HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, December 9, 1997

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[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): I call the meeting to order.

Good morning, everybody. This is the eleventh meeting of the Standing Committee on Health.

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We welcome the representatives from the department. It looks as though we have a lot of you here. Maybe Mrs. Jean could introduce all the people in front of her.

We'll follow the normal procedure. Perhaps you could keep your answers fairly short and precise, because all the members have questions they want answered and they feel you're using their time if you just go on and on. Some of the members might do the same thing, but that's their time. If they want to use up their time with a question, that's okay, but we'd like you to keep your answers as short as possible.

Madam Jean.

[Translation]

Mrs. Michèle S. Jean (Deputy Minister, Department of Health): Thank you very much, Madam Chair. I will introduce the people sitting at the table with me.

[English]

With me is Ian Potter, ADM, Health Promotion and Programs Branch; Paul Cochrane, who has already appeared in front of you, ADM, Medical Services Branch; Guy Bujold, a DG for federal-provincial affairs; Alan Nymark, my associate deputy minister; Joe Losos, ADM, Health Protection Branch; and D. Dann Michols, DG, Health Protection Branch.

[Translation]

I am very pleased to appear again today to answer your questions. From now on, it will always be a pleasure for us to accommodate you and appear before you as we develop our program.

Last night, minister Rock talked about the health portfolio.

[English]

Today I want to set out Health Canada's priorities very briefly. Then we can answer questions and explain to you how we have organized ourselves to manage and address those priorities over the coming months and years.

I will review for you the five business lines. As you know, following program review of the new expenditure management plan, departments were asked to organize themselves along different business lines. That's what we've done. That is the strategic basis of our work. It helps us to identify some specific things we want to achieve.

Before I do that I want to briefly remind you of the scope of Health Canada's budgetary spending. For the fiscal year 1997-98 our budgetary expenditure amounts to more than $1.5 billion. Over $1 billion of this amount, approximately two-thirds, is allocated to the Indian and northern health services activity, and more than half of that is for non-insured health benefits, as I think you know, for registered Indians, recognized Inuit or Labrador Innu.

There can be no doubt that the environment in which we work is dynamic and constantly changing,

[Translation]

and that environment affects all Canadians, our families, our children, our aging parents, etc.

[English]

We are very conscious of this changing context in Canada.

As we approach a new millennium it is quite clear to politicians, bureaucrats, non-governmental organizations and Canadian taxpayers that if we as a country are to successfully meet the challenges in health we must work together. At Health Canada we are directing more of our efforts toward a consensus-based approach, one that is open to new ideas and is transparent and inclusive.

The recent decision by Mr. Rock to ask your committee to examine the issue of herbal remedies is one example of how Canadians can be involved in issues that affect them directly. We look forward to your consultation with Canadians and to your advice on this issue.

[Translation]

In the department, we have several examples of partnerships set up during the last months or last year. This includes our work with the provinces in order to establish the Canadian Blood Service, the new agency that will take care of the blood supply, and the recent creation of five work groups with the provinces in order to review the future of several actions that are related to the health system, not only the medical aspect of it, but also health in a broader sense. As I often say, health does not only mean sickness.

[English]

We are also expanding our cooperative work with other partners, including the private sector and non-governmental organizations. Our work on HIV/AIDS and our Community Action Program for Children are good examples of productive community-based partnerships, plus the recent establishment of the Science Advisory Board and the committee on blood safety.

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I quickly want to go over the priorities for the five business lines. The five strategic areas of activity are: first, to ensure the long-term sustainability of a health system that has significant national character; second, to promote a public health approach to health that takes into account the importance of, and recognizes, linkages among the determinants of health, which include income, education, housing and so on; third, to anticipate, prevent and respond to health risks; fourth, to assist aboriginal communities reach a level of health comparable to that of non-aboriginal Canadians; and fifth, to foster strategic and evidence-based decision-making in Health Canada and to promote evidence-based decision-making in the Canadian health system, by Canadians.

There are a couple of things related to those five business lines around the health system's support and renewal.

[Translation]

You could see that the minister emphasizes maintaining the confidence of Canadians in the health system. In order to do so, we are working in close cooperation with the provinces on several issues.

[English]

Our work has been guided in large measure by the recommendation of the National Forum on Health. Following the forum in the last budget, some of its recommendations were funded, including the health transition fund, the health information strategy, and the augmentation of the CAPC budget by $100 million over three years. Those are the basic directions the forum gave us.

As well, there's the idea of working on pharmacare and homecare programs. This is a more long-term agenda, but we are talking about this with the provinces and are putting in place some projects under the health transition fund.

On promotion and population, I think for Canada this is a long-term agenda. Twenty-five years ago Marc Lalonde introduced the concept of population health. We are now, with the provinces, again trying to put in place some strategy that will show, as I said at the beginning, that health is not only being sick. We'll work on the determinants-of-health approach. So we have redone our framework in the government based on population health and on three streams—children and youth, middle life, and aging.

On population health, then, for the next three to five years we want to work basically on children. As you've seen in the estimates, a lot of our budget is going there. We want to encourage healthy behaviour. We want to promote better understanding of the determinants of health. We want also to promote and measure the success of intersectoral action for health.

On the management of risks to health, as you know, our mandate within the risk management business line is to protect Canadians against current or emerging health risks posed by disease, food, water, drugs, medical devices, products and environment. This work involves a range of activity, from setting policies and standards to national health surveillance, which includes disease surveillance, health information networks, etc.

So you're well aware of some of the changes we are working on and the fact that we will be advised by the Science Advisory Board on most of these issues.

While I will not review all of our risk management activity, our primary focus for the next three years will be to modernize our risk management approach. Like other developed countries, Canada is facing the issue of risk management and public expectation about safety.

I've just visited the European Union and the OECD, where these issues are under active review. We intend to respond to public expectation and work with our stakeholders in Canada and in other countries to develop a modern risk management approach and surveillance strategy.

On aboriginal health, you've already met with Paul Cochrane, the ADM. I think he explained to you what we're trying to do—work closely with aboriginal communities and people to address health inequalities and disease threats, and to assist those communities in attaining a level of health comparable to that of other Canadians.

You're also aware that there was a chapter in the AG report that dealt with first nations. While the chapter was wide-ranging in its approach, most of the public attention has been on the concerns about prescription drug misuse.

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In response, Health Canada has developed a multi-pronged approach to deal with the issue. It includes point-of-service adjudication implemented nationally by the end of this year, a new claim-processing system that will be in place in July 1998, and raising awareness among first nations leadership of community-based prevention programs.

[Translation]

I will end with the last line of business of the department which deals with the regulations, planning and information. In that area, we want to insist on the development of an information strategy with the provinces which will take into account new technologies, either to collect data, or for telemedicine or for the information of consumers, through the Internet for instance.

[English]

The minister announced the creation of the Advisory Council on Health Info-Structure in August. Its initial focus is on a national health surveillance system, a population health clearing house, and a first nations health information system. Alan Nymark, with Tom Noseworthy, is co-chairing this advisory committee.

[Translation]

Finally, I would like to thank you again for giving me the opportunity to come here. We have a very busy agenda and we are waiting for your comments and questions. We would be happy to appear again before you if necessary.

[English]

The Chair: Thank you very much, Madam Jean.

We'll start with Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you all for being present.

I would like to start by directing my first question to Dr. Losos.

The issue of a particular employee in the department who had her file retrieved without her written permission is one that concerns me. I would like to know from your own personal standpoint if you think that was a reasonable thing to do.

Dr. Joe Losos (Assistant Deputy Minister, Health Protection Branch, Department of Health): Yes, sir, it was. We have concerns in the Health Protection Branch about the level and the classification of a number of senior positions.

Dr. Brill-Edwards was the contestant of a position like that a number of years ago. I also met Dr. Brill-Edwards. She came to voice concerns to me about the bias in the branch, her perception of the bias in the branch in hiring practices, anti-physician bias, and I valued her counsel. I specifically looked at that record to try to find information about that competition several years ago. Finding none, I closed it and returned it. I accessed it purely for staffing reasons.

Mr. Grant Hill: I repeat, without written permission. The guidelines, to my knowledge, say written permission should be obtained.

We'll leave it there. I think you made a mistake by accessing without her permission.

Dr. Joe Losos: I believe, sir, that under the Privacy Act, section 7, I can access personnel records for staffing reasons. That's exactly what I did.

Mr. Grant Hill: Okay. We disagree.

I would also like to ask a question about a study by Health Canada. This wasn't widely publicized. I believe it came from your department. The issue was whether there would be an effect on youth when tobacco prices dropped. It was made public only through Access to Information.

Could you comment on why the department would do such a study? The results did not look positive. The results actually said there would be an increase in adolescent smoking, which has in fact taken place. In fact, in Quebec it's gone from 19% to 38% of our adolescents. This seems to me to be a political intrusion into science, something I disagree with strongly.

Dr. Joe Losos: As I recall, the study, sir, was several years ago. It was done out of the Laboratory Centre for Disease Control, which, as you realize, does a lot of the analysis in and around risk factors for cancer due to smoking, and environment and various others. This was a study done by a postgraduate student, and I believe the study had problems with a quotient.

I'm sorry I don't have the science at my fingertips, but there was an index or a quotient they were to use to gauge some of the pricing. They were out of date in the science behind building that index, so the thing was never accepted for peer review. There was no suppression of the paper.

Mr. Grant Hill: My colleague now.

Mr. Reed Elley (Nanaimo—Cowichan, Ref.): I want to make a statement at the beginning. It's just for the record.

Again, I find this process faulty, because we've already had the estimates tabled, and here we are, talking about the estimates. That's not your problem. That's our committee problem.

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I have a lot of questions—too many to ask at this point—concerning the whole role of Health Canada and our aboriginal peoples. The Auditor General pointed out a lot of concerns he had about the delivery of services and the abuse of the delivery of services when it concerns aboriginal peoples.

There's this gradual process, I understand, of turning over the delivery of services to our aboriginal peoples so they can be involved in it themselves and take care of this themselves. I'm wondering if you have any answers for me in terms of how you feel that process is going.

At the end of the day, with respect to the concerns the Auditor General raised about drug abuse and the abuse of transportation, in your view, will those problems be solved by the aboriginal peoples taking over this concern themselves?

Ms. Michèle Jean: I've worked with aboriginals in many departments as an associate deputy minister with the employment and immigration department and as under-secretary of state in 1993. I think generally speaking, when you empower people to manage their own business, most of the time they get more accountable and responsible. That's what we're trying to do.

We don't just dump and run; we train them. We talk with them. As Paul Cochrane must have told you, we spend a lot of time getting them ready to do that, and I think this is an important component.

As well, those transfers are monitored. Already we're seeing some positive results, like the bands themselves saying where that money should go. We're seeing things like that.

Hopefully it will achieve what you're talking about. Hopefully it will give them the power, the authority, the training and the capacity to manage their own business, and hopefully the accountability will increase and they will be more responsible about how they manage the funds.

If you want more details, Paul can add to that. Or maybe you want to move to something else.

The Chair: Mr. McTeague.

Mr. Dan McTeague (Pickering—Ajax—Uxbridge, Lib.): Thank you, Madam Chair.

I thought perhaps we'd go—

The Chair: I'm sorry, Madam Picard, did you want to ask a question? They didn't indicate—

[Translation]

Mr. Dan McTeague: You can have 10 minutes, Ms. Picard.

[English]

The Chair: Madam Picard, five minutes.

[Translation]

Ms. Pauline Picard (Drummond, BQ): Good morning and welcome.

I'd like to deal with the Medical Research Council. You know that between 1994 and 1998, the budget of the Council was reduced by 13% and that for 1997-98, it has been set at $237.5 million.

On what criteria did we decrease the funding? What impact will those cuts have on the quality of medical research? In your opinion, will the investment in research by the pharmaceutical industry be able to make up for the decrease in federal support? What are the advantages of a public funding for medical research?

Ms. Michèle Jean: The budget of the Council was reduced along with that of the other councils and of all departments. The decrease for the program review has been set, over three years, at 5%, 10% and 15%. So it's more or less 5 plus 5 plus 5.

Of course, the program review was made to streamline resources and eliminate the deficit. And I agree, it's never a pleasant thing to decrease the budgets granted to research. To help the Council, the department itself allocated the Council $1 million for the years when the budget was cut in order to help the Council face such decrease.

As a member ex-officio of the Council, I do not think this affects the quality of research, but this decrease has an impact on the number of research projects funded. This is what Dr. Friesen himself says. We will see what happens in the future.

As to pharmaceutical research—Dr. Friesen is looking into that issue—, the pharmaceutical companies are not far from reaching the target they set for themselves.

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I think that what they are doing is helping research in the universities and the various laboratories where research is done. I think it's a good thing.

Your other question had to do with—

Ms. Pauline Picard: With the advantages of a public funding.

Ms. Michèle Jean: The advantages of a public funding. In all the countries I know, there is a public funding for part of the research made in the medical area and in other areas as well and the private funding is really increasing.

Public funding very often makes it possible to pursue some objectives having to do with longer term policy, etc., and private funding, as you know, often makes it possible to be more targeted. It's absolutely necessary to have a good mix of the two.

Ms. Pauline Picard: Thank you very much.

Do you have a question?

Mr. Maurice Dumas (Argenteuil—Papineau, BQ): Yes.

Ms. Pauline Picard: Can we share our time?

The Chair: You have two minutes.

Mr. Maurice Dumas: That should be enough. First of all, I'm very pleased to greet you, Madam Jean.

Yesterday, I asked the minister about decriminalizing marijuana. Obviously, this is more of an issue for the Justice Department, but I think that nothing can be done without a recommendation from the Department of Health, especially when we consider it as an AIDS therapy.

Could you give us some details on the issue? Could we eventually get to that point, and I don't mean curing AIDS, but alleviating the pain for AIDS sufferers?

Ms. Michèle Jean: Obviously this is a fairly complex issue and I will ask Dr. Losos to give you more details. Presently we do have some medications that alleviate pain and that contain some components which are found in marijuana. But for more details, Dr. Losos might be able to answer.

[English]

Dr. Joe Losos: I'll start by saying the issue is complex. We have looked at it in the Health Protection Branch.

Dann Michols, the director general of the therapeutics program, has had some experience in this. I'll ask him to answer the question.

Mr. Dann Michols (Director, Health Protection Branch, Department of Health): Thank you.

Under the current act and regulations in the Food and Drugs Act, there is no barrier whatsoever to our reviewing evidence that would indicate that marijuana or any other substance has a therapeutic effect. If we determined there was a benefit and could mitigate against the risks, it could be approved as a medicine.

So it really is a separate issue entirely from decriminalizing marijuana or whatever. It can be approved now under the existing legislative framework as a medicine if sufficient proof is submitted to us to make that determination.

[Translation]

Mr. Maurice Dumas: Obviously, this is a plant that is more accessible than morphine or cocaine to alleviate pain. I don't think that it was in that sense that we wanted to decriminalize the substance to be able to use it. You have probably heard about the young man—

The Chair: Your time is up.

Mr. Maurice Dumas: I am sorry.

[English]

The Chair: The next round. Mr. McTeague.

Mr. Dan McTeague: Thank you, Madam Chair.

Dr. Losos, I have a couple of questions relating to the decision undertaken by the Health Protection Branch to close the Bureau of Drug Research. I note several articles from various papers talk about the closure this summer. Other articles say that inside sources suggest there is no moratorium, even though the minister had suggested that $12 million in cuts would not take place.

What type of assessment, review or document did you produce to validate the decommissioning of that very important drug research bureau?

Dr. Joe Losos: The analysis in both the foods program and the drug program vis-à-vis the cuts in basic science was quite intensive and involved peer review of the scientists internally. By way of preface I'd like to say the branch still maintains a very large scientific capacity. We have over 1,300 scientific and professional staff on site in the National Capital Region and across Canada, and 600 of those are on the laboratory side. We have well over 100 medical specialists, medical epidemiologists and the like. So the core of our 2,100-plus employees is very strong in science, and it's a science-based organization.

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So the budget realities were real to us. We decided the only capacity we would be willing to consider giving up was our basic research, which we could get from the academic sector and the huge research complexes in Canada, the United States and abroad.

Mr. Dan McTeague: Was there any study to suggest that was the direction you should take? Do you have any documentation you could provide to this committee that backs up the comments you are making now?

Dr. Joe Losos: Yes. About a year or so ago we had a task force of directors general with outside people, such as Paul Hough from the Canadian Federation of Biological Sciences, who on occasion worked on this with us to analyze our internal capacities and look for overlap, for example, between—

Mr. Dan McTeague: Is this available to the committee?

Dr. Joe Losos: Sure. I'd like to give you more detail on the Bureau of Drug Research specifically, as you asked about that. Would you like more detail on that?

Mr. Dan McTeague: There's that and also the fact that recently we received a list of some twenty or so projects under the food program that were restored after you had decided to cut them.

Dr. Joe Losos: That's correct.

Mr. Dan McTeague: I'm a little puzzled. At first you decided, based on a document, to shut down the food and drugs directorate, the research labs. You then decided to reverse that course. There are too many here to list.

Why did you cut the safety research in the first place only to reintroduce it later on down the road? It wasn't political pressure or anything, was it?

Dr. Joe Losos: No, there wasn't political pressure to cut these, but we certainly have fiscal realities to live under, and we targeted basic research.

Mr. Dan McTeague: Do those realities include having corporations and pharmaceuticals put you in a situation where, through cost recovery, you have to accept a much speedier process for drug approval, which then compromises the safety of the public?

Dr. Joe Losos: If I can go to the cost-recovery question second, the 24 projects were in fact involved in the minister's moratorium on cuts. We welcome that moratorium and are well on the way to re-establishing all 24 of those food safety projects.

Mr. Dan McTeague: In that moratorium.

Dr. Joe Losos: Absolutely.

Mr. Dan McTeague: Then there's no truth to the fact that.... There have been several articles suggesting that the moratorium was being ignored and that plans to cut, to emasculate and to destroy the Health Protection Branch, as far as the safety is concerned, were going full steam ahead.

Dr. Joe Losos: Absolutely. Anybody who says the moratorium is being ignored is not giving you the correct facts. As a matter of fact, through the minister's announcement on the transition program, we are going out of our way to strengthen and make the Health Protection Branch a continuing world leader into the next century.

Mr. Dan McTeague: Dr. Losos, you said to one of the reporters that change is very scary to everyone. You apparently did so under the guise of suggesting that Canada accept the regulatory standards of another country when it comes to drug approvals. This was a way of meeting your cost commitments.

I'm wondering, sir, if you or any of your colleagues would like to explain to us, if we're accepting a standard that is lower, how that improves or helps the safety of Canadians when it comes to the drugs we take. I cite the example of Phen-fen.

Dr. Joe Losos: We don't accept lower standards, sir.

I'll ask Dann Michols to answer the question.

Mr. Dann Michols: The drug review process in Canada is acknowledged by our contemporaries in Britain, the United States, Australia and the rest of Europe as being one of the best in the world. It is a very high international standard that we meet, and others do as well. It's not a case of reducing our standard, it's a case of sharing the workload amongst those who maintain a high standard.

Mr. Dan McTeague: Those countries accept a standard whereby pharmaceuticals tell them what's important and what's safe.

The Chair: Next time around, Dan.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Let me carry on from where Dan left off and get right to the whole question of the drug research bureau, which was officially eliminated entirely in July of this year.

What was the reason for its elimination? It was the only independent bureau we had in this country for assessing the impact of drugs once they were on the market vis-à-vis their interaction with other drugs, their interaction with other foods and their interaction with environmental toxins.

How much money did we save by the closure of this drug research bureau? How can the functions be picked up, as the minister said in the media in response to this issue, by the drug companies themselves, the universities, which are underfunded as it is and more and more tied in with the big brand-name drug companies, and three external agencies?

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Dr. Joe Losos: Ma'am, if you don't mind, I'll ask Dann Michols to answer.

Mr. Dann Michols: Thank you for the opportunity to clarify the circumstances around the closure of the Bureau of Drug Research.

Within the therapeutic products program there are now on the order of 750 people responsible for the regulation of drugs and medical devices. About 550 of them have senior science degrees or medical qualifications. After the closure of the Bureau of Drug Research, there are still about 150 involved in laboratory activity.

We had, when we were reviewing the organizational structure of the therapeutic products program, five labs in operation within the program. We made the decision to close one of them and to strengthen the other four accordingly. Only about twelve people left the therapeutic products program as a result of the closure of the Bureau of Drug Research, and they either retired or went into research activities in universities or hospitals.

The decision to close the Bureau of Drug Research was a reorganization of the resources and a setting of priorities, not in any way a weakening of our capacity to review drugs and to follow up post-market. In fact, one of the areas we did strengthen was the pharmaco-vigilance activities within the program because of the necessity to strengthen the review of drugs after they have been approved for the market.

Ms. Judy Wasylycia-Leis: What I'm raising is not simply a question of positions, since as I understand it some have moved into other parts of the Health Protection Branch or the Therapeutic Products Directorate. I'm questioning the fact that we have lost an important function. You have not addressed that issue. In fact, as I understand it, you have lost that capacity to have individuals who are in place to assess drugs once they have met all your standards and they are on the market and something happens, or there's some evidence to suggest a problem is happening in people's health and safety. We've lost the capacity to do research on the impact of that drug on people's health and safety.

One example that concerns me deeply is that we've lost the only reproductive toxicologist in this country as a result of your closure. How is that function and the other functions that were cut being picked up in your department? What is the total sum of money we're talking about? I understand it's $2 million. Is that correct?

Mr. Dann Michols: With the closure of the Bureau of Drug Research, we still have 150 people within the organization who do exactly what it is you have described. They are responsible for answering questions the review scientists have during the examination of a submission and auditing and monitoring the drugs after they are on the market.

Ms. Judy Wasylycia-Leis: But not during the research. You've lost that ability to have scientists in place doing the research to determine problems with a particular drug that's on the market vis-à-vis pregnant women, vis-à-vis any reproductive issues, vis-à-vis interaction with other drugs and other foods. We have lost that capacity. Who is going to do that? Who is going to do the research?

Mr. Dann Michols: The research that was being undertaken by the Bureau of Drug Research was research of a regulatory nature. One person within the Bureau of Drug Research is not a sufficient capacity to be able to undertake research in any particular area. So what we did was analyze where this type of research could be done in other areas, such as universities. We have good relationships with the deans of pharmacy and the deans of medicine to contract out research of that nature, so we can specialize in-house in other particular areas and strengthen those. Those areas tend to have to do with biological drugs, following Krever's recommendations on blood, vaccines, tissues, and organs; areas where the research capacity is not sufficiently developed and an in-house capacity is more important than being able to contract out. What we cut is available elsewhere.

The Chair: Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

The deputy minister referenced the population health approach, and I think you noted Mr. Lalonde's involvement in that. I wonder if you could give specific examples of programs that were altered to reflect this approach.

Second, what health indicators will be influenced most by looking at this approach, and will we see improvement in those areas?

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Ms. Michèle Jean: I would like to take one minute to come back to your question.

We also have the safety valve of the science advisory committee, which will look at all the things we've been doing and give us some guidance and some recommendations.

Just coming back to this trip to Europe, I met with people from about 50 countries. They're faced with most of these issues too. They also see us as one of the leaders in the drug sector. So we're not irresponsible. We are looking at what's going on sur la planète and trying to see what's the best approach and what we can share and what we can do, looking at what others are doing. I think this is important. Those are important questions.

If we go back to Lalonde, what he suggested was a framework looking at more than disease. Health is also related to your income, your education, your housing and things like that. You point out very carefully that you need to have health indicators. When you put money in children or in seniors or in whatever, what are you achieving? What are you producing? What is the impact on health care? Is there a way to assess the savings and things like that? So we have to work on health indicators.

We've already mentioned some of them in the performance report that we've submitted, but this is an area where we want to work with the provinces.

A year and a half ago we issued a report on the health of Canadians, which is the first try at looking at this broad framework. If you read this report—I think that you've been given a copy—you can see that we look at education, we look at all the determinants of health. So health indicators are really important.

It's basically a more holistic approach. First you have to assess where you should put your efforts. One decision we've made following the Fraser Mustard research, following some of the surveillance we're doing, is to put our major efforts into children.

Once you've done that, what do you do? We've tried to design major objectives like parenting, supporting children before they enter school, prenatal programs and so on.

One of the indicators we're working on is called “readiness to learn”. There is anecdotal evidence, and more and more scientific evidence, that if children, even at the prenatal stage, are being taken care of—parents are followed, you have programs like CAPC—when yyy they enter school they are more ready to learn...nutrition and all that stuff.

So population health is a more holistic approach. You look at all the facets of an issue and you try to address all of them.

At the end of the day, when you have good indicators and they tell you that this thing is better than it was, you can move your resources to another area or complement what you've been doing. That's what we mean by population health.

Instead of going disease by disease or by a stovepipe approach, we try to put together the research, the surveillance, the work of the stakeholder and the outcome of some strategies and see where, based on that broad approach, we want to focus our efforts.

Mr. Lynn Myers: Do I have time for another question?

The Chair: We'll come around again.

Ms. Michèle Jean: My answer was long, but it's not easy to explain that.

The Chair: That's all right.

Dr. Losos, could you remember to give us the report you said you would give us?

Dr. Joe Losos: Yes, ma'am.

The Chair: Thank you.

There's a lot of concern about the year 2000, and if our computer systems are up to scratch and are going to be able to cope with it. How has your department approached this? Do you have some strategy? Could you explain the situation you're in? Are you going to be okay when that date comes?

Ms. Michèle Jean: This is a good question. We have a strategy to deal with that. I can ask Bob Lafleur, the ADM of corporate services, to give you more detail on that.

Mr. Robert S. Lafleur (Senior Assistant Deputy Minister, Corporate Services Branch, Department of Health): We started assessing the problem a number of years ago. We now have an extensive program under way. We have the detailed plans of what actions need to be taken. We're about two-thirds through the program of adjusting our computers. That is for our internal capabilities and our linkages within government.

There is another issue, as you no doubt heard, with the survey done by StatsCan regarding the industry at large. Some of that industry is the health industry and the services industries related to that. That's a broader issue for the government, and a task force has been set up to try to press industry to address the problems more quickly.

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The Chair: Thank you. Mr. Elley.

Mr. Reed Elley: Can we understand, then, that the drug testing branch has been reinstated? You were saying that twelve people were reassigned or let go or whatever. I'm wondering how in the world the removal of twelve people would be able to effectively cut your costs down 15%. I find that hard to understand. You might like to expand on that.

Another I question that I have is more specific about the concern I think Canadians have about the drug testing branch. I'm sure it's very high on Canadians' concern list that we be able to trust the products that we are prescribed by our physicians.

I want to deal particularly with the drug Imitrex. My wife is a user of Imitrex, and has been for the last four years, for severe migraine headaches. She has had some side effects from that, and we have been told by some people that the Americans have a lesser dosage than ours. I think it's about half of what we're allowed to take in this country. When that news became public, my wife voluntarily reduced her dosage to half. Her side effects have disappeared.

The concern that comes out of that is that we have the government body telling us that it's okay to take the larger dosage when there are concerns about it. Some deaths have been attributed to Imitrex use. How do you re-establish confidence with the Canadian public when there are such conflicting reports out there on drugs as important as Imitrex?

Mr. Dann Michols: There are two questions there, so let me answer the Bureau of Drug Research question quickly.

There were 68 people within the Bureau of Drug Research, not 12. As a result of the ultimate reallocation of the people, 12 actually left the program. Others were moved to other laboratory operations or to the review function and so on. To go back to it, that resulted in about $2 million worth of savings.

Those savings are partly from the salaries of those who left, as well as the cost to support them. Many of the savings also come from the fact that we do not then have to maintain a laboratory operation, which is a very expensive operation, and we do not then have to upgrade it constantly to the current standards. We are free to take that money and to buy services from outside organizations that have maintained their facilities or have the latest scientific expertise, and we can move that around as is required. It's a much more flexible approach to getting the research we need.

Mr. Reed Elley: Before you answer the question on Imitrex, I might say that when my wife decreased her dosage to half, she got the same results as she did when she took the full amount in terms of taking away the symptoms of the headache, but with reduced side effects.

Mr. Dann Michols: I'm delighted to hear that.

I guess the general response to your question is that when a manufacturer comes in with a particular product, we review all of the test data, the claims the manufacturer wants to make, the dosages that were used in the clinical trials, and so on. We then make a range of decisions as to what should and shouldn't be allowed, in order to attempt to generally control the risk of the particular product. Obviously, all the products that are on the market have benefits or they wouldn't be on the market, but there are also risks that accompany those various products. Obviously, you cannot fine tune the regulations to each individual.

The first general decision is to say that this drug is only available under prescription status as opposed to over the counter, which brings in the element of a medical doctor controlling, if you like, the actual application of a particular drug to a particular patient. Because the circumstances of that individual—other drugs that he or she may be taking, the lifestyle of the individual, or even the diet of the individual—will have an impact on that particular product's operation within the individual, it is left to a medical doctor.

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We have said the drug is generally effective for the claims that the manufacturer is making. We've set upper limits on dosage, perhaps, but then, because it is prescription, it falls to the medical officer to say: “In your case, given your situation, this dosage would be more appropriate”, or whatever, and to actually titrate that dosage for the particular individual.

The Chair: Mr. Drouin.

[Translation]

Mr. Claude Drouin (Beauce, Lib.): Madam deputy minister, in your opening remarks, you talked about the new Canadian Blood Service. We can see clearly that the government of Quebec wanted its own agency to be distinct. As for costs and services, will the service to the public be as good? Could you tell us if it's going to be at the same price and if it's going to be as safe? Will it not be a duplication?

Ms. Michèle Jean: The Krever report recommends a national agency, and only one. So we can really raise the kind of question you are asking.

As for costs, I could not tell you, but I can say that minister Rochon always indicated he would have a business relation with the new Canadian Blood Service and that he would be meeting all the standards set by the regulatory body, namely the Department of Health.

Minister Rochon also indicated that we reserved three seats for Quebec at the transition bureau. So far, they have agreed to send one person. We are in close contact with Quebec to see if they want to change on that issue.

The questions you are asking are obviously relevant.

We buy products collectively, it costs less than if we buy them through 12 different kinds of purchases. So questions will have to be answered, assessed, but we have the needed channels of communication with Quebec to examine them.

Mr. Claude Drouin: If I have some time left, I can give it to Dan.

[English]

The Chair: Go ahead.

Mr. Dan McTeague: I have a very simple question.

Mr. Michols, when you were responding to Judy Wasylycia-Leis' remarks—and I may not have been listening as attentively as I should have—I believe you attributed comments of Justice Krever with respect to supporting the notion of contracting out.

Mr. Dann Michols: No. I hope I didn't. My comment vis-à-vis Justice Krever and his recommendations was that he has made a number of recommendations vis-à-vis blood and blood products and biologics and the regulator, and that is one of the areas we have strengthened in-house capacity to deal with. That was my—

Mr. Dan McTeague: But if you're making the analogy between what Mr. Krever has recommended and what you are doing, which is contracting out, I have severe problems with that, and I think Justice Krever would as well. That's the problem that got us into this pickle in the first place, by trying to suggest that somehow we should go to the outside in order to formulate our problems.

My question, however, is based on the recognition of the mandate of the Canadian Food Inspection Agency. It says in the preamble that the creation of this agency is to improve food inspection and to promote trade and commerce.

Sir, do you not find those two mutually exclusive and incompatible, and that it puts your food inspection people in a very awkward situation? Is it one or the other?

Ms. Michèle Jean: The Food Inspection Agency has that in its preamble. As the minister said yesterday, at Health Canada the food inspection is reporting to the agriculture minister. But in Health Canada we are setting the standard, the policy. We are auditing and we are doing some of the research. So again, from a safety point of view, we will be there to establish a standard, a general policy, and we will be there also to audit the agency. So I think this separation from policy standards to the action on the ground—

Mr. Dan McTeague: How do you get scientists to promote trade and commerce when their obvious interest is to protect the interest and safety of consumers?

Ms. Michèle Jean: Everybody wants to protect safety. We all live in Canada—

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Mr. Dan McTeague: Yes, but they are scientists. They don't know anything about promoting trade. How could you put them in a situation where they have to do something that is not part of their mandate, under the guise of cost recovery?

Ms. Michèle Jean: Those questions should go to Agriculture Canada. Ourselves, we are in the safety business.

Mr. Dan McTeague: No, I think they should go to you. You're here today. If I want to go to Agriculture and ask the questions.... It was your department that created this situation.

I'd like an answer to that question, Madam Chair.

The Chair: I think she's already answered it.

Do you have a further answer?

Ms. Michèle Jean: I've already answered it.

Mr. Dan McTeague: I'll have to come back and do another one.

[Translation]

Ms. Pauline Picard: Madam Jean, during the Budget Speech, in March 1996, the government announced the creation of a fund for health services research. We were supposed to allocate $65 million over five years, $15 million of which were supposed to come from Health Canada and from the Research Council.

I'd like to know the financial contribution of Health Canada to that research fund. Has funding been allocated to it for 1996-97 or 1997-98 and, if so, what research areas do you favour? If some funding has already been allocated, to which researchers and organizations has it been given up to now and why do we not have that information in the Estimates?

Ms. Michèle Jean: The Health Services Research Foundation has been established. It is now at arms length with the government. It is chaired by Arnold Naimark who has started working for the organization and is now asking for projects submissions. Therefore, no funding has yet been allocated to it.

Now the money has been transferred. Those $65 million over five years, $10 million of which are new funding given to us by the government which we are giving to the Foundation. One million dollars per year come from the Health Department itself, that's another $5 million, and $2 million per year from the Medical Research Council. That is $10 more million over five years. This is how you arrive at $65 million.

Brochures and an action plan are available and I could forward them to you. Michel Bureau, director of FRSQ, the Fonds de la recherche en santé du Québec, sits on the board of directors. Workshops have been held with the researchers to know what there needs are and what research areas should be funded.

Part of the work is being done in close cooperation with some universities, the Fonds de la recherche en santé du Québec and de department.

We are now asking for letters of intention and the funding of the projects will be forthcoming during the year.

Ms. Pauline Picard: Do I have any time left?

[English]

The Vice-Chair (Elinor Caplan (Thornhill, Lib.)): You have actually about one minute.

[Translation]

Ms. Pauline Picard: I just wanted to know what happened to Canada's Drug Strategy. Is the government still funding the Canadian Centre for substance abuse?

Ms. Michèle Jean: Yes. The Canadian Centre is still being funded.

[English]

Is it $500,000 per year, Ian, for the Canadian Centre for Substance Abuse?

Mr. Ian Potter (Assistant Deputy Minister, Health Promotion and Programs Branch, Department of Health): It's $500,000 base, plus, say, $300,000 in addition for the support of their substance abuse clearing house.

[Translation]

Ms. Michèle Jean: The Drug Strategy was a program with a sunset clause, a program that was being ended. But within our various functions, we have integrated a number of the objectives pursued by the strategy, just as did the Justice Department and the Department of the Solicitor General.

For more details

[English]

about what we're doing on drugs and things like that, Ian, you might want to add that.

Mr. Ian Potter: Yes, I could.

We are continuing to manage a program called the Alcohol, Drug and Treatment Rehabilitation Program, a $15.5 million program of which $14 million is distributed to provincial governments to support initiatives they undertake.

It also provides information on gathering information about alcohol and drug treatment services.

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Examples of how that money is used includes support for Saskatchewan's white spruce treatment centre, Canada's first stand-alone treatment centre dedicated to youth. It's an in-patient alcohol and drug treatment facility. It takes referrals for children between 12 and 20 years of age.

We continue to provide program coordination and prevention information. We gather information on best practices and share that with other provinces and agencies. We continue to develop substance abuse educational materials. We work with the non-profit sector in encouraging the development and use of those materials.

[Translation]

Ms. Pauline Picard: What is the cost of funding your programs?

[English]

Mr. Ian Potter: It's $15.5 million a year.

The Vice-Chair (Ms. Elinor Caplan): Mr. Myers.

Mr. Lynn Myers: Thank you, Madam Chair.

I wonder if perhaps the deputy minister could answer some questions in terms of the monitoring of private clinics and the facility fees charged. Which provinces do this? Where is this a problem? What amounts are being withheld from transfer payments as a result of that? Is that found somewhere in the estimates?

Ms. Michèle Jean: We have the expert with us.

Mr. André Juneau (Assistant Deputy Minister, Policy and Consultation Branch, Department of Health): There are currently three provinces where penalties are still being levied, the provinces of Manitoba, Nova Scotia and Newfoundland. In the case of Nova Scotia and Newfoundland, it has to do with abortion clinics, which are charging facility fees. In the case of Manitoba, there are abortion clinics and also a number of small surgical centres charging facility fees.

We can get you the amounts that are being withheld from the monthly payments to those provinces as soon as the committee may wish it.

The Vice-Chair (Ms. Elinor Caplan): On behalf of the committee, I would ask you to table that in writing. There's a vote on. We're just finding out now what time members have to be in the House to vote. We can probably continue for a few more minutes, if that's okay with everybody.

Mr. Lynn Myers: Madam Chair, a quick supplementary.

With respect to the private hospital in Calgary, how are you monitoring that, or what position do you have with respect to that?

Mr. André Juneau: We are working closely with the Alberta health ministry. As a matter of fact, when the issue of HRG came to the attention of the federal minister, we immediately contacted the Alberta health department to find out what services were being offered at that clinic. Thus far, as I'm sure you've been following in the press, it's quite clear that the dental surgery they're offering and the other minor things they're doing fit within the current definition of a clinic, not a hospital. Indeed, Alberta's College of Physicians and Surgeons took a decision on Friday not to extend the mandate of that facility to overnight stays.

Thus far, the operation of that facility does not cause a problem for us within the context of the Canada Health Act. As I say, we're maintaining this close rapport with the officials in the Alberta health department to ensure that as they try to change their mandate we're aware of it and we can advise the minister accordingly.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much. I've just been informed the vote is at 12.15.

At this time I declare this committee adjourned. We will pick up where we left off at the next meeting.