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37th PARLIAMENT, 2nd SESSION

Standing Committee on Finance

EVIDENCE

CONTENTS

Thursday, October 2, 2003

0930

The Chair (Mrs. Sue Barnes (London West, Lib.))

Ms. Carolyn Brooks (Chair, Heart and Stroke Foundation of Canada)

0935

0940

The Chair

Mrs. Christina Mills (Steering Committee Member, Chronic Disease Prevention Alliance of Canada)

0945

The Chair

Mr. Michael Howlett (President and CEO, Canadian Diabetes Association)

0950

Ms. Donna Lillie (Vice-President, Research and Professional Education, Canadian Diabetes Association)

0955

The Chair

Dr. Gordon McBean (Chair, Board of Trustees, Canadian Foundation for Climate and Atmospheric Sciences)

1000

1005

The Chair

Mr. Monte Solberg (Medicine Hat, Canadian Alliance)

Ms. Carolyn Brooks

Ms. Sally Brown (Chief Executive Officer, Heart and Stroke Foundation of Canada)

1010

The Chair

Mr. Monte Solberg

Ms. Christina Mills

Mr. Monte Solberg

Ms. Donna Lillie

Mr. Monte Solberg

The Chair

Ms. Christina Mills

1015

Ms. Sally Brown

Ms. Donna Lillie

Mr. Monte Solberg

The Chair

Mr. Pierre Paquette (Joliette, BQ)

1020

Mrs. Christina Mills

Ms. Sally Brown

1025

The Chair

Mr. Michael Howlett

The Chair

Ms. Donna Lillie

Dr. Gordon McBean

The Chair

Mr. Pierre Paquette

The Chair

Mr. Nick Discepola (Vaudreuil—Soulanges, Lib.)

1030

Ms. Donna Lillie

1035

Ms. Sally Brown

The Chair

Mr. Nick Discepola

The Chair

Mr. Michael Howlett

1040

The Chair

Ms. Donna Lillie

Mr. Nick Discepola

Ms. Donna Lillie

Mr. Nick Discepola

Mr. Michael Howlett

The Chair

Dr. Gordon McBean

1045

The Chair

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP)

The Chair

Ms. Judy Wasylycia-Leis

Mrs. Christina Mills

1050

Ms. Sally Brown

Ms. Donna Lillie

The Chair

Ms. Sally Brown

1055

Ms. Christina Mills

The Chair

1105

Dr. Alan Bernstein (President, Canadian Institutes of Health Research)

1110

1115

The Chair

Mr. Ron Forbes (President, Juvenile Diabetes Research Foundation of Canada)

1120

1125

The Chair

Mr. Jack Smit (Chairperson, Board of Directors, Credit Union Central of Canada)

1130

1135

The Chair

Ms. Judy Wasylycia-Leis

Dr. Alan Bernstein

1140

Ms. Judy Wasylycia-Leis

Mr. Ron Forbes

Ms. Judy Wasylycia-Leis

Mr. Jack Smit

Ms. Judy Wasylycia-Leis

1145

Mr. Jack Smit

Ms. Judy Wasylycia-Leis

Mr. Jack Smit

The Chair

Mr. Monte Solberg

Dr. Alan Bernstein

Mr. Monte Solberg

Dr. Alan Bernstein

Mr. Monte Solberg

Mr. Ron Forbes

The Chair

Dr. Alan Bernstein

1150

Mr. Monte Solberg

Ms. Joanne De Laurentiis (President and Chief Executive Officer, Credit Union Central of Canada)

Mr. Monte Solberg

The Chair

Mr. Tony Valeri (Stoney Creek, Lib.)

1155

Dr. Alan Bernstein

Mr. Tony Valeri

Mr. Ron Forbes

Mr. Tony Valeri

Mr. Ron Forbes

Mr. Tony Valeri

Dr. Alan Bernstein

1200

Mr. Tony Valeri

Dr. Alan Bernstein

Mr. Tony Valeri

1205

Ms. Joanne De Laurentiis

Mr. Tony Valeri

Ms. Joanne De Laurentiis

Mr. Tony Valeri

The Chair

The Honorable Maria Minna (Beaches—East York, Lib.)

Dr. Alan Bernstein

Hon. Maria Minna

1210

Dr. Alan Bernstein

Hon. Maria Minna

Dr. Alan Bernstein

Hon. Maria Minna

Dr. Alan Bernstein

Mr. Ron Forbes

Hon. Maria Minna

Mr. Ron Forbes

1215

Hon. Maria Minna

Mr. Jack Smit

Hon. Maria Minna

The Chair

CANADA

Standing Committee on Finance

NUMBER 076

2nd SESSION

37th PARLIAMENT

EVIDENCE

Thursday, October 2, 2003

[Recorded by Electronic Apparatus]

¿ (0930)

[English]

The Chair (Mrs. Sue Barnes (London West, Lib.)): The order of the day, pursuant to Standing Order 83(1), is pre-budget consultations.

Panel one this morning has witnesses from the Heart and Stroke Foundation of Canada, Carolyn Brooks as chair and Sally Brown as chief executive officer. Welcome to you both again. From the Chronic Disease Prevention Alliance of Canada we have Bonnie Hostrawser, executive director, and Christina Mills, steering committee member. Welcome to you both. From the Canadian Diabetes Association we have Michael Howlett, president and CEO. Welcome to you, sir. You have with you your vice-president, research and professional education, Donna Lillie—again, welcome. From the Canadian Foundation for Climate and Atmospheric Sciences we have Gordon McBean, chair of the board of trustees—welcome to you, Professor—and Dawn Conway, executive director. Bienvenue à tous.

We will start and will continue with the witnesses in the order of the agenda as printed for today. Also, I will let you know that we have a simultaneous finance debate day going on in the House, so members will be coming and going as they can and will participate in both of these. But it is your time right now to get your views to this committee on the record.

Let us please commence with the Heart and Stroke Foundation. Madame Brooks.

Ms. Carolyn Brooks (Chair, Heart and Stroke Foundation of Canada): Good morning, committee members. The mission of the Heart and Stroke Foundation of Canada is to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.

The Heart and Stroke Foundation, like the Canadian Diabetes Association, is a member of the Chronic Disease Prevention Alliance of Canada. The alliance is a coalition that represents organizations working to reduce the burden of chronic disease and its associated risk factors. This common purpose brings us together to appear before you today.

As in years past, we'd like to again commend the federal government for its leadership in health and health promotion over the last year, notably the $55 million invested in the Canadian Institutes of Health Research—CIHR—the food labelling initiative that was approved this past January, the recent series of tobacco tax increases, and Canada's signing of the Framework Convention on Tobacco Control. Thank you so much for that support.

Our brief today speaks to the need to dramatically improve and reform Canada's public health system and infrastructure, and the need to incorporate chronic disease prevention within the scope of this reform. It is our view that this should include a number of elements, notably a comprehensive, integrated, adequately financed, national approach to healthy living and adequate, available health information to guide decisions.

Madam Chair, I'd like to note some facts and figures from recent years. The leading cause of death in Canada is heart disease; 76,000 Canadians die of it annually. That's 35% of all deaths. Cardiovascular disease represents the leading cause of hospitalizations, accounting for almost 450,000. It's the single leading cause of drug prescriptions. This is a costly disease; it's responsible for about $18.5 billion annually in direct and indirect health care costs. Canadians believe that heart disease is a major problem. We had an Ipsos-Reid poll conducted in July that said 83% of Canadians perceive heart disease to be a major problem in Canada.

What is clear is that if we're going to combat the burden of chronic diseases such as cardiovascular disease, we need to have a reinvigorated public health system. Unfortunately, the public health system in our country has been neglected for a long time. Public health funding represents a very tiny 2% to 4% of our total health care resources.

In the past two years there has been a growing recognition of the importance of public health. Various health consultations across the country, as well as in the last two meetings of the federal, provincial, and territorial health ministers, have acknowledged the importance of improving our public health and disease prevention infrastructure.

Canadians believe our government must invest significantly more in public health. We have a Decima poll that was commissioned by the Chronic Disease Prevention Alliance of Canada this past April that indicated that Canadians feel 33% of our health spending should be allotted towards promoting healthy lifestyles.

We believe that public health reform and the integration of chronic disease prevention within this reform can be accomplished in a number of ways.

First, the federal government, in cooperation with its provincial-territorial partners, must implement an adequately financed, comprehensive, pan-Canadian healthy living strategy. Obviously up to this point federal, provincial, and territorial health ministers have agreed to work together on short-, medium-, and long-term pan-Canadian healthy living strategies. These emphasize nutrition, physical activity, and healthy weights. This is positive, but we're a long way away from being able to claim we have achieved a systemic reform of public health in Canada. To be effective, a healthy living strategy has to go beyond broad goals and address more specific measures. No one knows better than parliamentarians the impact of unhealthy lifestyles on health status, and the Canadian public is looking to you for this commitment to support an effective healthy living strategy.

The Senate Standing Committee on Social Affairs, Science and Technology has recommended $125 million be invested annually in an integrated national chronic disease prevention strategy. They've also called for a $200 million investment in our national public health infrastructure. We agree with that. We strongly believe any funds that support healthy living should be obtained in ways that don't cut into other public health funding such as tobacco control. So we look forward to the possibility that we'll have an implementation of a comprehensive, adequately financed pan-Canadian healthy living strategy.

¿ (0935)

Secondly, we agree with our Minister of Health. We need to create a national institute for public health. The SARS crisis and the ongoing West Nile virus have spurred a drive to create a national public health agency, and we believe the chronic disease prevention aspect is a critical element that should be integrated within the scope of this institution.

An interesting point about SARS is that people died from it, but people who died from it, by and large, were people who already had co-morbidities. They already had chronic illnesses such as diabetes and cardiovascular disease. This highlights the importance of a coordinated and integrated approach to public health, one that includes infectious and chronic diseases.

The third area where the federal government should assume leadership involves tracking and monitoring the status of the health of Canadians and their health care system. There are significant gaps now in our ability to track health information. For example, we don't know precisely how many Canadians suffer heart attacks annually or how many have a stroke. At a broad level, we're without timely data, standardized data, national monitoring of risk factors, or integration of the data we already have. Minister McLellan indicated that a future Canadian public health centre should have a capacity to promote public health as one of its key functions, and we believe chronic disease surveillance should ideally be undertaken under the scope of a national public health institution.

Finally, with a view to controlling obesity epidemics, the federal government should be exploring options to further regulate the food industry. There's a growing awareness by governments across the world that the regulation of unhealthy food products is a reasonable way to address the obesity epidemic, and Canadians agree.

We have a poll from Ipsos-Reid indicating that 56% of Canadians believe the government needs to play a major role in addressing the obesity problem in Canada, and a Decima poll said 59% of Canadians believe the government should require the food industry to limit the amount of fat and salt in foods they produce, in order to promote better health.

A number of measures have been proposed by various national and international organizations and are under consideration in many countries, including restricting and banning advertising to children, improving labelling and consumer information, restricting in schools the distribution of unhealthy products, and taxing unhealthy food products. We encourage the federal government to explore options in this area, and in order to do this, we need a more complete evidence base in the area of food regulation. This could be facilitated by having a strong health research enterprise in our country.

Various organizations that have appeared before your committee have recommended that the federal government announce its intention to increase CIHR's annual budget to the $1-billion level by the end of 2006-07, and we agree. We emphasize also that this funding would flow down through the various CIHR institutes.

In conclusion, by acting and taking a leadership role in these four areas—the implementation and financing of a pan-Canadian healthy living strategy, the creation of a national public health agency, ensuring that adequate health information is available to guide decisions, and exploring options to further regulate the food industry—the federal government could, in cooperation with the voluntary and for-profit sectors, make progress toward reducing the burden of chronic disease such as heart disease and stroke in Canada.

Thank you very much.

¿ (0940)

The Chair: Thank you.

Now we'll go to the Chronic Disease Prevention Alliance of Canada. Ms. Mills is going to make the presentation.

[Translation]

Mrs. Christina Mills (Steering Committee Member, Chronic Disease Prevention Alliance of Canada): Good morning. Thank you for giving the Chronic Disease Prevention Alliance of Canada the opportunity to speak on the budget.

[English]

Thank you very much for giving us the opportunity to speak today.

I'm Christina Mills, president of the Canadian Public Health Association and member of the steering committee of the Chronic Disease Prevention Alliance of Canada, hereafter affectionately known as CDPAC. I'd like to tell you a little bit about our alliance and then go on to our proposals for this committee.

CDPAC currently includes 25 member organizations—and growing—and over 150 individuals. We include governments, NGOs, professional associations, private organizations, academia—all of these at local, provincial/territorial, and national levels.

We got together because we feel it's important to work together to ensure that Canadians have access to a comprehensive, sufficiently resourced, sustainable, and integrated system of research, surveillance, policies, and programs that maintain health and prevent chronic disease.

This morning you'll hear, throughout these three presentations, that an investment in chronic disease prevention is essential. I am very glad to be on the same panel with two of our founding member organizations. We believe the greatest gains to the Canadian health system over the next few decades will be in reducing premature death and disability from chronic disease. The alliance has grown very quickly, because these national and provincial organizations recognize both the need for increased effort and the importance of effectively working together to prevent the major causes of death, disability, and health care costs in Canada.

A significant percentage of deaths in Canada come from cancer at 70%, heart disease at 25%, and diabetes, and could be reduced or delayed through prevention. Sustained efforts to prevent chronic diseases will mean that Canadians will live longer in good health and that rising health care costs can be contained. Indeed, this is the only way these costs can be contained. The best system in the world will be overwhelmed by the rising demographic tide if we don't do a better job of prevention.

Chronic diseases are the leading cause of death and disability worldwide. Nearly three-quarters of total deaths in Canada are due to cardiovascular disease, cancer, chronic obstructive lung disease, and diabetes, which not surprisingly share many common risk factors.

You've heard from the Heart and Stroke Foundation about the impact of heart disease. I'll tell you a little bit about cancer, because I know you're going to hear about diabetes later this morning.

Cancer killed an estimated 62,600 Canadians in the year 2000 and accounted for 29% of all deaths in the country. Chronic illnesses cause premature death and disease, but also place a tremendous strain on our health system and on Canadian society itself. Approximately $13 billion is spent annually on treating diabetes and its complications in Canada, another $18.5 billion in direct and indirect costs of cardiovascular disease, and $14 billion on cancer. These are the economic costs, but there are also costs to individuals. Living with a chronic disease has an immeasurable impact on an individual's quality of life.

The bulk of these chronic diseases can be attributed to the shared risk factors of physical inactivity, tobacco, and unhealthy eating. These may sound like individual choices, but research tells us that policies and environments strongly influence people's ability to make healthy choices. For example, it's fine to tell parents their children need to be physically active, but unless they have the facilities—the programs in schools and communities, the safe streets and environments—in which to be physically active, what kinds of choices are they able to make?

No single action can reduce the burden of chronic disease on its own. What we need is a comprehensive strategy, and we've learned from the experience of tobacco how well a comprehensive strategy can work. We can apply the lessons from the success of this comprehensive approach to tobacco to other risk factors. A comprehensive approach would include policies, programs, and mass media campaigns to influence knowledge and attitudes in the public and among decision-makers. But it must be built on a foundation of research and surveillance to adequately identify and characterize the problems, identify what works to address these problems, and measure the impact of our actions. We need strong leadership to carry out this effort at all levels of society, and particularly from the federal government. We're asking the members of the Standing Committee on Finance to provide this leadership by supporting three key recommendations.

First, commit to a $125 million investment to implement a chronic disease prevention strategy within the federal and provincial/territorial pan-Canadian healthy living strategy, as recommended and endorsed by the 2003 report issued by the Standing Senate Committee on Social Affairs, Science and Technology—also known as the Kirby report. This investment would be spent on the required integrated research agenda, development of surveillance and monitoring systems, policy development, and programs that would support the uptake of healthy eating, physical activity, and the reduction of tobacco consumption and exposure to second-hand smoke.

But an investment of this magnitude requires a lot of groundwork and planning in the start-up phase. We just don't throw big bucks at something without doing a bit of groundwork first. So our second recommendation is for $5 million in start-up funds to effectively plan for this national strategy. This $5 million investment would establish or enhance mechanisms for intersectoral, multi-level collaboration, which would involve not only public, private, and voluntary sectors, but also federal departments such as Health, Human Resources Development, Transport, Environment, etc. It would develop mechanisms to identify and reach agreement on key priority directions, goals, and targets, clarify roles and responsibilities of partners for integrated chronic disease prevention, and would guide, monitor, and evaluate progress.

CDPAC has created a multi-sectoral network of governmental, NGO, academic, and industry partners and would be pleased to help coordinate this work.

Third, balance investments between infectious disease and non-communicable disease to ensure that public health has the full capacity to meet the current and future health needs of Canadians. We cannot easily separate human health into infectious and chronic disease components. SARS is a prime example of how infectious and chronic diseases can be two sides of the same coin.

As Ms. Brooks has said, generally speaking, healthy individuals didn't die of SARS. In a review of 144 probable cases of SARS in Toronto, age and co-morbid chronic conditions significantly determined poor outcomes, defined as death or the need for assisted ventilation. All 29 patients admitted to the intensive care unit had at least one existing chronic condition.

It's imperative that we look at all public health needs when investing in public health. To focus simply on infectious diseases and emergency preparedness would be short-sighted, and I hope this morning's presentations will have persuaded you of the importance of investing in coherent strategies and improved public health capacity. The health of Canadians depends on it.

¿ (0945)

The Chair: We'll go to Mr. Howlett from the Canadian Diabetes Association.

Mr. Michael Howlett (President and CEO, Canadian Diabetes Association): Merci, Madam Chair. Thank you very much for inviting us.

Before I turn our presentation over to Mrs. Lillie, I would like to take 30 seconds to tell you about our association and what I have found over the past year in travelling our country.

Our association represents approximately 2.3 million people with diabetes, and it's growing. If we use the example of what's happening in the United States today, we're probably far greater than 2.3 million. Approximately one out of every seven dollars spent on health in Canada is spent on diabetes at the present time, and that is also climbing.

My greatest concern is that diabetes is starting to hit younger and younger people, the youth of our country; not only the type 1, the beginning, but type 2. Our programs are not keeping up and they're not properly financed to be able to educate the people of Canada on prevention through education.

If I may, at this time I'd like to turn to Donna Lillie to give our presentation to your committee. Thank you for having us.

¿ (0950)

Ms. Donna Lillie (Vice-President, Research and Professional Education, Canadian Diabetes Association): Thank you, Michael.

Good morning, ladies and gentlemen.

As Michael has suggested, diabetes is a serious and growing public health issue in Canada today. Two million Canadians live with diabetes or, perhaps more simplistically, one in three Canadians, and every eight minutes in Canada a person is diagnosed with diabetes. We know also that these are huge underestimations. According to international population-based studies that are looking at prevalence around the world, 33% of people in America live with undiagnosed diabetes; 50% are undiagnosed in Australia. So the problem escalates.

We will look at a few charts based on wonderful work done by Dr. Jamie Blanchard out of the province of Manitoba. He has positioned us very nicely to forecast the storm. Looking at the estimated prevalence chart in front of you, you will see the baseline data for the year 2000 and projections that the prevalence of diabetes in Canada is positioned to escalate quite dramatically as we move forward to the year 2016.

Along with this, obviously, there is a huge economic impact. Recent studies out of the U.S. have noted that if we take estimates in Canada, $13.2 billion was spent in this country in the year 2002 on diabetes. That was up significantly from the $9 billion in 1998. Those costs are forecasted to escalate to $15.6 billion by 2010 unless action is taken.

Much of the economic impact is related to the complications of diabetes. The next chart is a projection of cardiovascular disease hospitalizations for Canadians living with diabetes. In the base year of 1996 we were at 99,000 people being hospitalized with cardiovascular disease and diabetes, jumping to 158,000 by the year 2006 and projected to rise to 228,000 by the year 2016. Diabetes with cardiovascular disease is a major issue. People with diabetes are two to four times more likely to develop cardiovascular disease than other people.

Moving forward, we see projections for lower-limb amputations among people living with diabetes, and there's a similar story. Starting with the base year of 1996, we see an escalation by the year 2016 to over 15,000 Canadians suffering and dealing with lower-limb amputation. People with diabetes have a twenty-fold increase for amputation. One amputation procedure alone costs $75,000, and that does not begin to address the issues associated with rehabilitation and lost productivity.

For projected new cases of people with diabetes on dialysis, again, there's a similar story: 42% of kidney failure is associated with diabetes; 40% of people with type I diabetes will have kidney failure by the time they are 50 years of age.

Another very significant and equally important complication we have not addressed this morning is that diabetes is the leading cause of adult blindness in Canada.

Certainly this all has an amazing impact on the individual as well. People with diabetes live with this condition 24 hours a day, day in and day out, with a huge personal and financial burden. They know that aggressive management of diabetes can make a difference and they know there are opportunities to prevent complications, but it comes at a huge cost. People with diabetes spend five times more money on managing their disease than those without.

We are certainly very grateful that we had a previous commitment from the government on a Canadian diabetes strategy that encompassed the years 1999 to 2004 and focused on increasing the awareness of the issues, trying to understand and establish the magnitude of the problem, and setting up the appropriate systems and strategies that could help us move forward. That is coming to a conclusion. We have just hit the tip of the iceberg on that, and ensuring an ongoing investment after the initial work done will be extremely important.

¿ (0955)

Along with that we have many new challenges. Research shows that one out of every three American children born in the year 2000 will be diagnosed with diabetes in their lifetime. Canadians are aging and obesity rates are rising, and these are both increased risk factors for type 2 diabetes.

If you look at the chart that shows us the Canadian population age distribution estimates, one you're perhaps familiar with, you'll certainly note the impact of baby boomers as they move through that classic timeframe. This looks, again, at the base year 2000 with a projection to the year 2016.

The next slide shows you the age distribution of people with diabetes reflective of these two years, and you see the significant jump that will occur for diabetes following the age frame of 40 to 45 to 50, aging baby boomers who are at very high risk for diabetes.

Indeed, our first nations, Inuit, and Métis people are three times more likely to have type 2 diabetes and are more likely to have it earlier in their lives. The most recent survey has shown us that 8.5% of first nations individuals living on reserve have diabetes, 5.3% of first nations individuals living off reserve have diabetes, 5.5% of individuals from a Métis background have diabetes, and 1.9% of individuals in Inuit populations have it.

An additional challenge for the wonderful country of ours is that 77% of our new Canadians are from populations known to be of high risk for diabetes: South Asian, African, and Hispanic.

In our opinion there has never been a more urgent time to act in multiple directions. The Canadian Diabetes Association certainly recommends and supports all efforts to ensure a healthy Canadian population, with chronic disease prevention as a national commitment. Along with such a strategy, however, there must also be a renewed commitment to a diabetes strategy. This investment is critical for us to deal with the secondary and tertiary prevention components of managing this condition to decrease the complications people live with every day and to ensure a brighter future for people with diabetes in Canada. An investment in an enhanced renewal, the Canadian diabetes strategy is an investment in the future of Canadians. Please act.

Thank you for your time.

The Chair: Thank you very much for your presentation and the charts. They are very useful to us.

Now we'll go to the Canadian Foundation for Climate and Atmospheric Sciences, Gordon McBean.

Dr. Gordon McBean (Chair, Board of Trustees, Canadian Foundation for Climate and Atmospheric Sciences): Thank you. I'm very pleased to be here to have the opportunity to speak to the committee this morning.

The Canadian Foundation for Climate and Atmospheric Sciences congratulates the government for its forward-looking initiative to support research in climate and atmospheric sciences, including the mid-term renewal of this foundation.

The CFCAS is the only funding body entirely dedicated to supporting university-based research in climate change, weather prediction, extreme weather, air quality, and the marine climate. Since the year 2000, the foundation has invested $45 million in climate and atmospheric research to help meet Canada's needs. A good portion of these funds is going toward the training of researchers and helping to retain the skilled researchers who will help Canada address its Kyoto commitments and will tackle the environmental problems of the future. The CFCAS will continue to invest up to $10 million per year in weather and climate research important to Canadians.

Weather and climate have a major impact on Canadians and the Canadian economy. Weather directly impacts Canadians, as evidenced by Hurricane Juan, which struck Atlantic Canada earlier this week. The cost of fighting this year's B.C. forest fires has ended up at over $7 million per day. Most of these fires resulted from lightening strikes impacting on drought-stressed forests. The changing climate has also influenced disease vectors, resulting in an increase in West Nile virus in the Prairies and the spread of exotic species that affect agriculture, clog our waterways, and infest our forests. Better climate information will give policy-makers the sound scientific advice they need for decisions on these and other issues.

In commenting, I would like to support the proposal made earlier this morning by the Heart and Stroke Foundation on the need for a national health monitoring system. I'd also like to note, though, it's important that these monitoring systems be able to be integrated with those for weather and climate so we can undertake those important weather-climate health studies that need to be done to better understand these relationships.

We're all concerned with the rising insurance rates. Climate-related disasters cost the global insurance industry $55 billion U.S. in the year 2002, most for damages from windstorms and floods. The 1998 ice storm cost Canada over $5.5 billion in addition to the tragic human impacts. Quebec has already moved entire communities in its north due to melting permafrost.

As we look to rebuilding our national infrastructure, we need to make our cities, where most people live, more resilient and less vulnerable to hazards. The research supported by the Canadian Foundation for Client and Atmospheric Sciences will directly input the natural hazards assessment component of the proposed research alliance for disaster and resilient cities, RADR-Cities, which will build our overall capacity to provide input to critical decisions in the future. The Insurance Bureau of Canada, in its brief to this committee, will also speak on the importance of supporting these initiatives.

In short, weather and climate impact heavily on Canada's economy, on Canadians, and on our security at all levels—local, provincial, national, and international. We must continually advance our understanding of weather, improve our prediction abilities, refine the tools and strategies needed to adapt to climate change, and learn to manager weather risks.

The CFCAS recommends that the federal government enhance its financial investment in climate and atmospheric research.

University and government research in weather, climate, and oceanography are mutually reinforcing and complementary. The Canadian Foundation encourages partners among researchers, technicians, policy-makers, and other stakeholders to make the best use of the human and physical resources available. Professors funded by the foundation work closely with scientists from federal laboratories and with the private sector. This gives us a good bang for our buck.

Partnerships also concentrate resources on problems of national or international importance and minimize duplication of effort. The 12 CFCAS research networks depend heavily on federal facilities for basic weather data, sophisticated computer models, technical support, or complementary expertise, yet many federal facilities are inadequate. The 2002 closure of Canada's Arctic stratospheric ozone observatory at Eureka removed a world facility. Canada is vast and its conditions are unique. Do we really want to depend on other countries for essential weather, climate, and ozone information?

Canada, the United States, and other countries are collaborating on research on earth observing system aimed at better weather predictions. Canada must work with its international partners on surface, in situ, and remote sensing of our climate and ocean conditions and their effects.

À (1000)

CFCAS recommends that the government reinforce its investments in scientific infrastructure as well as in monitoring systems that are essential for acquiring long-term systematic weather, climate, and ocean observations—this capacity resides primarily in federal laboratories—and support international scientific links in research involving the earth observing systems. This infrastructure will serve academics in the private sector and is needed for the training and retention of good scientists.

Canada is gaining and losing skilled people. The foundation is working to redress this chronic shortage of climate scientists, but we recommend the establishment of programs for short-term international scientific exchange to encourage mobility in the sharing of research and best practices related to climate factors.

Huge opportunities and needs exists for work in Canada's north and we are pleased that arctic.net has now been funded. Yet logistical support for the Arctic remains inadequate and piecemeal. A better mechanism to coordinate partnerships and logistics for Arctic research is long overdue, as is the mechanism to coordinate work on issues such as the preparations for the International Polar Year in 2007.

The Amundsen icebreaker research vessel is an excellent initiative that needs to be fully dedicated to research, not split with coast guard patrols. Canada could learn from other countries' arrangements, including those of the United States.

CFCAS recommends early and decisive action on coordinated, cost-effective, and efficient provision of logistical support for northern research.

The north is already affected by climate change, and we need vastly improved tools to know what is going on and its likely impact. Within four years the world will celebrate the International Polar Year, yet Canada, with sovereignty over large polar regions, is the only polar nation that does not yet have an intersectoral planning group busy coordinating IPY plans at home and with other circumpolar nations.

The CFCAS recommends that the federal government expand the mandate of an existing organization to lead and coordinate Canada's activities for the International Polar Year and as a clearing house for information resulting from Arctic research.

Canadian scientists, with foundation support, have been and will continue to be very active in international global environmental change and related scientific programs. Unfortunately, the overall coordination mechanisms within Canada to effectively link with these international programs have largely disappeared. By taking a coordinated approach to participation in international programs, Canada benefits from better knowledge transfer, leverage to shift the priorities and emphasis of these international programs, and more effective participation in general.

The Canadian Foundation for Climate and Atmospheric Sciences recommends that the federal government provide support for an existing organization, such as the CFCAS, to provide the much-needed and very beneficial coordination of Canadian participation in international environmental change research programs.

In conclusion, I would note that over the three years of its existence the CFCAS has committed over $45 million to weather, climate, and air quality research in Canada's universities. But ours is a small country in population, though vast geographically. We urge renewal of infrastructure in federal research laboratories to ensure that they meet both public and private needs and can support partnerships that concentrate intellectual resources, stretch financial resources, and enable us to compete in and, in some cases, lead international research efforts. We recommend better coordination of logistical support for northern studies and for participation in international programs and continued support for the training and retention of young scientists who will help Canada meet its climate change commitments and domestic needs in the future. These initiatives will enhance Canada's activity and image as a responsible, respected, and competitive nation and will push Canada toward its innovation goals.

Thank you for your attention.

À (1005)

The Chair: Thank you very much.

That completes the presentations. I'll now go to rounds of questioning of up to seven or eight minutes.

Mr. Monte Solberg (Medicine Hat, Canadian Alliance): Okay. That's all the time I can spare. I have to give a speech in the House.

Thank you, all of you, for your presentations this morning.

I will start by asking a question of Ms. Brooks about the proposal in your brief respecting taxing and banning of junk foods. Obviously that's a fairly controversial proposal, but you've raised it and I want to ask if you would elaborate on that a little bit.

You've mentioned that there are jurisdictions that already tax them—I don't expect they ban them—but can you provide us with any evidence that this has the type of impact that you would like to see? For example, have people quit eating potato chips in the numbers that they usually do because of this?

Ms. Carolyn Brooks: It's all at the very early stages, quite frankly. This is a new initiative in many of the countries that are maturing industrial countries, where we're dealing with these issues. At this point, there are certain areas where people have taken steps forward, but we don't yet have the initial wash of data that says that if we put a dollar tax on a big bag of potato chips people are going to buy apples instead. We're not even sure yet if that's the most effective way to go at it.

What we do know is that many people ask that there be almost like a guardian angel in the government that forces them to a point where they realize that if they're buying those potato chips it's a bad choice. How we get there, we're not sure; as I said, it's very fledgling at the moment.

Maybe Ms. Brown could add something to that.

Ms. Sally Brown (Chief Executive Officer, Heart and Stroke Foundation of Canada): Let me add that a number of jurisdictions are moving in this direction. There are some small-scale studies that show, for instance, that if you expose small children to fruits and vegetables as opposed to potato chips, they will come to prefer them. They eat what is available, but if other things are made available, they're quite happy with the alternative. So there is a certain amount of research that shows you can change children's behaviour and that a lot of their behaviour is driven by what they're told over and over and see on TV.

We know there's a lot of data; these proposals to regulate the food industry are coming out of research. What we lack still are large population studies that show how you implement this on a large basis. We soon will start to get them, because other jurisdictions are moving in this area.

À (1010)

The Chair: Mr. Solberg, if you would prefer, I can save your time to a little later.

Mr. Monte Solberg: That's okay, thank you. I'd be interested in hearing from everyone on this, because I'm sure everyone has something to say on this issue.

Ms. Christina Mills: We know from tobacco that price is a very powerful influencer of behaviour, and that particularly young people are very price sensitive to tobacco. It influenced smoking behaviour in youth even more than in adults. That could be one of the lessons from the successes of our tobacco control strategies. Maybe this isn't the perfect way, but it's one lever we have to create an economic environment that predisposes people to a preferred behaviour rather than the noxious behaviour.

Mr. Monte Solberg: Ms. Lillie, you might have an opinion on all of this. It affects your group.

Ms. Donna Lillie: Indeed, it does greatly affect people with diabetes. Certainly obesity is a very significant issue, both as it relates to the diagnosis of diabetes and obviously to the management. What we have seen is that this is very much related to what is required as a commitment across the country to healthy living and major systematic changes. Certainly our aboriginal individuals are in communities where their only access is to high-fat food—food that sells and is popular because the system has positioned it to happen. We have been looking very seriously at how you can implement change, particularly in some of those communities. Much as Sally has suggested, if you institute the healthy eating behaviour within the community, you have a much more effective way to deal with the problem.

Mr. Monte Solberg: It just strikes me that you're talking about putting an economic incentive in place—or disincentive in this case to purchase high-fat foods—but on the other side of it, we provide health care completely, in a sense, free to people. I don't know if you have an opinion on this—I'm sure you do—but couldn't it also work the other way around? If there is a bit of an incentive with respect to a user fee for health care, it could also have the same sort of impact, but you wouldn't have to regulate a million different types of products, which strikes me as....

I don't know how you would do it. I don't know how you would regulate all the things that are high in fat. And there are differing opinions, of course, on what things are healthy and what things are unhealthy—you know, the debate over the Atkins diet now, and that kind of thing. Couldn't you get at the same issue by doing it the other way around, having a small user fee provision in health care services?

The Chair: I'll start with Ms. Mills and then go to Ms. Brown, and perhaps Ms. Lillie wants to add something.

Ms. Christina Mills: Are you familiar with the concepts “upstream” and “downstream”? I don't want to be talking in disciplinary jargon, but we use these metaphors of upstream and downstream to talk about prevention versus taking care of things that have already happened, individuals who have succumbed to various risks.

So the health care system essentially pulls people out of the river. What we're talking about is keeping people from falling into the river. The system that pulls people out of the river deals with individuals who already have problems, who've been exposed to high risks, whether voluntarily or involuntarily.

The upstream approach deals with changing the conditions that create the exposure to those risks. So what we're talking about here is starting at the front end with policies and environments that will influence the entire population, as opposed to picking up individuals and trying to get them to change their behaviours.

There is a place for clinical prevention, but population-based prevention is our only hope to make substantial changes in the distribution of disease and disability in the population.

À (1015)

Ms. Sally Brown: You mentioned changing all those food products. We're actually becoming fairly successful at doing that.

The Heart and Stroke Foundation of Canada runs the Health Check program. This is voluntary, and companies apply for the right to show a label on their cereal, or whatever, to say this food is a healthy choice.

What's happening is that more and more companies are joining the Health Check program because they see there's a competitive advantage to having the health check on that box of cereal. But even more interesting, companies that don't meet the fat or salt requirement are now changing their ingredients to meet it. So not only are you providing the consumer with a healthy choice in the grocery store, but we're also now encouraging companies to actually change their ingredients to make them healthier. So the food regulations that are put in and just the packaging and the labelling regulations will encourage the companies to do the same thing.

So you don't have to have a heavy hand, but you have to have a consistent hand and a consistent message that this is what we expect of the food industry, and we can do it.

Ms. Donna Lillie: I think it's a complex issue. Multiple strategies are required, which are certainly being suggested by my colleagues.

I think there's also a caution that if you are really positioning yourself well to manage chronic conditions, particularly if physicians and health care professionals are taking an active role, that may mean more physician visits or more health care provider visits. That's very focused on ensuring that the individual understands what they need when they need it and they get the right test at the same time. If you're aggressively managing, you are ultimately keeping people out of hospital and avoiding complications, but you may be utilizing the system more in that instance and less in another.

Mr. Monte Solberg: Thank you very much.

I'm going to have to leave. I have to go to give a riveting speech right now, but thank you.

The Chair: Actually, your time is up anyway, Mr. Solberg.

Maintenant, monsieur Paquette, c'est à votre tour.

[Translation]

Mr. Pierre Paquette (Joliette, BQ): Thank you, Madam Chair.

Thank you for your presentations. You are lucky because I have to make a speech in the House at 11 a.m. and this roundtable should be over by then. Unfortunately, there might be fewer players for the next roundtable.

I liked your presentations. First, as far as the recommendation of the Heart and Stroke Foundation is concerned relating to additional regulation of the food industry in order to prevent obesity, I believe that the discussion shows that we need a multidisciplinary approach. A single intervention could have perverse effects. We had the case of a school in Joliette which decided to forbid junk foods in its cafeteria and the students just went outside to eat in the neighbouring restaurants, which created other problems. Obviously, when they go outside, they are in an environment where some organized groups or street gangs can take the opportunity to try and sell them drugs, etc. So, we really need a broad approach. I see in your brief that you have many suggestions on that and I can tell you that we are on the same wawelength.

My question is for all the witnesses. We know that Paul Martin will be Prime Minister in a few months. We had invited him to come to the Committee to speak on his priorities but, unfortunately, our Liberal friends preferred to keep all that information to themselves. However, Mr. Martin went to the Montreal Board of Trade to express his priorities.

His first priority is to bring to 25 per cent the ratio of debt to GDP, which is at this time around 43 per cent. We know that it was 70 per cent five our six years ago. So, we've made a significant effort.

His second priority is to cut taxes.

Then, in third position, there is a broad package of what we call social programs.

The situation in our provinces is terrible. You know that all the provinces are in a deficit position, except Alberta and Quebec which, this year, will just manage to balance their budgets. The Minister of Finance of Quebec has already announced what he has called a budgetary impasse of $3 billion for next year. When one looks at Quebec spending—and I suppose it is the same thing in the other provinces—it is about $50 billion. When you leave out health and education spending, which represent a huge chunk, Quebec is left with $9 billion. If we have to cut spending by $3 billion without hitting health or education, it is nearly impossible, because you also have culture and road infrastructure. So, provinces have to cut in their health spending in the present situation.

You've all talked about federal investments in the health sector. I believe that the first problem of our health system is a lack of funds from the federal government to the provinces.

In your environments, do you believe that the first priority of the Canadian government should be to reimburse the debt? Secondly, do you believe that we should recommend a more substantial investment than in the past few years, in order to come close to what Mr. Romanow had suggested, that is to say that the federal government pay for about 25 per cent of our health spending? I put this question to all our witnesses since you work either in the environment sector or in the health sector. If the federal government does not accept more financial responsibility, we will be in an impasse.

À (1020)

Mrs. Christina Mills: If you allow me, I will answer in English because the interpreters will be better able than me to express my thinking in French.

[English]

I'll use a metaphor of the foundation of a house and the walls of a house. If I have a crack in my foundation, I will be constantly having to patch up cracks in my walls. They will keep cracking as long as that crack in the foundation is there.

The treatment system is like patching up the cracks in the walls. With the demographic pressures we're facing, the supply of new patients to the treatment system is growing logarithmically. Unless we fix the foundation, which is primary prevention, we will not be able to withstand the demographic tide in any reasonable way, even if we have a perfect health care system.

If you were to look at a graph showing the predicted burden of chronic disease in Canada and see it divided into preventable and non-preventable causes--non-preventable basically being age and sex; we can't really do anything about that--you would see that there is a substantial non-preventable part but, depending on the disease, an even bigger preventable part. This is our only opportunity to contain rising health care costs.

Getting back to the metaphor of the house, we can keep paying a tradesman $100 a month to keep patching the walls, or we can invest in a different tradesman to do something about that foundation so the walls are no longer having those cracks. What we're talking about is an investment that will pay off, in the very long term, in contained costs at the other end.

I have to say we are talking long term. It is not something we're going to see in two years, three years, or five years, a dramatic effect. But unless we do something now, what we will see in 20 years is going to be a total disaster for our system.

Ms. Sally Brown: I have two comments. First of all, on your very first comment with respect to our proposals for obesity, I think we agree totally. What we're here to say is that the federal government needs to take an integrated approach to this problem because we're not going to solve it any other way.

With respect to your last comment about the Romanow commission, I would say we strongly supported most of the recommendations of the Romanow commission and we think the government should get on with it. The missing piece, however, despite what I believe to be a personal commitment on the part of Mr. Romanow to prevention and promotion—at least he has spoken about it very eloquently—was the foundational piece. It had short shrift in the report and it's the missing piece; it's the missing link for going forward.

Again, we're here to say that you can do what Mr. Romanow recommended, all of that, and probably should, but if we don't step back and also invest in promotion and prevention, we're not going to get where we need to go.

À (1025)

The Chair: Mr. Howlett.

Mr. Michael Howlett: Mr. Paquette, your question is a great question. I quite frankly didn't know it was going to be asked today, but I think it's very appropriate. There are so many better ways to spend our tax dollar with regard to health. A lot of it is not in the treatment. Most of it, with regard to diabetes, is in prevention and education.

We know we can maximize the potential of the taxpayers' dollars and donor dollars through education and prevention, more so than we can through treatment and drugs. It's the prevention and education aspect that we're promoting. If we don't start practising the spending of intelligent dollars with regard to that now, we're going to pay for it very heavily in the future. We're mortgaging the future of our health programs so badly right now and we're not looking properly for alternatives.

Mr. Charest in Quebec and Mr. Klein in Alberta are examining those things constantly. We're very pleased about that. Diabète Québec is doing a great job through education and helping us to better understand it in the rest of Canada.

In Ontario, who knows now? Today we will find out who's going to run our province tomorrow. Before I turn the rest of the answer over to Mrs. Lillie, I thank you for the question, because it's one of the most appropriate things. If we don't have gas for the car, we can't do the program.

The Chair: Ms. Lillie, then Mr. McBean.

Ms. Donna Lillie: Perhaps I can try to be as simplistic as possible. I think it's pay now or pay later. I think we are making an investment in the future of this country that's very significant and relevant. Healthy Canadians drive the environment and drive the economy and position our country. So I think if we don't consider the best interest of their health and keeping them healthy, we will do damage to the country over time.

Dr. Gordon McBean: I want to comment that clearly all evidence shows that scientific research provides benefits with a very large return on investment. If we fail to invest now, by one means or another, the impacts of that will come back to cost us more in the future, and that applies whether it's in health or environmental research.

Universities, of course, are primarily under the purview of the provinces, and the foundation is supporting university-based research. In that sense, it's effectively part of a federal-provincial partnership in supporting university-based research that will contribute collectively to the overall Canadian good.

I could note that several provinces, particularly Quebec, are actually already making investments in this area of climate-related research. The Ouranos project in Quebec, which is supported by six ministries, is one of the more effective in the country, and the foundation is working in partnership with Ouranos to fund research programs.

I think these partnerships in areas where different jurisdictions have responsibilities are the way to accomplish what, I think, Canadians will need to have done for them and for their benefit in the future. Thank you.

The Chair: We're out of time. Did somebody else want to add anything? Is there something else, Mr. Paquette?

[Translation]

Mr. Pierre Paquette: I will conclude my questions, Madam Chair.

From what I can see, health investments, especially in the prevention field, are actually savings for the future. Unfortunately, when we don't have enough money, it is very often prevention that is the first to suffer because the effects are not immediately visible. So, instead of having a health system, we have a health care system.

As you mentioned, if we don't reverse this logic, we will not be able to meet our needs in future years. Thank you.

[English]

The Chair: Thank you.

We'll have Mr. Discepola now for up to nine minutes because I've been allowing that.

[Translation]

Mr. Nick Discepola (Vaudreuil—Soulanges, Lib.): Thank you, Madam Chair. For Mr. Paquette's information, I would like to be a bit more specific about the context in which Mr. Martin was invited to outline his vision. It was during a speech to the Greater Montreal Board of Trade, a few weeks ago. So, he knew that he was speaking to business persons and, furthermore, he had been asked specifically to give his economic vision.

To state now that he expressed his own vision while ignoring other priorities, such as health, would be far-fetched. Furthermore, if he mentioned the need to cut taxes, it is because he was speaking in the most highly taxed jurisdiction in North America. So, I believe he was quite right in underlining the need to do more.

À (1030)

[English]

For the Diabetes Association, I have an anecdote. I think I'm probably the only member of Parliament here who knows where Outlook, Saskatchewan, is, having grown up there and lived there for six years. You had 2 million people to choose from for your case study and you chose an individual named Glenn Richards, who I'd like to take my hat off to because my parents used to shop in his parents' grocery store. So it's quite a small world.

I would like to ask for a general opinion. I think one of the most frustrating things for me—and I probably speak on behalf of all of our colleagues—is to hear this internal constant bickering between the provincial and federal levels of government over the necessity of what to invest in health care, how to invest it, who should do it, and what should happen. I'm getting quite fed up, personally, having to defend our government, because I always have to essentially give examples of how we have failed—“we” in general, as politicians. Their frustration is they don't want to hear that from me, because they want the problem solved. Notwithstanding that the provincial premiers met in 2000 and said they needed, I believe, $22 billion or $23 billion, and the federal government acquiesced and they gave it to them; and notwithstanding that two years later they came back and said, we need $34 billion, and the federal government said, we'll give it to you with very specific conditions, we found ourselves in the situation, if you take the analysis of the Ontario budget, for example, in health care spending, where all the new funding of this grant came from the federal government, the Ontario government spent nothing in that area.

If you take an analysis of the Quebec government, which I'm very familiar with, we all remember that the former finance minister, who then became the premier of the province, had $800 million sitting in a bank account in Ontario when the health care sector was just begging for additional spending in that field. We see that the federal government put a $1 billion fund for specific targeted areas in new innovative technologies, such as MRIs, and the provincial governments haven't even tapped into it. There's still, I think, in excess of $800 million left in that fund.

So when people such as you make very valid recommendations—and I think they're all excellent recommendations—my problem is that most of them are very targeted recommendations in specific areas, which you defend very well. But during that health care accord negotiation, I remember very vividly where the premiers stood up and said, you're not going to tell me, federal government, what I'm going to do and where I'm going to spent it. And despite what the needs are there, the general tendency is that the provinces' attitude is that the feds give us the money and we'll spend it the way we want to, including maybe on asphalt, or roads, or other areas. So how do we get over that impasse, whereby we do actually sit down with the provincial governments?

The national health care monitoring system that you present, to me, is an absolute necessity. When we take a look—and you've brought up very clear cases—at where we don't have any sharing of data, we don't have any sharing of best practices, we seem to have 10 or 12 or 13 individual health care systems in this country and it has to stop. So there has to be more of a willingness to work together to look at common best practices in these individual areas. How do we overcome that impasse?

Ms. Donna Lillie: The commitment the federal government made to the Canadian diabetes strategy over the previous five years provides a wonderful example of that, and this is the national diabetes surveillance system. It really has been one of the most unique opportunities I've ever had to work with the federal government, and the provinces, and the territories, who agreed to come together to understand the magnitude of one problem, and that relates to really trying to get the Canadian picture.

So it is a very unique system that has started to collect the data on common databases across the provinces. The provinces still have accountability for their own data, but have agreed to roll up general data and have a national picture. And they've done that out of a commitment to having to understand a major issue that's relevant to all Canadians.

So I think there are models. I think they are perhaps unique at this point in time, but certainly I think even across sectors we've worked within our organizations and across provinces and territories.

I believe the silos are falling. I think people are recognizing it's incredibly important to work together on these issues and that there should not be a difference for people where they live in the country and what they're supported with, in terms of dealing with their health and wellness.

So I think we are making steps, and perhaps they're baby steps, but I think there are good models. The Chronic Disease Prevention Alliance is one that has put the charities together under a common vision. The national diabetes surveillance system is a unique proposal that is really to expand itself to a wider model, as well.

So I could not agree with you more, but I think we are making headway.

À (1035)

Ms. Sally Brown: To agree with my colleague, I think it's a serious problem and it frustrates health promotion providers and groups like us. It's clearly a major source of frustration for those who want to move the yardsticks forward in prevention and promotion, but we do have a number of models. I think we were all supportive of the health council. It's a fledgling, it's taking a long time to get off the ground; but if it does, it will help. The Chronic Disease Prevention Alliance of Canada is not only federal-provincial, but also cities, municipalities, and communities, and that's what it's going to take. And it's when the communities get involved and get active, as we have seen in other countries, that they can put pressure on the federal-provincial bodies to clean up their act, because communities across the country and individuals across the country don't have the same jurisdictional hang-ups.

In our presentation we recommended a Canadian public health centre, which the Minister of Health is looking at. This too will go a long way to resolving some of the issues.

So I do think we're on the cusp of putting new models in place that will help us as a country deal with these issues, and we have to stay committed to this even though there are going to be bumps in the road.

The Chair: Go ahead.

Mr. Nick Discepola: Thank you.

One other opinion I'd like to get from the panel is on the subject that we seem to be heading probably on another confrontational path with some of the premiers again on the $2 billion additional health care funding that was promised several months ago by the Prime Minister. It was very conditional funding, based on our ability to invest in that exact target area that the Prime Minister had negotiated. It was predicated on the fact that we had expected surpluses of a certain amount annually that historically the premiers had looked at and said the federal government was being dishonest with them, in the sense that the projected surpluses were always in excess of what was actually budgeted.

So I can see another confrontational path within weeks, for example, because the $2 billion was predicated upon the economic growth and the surplus being in excess of the contingency reserve, which has been $3 billion. And because of various things that we're all familiar with--SARS, tourism down, the impending disasters throughout the country--we may not reach that target.

So again, in my home province the Minister of Health and the finance minister budgeted the portion that they were expecting from the federal government. So I can see again a blame put on the federal government. We saw in the Ontario election that blame being put towards the federal government. So what should we recommend in our report to the Minister of Finance with regard to that undertaking? Do we cut back in other priority areas and maintain that commitment, despite the fact that it was a very clear, precise undertaking that on paper we can get away with, but I think politically we wouldn't?

I want your suggestions, more importantly. Do you have any?

The Chair: Who would like to start?

Mr. Howlett.

Mr. Michael Howlett: If I can speak for my own province, I think the one thing the Minister of Health in our province has started to do is examine every program they're going through. Everybody knows what audits mean and everybody knows what scorecards are. It's unfortunate you don't use scorecard in a Parliament get-together.

I'm speaking strictly from a management standpoint at the present time, and I'll allow Mrs. Lillie to discuss the research and other areas, but we're obliged to start evaluating everything we're doing and examining every program we're involved in, and we're obliged now to start prioritizing along what we really need rather than what's politically correct. In effect, in the moneys that were allotted for the diabetes strategy four or five years ago, I think some of the decisions made by this government were excellent. Unfortunately, we could have used double the amount of money. Everybody could.

But one of the things that I do agree with in the strategy is that they did prioritize and they chose the areas, in discussions with us and others, of where to maximize the potential of the dollar. We have to do that because, in effect, if we don't—without sounding too emotional or getting too passionate about this—then all that's going to happen in our area of the world is that it's going to get worse. And prioritizing means going to programs that really mean something, that in the long term we're going to be able to get a return on.

That seems like a simplistic answer, but in effect it's true.

Donna.

À (1040)

The Chair: Ms. Lillie.

Ms. Donna Lillie: Madam Chair, I would like to make an additional comment, and I think again it's very reflective of the changing environment. I think there is a very concentrated effort by different organizations to work in collaboration, to work in partnership, to leverage dollars to make things work. Again, that commitment, I believe, has the potential in those types of integrated approaches, combined efforts, collaborations, to move things forward substantially. I think the commitment is probably critical for the health of Canadians at this point in time, but one that is positioned around major strategies and integrated collaborations across boundaries and borders will go a long way to leveraging those dollars. And that may be an expectation on the money spent as well.

Mr. Nick Discepola: Would you go so far as to say that the commitment has to be kept short of going into a deficit position?

Ms. Donna Lillie: I'll let the boss answer that question.

Mr. Nick Discepola: You seem to have implied that you could find it elsewhere by revisiting certain programs.

Mr. Michael Howlett: Your question of whether we should go into a deficit position is one I am not qualified to comment on. But I certainly can comment on one thing. It's like the Fram oil filter; either you pay them now or you pay them later. So we borrow now to make sure it goes right for the future.

The Chair: I'm going to go to Mr. McBean, and that will be the last comment on this.

Dr. Gordon McBean: Thank you.

This is not really necessarily in answer to your question, but I did want to comment in view of the comments made by colleagues at this table. I think it's interesting and a fortunate circumstance that we, as a foundation on atmospheric and climate sciences, are appearing at the same time with all the health groups.

I support fully the idea that prevention of ill health and promotion of healthy lifestyles are where we need to be spending more of our resources. This is a personal view, but I think it is supported by information given at a recent meeting I was at with the medical community. It was noted--and I don't remember the numbers exactly--that more than 50% of the health dollars in our present system are spent keeping people alive in the last six months of their life, rather than keeping them healthy for the first 90 years of their life. The connection there does then connect to the things we're involved with, with the Ontario Medical Association estimates that 5,000 Canadians die prematurely due to urban air pollution in Ontario. And that's where the research we're doing on air quality to better understand how to predict that, how to provide the scientific basis for regulation, is important.

In August I visited a small community in Alberta, where a few summers ago 12 people died and 140 others were in the hospital due to a tornado that rode through their community. I was very disappointed to discover they've rebuilt the community exactly the same way as it was prior to the tornado. There was no investment, as should have been done, in making themselves less vulnerable to these kinds of health impacts.

We see every year Canadians dying due to weather and storms of a variety of types, and we need to, let's say, invest collectively across the health, weather, and climate communities in a more integrated way in order that Canadians are less vulnerable and live better lives longer, or live better lives for whatever time they have.

Thank you.

À (1045)

The Chair: Thank you very much.

We'll go to our last questioner, Ms. Judy Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): I see I have 15 minutes.

The Chair: No, you get the same as everybody else. It was a good try, though.

Ms. Judy Wasylycia-Leis: Thank you, Madam Chair.

I just wanted to start by saying this has been an excellent panel, with so many experts on this critical issue of disease prevention and health promotion. I think it's helping us, just having you, all together, grapple with a severely neglected issue on the public policy front.

I disagree with Nick when he posits what I think is an artificial concept, that you have to choose between balanced budgets or putting money into disease prevention and health promotion. In fact, we all know we've lived over the last number of years with surplus budgets, with a significant portion going against the debt—not the deficit: we're talking about the debt—which many would say is at an appropriate ratio to GDP. I think it's an artificial concept; I would rather have focused on how we get the federal government to move beyond paying lip service to an area that is so critically important.

I also want to disagree with Nick when he suggests there are jurisdictional problems that have to be sorted out. I think there are clearly specified areas of federal jurisdiction, especially in the area of disease surveillance, where the federal government is not living up to its mandate. I think it did make major progress in diabetes surveillance, but—both Sally and Carolyn mentioned this in their comments in the brief—when it comes to cardiovascular disease, most forms of cancer, and other chronic diseases, the federal government refuses to accept its mandate to execute proper surveillance and monitor it from a public health point of view. I think it's not a question of jurisdiction, as the diabetes example points out; it's a question of political will.

So my question to all of you is how do we do it? I think we're at a critical juncture. This is an important budget. How do we get beyond lip service? What would be your targets and timetables for doing this?

We know now that CIHR says we might, if we're lucky, spend 6% of the total health budget on prevention. We know that the estimates show us dropping from about $400 million a year for disease prevention and health promotion to about $308 by the year 2005-06. That's a significant decrease at a time you're saying we should increase. We know the SARS epidemic likely is going to cost over $2 billion.

What would be your advice for this budget? What's an appropriate target for federal expenditure for commitment to health disease surveillance and for putting some flesh on this idea of a public health officer, or a national office—some way to advance this agenda? This is wide open, I'm sorry, but I think we need to get at what we can do in this budget and what concrete advice you can give us.

Mrs. Christina Mills: Coincidentally, I was speaking with Senator Kirby's committee last evening about this very question, and the problem of jurisdictional hurdles was brought up. I think the establishment of a national arm's-length health agency, with a chief health officer who would be the focal point for leadership and expertise on public health for the nation, to exercise both our national and our international responsibilities for global health—because as you know, SARS was not a local problem—is an essential step to take.

There are precedents. In the area of veterinary health we have a chief veterinary officer of Canada. It was not a problem with the Constitution to have a chief veterinary officer who in an hour can mobilize thousands of inspectors and can close down farms without any demur or wrangling in jurisdictional terms. If the Constitution is not an obstacle for veterinary health, why are we allowing it to be an obstacle for human health?

I think you've really identified the question: it's the political will. First of all, we have to recognize the importance of the problem, the essential steps that need to be taken to address it, and then move forward and make it happen. Instead of asking ourselves whether or saying why it can't be done, we should be saying, how can it be done?

À (1050)

Ms. Sally Brown: It's an excellent question, Judy. I think we'd also agree it's more about political will than about jurisdictional battles.

I think there are a number of things. We used to be told all the time that we couldn't go there because there wasn't enough research to show that prevention and promotion worked. That's no longer true; there's a huge body of research. There needs to be more, and this is why CIHR is so important, but the balance of where the research funding goes in CIHR still needs to be looked at. The institutes that have strategic research initiatives--I think we have to start saying that's where we need our money spent. There has to be more balance there.

We know that the impoverished area of research now is the behavioural sciences. But that's the research that's going to show us how you get behavioural change and how you push an agenda like this—which isn't clinically based; it's all about behaviour. That's one thing we can do, and we're heading in that direction, but we need to keep moving there.

I think we're doing our part because of the ChronicDisease Prevention Alliance of Canada. I think that as the government realizes we're coming together in a bigger and broader group that's interprovincial, it's harder and harder to say no, because we're bringing a broader and broader constituency forward. We need to make our effort.

We mentioned, almost as a throwaway line around parliamentarians, that it's true that in some ways you have to individualize and personalize this issue. Maybe we need to start doing a better job of that, because it affects every single one of the decision-makers and where they're going. It is a question of will.

We can try—and we are trying—to put dollar figures on it, because that's how in the past governments have responded. But it's not going to be possible to do that for something that's so long term and so behaviourally and environmentally related, so we're going to have to change the thinking a little bit in government about how we show the long-term benefits of this, and put more value on the social and quality-of-life benefits than just on the economic parameters. We're being trapped into pushing it as an economic benefit when I don't think that's the right paradigm for where we're going.

Those are just a few responses.

Ms. Donna Lillie: I certainly support the comments of my colleague. I would add that I believe it's incredibly important that the decision be made on the basis of good evidence and good information. The case does need to be built, but I believe the case is there in many instances. Perhaps it hasn't been politically positioned as powerfully as it could be, but I think there's tremendous new evidence that supports the prevention agenda, both at a population health level and at secondary and tertiary levels, as a commitment to what has to happen in health.

I believe it's there; I believe the government should be looking at the research that supports the case. But particularly in this area it's with a very clear understanding that there will be no immediate change: it is a long-term commitment. I think it's appropriate that we build in expectations on that commitment, that there be outcome expectations, and that there be accountability and evaluation built in with the process. I believe there's a will and a way to build that case that certainly could support what needs to be done in the country. We have tremendous resources that can facilitate that process.

The Chair: Ms. Mills, I'll let you also add in.

Ms. Brown.

Ms. Sally Brown: One of the thoughts we too have had is that we seem in this country to believe all provinces must move forward with the federal government together in a policy area like this. I would say we need to question that.

If one or two provinces are ready, because either their population health statistics are worse than those in other parts of the country or they're ready to try new approaches, then why aren't we starting to say that if two or three provinces are ready to move forward with a population health-based approach to their health care provision, maybe we don't have to wait for everybody? Maybe the federal government can start to partner with those that are ready to go, so you don't have the reluctant ones holding us back. Regional health authorities were put in. That was a provincial initiative, but they're not everywhere. They've proven to be the right thing to do, I think. But I think we should get away from the assumption that we all have to go together.

À (1055)

Ms. Christina Mills: We're talking about a different way of thinking about public policy. Perhaps there is a more holistic way of thinking about public policy. I am also glad that our colleague from the environmental sector is here, because that's a perfect example. Support for public transit, for example, in most places is expected to be self-financing, but if we looked at it as a social investment there would be benefits to making public transportation free or very low cost. It would have health benefits. It would have air quality benefits.

The health benefits would be myriad, because a lot of people only have cars because they need them to go to work. If they could go to work free, they wouldn't have cars. They would walk to the store instead of hopping in the car to do it. They'd be healthier. They'd know their neighbours better. Their streets would be safer. I could go on and on. There'd be a myriad of collateral benefits to seeing that as a social investment. It has benefits in health, in environment, in safety, in municipal quality of life and, incidentally, economically for the community, which would be a healthier community and a more favourable place in which to live.

I think we have to think bigger when we're thinking about policy and look at all of these implications.

The Chair: Thank you very much.

I'm afraid we've run out of time. Our next panel has to start in two minutes.

On behalf of all of the members of the committee, those here and those who are in the House and doing other work on the Hill, I want to thank you for your input, for getting in your written material on time and being available for our questioning.

We are now suspended. We will change panels and start in less than five minutes.

À (1058)

Á (1104)

The Chair: We will resume with our second panel of the morning under the order of business, Standing Order 83(1), pre-budget consultations.

On our panel there is one person absent at present. The Child Care Advocacy Association of Canada is not yet here and we have not heard from them, so we will start the panel without them. If they show, we will add them to the panel.

The members who are here are as follows: the Canadian Institutes of Health Research, and Dr. Bernstein, the president, will join us today for his presentation; from the Juvenile Diabetes Research Foundation of Canada, Ron Forbes, president of the association; and from the Credit Union Central of Canada, Jack Smit, the chairperson of the board of directors, and Joanne De Laurentiis, president and chief executive officer.

Bienvenue à tous. Welcome to all of you. With the exception of one, I think you've all testified before. I will give the floor over to you in accordance with the order on the agenda.

Dr. Bernstein, I'll take care of the mikes for you so you can concentrate on your presentation. Go ahead, sir.

Á (1105)

Dr. Alan Bernstein (President, Canadian Institutes of Health Research): Thank you very much for inviting me here today, and also for this committee's support for the Canadian Institutes of Health Research since our launch three years ago.

[Translation]

I am pleased to have this opportunity to talk to the Committee about the progress made by the Institutes over the past three years. I will summarize what we have accomplished with our partners in order to transform the whole area of health research.

[English]

I'll outline our plans for health research and its exploitation for improved health, a stronger health care system, and our economy over the next five years. Finally, I'd like to discuss our budget situation—indeed, I would say our budget crisis—for next year.

Health research is transforming our lives and our health care system, from understanding the most intimate molecular secrets of the cancer cell to the sequencing of the genome of the SARS virus. I would point members of the committee to some important newspaper stories today in three national papers. I'll just quote from one of them. On SARS, the headline is, “Potential vaccines against SARS to be tested”:

The national effort involves researchers from McMaster [University], the National Centres of Excellence in Vaccine and Immunotherapy in Winnipeg, the SARS Vaccine Initiative of the British Columbia Centre for Disease Control and researchers who are all part of the SARS Initiative of the Canadian Institutes of Health Research.

Madam Chair, I think that's a wonderful example, actually, of the Canadian approach to a problem facing the health of Canadians: three different centres, researchers from across Canada, working together under the CIHR umbrella to develop a SARS vaccine, leading the world.

From the discovery of new drugs and transplantation procedures to prevent or cure diabetes, to a proper and effective evaluation of which clinical procedures work and which don't, to addressing the unique poor outcomes of Canada's aboriginal population, to documenting adverse events or medical errors in our health care system, to working with the fisheries and canning industry trade unions to increase workplace safety in the east coast fishery, to understanding the genetic, economic, and psycho-social conditions that predispose to schizophrenia, to fundamental research on how our nervous system works—CIHR is funding all of this and much more.

In just three short years our institutes have developed their individual strategic plans, and CIHR has developed an overarching national strategic plan or blueprint for health research that's built on excellence in research. Excellence is the fuel that will drive the engine of discovery and mobilize research to improve the health of Canadians, build a stronger, innovative health care system, and drive the knowledge-based economy of the 21st century.

In just three short years our institutes have developed and implemented new programs to encourage problem-based, multidisciplinary approaches to the health challenges facing Canadians and to the exciting scientific opportunities that are opening up daily.

We've also launched innovative new programs to encourage and catalyze the commercialization of research, including our new “proof of principle” program that allows researchers to add value to their discovery prior to going to the marketplace. I've never seen a more successful launch of a new program.

Over the past three years our institutes have also developed new partnerships with provincial health research agencies, industry, and health charities both here in Canada and abroad. These partnerships have already resulted in almost a doubling of our partners' contributions to federal government investments in research.

Building on these successes, we plan to focus on five major broad objectives over the next five years:

(1) continue to build a base of health research excellence in Canada;

(2) develop major national initiatives and platforms to address the health challenges facing Canadians—I gave SARS as one example; I could give many others;

(3) develop and implement a balanced research agenda that embraces both research on disease mechanisms and fundamental biology, treatment—you had a discussion in your previous panel, Madam Chair, on that—prevention, health promotion, the population determinants of health, and the capacity of our health care and public health systems to deliver the services Canadians want and need;

(4) harness research and evidence to improve the health status of our vulnerable populations; and

(5) support the strengthening and renewing of Canada's health system and our economy by innovative new programs and approaches that bring together both the creators and the users of new knowledge to advance our health system and the economy.

I'd be happy to talk about this in the question period.

The benefits for Canada are clear, and I believe they are significant. They include:

(1) developing a health care system that's leading edge, evidence-based, and cost-effective;

(2) improving the health of Canadians through new understanding of disease, developing and testing new diagnostics and treatments—such as a SARS vaccine—new approaches to the delivery of health services, and evidence-based changes to public policy;

(3) strengthening our economy through specific programs that develop and build human and knowledge capital that are so critical to success in the competitive global marketplace; and

(4) branding Canada as a country of excellence in health research in this century.

As for our funding situation, the launch of CIHR by Parliament three years ago has transformed the health research enterprise in Canada and I believe almost overnight has catapulted us to become a significant player internationally in health research.

Á (1110)

Our work together has just begun, though. With the generous financial support by the Government of Canada and our many partners, we are together building an organization that has already become a model for the world. Yesterday, my counterpart in the United States, the director of the National Institutes of Health, released their strategic plan to the press. In an interview with the press, he quoted CIHR's blueprint, our strategic document, as a paradigm for what the U.S. is trying to achieve.

We still have a way to go. The next stage of our strategic plan calls for the sustained, up-front, multi-year growth in our budget from its current level of just over $600 million to $1 billion per year over the four years starting in 2004. I believe—and I'm not saying this lightly—that failure to sustain this investment at this truly critical juncture would seriously jeopardize our progress to date.

Let me explain. We're facing a funding crunch for 2004. This situation arises as a result of how we're funded, the nature of research investments—which are long term—and the tremendous growth in the size of the health research community in this country.

Let me speak to that for a moment. As you know, the Government of Canada, through the Canada Foundation for Innovation, is investing in a major way in developing research capacity and infrastructure in this country. Approximately 65%, almost approaching 70%, of CFI investments are now going into health research infrastructure. What that means is we're building buildings across Canada for tens of millions of dollars, equipping them with state-of-the-art new equipment, hiring young people with the Canada research chairs program, giving them start-up funds to get their labs going. Then, when they apply to CIHR for operating grants, because of our funding situation, the chances of their being funded with the $100,000 they need is less than 20% this year and will be even less next year. To me at least, that's unacceptable.

Most of our budget is locked into long-term commitments for grants that extend over three to five years. Thus the amount of money we have to invest in new research every year stems from the redistribution of funds from research projects that were started five years ago and have now come to an end. Five years ago CIHR did not exist. Our predecessor organization was the Medical Research Council, and it had a much narrower mandate and correspondingly a much smaller budget—less than $250 million. So the amount of money that will be freed up from five years ago is much too small to really sustain the size of our mandate and the research community here in Canada today.

Fortunately, budget increases over our past three years have significantly augmented the amount of funding we've had available each year up until now to support new research and to transform CIHR from simply being a granting council into CIHR, a health research agency that's strategic and with a broader mandate. Without a budget increase in 2004, the levels of uncommitted funds we would have available to support new research will drop by more than 40%, from $171 million in 2003-04 to about $100 million in 2004-05.

To reach that $100 million, we've already had to announce the suspension of certain programs and a clawback of 5% on funds we've already committed over the past three years. We've been trying to get our house in order to deal with this funding crunch in 2004.

What is the funding required? As I said, I'm asking Parliament for a four-year, up-front commitment in the growth of our budget, which would allow a “soft landing”—that's the American phrase when the NIH budget was dealt with; they had exactly the same cashflow issues in the United States. More importantly, it would allow us, if we had a four-year window, to realize the bold, strategic, and transformative vision that was set out for CIHR by Parliament three and a half years ago.

I believe that CIHR and the health research community have demonstrated excellence, impact, and outcomes that Canadians expected when CIHR was launched. The SARS story today is just one example, I think, of the great research that's going on across this country today. I believe we have more than delivered on our commitments over the past three years. With your continued support, particularly from this committee, I'm confident we'll continue to deliver the return on investment that Canadians expect and want.

Thank you. Merci.

Á (1115)

The Chair: Merci. Maintenant, c'est votre tour, monsieur Forbes, from the Juvenile Diabetes Research Foundation of Canada.

Go ahead, sir.

Mr. Ron Forbes (President, Juvenile Diabetes Research Foundation of Canada): Madam Chair, thank you very much for the opportunity to appear before you today on behalf of the Juvenile Diabetes Research Foundation.

My name is Ron Forbes, and I am the president and CEO of JDRF Canada. Founded in 1970, the Juvenile Diabetes Research Foundation is the largest non-profit, non-governmental funder and advocate of diabetes research in the world.

JDRF's mission is very focused. It is to find a cure for diabetes and its complications through the support of research. Juvenile or type 1 diabetes is an autoimmune disease and is the most severe form of diabetes, striking infants, children, and young adults, leaving them insulin dependent for life, with the constant threat of developing devastating complications.

Type 1 diabetes is different from type 2 diabetes. Type 2, generally referred to as adult onset diabetes, can be treated and in most cases prevented with diet, exercise, and drugs.

JDRF has an international presence, with over 100 offices worldwide. In Canada we have 12 chapters from B.C. to the Atlantic region, with head office support in Toronto.

Since the inception of JDRF, we have provided more than $900 million to diabetes research worldwide. Our research activity spans several countries, including the U.S., Canada, Australia, the U.K., Sweden, Finland, Italy, Switzerland, and Belgium. JDRF has been at the forefront of all major breakthroughs in diabetes research worldwide.

First, I would like to take this opportunity to thank the committee for its continued support of the Canadian Institutes of Health Research. JDRF sees the CIHR as an important partner in our research work. The need is strong for consistent, long-term funding of health research, rather than sporadic injections in the CIHR budget.

In order to help make Canada one of the top research-intensive nations, JDRF would like to see the federal government announce its intention to increase the CIHR's operating budget to the $1 billion level by the end of 2006-07, an amount that has been used for the past two years by both Health Canada and the CIHR as a future research goal.

The main reason I'm here today is to draw your attention to type 1 diabetes, a disease that we strongly feel must be a funding priority for the Government of Canada. Diabetes affects more than 2.25 million Canadians, from the youngest children to the oldest adults. It is the leading cause of life-threatening and debilitating complications, such as blindness, end-stage kidney disease, nerve damage, heart attack, stroke, amputation, and even death.

On August 25 of this year the International Diabetes Federation reported that the world faces an explosion in the number of people with diabetes. Currently there are 194 million diabetics worldwide; 300 million additional individuals are at risk of developing the disease. There is urgency to find a cure.

In his September 18 address to the Board of Trade of Metropolitan Montreal, the Honourable Paul Martin stated: “To date Canadian researchers are on the cutting edge, clearly we need to keep doing research in many areas, but the key of any good strategy is to concentrate on your strengths.”

One of Canada's great research strengths lies in the area of diabetes. Canadian researchers, using innovative techniques and basic ingenuity, have persevered to make dramatic advances in fighting diabetes. After all, it was 80 years ago that Doctors Banting and Best, after many years of collaborative work, discovered insulin at the University of Toronto. Their discovery is the reason that people with type 1 diabetes are able to avoid inevitable death, sometimes slow and painful. However, insulin is not a cure.

Á (1120)

Since that time, both Canadian and U.S. researchers have made significant advances, leading ultimately to a major breakthrough in 2000 in islet transplantation, again by a Canadian team of researchers led by Dr. James Shapiro. The procedure known as the Edmonton protocol uses islets isolated from a donor pancreas and prepared for injection into the recipient's liver through the portal vein. The procedure is simple, and the patient is hospitalized usually for no more than a day. The procedure is also combined with a new less-toxic regime of anti-rejection drugs. To date there have been 257 transplant patients, over 40 in Alberta, with an overall success rate of 80%. However, obstacles still remain in perfecting this procedure to make it safe for all diabetics, especially children.

Research is continuing in several Canadian institutions to overcome these obstacles, and JDRF is helping fund these researchers. However, much more funding is needed to bring this work and other cutting-edge research from the bench to the bedside. This is why JDRF is here today urging the federal government to increase research funds allocated to type 1 diabetes research.

In 1999 the Government of Canada granted $115 million over five years to the development of a Canadian diabetes strategy to enable Canadians to benefit more fully from the considerable resources and expertise available across the country. Allan Rock, then the Minister of Health, specifically referenced type 1 diabetes as an area that would receive special consideration. Unfortunately, since 1999 we have seen the CDS focus exclusively on type 2 diabetes.

Both types of diabetes need funding, since complications of both diseases are the same. But unlike type 2, type 1 diabetes cannot be controlled and prevented with diet and exercise. Type 1 diabetes does not strike as a consequence of living an unhealthy lifestyle. Type 1 diabetes is an autoimmune disease and is not preventable.

The burden of diabetes on individuals and on society is extraordinarily high. Researchers have suggested that islet transplantation could also cure type 2 diabetes. It is therefore important to find a cure for type 1 diabetes. You can see why we are so devoted to finding a cure. However, we cannot do it alone.

Canada has one of the highest incidences of type 1 diabetes in the world. Fraser Scott, senior scientist with the Ottawa Health Research Institute, said, “There is information that type 1 diabetes in certain populations has increased three percent a year over the last four decades. Newfoundland, southern Manitoba, P.E.I. and Edmonton, Alberta have some of the highest incidences of diabetes in the world.”

This summer, researchers at the University of Alberta's Institute of Health Economics reported for the first time on the actual costs to Canadian health care of diabetes. Using Saskatchewan as an example, they found that while diabetics represented 3.6% of the population, the disease accounted for 15% of the spending on hospitals, physicians' services, and prescription drugs. Well over one-third of spending related to the disease was due to co-morbidity, which is the effects of cardiovascular, kidney, and other diseases that are associated with diabetes.

This is does not include the economic cost due to absenteeism and lost productivity. Indeed, Health Canada suggested quite conservatively that diabetes costs Canada approximately $9 billion annually, making it one of the nation's most costly illnesses.

The government can no longer afford to ignore the significant impact of the disease on individual Canadians, on the health care system, and on the Canadian economy.

Á (1125)

This year JDRF funded over $12 million in research projects in Canada and close to $140 million worldwide. Our commitment in Canada over the past four years has been more than $75 million. Yet we fully recognize that much more funding is needed to find a cure for this life-threatening disease.

In the United States the National Institutes of Health will invest $1 billion over the next five years specifically for type 1 diabetes research. In addition, the Juvenile Diabetes Research Foundation advocated with the government and have obtained supplemental funding from the NIH of $750 million over five years. This translates into approximately $350 million U.S. per year in U.S. research funding for type 1 diabetes. Ideally, on our 10% rule, and on a proportionate basis adjusted for our population, we believe strongly that Canada must make an equal, if not greater, commitment to this important research.

Given the current levels of funding for research in Canada, we recognize that this would be a substantial new commitment by the government. Therefore, we propose that the governments should specifically fund type 1 diabetes research at 50% of the U.S. level for the next five years. This would represent an investment of $25 million per year for the next five years. This funding should be specifically directed to research that will lead directly to a cure for this devastating disease. Given the cost to the economy, estimated at over $9 billion per annum, the government's investment would produce a very significant return.

I thank you for the opportunity to appear before this committee today. JDRF looks forward to working closely with you to make this area of research a major success.

The Chair: Thank you very much.

Now we'll go to the Credit Union Central of Canada, Mr. Smit.

Mr. Jack Smit (Chairperson, Board of Directors, Credit Union Central of Canada): Good morning, Madam Chair. I want to thank you for this opportunity to come before the finance committee today to discuss our recommendations as you prepare for the next federal budget.

I'm the chairperson of the board of directors for Credit Union Central of Canada, commonly referred to as Canadian Central. With me this morning is Joanne De Laurentiis, the president and CEO of Canadian Central.

As many of you know, the Canadian Central is the federally regulated financial institution that operates as the national trade association and finance facility for our shareholders, provincial credit union centrals, and through them, for more than 600 affiliated credit unions across the country. Our system's credit unions employ more than 21,000 people serving our customers, or members, if you will, who number 4.6 million in communities across the country. At the end of last year our credit unions held more than $69 billion in assets. Canadian Central has long participated in the pre-budget consultation process of this committee, and we're happy to do so again this year.

Madam Chair, I just want to take the opportunity to commend the committee on the recent report on bank mergers, and we thank the committee for its support of credit unions to provide more competitive financial services to Canada's communities. We certainly appreciate the hard work the committee has done to reach consensus on the report.

You'll all have received our formal submission by now, and I want to take a few moments this morning to share with you the concerns of our members.

We're pleased that the federal government appears to be on track for another balanced budget, given the challenges we've recently faced, an economic slowdown in Europe and the U.S.A., the BSE crisis, the fires in British Columbia, SARS, and the recent blackout in Ontario. The credit union system is encouraged to see that the accumulated federal debt has declined from 72% of gross domestic product in 1995-96 to our current level near 40%. This has helped Canada to keep interest rates low and to lower taxes. However, we also feel that Canada's accumulated debt leaves the nation somewhat vulnerable to economic shocks. In the event of a recession, we fear it could once again grow as a percentage of GDP. That's why we recommend that the government exercise some caution in contemplating cutting taxes further or increasing program spending. Moreover, we suggest the government continue to work at reducing the ratio of debt to GDP and not undertake fiscal measures that would unduly threaten the hard-won budgetary victories it has achieved over the last several years.

An issue of some concern to our members relates to Farm Credit Canada, FCC. As you know, FCC is the crown financial corporation focused on lending in rural Canada, and it certainly plays a useful and productive role in many rural communities across the country. Credit unions also have a very strong presence in rural Canada, and a large number of our members are agricultural producers. Our rural presence means that we often do business in the same markets as FCC, and we often play complementary roles to one another.

However, since FCC received an expanded mandate in 2001, we've noted that it has been actively competing with credit unions to lend to businesses in rural Canada. Some of the lending does not appear clearly related to agriculture, and some of our members have commented it may overlap with lending undertaken by the Business Development Corporation. At the same time, some credit unions have indicated to us that FCC is often structuring transactions so that the borrower is advised to approach a credit union to pick up the least attractive or highest-risk component of a deal. Our members believe it's fundamentally unfair, since smaller community-oriented credit unions are not on a level playing field with FCC, a large and lightly regulated financial institution backed by the federal government.

That's why we're recommending that in the next budget the government should signal an intention to re-examine the role of existing and proposed crown financial agencies to ensure that their mandates remain focused on activities that are complementary to the role of private financial institutions. Canadian Central also recommends that the government consider ways in which crown agencies, such as FCC, can more effectively partner these credit unions and other lenders.

Á (1130)

BSE, or mad cow disease, is a national issue that has significantly affected our credit union members, many of whom are cattle producers. Credit unions are also major lenders to the cattle industry, and we're seeing at first hand the impact of the border closures on our members. I want to congratulate the government on its recent success in the partial opening of the U.S. and Mexican borders to beef exports. Those openings certainly offer much needed relief to the beleaguered sector. Nonetheless, there are a number of other initiatives the government can undertake to ease the crisis in rural Canada and ensure that Canadian cattle producers are treated in a fair and equitable manner.

The government's next budget should signal a commitment to continue funding the BSE recovery program until the border is open to all classes and sizes of cattle. Second, we recommend that the government take steps to ensure fair and equitable access to slaughter facilities for cattle producers in all parts of Canada. As committee members may know, most slaughter capacity is situated in Alberta and Ontario, and as cattle stocks have grown, it has become more difficult for farmers in other provinces to gain access to that capacity. This aspect of the BSE issue has recently gained greater attention. It was in the national news media. We hope this added attention will facilitate some greater relief.

Related to this is that government funding programs have in the past been geared to support the feeder cattle sector, as opposed to the cow-calf sector. This has made it difficult for some producers to secure compensation. Cow-calf producers must sell their stock in order to be eligible for compensation, but with limited access to slaughter facilities, producers outside Alberta and Ontario have great difficulty getting funding. That's why we also recommend that the federal government institute a new funding program specific to the cow-calf sector.

Finally, Madam Chair, our members have raised concerns with regard to the policies of the Competition Bureau. In particular, we have been asked to raise awareness of the $50,000 flat fee the Competition Bureau charges for advance ruling certificates or for reviewing merger notifications. As it currently stands, the Competition Bureau charges the same fee to review proposed mergers between some of Canada's largest corporations as to review the same between some credit unions. This flat fee framework actually discourages mergers in the credit union system. Such mergers will only enhance the ability of credit unions to offer quality services to their members and to act as stronger competition to the banks. The flat fee may also dissuade larger credit unions from merging with smaller credit unions that could face closure due to a declining membership base.

That's why we recommend that the Competition Bureau adopt more equitable sliding-scale fees based on asset and transaction sizes for advance ruling certificates and merger notifications. That would help ensure that very large businesses do not have an unfair advantage over small firms seeking to merge. Sliding-scale fees would also reduce the current disincentive faced by smaller credit unions seeking to become more competitive by merging with other credit unions in their province. We're fully aware that there is a consultation process under way to reform the Competition Act. However, the examination of the Competition Bureau fee schedule is not part of the mandate of the review.

I want to thank members for their time today and commend the work this committee is playing in ensuring that all Canadians have input into the government budget planning process. We'll be happy to answer any questions members may have.

Á (1135)

The Chair: Thank you for your presentations this morning.

Now we'll go to our rounds of questioning. Thank you to Mr. Solberg for allowing Ms. Judy Wasylycia-Leis to be the first questioner, so she can accommodate another appointment.

Go ahead.

Ms. Judy Wasylycia-Leis: Thank you, Madam Chairperson, and thank you to my Alliance colleague, and of course, my Liberal colleagues too. I won't take very long, because I do have to rush, but I wanted to focus on a couple of areas.

Mr. Bernstein, you might have been here at the tail end of the last set of presentations, where the focus was on prevention and health promotion. I think groups this morning expressed a sentiment we've heard often. There's an imbalance in research in this country between the standard or normal or traditional research and research that looks at behavioural issues, socio-economic factors, health population research. They would like to see more money being allocated through CIHR towards health population research. Are you doing that now? What are you planning to do? How can we shift that balance?

Dr. Alan Bernstein: I'm glad you asked that question. It's part of what I said in our blueprint, developing this balanced research agenda. Since we were launched just three years ago, we've increased about twelvefold the research dollars going to population health research. It has been a huge increase in the amount of money going there.

In addition, we've started a number of new programs aimed at prevention, for example, on workplace safety and preventing accidents in the workplace. Accidents are the fourth largest killer in Canada. We're funding the major program I alluded to in Newfoundland on workplace safety in the fishing industry. That's a partnership between researchers at Memorial and trade unions in the canning industry in Newfoundland. As another example of prevention research—and again this would not have happened under the old Medical Research Council—you all know about the issues with obesity and the need to get Canadians more physically active. We've launched a program in Saskatoon at $500,000 a year with the community called “Saskatoon in Motion”, which is designed to do exactly that. Our Institute of Nutrition, Metabolism, and Diabetes has declared obesity as their major priority area. They will be announcing in the next few months a major initiative in that area. We're very aware of this issue. We are also launching a major initiative on prevention of tobacco and alcohol addictions.

I think one of the big challenges worldwide on prevention research is to actually demonstrate that the research is having impact. How do we know anti-cigarette smoking ads actually influence behaviour of kids, for example? We're going at this in a very scientific way. What's the evidence? What can we do that will actually have impact on people's behaviour? Where do we actually need to change people's behaviour?

Á (1140)

Ms. Judy Wasylycia-Leis: I appreciate that, although sometimes we go overboard in looking for evidence or outcomes. For example, it should not take much to imagine that cigarette girls, young women dressed up in skimpy clothing selling cigarettes, are going to have an influence on young women, who are turning to smoking in larger numbers than ever. I hear what you're saying, but I think we sometimes make that an unnecessary barrier.

You can respond later if you want, but I'd better get on to Mr. Forbes. You're asking in your brief for significant additional money for research into juvenile diabetes. I know money's part of the problem, but I would like to hear from you some sentiments on what would happen if we don't pass Bill C-13 fairly quickly in respect of the research opportunities available for possibly finding a cure for juvenile diabetes.

Mr. Ron Forbes: It's a very difficult question; it's a tricky subject that is still being debated. The interest we have in Bill C-13 is the use of embryonic stem cells. It's not to the exclusion of adult stem cells, so it's stem cells in general. All we're saying is that we don't know enough, so let's not stop one or the other, let's continue. The reason is that the Edmonton protocol has been such a successful procedure, but the obstacles there are tremendous. Our estimation now is that with the existing number of pancreases that are available in the world today, we would only be able to do 2,000 operations. So how do we get the supply of these islets? That becomes the big issue. To be able to take it further, we do need to look at all avenues, not only stem cell research.

So it is an important piece for us, very important.

Ms. Judy Wasylycia-Leis: Thank you very much.

I have one quick question to Mr. Smit and Credit Union Central. I hope you don't mind me asking this, but we're expecting that once Paul Martin becomes the Prime Minister, he's going to advance the agenda on bank mergers. I'd like to get a word from you about whether you sense that might be the case and the impact that has on the credit union movement in Canada today. We had some big changes in the last legislative round, in the last bill, but are there shortcomings in that last legislation pertaining to innovations on expanding credit unions that need to be addressed soon?

Mr. Jack Smit: I can't comment on where the legislation will be going, but we did testify before the committee on our views on the mergers. We said it's a legitimate business strategy for the banks to do that, but there are some important things that need to be kept in mind, such as service to Canada's communities. Every time a merger takes place, there is the potential for closing of branches. We believe credit unions are positioned very well to fill those gaps and serve particularly the rural communities in Canada, because the banks tend to withdraw from rural rather than urban communities when they do so. We just want to ensure that we have legislation that enables us to expand. The federal government has been very receptive and cooperative in working with the credit union system to ensure that we have the appropriate legislation for us to fill that void.

Ms. Judy Wasylycia-Leis: The loss of banks is also happening in urban Canada; I've just lost the last bank in most of my constituency. We've had 10 bank closures in five years, but it's been hard for the credit unions to move in. I think it's partly the fact that they also have to balance new investments and so on. What needs to happen to make it possible for credit unions to expand in urban areas like mine, North Winnipeg, where we desperately need a financial institution?

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Mr. Jack Smit: I think it's a matter for credit unions to ensure that they have sufficient capital to expand. In many cases that is provincial regulations, because credit unions are provincially regulated. Going forward to a financial services review in 2006, we may want to talk about ways in which we can make sure credit unions, not just provincially but federally, have the opportunity to expand their services.

I know a number of credit unions and colleagues in Winnipeg, and I know they're very interested in expanding services into the communities. I believe Steinbach Credit Union has just moved into Winnipeg, in the city.

Ms. Judy Wasylycia-Leis: That's right.

Mr. Jack Smit: I think capital is the main issue.

The Chair: Mr. Solberg, the time is yours now.

Mr. Monte Solberg: Thank you very much, Madam Chair.

I appreciate the presentations, and I'd like to start with Dr. Bernstein.

I'm curious about how successful you've been with commercialization and what revenues that brings to your organization. It wasn't clear to me in your brief. And an add-on would be, is there potential for that to become a major source of funding? What about the partnerships you're in? Can that area be expanded and become a greater source of funding to help you get over this hump?

Dr. Alan Bernstein: We take no commercial interest in any spin-off activity that comes out of the research we fund, as a matter of government policy. We do expect, though, that the universities, hospitals, and other host institutions where that research is taking place will take an active role in the commercialization and the commercial benefits of that commercialization.

Mr. Monte Solberg: But you're not asking us, obviously, for the ability to do that.

Dr. Alan Bernstein: No, I'm not.

Mr. Monte Solberg: Is there a reason for that?

Mr. Monte Solberg: Okay. I have a question for Mr. Forbes, following up on a question from my colleague in the NDP.

The success you've had with the discovery in Edmonton, how did that actually come about? This is really tied to Bill C-13? Was that as a result of research with stem cells?

Mr. Ron Forbes: No, it wasn't. I think Dr. Bernstein may be able to answer that more efficiently than I can, because he is a researcher, I'm not. But that was not part of the issue.

The Chair: For clarification, you might give your credentials on stem cell research, because a lot of this committee don't know them.

Dr. Alan Bernstein: The first thing I'll say is that the way it came about was first as a great partnership between JDRF and CIHR, a funding partnership. Second, I think this committee should be interested in knowing that with JDRF in New York and the NIH in the United States--and I sit on their senior advisory board--all the millions Mr. Forbes alluded to in his presentation that they are seeking to invest in type 1 diabetes will go into “ways of improving the Edmonton protocol”. It really is a breakthrough discovery. It's really the single most important advance in type 1 diabetes that has happened right here in this country, in Alberta.

Two talented individuals, Dr. Shapiro, a transplant surgeon, and Ray Rajotte, an immunologist/cell biologist, got together and said, we're going to lick this problem somehow. Using support from our two agencies, they developed a protocol dealing with the transplant rejection issue when one takes tissue from one individual and transplants it into another. So they took a very simple idea: if the reason kids have type 1 diabetes is that their insulin-producing islet cells are being destroyed, let's put new ones in to cure that disease. And the source of the new ones is not stem cells at the moment, but cadavers. As Mr. Forbes said, cadavers are in very short supply, and so the number of individuals who have benefited from the development of this protocol is extremely small, and it's a small subset of a number of people who could benefit if we had a more ready source, whatever that may be, of insulin-producing islet cells.

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Mr. Monte Solberg: Okay, thank you.

Mr. Smit, you made reference to the FCC. Essentially, you're saying they're picking the low-hanging fruit. They're really moving into areas that traditionally have been serviced by credit unions, and probably banks. Is that the essence of what you're saying?

Mr. Monte Solberg: Can you give me a sense of how big a problem this is? What is the size of the FCC portfolio in these non-traditional areas?

Ms. Joanne De Laurentiis (President and Chief Executive Officer, Credit Union Central of Canada): It's growing. We don't have an actual number for you, but the sense we're getting from our members is that it's more an issue in the Prairies than it is in other parts of the country. We want to raise it as an area where a little more research should be done. As Mr. Smit says, we think there is certainly value in a complementary role, but there has to be consideration of the extent to which they're going to move into more of a private sector role compared to the extent to which they are there supporting the industry.

Mr. Monte Solberg: Thank you. I have to run, but thanks very much for your presentations.

The Chair: Thank you very much.

Now we'll go to Mr. Valeri, followed by Ms. Minna.

Mr. Tony Valeri (Stoney Creek, Lib.): Thank you very much, Madam Chair.

I want to start off with the Canadian Institutes for Health Research, and first acknowledge McMaster University, the great work they've been doing. Certainly we need to ensure that we continue to fund these types of activities in a very stable manner. We are, essentially, behind the United States in investment research. We're certainly behind the U.K. as well. This committee has consistently supported stable funding for further research. I don't believe we've done so in the past, but I think the committee in this report might want to entertain putting out 1% of health spending as our ultimate target and maybe build a framework around that, so that we can keep government's feet to the fire with where we want to go on this particular issue.

A couple of specific questions have to do with the actual amount of funding that's being requested now. In your presentation you suggest that “without a budget increase in 2004, the amount of uncommitted funds available to support new research will drop by 40%, from $171 million in 2003-2004 to $100 million in 2004-2005.” When I look at the chart in your deck—it doesn't have a page number—“Resources Required to Sustain Support for Health Research”, a bar graph indicates you're going from $171 million to $180 million in uncommitted funds, with the budget increment from $55 million to $130 million. I just want to make sure I understand what's actually happening.

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Dr. Alan Bernstein: I appreciate your pointing that out. Let me try to walk the committee through this; it's a bit complicated.

If you look in the graph at, for example, 2003-04, in blue we have $171 million in uncommitted funds. That is made up from three sources of funding. One is the green, which is the $55 million increase we got from Parliament this year. Second is the rollover of funds we committed five years ago from the old Medical Research Council. Third, we do have some small programs that are one-year programs. For example, many of our commercialization programs are one-year programs. If you go to 2004-05, that $130 million at the moment is fictitious; we have no guarantee of any increase from Parliament. That's what we're asking for, if you will. What we can count on for sure is about $50 million, and that $50 million is made up entirely of the rollover from five years ago from the old Medical Research Council. We will find another $50 million—that's how we got to the $100 million, Mr. Valeri—from one-year programs and the 5% clawback we've announced already to the research community, so that we dampen this whipsawing effect from year to year.

Is that clear?

Mr. Tony Valeri: That's much clearer. Thank you.

The other question I have is to the Juvenile Diabetes Research Foundation. You're asking for an additional $25 million per year directed to research in type 1 diabetes. Is that $25 million money we would incorporate and allocate to CIHR or separate from that? In your presentation you talk about $25 million of additional research money, but then you also talk about increased funding for CIHR. Would we satisfy your request for $25 million if we actually rolled it into CIHR and directed it?

Mr. Ron Forbes: Yes.

Mr. Tony Valeri: Then we'll ask Dr. Bernstein whether we can direct it, and he'll agree with that.

Mr. Ron Forbes: The Juvenile Diabetes Research Foundation is not interested in discovery unless it actually leads to a cure. So even with the NIH funding in the U.S., the JDRF is playing a major role in trying to direct those funds to specific research, where there are results, there's accountability, and there's not a black hole of research dollars going in. From our standpoint, who has the money is not relevant, as long as it goes in the direction that gets us to a cure. We would work very closely with Dr. Bernstein and his people, if this was granted, to make sure that money was directed to type 1 diabetes.

Mr. Tony Valeri: Do you have anything to add, Doctor?

Dr. Alan Bernstein: The graph before the graph you referred to, Mr. Valeri, is an interesting one. It speaks in a broader sense to the point you've just discussed with Mr. Forbes. It's what we've called the funding gap. To me, these are lost opportunities for Canada, including some in type 1 diabetes. These are grants that were ranked by peer review committees as very good to excellent, but we did not have the resources to fund, including some in type 1 diabetes, in cardiovascular disease, in prevention research, right across the board. Many of these relate to young people who've just been hired by universities and hospitals with CFI money, for example, who are doing very good research. I don't want to leave this committee with the impression that they're not doing very good to excellent research. You'll also notice the numbers have gone up two and a half times. The number of young people and others in this country who were ranked by peer review as very good to excellent, but whom we could not fund, has gone from about 199 to about 500 as of March 2003, the most recent data I have. To me, that's a waste of human capital, particularly when we're investing tens of millions in the buildings they are now sitting in.

I guess my point here relative to type 1 diabetes is that there is untapped human capital, scientific knowledge, out there that we are not able to fund because of a lack of resources.

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Mr. Tony Valeri: Okay.

The other question I have for you, Dr. Bernstein, and I'm not sure whether we'll be able to get an answer on this, has to do with the commercialization side of it and the partnership side of it. I've heard of a number of instances where teaching hospitals or research facilities are doing work in various areas and have put in place partnerships with manufacturers, not necessarily of pharmaceutical products, but perhaps of diagnostic technology. I'm hearing that while the research is going on and the research is now at a point where there is an opportunity to commercialize it, we're running into delay in approvals or some of the regulatory burden. I'm wondering whether CIHR does any advocacy work or any research work at all into the impact this might have in preventing these types of private sector partnerships in Canada. I'm certainly a big supporter of stable funding to attract and retain talented people and brand Canada as the place for research. I'm wondering whether you could speak to the other side of that equation at all, with respect to how well we're doing as a result of some regulatory impediments we may face.

Dr. Alan Bernstein: You'll be aware that Health Canada is looking at developing so-called smart regulations that will balance the obvious need to protect the health of Canadians with the opportunities to commercialize discoveries made here in Canada, and also to make available to Canadians the latest drugs and other treatments they want. That's the most important thing I can say.

The second thing I would say is, no, we are not doing any advocacy work; that is certainly not our role. We are in close discussion with Health Canada about all aspects of research involving human subjects, whether it's a regulation of new drugs or the ethical issues with clinical trials involving humans—we have a very tight ethical regime on that sort of thing. We certainly provide a perspective to Health Canada and other government officials about the importance of having smart regulations that balance those two issues.

Mr. Tony Valeri: Okay.

To the Credit Union Central, in your presentation you talk about the importance of maintaining a strong financial commitment, fiscal balance, and you talk about the debt. Has your group given any thought to whether there should be debt targets or a range? Have you given any thought to the timeframe? I understand what you're saying, but have you taken it a step further and come up with a framework government might pursue in reducing its debt? Is it a percentage of GDP, and if it is, what timeframe do you see? With the deficit, our initial target was 3%, and then we had a plan in place to get it to zero. Have you given any thought to that?

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Ms. Joanne De Laurentiis: No, we have not, Mr. Valeri. We don't normally do primary economic research. Our comments really are a result of the consultations we've done with our members locally. The clear anecdotal evidence, in the absence of empirical evidence, is that debt reduction has a very important stimulant result. We leave it up to the economic analysts to determine whether there's an appropriate formula.

Mr. Tony Valeri: So a statement that we continue to reduce the debt, essentially, is what you're hearing from your community group?

Ms. Joanne De Laurentiis: Exactly. There is certainly a beneficial result in lower interest rates, making mortgages more affordable, allowing the expansion of operations. These are all very beneficial results in the communities.

Mr. Tony Valeri: Thank you.

The Chair: Maria Minna.

The Honorable Maria Minna (Beaches—East York, Lib.): Thank you, Madam Chair.

I want to start with Dr. Bernstein. In your presentation you talk about developing a balanced research agenda, and I heard the answer that you gave to our colleague earlier with respect to behavioural change and so on. You can do research in behavioural change, but one of the questions I have concerns the extent to which you have the ability then to communicate and educate the public.

Are you working closely with other government departments or entities that have that ability, or is it not happening to the extent that you would like to see it happening? It's nice to do the research and to say this behavioural change is what would make matters better, but I suspect you don't have the dollars or the capability to do the follow-up after you've done the research. Research is great, knowledge is great, but if you don't make it happen, it's kind of in a vacuum.

Dr. Alan Bernstein: This is a very interesting area. We have an Institute of Population and Public Health, led by Dr. John Frank at the University of Toronto, one of our 13 institutes, and behavioural change and prevention are very much part of his own research interests. So we're moving into this area. I think our main contribution to this will be how we evaluate the success or failure of various interventions, putting on cigarette packages labels that cigarette smoking is bad for your health, etc., and whether we can pilot on a small scale new ways of intervention. I'll give you one example.

With various addictions, whether it's tobacco, gambling, or alcohol, we have tended to think of them historically as your responsibility: you shouldn't be smoking, you shouldn't be gambling, you shouldn't be drinking. But I think there is increasing scientific evidence that some of us are more genetically prone to addictive behaviour than others and perhaps this is an illness like anything else. Maybe a more effective way of changing behaviour is to recognize it as something you're born with and working with. So our tobacco initiative is in part going to focus on the neurophysiology of addiction and the genetics of addiction and how we work with people who are at risk of showing addictive behaviour.

Further, we will be launching over the next few years, if our budget allows it, a major outreach program to young kids on the importance of science and technology. One of the expected benefits from that will be that if young kids see the importance of science and evidence, they will come to their own conclusions about smoking, for example, or other kinds or risk-taking behaviour.

In the end, I don't think we know enough yet about what makes people make decisions about things, and so I think our role is to do the research on that, as opposed to actually running the programs, except perhaps in a pilot sense.

Hon. Maria Minna: That was my question, actually. The programs themselves obviously need to find partners, someone else to pick up the work.

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Dr. Alan Bernstein: As I said in my presentation, we'll be announcing in the next few months a major program with a major partner, a national program on changing behaviour in a certain area. Our role there will not be to pay for the actual activity but to evaluate it. This is a private sector partner.

Hon. Maria Minna: When you're talking about improving the health and state of the vulnerable populations, we've talked about this before, and I just wondered how that's coming. Are you also looking at populations beyond average Canadians, immigrant groups or other cultural or racial groups as to their specific health needs?

Dr. Alan Bernstein: The short answer is yes. Dr. Miriam Stewart from Edmonton is the scientific director of our Institute of Gender and Health, and she is championing that whole initiative. We just had a meeting here in Ottawa a week or two ago. Minister McLellan was there talking about vulnerable populations in low-income countries, particularly women who are subject to violence. We are, in partnership with the homeless secretariat, funding a research initiative now on the homeless. We're funding a big project in Dalhousie University on violence against black women. So there is a spectrum of activities that's embraced in number 4 in our blueprint document.

Hon. Maria Minna: I'm glad to hear that. It's not that long ago that we were pushing for multicultural health and couldn't get it through. I'm only talking 10 years ago. This is great.

I just have one more quick question for you before I go on to the credit unions, and that has to do with type 1 juvenile diabetes. Earlier, Dr. Bernstein, you said cadavers were not in great supply, but would stem cells provide a ready supply, and would education for tissue transplantation in the country also be of help?

Dr. Alan Bernstein: If we could convince stem cells to start making insulin, they would be in ready supply. At the moment the basic science question has still not been addressed: how do we convince either an adult or an embryonic stem cell to think it's an islet cell that is supposed to be making insulin? So we're funding a lot of the fundamental research on the molecular genetic controls that actually allow the cells to make those kinds of decisions. Once we understand that, we can kind of tickle them, I hope, to convince themselves they should become insulin-producing islet cells, and then we would have almost an infinite supply of those cells.

I'll let my colleague address the matter of cadavers.

Mr. Ron Forbes: The government in fact launched an organ donor campaign two years ago, and we were very much involved in that. I think people accept that as a good thing, but to get people to actually donate is a major task, an uphill battle, because of the amount of money you need. In fact, the government did spend quite a lot of money in all the advertising when this first was launched, but the results have been no improvement on what they were before.

Hon. Maria Minna: I was on the health committee when the whole issue of organ and tissue transplantation was analysed, and one of the things we found that was fundamental wasn't so much communication in the generic sense, but the education, educating health systems at the appropriate time on how to approach people, have a team ready, and all of that. It's much more focused than a general communication package, although it's helpful to raise the awareness. In this case it would save the lives of a lot of children, so it would definitely be something to look into.

Mr. Ron Forbes: There's one more point on that. The present results we're getting with transplantation, getting the islets—this is diabetes specifically—show that less than 30% of a pancreas can actually be used, and even with the 30% that's transplanted, there's loss in between. It's a very delicate cell that scientists are working with now to see how they can strengthen it, if that's the right term. To get to the stage we want to, I think we'd need a combination of organ donations and other forms.

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Hon. Maria Minna: Thank you.

I want to go again to debt reduction. My colleague already asked the question with respect to whether you were looking at a range. My understanding is that the major reason we've gone from 75% to 40% is economic growth, not the actual dollars we've applied to the debt. So while you're talking about debt cuts and not tax cuts and not anything else, would it not be fair to say that investment, such as in research, high technology, and other areas, which would make our economy much more resilient and strong in all aspects, is actually more effective in achieving the GDP levels you want to have, as opposed to saying that cut does help, but it's not the primary fuel that actually brought the ratio down? You seem to focus only on the debt cut and not on the economic, innovative, technology stimulation spending.

Mr. Jack Smit: It is certainly a combination of factors. I think it's not just one or the other. Economy recovery is certainly part of it. One of our major points is that we've had economic growth, and should we get into economic shock or recession—and inevitably that is going to happen, as economies go in cycles—we should be prepared for that and not get into a situation where our ratio of debt to GDP goes up, and then we are forced to cut spending and forced to increase taxes in order to finance that. We want to prevent that cycle.

Hon. Maria Minna: I like to believe that one of the ways to minimize the amount of recession one goes into--the last one was the one of the worst we've ever been into--is to ensure that we continue to have the kinds of investments that will strengthen all of our economic outputs and productivity. Because we were practically at zero in this country, we were down in everything. If there is a downturn of the economy, we should minimize it, so that it might be very slight, as opposed to very deep. I'm just saying that we need to address both sides to ensure that we don't get into as deep a recession as we had the last time ever again. I think it's possible to minimize by making sure we make the right kinds of investments.

Thank you.

The Chair: Thank you to all of our presenters, on behalf of all the members here and those in the House who will also have your brief. Thank you very much.

The meeting is adjourned until 12:30.