:
Good afternoon, ladies and gentlemen. I welcome our guests to the committee today.
Before we start, I want to very quickly bring one thing to the committee. Last time we had an extra member from the NDP party who sat down and joined in the questioning. There are rules, and I only want to make you aware of the rules. After the committee meeting yesterday, a couple of people talked to me about the participation of other members in committee meetings. This is what everybody has to be aware of.
In addition to regular committee members, the Standing Orders also provide for associate members. Associate members are eligible to be named to subcommittees and may be designated to act as substitutes for regular members who are unable to attend committee meetings. Of course, that's when we sign the form and they sit in.
Any member of the House may attend committee meetings, question witnesses, and participate in the committee's public proceedings unless the House or the committee concerned orders otherwise, which means it's at the committee's discretion. In other words, someone may sit in, at the discretion of the committee, unless someone objects. In most committees, there is an objection if someone else sits in without permission from the committee itself. These members may move motions, vote, or be part of a quorum only when acting as an officially designated substitute for a permanent committee member.
I only want to make you aware of the rules. We'll be watching to make sure that everybody abides by the rules.
I would now like to welcome all the witnesses today who are coming to join us. We have witnesses from the Office of the Auditor General of Canada. Mr. Neil Maxwell is the assistant auditor general. I welcome you, Mr. Maxwell. It's great to have you here today. Glenn Wheeler, principal, thank you as well for being here. Louise Dubé, principal, I'm so glad you could join us.
From the Department of Health, we also have Karen Dodds, assistant deputy minister of the strategic policy branch. Welcome, Karen. Janice Dyer is the director general of applied research and analysis, strategic policy branch.
We also have the Department of Finance represented here today. Monika Bertrand is the chief, federal-provincial relations division, federal-provincial relations and social policy branch. It's a long title for one person.
I want to welcome you all. We look forward to your presentations today.
The Auditor General's office, the Department of Health, and the Department of Finance each have seven minutes to make a presentation. Following that, we will then go into the rounds of questioning.
Mr. Maxwell, would you be so kind as to begin. Thank you.
:
Madam Chair, thank you for this opportunity to present the results of two chapters in our December 2008 report, a study on federal transfers to the provinces and territories and our audit of Health Canada's reporting on health indicators. With me today, as the chair has mentioned, is Glenn Wheeler, the principal responsible for those two chapters, and Louise Dubé, the principal responsible for our Health Canada audits.
Federal transfers to the provinces and territories make up a significant portion of the federal government's annual spending. They are a major source of funds for services provided to Canadians in areas such as health, post-secondary education, and social assistance. In the 2006-07 fiscal year, the most recent year for which complete information was available to us during the study examination period, these transfers amounted to about $50 billion or just under 23% of federal spending.
Our study looks at the three main types of transfer payments made by the federal government to the provinces and territories. We undertook this study to answer questions that parliamentarians have raised about federal transfers and our mandate to audit. Because this is a study and not an audit, it is descriptive and does not include recommendations.
In this work, we examined the three main mechanisms the federal government uses to transfer funds to the provinces and territories. The first and largest includes four major transfers managed by Finance Canada, including the Canada health and social transfer. The second mechanism involves the transfers of funds by individual federal departments to support specific programs areas. Finally, the third mechanism involves the federal government's transfers of funds to the provinces and territories using trusts managed by Finance Canada.
[Translation]
We found that the nature and extent of conditions attached to federal transfers to the provinces and territories varies significantly. While some transfers have specific conditions that recipients must meet, often including reporting to the federal government on the use of the transferred funds, others are unconditional. In all cases, the federal government is accountable for its decision to use transfers with or without conditions as the best policy choice available in the circumstances. However, as auditors, we recognize that decisions on whether, and to what extent, conditions are attached to transfers are policy decisions, often involving sensitive federal, provincial and territorial negotiations. In our work, we do not question policy decisions.
A significant change in transfer mechanisms used by the federal government was its introduction of trusts in 1999. Since then, 23 trusts have been established to transfer almost $27 billion to the provinces and territories. Transfers of this type are earmarked in public announcements by the federal government for specific purposes (for example, patient wait times guarantees), but there are no conditions that legally obligate provinces and territories to spend the funds for the announced purposes or to report subsequently on that spending to the federal government. As an alternative, federal officials told us that the government has opted in recent trusts to require provinces and territories to publicly announce how they intend to use the funds, on the assumption that their legislative assemblies and citizens will hold them to account for these commitments.
[English]
As mentioned, our December report also contains a chapter on our audit of Health Canada's reporting of health indicators.
The Government of Canada and provincial and territorial governments reached a series of agreements to strengthen and renew Canada's publicly funded health care system. The 2000 health communiqué, the 2003 first ministers accord on health care renewal, and the 2004 first ministers 10-year plan to strengthen health care called for governments to demonstrate accountability through comprehensive and regular reporting to Canadians.
One of the key commitments was for the federal, provincial, and territorial governments to report to the public on comparable health indicators. First ministers saw health care reporting as an important vehicle for enhancing transparency and accountability. All jurisdictions subsequently agreed on a comparable set of health indicators to report on. Public reporting by governments promotes accountability in a number of ways, for example, by allowing Canadians to see the extent to which governments are attaining their goals and objectives.
[Translation]
On behalf of the federal government, Health Canada has responded to commitments in the agreements on health indicator reporting by preparing Healthy Canadians: A Federal Report on Comparable Health Indicators. This report is published every two years, with additions in 2002, 2004, 2006 and one upcoming for 2008.
In our audit, we examined whether Health Canada's reporting on health indicators met the commitments made in the first ministers' health agreements. We also examined whether its reporting has improved over time.
We found that Health Canada met specific health indicator reporting obligations that were required by the agreements—including identifying common indicators for reporting with its provincial and territorial counterparts. The department has produced a health indicators report every two years.
Although Health Canada met the specific commitments to report on health indicators, The Healthy Canadians reports do not fulfill the broader intent of the agreements—that is to provide the information Canadians need on the progress of health care renewal. While the reports provide indicators, such as self-reported wait times for diagnostic services, they do not provide sufficient information to help readers interpret them. There is no discussion of what the indicators say about progress and health renewal. Without interpretation, their ability to inform Canadians is limited.
[English]
We reviewed each edition of Healthy Canadians to see if it had improved over time. We found the presentation of the information in all three editions was essentially the same, with some modest improvements, despite the fact that Health Canada had received feedback through consultations indicating that the information needs were not being fully met through the reports.
Madam Chair, Health Canada agreed with our recommendations and committed to a number of improvements for the 2008 edition, with the remaining action to follow, including a thorough review of its role and its approach to health indicator reporting in 2009. Health Canada needs to clarify its role relative to other health indicator reports produced by the Canadian Institute for Health Information, Statistics Canada, and the chief public health officer. Your committee may wish to ask Health Canada what improvements have been made in the 2008 edition and what plans are in place for subsequent improvement.
Madam Chair, that concludes my opening statement, and we would be very pleased to answer your committee's questions.
:
Thank you. Madam Chair, members, I'm very pleased to have the opportunity to be here with you this afternoon.
[Translation]
I am here to talk about two important aspects of the Auditor General's report—federal funding and reporting, as related to health care.
The federal government has demonstrated its commitment to health care by increasing transfers to provinces and territories, including growing support for health.
[English]
I'd like to set the context for my remarks by noting that we've had a long and productive relationship with the Auditor General. We invited the Office of the Auditor General to audit the first release of Healthy Canadians in 2002, and then again in 2004 and in 2006. In 2008 the Office of the Auditor General decided a more overarching review of health information reporting would be useful. We're pleased that the Auditor General has undertaken this task and has provided to us the very useful feedback that they did in their report.
[Translation]
To clarify, Healthy Canadians is a federal report to all Canadians, on comparable health indicators at a national level.
Each province and territory is committed, in the health accords, to releasing a separate indicator report covering their own jurisdiction, to their own citizens.
[English]
The Auditor General has indicated that Health Canada has met the specific health indicator reporting obligations of the accords. However, it noted there are ways that Healthy Canadians can be improved, and we've taken time to rethink some of those improvements for its next release. In Healthy Canadians 2008, to be released next month, we've taken the Auditor General's recommendations to heart and have made some significant improvements. We have expanded the report's scope by adding 19 new indicators drawn from a list of 70 comparable indicators approved by federal, provincial, and territorial health ministers. This brings the total number of indicators in Healthy Canadians to 37.
For example, on access we've added the proportion of the population that reports having a regular family doctor. We've added wait times for surgery and specialists.
[Translation]
On quality we have added, for example, mortality rate for stroke; mortality rate and readmission rate for acute myocardial infarction.
[English]
On health status and wellness, we've added, for example, life expectancy; infant mortality; low birth weight; and mortality and incidence rates for lung, prostate, breast, and colorectal cancer. We've also added more in-depth interpretation of the data by clearly relating it to accord commitments.
We will have a more proactive communications approach with a media release, posting on the Health Canada website, notification of health professionals, and highlighting of the report in announcements and speeches. For Healthy Canadians 2010 and beyond, we will be providing more data on first nations and Inuit health from the Aboriginal Peoples Survey. We're also working with other federal departments to determine how health data can be collected and reported for federal population groups, including the military and RCMP staff, veterans, refugees and some immigrants, and federal prisoners.
[Translation]
Our minister is very interested in the health status and well-being of Canadians. She is well aware of the indicators and statistics surrounding life expectancy, infant mortality and the prevalence of diabetes in the population. She is very supportive of improvements in reporting on health and the health care system.
[English]
So reporting to Canadians is, and will be, very important, and we'll do our utmost to go further in comparable indicator reporting.
We're here to answer any questions you may have. We look forward to profiting from the Auditor General's observations and the discussion this afternoon.
I'm taken aback by the idea that the 2008 report is due in two days and we're spending two hours on the 2006 report. I hope I can make some questions and comments that will still be useful.
My background is having sat at a cabinet table for four years, wrestling with health spending that was ballooning out of control and gobbling up the budgets of other important ministries, like environment. At the same time, I have lots of constituents who are very concerned about health care and value for money and how we can avoid this continuing to balloon while maintaining a public health care system. I think indicators, measures, and goals and targets are critical to improving things. Just by measuring things, you improve them. There's research on continuous quality improvement.
A quick question I have is to the assistant deputy minister, Ms. Dodds. Given the purpose of the 2006 report—to provide information on comparable health indicators to help federal, provincial, and territorial jurisdictions and health care providers monitor trends and progress toward improving the health of Canadians—do you believe this report does that?
Again, when you go beyond comparable indicators to trends and progress about health care, Health Canada provides up to $10 million every year to the Health Council of Canada. In the accord, the Health Council of Canada was mandated to do the overall reporting on trends and progress from the health accords. That's different and separate from simply the comparable indicator reporting.
We also provide $81 million every year to the Canadian Institute for Health Information. As well, we provide some funds to Statistics Canada. Those two organizations are very important in putting together the data which we then collect and put into Healthy Canadians.
What you see going into Healthy Canadians is just one small part focused on comparable indicators. In terms of the money, as my colleague said, it's three professionals versus several hundred at the Canadian Institute for Health Information and the large staff at Statistics Canada and their health program.
:
Thank you for the question.
[English]
Health Canada, as you've noted, does provide a range of health care programs and services to first nations and Inuit. We don't provide all health care services, and much of the difficulty in collecting data is the fact that we don't provide all services.
We do continue to support the collection of data. We have supported the First Nations Regional Longitudinal Health Survey, which is administered by the Assembly of First Nations. Results from the first cycle of that survey were released in November 2005, and we've committed $12.5 million to support infrastructure, data collection, and dissemination for the next survey, with results expected in 2010. So the frequency with which we get data on the first nations and Inuit people doesn't match our two-year cycle for Healthy Canadians.
We've also contributed $5 million, in collaboration with other departments for a total of $40 million, to fund Statistics Canada's 2006 on- and off-reserve Aboriginal Peoples Survey. That's an omnibus survey that collects information from first nations, Inuit, and Métis on health and social determinants of health indicators. That information was released in December 2008, and we look forward to further studies on that information.
We're an active participant on the federal-provincial-territorial task force on aboriginal health data and indicators, which is overseeing provincial- and territorial-led pilot projects aimed at improving existing aboriginal health data sources.
:
Thank you, Madam Chair.
As we noted in our audit, the department is obviously facing several challenges. This is very difficult work to undertake.
[English]
That is true, and this perhaps gets to the earlier question as well.
There are many challenges. It seemed to us that probably the most important thing for Health Canada to do, both in terms of first nations information and indicators more generally, was a really good job of mapping out all these different forms of reporting, which are done both inside Health Canada and outside, and then try to have a good plan for filling the gaps.
The gaps are as much about aboriginal health as they are about all the other parts of the national picture and the other parts of the federal population. If you look at the veterans, members of the Canadian Forces, and Correctional Service of Canada inmates, there's a number of populations there too where there's very little information.
:
Thank you, Madam Chair.
We've had a chance to skim that report. I believe it was just released yesterday. I have a sense of the Health Council, and of course, we follow its work quite closely in terms of our audit work.
The reason we did this audit goes back to those three health accords. As I said in my opening statement, it's really about the importance of accountability. As we looked at the Healthy Canadians report, what we'd often ask ourselves was, is this a good report card? Does this give you a good sense of what's being accomplished by those many tens of billions of dollars that we've invested in health care in 2000, 2003 and 2004?
As we said in the audit, we found the report—and certainly the 2006 one, which we audited—quite deficient. We really questioned the value of putting it forward, but I would then certainly say that accomplishing this or getting a good report card on health outcomes is clearly something that's important for accountability.
:
Thank you very much, Madam Chair.
I want to thank the witnesses for being here today. When I knew that both of you were coming I was kind of excited, because one of the criticisms I always get as a politician is that people say the right hand doesn't know what the left hand is doing, and it seems that today we have a great opportunity because we have both hands right here in front of us at committee.
I wanted to ask a particular question, and it's directed to Mr. Maxwell.
You mentioned that the 2006 report was quite deficient, and here we have Health Canada in front of us and they've responded with the 2008 report. I thought Madam Dodds did a great presentation here. She's indicated that in Healthy Canadians 2008 they're going to be adding 19 new indicators.
What do you think of that? We have you here in the room now and I think it's a unique situation. Health Canada is saying what they have in this report coming up, but they also outline in 2010 what they would like to do: provide more data for first nations and Inuit health from Aboriginal Peoples Surveys, work with other federal departments, etc. In the spirit of efficiency and accountability, do you have some suggestions or comments for Health Canada proactively? What do you think?
There are several things. One is that, like any good auditor, we would reserve judgment until we can see it--we're from Missouri. Nonetheless, I think that in listening to what Health Canada has said it has done as part of 2008, there's certainly much more change there than we saw in any of the previous editions, and their conclusion was that each of the previous three editions was largely just a repetition of the one that preceded it, with relatively little creativity, relatively little sense of trying to continuously improve. On the face of it, what they have set out to do in 2008 is a step in the right direction.
In response to our recommendations, Health Canada made very clear, as does your question, that this is just an interim step, that there are a number of recommendations we made that they have not attempted to deal with in 2008 and that remain for future years.
Certainly, to your question and to some of the previous questions, I think one of the big unknowns in here is the extent to which the federal government, through its leadership, can bring the provinces back to the table. As Ms. Dodds said, when this all began after the 2000 and 2003 accords, the provinces were on board. Slowly over time the provinces chose to no longer publish comparable indicator reports in the form that was called for under the three accords, leaving just the federal government in that game. Certainly part of the original and continuing logic, the raison d'être of all this, is that Canadians would have the basis to look not just at what the federal government has to say but also at what the provinces have to say. That's the notion of comparable. In the title, “comparable” has a very important meaning, the ability to compare.
:
Thank you, Madam Chair, and thank you to all of you for coming.
I think we admire the goal of Healthy Canadians—anything to increase transparency and accountability. We're all interested in improving the health of Canadians. But I do have some concerns.
First of all, I guess it is national data. I wonder why the data are not disaggregated, because health conditions vary so much from one part of the country to another. I'm wondering what the data are comparable to. If we really wanted to do this, I think we would have a table of the health indicators and then by region and perhaps by vulnerable population.
These are some of the questions. I'm wondering when the 2008 report is due. I understand that a committee has been struck but that they're going to report after the 2008 report. I could be wrong on that. Is there a template for doing this? Is there a province or someone we can point to and say they're doing this well, and can we emulate that?
:
Thank you, Madam Chair.
Thank you very much to the presenters for being here today. Certainly this is an issue of great importance to all of us and of great interest to us.
One thing I would like to return to and perhaps get some comments on from both Mr. Maxwell and Ms. Dodds is the transfers and the accountability and whether or not people have to be accountable for how they spend those transfers. This is the one thing I get the most comments on from residents, the fact that the federal government transfers all of these millions of dollars to the provinces but there is no accountability or no way to hold the provinces accountable for how they spend that money.
It may be determined that this money, when it leaves the federal coffers, is thought to be for a specific purpose, but it may not end up being used totally for that. I think this causes a great deal of concern to Canadians: the fact that we have a federal government, regardless of who that government may be, that is interested in health care and is contributing, and we've made the commitment that we're increasing the health transfers by 6%.... How can we assure people that those health transfers are going to go where they need to be going and that they're going to go where the federal government intends them to go? Is there a mechanism? It's my understanding that there is not a mechanism right now to do that, but is there something we can do once the accords are renewed, or once there is something else negotiated? Is there something we can put in those agreements that would allow for this?
Maybe, Mr. Maxwell, you could respond from your point of view, and Ms. Dodds or Ms. Bertrand, you could respond from yours.
:
Let me start with a general comment on transfers. At the Department of Finance we are responsible for four major transfers. Two of those are unconditional transfers—and they're in support of health, of course, depending on provincial and territorial priorities. There's equalization, which is an unconditional transfer that exists to ensure that provinces can offer comparable levels of services at comparable levels of taxation. Territorial formula financing is a similar transfer that takes into consideration the needs and the costs of the north. These two transfers are unconditional, and provinces use them wherever their most pressing needs are.
Two other transfers, health and social transfers, are conditional transfers. The health transfer provides support to health care systems in provinces and territories, and there is a condition attached to them. It is the Government of Canada's main support for the Canada Health Act, so the condition is related to the five principles in the Canada Health Act and to extra billing and user fees. The social transfer is also a conditional transfer, and the condition attached to it is that there cannot be any minimum residency requirements. Those are the two conditions that guide these two large transfers to provinces and territories.
In terms of accountability, Canada is one of the most decentralized federations in the world. Provinces are free to set their own tax rates and to decide what they're going to tax. With that revenue, the provinces are free to set their own priorities as to what their key policies are and what policy priorities they wish to fund with these revenues. Similarly, with the transfers—the $52 billion that we provide to the provinces and territories—they are fairly free to use these large amounts to meet their own needs and priorities, and they're not obliged to report back to the federal government. In a mature federation, they are obliged or encouraged to report back to their own residents, but not to the federal government. This is how the transfers have evolved over time.
If you go back to when we were looking for national standards, our transfers were cost-sharing transfers, and there was a specific goal and purpose defining why these were cost-sharing transfers and why we expected provinces to report back to the federal government. Starting in 1977, we have pretty much moved away from that principle and towards the principle of public accountability.
This is just how the transfers have evolved and how the federation has evolved.
Thank you for coming today.
In her November 2006 report, the Auditor General concluded that: "Health Canada does not know whether regulatory responsibilities are fully met", with respect to the product safety, drug products and medical devices programs.
According to the report, failure to carry out these responsibilities could have consequences for the health and safety of Canadians, such as exposure to hazardous non-conforming products and to ineffective and dangerous therapeutic products.
Health Canada should undertake a review and establish program baselines in order to meet their regulatory responsibilities. What is the status of that review?
:
Certainly we collect, as others do, information about wait times. Part of the focus on wait times has helped to elaborate these different sorts of process parts in the different steps between somebody thinking they have a serious problem that needs to be addressed by a specialist, seeing their family physician, being referred, going to emergency, and all of those different things.
What we do from the federal level is align what we're doing with federal roles and responsibilities. So to support provinces in their responsibility, because it's a provincial responsibility to deliver health care and hospital services, we have worked with them very much on health human resources, which should help issues such as wait times.
This most recent budget announced another $500 million for Canada Health Infoway to support a number of things, including the goal of having 50% of Canadians with an electronic health record by the end of 2010, I believe it is, which really should also help the issue with wait times across the system.
:
There's a little frustration in that if it's measured, it gets noticed. If it gets noticed, it gets done. It's a frustration that we all feel. There's a cottage industry of people looking at data and indicators and steering away from ranking. The whole objective of Canadians being able to understand whether we're winning or losing, with all this money that's going into it, is really not happening.
From the Public Health Agency, the chief public health officers report annually to the CIHI, the Health Council of Canada, and the OECD. The OECD data seem to be better than what we get from any Canadian government department. I'm not sure where the OECD gets theirs from.
But it's frustrating that the goal of being able to tell a Canadian who lives in B.C. whether or not he or she is really doing better on cancer outcomes than somebody who lives somewhere else seems to be not possible. As our colleagues have said, it needs to be put into a grid somewhere to let people figure out that certain provinces are doing better at some things and other provinces are doing better at other things. In the way they have actually reported, interesting provinces, such as Saskatchewan, have said these are the things they're doing really well, these are the things that they've improved on, and these are things where they still need work.
Can we not find a way to get everybody together around a table to say this is the way we would like everybody to report and step up to the table? I would like to know whether or not it's been tried. Have all these groups ever sat in a room together and had a little chat about indicators or data? Whether it's hepatitis C in prisons, or aboriginals on and off reserves, or any of these things, we really need to know if we're winning or losing in terms of our policies. How do Canadians find out how we're doing on post-traumatic stress for the military?
In order for us to fight for more funds for these things, we really need to know that we're funding what works and we've stopped funding what doesn't work. The most exciting thing in the report is to see that tobacco has gone down. We spent $100 million on that. When I was elected, the rate was 31%. It is now 19%. That's a success. Those are the kinds of things that Canadians would hope we're doing.
But maybe I should ask this of the Auditor General's office. You could study anything that you wanted to and you chose to study this. But you chose to do a study instead of an audit, and there are no recommendations. As a group, what are we supposed to do with all this? There are five or more different groups doing the same thing, and not one report speaks to Canadians about what we're doing or how we're doing across the country.
:
Thank you, Madam Chair. I'll be brief.
There are really two levels, I would say, where activity has to go on. First of all, Health Canada really needs to get together with all of the other players here. You mentioned the CIHI, the PHAC, and Statistics Canada. When you look at what's been published, there's clearly an opportunity to make some low-hanging fruit, as I would characterize it. There are clearly a lot of things they could be doing, the least of which is simply interpreting the data that they already have.
In the report, there are many examples both provincially and within the federal family, including the chief public health officer's own report, where very insightful interpretation is provided, sometimes with quite limited data. A lot more could be done. But in the longer term are the opportunities that come from improving the indicator set and the data sources. Again, we were quite disappointed to see that four editions into this--eight years--things have been relatively stable, with very little improvement. Again, we're encouraged to see some of the steps that are being taken.
:
I want to thank you again for all your input. It's certainly greatly appreciated, and the work that you do.
We find quite serious the problems identified in chapter 8 concerning the quality of Health Canada reporting. One other glaring illustration is the department's annual reporting on the Canada Health Act. It shows that the problem is systemic in the culture of the department, if not the government, not limited to the Healthy Canadians report, and that it really must be dealt with.
The latest Canada Health Act report was basically slipped into the parliamentary record again with the Clerk of the House on February 12. There were no bells, no whistles, not even an announcement. It's very much like last year, when it was tabled while the House wasn't sitting.
We find that the quality of the report is very inadequate. Just as in the Healthy Canadians report cited in chapter 8 in front of us, there is no contextualization, no explanation of what the data signifies for a public health system, and once again there are huge gaps in information.
This is a report to the Canadian public on its number one social program. We really rely on this. It is a report to Parliament in order that we as members of Parliament are able to assess the state of the public health of Canada and that we be able to make some changes or suggestions or at least try to improve it.
In preparing for today's meeting, I reviewed past Auditor General reports and referred specifically to the 2002 report, chapter 3, Health Canada, federal support for health care delivery, and its earlier chapter 29 in the 1999 report. The conclusions can still be applied directly today, more than six years later.
So to the Auditor General, basically are you satisfied that your conclusions and recommendations are not treated seriously by Health Canada?
:
Thank you, Madam Chair.
Just by way of a little bit of information, we do monitor on an annual basis how well departments are doing on our recommendations. I'll turn to Health Canada specifically in a moment, but in general what we find—it's one of our performance indicators and we publish it in our own departmental performance report—is that, by and large, departments do listen to what we have to say. Our statistics have consistently shown the majority of our recommendations and such get acted on. That's the general case.
More specifically in this case, we have not recently returned to looking at the state of the monitoring of the Canada Health Act, which we looked at in 1999 and again in 2002, as the member has mentioned. So without further study, I wouldn't want to opine the extent to which we're satisfied with the action taken.
:
Thank you, Madam Chair.
First of all, I would like to briefly talk about indicators. The collection of indicators is an ongoing science, and we have increasingly sophisticated opportunities. I think we are making great strides as a government. We've talked about the OECD reports and how they feed through. We truly are doing much better now than we were a number of years ago in looking at these questions.
Perhaps I can also state that to think that anyone who has ever worked at the provincial level is not incredibly accountable to the public for those health care dollars.... You're under an incredible pressure, as I'm sure Madam Murray could attest, of accountability for those dollars. Having said that, it is a responsibility of the provinces, and they are often under a lot of heat for it. The ability to look across Canada is, of course, very important.
I have a few questions, and the first would be this. I appreciate the look at indicators and how you're going to monitor indicators. Where are you going, over time, with that particular piece? You mentioned that there will be some consultation, but is there talk about a framework of regular dialogue to look at the ever-changing opportunities for gathering data on indicators?
As I said, one of the issues is that when we get the information from the provinces, there's no differentiation with respect to ethnicity. We get a big pool and we can't pull it out. Not all reserves participate in surveys. We have continued to support specific surveys looking at first nations, Inuit, and aboriginals. I've mentioned them before. There's a regional longitudinal health survey, which we've helped support by funding of $12 million. There's another one that we've worked on, the Aboriginal Peoples Survey. With time, with improved relations between government officials and first nations and Inuit health people, and a collaborative approach to indicating what data you want and why.... For Inuit and aboriginal people, their data is their data, so you have to approach surveys and research with them in a specific way. Increasingly, we're able to do that and get better data.
I'd like to make some comments about health spending writ large, because we certainly do track health spending and track the drivers of health spending and that kind of information.
A study done internally looking at every year going back to 1970 has shown that the increase in health funding has not had a negative impact on other programs at the federal or provincial levels. When you look at our expenditure, GDP versus health expenditure, we're right in the middle of the pack with respect to other OECD numbers. When you look at GDP growth versus expenditure growth and compare us to other OECD countries, we're the lowest. So to put things in context internationally, we're all seeing increased health costs, clearly improvements are being made, clearly we are increasing our usage of the system, and yet our health spending is, over GDP, the lowest of the OECD countries.
:
Yes, thank you, Chair. Thank you very much for this opportunity to come here and talk about our work. This is what we live for, and this is why we do all this work.
The other thought I had to leave with your committee is in terms of what next steps might be. As I mentioned before, as the auditors we monitor annually what kind of action is done by departments, satisfactory or unsatisfactory. We will do that for the health indicators.
I might suggest that the interest that's been shown today might well lead your committee to revisit this question. It seems to me that in the coming year there will be two very important events. One will be when the 2008 Healthy Canadians is available, when people are no longer talking about it in theory but have something concrete to look at. Your committee might wish to revisit this topic then. I think the other very important thing in the next year—and we haven't talked much about this—is the response by Health Canada, but they intend to do quite a thorough evaluation by August 2009.
Again, I thank you for the interest.