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CHAPTER 5: PUTTING PEOPLE FIRST: ENHANCING THE HEALTH OF ALL CANADIANS

Over the last few years, the Canadian system of social programs has experienced major restructuring at the federal, provincial and municipal levels. Its role has been seriously re-evaluated and many social programs in every jurisdiction across the country have been redesigned, and in some cases terminated.

Putting more money into the system, even if it were available, is not the answer. International comparisons indicate that the total level of financial support to Canadian health care as a percentage of gross national product is among the most expensive in the world.

Gretchen Van Riesen (Director, Pensions and Benefits Policy, Canadian Imperial Bank of Commerce: Member, Employer Committee on Health Care - Ontario)

Part of this has been due to the need for governments to restore order to their finances. For example, given the large budget deficits the federal government has been faced with for the past decade, and the size of federal transfers to the provinces and territories, a balanced approach to deficit reduction required a reduction in program spending, including transfers.

Major transfers to the provinces were not reduced by as much as were direct program spending.

When the government originally made eliminating the deficit its first priority, it was decided that the burden of spending restraint measures would be shared by all - from small businesses to large banks, from students and the unemployed to skilled workers, from the Armed Forces, to public servants and individual parliamentarians. Every Canadian was asked to contribute for the common good.

Health costs have risen disproportionately to the marginal improvement in health status. ...We know that spending more money on health care does not necessarily lead to better health. The quest to balance budgets and reduce indebtedness at all levels of government has accelerated the speed of change in the health sector.

Canada Health Action: Building on the Legacy - Report of the National Forum on Health.

Thus the federal government curtailed the growth of transfers for health care, social assistance and post-secondary education. It reformed its system of transfers, creating one block grant known as the Canada Health and Social Transfer (CHST), offering more flexibility to the provinces and territories in the establishment of their own priorities. A much-needed review of the role of the different levels of government in social policy was initiated as a result. But several provinces had already initiated health care reforms.

In response to the questions your Committee is asking in your consultation process regarding the NEW fiscal dividend, we strongly urge the government not to spend more money on health care services but rather to find ways to encourage and promote effective pilots and ultimately implementation of an integrated health care delivery system.

Gretchen Van Riesen (Director, Pensions and Benefits Policy, Canadian Imperial Bank of Commerce: Member, Employer Committee on Health Care - Ontario)

Each province and territory could decide how to spend their resources, based on their own priorities. They all reviewed the importance of the services provided to their constituencies and sought to introduce more efficient delivery mechanisms. Among the methods used for fiscal restraint were rationalization of the size of public services and reductions in program spending.

By reducing the health services they provided, the provinces challenged one of Canada's most cherished national symbols. Canadians believe in a health care system that treats all individuals equally, with compassion and respect. They also believe in a regime that provides quality health care, whenever and wherever needed.

[A] strong federal presence in our health care system is necessary to ensure access to comparable health services for all Canadians regardless of where they live.

Sharon Sholzberg-Grey (President and CEO, Canadian Healthcare Association)

In this context, the provinces embarked on a series of reforms designed to provide the same level of health care with limited financial resources. Not only was the fiscal environment restrictive throughout the period of reform, but other developments gave provincial governments cause for concern. The costs of new technology and medication were rising rapidly, coupled with an aging population that is growing in size. The provinces acted to meet the challenges that faced them.

Reform of the health care system was long overdue. In some aspects, the system was characterized by a lack of accountability and a considerable amount of inefficiencies, unnecessary procedures, lack of proper resource management, and ineffective treatment. Services were in many instances failing to respond to changes in health care delivery that have, for example, led to shortened hospital stays.

The underlying problem is thoughtless, mechanical tinkering with the system in nearly every province.

David McKinnon, Executive Director of the Ontario Hospitals Association.

Rationalization meant difficult but necessary choices such as, reviewing the list of medical interventions considered essential, reducing the number of beds, and in some instances, closing hospitals in areas where their continued operation could not be justified. Shorter hospital stays and the increasing number of outpatients have changed the demand for these physical facilities.

Reforming Canada's health care system has been a difficult process and has created anxiety among Canadians. People are concerned about the future of the system. They sense that waiting times for medical services are increasing, and many Canadians question whether or not their health care system will be there for them when they need it.

The crisis is rooted more in faulty planning than in demographics, finance or technology. The good NEWs is that the management crisis can be fixed.

David McKinnon, Executive Director of the Ontario Hospitals Association.

The difficulty governments face is how to address the concerns of Canadians. While some will argue that the health care system is not functioning as well as it once did, there is little agreement on where the limited resources should be directed.

Canada ranks fourth among the G-7 nations for health-to-GDP ratios, behind the U.S., Germany and France. - Canadian Institute for Health Information

There are many innovative measures which have merit. For example, as the percentage of elderly Canadians increases, it makes sense to increase the amount of resources invested in home care. Ideally, by helping people with major or minor limitations to live in a familiar home environment, home care can help delay the need for long-term care or acute care. A well-established home care system can also liberate limited acute care beds in hospitals for patients in greatest need.

Similarly, as advances continue to be made in pharmaceuticals, illnesses which formerly required care in hospitals can now be treated more effectively outside. Examples include modern oral antibiotics, which are more powerful than the intravenous antibiotics used in the past. Anti-psychotic medication enables certain individuals suffering from mental illness to live rewarding lives in society instead of being institutionalized. And people suffering from deep-vein thrombosis can now be treated with blood thinners at home, instead of requiring hospital care.

In 1998, the ratio of health spending to GDP is expected to rise to 9.1 percent - the first time this ratio has increased since 1993. - Canadian Institute for Health Information.

Unfortunately, while medication used in hospitals is covered by our health care system, in most cases that used in the home is not. This would seem to place an unfair burden on the patient, and act as an incentive for certain people - such as those who do not have the resources to pay for their own medication - to seek hospital care.

Spending on Canada's health care system is expected to reach $80 billion in 1998, an increase of 9.8 percent from the $77.1 billion spent in 1997.

Canadian Institute for Health Information

In some instances, health care reform can be seen as an attempt to address these newly emerging gaps between how care is provided and how it is financed. But the proponents of such new approaches have a responsibility to clearly demonstrate that the new methods will ensure quality patient care. Otherwise, the end result may be to place an even greater burden on the traditional health care system.

If governments and the health care community are to make the most efficient and effective use of limited resources, there is clearly a need for reliable and accurate information on which to base policy decisions.

During the current wave of health restructuring, a clear need for better information has become evident, not only to assist in making decisions about allocation of scarce resources, but also to monitor the impact of decisions already taken.

Decentralizing health services at the regional level makes this information all the more important. It is in the interest of all Canadians that data be standardized and pooled at the national level.

Therefore, the first step recommended by this Committee in strengthening the health care system, is to clearly identify those areas where the system is not functioning effectively and efficiently.

In this regard, as part of its Access to Quality Health Care Project, the Canadian Medical Association (CMA) has proposed principles that are aimed at enhancing the health of every Canadian. When in place, these guiding principles should guarantee timely access based on patient needs. Hence, all Canadians, whatever their culture, age, ethnic origin, socio-economic status or medical condition will have access to the best clinical care at the right time and the right place. This quality of health services should reflect an efficient and optimal use of resources. To achieve this the CMA is proposing an evaluation system to monitor and measure the quality of care.

Canada's the only country in the world that does not have a health policy goals document around which, even if you missed the goals, you can be held accountable by how much you missed and then what were the reasons behind not meeting your targets. It seems to be the idea of a health report card warrants more attention.

William Tholl (Executive Director, The Heart and Stroke Foundation of Canada)

The Committee recommends that the federal government invest (in collaboration with the Canadian Medical Association, the provincial governments and other stakeholders) in the development of a clinically-based measurement system to monitor and evaluate access to quality health care and other performance indicators of the health care system. Based on these observations and new evidence, the federal and provincial governments would be able to assess precisely the financial needs of our health care system. The Access to Quality Health Care Project should guarantee Canadians that they will have access to a health care system reflecting their values and their expectations.

We would advocate putting [the fiscal dividend] ... into health care because we feel that health care has suffered the most due to the focus of dealing with fiscal deficits by all levels of government over the last number of years. There is no question in almost every Canadian's mind that health care has suffered significantly as a result of the focus on dealing with the fiscal deficit.

Rob Hilliard (President, Manitoba Federation of Labour)

Canadians should be proud of the health care system they have built, and continue to build each day. That system has experienced difficult but necessary changes over the last few years. Some benefits and new initiatives are already apparent.

Individual Canadians and all provinces believe more should be done. Many argue that the health care system is threatened by cuts in funding. They are concerned that the cuts have gone too far and as a result, the system may no longer be adequately funded. They argue that the health care system should be the number one priority of the provincial and federal governments.

The second step recommended by the Committee to strengthen the health care system is to review transfers to provinces. It is because the federal government took decisive and consistent action to eliminate the deficit that it is able to reinvest in our health care system. The federal government is committed to the Canada Health Act. Under Bill C-28, enacted earlier this year, the provinces were provided with a cash floor of $12.5 billion, up from the $11 billion floor previously in place (as well as the large and growing tax point transfer). As a result of this Bill, provinces will receive approximately $7 billion of extra cash under the CHST from 1997-98 to 2002-2003. This increase in cash transfers is a tangible example of the federal government's ongoing and active involvement in the system of health insurance and social programs.

Our latest statistics show that the number of nurses working part-time and in casual jobs has increased from 3.1% in 1992 to 17.3% in 1997. That's almost half of our profession ... One nurse in Ottawa explained to me recently that she works in three different emergency rooms, two of them attached to teaching hospitals, one a community emergency.

Mary Ellen Jeans (Executive Director, Canadian Nurses Association)

However, witnesses generally felt that more must be done. Any budgetary surplus should be dedicated to increasing health care spending. It was said by many that the federal government should use its budgetary surplus to restore all, or at least some, of the cuts made to the CHST.

The restructuring and reform process, while absolutely necessary, has, in some cases, missed the mark. Modernizing a $74 billion enterprise is anything but simple. It is not likely to be completed with uniform success. There have been some mistakes and frustrations.

Allan Rock, Minister of Health, September 7, 1998.

It is quite apparent, despite the efficiency gains, that the health care system has had difficulty in handling drastic provincial expenditure reductions and significant federal cuts in transfers. When we compare projected total entitlements (i.e. cash transfers and tax points) for 1999-2000 to the ones that prevailed in 1995-96, CHST entitlements will have decreased by $3.108 billion. When large fiscal constraints are imposed and when decisions are taken rapidly, there is no guarantee that the ineffective services will be the first ones to go. Instead of making reforms that were well planned, pilot tested, monitored and evaluated, many provinces simply made across-the-board spending cuts. This sort of policy initiative eliminates the good and the useful as well as the outdated and the inefficient.

When you consider the demographics of the Canadian population and the fact that we are an aging population, health care costs are bound to rise. It doesn't matter what you do. With an aging population, we are going to see health care costs rising.

The Honourable Judith Erola (President, Pharmaceutical Manufacturers Association of Canada)

The Committee is concerned that the quality of health services could be undermined if funding is not further increased. Previously, we stressed the importance of an accurate and scientific assessment of the health care system. The Committee feels at this point that we should err on the side of caution and inject additional funds into health care. This additional funding is also vital in sending a signal to Canadians that the federal government is committed to the continued success of our system of Medicare. The intensity of the public debate about health care and the role of the federal government both suggest to the Committee that additional funds are needed now. The Committee wishes to express our gratitude to the witnesses who cared and documented the challenges faced by the health care system. In particular, we are impressed by the way in which many groups were able to coordinate their efforts within the Health Action Lobby and present a united front to the Committee.

In 1997, the federal government transferred more than $12 billion to the provinces in tax points.

The increase we are proposing at this time is not as large as those recommended by some witnesses. As mentioned above, the Committee believes that substantial increases should be justified by an efficiency assessment of health care spending.

As Canadians enter a new era of budget surpluses, the time has come to restore more of the funds removed in recent cutbacks. The federal government should reinvest additional funds to address some urgent needs as we go through this important transition period. The new funds could alleviate some of the short-term difficulties the health care regime is facing. Investing part of the surplus into improvements in Medicare would send a signal that the federal government is still strongly committed to the Medicare system.

The Committee recommendation to raise by $1 billion the cash floor, will provide an extra $4 billion cash transfers by 2002-2003.

The Committee recommends that the federal government strengthen its involvement in the health care system by further increasing the cash floor by $1 billion starting in 1999-2000. If the cash floor is raised by $1 billion, the 1999-2000 total entitlements will increase by 6.3% as a result when compared to 1998-99 ($27.6 billion compared to $25.97 billion). Provinces will have received another $4 billion extra by 2002-03. Total CHST entitlement will reach $29.5 billion in 2002-2003.

For example, if enacted, Ontario will receive an extra $1.5 billion over the next 4 years; Quebec: $1 billion; British Columbia: $528 million; and Alberta: $360 million. This measure will further strengthen the commitment made in the Red Book concerning cash transfers. Meanwhile tax transfers will continue to grow by almost $600 million a year.

The Committee's recommendation to raise by $1 billion the cash floor, will provide an extra $4 billion cash transfers by 2002-2003.

Under the current formula, CHST transfers do not provide an equal per capita entitlement in each province. Extra money injected into the CHST would make it easier to achieve more rapid progress towards an equal per capita distribution of the transfer across the country. This "fair share" approach to allocating CHST among provinces should take both the cash and the tax point elements of the CHST into account.

The value of tax points transferred to the provinces is growing by approximately $600 million per year.

Table 2

CHST Transfers
(After Committee recommendations)

It is important to remember that the CHST helps provinces carry out their responsibilities with respect to health care, post-secondary education and social assistance. As long as the provinces respect the criteria of the Canada Health Act (universality, accessibility, comprehensiveness, portability and public administration) and do not impose minimum residency requirements on social assistance applicants, the provinces are entitled to the financial resources. They can then decide to allocate the money in ways they consider appropriate.

Canada continues to rank near the bottom of the list when compared to its major OECD competitors, having a ratio of gross expenditures on R&D to GDP of a mere 1.6 percent, compared, for example, to 2.6 percent in the U.S. and 3.0 percent in Sweden.

Provincial governments have initiated reforms to social assistance and post-secondary education. After listening to the numerous witnesses who testified on this issue, the Committee believes that, at the present time, new CHST money should be directed to the improvement of the health care system. For this reason, we believe that there is no need to restore the full amount of CHST entitlements cut in the 1995 budget.

I do not believe that the needs and will of the people of Alberta differ drastically from the will, needs, hopes and aspirations of their fellow Canadians. Albertans want to see investment in our people, our health care and our education.

Heather Smith (President, United Nurses of Alberta)

There is no guarantee that the provinces will inject any extra funds into the health care system. However, given that the provinces have argued for so long that the health care system is short of funds, and given the commitment made by the premiers to use any increase to the CHST for health care, it is believed that they will earmark the additional $1 billion in annual cash transfers to their respective health care regimes. This money could be used to improve service delivery, invest in new technology and to reduce waiting lists.

MEDICAL RESEARCH: KEY TO STRENGTHENING HEALTH CARE

The third step recommended by the Committee to strengthen the quality of health care is the funding of new medical research initiatives. The ability to find and commercialize innovative ideas is an essential element in maintaining a successful and competitive economy especially in a brain-based economy, such as Canada. Medical research can ensure the highest quality of health care for Canadians.

We need research projects to demonstrate better ways to provide home and community services and drug delivery programs and we need appropriate dissemination methods so that we can all benefit from new research in a timely manner.

Taylor Alexander (President & CEO, Canadian Association for Community Care)

Medical research is an important issue to the government.

As the population ages, as financial resources become more scarce, as innovative technology becomes more and more sophisticated and expensive, one must make sure that Canadians will have access to the best medical treatment possible, including Canadian-made medical innovations. For this reason, the federal government further increased the funding of the Medical Research Council of Canada (MRC). The $134 million announced in the budget should provide grants for research in the health sciences and the training of researchers. This will enable the MRC to promote cooperation between university researchers and industry, thereby turning the results of research into marketable products.

We know that with respect to the social determinants of health when you don't put the money there, and certainly, millions of dollars have been yanked out of social services programs, that ultimately comes back into costs in the health care sector. If people have not had adequate food, housing and that sort of thing, that's where it comes in.

Kathleen Connors (President, National Federation of Nurses' Union)

The Committee believes that more resources should be allocated to the Medical Research Council. Health research today is more challenging than when the MRC was first established. Medical research now encompasses many fields, such as genetics, nutrition, evolutionary theory of ethics and lifestyle choices, molecular biology, and microelectronics, just to name a few. Medical research therefore requires a multidisciplinary and multi-dimensional approach.

In order to appreciate the diversity of medical research, many witnesses agreed that the Canadian Institute of Health Research (CIHR) should be funded. The institute would fully integrate health research into Canada's health care system; enhance research in areas where scientific opportunity converges with public health needs; coordinate and provide a national focus to Canada's research efforts; and drive the system forward to generate, for Canadians, the greatest possible human and economic benefits from health research.

Population health is putting the finger on the pulse of the well-being of the nation.

Robert McMurty, (University of Western Ontario)

If successful, CIHR will be an important platform for a knowledge-based economy. CIHR will provide job opportunities, allow new entrepreneurial possibilities and help the economy become more productive. It will also maintain and improve the health of Canadians and enhance the quality and access of health for all.

[A]s a major funder of health care services across the country and a co-funder with you, we were delighted to hear the thoughts of the federal government of enhancing funding in this area in the next budget. We would strongly support this, and we would strongly support not just restoring funding, but working through the Department of Health with the officials there to look at creative ways of working with the voluntary sector and producing health programs and services across Canada that meet the shared objectives of Canadians.

David Armour (President, United Way of Canada)

Hence the Committee recommends that the federal government provide adequate funding for the proposed Canadian Institute of Health Research.

The 1998 federal budget reversed the cuts that had been previously applied to the granting councils. The current funding levels for the Medical Research Council (MRC) are presently slightly more than they were in 1994. Still, our health care research pales in comparison to that in the United States, when measured on a per capita basis. Indeed, recent increases in American funding of the National Institute of Health are approximately equal to the level of MRC funding, when expressed on a per capita basis.

The Canadian research community has the capacity to undertake additional research if the funding was made available to them. The fact that high-quality, peer-reviewed proposals, are being rejected is evidence of this. The lack of funding is, in fact, causing Canada to lose its capacity to do research; that capacity is largely defined as brainpower.

Clearly, health care is at the top of the list for Canadians in every region of the country. It is at the core of how we define ourselves as a national community - one of fairness and compassion.

Paul Martin, The Economic and Fiscal Update, October 14, 1998.

A very telling anecdote in this regard was presented to the Committee by the MRC. During the current competition for the Burroughs-Wellcome Fund Career Awards in Biomedical Sciences, applications were received from 18 Canadians. Only four of them currently reside in Canada.

Research and development is the cornerstone of productivity, especially in the biomedical sciences. Currently, we are on the verge of becoming a leader in biotechnology, next to the United States. In comparison with the European Union (EU), our biotechnology revenues are one-half those of the European Union. Our R&D expenditures are more than one-third that of the EU and we possess one-third the biotechnology companies that the EU holds. Furthermore, we have 8% the EU's population. Clearly the small size of our economy and population are no barriers to being world-class.

The loss of these 12 physician scientists represents an investment of resources on which we have failed to capitalize. Repeatedly these people told us that the infrastructure support, salary and start up funding for a NEW laboratory were far superior elsewhere to what we could provide.

Dr. Barry Posnar (Professor of Medicine, McGill University, Montreal Neurological Institute and Hospital)

The Committee recommends that federal government funding for health research be doubled. This target should be achieved within five years. The recommendations pertaining to the MRC, the CIHR and the Access to Quality Health Care Project would all be part of this total budget.

On a per capita basis, direct federal funding for health research and development is five times as high in the United States as it is in Canada. Even with the 1998 Budget measures, the Medical Research Council will have only 10% more funding in 1999 than it did in 1991. In the United States, on the other hand, funding for the National Institute of Health is half again as high as it was in 1991. The budgets for medical research in the United Kingdom and France have also increased much more rapidly than in Canada. The following two charts illustrate these international comparisons.

The CIHR concept envisions partnerships between all three national granting councils [and] the existing networks of centres of excellence... Why is this dramatic reorganization in health research necessary? To ensure that Canada realizes its commitment to be at the forefront of international health research.

Dr. Gary Glavin (Regional Director of Medical Research Council of Canada, Manitoba Medical Research Council)

The recommendation of the Committee to double federal funding for health research will bring Canadian funding closer to that of the United States.

It is however, the wish of the Committee that when conditions permit, the federal and provincial governments commit themselves to a long-term target for health research equal to 1% of total public spending on health care.

A healthy society is not just one that spends a great amount of resources on curing the sick. A healthy society is one where individuals are given the opportunity to be healthy and stay healthy. Early intervention, rather than cures, is truly an investment in the future health of Canadians.

The Community Action Program for Children (CAPC) is an example of a program designed to improve children's health by building healthy families and communities. This program is popular amongst those working with poor families. The Committee sees this type of program as an example of successful, early intervention models that can be used to facilitate a healthy society.

The family is also crucial to the development of healthy Canadians. Early childhood development is a function of the quality of health care that children receive. The importance of healthy outcomes for children should be recognized and promoted by health, social and taxation policies that recognize the primary role of parents, respect their choices and recognize special circumstances.

The government must be sensitive to the ways in which tax policy can discriminate against women and in particular against low income women.

Margot E. Young (Associate Professor, National Association of Women and the Law)

Responding to Canadians' Priorities

In response to the clearly expressed priorities of Canadians, the government has taken steps to put its fiscal house in order while protecting Canada's enviable system of social programs. Indeed, as its finances have steadily improved over the past five years, the government has introduced several innovative new programs designed to help build a strong and compassionate society.

Some have been established to address urgent present-day needs, while others represent a forward-looking investment in the future. But all of them reflect the same philosophy, one that states that government must make the most effective use of its limited resources by focussing its actions in those areas where it can do the most good.

In that spirit, the government has devoted the greater part of its social resources to three key areas: renewing the health care system, helping Canada's youth overcome many of the challenges facing them, and investing in post-secondary education.

In fact, over 80% of the government's spending initiatives reflect 2 of the highest priorities of Canadians - access to knowledge and skills, and support for health and education.

A Renewed Health Care System

Clearly, the first priority is health care. Our national health care system is the embodiment of such Canadian values as compassion for the less fortunate and a sense of equality among citizens.

That is why, as the government's fiscal performance improved, its first major reinvestment initiative was to raise the cash floor of the Canada Health and Social Transfer (CHST) from $11 billion to $12.5 billion a year. As a result of this increase, the total CHST contribution the government provides to the provinces is now $26 billion a year.

Public sector spending on health care accounted for 70 percent of all health care spending in 1996. - Canadian Institute for Health Information

However, while the government is strengthening its commitment to the traditional health care system, it is also seeking new ways to prepare that system to meet the challenges of the future. As Canada's population continues to grow and the proportion who are elderly increases, the demand on our health care system is expected to rise.

In 1997, there were 1.2 million Canadians employed in the health and social services sector. Of these, 520,000 were employed in hospitals. - Statistics Canada

We must therefore find ways to provide the same high-quality care outside the confines of the traditional hospital-based approach. The government has allocated $65 million to the Health Services Research Fund. Furthermore, the $150 million invested in the Health Transition Fund will help provinces pilot test new approaches to health service delivery, while an additional $50 million was allocated to help establish health information systems.

The number of people working in hospitals in Canada dropped by 7 percent between 1994 and 1997. - Statistics Canada

The government has also provided funds to meet specific health-related challenges. It increased its contribution to the new blood agency by $60 million over the next 2 years. The 1998 budget also confirmed funding of $211 million over 5 years to fund the HIV/AIDS Strategy.

I'd like to congratulate the current government on the establishment of the Canada Foundation for Innovation about a year and a half ago. That's been a real boon to universities. It's going to help us bring our infrastructure up to standard.

Dr. Ian R. Dohoo (Associate Dean, Graduate Studies and Research, Atlantic Veterinary College, University of P.E.I.)

Canada's Youth: The Promise of a Bright Future

Too many young Canadians face imposing obstacles in their attempts to enter the world of work. Unfortunately, having difficulty finding that first job can have repercussions throughout a person's career. That is why helping young people find work is one of this government's top priorities.

In 1997, in response to the Ministerial Task Force on Youth (1996), the government unveiled the Youth Employment Strategy, a bold new initiative designed to help give young people all the advantages possible as they enter the workforce. The Strategy, which combines the efforts of the government, the private sector, non-profit organizations and community groups, creates work opportunities in promising professional fields, where long-term career prospects are brightest. In the 1998 budget, the government committed $427 million to the Strategy.

The Youth Employment Strategy has four components:

... 85% of those taking part in the Youth Employment Strategy are working or in school within one year of completing their placements.

• Youth Internship Canada provides wage subsidies to employers to encourage them to offer meaningful work experiences to unemployed and underemployed young people. Participants acquire valuable work experience in such fields as science and technology, and international trade and development.
• Youth Service Canada funds projects designed for young Canadians with social or economic disadvantages, also known as "at risk" youth. Young people involved in this program invest their time, energy and expertise in community service projects.
• Summer Student Job Action provides wage subsidies to employers who offer summer employment to students. This program also funds information seminars and workshops on resume writing, looking for summer employment and preparing for job interviews.
• Youth Information Initiative provides young people with information they need about their education and careers.

The comprehensive approach represented by these four programs is the key to the impressive success enjoyed by the Youth Employment Strategy. Surveys of participants indicate that over 85% of those who have taken part in the program are either employed or in school 6 to 13 months after completing their placements.

Lifelong Learning: The Key to Success

For individual Canadians, a better education brings with it the promise of a better job and a higher standard of living. In recognition of this fact, this year the government introduced the Canadian Opportunities Strategy, an undertaking designed to ensure that Canadians - especially those with low and middle incomes - have an equal opportunity to succeed in the new knowledge economy.

The cornerstone of this new Strategy is the Canada Millennium Scholarships. These scholarships represent the largest investment ever made by the government to support equal access to post-secondary education for all Canadians.

The government's initial investment of $2.5 billion will enable the presentation of 100,000 scholarships to full-time and part-time students. Every year for 10 years, these scholarships will be awarded to individuals who need help financing their education and who demonstrate merit.

There is also the newly created Canada Study Grants, to provide financial support to students in need who also have children or other dependents. These new grants will cost the government $100 million annually. Over 25,000 students in financial need with children could benefit from this aspect of the Strategy.

In order to make post-secondary education more accessible to all Canadians, the government has also adopted a number of measures in the area of debt management. These include: tax relief for interest on student debt; interest relief extended to more graduates; an extended repayment period for those who need it; an extended interest relief period for individuals who remain in financial difficulty; and a reduction in the loan principal for individuals who continue to face difficulties.

The Canada Opportunities Strategy also includes components designed to help people who are already in the workforce upgrade their skills, as well as to encourage families to save for education. What these two illustrate perfectly is that tax policy can, when used wisely, be an effective instrument to shape social policy.

Innovative Approach Toward Building Social Equity

The government has also taken that approach by introducing tax relief measures aimed at Canadians with disabilities; at individuals providing care for elderly or infirm family members; and at families with low incomes.

The federal government will spend $6 billion on the Canada Child Tax Benefit in 1999.

The 1998 budget also reinforced the government's commitment toward Canada's Aboriginal peoples. Initiatives specific to Aboriginal Canadians include a $350 million fund that has been set aside for a Healing Strategy to help address the legacy of abuse in residential schools. Also, $126 million that has been allocated for new and expanded Aboriginal programs, including basic services such as housing, and water and sewer systems, as well as investments in education, and social and economic development.

Aboriginal persons will also benefit from new initiatives such as the Canada Millennium Scholarships and the other components of the Canadian Opportunities Strategy, and the Canada Child Tax Benefit.

The Canada Child Tax Benefit is at the centre of the government's efforts to create a National Child Benefit (NCB) System. The objective of the NCB is to create a solid base of services and benefits for Canada's neediest children.

We look at gender analysis, protecting seniors' living standard, social housing, and court diversion programs for young offenders. These are other priorities.

Helen Saravanamuttoo (Vice-President, National Council on the Status of Women)

Announced in 1997, the Canada Child Tax Benefit is designed to provide a benefit to all eligible families with children. The 1998 budget allocated additional funds for this Benefit, increasing it by $425 million in July 1999 and a second increase of $425 million annually in July 2000.

All of these programs will help Canadians deal with the challenges they face. Now that our nation is entering a new era of balanced budgets, we are in an excellent position to build on the successes of established programs, and focus our energy on responding to the emerging needs of our society.

As the Finance Committee continues to undertake this pre-budget consultation process in future years, we look forward to working with Canadians to identify those emerging needs, and to develop innovative new ways of meeting them.