HEALTH
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Mr. Chairperson (Marcel Laurendeau): Would the Committee of Supply please come to order. This section of the Committee of Supply has been dealing with Estimates of the Department of Health. We are on item 1.(b).
Would the minister's staff please enter the Chamber at this time. We are also by leave dealing with the Health of Manitoba's Children report.
Mr. Dave Chomiak (Kildonan): Considering the minister's comments, I just want to take us back to the recommendations on page 135, and the minister talked a bit about the history of the children's dental plan, et cetera, but there is a specific recommendation in here that says that in those areas where dentists are unavailable or cannot be recruited, the use of alternate and complementary dental personnel should be considered.
I am just wondering what the status is of that particular recommendation.
Hon. James McCrae (Minister of Health): Mr. Chairperson, earlier today I agreed to hand out our Interdepartmental Protocol Agreement between the ministers of Education and Training, Family Services, Health and Justice for the Co-ordination of Services for Children/Adolescents with Severe to Profound Emotional/Behavioral Disorders. I will do that now.
With respect, Mr. Chairperson, to the oral and dental health of Manitobans and specifically Manitoba children, we have some existing programs which I will briefly outline for the honourable member.
We have the community water fluoridation program. That is facilitated by Manitoba Health. There are 61 treatment plants in Manitoba serving 83 Manitoba communities and they are optimizing the fluoride content in the water. This is reaching more than 750,000 Manitobans and is considered the most effective, preventive measure against dental decay. That is one of the things that is making a great difference in oral health in this particular generation.
Secondly, there is a weekly school fluoride rinse. This rinse program is offered to all rural Manitoba schools funded and facilitated by the department. Approximately 65 percent of rural schools are participating.
Thirdly, there is resource distribution. Educational materials are available through the department for classroom and for group presentations.
Fourth, there are the community grants in 1994-'95. There is $40,000 to the nursing caries committee, a northern rural community facilitated lifestyle education and resource development project to address nursing caries or what they call baby-bottle caries.
The Swampy Cree Tribal Council received in '94-95 a $10,000 grant for community dental health projects. A smaller grant to the Manitoba Dental Association of $2,100 has been made available for resource development.
We support the first free dental visit program aimed at children under three years of age. This involves a free check-up and education session provided in dental offices. This is something for which I think there should be commendation to the Manitoba Dental Association because what it does is at an early age, it makes children and their parents mindful, mindful of oral health issues and also helps bring about a comfort factor level for the young potential dental patient.
In the developmental stages are the following items. There is an oral strategy document for our province being prepared. There is, of course, liaison with the Child and Youth Secretariat to review the recommendations of the Child Health Strategy document that was recently released. Here again, the Youth Secretariat is at work, Mr. Chairperson.
There has been mandated a plan to establish a preventive oral health strategy, and this will bring all the stakeholders to the table to discuss oral and dental health needs for all Manitobans. All private associations will be involved. Educators and allied health workers and the public will be involved. The provincial strategy document will be discussed, and children's, youth, aboriginals, and seniors needs will be targeted. Issues involving access to care and professional regulation will be addressed, as will professional associations' new responsibilities in public health.
It should be noted that the equipment and supplies formerly utilized by the Children's Dental Program have been distributed to communities throughout the province for utilization in dental treatment programs. Recipients of this equipment included hospitals, health centres, educational facilities and personal care homes.
To date, three communities have attracted new satellite dental offices by having the available equipment to offer to a practitioner.
So we are able to offer a variety of programs in our province dealing with oral health, dental health.
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Of course, this is an important aspect of health and we look forward to continuing our work in developing further strategies that are in the development stages now.
We look forward to the work of the Youth Secretariat and working with other Manitobans to develop a healthy, preventive oral health atmosphere in our province.
Mr. Chomiak: I thank the minister for providing me with a copy of the interdepartmental protocol agreement. Can the minister indicate who is on the provincial co-ordination of services committee? Does he have a list of individuals who are on that committee?
Mr. McCrae: We will obtain the names for the honourable member.
Mr. Chomiak: Mr. Chairperson, I am just reading through this protocol. It differs in form, a little bit, from what I am most familiar with, having reviewed them in other jurisdictions. I want to understand how this process works. We have the provincial co-ordination of services committee which basically, from the way I read this protocol, it is the entry point into the process.
This may seem like an overly bureaucratic question, but I think it is significant, and that is, the protocol indicates that submissions to the committee can be made by contacting the particular representative at the various departmental offices. It just seems to me that the entry point--if the individuals enter, say, a Child and Family Services office in whatever location of the city, who will be there to direct them, as the case may be, or how will they be entered into the system and determine that they are appropriate to enter into the system? Who will do that?
Mr. McCrae: I do not think the honourable member was asking a bureaucratic question. I think that what we are trying to do is steer clear of too much bureaucracy, so his question is important.
This multisystem process is initiated at the local level between the various caregiver organizations or groups who are being given copies of the protocols. All the people in the field are being made aware of the various co-ordinating bodies and groups so that you cannot just say you are going to have co-ordination without letting people know how it is going to work. That is being done by making the protocol agreement and how it is supposed to work available to all the caregivers in a form that will bring about the result that the member is looking for.
Mr. Chomiak: That does help answer the question. In terms of form, is this protocol presumably signed off and now actually functioning in the system throughout the province?
Mr. McCrae: It is signed off, Mr. Chairperson, in the sense that there is agreement that this is the direction we should be going. It now remains for us to implement by way of making sure training happens in areas where that is required. There is agreement and now it is getting everybody singing from the same sheet as it were.
Mr. Chomiak: I am only aware of one other protocol of this kind in Manitoba and it relates to education for individuals who are beyond school age, if I recall correctly. Are there any other protocols that have been entered into or being negotiated at this point, in this area, in the field of children's health?
Mr. McCrae: Mr. Chairperson, the project respecting medically fragile children works essentially the same way.
Mr. Chomiak: Just returning again quickly, I hope, to the area of oral health, one of the recommendations on page 135 is that regulations of alternative dental health personnel be reviewed, et cetera. This has been talked about for some time. Can the minister indicate whether we are anticipating any change in any of the regulatory authorities concerning dental health in the near future?
Mr. McCrae: Mr. Chairperson, the honourable member is right. There has been a lot of talk about the regulation of professionals. The Law Reform Commission, as the honourable member knows, has released its report on that issue. Just by way of background, not to drag this out, but by way of background, the Law Reform Commission was something that was going to be wound down at one time, and when we took office in 1988 in that very first session--I remember it well because I was the Attorney General--one of the first pieces of legislation we brought in was to reconstitute the Law Reform Commission, which was being wound down at the time.
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We put legislation before the House to guarantee the independence of the Law Reform Commission, and since that time the commission has done some important work, and before that time as well, but important work in the area of professions. That includes legislation for judges and that type of thing. I think the most extensive project the Law Reform Commission has ever been involved in has to do with the regulation of professionals, and that is the report that I am talking about now.
The commission has released information on dental auxiliary self-regulation and the issue of private associations serving as both the licensing body and an association for members. The Manitoba Dental Association, I am told, prefers that the status quo be retained. On the other hand or on the contrary, auxiliary groups have lobbied for a long time for self-legislated regulatory privileges.
Some of the information I have is more detailed than I think the honourable member was looking for. The point I think I should make, even though many of the professions dealt with by the Law Reform Commission are health related, the Minister of Justice has been the designated minister because the commission itself comes under her responsibility. Her department and other departments have been working on reviewing the Law Reform Commission report. It was a very important one; it took a long time to prepare. We are all reviewing that report with a view to which direction we might go in the future with respect to the regulation of health professional organizations.
Mr. Chomiak: Mr. Chairperson, turning to recommendations regarding smoking, there has been virtually unanimous support for actions to deal with smoking, particularly to prevent young people from becoming smokers. I wonder if the minister has any update as to the status of this situation, particularly in regard to children and youth and particularly in regard to the whole question of enforcement that seems to be one of the key issues surrounding the activities of youth and smoking.
Mr. McCrae: While we are preparing to answer the honourable member's question, I would like to ask him a process question if I may. Was it tomorrow that the honourable member wanted to discuss SmartHealth, or does the honourable member want to wait until it comes up next week under the appropriate line? If the honourable member wants to discuss SmartHealth tomorrow, that is all right. We will have appropriate staff here for that.
Mr. Chomiak: Mr. Chairperson, I appreciate the minister raising that. My sense is, subject to the discussion with the member for Inkster, we will continue throughout the appropriations tomorrow and probably will not get into SmartHealth until Monday, right on the particular line of SmartHealth which I think is 2.(c) if memory serves me correctly.
Mr. McCrae: Mr. Chairperson, with respect to the question about smoking raised by the honourable member, on October 31 of last year, the nonsmokers health protection act was proclaimed. The act allows for prosecution of people who sell tobacco products to minors. It also protects the public from exposure to environmental tobacco smoke by restricting smoking in public places.
A general information campaign about these legislative changes was conducted in January and February of this year. This included notification of all restaurant owners in Manitoba about the legislative changes. Public health professionals are also working with the communities to create awareness of the health hazards of environmental tobacco smoke.
Health Canada has four inspectors in Manitoba who specifically respond to complaints about the sale of tobacco to minors. All tobacco retailers in Manitoba have been informed about the penalties for selling to minors.
Manitoba Health has also been working closely with Manitoba Finance on the smuggling issue. To date, smuggling of tobacco products into Manitoba is being controlled through a vigilant surveillance system.
Finally, Manitoba Health has been co-ordinating provincial initiatives funded by Health Canada under the tobacco demand reduction strategy. This amounts to approximately $1 million in grants to communities over the next three years. All these things probably are important to do, in any event, but they have been made even more important because of the actions of our federal counterparts. This is an area of some criticism that I feel is deserved by the federal people.
I remember the first opportunity I had to meet the new federal Liberal Minister of Health, it was, I guess, February or March of last year, on the very day that the federal Liberals decided to let the smugglers run our health policy in Canada and our tax policy. It was that day that I met the Health minister for the first time. It was not the most auspicious beginning for a federal-provincial relationship. I know the federal Minister of Health was very embarrassed by the whole situation.
I hope the federal government has improved since that time in the sense that it is the government and not the smugglers--I guess, on the basis of concerns about the province of Quebec, and aboriginal concerns and whatever, the federal government decided to wilt and crumble and turn over tobacco tax policy to criminals. I think, from a policy standpoint, allowing criminals to make the most important negative health decision in the history of this country was the wrong move. That was the way that decision was described, as a negative health decision and it was a very, very important one because of the damage that it does to all the programs. Then everybody talked about putting funds together to really do something about this problem and spend all these dollars to do advertising and all the rest of it. It is almost like arm wrestling with yourself. That is about how productive this has all been.
In any event, in Manitoba, I am told by the Minister of Finance (Mr. Stefanson), the last I heard is that our strategy is working reasonably well and we have on the smuggling part anyway, although we do not win all our battles, we think that--judging by revenues at least, we are able to keep, it appears, smuggling to a minimum. That is important. Any smuggling will be too much. I needed to say that because I felt so badly for the federal minister who really was not able to carry out the function of a federal Health minister on that occasion. It is always a dangerous thing to allow criminals to take over for the government.
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Mr. Chomiak: Mr. Chairperson, the two recommendations on smoking, namely that a drug and alcohol education unit of health be delivered on a mandatory basis, and that Bill 16 be enforced and necessary regulations developed with a clear strategy, where are we in the status of those two recommendations?
Mr. McCrae: With respect to Recommendation No. 54, that the drugs and alcohol education unit of the health education curriculum, I am advised that it is not at this time delivered on a mandatory basis, to address smoking within a preventive framework. I say at this time, because we really only received this recommendation a couple of short months ago. Bill 16 is in force but, like so many other bills that constrain people's behaviour, it is only enforced on the basis of complaints received.
Mr. Chomiak: Is the minister aware whether there have been any convictions under Bill 16?
Mr. McCrae: We will obtain that information. We are not certain if there have been any.
Mr. Kevin Lamoureux (Inkster): I appreciate the minister providing copies of the Health of Manitoba's Children. I actually had my first opportunity to read through parts of it since this morning, and I have found it to be extremely enlightening. In fact, I would go as far as to say it is probably one of the best prepared reports that I have encountered, and I extend my compliments to all of those that no doubt put in a considerable amount of effort in bringing forward this document which will hopefully be well utilized by this government.
I can speak for my part that it is my intention to refer to this, no doubt into the future, as a document that has a lot of substance, and if the government were to take action on a number of these things, no doubt we would see a lot of things happening that would be very positive to the children of the province.
(Mr. Frank Pitura, Acting Chairperson, in the Chair)
One of the big issues during the campaign, and I think the issue which in all likelihood the Liberal Party leader was most successful at getting on the agenda, was the whole issue of child poverty. In what reading I have done of this, it again illustrates the importance of us addressing that particular issue amongst everything else that is made reference in it.
On the conclusions on page 125, I was interested in the one recommendation where it makes reference to the need to convene a youth health forum that would basically look at, review and possibly come up with some recommendations for the government. I see it as actually a very positive way of trying to ensure, even though this document itself is very thorough, some sort of feedback, and I would solicit the Minister of Health's opinion on that particular recommendation. What his intentions are to do from this point, realizing of course that he has had this document, if you take out the 35 days of a campaign, only for a few weeks. I do not expect that he has achieved every recommendation in there as of yet.
That one particular recommendation, in the conclusion, I am interested in knowing if the Minister of Health does intend on acting on that particular recommendation and, if so, when would we anticipate something? Even if I can make the suggestion that I have attended the parent councils, parent forums that the government has put through with respect to education and I was quite critical in the past in terms of the timing of them being called, and so forth.
I do believe that, and you can virtually guarantee representation throughout the province by allowing, for example, and I just use it as a suggestion, that in each area, each provincial riding, if you like, 10 delegates coming, whether it is to the Convention Centre or a school facility in which they can be provided copies of this particular document.
There are fairly extensive lists of individuals that have the experience and credibility to be able to comment on such a report and that we take advantage of that, not too far in the distant future, because I would anticipate that the government is going to want to start taking virtually immediate action on some of the recommendations that are there. Others, there might have to be some other form of a time schedule put into place. I would think getting some sort of that public feedback should be something not too far in the future. I would ask the minister for his comments on that particular recommendation.
Mr. McCrae: I thank the honourable member, too, for his very supportive comments respecting the document the Health of Manitoba's Children and the work that went into its production. The recommendation he talks about is the one about a youth health forum to review the recommendations in the report and to serve as an ongoing resource to Manitoba Health. Indeed, there were some 50 people involved in the production of this report and their work involved very, very significant consultation throughout Manitoba. We have a good thing going in the sense that that consultation, combined with the success that the honourable member referred to of his leader and others in raising the issue of poverty amongst Manitoba children, we have laid, I think, all of us, a very strong foundation for further efforts in that regard by way of a forum or by way of further consultation.
I am assured that the consultations that will flow as a result of this recommendation and this report will be very, very significant. We have not got it all tied down as to what it is going to look like, but we expect some pretty major attention to be drawn to this particular issue by virtue of our efforts this coming fall, and the honourable member, of course, is welcome to be part of any effort like that. I think that if he concentrates his efforts and those of his colleagues on the issues of children, children's health, poverty amongst children, then their time and mine as servants of the public will have been well spent.
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I feel very, very strongly about issues related to children, probably more because children find themselves in the circumstances they do less because of their own fault than other people do. You know, you get older and maybe you have to take some responsibility for whatever your lot in life happens to be. When you are younger, or a young child, it is a little sad to think that there are children who are quite disadvantaged and it is no fault of their own whatsoever. So, for that reason, I agree with the honourable member, and in a whole lot of other reasons, too, but that one for sure that we have to bend every effort in the direction of achieving some of the ends envisioned in this report.
There are indeed other very good reasons for doing it besides the fact that our hearts do go out to the children, I am sure. But they are a wonderful investment in the future if the investment is well placed, and this report helps us to focus and give some direction to the type of investment we ought to be making. So I welcome the participation of the honourable member in the discussion and in further discussions, and I expect that in the fall of this year he will see some very significant discussions happening around this issue.
Mr. Lamoureux: Recommendation No. 96 is an issue in which I have long been somewhat of a strong advocate, and that is the whole question in terms of the roles of our schools. I have always believed that we do not utilize some of the spaces, some of the potential resources that are out there that could be incorporated into our schools.
In fact, I talked about the idea of having a pilot project, if you will, where we would see different departments actually within a school facility so, for example, you might have nursing, Family Services, Justice all working together within the school, as opposed to having, here is a social officer, a health-care worker is dealing with this family in many different ways, or a particular student. There is no co-ordinated approach.
When I see in Recommendation No. 96 that in fact we seem to acknowledge that the schools do have that primary delivery, if I quote right from it, primary delivery site of community-based child health care programs. I think it is something which could and should be acted upon once again in the not too distant future.
When I look through the many different recommendations that are there, is the minister looking at the possibility of announcing potential pilot projects on any of the current recommendations that are there, again, knowing full well that he has only been dealing with the report realistically for the last three weeks as the Minister of Health? Are there areas, in particular, recommendations--and I do not need a detailed response now, but rather here are the recommendations in which we believe we can act upon short-term, mid-term, long-term type thing and the idea of pilot projects. Do we see anything in the not too distant future for some of the recommendations?
Mr. McCrae: I do indeed, Mr. Chairperson, see some initiatives coming forward as we get our Youth Secretariat more and more established. It is established now, but it has work to do in the sense of bringing more of an understanding of this particular approach amongst mainly four departments--Health, Family Services, Justice, Education and Training--together. That is a major part of the mandate of this secretariat.
We did make, I think, some important signals and first steps on March 17 when we released this report on the same day. Monies were transferred from Health to Education and Training to provide nursing services and also to provide some training for teaching professionals in the system with regard to certain children in the system. So some beginnings have been made. I think they were auspicious and important in the sense they signalled the intention of the government as to the direction it is going to be heading.
I do not have a lot of detail for the honourable member, as he already knows, but it may include such ideas as experimental projects or pilot projects that can show to us the efficacy of a certain approach and that could later be applied throughout the system.
While our minds are open, we are also given some direction in the Child Health Strategy report, which we already know we do not really have to pilot because there are sufficient population health data referred to in making these recommendations. I do not say no to any of those ideas the honourable member is raising. I do say that we are in a fairly formative stage yet, but we are determined to move forward.
As I said in answer to one of the questions from the honourable member for Kildonan, I believe that the first steps will be the slower ones. Then as we can see results happening and we can get the so called buy-in from the various components of the Health, Education and Family Services departments then we will see progress snowball later on.
(Mr. Chairperson in the Chair)
I think there is a necessity because we are changing the way we fundamentally do things. The first steps will take a little longer and the subsequent steps will happen with more rapidity.
Mr. Chomiak: Mr. Chairperson, turning to page 133 and in reference to the Child Protection Centre, the Child Protection Centre, I am aware, does some outstanding work. There is a recommendation that an abuse treatment co-ordinator be funded on a full-time basis at the Child Protection Centre.
Can the minister provide me with details as to the funding for the Child Protection Centre and the number of staff years involved? I believe it is funded from Health.
Mr. McCrae: You know, it is a sign that we are getting into more integration when the honourable member asks me a question like that, because, unfortunately, it is my fault, or whomever, not the honourable member. This is a Family Services question the honourable member is asking, and, yet, it is appropriate that it be asked here because we are now talking about more integration.
We will either do it one of two ways. We will ask the Family Services department for the information to pass on to the honourable member or honourable members can raise it in Family Services Estimates. Whichever way the honourable member wants it, is okay.
This is the kind of change we are both going to have to adjust to as we begin to think more multidimensionally.
Mr. Chomiak: Yes, I would appreciate it if the minister could provide me with that. I was under the impression that it was actually funded through, and I guess I was wrong, I thought it came through Health.
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The recommendations on nutrition, I have a myriad of questions. I am going to try and go a little more quickly so I can cover more territory. The nutrition questions, I just wonder if the minister can capsulize for me. There has been a study now by the dieticians and nutritionists the minister has received. That report came out, I believe in February, dealing and covering some of these areas. We have the recommendations on the Health of Manitoba's Children. I am wondering what the status is of the nutrition recommendations and, in particular, the one dealing with food supplements for prenatal women as it impacts quite directly on health.
Mr. McCrae: Again, we say it as part of a list of things that we should be working on in the area of the health of our children. We talked about nutrition, and so I am glad the member has asked a specific question about it. The leader of the Liberal Party during the campaign, recent campaign, talked about a free breakfast or a free lunch program--I forget which, breakfast, I think it was--to be made available for every child, and I disagree with that approach in the same way that I disagree with the universal approach to the delivery of dental health treatment services. I do not think that we can afford that sort of approach.
There are so many families that are able and willing and do on a regular basis ensure that the nutritional needs of the children are met. I agree with what the leader of the Liberal Party was trying to put across, that kids need to get proper nutrition, or they are not going to learn, they are not going to thrive. I just could not see why the universal food or meal program should take the place of a caring family environment which nurtures in that way. That is a difference in approach rather than in substance, because basically we all agree about nutrition.
In July of 1994, Health Canada announced the Canada Prenatal Nutrition Program designed to reduce the incidence of low birthweight infants, a matter raised by the honourable member for Kildonan (Mr. Chomiak) and his Leader on frequent occasions. Financial assistance will be provided to nonprofit organizations who deliver community-based nutrition services to economically disadvantaged pregnant women. Components may include food supplements, lifestyle counselling and referral to other agencies. Allocations to this Canada Prenatal Nutrition Program are as follows: 1994-95, $186,000; 1995-96, $186,000; a significant increase in 1996-97, up to $444,800; and for 1997-98, $433,500 on an ongoing basis.
This program is implemented through the existing structure of the Community Action Program for Children and is to be managed provincially through the joint-management committee. Manitoba Health has two representatives on this committee. Other departments include Family Services, Education and Training and Health Canada. A subcommittee of the joint-management committee responsible solely for the Canada prenatal nutrition program includes two representatives from Manitoba Health and one representative from Health Canada. Reference is made to this prenatal nutrition program in the report of Nutrition Services Review from October '94 and the Child Health Strategy in March of '95.
Probably more to the point the honourable member was raising too, although I think the last answer was very, very relevant too, I mean all these answers are relevant to these questions but he did ask specifically about the Nutrition Services Review. In October of 1994, the Nutrition Services Review Committee released its report, titled Nutrition Services in Manitoba: A Review, 1994. The committee comprised community and government members and was chaired by a community member.
The report--and I think the honourable member got this report very early in the process--identifies the nature and scope of existing nutrition services in the province, what is known about the nutritional state of Manitobans, and what evidence exists concerning the effectiveness of nutrition programs. The report suggests five main areas in which action is required: policy, planning, evaluating and monitoring, promotion of health professionals, healthy growth and development and food security, education of children and adults, intersectoral collaborations and enhanced service delivery. It makes 43 recommendations, some of which are directed at government, including Manitoba Health.
Approximately 800 copies of the report have been distributed across Manitoba to the public, community organizations and government. Staff are studying recommendations for their policy indications and to determine the feasibility of and requirements for implementation. Report findings and recommendations are being discussed with provincial and federal government staff at central and regional levels, including the Child and Youth Secretariat. The report has been instrumental in the development of the Manitoba Child Health Strategy, the Canada prenatal nutrition program and regional health associations. It has also prompted the development of an inventory of nutrition services in Winnipeg. That kind of thing is very important, I believe, as we make plans.
Discussions are continuing at the community level with representatives from professional associations, the University of Manitoba and other organizations, including organizations like the Heart and Stroke Foundation of Manitoba.
Mr. Chomiak: If possible, I would like a copy of the document Nutritional Sources in Winnipeg for information, if that is at all possible.
Mr. McCrae: We are not sure today if that document is yet available, but we would be wanting to share it with the honourable member.
Mr. Chomiak: I thank the minister for those comments. I am very pleased to see that the prenatal program nutrition is moving ahead. I agree we are in an era where we have to target these programs. It just seems to me that functionally it ought to be, and I know it is much more complex than this, but it ought to be relatively simple to move relatively quickly on a number of these programs, such as the vitamin D deficiency in aboriginal kids and the question of targeting low birthweight moms, et cetera. It seems to me that we could probably move fairly quickly to have a four- or five-pronged program fairly quickly as a result of all of these reports and recommendations. We actually have the infrastructure in place. I am wondering if we are looking for something to happen relatively quickly in that area along those lines.
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Mr. McCrae: It seems to me that it is generally agreed that we can identify, as the honourable member says, fairly quickly the need that ought to be targeted through nutrition program initiatives. I think there is agreement in the department that we should be moving as quickly as we can to address that. It makes so much sense to me, too, and like everybody else, do not forget that departments and agencies in the past have been directed by governments of one kind or another, and it is only in recent years that everybody seems to be smartening up. I think maybe departments have been probably pointing ministers in this direction for some time, and now we have ministers and members of legislatures and parliaments all willing to start looking at these things that the health people seemed to know about all along.
Mr. Chomiak: I am just moving on to page 132. I must apologize, I am not using the recommendations per the number. The copy that I am referring to seems to be an earlier version--actually I think it was the version that I got the day, March 17. It does not have the numbers beside it, so I apologize. When I say we are on page 132, I hope I am not confusing anyone.
Okay, the recommendation at the top I think is something that everyone agrees with, and it is clear that it is a recommendation for a headstart form of programming. I note that in the earliest planning document concerning this committee, that is, the Healthy Child committee--and the very earliest documentation was in fact tabled in this Legislature--much was made about the headstart program. Of course, not surprisingly, we see recommendations suggesting implementation of a program like this. I was also struck by the fact, when I attended a meeting, Mr. Ferguson at one time made the point, and I was struck by this, that he often feared that even if we got the kids by the time they were two years old, in some areas we were too late.
So I am just wondering, again this is one of these that is fairly fundamental, fairly significant--what are the department's plans? I mean, it seems it certainly strongly suggests a headstart kind of program. Where are we in the planning phase for this particular recommendation?
Mr. McCrae: Just for the member's information, the secretariat has identified zero to three as a target group because we agree with what the member said about that very early start.
I should tell the honourable member that my understanding of the history of the headstart concept is that it originated in the United States, so you have got to be careful, I guess, sometimes when you are looking at those sorts of things, but like our Bill 3 legislation here on drinking and driving, we borrowed from Minnesota, but Minnesota borrowed it from the Scandinavian countries, so it is all right.
Federal funding to Manitoba for aboriginal headstart, and I compliment the federal government for being involved in this sort of thing, was initially allocated as follows: year one, $854,000; year two, $3 million; year three, $4.4 million; and year four, $4.6 million and ongoing funding after year four. When looked at in a long term way that is a very good investment, I would suggest. With the recent federal budget reductions, these funding levels will be significantly reduced.
When you look at those numbers in national terms and they talk about reducing them, it is not a significant amount of money. This is the big criticism I have of the federal budget, that it lacks priority setting. If they had said that, you know, this is an area--I might not get after them if they were going to cut somewhere else, even in health, I might not get after them so much. These numbers are not big in federal terms, and yet here we see some cuts, and I do not think it is a very smart way of budgeting.
Aboriginal headstart projects will be designed, managed and controlled by aboriginal people. In September of '94 a provincial interdepartmental committee was established to make recommendations to Health Canada and to participate in collaborative development of the initiative. On September 30, 1994, federal Health Minister Marleau announced a grant of $50,000 to an aboriginal headstart steering committee located in Winnipeg to develop a national model to implement this initiative. This steering committee is an independent, stand-alone aboriginal, community-based group chaired by Ms. Josie Hill.
Manitoba will participate in this initiative upon invitation by the steering committee and Health Canada. We will be doing that. As yet, the amount of money that Manitoba Health will have in the project is not known, but we are committed to the project.
Mr. Chomiak: Can the minister indicate whether those figures, those budgetary figures that he provided, were Manitoba or national figures?
Mr. McCrae: I asked the same question. Those are the numbers for Manitoba coming from Ottawa.
Mr. Chomiak: So we have on the one hand, we have the federal initiative which appears to be in the process of being downsized, and we have provincial involvement in regard to the federal initiative. What other activities are taking place from an overall provincial standpoint to deal with the overall issue of what we are calling the headstart program?
The reason I say that is, for example, there are some types of headstart programs already in existence in Manitoba. One would presume they will be weaved together or expanded or brought in somehow. In other words, I guess the question is where is the province in this regard in terms of some of the specifics?
Mr. McCrae: Mr. Chairperson, we do have--I call it a menu of some four pages--listing all the programs that we are engaged in for the kids in Manitoba, and I will try to have it here tomorrow. How it should all mesh or integrate or whatever the honourable member--he was searching for the words, too--is a role, I suggest, that our secretariat will be playing as we engage in that activity to make sure those four pages of programs are getting the results they should be getting, that departments are not sort of stumbling over each other, kind of targeting the same people, when all those departments may well serve these people, but we want them to serve them well, too.
Mr. Chomiak: Mr. Chairperson, I look forward to receiving that list because I certainly am not as familiar in the area as I should be, but I am aware of some programs, and it will be most interesting how we build upon the existing programs and tie it in together and expand to where the services are obviously necessary and everyone frankly agrees on in terms of the application of these programs. I will probably have more questions tomorrow as a result of receipt of those documents.
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Having said that, I was going to move on to page 131, speech and language. The speech and language area has been one that has come up from time to time in the House.
Can the minister indicate whether or not the additional four equivalent full-time speech language pathologists will be up and running as well as the one full time to be funded at Children's Hospital? Will they be in effect for this fiscal year?
Mr. McCrae: These three recommendations, Mr. Chairperson, are ones that have been singled out for requiring specific review, with a view to looking at other services that are in effect to see if we are providing services appropriately in the first place. So the answer at this point to the honourable member's question is that it would be in the negative.
Mr. Chomiak: I am not entirely clear on the minister's response. Is the minister saying that the implementation of these recommendations is pending a review of services being presently offered, to see if these services are provided in some other form or means in the province?
Mr. McCrae: I believe that is the correct way to put it, yes.
Mr. Chomiak: That is a very interesting issue. It seems to me that the report very strongly recognized a deficiency in this area and made some very specific recommendations to try and address that deficiency. It seems to me, effectively, is it the department or the Youth Secretariat saying, we do not believe that the recommendations or that the data are accurate that have been forwarded to us on which the recommendations have been made?
Mr. McCrae: I do not know if that is the way the department or I would answer that. I think what I said was, though, that it does call for additional resources to be directed at a particular problem. The department at this point--and not having thoroughly reviewed the issue as a department now as opposed to a committee--as a department, we always review committees' recommendations no matter which committee it is. We still do that because ultimately no matter what is recommended, we will be judged by what the department and the minister lend support to. That is what we are going to be judged by.
While we have not provided an additional four equivalent full-time speech language pathologists in Winnipeg, we are saying that we need to look at these three speech and language recommendations, look at what is going on now and ask ourselves, are we applying resources appropriately? If we find on our review that these are the recommendations that should be followed, then that would be the proposal we would be making. That is what I am trying to explain.
I have perhaps a more complete response to make about speech therapy. Speech and language assessment and therapy have continued at the children's centre with the addition of one speech language pathologist in 1994, which brought their complement up to seven equivalent full-time pediatric clinicians. The Health Sciences Centre currently employs seven pediatric speech language pathologists.
Other options for preschool children requiring speech language pathology services include the Society for Manitobans with Disabilities. They provide outreach services to children in daycare centres. Nonprofit organizations might provide funding on an individual basis for private speech language therapy services, and services may be obtained on a fee-for-service basis from private speech language pathologists.
Departmental staff are currently reviewing and developing options to address the recommendations in the Child Health Strategy, and that is basically where we are at. As I say, and as the member for Inkster acknowledged (Mr. Lamoureux), in real terms we have really only been working with this report for a very short period of time. So we have not dismissed any recommendations along this line, but I also acknowledge we have not gone ahead with that either.
Mr. Chomiak: I accept and I recognize the minister's answer. Just that the response initially was a little different than on some of the other recommendations, and I was trying to ascertain whether the department was going a different route in this area. [interjection] No, I recognize that is not the case, now the minister has clarified.
When we talk about the comprehensive approach to children's health and when we talk about co-ordination and when we talk about entry point, I guess if a parent has a child with a specific problem, presumably the entry point would be through the school system if that child is in school. If not, what would be the options available to the parent in terms of the diagnosis and the treatment of that particular difficulty?
Mr. McCrae: Mr. Chairperson, the Children's Hospital, the family doctor or a public health nurse could be the other entry points.
Mr. Chomiak: Would it differ for a parent living in Winnipeg and one living outside of Winnipeg?
Mr. McCrae: Mr. Chairperson, not really different, other than the fact that due to geography the Children's Hospital is farther away. They can be referred to the Children's Hospital by the other primary caregivers.
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Mr. Chomiak: Mr. Chairperson, does the department and minister have any idea of the time lag relating to initial contact with the system and ultimate assessment and treatment of speech or language difficulties?
Mr. McCrae: The waiting time for this particular thing can vary, depending on the severity, nature, priority attached to the circumstances, all the way from immediately up to a year's wait.
Mr. Chomiak: Mr. Chairperson, the minister indicated there were seven, basically, pathologists on staff at the Children's Hospital. Is that the sum total?--because you had initially mentioned seven and then seven again. Is it seven that are actually engaged in that?
Mr. McCrae: Seven in total, Mr. Chairperson.
Mr. Chomiak: Mr. Chairperson, the minister indicated there had been an increase in staff. So that we have gone from six to seven since last year. Is that correct?
Mr. McCrae: Yes.
Mr. Chomiak: Mr. Chairperson, I presume that the department is aware of the fact--
Mr. McCrae: The increase was in '94. There has been no increase in '95.
Mr. Chomiak: Mr. Chairperson, is there any kind of a screening program in existence for these kinds of difficulties? The equivalent that I am familiar with would be the audiology screening that is done.
Mr. McCrae: There are two ways, Mr. Chairperson, through referral by a primary caregiver as a result of the matter being brought in, or brought to the doctor or public health nurse; or there are public health nurses--when they, in their offices or in their work--in doing other work--what they call the Denver Developmental Screening Test, then certain deficiencies might come across, then a referral is made. So it is in those two ways.
Mr. Chomiak: Is any consideration being given to a screening- process to take place at the school level?
Mr. McCrae: It is something that could and would likely be looked at, but I am advised that these kinds of problems usually become known before school time.
Mr. Chomiak: Notwithstanding, the minister has indicated that these recommendations are being reviewed by the department. One of the issues that keeps arising over and over again in Manitoba is the training and provision of programs in speech and language pathology. In fact, a recommendation recently went to the University of Manitoba to establish a graduate program. I believe the board of governors rejected that proposal.
Is there, and I understand that this issue is being reviewed, and the question is being prompted by the couple speech- and language-trained people that I know of who have graduated from the States and are practising in the States and not coming back to Manitoba because they feel there are not sufficient positions here.
I am just wondering if the minister can advise where we might be going in this area.
Mr. McCrae: The problem, I think, has as much to do, or perhaps more to do, with the issue of the fragmentation of speech and language therapy services. It does not really have to do with--maybe the honourable member will probably not accept this, but that is all right--I think it has more to do with the fragmentation than an unwillingness to make the dollars available to address the problems that no one is saying do not exist. We are saying that they likely do. We agree with this report about the problem, but if we could unfragment the system and get it better functioning, we might be able to do a better job with little or no more money.
However, if more money is required, in my experience as a Health minister in a year and a half, coming on to two years, money has not seemed to me to be the problem for some of these types of programs. Although we hesitate as a government to throw money after a problem that can be solved in some other way, I think that is probably a fair comment to make. We want to see if it can be solved in some other way. If that cannot happen, then we would obviously view this situation from a resource point of view.
Mr. Chomiak: Mr. Chairperson, I appreciate that response. I wonder if the minister might, because it is not specifically identified in the report, outline what he means by the fragmentation of services, illustrate for me what he is referencing.
Mr. McCrae: It is a little bit difficult for me, but I will try. Because I am the one who has the voice around here, we are at a disadvantage sometimes that way. When we know that services are delivered by a number of agencies and we do not have a clear enough picture as a department as to how efficiently that is being done and how regionally or geographically those agencies are delivering services, when we do not have a good handle on that, then we are not really in a very good position to take on programs ourselves in addition to those other programs or find a way to assist those other agencies to deliver their programs better. It is that kind of thing, I believe, that the department is talking about here when we talk about fragmentation.
We do not wish to take over all these other organizations, but we do want to know the dollars that we or the government is making available to them to provide services to Manitobans, are getting the maximum benefit for the dollars being spent. I think it is a discussion like that that we are talking about.
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Mr. Chomiak: I appreciate that response from the minister--[interjection].
Mr. McCrae: Just to lend some credence to what I said, we put together a new way of dealing with technologically dependent children through a better integrated approach. That was one of the first things we did. This is another kind of program that may well lend itself to our approach that we used for technologically dependent children.
Mr. Chomiak: That prompts two questions from me. Firstly, can I have a description of the new program for technologically dependent children? And, secondly, does the minister have an inventory similar to that of the four page inventory that was being prepared on nutrition? Does he have an inventory of the speech and language programs and the like that he could share with us?
Mr. McCrae: The second part of the question, we will get that. I do not think it will be four pages, but we will get that for the member. In addition, we will come back with a detailed answer on technologically dependent children.
Mr. Chomiak: Even though poverty is a thread that flows completely throughout this report, I do not think I am going to question it in great detail because we all agree we have got to eliminate poverty and lessen it. We all agree that there has got to be some targeting. It is probably difficult to ask the Minister of Health direct questions on some of the specific recommendations on poverty although I probably will get into it in terms of some questions regarding aboriginal people. I am going to move on to page 130.
With respect to fetal alcohol syndrome and fetal alcohol effects, can the minister indicate what recommendations have been made by the committee on alcohol and pregnancy that the report is recommending we support?
Mr. McCrae: Mr. Chairperson, the committee on alcohol and pregnancy is supposed to be supportive, according to this recommendation, and I think that is a good recommendation. We will ascertain the present status of the alcohol and pregnancy committee and bring that back for the honourable member.
Mr. Chomiak: An issue that has come up many times in the Estimates, over and over again, is the whole question of warning labels on liquor bottles, and I still do not quite clearly understand why it cannot be done. So perhaps the minister can outline for me why we have not moved in this area.
On the one hand, I have been told in this committee that it is a question of national and international difficulties because of the labelling. Yet I understand that in other jurisdictions it has been done. On the other hand, I have been told it just does not work so that is why it is not proceeding.
I wonder if the minister might indicate for me what the status is of warning labels and/or why it cannot be done, if it is not being implemented.
Mr. McCrae: We do not have the department staff person here today who is quite familiar with this. However, we will get that information from the department's point of view and share with the honourable member. We will also probably talk to AFM as we develop that response.
Mr. Chomiak: Moving on to the section on neonatal services, I want to commence by--maybe I am reading it wrong, but it is interesting that the recommendations here are pretty strong directly towards the College of Physicians and Surgeons, and that is not the normal practice. The Recommendation No. 3, the third one down, that the College of Physicians and Surgeons recommend the establishment of standards of care, et cetera, it seems to me that it is--are we not treading on ground that normally is not done in terms of recommendations, or is it just a question of style?
Mr. McCrae: I do not want to tread too far in the wrong places, either, but you know you have Dr. Brian Postl as the chair of this committee. He is a renowned and highly respected pediatrician, and I suppose if I were a renowned and highly respected pediatrician it would not bother me to make suggestions to the College of Physicians and Surgeons, and I would be very surprised if the College of Physicians and Surgeons did not want to look very seriously at these recommendations. I am sure that they are.
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Mr. Chomiak: Mr. Chairperson, I will accept the minister's--I mean, that is a fair answer. I mean, I actually have a very high regard for the work of Dr. Postl, and it was just a question we had discussed earlier in committee, recommendations to the College of Physicians and Surgeons respecting foreign graduates. We had talked about approach to them, and it is just a little difference in style in terms of these recommendations. I look forward to movement in some of these areas.
In fact, I wonder if the minister can update me on the status of some of these issues relating to neonatal services, particularly because they intersect quite directly with the obstetrics report done by Dr. Manning, as well as some of the other secondary services report. Where are we going in terms of the neonatal care, the Level 1 and Level 2 facilities, and specifically, the Level 2 care at Thompson General Hospital?
Mr. McCrae: Yes, the only hospitals in Manitoba that are licensed or recognized to provide Level 2 services are the Winnipeg hospitals, Brandon and Thompson, and at the present time we are working with the University of Manitoba to ensure that obstetrician services will continue to be available at Thompson. Thompson is appropriately equipped to be a Level 2 facility for this, and there is a sufficient demand to justify a Level 2 service at Thompson.
Mr. Chomiak: Mr. Chairperson, does that include the linking of Thompson with the university and the Health Sciences Centre as per the discussion and recommendations in this report?
Mr. McCrae: Yes, Mr. Chairperson.
Mr. Chomiak: I wonder if we are near that time again when it might be appropriate to take a five-minute break.
Mr. Chairperson: Is it the will of the committee to take a five-minute recess? [agreed]
The committee recessed at 4:26 p.m.
________
After Recess
The committee resumed at 4:39 p.m.
Mr. Chairperson: Order, please. Will the committee come to order.
(Mr. Mike Radcliffe, Acting Chairperson, in the Chair)
Mr. Chomiak: Mr. Chairperson, just taking a step back for a moment and for purposes of my clarification, within the report there is discussion about the fact that alcohol sales are subsidized in the North and milk and other basic food stuffs are not. I wonder if the minister might clarify for me that particular comment in the report.
Mr. McCrae: I think the honourable member may already understand the reason for this, as he calls it, subsidized price for alcohol and not a subsidized price for milk. As the honourable member knows, alcohol pricing is a monopoly situation in our province, and that price is set province-wide for alcoholic beverages. Milk on the other hand is something that the market sets the price on, and that is the simple answer to the question as far as I understand it.
Mr. Chomiak: Mr. Chairperson, it seems a reasonable answer to me. I mean, I do not necessarily agree. I never understood and I actually read in the report and--[interjection] No, I meant to ask Dr. Postl or some of the authors of the report when next I saw them about that particular point.
Mr. McCrae: I guess the "subsidy", which I will put in quotation marks, is the fact that the provincial government has not by virtue of charging the same price up North as it does in the south is giving northerners a bargain, because everything else costs more in the North. That is how the word "subsidy" must come into it, but I do not think it is any deliberate type of subsidy or anything like that. It is just we are dealing on the one side with the market forces and on the other side with a monopoly price.
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Mr. Chomiak: Mr. Chairperson, I am not sure where to place this question, but since we are relatively in the area of neonatal services, I will pose it here. The pediatric death review committee report that came out last week identified a relatively high level of deaths from SIDS, sudden infant death syndrome, and made a number of recommendations. I wonder if those are being considered in the context of this particular report and what strategy is being adopted, because there were some specific recommendations from the pediatric death review committee last week.
Mr. McCrae: The literature and the research shows that babies under the age of six months should be on their backs when they are sleeping as opposed to their tummies. The child death report, referred to by the honourable member, made specific reference to that, it is true. Manitoba Health puts out documentation or periodic information respecting health and that information is put out to public health nurses, to doctors' offices who are trying to target people who advise new moms about these things, and to make this information known that it is now a well-documented piece of advice.
So it is a question of getting the information out and the Health department does that and will be updating the information that it sends out to make specific reference to this idea that it is proper to have the babies sleeping on their stomachs. Pardon me, not to sleep on their stomachs. I am sorry, I left out the word "not."
Mr. Chomiak: I have to think that through very carefully too--having been a relatively recent parent--I remember I had to always think in own mind as I thought about it. I am just not certain, and this is not a criticism, it seems to me that the message is not necessarily getting out. I wonder what other initiatives can be adopted such as, perhaps, documentaries or other means of communicating the message to the public at large, particularly those outside of Winnipeg.
Mr. McCrae: I appreciate the approach the honourable member takes. It is probably true that this campaign or this effort could be stepped up to make sure the message is not lost on parents in Manitoba.
As I say, we deliver some 12,000 babies in Winnipeg and a proportionate number elsewhere in the province, and care providers at facilities where babies are born are being instructed on this issue to--as part of the discharge instructions and that sort of thing--make the message clear. But we accept the enjoiner that it would be good to step up efforts to make sure that the message is spread widely in Manitoba. It may be that other media could be used to help get that message out and we are looking at ways to increase the incidence of that particular message as it is a very important one.
Mr. Chomiak: Just turning to page 129 and the issue of adolescent pregnancy, my colleague from the constituency of Radisson (Ms. Cerilli) asked some specific questions in this regard. I am just wondering, perhaps we could just commence by, if the minster has the responses at this point in terms of the adolescent pregnancy.
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Mr. McCrae: Mr. Chairperson, it may be of interest to the honourable member to know, but it probably will not surprise him, that the rates of pregnancy amongst unmarried females between the ages of 15 and 20 vary throughout the population. The information I am going to give to the honourable member is by percent of female population 15 to 20 years of age. In other words, in the Winnipeg area, something over 4 percent of that population between 15 and 20 are unmarried parents. So that is just over 4 percent in Winnipeg. By contrast, nearly 8 percent in so-called Norman, northern Manitoba; 1.5 percent in the Parkland Region; 3.75 percent in the Westman Region; 2.5 percent in the Central Region; 1.3 percent in Interlake; and about .9 of 1 percent in Eastman. That is just by way of background.
Pregnancy rates for females aged 15 to 19 years increased from an average of 49 per 1,000 in 1982 to 58.6 per 1,000 in '93-94, so there is an upward movement in that statistic. Therapeutic abortion rates for females in that age group have decreased slightly. I do not have a number, but decreased slightly since 1989-90.
Current activities related to reproductive health promotion in Manitoba would include the following: Manitoba Health provides reproductive health information and resources to professionals and the general public, grants for reproductive health services, and family planning supplies for individuals who are at risk for unintended pregnancy.
The Department of Education includes an optional family life education curriculum component throughout the province.
Child Health Strategy is exploring the issue of teen pregnancy with that multidisciplinary approach that we have spent some time talking about.
The Community Action Program for Children has identified adolescents, who are pregnant or at risk of becoming pregnant, as a target priority for program funding.
The reason I started out by giving the honourable member those numbers in the various regions of Manitoba is because of my belief that if we are going to make a good start we should maybe do some targeting. I think the numbers are obvious as to where the target population is.
Mr. Chomiak: Mr. Chairperson, I thank the minister for that response. There are some very specific recommendations in the healthy child plan, the Health of Manitoba's Children plan, rather. This is an area, of course, that is rife with controversy, more or less.
I wonder if the minister might outline what the status is of these particular recommendations?
Mr. McCrae: Mr. Chairperson, the honourable member for Kildonan had spoken about the potential controversial nature of some of these issues, and I was just checking with one of my colleagues to find out if it indeed was a controversial issue, and it may well be, I have learned.
Mr. Chairperson, the recommendations that are listed at the top of page 129 are in the direction of the kind of common-sense things that we have talked about before. The reason for having the secretariat is set out in the very first recommendation because there is a reference to the school system.
As we discussed earlier on, and as we have acknowledged repeatedly, I think, the school is an important point of entry for a number of things. In this area, it also needs to be said that adolescents are one of the other so-called target groups. We talked about that group between the ages of zero and three as being an important group. This, too, is a very important group.
The recommendations here talk about things like emphasis and talk about things like co-ordination of comprehensive supports. It talks also about prevention and delay of sexual activity, and programs should be implemented through the school system. That is precisely what we expect our secretariat to be working on is issues like this and working in a multidepartmental, multidisciplinary way to address this problem which appears to be a growing problem.
Mr. Chomiak: The minister is correct. It is indeed a multifaceted, very difficult problem that probably will continue to be a problem, generation after generation, but clearly we have to do something to stem the increase in unplanned pregnancies in our society, there is no question.
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Can the minister give any idea as to whether or not consideration is being made to make the Family Life unit of the health education curriculum mandatory?
Mr. McCrae: This is certainly an area where ministers and senior levels of departments have to have some very open dialogue. As the honourable member knows--surely he would have been involved in similar discussions as I was in the recent election campaign with people involved in the education system as well as--I mean, the honourable member and I no doubt agree that any way we can get some education, family life education for the kids, we ought to be attempting to do that. But we have to make all our efforts within the confines and within the scope of the education system as we have it and as we hope to have it in the future. This is very much an issue that through the co-ordinating efforts of the secretariat will be brought to a serious discussion by the departments involved.
This business about the mandatory, surely a good argument can be made for that. On the other hand, there are also in some communities moral and religious or whatever reasons for wanting not to be involved in a mandatory sort of approach. But, from a population health perspective, again let us look at those targets and those areas, and, with the right approach to advising the population of the issues, we may get the same job done.
At this point I do not know how precisely I can answer the honourable member's question, because we are in the process of developing curriculum for our schools. We are in the process of working with the various components in a number of departments all at once. These three are very important recommendations, and we will be dealing with them in that context, that they are extremely important. But I harken back again to where the needs are greater, and that is where we should be concentrating most of our efforts.
Mr. Chomiak: We perhaps will get into this further at different appropriation lines in terms of the Estimates. This is a very large issue. The minister touched on it; the recommendations of this report are more of a health-based kind of recommendations rather than of the broader social, economic or cultural recommendations concerning this particular issue. I suggest that the approach has to be more comprehensive than actually these recommendations indicate in this particular report.
Mr. McCrae: Well, I tend to agree with the honourable member on that point. It is true we are talking about health, but as we already know from a study of determinants, there is a lot more to it than strictly a health-only sort of issue. So the honourable member's comment gives me some comfort at least for today, but I know that the discussion is going to come up again, and we look forward to the honourable member's points of view on these issues, too.
Mr. Chomiak: Mr. Chairperson, moving on to page 128, I frankly admit that I was struck by the significance of injury as it relates to child health. I was aware of it in rural Manitoba and perhaps in northern Manitoba but I was not aware of the severity of the problem. It certainly is one area where we can do a lot quickly to try to turn the tide, as it were. These recommendations are all very, very useful and I cannot imagine not moving very quickly because it is so well set out. Can the minister give me an update in terms of those particular recommendations, those relating to injury?
Mr. McCrae: I, too, am like the honourable member. I was looking at the child death report recently and was struck by the number of deaths of children that are due to accidents. Of course, there are so many ways for a person to get into an accident, how do you prevent, I guess. So you want to make sure your fire safety issues are all looked after, you want to make sure farm issues are on farmers' minds, farm safety issues and on and on and on. There are just so many ways that a person can get hurt or killed that planners must really have a time with it.
However, in 1991, treatment of injuries accounted for 9.4 percent of all days spent in hospital. That accounts for not only children, but for everybody, that statistic. That is pretty significant, and in terms of numbers, I wish I could translate for you today, but in terms of hospital days and people spending those days in hospitals, if you think about it in real terms, rather than in percentage terms, it would really jump out at you, the number of people who are hurt annually in our province.
In the same year, treatment of injuries in doctors' offices--I should ask the honourable members opposite to guess what this number is going to be, but that cost $17 million, 8 percent of the total health care costs in Manitoba, and if you are like me and you sort of preach sermons about how all accidents can be prevented, then you say, well, let us do a better job here. Maybe not all accidents can, but that is what I have always tried to put across to the children that I know, that is, do not get yourselves in accidents. There are ways to avoid all of them.
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While injury mortality in Manitoba has decreased over the past 20 years, injuries still remain the leading cause of death for people under 24. The three leading causes of injury deaths in Manitoba are suicide, motor vehicle collisions and falls.
The populations at greatest risk for injury are children and senior citizens. Manitoba Health has worked in partnership with other government departments and community agencies to develop a strategic plan and a resource manual for injury reduction. This manual is available to all staff and community groups that work in the area of injury reduction.
I guess I and others should take a little bit of comfort or satisfaction from knowing that with our drinking and driving regime in Manitoba, we know we have reduced the incidence of death and injury through Bill 3 and the initiatives contained in that. That certainly leaves one feeling good about what we do, but you should never get very smug about these things, because those statistics seem to sometimes go up just as much as they go down, so the job is never done.
Manitoba Health is currently participating with Manitoba Agriculture, the Workers Compensation Board of Manitoba and Manitoba Labour, Workplace Safety and Health, on a major initiative to reduce farm injuries. As well, funding assistance has also been provided to the City of Winnipeg to install smoke detectors in core-area homes where there are infants.
Manitoba Health has also offered a training course on injury prevention to all provincial volunteer ambulance co-ordinators. These individuals will undertake injury awareness and prevention initiatives at the community level.
So there are a number of things happening. It is just that it is hard to know when you have done enough in the area of accident or injury prevention, and, I assume, when the statistics are zero, then we can say we have done enough.
Mr. Chomiak: Mr. Chairperson, have we set in place the surveillance system to track visits to emergency wards?
Mr. McCrae: We for some years have not been asking for that information from hospitals. However, we think that the time is soon upon us, if it is not already there, for us to be looking at that information again, because it is the kind of information that helps you establish trends and helps you address specific items or specific areas where we could do some public information or public education campaigns.
Most of our hospitals have that information and can probably make it available to us. We simply have not been asking for it for a number of years, and I think it is something we should be looking at asking for again. I also think that information will probably be even more retrievable than ever once SmartHealth is up and running.
The honourable member smiles a little bit, but that information could be obtained now, but I say that SmartHealth will also help us use the information more effectively than we have in the past, as we develop policy and we develop initiatives to deal with not only accident issues but also other issues that present to emergency rooms in Manitoba.
Mr. Chomiak: Mr. Chairperson, at the top of page 128, there is a specific recommendation concerning housing policy for low-income families. It, of course, is health related, although it covers many aspects and many departments of government.
I am wondering how that specific recommendation, and I am using it as an example of other recommendations of this kind, is being worked through in terms of the overall strategy.
Mr. McCrae: Excuse me, Mr. Chairperson, for the delay. Housing, like other environmental matters can be a determinant of our health status, and I expect that is why we see that recommendation on page 128 at the top. It is one of the recommendations the secretariat will be reviewing, along with a number of other recommendations that are in that reviewing category, with a view to bringing in the Department of Housing for discussion of the recommendation.
Mr. Chomiak: This next question is similar to the previous question. It is an attempt to understand process in terms of how recommendations are going to be implemented and how the system will function.
On page 124 of the report is a recommendation that the rural northern health associations be developed in an intersectoral manner and they focus on the needs of children. The minister has indicated that, very shortly, recommendations regarding the rural northern health associations will come down. It probably is difficult because of the time frame, but have recommendations of this strategy been superimposed or been passed on to the association? How are they integrated in order to fulfill this particular recommendation?
It seems to me that if this policy and recommendation is followed through, almost every government, in fact, it is the case, almost every committee dealing with any aspect of children would have a little box at the top of the structure, has this been reviewed by the Child Health Strategy committee? That is functionally the way it almost has to work. Is this recommendation going to be integrated? Obviously, it will be at some point, but how are we moving on towards that to make sure that the recommendations are followed?
Mr. McCrae: The Northern/Rural Advisory Council has prepared its recommendations and they have arrived on my desk as recently as yesterday. That process is now at the stage where we will soon be making decisions about how the regional councils are going to be governed and steps would then be taken to get the regional councils in place, and all that has to happen before they actually start doing any work.
From our department's point of view, children, seniors, are very much priority population groups that we would be asking the health associations to prioritize in the same way we do as a department. We will want the regional councils, and if there are other subcouncils as a result of the recommendations, we would want them all to embrace the same kinds of priorities that we as a department embrace. We embrace them as a result of the work of Dr. Postl and his group, the result of the advice given to us by the Manitoba Centre for Health Policy and Evaluation, which will be there for the regional organizations as well.
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As the honourable member says, if there is a check list with a box there, this would be right up there at the top as one of their priority items to deal with in their regions. Some regions are going to have a bigger job in that area, as I have pointed out earlier, than other regions. There are children--I am just guessing right now, but going by other statistics I have seen--in the NorMan region, their regional council is going to have to look very, very seriously at child health issues. Children in Winnipeg, and when Winnipeg gets more organized in the sense of regional health planning in the city of Winnipeg, they are up there too in the statistics as showing that there is requirement for attention to be paid to child health issues.
What I am saying is that it is early, because we do not even have these regional health councils yet, but they are coming, and when they do, they will be, as part of their mandate that the Department of Health would be wanting to extend to them, their priorities, we would hope and expect, would be the same as ours, and that is that children are a major priority as one of the first steps in their planning of the systems that are going to run in their regions.
Mr. Chomiak: Mr. Chairperson, I appreciate the minister's response. Somewhere in the back of my mind a question is fermenting or fomenting, as the Premier often puts it, regarding--something structurally does not sit correctly with me, but maybe I will come back to it. I cannot focus on it at this point.
Having said that, on page 125 there is a fairly significant recommendation, quote: That the government of Manitoba institute a complete system review regarding services of children, reallocation of funds and development of long-term policies.
Where is that particular review at?
Mr. McCrae: That recommendation is in the process of being followed not only in the departments, but the raison d'être of the secretariat is to begin, obviously, with a review of what is out there and what is happening out there and realigning it to make it work better for young Manitobans. So that is a very fundamental project. It is a very fundamental beginning to a new way of looking at child health, and that is exactly what is happening.
Mr. Chomiak: Mr. Chairperson, this is a question and/or a suggestion. Will the annual report to be published, the state of Manitoba's children, include that kind of data and update with respect to that recommendation, such as how funds are being allocated, how programs are being developed, what the long-term plans are. Will that be part of the state of Manitoba's children report?
Mr. McCrae: I believe that I detect that this would be important to the honourable member that such an annual report be prepared and published, and that is under consideration.
Mr. Chomiak: Mr. Chairperson, I appreciate that response and look forward to the receipt of the annual report.
Certainly throughout the report--and I highlighted many aspects in the report, particularly pages 26 and 27 as well as 23--there is a tremendous disparity and tremendous health problems being encountered by our aboriginal brothers and sisters. We have talked about targeted programs and we have talked about initiatives, and there is some good discussion of the issue in the report under a specific section. I am wondering what the minister has to say about that specific issue and where we are going, unless in terms of integrating within the overall child strategy, because it is of such great significance to the report.
Mr. McCrae: If this was not such a serious matter, I would say to the honourable member that this is about time for speech No. 8, and I am going to be careful about that today, Mr. Chairperson.
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Without getting too excited about it or anything, I would like to deal briefly with the matter and try to be responsive to the honourable member's question. I recently was involved in a very serious discussion about this very matter. When you look at the statistics about the different kinds of illnesses, accidents I think are included, aboriginal Manitobans are disproportionately represented in those statistics. The honourable member is right, and he is right to identify it as an important matter for us to look at and grapple with.
It is almost like our Constitution is one of those determinants of health. When you think about it, it is true. Our Canadian Constitution and the treaties are determinants of the health of the aboriginal population of this country. Treaties have people living in communities that have very little by way of an economic base. You have a constitution that says that aboriginal people and lands held for aboriginal people are the responsibility of the federal government.
What has been the result of those arrangements for more than 150 years? The result has been the highest level of alcoholism amongst any identifiable population group, the highest level of drug and alcohol abuse and the highest level of various kinds of illnesses. Those health status indicators are all well know to honourable members. I am not being foolish or silly or wrong headed when I say that our Canadian constitutional arrangements are a determinate of poor aboriginal health.
So what do we do about it? I am looking to the honourable member for wisdom, too, because I, alone, after my relatively few years in public life, and previous to that working in the system that was there disproportionately used by the aboriginal population, my experience is there but the results are not. I do not take any pleasure or satisfaction from that.
I hear one side say, well, just respect the treaties. I hear another side say, get rid of the treaties all together. Another group says, well, the treaties are fine, just start interpreting them properly. Or another point of view, there is no modern, appropriate interpretation of the treaties that will work for anybody.
Then in times of economic difficulty or economic realignment, I guess you could call what we are in right now, I want very much to play some kind of constructive role in the resolution of some of these issues, and yet I am told by aboriginal governments, we do not recognize you as a player here so, you know, we do not want to do any business with you. I have even heard some aboriginal leaders say I am not a Canadian. That makes it even harder for me to do business with them as a fellow Canadian.
So I am pretty good at setting out what I see to be the problem, but I am not as good at solving the problem all by myself, and I wish I could. I know that people who work in the Department of Health very much would like to solve some of those problems, not only because it can bring some measure of relief to aboriginal populations, but it can make our health care system work better.
It can make our health system work better if we take a better look as a nation, as all of us together, at issues like primary health and place some constructive and effective emphasis on issues relating to cause, relating to conditions that bring about poor health.
Ask yourself, how many dollars do we spend on the Health Sciences Centre? Well, it is about a quarter billion dollars. How many dollars do we spend on Thompson General Hospital? I do not have that number at my fingertips, but again millions and millions of dollars. Look at usage of those facilities. How much of that usage would not be happening except for an effective primary health policy for aboriginal Manitobans?
So I use the opportunity the honourable members asked, not to give speech No. 8 so much but to make this point as passionately as I can: when are we, as a country, going to start addressing this problem and leave all of our jurisdictional turf-protection instincts outside the door and go into the meeting room and work on these things together? I am asking for that.
I cannot commit my government to expenditures of money under the present constitutional arrangements for Status Indians who are the responsibility of the federal government. I am not entitled to do that. I cannot do that, and I am not going to because that is not simply the answer anyway.
We, as a province, pay all kinds of expenses for people off reserve, or a significant share of those expenses which we would not be paying if those communities had effective primary health services. I am speaking of the reserve communities. I am not even talking about the city of Winnipeg for the purposes of what I am saying, but there are some issues there that overlap, too.
I really think of those reserve communities, because I have visited many of them in my life, and I do not feel proud when I do that. It is one of the things that remains to be resolved, and I mean seriously resolved, and nobody should be proud of the circumstances that some of our fellow Manitobans live in. That is wrong and it is not even moral in the 1990s in Canada, which is supposed to be and has been called the best country in the world, for that to be going on.
So I feel very strongly about this, and I would like to work with the others still again. I have met with failure so many times you would think I would want to quit banging my head against the wall, but I remain willing and interested in resolving some of these issues working together with the others because it makes good economic sense and it makes good health sense, obviously. If none of those arguments cut it with anybody, take a visit to a reserve community and look into the eyes of the children. It will not take you very long to move over to the idea of, how long have we allowed this to be like this and why have we not done something about it before now?
It is really a moving experience for someone to look into those little smiling faces and know that those children have not had the start that other children in Manitoba have had and there are things that could be done that would make their lives have so much more meaning and our whole society would be so much richer for it.
So I guess this is speech 8(a) or something, but the point is, if I could hear some suggestions which do not sound like this, well, if you would only just do it my way, then we would have the problem solved. Those arguments have not worked.
Even when we all did come together one time, there was not unanimity--I am talking about the Charlottetown Accord--I am not whining about the Charlottetown Accord for all the appropriate reasons. Canadians made a judgment about that. But it was a special time in our history because we did have the leadership of four aboriginal organizations and the leadership of about 13 or so other governments in Canada all agreeing on something. That was a historic thing that so many people in Canada could actually agree on something and something as complex and comprehensive as a constitutional package.
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Even that, I have since decided, is not the thing that is going to change things. Constitutions are there to be disobeyed, and they are, day in and day out. I have seen it all of the years that we have had a formal Constitution. No, it is not constitutional arrangements per se that are going to change the circumstances for aboriginal Manitobans. It is a question of the kind of will that is required on the part of everybody at all levels.
I sometimes get into trouble for some of the things I say with respect to aboriginal politicians. They may get into trouble from time to time about things they say about other levels of government and so on down the line or up the line all the way to Ottawa. I remember when Ron Irwin was appointed Minister of Indian Affairs and Northern Development in Ottawa. He was saying some pretty high-sounding things, and his intentions, I am sure, were as good as I believe mine to be, and yet he has met with some pretty important failures too. I cannot blame him as a minister, or I cannot blame even his government as a government. We always want to blame somebody, but I think that we should get off that sort of mentality, and I asked previously in these Estimates for a nonpartisan approach to health.
I am asking for a nonpartisan approach to some of the aboriginal issues that are so very important. Even if we cannot agree on things like self-government arrangements, or even if we cannot agree who should be paying which taxes or not paying which taxes, and even if we cannot agree on which species can be hunted or not and how it should be done, and all those kinds of issues, there are some more basic and fundamental things even than those that I think that we should be working together on. We should leave our jurisdictional differences outside the door and start from zero base, and leave the treaties outside the door too, and leave the Constitution outside the door.
Does anybody think that is possible in the last four or five years of this century? I think it is, but maybe I am too optimistic. Up until now, it has not been. [interjection] Let us go for it, I hear my colleague from Morris (Mr. Pitura) suggest. He, no doubt, says that because he shares with me the same rage inside his heart for the future of those children and the mothers of those children.
I have a rage in me on this point, and I think the member for Kildonan (Mr. Chomiak) has seen it come out before, and it is a rage that is not going to go away within me until I see something very, very significant happen in this country. I speak in national terms here because it is a national issue, but it should be very important to a Manitoban, because we have amongst the highest aboriginal population in the country and the problems are proportionate.
So I do not know what more proof we need that we need to do something, but I believe that the time for blaming it on the Constitution, the time for blaming it on the treaties or blaming it on a government or blaming it on a person, surely it is over. We have seen plenty of it over the years, but what good has it done anybody? It has just done nobody any good whatsoever, and there are so many opportunities for us to put our heads together and make a real, positive difference for our fellow human beings.
I hear, well, we want to have better primary services in our community, but we will run it, we will have our own governance, and you will stay out of our way. What good has that approach done so far? What good has it done so far? Because, you see, all governments that talk about self-government, any government that talks about self-government in an approving way, still attaches a rider, and that rider is with accountability. I have used this expression myself to those who are being governed, as well as to those who are paying the bill.
No government, I suggest, not even the government that will be gone within an hour and 15 minutes, would ever have granted full autonomy, or full governance, without any accountability whatsoever. No government would have done that because the population simply will not allow that sort of thing to go on for very long at all.
(Mr. Chairperson in the Chair)
So I say to the honourable member, who I believe to be a person of integrity and good will, to use his powers as the critic of the most important department of government in terms of spending, in terms of human beings because we are talking about health. I ask him to use his powers of persuasion, his powers of reason and logical argument to make this case, the one I am trying to make today with his colleagues, with his associates in the union movement, with his friends and associates in aboriginal organizations.
Let us try it as a concept--zero-based thinking, what do we need and how should we get it leaving all the turf protection issues outside the door.
Hon. Leonard Derkach (Minister of Rural Development): Zero-based thinking, can you define zero-based thinking?
Mr. McCrae: My colleague the Minister for Rural Development, who may not have heard all of my comments, asks me to define zero-based thinking. Am I the only one that has ever used that expression? If I am, I will try.
Look at the situation as it exists today and forget about all of the history of how we got there. Forget about it. Forget about all of the jurisdictional squabbles that we have been engaged in all these years, and forget about power. Forget about power, and start to address issues of fundamental human importance, and maybe, just maybe, something can happen.
I saw Ovide Mercredi do some of that in discussions on constitutional development. He must have had to give up more than the people that he represented would allow him to give up, because it did not work out. I saw that spirit, and the gentleman, who will be Premier only for a little while longer in Ontario, was a key player, and maybe in his future he may have some role in this regard. He has some skills when it comes to doing business with aboriginal leadership. I was impressed with that, and others as well, people like Joe Clark, maybe can play a role yet in redefining this country, maybe.
I always speak in those terms because we have not really come very far yet. The conditions do not seem to be getting better according to my understanding of the statistics. Things are not getting better, and if they are they are getting very marginally better. I do not even know that they are.
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The honourable member asked the question, so I have tried to answer it. I do so by issuing a challenge to him. The challenge is that somehow--never mind all the jurisdictional squabbles, maybe we could even put aside some partisan squabbles, which we like to have and enjoy from time to time, and need for our own purposes. I just do not have as much hope as I would like to have about this, unless a couple of very important things happen. I think I have mentioned what they are to the best of my judgment of the situation. It is just not good enough for me to share this province with people who are not able to even have the hope of the kinds of things that I can hope for myself and for my family. I just do not think that is fair, and I would like to see something done about it.
Mr. Chomiak: Just before I ask my next question in terms of structure, I just want to indicate from my perspective, and I think my colleague in the Liberal Party, that we will probably conclude today our questioning on the Health of Manitoba's Children strategy. There are numerous questions and lots more that we could deal with, but I think we would like to move on to other appropriations.
I do want to express my appreciation to the staff and the minister for what I thought was one of the more useful encounters I have had in this Chamber in terms of the committee and the dialogue and the response to questions. I think we appreciate it, and I think we worked through some very useful material today.
There are nine recommendations in the report dealing with aboriginal people, and I wonder if the minister might comment on the specific recommendations. They are on pages 103-104 in the report.
Mr. McCrae: Mr. Chairperson, in the few minutes remaining, I will try to answer that question, and if it is okay with the honourable member, answer two other ones that have been raised previously.
Just off the top, I do not have something more specific than I have given in my last response, except as you look at the page, it refers to Status First Nations and aboriginal Status and non-Status, and if you check the Indian Act, I am told by some people you might find 11 different kinds of aboriginal people in this country.
In fact, Ovide Mercredi himself I think said he has been a Cree all his life, but he has only been an Indian for about seven or eight years because of the way the legislation has worked in our country; again, another little piece of frustration on my part.
The recommendations talk about the development and negotiation of a health framework between Canada and Manitoba First Nations. Well, I can certainly agree with that, but you could have written that recommendation 150 years ago, and nothing would have happened; thus my frustration.
I am sorry, I do not mean to demean the report by any stretch. It is an obvious thing that there ought to be the development of something that will give us a better result than we are getting, and it just has not happened.
Manitoba Health seeks confirmation and ensures that programs and services currently funded and/or delivered by Canada to First Nations will continue to be funded by Canada.
That is fine with me, but is Canada prepared to work with Manitoba in our development of a Manitoba-wide health strategy or child health strategy? I hope so. We will try to get Canada to work with us, and I wonder if they will throw away their jurisdictional rule books and stuff like that as we go in to discuss strategy for health.
Manitoba Health recommends that the federal government immediately address the deficiencies in services in infrastructure on reserves to ensure that essential health--Pukatawagan is a good example of that sort of thing. The former member for Flin Flon very wisely and appropriately raised the question of water at Pukatawagan, and the two of us kind of got together and basically helped to force the issue in that area, but here again, it is a federal government matter.
Manitoba Health remains open to working together with Health Canada and First Nations on a tripartite designed to alleviate the burden of ill health. The honourable member will agree these are general sorts of statements, and they make clear common sense, and why is it that governments have not followed those recommendations years and years ago?
I think what I would like, if the honourable member would not mind letting me deal with the remainder of those recommendations tomorrow or at some other point, I want very quickly, if I can--I can do this very quickly, because then I want to ask the honourable member what areas we are going to cover tomorrow. Then we will have to shut it down at six o'clock.
On June 2, the honourable member asked about the short-term emergency project. It is a demonstration project sponsored by the Home Care Branch and funded by the Health Services Innovations Fund.
The purpose of the step is to implement a study in each Winnipeg acute-care hospital and Brandon General which will test the feasibility of providing alternative approaches to managing and/or co-ordinating targeted clients in an effort to reduce admission to hospitals, especially through emergency departments, and/or to shorten hospital length of stay. Each hospital has developed a unique project of its own.
The majority of those projects are aimed at the elderly population. Examples of specific goals of some of the projects include the identification and prevention of inappropriate hospital admissions and expediting the reintegration of hospital inpatients back into their own environments. They want to reduce length of stay for targeted patients by providing rehabilitation and nurse-home visit teaching to facilitate discharge and prevent recurring use of emergency services. They want to assist and empower individuals with respiratory disease by maintaining or improving their quality of life through education, exercise and counselling. They want to identify and intervene in evolving geriatric crises of the frail elderly population dwelling in the community in order to improve their health status and prevent visits to the emergency department.
There was a question about the Air Ambulance Licensing Review Committee. The air ambulance implementation advisory committee will, through a process of public consultation and material research, formulate recommendations concerning the operation of air ambulance services in Manitoba. The air ambulance implementation advisory committee will report its recommendations to the Manitoba health board.
The membership on the committee includes Dr. D. Roberts, Mr. Craig Brown, Donna Hohle, B. Rutherford, Penny Triggs, Dr. G. Bristow, John Smith, and Oliver Owen.
If the honourable member would be kind enough to tell us what areas he thinks he might be covering tomorrow for the benefit of staff.
Mr. Chomiak: What I anticipate is reverting back to 1.(b) and moving through the appropriations up to and including 2.(c) which would take us into SmartHealth. It seems to me that it is probably not necessary for the minister to bring staff relating to SmartHealth here because we would probably just start it and then have to conclude and bring back staff Monday. I would suggest that, if we do get to that area, we jump over 2.(c) and go to 2.(d) and on and then come back to SmartHealth on Monday. At least, structurally for me, that makes most sense. So that is how I anticipate from our end.
Mr. McCrae: That sounds agreeable to us.
Mr. Chairperson: Just to advise the committee then, when this does happen tomorrow, we will have to do it by leave to get leave of the committee so that we can set aside the appropriation 2.(c) to move on to (d).
Mr. Chomiak: We may not even get to there but I was just advising.
Mr. Chairperson: The hour being six o'clock, committee rise.
Call in the Speaker.
IN SESSION
Mr. Deputy Speaker (Marcel Laurendeau): The hour being 6 p.m., this House now stands adjourned until tomorrow morning at 10 a.m. (Friday).