Canadian Health Minister's speech to the Canadian Medical Association

Main Category: Public Health
Article Date: 22 Aug 2004 - 0:00 PDT

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This is a speech made by Ujjal Dosanjh, Canadian Minister of Health at the Canadian Medical Association's Annual General Meeting in Toronto, Ontario, August 16th, 2004.

Thank you. And thank you to the Canadian Medical Association for inviting me to join you today.

It is a particular pleasure to be with you because, as small boy, growing up in Dosanjh Kallan, India, I wanted to be a doctor. I read every book I could get my hands on in our small village that had anything to do with medicine. Finally, when I graduated from high school, which was about grade 10 in India, I got on my bike and headed out to the college to enroll.

My father saw me and he asked me where I was going. I told him I was going to enroll in college so that I could be a doctor. But my father advised me against medicine because, he said, it was a restless life; one that would keep me awake at nights, worrying.

And so, I took his advice and opted instead for the more tranquil pursuits of law and politics!

But it is good to be with those of you who chose the harder path!

And it is certainly appropriate that my first major speech as Health Minister should be to this organization, which has long been the voice of medicine in Canada, and whose members are the face of medicine to Canadians.

In fact, for as long as there has been a Canada, there has been a CMA, contributing its wisdom, demonstrating its professionalism and helping to shape the public discourse about health care in this country.

Part of the reason the CMA has been so effective through the years is that it has always had outstanding leadership and that tradition was certainly continued over the past year by Dr. Sunil Patel. Dr. Patel, you have served your Association well and your country with distinction. And I want to thank you for your great service.

Let me also say how much I am looking forward to working with Dr. Schumacher in the year ahead. Al, (Albert) by the luck of the draw, you and I find ourselves in positions of leadership during what will certainly be one of the most interesting years in the history of medicare! And I can't think of anyone better to help me through it! So congratulations and best of luck as you assume your new responsibilities.

Now, this morning, I realize that I bear a special responsibility: not only am I the new kid on the block, I am also the only thing standing between you and lunch! So let me assure you that I do not intend to speak for very long. Of course in India, very long has a somewhat different meaning than it does here, but I do want to leave lots of time for your questions, so I will try to be brief!

An Annual General Meeting such as this is a wonderful opportunity to take stock: to see where we have been and to say where we must go.

Certainly recent years have brought some important successes, not only for the CMA, but for health care in Canada. Thanks to your efforts, real progress has been made on establishing criteria for integrating qualified foreign trained health professionals into our health system; in creating a patient safety institute and, of course, great strides have been made with respect to applying the lessons learned from the SARS outbreak.

Most notably, we will soon have in place a new Canadian Public Health Agency to facilitate intergovernmental collaboration, to help us deal with chronic disease and to ensure that we are prepared should another serious infectious disease enter our country and threaten our people.

This Agency will build on the excellent progress that has already been made by all levels of government working together to achieve something truly significant for Canadians. I know that it will make an important contribution to building a stronger, more coordinated approach to public health.

My colleague, Dr. Carolyn Bennett, is here today and I want to thank her for her outstanding leadership in making this Agency a reality.

As I mentioned a moment ago, we meet at an opportune time in the history of health care in this country.

And over the coming weeks, there is going to be a lot of discussion leading to the First Ministers' meeting in September. While fixing health care for a generation for a generation will not be realized in one meeting, it can mark an important step.

But perhaps even more important than the details we reach will be the principles on which they rest. Principles which transcend jurisdictions and unite all Canadians. Principles which reflect what it is to be Canadian.

Health care is a national issue, involving both the federal and provincial governments. And while it largely falls to the provinces to deliver health care, it is up to all governments to ensure medicare's future.

That is why I am so pleased to see the Premiers continue to affirm the principles of medicare as enshrined in the Canada Health Act. Those principles create our common purpose and objective and define a national interest in which we all share.

So let me state, in no uncertain terms, that when it comes to defending the fundamental values of medicare, we will not bargain those principles away; we will not barter over the soul of this country.

Where does the national interest lie?

The national interest lies in upholding and defending the five principles of the Canada Health Act.

The national interest lies in addressing waiting times because this is the fundamental test that Canadians apply to their health care system.

The national interest lies in providing Canadians with access to qualified health workers - doctors, nurses, pharmacists - where they need them and when they need them.

The national interest lies in ensuring that no Canadian faces financial ruin in order to get the medicine they need.

The national interest lies in real accountability - in reporting to Canadians in a way that is meaningful and credible. Accountability that will drive reform, leading to better care.

The national interest lies in ensuring a financially sustainable health care system.

And the national interest lies in a health care system where both levels of government ensure its success by sharing its risks.

These are principles that I will defend as Minister of Health. And it is on these principles that we will base our discussions with the provinces and territories in September.

Let me turn for just a moment to the issue of funding because I'm sure there is going to be a lot of discussion about the proper levels of funding over the next little while!

The Government of Canada has already made significant investments in the health system - some $37 billion in new money over five years.

And today I want to assure you that we have heard the calls for increased funding and that we are not deaf to those concerns. The Government of Canada has been there with funding in the past and we will be there in the future.

Indeed, we are prepared to make further investments, including addressing the gap identified by the Romanow Report and providing long-term funding that is sufficient, stable and predictable.

We also recognize that all governments need to manage their health systems so that the growth of health care costs doesn't crowd out other priorities.

So there will be much to discuss at our meeting in September. And while the issues will be challenging, I have great confidence that great progress will be made.

I say that because I believe politicians of whatever political stripe or level of government, understand, on a fundamental level, the importance of the work we're undertaking. They know that when we talk about health care, we're talking about the country -- not about powers or processes, but about people.

People who trust the system to be there for them when they take their sick child to emergency at 1:00 in the morning. Who simply want to be seen by a doctor and receive the treatment their child needs so they can take them home again.

People who want their aging parents to get a hip replacement should they need it - without having to wait an unreasonable time to get it.

People who trust a system that doesn't check their credit rating before it checks their pulse.

In a very real and personal way then, medicare is the meeting place between our citizens and their government; the place where public policy meets private lives.

When Canadians look at medicare, they see reflected back their own best selves, their strongest values and their firmest beliefs about what makes this country different - and special - in the world.

I have felt the depth of that attachment - and shared it - from the provincial perspective. As Premier, I worked - as did my fellow Premiers - not only to serve my own province but to serve and strengthen the country as a whole.

I did so because I believed in a nation-wide, universal system that provides comparable services to all Canadians no matter where they live. An expression of our shared values - not merely a collection of 13 separate systems.

This belief - and this commitment - has not changed simply because the capital I work out of has changed.

At the moment, Canadians are worried about that system. They're worried that it won't be there for them - or their loved ones - when they need it. That they won't be able to see a doctor or get treatment.

Canadians understand the pressures the system is facing and they want their governments to work together - and to work with providers - to fix what needs fixing. And I think all of us understand that responsibility.

So I am optimistic.

And as I said, I approach the First Minister's Meeting with some very simple beliefs, based on some very simple truths. Chief among these is the conviction that our treasured system of universal health care is worth preserving, worth improving and worth defending.

Why? Well first of all, because, as I've said, medicare speaks eloquently to our values as a nation, to our priorities as a people. It is tangible expression of a collective dream - to build a fairer and more just Canada.

It's the great equalizer, allowing every single Canadian to pursue their dreams without worrying about losing their homes or farms or businesses because of illness. That was the original driving force behind medicare in Canada. That same principle animates and inspires us still, today.

Second, medicare is a competitive advantage in a competitive world - a key driver of innovation and economic activity.

Medicare also levels the playing field for our businesses, enabling them to attract skilled workers and offer them a standard of living comparable to their larger competitors.

It allows our workers the freedom to move between jobs and regions, unlike other nations where millions of people are reluctant to move for fear of losing their coverage. Worse still, many in those countries are just a pink slip away from having no health care benefits at all.

None of us should lightly dismiss a health care system that has, for more than four decades, served us remarkably well, providing Canadians with a world class standard of care at an affordable cost. We should celebrate that!

The economic arguments for a public system are easy to understand: because medicare covers everyone, economies of scale lead to lower cost; because there is no discrimination or rating, huge administrative costs are avoided; because the system is financed through taxation and payments to providers come directly from government, there is no need for the proliferation of billing stages and practices inherent in a multi-payer system.

Canadians understand these benefits of a public health care system and they have made it abundantly clear that they want their governments to fight for medicare, not over medicare. That they expect the social contract which medicare represents to be honoured, not abandoned.

The federal government has a role, it has a responsibility, to defend the national interest and our shared objectives: to ensure that medicare survives and thrives; to ensure the principles of medicare are respected by enforcing the Canada Health Act and to share in the cost of the system by providing funding to the provinces and territories.

There are some who say that the federal role in health care is contingent on how much money we provide. I am not one of them. I am not one of those who believes that the federal role in health care is simply to play banker.

Quite apart from the issue of funding, the Government of Canada has a responsibility to work on behalf of all Canadians to preserve and enhance our national system of health care.

That's what the Canada Health Act is all about. It's about equity. It's about ensuring comparable levels of high quality health care to all Canadians, from one end of this country to the other. It's about making real the promise of healthcare to every Canadian in every province and territory.

And while it is the responsibility of all governments to honour the CHA, it is the obligation of the federal government to ensure that its principles are respected, upheld and enforced.

As Minister of Health, I take that responsibility very seriously and, let there be no doubt, I will work to ensure that the benefits of medicare are available to all Canadians, all the time.
v Of course disputes will arise over the Canada Health Act. They have in the past and they will in the future. But when they do, we must try and work things out with the province or territory involved in a spirit of goodwill and real trust.

To that end, we have suggested formalizing a procedure which would give the provinces a voice and enable an independent panel of experts to assess if the Act had been breached and, if so, to recommend appropriate action.

While it will still fall to the Minister of Health to take such action, by bringing in impartial experts, our proposal aims to keep the politics to a minimum, making it more transparent and impartial.

I believe our goal - together - must be to properly fund the current system and to manage it effectively. To reform it wherever necessary. And to change what isn't working.

And if meeting the health needs of Canadians means investing in additional capacity - be it doctors, or nurses, MRIs or hospital beds, then we have both the duty and the responsibility to act.

Those of you on the front lines know better than most, there is a lot more we can be doing to improve our health care system: whether it's sharing information and best practices, or investing in prevention, or adopting electronic patient records or by building on the groundbreaking work of the Canada Institutes of Health Research and Genome Canada or enhancing inter-professional collaboration across the primary health care system or by anticipating the needs of an aging population, or by making use of the kind of information that will be provided by the new Canada Health Council.

In these and a hundred other ways, we can do better and we can do it now.

Moreover, as initiatives like the Western Canada Waitlist Project and the Ontario Cardiac Care Network make clear, the public system's capacity to innovate should neither be overlooked nor underestimated.

Let me turn now to the key elements of reform for our health care system.

As you well know, there is already a broad consensus on what needs to be done - much of it reflected in the 2003 Accord. We need to act on waiting times, health human resources, home care, pharmaceuticals, Aboriginal health and healthy living.

Let me talk about some of the priorities.

Above all else, we must reduce waiting times because that's what Canadians care about. Getting the care they need, when they need it.

The Taming of the Queue not only has the best title of any report produced this year, it also provides a clear and cogent analysis of the issues involved with waiting times. Health Canada was pleased to have supported the recent Colloquium of the same name and I want to thank the CMA and the Canadian Nurses Association for this outstanding contribution to our understanding of the issues involved with waiting times.

As doctors, you know that good outcomes depend on quality service and that quality service is not simply fast service. At the same time, care delayed can effectively be care denied and that is why we talked about "five in five", which aims to significantly reduce waiting times over five years in five key areas - cancer, heart, diagnostic imaging, joint replacement and sight restoration.

And that is why we are working hard to make real progress on this issue at the First minister's Meeting. We think Canadians deserve to know how long they will have to wait. And that means that governments have to measure waiting times for these key procedures on a comparable basis and report to Canadians so that we can begin to benchmark and make real headway on reducing waiting times.

With respect to health care workers, I am delighted to see that you have dedicated such a significant portion of your agenda to this issue, because it is critical. I know that this has been an issue of particular concern to the CMA for many years and I want to thank you - and in particular Dr. Hugh Scully - for the leadership you have demonstrated and for the recommendations you have made.

We share your concern over this key issue. That is why we committed $75 million to the question of foreign credentials.

As you know, following the First Minister's Accord of 2003 a lot of work has been done and more is underway.

We are currently working on a pan-Canadian Health Human Resources Planning framework that will include a strategy to improve our knowledge about current workforce capacity and what we will need in the future. There is also exciting work going on in interprofessional education as well as new strategies for the recruitment and retention of health care providers.

So this will be a key agenda item at our meeting in September and I am hopeful that all governments will commit to making progress in areas like the supply and mobility of health care workers, scopes of practice and for our international medical graduates so that trained professionals can start helping patients instead of driving cabs.

On home care, we need to weave the current patchwork quilt of programs into a national home care strategy which provides appropriate services to all Canadians, in all parts of the country.

In 2003, all governments committed to providing home care services to post-acute care patients - including drugs and rehabilitation services - as well as palliative care and services for the mentally ill.

And quite frankly, I'm disappointed at how little progress has been made.

At a time when many patients can receive just as good - or better care - at home; when there are not enough hospital beds for all who need them, it simply makes sense to make home care a priority and I pledge to you today, it will be.

Let me turn now to pharmaceuticals. And in doing so, I think it's important to put pharmaceuticals into the proper perspective - to see them as a key part of the whole, not as an isolated item on their own.

I met recently with the Canadian Pharmacists Association and I was struck by their strong advice that pharmaceuticals must be part of an integrated approach to health care reform. That an effective pharmacare initiative cannot stand alone or exist in isolation from other elements of health care. I agree.

The real challenge is to meet a very simple test: together, governments must provide catastrophic drug coverage for Canadians to ensure that no one - not the elderly or unemployed, not the working poor or those with young children - suffers financial ruin in order to receive the drug treatment they need.

And I can tell you that Government of Canada will work very hard to meet that test. In that regard, I think there is a lot to work on in the Premiers' proposal. There are certainly advantages to a collaborative approach to managing pharmaceutical issues and in fact, we have already seen positive results from the common drug review.

We could see similar benefits with respect to working collaboratively to manage the costs of pharmaceuticals as well to ensure their safe and effective utilization.

We also need to make progress with respect to Aboriginal health. Quite frankly, we haven't done a very good job. Aboriginal people continue to suffer from poorer health outcomes on almost every measure, from infant mortality to overall life expectancy.

These are not sterile statistics. They are the realities of life for our first citizens - and they are absolutely unacceptable to any of us, as citizens. Aboriginal people deserve better and equity demands that we do better.

I have had the opportunity to start discussions with the national Aboriginal organizations and I look forward to working with them to find the best ways to make real progress.

The Prime Minister has also made Aboriginal issues a key priority of our government as evidenced by the creation of a committee of cabinet which he himself chairs. He has hosted a Canada-First Peoples Roundtable and follow-up sectoral tables will be held including one on health which I will lead.

So our commitment is clear, but we need to go further, including measures to recruit more Aboriginal people into health careers, as doctors and nurses and to support their training.

Finally, we must act in terms of helping people to remain healthy rather than simply treating them when they are ill. These are areas where you as frontline practitioners can make a real difference and where both the federal and provincial governments can make real progress.

By getting upstream of the problems - through early detection, managing risk factors such as smoking, diet and physical activity and by developing strategies to better manage chronic diseases - we can improve health outcomes, reduce the demands on the health care system, and, I believe, make a significant contribution to its sustainability.

As I close, let me say that the key to all of these reforms - whether it's waiting lists or health human resources, home care, pharmaceuticals, Aboriginal health or healthy living - is the results they achieve for Canadians. That is why I am committed to ensuring accountability to Canadians.

In fact, in some ways this is a critical issue because it speaks to the trust and confidence Canadians have that their most cherished social program is being managed wisely and well. That they are getting the results they deserve and the value they demand.

There is no question that our health care system costs money. And as I've said, the federal government is prepared to invest more in the health of Canadians. At the same time, we want to attach investment to results.

And this requirement applies to all jurisdictions - including the federal government. And that's only right. After all, the health care system belongs to Canadians and they should see how their tax dollars are being spent.

That's one of the reasons I'm so delighted that the September meeting will be televised. Open and transparent. That's how government should operate. That's how the health system should operate too.

So these are the priorities - and these are the values - that I carry with me to the First Ministers' Meeting in September.

And I believe they are pretty much the priorities and values that the Premiers and provincial health ministers bring too.

They also cherish medicare. They too understand its inherent fairness. They know the place it has in the hearts and lives of Canadians.

Above all, they know that medicare is something that belongs to all of us, as Canadians. That we inherit it not by the status of our birth but by virtue of our citizenship.

And that we now have an opportunity to add our hands to the work of our forebears; to secure what they started, to confirm what they believed.

In those efforts, and in that spirit, I look forward to the meeting in September and to continuing to work with the CMA in building a strong, sustainable and dynamic health care system for all Canadians.

Thank you.

Now, if you're not too hungry, I'd be happy to try and answer your questions!

Health Canada