The state of Canada’s health-care system continues to be among Canadians’ leading concerns. Some 68 per cent of Canadians say that improving health care in Canada should be a top priority for the federal government, according to a poll released by Ipsos Reid and Postmedia News on the heels of September’s provincial and territorial health ministers’ meeting in Halifax, N.S.
Canadians may value their health-care system, but the jurisdictional reality is that Canada has 13 different provincial and territorial systems. The Conservative federal government has made it clear that it will respect jurisdictional boundaries when it comes to health care in Canada, and last December Finance Minister Jim Flaherty (Whitby-Oshawa, Ont.) informed Canada’s premiers that the pace of growth of the federal Canada Health Transfer would be curbed beginning in 2016.
In this week’s Hill Times’ Health Policy Briefing, Ms. Aglukkaq makes it clear that the federal government sees itself in a collaborative role, rather than a leadership role.
“As a former territorial health minister, the recognition of the differences is very important. It’s important to recognize that one solution for one jurisdiction cannot be one-size fits all for Canada,” Ms. Aglukkaq said in an exclusive interview with The Hill Times. “My approach has been to work with jurisdictions in areas where there is a collective interest.”
When it comes to the issues her department is concerned with, the minister is specific: obesity, preventative medicine, aboriginal health, and cutting the red tape around health regulation.
An experienced public servant, Ms. Aglukkaq, 45, was first elected to the House of Commons in 2008 and was appointed Health minister soon after. Prior to her entrance into federal politics, she served as an MLA and health minister in the Nunavut government.
Although she avoids major media appearances and prefers to distance herself from political frays, Ms. Aglukkaq, who represents Nunavut, clearly enjoys the confidence of Prime Minister Stephen Harper (Calgary Southwest, Alta.), accompanying him on his annual August Arctic tours.
Following this past summer’s tour, Mr. Harper appointed Ms. Aglukkaq to chair the Arctic Council from 2013 until 2015. The international body is responsible for coordinating collective actions to Arctic issues taken by Canada and fellow member states Denmark, Finland, Iceland, Norway, Sweden, Russia, and the U.S.
Minister Aglukkaq spoke with The Hill Times prior to the federal, provincial, and territorial health ministers’ meeting in Halifax, N.S., where she announced details on Phase 1 clinical trials for treating chronic cerebrospinal venous insufficiency (CSVI) in MS patients, which will begin Nov. 1, 2012 in British Columbia and Québec.
This Q&A was edited for length and style.
The federal government has been criticized for being disengaged on health policy in Canada. How do you respond to this criticism, and what are some examples of federal-provincial/territorial initiatives that this government and your ministry have taken to address regional health issues?
“First of all, it’s very important to recognize the fact that the provinces and the territories do deliver health care and there are 13 jurisdictions that I have to work with. As a former territorial health minister, the recognition of the differences is very important. It’s important to recognize that one solution for one jurisdiction cannot be one-size-fits-all for Canada. In the North, we have a very young population, in the South we have an aging population. How do we ensure that the investments that we are making are flexible by jurisdiction?
“In terms of our commitments to provinces and territories, we’ve been very clear that we would not cut transfers to the provinces and the territories to balance our books. We’ve committed to an all-time high of $40-billion invested in health by the end of the decade. In addition to that, we have focused our research funding. The Canadian Institute of Health Research (CIHR) has a budget of $1-billion. That is used to look at how to take health research projects and translate them into better health outcomes in different jurisdictions.
“As a former health minister from the territories, much of the research didn’t always apply to improving health outcomes, nor did the research take place in the regions of the people who were being impacted, such as aboriginal people on the ground. We currently have about 10,000 health research projects on the go across the country in partnership with the provinces and territories. We’ve also made significant investments related to cancer research. Again, that’s in partnership with jurisdictions across the country.
“We continue to collaborate. My approach has been to work with jurisdictions in areas where there is a collective interest. One big challenge for many jurisdictions is MS research. That requires collaboration from the research community and the medical community in moving forward. We’ve got great news from some of those initiatives that we’ll report to the health ministers in Nova Scotia.”
A recent study by the Fraser Institute estimated that hospital wait-times cost Canadians $1-billion annually in lost time and productivity, while recent research from the University of Toronto estimates that federal and provincial governments could save millions annually if hospitals and jurisdictions harmonized their drug plans. Does the federal government have a leadership role to play in addressing these issues? If so, what is that role, and what is being done federally?
“On the issue of wait times, our government has made significant investments related to wait times by jurisdiction. At the same time, it was important for the jurisdictions to recognize and identify some of their own challenges that were affecting wait times.
“One example is hip and knee surgery. We’ve made significant investments in a number of areas across the country. One of the things that contributes directly to hip and knee injuries is obesity. When it comes to wait times on the treatment side, I can say from my conversations with the jurisdictions that some people who are waiting for surgery are waiting to lose weight before they can actually have surgery.
“We need to look at the issues related to wait times much more broadly. It’s not just the treatment side of things, but what are the causes of that? The WHO has stated that obesity is an epidemic. Collectively, the provincial and territorial health ministers two years ago signed a declaration in Newfoundland at the federal-provincial-territorial meetings to start tackling the issue of childhood obesity in this country, recognizing that it was an emerging health issue. What we’re seeing in our jurisdictions, whether it be related to diabetes, hip and knee, or heart disease, is that a lot of cases are preventable in that obesity is the root cause of it.
“Thinking about prevention as treatment is an area that the provinces and the territories have collaborated on and are working towards. How do we make sure that it’s equally important when you fall ill that the system be there for you, but also ensure that we prevent people from [ending up] in the institutions in the first place? It’s really about thinking outside the box, considering what our role is. What is my role as a parent to make sure my child is not obese? What is my role to ensure my child is active to prevent some of these diseases?
“Given what we’ve been able to invest, we are also looking at different ways of doing things. You can describe that as being innovative or thinking outside the box to mitigate some of the impacts that we see in our health-care system. I think this is a worthwhile cause for us to address. The decision of all [provinces and territories] to come together and do this in collaboration was signed two and half years ago, and we’ll be reporting on that progress at the federal-provincial-territorial ministers meetings at the end of September.”
Health Canada and the CIHR will invest $25-million over the next decade in aboriginal health research. Have any research projects been approved as of yet? What will they address?
“One of the things that I’ve said all along is that we will protect the delivery of health care in aboriginal health, and my job in moving this forward was to ensure that frontline health-care services were not impacted.
“In the area of aboriginal health, the investments we made through the CIHR were to ensure that any research funding related to aboriginal health was in partnership with aboriginal people. Far too often, we would have research projects being conducted down in the south and not actually working in partnership with the aboriginal people that are impacted by this study.
“One example that I was very proud to initiate was on the issue of tuberculosis. How do we ensure we study the issue and the challenges we have with tuberculosis within the aboriginal community, in partnership with the aboriginal community? We needed to do things differently, so we invested in research projects in Iqaluit, Nunavut to combat tuberculosis on the ground with Inuit people, with the hospitals, and frontline health care services. The studies were actually conducted in partnership with the people who were being studied.
“The investment that I announced of $25-million basically opens research in areas that are most pressing within the aboriginal communities—suicide, oral health, tuberculosis, obesity and a number of other areas. That project application process is being rolled out in October. A number of stakeholders across the country — aboriginal groups, governments and researchers — will come together to learn about the program, how they can apply, and at the same time network and determine some of the challenges that we have in health and what health indicators we are dealing with within the [aboriginal] population in Canada. That is being rolled out in October, and from there we’ll have a process where we review the applications and decisions will be made about which research projects will be supported.”
The 2012 budget also eliminated the National Aboriginal Health Organization, which was credited with doing world-leading research on aboriginal health, and was conducting research that was sensitive to the differences between First Nations, Métis, and Inuit. The official reason was that NAHO was not “functioning properly.” What were the issues at NAHO that led to its elimination, and what will replace that research?
“I worked very hard with those leaderships to come together to deal with some of the governance issues related to NAHO. In fact, I took two years dealing with some of the governance issues. After two years, the leadership basically wrote to me and said, ‘Dissolve the organization, we’re not able to come to a consensus on how we structure the organization.’ I listened, I gave them an opportunity to sort through some of their own challenges, and they were not able to do so, and collectively they had written me to say ‘dissolve the organization.’
“Our government invested $4-million to that organization [annually]. Recognizing the importance of continuing aboriginal health research, I invested $25-million in CIHR, which is a lot more than the $4-million that was invested in [NAHO]. The $25-million in research funding that I announced in partnership with aboriginal organizations is basically to address that issue. I’m looking forward to projects coming forward through this process, through the new investments that we have. Unfortunately the issue with NAHO was not resolved. We did put in all our energy and resources to try to support getting that group to work together, but it was not possible at the end of the day.”
You’ve served as both a territorial and federal health minister. How has aboriginal health improved during your time in government? How do you measure success in improving the health of First Nations, Métis, and Inuit Canadians?
“I go back to the fact that the provinces and the territories deliver health care. The Nunavut government delivers health care to the Inuit people, and the province of Quebec delivers health care to Inuit people in northern Quebec, and so on. It’s a partnership approach.
“What we’ve said along that we would not cut transfers for the provincial and territorial governments delivering health care. I was in the North as finance and health minister when we were dealing with cuts. The government of the day made cuts and it was a very difficult time in the North for any jurisdiction.
“Our government has been very clear that we would not balance our books on the backs of provinces and territories that deliver health care to their people. In addition to that, our government has made investments related to aboriginal health research, in partnership with aboriginal people. It’s very important that any research related to the population be in partnership. Some of the solutions have to come from the communities themselves. We need to ensure that the models of how they deliver preventative programs or community wellness programs are from grassroots up.
“It is a huge challenge to get our resources to make a difference at the community level. Changing how we fund programs at the community level is a better way of ensuring that communities have access to those preventative models. That’s one issue we’ve been working on. Recognizing that the solutions and models of delivery will be different, by jurisdiction, by community size, we’ve tried to focus on areas that would empower the communities to work in partnership with us.
“In terms of overall health, provinces and territories have been working in partnership to deal with obesity. This is a preventative issue. It involves not just health — it involves education, it involves communities, it involves parents. How do we deal with this emerging issue in our country? We talk about childhood obesity, but it’s the parents that purchase the food. Our government has been focused on educating parents on knowing nutritional requirements and reading the labels for their children, working with education ministries to increase physical activities in schools, and implementing the child fitness tax credit. There are a number of investments that we’re making for all Canadians in addressing how we deal with keeping our population healthy.”
The 2012 budget has invested over $50-million in the CFIA, Health Canada, and the Public Health Agency of Canada to address food safety. What steps is Health Canada taking to improve food safety in Canada?
“This is something that we’ve been working very closely with CFIA on. One of the things that we’ve focused on is getting rid of some of the red tape. When we have, for example, an additive that’s already approved, we don’t need to go through the whole process of reviewing it again. If it’s approved, why not for this product? Some of these things are common sense. We were dealing with legislation that was a bit outdated, so we needed to ensure that we have addressed the Weatherill recommendations.
“Basically, it’s about reducing the red tape, improving collaboration, and working together with CFIA and Health Canada on our response and investigations when issues emerge. It was important to modernize the legislation. When you’re dealing with a 20 or 30-year old law, a lot has changed in that time.
“It was no different when we were dealing with the consumer product safety legislation. We were dealing with 30-year old legislation that did not give us the mechanisms to even withdraw unsafe products from the market. At the same time we needed to address the recommendations coming from Sheila Weatherill’s report on how to better coordinate. From our standpoint, it really is about reducing some of the red tape and working with CFIA to be able to respond to product applications that could prevent E. coli, for example. How do we prioritize internally and build that capacity to better respond to public safety issues?”
What message are you bringing to this year’s provincial and territorial health ministers’ meeting?
“We’ve been working very hard in a number of areas over the last year. The one that everyone is anxiously waiting on is the issue of MS research and clinical trials, but a number of other areas, as well. The provinces and territories have been working closely on some of their innovative ideas, so this an opportunity again to sit down with the PTs and have a discussion on a number of subjects. When the conference is over I will be conveying some of the decisions that came out of that, but really it’s an annual opportunity for us to have a discussion on some of the work that has been going on for some time. It’s also an opportunity for me to meet the six or seven new health ministers at the table. I’ve been at this for eight years now, so there’s a lot of new faces at the table that I’m looking forward to meeting.”
What is more challenging—your work as minister of Health, or representing a riding like Nunavut as an MP?
“I love the work I do for the North. The North is a special place for me. It’s a riding that’s larger than the province of Ontario. It is the only riding in all of Canada with three time zones. It takes me two days to get from east to west—the flights are daily. We have a small population and I’ve been working in government and politics for over 20 years, so I know a lot of people and it makes my job easier in that way.
“The job as an MP for this riding is very rewarding. It’s challenging of course, but I try to make a difference and try to address the issues that are there. I also recognize that the North is a happening place, it’s the area where development is occurring. We have to be able to respond to the emerging opportunities that are before us, and ensure that people in the North participate fully in those decisions and be a part of the opportunities related to employment and so fourth.
“The opportunities in terms of working to realize some of those potential developments is great and I’m enjoying the work I’m doing in promoting the North to the South. At the same time, there’s a number of old issues that need to be resolved around people’s food security. We need to deal with advocates who try to put a stop to our seal hunt, our narwhal hunt, our polar bear hunt. People need to understand that we are a product of our environment. We’ve depended on the wildlife for hundreds and hundreds of years, just like those in the South depend on farms with cows, pigs, and chickens. In the North we have to go out and continue to hunt. It’s not easy. My brother is full time hunter who continues to provide for his community. The aboriginal groups in the North, the Inuit in particular, are continually fighting animal rights activists that try to stop these types of hunts in the North. The fact that people are impacted is not talked about. What about the people? When you make statements that you want to stop the seal hunt, what about the people that depend on it?
“A large part of my job is to educate people in the South about why we’re unique in the North, what opportunities we have in the North, and how the North is contributing to Canada. It’s an exciting time for us in how we balance the traditional way of life with the emerging opportunities that we have.”
Original Article
Source: hill times
Author: Chris Plecash
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