Question: 1. In your opinion, what is the role of the federal government in health care? 
Hon. Leona Aglukkaq, Federal Minister of Health: 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 2. With the nature of health care changing (less hospital care, more alternative providers, more prescription drugs), how should Medicare be changed to meet the needs of Canadians? 
Hon. Leona Aglukkaq, Federal Minister of Health: 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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…”Because the Conservative government, in 2006, walked away from these elements of the Accord, little has been done to achieve this objective.
Hon. Libby Davies, Federal NDP Health Critic: 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, dietitians, and mental health treatment, must be expanded across the country…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.

Question: 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? 
Hon. Leona Aglukkaq, Federal Minister of Health: “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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 4. How do you ensure our health policies are informed by good evidence? 
Hon. Leona Aglukkaq, Federal Minister of Health: Response combined with answer to question 5.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: Health care policies must be backed by a wealth of good evidence. 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.

Question: 5. Still 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?
Hon. Leona Aglukkaq, Federal Minister of Health: Health policy decision-makers and health care professionals need evidence to deliver high-quality, appropriate, and effective care. The Government of Canada, though Canadian Institutes of Health Research (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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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? 
Hon. Leona Aglukkaq, Federal Minister of Health: Federal investments in science take many forms. In Health Canada’s portfolio, we make investments in university-based health research through the 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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?
Hon. Leona Aglukkaq, Federal Minister of Health: 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 the 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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?
Hon. Leona Aglukkaq, Federal Minister of Health: I would refer you to Minister Gary Goodyear’s office to respond to this question.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: In his plenary speech at (the) 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.

Question: 9. Can you describe your health research priorities? 
Hon. Leona Aglukkaq, Federal Minister of Health: 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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? 
Hon. Leona Aglukkaq, Federal Minister of Health: 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 CIHR, 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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. How do you plan to address this concern?  
Hon. Leona Aglukkaq, Federal Minister of Health: 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.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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?   
Hon. Leona Aglukkaq, Federal Minister of Health: I would refer you to Minister Kent’s office, as Environment Canada is the lead department on climate change.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.

Question: 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?  
Hon. Leona Aglukkaq, Federal Minister of Health: 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 Boards, ‘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.Finally, Health Canada is planning on publishing information on its website about all clinical trials to be carried out in patients.
Hon. Hedy Fry, Federal Liberal Health Critic : 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.
Hon. Libby Davies, Federal NDP Health Critic: 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.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.