on that approval, and I know those have been the subject of some debate publicly.
What I could share is that certainly having been on the receiving end of many of these kinds of questions and concerns, we have had an opportunity to spend a lot of time discussing with stakeholders and others just how the Canadian regime stacks up internationally. What I can say is that while I think it's popularly understood that the Health Canada approval is quite strict, in actual fact our regime lines up very closely to the regime in virtually every other industrialized country, including jurisdictions like France, where this particular drug has been made available for decades.
I think sometimes there is perhaps a sense that this is a little bit like an over-the-counter Plan B type of thing, but actually, this is a drug that has potentially serious side effects if not used appropriately. There is treatment failure in I believe up to 1 in 20 cases, which then require surgical intervention, so for a variety of very sound evidence-based reasons, this was how the kind of conditions came out in the approval, and indeed it's actually the company that proposes the risk management strategy. So in this case the company proposed a series of measures that look very similar to those in place in other jurisdictions, and ultimately those were accepted through the Health Canada approval.
I would be more than pleased if there is an interest in providing the committee — we've done the charts to show how the Canadian approach lines up with the United States, Norway, the U.K., Australia, et cetera. We're very sensitive. We know that there have been a lot of questions about why Canada did it this way. We're just strictly following the evidence and we do line up very much with what most others have done.
In terms of access, not to avoid the question, but in terms of reimbursement and so on, that's largely an issue of provincial policy around what is reimbursed through provincial drug insurance plans, what gets reimbursed by private insurance plans, so that would be something that we potentially would talk about with the provinces through the work we're doing at pharmaceuticals. That's not an area we lead directly.
Senator Nancy Ruth: Access to abortion won't be under discussion in the new health accord?
Mr. Kennedy: We will be talking about pharmaceutical access more generally. Certainly, we have had jurisdictions, I think it's fair to say, that have written to us and we have been actively talking to them, and I think even through medical officers of health. But we have had conversations with jurisdictions that have asked, in effect, why do we choose to do it this way? What was the rationale? We have been actively talking to some provinces about that.
Senator McIntyre: Thank you all for your presentations. I have two brief questions, which are all related to the Healthy Eating Strategy and the revision to Canada's food guide.
My understanding is that, as part of this revision, Canadians can provide feedback to Health Canada until December of this year. As a matter of fact, Mr. Kennedy, I believe you mentioned that briefly in your presentation. I would like you to elaborate a little bit on the feedback. What kind of feedback are we getting? Is it good feedback?
Also, it's my understanding that the U.S. Food and Drug Administration revises its food guide every five years. Will Health Canada undertake regular revisions of the food guide as the U.S. does?
Mr. Kennedy: Senator, I'll have to get back to you with a specific answer to your question. I'm a bit worried if I answer it off the top of my head it might not be 100 per cent accurate.
Senator McIntyre: Give it a try.
Mr. Kennedy: That isn't to duck the question. I'm not aware of the character of the feedback we have received so far or the number of responses. I would be happy to try to provide an update in writing.
What I can say is you're right that we have launched a public consultation. We're actually quite interested in getting Canadians' feedback. We publicized it, and consistent with what we typically do in these situations, we would publish a "what we heard'' report. That would certainly be a synthesis of what we heard and we would be making that publicly available.
In terms of the issue of regular updates, what I can say is that I think our view is it has absolutely been too long since the last update, which was in 2007, I believe.
The Chair: We would agree with you on that.
Mr. Kennedy: I think as a matter of good public policy, we would want to move to a regular cycle of updates. Certainly, that's the thinking in the background. What I can't recall, sir, is whether we have actually come out and publicly announced that it will be every set number of years. I can get back to you on that but I think we would accept the premise that it has been too long, the update is overdue and we would like to go to something more cyclical. I can say that much here today.
Senator McIntyre: I'm pleased to see there is a revision of the food guide. Congratulations on that one.
Senator Raine: Thank you. I have been dying to ask this question. You know, we're all concerned about sugar and people eating too much added sugar in their diets, yet there is no percentage daily value on the nutritional facts label for sugars. Why is there not when there is a daily value for many of the other ingredients or nutritional items?
I know that the WHO recommended a maximum of 10 per cent of your total calories should be in the form of added sugars, and they have now dropped that down to, ideally, 5 per cent and yet we don't have that anywhere on our labels. Will that be on the new label?
Mr. Kennedy: I don't want to get ahead of the promulgation of the final regulatory package, which is going to happen within a matter of weeks. In fact, even with the follow up to the committee, I think we would be in a position to send you the kind of final regulations.
I'm happy to share the developments to date. But you would note the proposal, I believe, when we went to Gazette 1, initially what we had been discussing publicly with stakeholders and Canadians and others was actually to have a daily value for sugar. There were a number of changes proposed to the nutrition facts table: to group sugars together, give them a daily value and to make it more prominent in the nutrition facts table when a product has a lot of sugar or a little bit of sugar. My hope would be, when you see the final regulations, that you will be pleasantly surprised that we're moving in the direction of the kind of things you have been talking about.
The issue of added sugar versus total sugar is one we have spent a lot of time looking at. The United States has proposed a rule which would have added sugar; that is something that, at least in the proposal we have discussed publicly, has not been a prominent feature. I don't want to put my colleague on the spot, but I think that there we have a number of concerns. There is consumer research that frankly suggests that consumers, when they look at labels, have some difficulty distinguishing between total sugars and added sugars. That's the first thing.
The second thing is that once you know the sugar is in the muffin, the cupcake, or the breakfast cereal, it's very hard to figure out whether that molecule was added or whether it was from a natural source. There are actually very practical compliance and enforcement challenges around adequately enforcing a standard where you require added sugar to be on the label because it actually gets you into checking formulations and so on, whereas total sugar is very easy to check. You put it in through a process and you know how much sugar is in it. So there are a couple of concerns around the added sugar.
We are hopeful with the nutrition labelling changes that we have made that we will achieve the kind of objectives people want in terms of putting a spotlight on sugar, giving people an idea of how much sugar is consumed and whether it's a lot or a little relative to what they should be consuming in the run of a day.
Mr. Glover: Just to follow up on what Mr. Kennedy said, CFIA would then be responsible for enforcement should that come into play in terms of the added sugar. It is, frankly, at this point and time, given technologies, almost unenforceable because we would then have to look at the product, and it would just say sugar. So how do you know what is naturally occurring, versus what is added. You would have to go back to compositional issues and recipes, and then how do you know the recipe has translated into the final product? It's a wonderful theory and we understand why people are interested but our ability to actually enforce it and make those regulations meaningful to industry would be really quite challenged.
I think the approach, as the deputy suggested, is to make sure consumers are well-informed on what is a lot and what is a little. Whether it's occurring naturally or not the body will still metabolize it. It is still sugar and we want to really inform consumers that way. We hope that through education people will be able to make really informed choices and not put us into a quagmire where I would be called back here to be asked why I am not enforcing something unenforceable. It's to be pragmatic in that kind of situation and inform consumers and hopefully that's what you'll see in the final package.
Mr. Kennedy: Not to pile on, but the proposal that we are now consulting on publicly on front-of-pack labelling works in concert with the proposed changes to the nutrition facts table. If you have a breakfast cereal or something else high in sugar, not only will the detail be very clearly visible on the label, it will be right on the front of the box that a typical serving of this is actually sufficient to put you in danger of going above the daily limit. We're hopeful that this is going to give a lot more detail on sugar to consumers.
Senator Raine: That's good.
The Chair: The testimony before us indicated that the total sugar is the real issue overall.
Second, with regard to your labelling, you know we would urge key, clear numbers up front and then all the rest of the 10 pages that come with a pharmaceutical product would be on the back. I was on an airplane recently and got a package of a product that was provided. It had an amazingly clear front-of-package label with the key ingredients, and then on the back, additional kinds of features.
Dr. Taylor, with regard to our report on dementia, one of the things that we had identified clearly as part of our recommendations with regard to a national strategy is giving individuals access to information that could help them in dealing with this. Right now, basically, a person goes to the doctor because they think they have some issues and they are told they likely have dementia. They are essentially sent home. They lose their job almost immediately and they are sent home with no guidance whatsoever. Whereas if you are identified as having had a stroke, ischemic or otherwise, heart attack or cancer, a whole system of support goes into place with regard to helping you deal with lifestyle and what you should do.
We have felt in several of our studies that the Public Health Agency of Canada is not identified as a go-to source for public information. Part of that is because it doesn't always have, for example, in the case of dementia, best practices. I go on your site regularly to see if there is any change after we have made comments in the press. There isn't a particularly good access through any source, and even if a seriously knowledgeable person goes to the web and types in "dementia supports,'' they find it difficult to detect the key information sources. Ordinary citizens are having great difficulty in that regard.
We feel that the Public Health Agency of Canada has an opportunity to have a much higher profile in a number of these areas. We have recommended that there be a central point for access to best practices and information on the various categories that dementia patients would require access to.
Do you see that as a potential role for the public health agency moving forward, not just in this aspect, but in other significant areas of prominent disease in Canada?
Dr. Taylor: That's an excellent question. The agency has been altering the target audience for some years. Historically when the agency was first created, we thought our main target audience was other professionals. It's crystal clear in the last 5 to 10 years that we need to change that. More and more of our products are targetted to Canadians directly. The CPHO report is a good example. They have changed that dramatically in the last couple of years so parliamentarians and Canadians can understand it. That's the direction we are going in.
Dementia is in Kim's area; she can address that. We do need to have better information. We have been working with some of the NGOs — for example, the Alzheimer Society — a lot and supporting some of the work they do. Dementia Friends was an intent to educate communities about dementia.
I certainly agree that the agency's products and information products continue to be more targetted specifically to Canadians on a number of issues. That's a work in progress. I would love to hear any feedback on our website, if it is understandable, because that is the intent.
Kim, do you want to comment on the dementia work?
Ms. Elmslie: In the work we do in public health, we're often focusing on the upstream and the prevention aspects of conditions. When it comes to vascular dementia, our work in terms of prevention of heart disease and stroke really applies to that area.
When we get into areas of treatment, and best practices in treatment, that's where we're into a different kind of collaboration, one with provincial and territorial governments, and with health professionals more broadly on what are the best practices in treatment.
I take your point about needing to have a place where Canadians can go and be directed to the right place, that single window that takes them into best practices. So we aren't reinventing the wheel when others are better placed to provide that information than we are.
Just to open a bracket on Dementia Friends, because you mentioned that in your report, senator, and that's been a very important part of the work we're doing, not only domestically but also globally. Because Japan, the U.K., other countries are now developing similar resources for people with dementia and caregivers, to start to reduce some of the stigma around dementia and to provide the one-stop shopping for resources you're talking about.
We're starting to think in that direction. How can we use Dementia Friends, which now has over 300,000 Canadians enrolled, in order to get to that place of greater understanding and better resources?
The Chair: We think your agency has credibility that with regard to diseases, as Ms. Elmslie, you described in terms of prevention.
An organization with a high profile and credibility is essential in this and many areas. We would urge you to move in that direction and to advertise your presence in that space. Right now, it is almost impossible for a new person to know whether the group Dementia Friends is really a group for friends of people with dementia. They are in this case; I want to indicate that. There has to be a source in which people have some feeling that the information listed has that kind of credibility.
On behalf of the committee, I want to thank you for being here. We often get an opportunity to see one of you at a time in different areas, but to have had this opportunity with the minister and your presence has been tremendous for us as a committee. We very much appreciate your response and the support you have given us with information over time in our various studies.
If there is anything that occurs to you after you leave that you think might be helpful to us in any areas we have covered, please get it to us through our clerk, and then we will get it to committee members.
(The committee adjourned.)