Uncut replies from the Science-ish questionnaire

From the Hon. Leona Aglukkaq, the Hon. Hedy Fry and the Hon. Libby Davies

Replies from the office of the Hon. Leona Aglukkaq, Federal Minister of Health

1. In your opinion, what is the role of the federal government in health care?

Our Government has a clear and strong commitment to health care.  We actively support a publicly funded, universally accessible system that respects the principles of the Canada Health Act. Federal funding for health care has reached historic levels.  With Budget 2012, we have put the Canada Health Transfer on a sustainable long-term growth track, reaching at least $40 billion by 2020 21. This will provide provinces and territories with the certainty and flexibility they need to address current priorities and to plan for the future. We also work with our partners to support health care innovation, with annual investments of over $1 billion in research and system improvement.  And we play a direct role in promoting healthy lifestyles and regulating health and consumer products to reduce health risks. These federal actions and investments in health care are helping to keep Canada’s health care system strong so that Canadians can get the care they need, when they need it.

2. With the nature of health care changing (less hospital, more alternative providers, more prescription drugs), how should Medicare be changed to meet the needs of Canadians?

Our Government respects provincial and territorial jurisdiction, and believes that each province and territory has unique challenges.  We will not impose an “Ottawa Knows Best” approach; rather, we will provide stable, predictable financial transfers that will allow governments to properly plan and deliver medicare.

We will also continue to invest in research and innovation, which provinces and territories can use to strengthen how they deliver healthcare.

3. Is there a role for an independent science advisor to the federal government? If not, why? And how might scientific advice be better sought by or provided to government?

“Science” is a very broad field and it would be impossible for one person  to provide expert advice on all science.  As a science based Department, Health Canada depends on access to high quality scientific knowledge to support policy formulation, the development and implementation of regulations, and the delivery of programs and services.  Scientists contribute to decision making by collecting and analyzing information related to health risks and identifying possible ways of dealing with those risks. To this end, the Department conducts science, as well as uses scientific knowledge derived from external sources.
The Department uses several internal mechanisms including peer review and committees, where policy makers and scientists provide Health Canada senior management with advice on scientific matters.
Additionally, the Department relies on the advice and expertise of over 100 advisory committees and panels that are each specific to a highly specialized area.  These committees and panels assist in the early identification of issues and bring to the table views and findings that may otherwise be overlooked. URL: http://www.hc-sc.gc.ca/sr-sr/advice-avis/com/index-eng.php   When using science from outside, we consider all the available evidence and make decisions with this in mind.

4. How do you ensure our health policies are informed by good evidence?

See below for combined response with the next question.

5. Sometimes all that¹s known in health research is not reflected in the policies that are made. Do you have any particular plans to close the research to action gap in this country?

Health policy decision-makers and health care professionals need evidence to deliver high-quality, appropriate, and effective care.  The Government of Canada, though CIHR, is making this happen through the Strategy for Patient-Oriented Research (SPOR).

SPOR emphasizes the translation of research evidence and innovations to patient care settings to improve patient outcomes and the quality of health care. SPOR also leads to the commercialization of new health products and therapies. It helps bring the best products and therapies out of the research environment and into the hands of patients and health care providers.  And because SPOR is a collaboration between the federal and provincial/territorial governments, the speed of uptake of these policies, practices, therapies, and innovations is maximized. CIHR has also had great success with programs such as Partnership for Health Systems Improvement (PHSI), which supports teams of researchers and decision makers interested in conducting applied and policy-relevant research that is guided by the information needs of users of research. This meaningful collaboration between researchers and decision makers is jointly funded 70% by CIHR and 30% by partners, to ensure that evidence is built in conjunction with policy makers to increase its uptake.

6. Do you have any plans for measures and benchmarks for federal investments in science and medicine, to ensure accountability and that money is being spent wisely and with good results? If so, what do these look like?

Federal investments in science take many forms.  In Health Canada’s Portfolio, we make investments in university-based health research through the Canadian Institutes of Health Research (CIHR).  CIHR, along with the other university research granting councils, is taking steps to strengthen its performance measurement of both its investigator-driven and strategic investments.  Science done within Health Canada is subject to the same accountability measures as any other government spending — managers are accountable for ensuring value for money for their spending.

Through its Strategy for Patient-Oriented research (SPOR), CIHR is focused on getting results for Canadians. SPOR is about value for money, and funding is contingent on the evaluation of performance metrics, outcomes, and progress. CIHR, through SPOR, is working in close collaboration with provinces/territories in developing and promoting new research approaches that will result in more efficient, cost-effective health services in patient care settings. Most importantly, SPOR will improve patient outcomes and the quality of health care.

7. There is a growing acceptance that universities need to engage more with industry and other non-academic partners, but there is some concern about how and where basic research is going to be supported. How do you ensure support for basic research amid this emphasis on industrial R&D?

It is indeed important to engage with industry and other non-academic partners to move health research through the innovation pipeline – for both the health and economic benefits to Canadians. However, CIHR remains committed to supporting basic research.  This research is central to the mandate of CIHR, and central to health research enterprise in Canada.  Through its open funding programs, for example, CIHR provides strong support for  basic research that helps Canada sustain a broad-based foundation of expertise.  This allows us to draw upon this expertise to address the pressing health concerns of Canadians and of those responsible for health care delivery.

8. At the recent Science Policy Conference in Calgary, a key topic of discussion was the question of how to increase private sector investment and involvement in research and development, since the scientific community is concerned that despite having one of the most generous incentive programs in  the world it doesn’t seem to be working effectively. What does your party believe is the problem and how might you address it?

I would refer you to Minister Goodyear’s office to respond to this question.

9. Can you describe your health research priorities?

Our government is focused on supporting research that produces outcomes for Canadians. In its latest strategic plan published in 2009, CIHR identified five broad priorities in which they committed to invest in order to respond to Canadian health and health system challenges:

1)        Enhance patient-oriented care and improve clinical results through scientific and technological innovations
2)        Support a high-quality and sustainable health-care system
3)        Reduce health inequities of Aboriginal peoples and other vulnerable populations
4)        Prepare for and respond to existing and emerging global threats to health
5)        Promote health and reduce the burden of chronic diseases and mental illness

To support these priorities, CIHR launched a process in 2010 to attain greater focus and impact from its strategic investments. This process involved environmental scanning and evaluation to identify needs and opportunities where additional research could make a difference and produce measurable results. From this process, CIHR identified eight Signature Initiatives that will help CIHR allocate its resources to make the strongest possible impact on health and health care. They are:

·        Canadian Epigenetics, Environment and Health Research Consortium

·        Inflammation in Chronic Disease

·        Community-Based Primary Health Care

·        Personalized Medicine

·        Evidence Informed Healthcare Renewal

·        International Collaborative Research Strategy for Alzheimer’s Disease

·        Pathways to Health Equity for Aboriginal Peoples

·        Strategy for Patient-Oriented Research (SPOR)

Significant progress has been made in the development and implementation of the initiatives and funding opportunities have been announced for some of them.

10. Given that health research is largely managed federally but healthcare funding and delivery is managed provincially, is Canada achieving optimal coordination and proportional impact in its health research investment?  If not, what would better structures or links look like?

Coordination between the Government of Canada and the provinces/territories is essential if we are to support research that delivers results  for Canadians. Through the Canadian Institutes of Health Research, the federal government is tackling this issue directly with its Strategy for Patient-Oriented Research (SPOR).   SPOR is a new way of working collaboratively with the provinces/territories and like-minded partners, to leverage resources and support research that will transform Canada’s health care system.  CIHR is currently working with the provinces/territories (as well as patients and other partners) to create research networks and SUPPORT units.  These networks and SUPPORT units will help take our best research evidence out of the research environment and put it into the hands of the health care providers and policy makers who can make a real difference in the lives of Canadians.

11. There is concern among health professionals, particularly in motions passed at the Canadian Medical Association annual meeting this summer, about the study and data availability on the effects of the fracking and oil sands industries on health. One suggestion was to establish an open and centralized database with mandatory reporting by independent researchers, government and industry on all data collected on the effects of resource extraction projects  on health and the environmental determinants of health. What do you think of this idea? Or how do you plan to address this concern?

In Canada, except on federal lands, the responsibility for managing natural resource development, including oil and gas exploration and production, falls primarily under provincial jurisdiction.  Health Canada works with the provinces and territories to protect the health of Canadians by assessing chemicals that may be harmful to human health.

Health Canada has provided input and support for an Environment Canada-led voluntary survey to identify substances used in fracking, and methods for handling and disposing of fracturing fluid. The Government will evaluate information from this survey to determine if additional actions are required. Health Canada is also working with international partners to share information and best practices on assessing the risks of chemicals used in shale gas extraction.

12. The World Health Organization calls climate change the greatest global health threat of the 21st century. What steps are you taking to tackle this challenge?

I would refer you to Minister Kent’s office, as Environment Canada is the lead department on climate change.

13.  As other jurisdictions have moved ahead with clinical trials registries  and other types of oversight and stringent regulation of clinical trials, researchers have called Canada’s regulatory response inadequate and comparatively weak.  How do you plan to address and respond to those concerns?

Health Canada allows access to drugs in clinical trials when the use of the drug for the purposes of the clinical trial does not endanger the health of a clinical trial subject, as well as when the clinical trial is not contrary to the best interests of a clinical trial subject and the objectives of the trial are considered to be achievable.  Health Canada has a strong regulatory framework for clinical drug trials involving humans – our objectives are to help ensure that participants are not exposed to undue risks, as well as to promote sound clinical trials.

Health Canada is involved in several initiatives that together aim to improve the regulatory environment.  For example, Health Canada supported the new Canadian General Standards Board standard Research Ethics Oversight of Biomedical Clinical Trials which establishes a common framework for research ethics boards in Canada.  These standards aim to further protect Canadians participating in clinical trials.  Internationally, Health Canada has engaged with other countries in the OECD to establish common expectations for a risk-based approach to regulatory review of clinical trials  (http://www.oecd.org/sti/scienceandtechnologypolicy/49344626.pdf).  Such a regulatory approach aims to increase the number of international clinical trials in Canada thus making more trials available to Canadians.

Finally, Health Canada is planning on publishing information on its website about all clinical trials to be carried out in patients.  By providing access to this information, Canadians will be able to check for potential drugs to treat their disease, as well as confirm if a drug is allowed (by Health Canada) for use in a clinical trial.  This is an important first step in providing more information to Canadians.

More broadly, Health Canada has embarked on a far-reaching agenda to change the way we regulate pharmaceuticals. Our goal is a modern system that delivers more timely approval of needed medications, strengthens drug safety and is more transparent and understandable to Canadians.

Replies from the office of the Hon. Hedy Fry, Federal Liberal Health Critic

1. In your opinion, what is the role of the federal government in health care?

The federal government is the founder of Medicare and the keeper of the Canada Health Act. It is responsible for equality of access to medically necessary care across this country and for that reason has a leadership role. That role was strengthened in the 2004 Health Accord, signed between Prime Minister Paul Martin and the Premiers.

The Accord set out objectives for achieving the transformative change necessary to maintain Medicare and a proactive health promotion and disease prevention strategy.

The Accord created a new jurisdictional flexibility that allowed the federal government to play a strong role in hitherto provincial jurisdiction in partnership with the provinces and territories. Therefore, it included the development of a national pharmaceutical strategy to facilitate access to medically necessary drugs for the chronically and terminally ill and a pan-Canadian Health Human Resource Strategy to ensure access to health care professionals – both of which were exclusively provincial jurisdictions.

In effect, the ten-year 2004 Health Accord expanded the role of the federal government to more than a cheque-writer for the provinces and keeper of the Canada Health Act.

2. With the nature of health care changing (less hospital, more alternative providers, more prescription drugs), how should Medicare be changed to meet the needs of Canadians?

When Medicare and the Canada Health Act were established, the objective was to cover hospital and physician-based care only.

Today, with demographic changes, increased longevity and technological advances, the health care needs of Canadians have changed. “Wait times” have increased. Chronic and long-term care patients are cared for in hospitals, contributing to bed shortages and overcrowding in emergency departments.

Moreover, where, when, and by whom, health care was delivered was purely a provincial jurisdiction. The cost of Medicare spiralled and private/public models, with user-pay, co-pay were being discussed.

In 2003, Prime Minister Chretien met with provincial/territorial premiers with the objective of finding new ways to make Medicare affordable and sustainable.

In 2004, Prime Minister Martin met again with the premiers to bring about the transformative changes that everyone agreed would be needed to achieve that goal. As a result, a 2004 Health Accord was signed between the Federal/Provincial/Territorial First Ministers. It ushered in a new era of jurisdictional flexibility in which the federal government would act as a partner in bringing about required changes in the system.

The Accord identified the need to shift from an acute care model to a community/home based model of care.

It also identified the need to expand from physician-based care to multidisciplinary teams, each working within their scope of practice.

As one of the core five objectives established under the Accord, part of the $41.2 billion federal contribution, was targeted specifically to pilot these models in order to “meet the objective of 50% of Canadians having 24/7 access to multidisciplinary teams by 2011. Building on this progress, First Ministers agree[d] to establish a best practices network to share information and find solutions to barriers to progress in primary health care reform such as scope of practice. First Ministers agree[d] to regularly report on progress.”

Because the Conservative government, in 2006, walked away from these elements of the Accord, little has been done to achieve this objective. While some provinces have developed certain successful models, many other provinces have not and the “best practices”, which would have been a federal role, was never shared.

3. Is there a role for an independent science advisor to the federal government? If not, why? And how might scientific advice be better sought by or provided to government?

We need more than a science advisor; we need an independent science panel for different sectors.  However, this question is moot since we have seen this government ignore the advice of its own expert panels, its own scientific advisors within the bureaucracy, and scientific researchers at facilities independent of government. Currently there are many scientific advisory panels, who continue to advise, but are generally ignored.

4. How do you ensure our health policies are informed by good evidence?

Evidence-based information must be the core of any decision-making surrounding good health policy, public health initiatives, health care management and delivery.

We can achieve this by:

ensuring the federal government maintain a leadership role, in close partnership, not only with provinces and territories, but also with research bodies and deliverers of health care, and public health officers;

creating new structures for sharing information and best practices, as mentioned in the research answer above;

Setting clear indicators for population health, measurable outcomes and objectives, and regular evaluation processes; and

Creating rapid response communication links between federal, provincial and intra-provincial governments and public health institutions for response in health care crises.

In some cases, Ministers of Health, including the federal minister, should be guided by expert advisory groups in areas where policy may be controversial or complex. There must be regular First Ministers Meetings on Health to focus on setting priorities and goals, share resources and develop accountability mechanisms to the public.

Evidence shows that major transformative change is necessary in order to sustain Medicare, so that acute care will be delivered in hospitals, but chronic, long-term, and home care should be part of new community care models that will decrease the need for hospital care. This is why, in 2004, F/P/T Ministers agreed on the need for a third party reporting mechanism by independent agencies, to report back on progress and outcomes.

Evidence also shows that multidisciplinary teams including, but not limited to, health care providers can achieve better outcomes and quality care. For example, a community care team may include, as well, housing experts, social workers, school counsellors, and NGOs service delivery workers.

Evidence also shows that approximately 60% of illness is preventable, so that strong disease prevention and health promotion policies, supported by appropriate funding, will result in healthier, more productive populations, with less need for illness care services.

Public policy, based on ideology, can be dangerous when it comes to health. Clinical guidelines, established by physicians, researchers, and other experts are essential to effective health policy.

5. Sometimes all that’s known in health research is not reflected in the policies that are made. Do you have any particular plans to close the research to action gap in this country?

All levels of government must be guided, in their decision-making, by a process that is based on evidence, strong indicators, measurable outcomes, identifiable goals, and frequent evaluation. Partnerships with expert advisory groups would result in action that reflects health research.

We have witnessed, with this government, that policy decisions are not often based on evidence. One example is the Minister of Health refusing to heed the advice of expert working groups on sodium, trans-fats, and energy drinks to regulate these products.

Another example is the government’s refusal to heed the advice of physicians and public health officers on the negative impact of health care cuts to refugees, not only on the health of refugees themselves, but in the case of undiagnosed communicable diseases, on the public at large.

6. Do you have any plans for measures and benchmarks for federal investments in science and medicine, to ensure accountability and that money is being spent wisely and with good results? If so, what do these look like?

Yes, we think that measures and benchmarks for federal investments in science and medicine are essential. We also think this should be extended to setting benchmarks for population health, environment, and technology.

In the 2004 Health Accord benchmarks and timelines were set in the areas of wait-times, health human resources, pharmacare, e-health, and community care models.  Third party institutions such as the Canadian Institute of Health Information, the Health Council of Canada and the Wait Time Alliance were established to monitor progress and report annually with regard to the progress and achieving benchmarks. Since 2007, each of these groups, in their annual reports, cited lack of federal leadership as the reason for failure to progress. As we know, the current government ignored these reports.

It is essential to have third party accountability structures to measure, evaluate, and report on government’s adherence to, and progress on, benchmarks. These third party bodies should report to the public through Parliament.

7. There is a growing acceptance that universities need to engage more with industry and other non-academic partners, but there is some concern about how and where basic research is going to be supported. How do you ensure support for basic research amid this emphasis on industrial R&D?

Government must invest as a public sector into basic research on merit that would lead to improvements in the lives of its citizens.

At the same time, one must acknowledge that basic research can lead to new products, new drugs, and new innovations that could have commercial applications within and outside of Canada.

For the two of them to be totally separate and isolated may not be practical. Inevitably, the majority of basic research is a stepping stone to new product and new technology development.

8. At the recent Science Policy Conference in Calgary, a key topic of discussion was the question of how to increase private sector investment and involvement in research and development, since the scientific community is concerned that, despite having one of the most generous incentive programs in the world, it doesn’t seem to be working effectively. What does your party believe is the problem and how might you address it?

Research and development itself is not enough. Private companies must be able to commercialize and market the products, technologies, or ideas. This is why the previous Liberal government established Technology Partnerships Canada and the Canadian Foundation for Innovation, which proved successful.

These partnerships led to commercialization of ground-breaking technological innovations such as RADARSAT, Cassiopeia, new drugs, and biomedical technologies.

Another solution would be for government to partner with new research that has a commercial value, through the Department of International Trade. Government-hosted trade shows and promotion of these products and technologies in international markets could provide an incentive for private research.

9. Can you describe your health research priorities?

Health research priorities must be informed by the health needs of the population and national health care goals, and must be linked to goal-driven outcomes, and backed by the financial and human resources necessary to drive progress.

Priorities could be:

Practical research in terms of innovative health care delivery systems that would improve the sustainability of Medicare;

Health promotion and disease prevention measures;

Research that would establish clinical guidelines resulting in better quality outcomes of care;

Alzheimer`s disease and other forms of dementia; and

Links between genomics, disease, and treatment.

10. Given that health research is largely managed federally but healthcare funding and delivery is managed provincially, is Canada achieving optimal coordination and proportional impact in its health research and investment?  If not, what would better structures or links look like?

Provinces already conduct health research in areas of health innovation, management, treatment, and delivery models. The federal government, through the Canadian Institutes of Health Research, which were established under the Chretien Liberal government, plays a greater role in various levels of research including in health promotion and disease prevention, etc.

A collaborative model should be set up, in which the CIHR worked with provinces to identify regional research priorities, pool resources, set indicators and common outcome measurements. It would also allow for sharing of data and best-practice models. This would achieve efficiencies, cost-effectiveness, and focus, allowing fewer areas of duplication and omission.

11. There is concern among health professionals, particularly in motions passed at the Canadian Medical Association annual meeting this summer, about the study and data availability on the effects of the fracking and oil sands industries on health. One suggestion was to establish an open and centralized database with mandatory reporting by independent researchers, government and industry on all data collected on the effects of resource extraction projects on health and the environmental determinants of health. What do you think of this idea? Or how do you plan to address this concern?

This sounds like a good idea. Our party believes in evidence-driven policy, and firmly supports applying health impact assessments to economic, environmental, and social development projects in order to ensure that the impact of government policies and programs, on human health, are positive, and not negative. The Environmental Protection Act was brought in under Pierre Trudeau’s Liberal government, precisely for this purpose. It has been weakened and often circumvented by this current government.

12. The World Health Organization calls climate change the greatest global health threat of the 21st century. What steps are you taking to tackle this challenge?

The previous Liberal government had a plan that would have met our Kyoto emissions targets by 90% in 2017.

Canada was a world leader in climate change talks, in fact, being a key promoter of the Kyoto Accord in 1997 and led the world to an agreement in Montreal in 2005.

Canada has a responsibility to be a global leader in meeting our greenhouse gas emissions targets, if only because we are one of the world’s highest consumers of energy and therefore a major contributor to global warming.

Under this Conservative government, Canada has become a laggard on the issue of climate change, labeled “Fossil of the Year”, for each of the past five years, during international climate change talks. They abandoned Kyoto, eliminated scientists at Environment Canada and Fisheries and Oceans and did not renew the Oceans Strategy brought in by the last Liberal government. They have gutted environment protection legislation and closed the PEARL Arctic Research Station.

There is clear evidence that climate change has led to rising sea levels, more intense storms, fires, droughts and floods. The result being displaced families, famine, and destruction, leading to concerns for food security, since famine would inevitably affect the ability of many nations to grow enough food to feed their citizens.

There is no doubt that climate change is a global health crisis.

There is evidence of increased asthma in children and higher rates of skin cancer. Preliminary evidence has linked certain cancers (especially Leukemias) to climate change and other environmental hazards.

We need a government that accepts the science of climate change.

We need a comprehensive climate change strategy that would:

Reduce the expected “annual adaptation costs”, estimated as $21 to $43 billion annually by 2050.

Eventually attain the ghg emission goals we committed to internationally.

Commit Canada to its fair share to fill the megaton gap. (There is a shortfall between what the world promised and what we need to do slow climate change.)

Maintain global temperature rise to no more than 2 degrees Celsius.

Recognise that non-renewable energy sources are unsustainable and transition to national sustainable energy and economic growth strategies.

Set targets for efficiency, renewable energy, and transportation.

Protect air quality, the Boreal forest, and water quality.

Assess the potential human health impacts of the oil sands.

Assess the use of water by extractive industries to ensure they do not deplete Canada’s water resources.

Assess, invest in, and create incentives to develop the best technologies needed to achieve these goals.

13. As other jurisdictions have moved ahead with clinical trials registries and other types of oversight and stringent regulation of clinical trials, researchers have called Canada¹s regulatory response inadequate and comparatively weak.  How do you plan to address and respond to those concerns?

Safety and efficacy of drugs is a key objective of the regulatory authority of Health Canada. Therefore, attention to process, timeliness, and reporting to the public is important.

The Auditor General found that Health Canada did not disclose trials that were rejected, nor did the department fulfil its commitment to disclose authorised clinical trials to the public, leading to potential risk of Canadians participating in an unauthorised clinical trial.

We will ensure that there are adequate resources, both financial and human, to fulfill requirements in a timely manner.

Evaluate outcomes of processes regularly.

Change regulations as necessary in order to improve safety and accountability

Ensure the public is fully informed about risks associated with drugs undergoing or have undergone clinical trials.

Ensure processes in place are evaluated regularly, so that physicians, pharmacists and the consumer are aware of adverse drug reactions as early as possible.

It is the responsibility of the Minister of Health to protect the health and safety of Canadians.

Replies from the office of the Hon. Libby Davies, Federal NDP Health Critic (in conjunction with NDP Critic for Science and Technology Kennedy Stewart and NDP Environment Critic Megan Leslie)

1. In your opinion, what is the role of the federal government in health care?

We need a federal government that makes health care a priority like Canadians do; a government that is actively engaged with provinces and territories to ensure that Canadians continue to have access to high-quality public health care throughout their life.

The NDP believes that, in order to achieve that goal, the government must meet with the provinces and territories to:

establish a pan-Canadian pharmaceutical strategy that guarantees access to affordable and safe prescription medications;

develop a continuing care strategy, to provide comprehensive community care and long-term residential services;

reduce wait times for access to care and ensure a community health care provider for every Canadian;

help create social and economic conditions that allow every Canadian to lead a healthy life.

In contrast, the Conservatives have regularly refused to meet with provincial and territorial Health Ministers, and unilaterally cut $36 billion from provincial health transfers —even before provincial Health Accords come up for renegotiation in 2014 .

To hear more about the NDP’s vision for the federal role in health care, go to: ndp.ca/health

2. With the nature of health care changing (less hospital, more alternative providers, more prescription drugs), how should Medicare be changed to meet the needs of Canadians?

Health care is a priority for Canadians, and it should be a priority for their government too. New Democrats are committed to ensuring Canadians have access to sustainable, affordable, and high-quality public health care in every corner of the country. Working in collaboration with the provinces and territories, New Democrats would bring Medicare into the 21st century.

The federal government should work with provinces and territories to ensure Canadians have access to better coverage for prescription medications at a lesser cost, by expanding and maintaining public coverage and ensuring that bulk buying reduces costs.

More and more Canadians have multiple chronic conditions, such as diabetes, asthma, or heart conditions, which are best addressed through services in the community rather than the hospital waiting room. Access to community care clinics that offer a variety of practitioners, including nurse practitioners, family physicians, physiotherapists, dieticians, and mental health treatment, must be expanded across the country.  Canadians, and particularly seniors, deserve more options like home care and more affordable and reliable residential care.

We need to improve the social determinants of health – factors such as access to nutritious food, active living, clean drinking water, education, adequate incomes, and affordable housing. These have the largest impact on the overall health of Canadians and, when unattended, create significant costs for the health care system.

Finally we need a commitment to long-term and stable funding for health care.  Whereas the Conservatives have unilaterally imposed $36 billion in cuts,  New Democrats would uphold the agreed-upon 6% escalator in federal health transfers and work with provinces and territories for a new set of health accords that ensure improved health outcomes for Canadians.

Now is the time to start building the next generation of health care in our country. To find out more about the NDP’s vision for the future of health care, check out: www.ndp.ca/health

3. Is there a role for an independent science advisor to the federal government? If not, why? And how might scientific advice be better sought by or provided to government?

The Conservative rejection of science is especially offensive, but it has long been a challenge for science to be accurately represented within policy processes and political discussion.

One idea we have heard during the early stages of our consultations to strengthen science in Canada is to create a Parliamentary Scientific Officer – much like the current Parliamentary Budget Officer. This independent office of the legislature could be appointed by a legislative committee and empowered to study the widest possible range of issues related to natural, health and social sciences.

His or her non-partisan, expert, and public assessments would provide Canadians with advice they need to deal with issues that will dominate Canada for the foreseeable future regarding the economy, security, health and the environment. This is one option that deserves serious consideration, but certainly an NDP government would ensure better internal support and promotion of science and evidence in policy making.

4. How do you ensure our health policies are informed by good evidence?

New Democrats understand that health care policies must be backed by a wealth of good evidence.

As an example, our health critic Libby Davies has worked with a variety of organizations in the health and scientific community to draft her Bill C-460, An Act respecting the implementation of the Sodium Reduction Strategy for Canada. Researchers and expert organizations presented compelling evidence that reducing the amount of salt in our food would prevent up to 23,500 cardiovascular disease events, and in turn, the deaths of 10,000-16,000 Canadians every year.  Bill C-460 illustrates how the federal government can consult the health and scientific communities to develop policy responses that tackle pressing health issues.

Consensus is building that ensuring every Canadian has the opportunity to lead a healthy life –through access to healthy food, affordable housing, and decent incomes – is the best way to prevent persistent health problems.

We need evidence and research to inform what policies can best tackle these issues, what experts call the social determinants of health, but the Conservatives have cut government science and are not listening to the evidence of their own researchers. The Public Health Agency of Canada is being eroded, despite its vital role of oversight of public health for the Federal government.

5. Sometimes all that’s known in health research is not reflected in the policies that are made. Do you have any particular plans to close the research to action gap in this country?

There is a clear knowledge gap between Conservative policy makers and those impacted by government policies, including Canada’s leading health researchers. To close this gap we must rebuild trust with researchers and garner direct input from them through substantive consultations.

Additionally, provinces and territories must be treated as partners rather than opponents. As provinces carry the bulk of health care cost burden, they have a tremendous potential to promote R&D through procurement policies. They also invest directly in Science &Tech (S&T) and develop expertise relevant for policy areas (‘clusters’) within their jurisdictions. We need to better coordinate these efforts and support this process.

We believe that the Federal Government must build a healthy and respectful relationship with the health and scientific communities, as well as with the provinces and territories, to determine the important health care issues facing our country and to develop policies that provide the funding and programs needed to address them.

New Democrats are taking a leading role on this, working with scientists and researchers across the country to develop a national science policy. See www.kennedystewart.ca  for the first in a series of discussion papers, “Toward a National Science Policy for Canada”.

6. Do you have any plans for measures and benchmarks for federal investments in science and medicine, to ensure accountability and that money is being spent wisely and with good results? If so, what do these look like?

First, we have to recognize that overall government S&T funding is declining. Second, we need to follow other OECD countries and publish data on the percentage of government funds used for discovery research and the percentage used for applied research. Once we have these input benchmarks established, then we can work on output measures.

In terms of discovery research, payoffs through commercialization often do not materialize until decades after the original investment.  We need to continue to rely on the production of peer-reviewed publications to assess research progress – although new assessment measures such as ‘article impact’ will help refine these standard measures of success.

In terms of applied research, we need to work more closely with international partners to develop effective measures, for example looking at how research leads to cluster development in particular cities and regions. Parliament should receive regular reporting on these benchmarks.

7. There is a growing acceptance that universities need to engage more with industry and other non-academic partners, but there is some concern about how and where basic research is going to be supported. How do you ensure support for basic research amid this emphasis on industrial R&D?

The NDP recognizes the important work that arises from academic-industry collaboration, but we assert that the decision to work with industry must be made freely by individual researchers, not be forced upon them because public funding for basic research is no longer available.

For example, Conservative budget cuts to basic science have forced the National Sciences and Engineering Council (NSERC) to terminate the Major Resources Support (MRS) program, radically restructure the Research Tools and Instruments (RTI) grants, and reduce NSERC Post Doctoral Fellowships funding.

It is misguided to put the onus on universities and researchers for low levels of innovation rather than recognizing their achievements despite dramatically reduced funding. Instead, we must focus on where stimulus is actually needed to promote industrial R&D. While this budget cycle sees a six percent reduction in government spending on R&D in Canada, our international competitors are continuing to invest smartly in proven fields of growth.

The Jenkins report on innovation states the onus is on industry to seek out and invest in new ideas. Unfortunately, the Conservatives paint discovery researchers as failing and then use this narrative to shift money away from basic research and toward industry subsidies. This is a dangerous game as it undermines the highest functioning segment of Canada`s innovation ecosystem.

The NDP believes in science and our scientists. We are working with the research community to undo the damage Conservatives are causing with this tactic.

8. At the recent Science Policy Conference in Calgary, a key topic of discussion was the question of how to increase private sector investment and involvement in research and development, since the scientific community is concerned that despite having one of the most generous incentive programs in the world it doesn¹t seem to be working effectively. What does your party believe is the problem and how might you address it?

In his plenary speech at this year’s CSPC conference, the NDP critic for Science and Technology Kennedy Stewart, made this exact point. One of our major economic problems is our abysmal productivity rate, in large part caused by a lack of private sector investment in R&D.

Conservative policy in this area is confused. They speak to the importance of stimulating innovation and growth but then cut the SR&ED tax credit program by $500 million per year, and reduce innovation funding. They say they value science and then cut 1500 scientists from federal institutions and muzzle those who remain.

New Democrats are consulting widely across the innovation ecosystem to discover what causes this productivity gap and developing policy to place Canada in a position of strength in the highly competitive global economy.

9. Can you describe your health research priorities?

Research into the safety and efficacy of medical treatments is a key priority. The letters and emails we receive from Canadians request more research into new or emerging treatments for many illnesses, such as MS, rare diseases, juvenile diabetes, Autism, as well as better investigation of the safety of current prescription medications.

Canadians are worried the government is making health care decisions based on ideology or misinformation, rather than supporting or paying attention to the research.

The process for federal funding of health care research should be largely guided by the health care research community through a rigorous peer-review process and extensive consultation. The process should be transparent and accountable.

One idea we have heard through our consultations on science policy is rather than cabinet appointing the head of major funding agencies such as CIHR, NSERC, SSHRC and NRC, these agency heads should instead be elected by the scientific community. While this idea needs further exploration, in combination with other accountability mechanisms it is one way to further insulate research funding from the partisan interference we currently experience.

10. Given that health research is largely managed federally but healthcare funding and delivery is managed provincially, is Canada achieving optimal coordination and proportional impact in its health research investment?  If not, what would better structures or links look like?

As long as Conservatives continue to actively undermine opportunities for federal and provincial cooperation and sustain coordinated attacks on scientific research capacity, we cannot achieve optimal health coordination or impacts for Canadians.  The Conservatives are set on waging a war on knowledge by abolishing critical health research tools such as the long-form census, while at the same time firing hundreds of federal government researchers, muzzling scientists, and massively reducing funding for science and technology research.

A better approach would be for Canada to work with the provinces to become a global health research leader. Cooperation will require a “no surprises” approach where the federal government provides predictable and adequate funding to healthcare research programs with minimal political interference. The federal government should also work with provinces to make important health data available to researchers while protecting privacy.

11. There is concern among health professionals, particularly in motions passed at the Canadian Medical Association annual meeting this summer, about the study and data availability on the effects of the fracking and oil sands industries on health. One suggestion was to establish an open and centralized database with mandatory reporting by independent researchers, government and industry on all data collected on the effects of resource extraction projects on health and the environmental determinants of health. What do you think of this idea? Or how do you plan to address this concern?

Part of protecting human health is to ensure that industrial projects affecting our environment – including fish habitat and watersheds – undergo rigorous environmental assessment. These should always incorporate analysis of a project’s impact on climate change and related human health implications.

New Democrats oppose the dismantling of environmental assessment in successive Conservative omnibus budget bills. Effective and comprehensive environmental assessment, including analysis of cumulative effects of multiple projects, has long-term economic benefits as it prevents environmental degradation affecting human health, particularly with respect to the monitoring and maintenance of water, soil and air quality.

In our report, Missing in Action, prepared in response to the parliamentary committee study on the oil sands in 2010, New Democrats called for an independent study and long term monitoring of the health impacts of oil sands development on people, particularly for those living downstream and downwind.

New Democrats also strongly support the mandatory disclosure of fracking fluid components. Although industry is favourable to stricter disclosure requirements, the federal Conservatives are pursuing a voluntary approach, not mandatory chemical disclosure. Federal New Democrats have advocated examining federal legislation like the Canada Water Act and the Canadian Environmental Protection Act, to ensure that the provisions that protect drinking water and water resources are adequate.

12. The World Health Organization calls climate change the greatest global health threat of the 21st century. What steps are you taking to tackle this challenge?

The potential human and social costs of unchecked climate change are staggering. Managing the impacts of climate change could cost $5 billion per year by 2020, particularly because of its negative impact on health outcomes. Federal leadership is required here in Canada and internationally on the issue of climate change; it is a matter of national security.

A NDP government would strive to provide a framework for ambitious, science-based reductions in greenhouse gas emissions. This framework would achieve the national emissions reduction target of 80% below 1990 levels by 2050, through policy tools that will not only cut GHG emissions, but also create jobs, provide regulatory certainty for industry and save Canadians money.

It is also essential that programs be put in place to help Canadian communities adapt to and mitigate the impacts of climate change, including health impacts. The reality is that taking action on climate change means cleaner air and water, which improves health outcomes.

Internationally, Canada must work to achieve a fair, ambitious and binding agreement with our global partners, so that we can avoid a 2° increase in the planetary temperature. Increases over two degrees would lead to massive flooding of low-lying areas, untenable ocean acidification, and extreme weather including drought, all of which will seriously affect agriculture, fisheries, food production, human migration and human health.

Ambitious action will place Canada advantageously in the race to develop and manufacture leading green technologies. There is great economic potential in leading the world in efforts to pass on a healthy planet to future generations.

13. As other jurisdictions have moved ahead with clinical trials registries and other types of oversight and stringent regulation of clinical trials, researchers have called Canada¹s regulatory response inadequate and comparatively weak.  How do you plan to address and respond to those concerns?

The federal government has a responsibility to institute a clear and transparent regulatory process, to ensure that Canadians receive safe and adequate treatment.

As it is, Health Canada does not track and release information about the clinical trials used to determine the safety and efficacy of prescription medications, even though the FDA follows such a system.  This undermines the ability of medical professionals and patients to make decisions about what medications best treat specific illnesses.

Well-regulated clinical trials bring important human, social, and economic benefits to Canadians. Patients can benefit from cutting-edge medical developments, and researchers can work at the vanguard of their fields. It is also an integral part of the health R&D ecosystem, providing millions of dollars and thousands of jobs.

A leadership role for the government in this area would improve safety for Canadians and help generate important research. A bold vision for the integration of research and health care could include sustainable infrastructure, staffing, resources, and career support for the generation and integration of research. It could provide a focus on patient care and more stimulus for patient-oriented research.

 




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