GOVERNMENT ORDERS

DEPARTMENT OF HEALTH ACT

Mr. John Murphy (Annapolis Valley-Hants, Lib.): Mr. Speaker, it is an honour and a privilege to speak today on Bill C-18 which will establish the Department of Health.

Many in the House have observed that the health related duties, powers and functions which are set out in the proposed new legislation do not differ greatly from the previous act. Indeed, it can fairly be said that the old act has served us very well over the past half century.

At this point I would like to congratulate my hon. colleague from Fredericton-York-Sunbury for a motion he put forward. His amendment reincorporates a clause from the current Department of National Health and Welfare Act, an act dating back to 1944. This amendment explicitly defines the minister's personal and legal responsibilities for the department.

I am pleased to say that the government gave the member for Fredericton-York-Sunbury its full support on this amendment and it was passed at report stage. The Minister of Health as well shared the concerns of the member that this legislation makes things perfectly clear with regard to his powers, duties and functions.

There are some obvious differences in this bill which is to be expected in a knowledge intensive field like health. One of these differences is found in clause 4(2)(a) where there is explicit reference to:

-the promotion and preservation of the physical, mental and social well-being of the people of Canada;

What does this mean? Some people have read into it something of a sinister message, a sign of an as yet undeclared plan by the federal government to occupy the full arena of physical, mental and social well-being. Such a move would have a significant impact on the division of responsibilities for health between the federal and provincial legislatures.

Others have observed that the inclusion of this clause seems somewhat odd, given the transfer of the welfare side to the Department of Human Resources Development. After all, would it not make sense to consolidate all federal responsibilities for physical, mental and social well-being in a much more inclusive health department?

My first observation is that the legislation makes it abundantly clear that the powers, duties and functions of the Minister of Health do not extend beyond the area over which the federal Parliament has jurisdiction. This means that the reach of Health Canada cannot and will not extend to the legal mandate of other federal entities. Rather, section 4(2)(a) says how the federal government views health. The choice of the words ``physical, mental and social well-being'' is no accident.

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These are the exact words used by the World Health Organization to define health. It is a concept that goes beyond seeing health in terms of the presence or absence of disease. It is a concept that sees health in terms of the whole person. This is a concept of health that embraces quality of life rather than just duration of life. Including the phrase ``physical, mental and social well-being'' in the bill before us today does little more than to formalize what has long been a reality.

In my former life I was in the health industry for 30 years and for many of those years advocated bringing those three elements together. Rather than divide a person let us look at the person in a holistic fashion.

It is neither new nor startling. It makes it clear that health means so much more than the absence of disease. Good health across a society flows from an entire set of public policies and personal decisions.

The determinants of health are the complex web of factors that contribute to the overall state of a person's health. These are social, economic, physical, psychological and other elements. Is it any wonder that research shows that people who are unemployed experience both stress and greater health problems? Or perhaps

hon. members have seen some of the reports in the newspaper where researchers have found real differences between the health of people who feel a sense of personal control in their livesand those who do not. All of this simply reinforces what wealready know.

Despite the best technology and the advances in drugs and procedures, what takes place outside a doctor's office is more important than what goes on inside that office. This fact has become a common theme in the analysis of health policy options. For example, Health Canada spends a large sum of money each year to provide health services to status Indians and Inuit. Yet aboriginal people continue to suffer, with many of the poorest health statistics in our society.

This of course is not a place to discuss these health statistics but it makes clear the importance of the comprehensive focus on well-being. It also underlines one of the basis facts of health, system renewal. We cannot spend our way to good health through the health care system no matter how much we invest.

We are better off to help people achieve a state of well-being that results in better health and less need for health care. A growing appreciation for the many factors that contribute to the health of Canadians has sparked an increased focus on the elements of well-being. Progress in this area establishes a foundation from which our health care systems can operate more effectively. It is rightly seen as an investment that minimizes future health care costs and that is extremely important.

Some of these factors lie within the mandate and the programs of the federal health department. Others lie within the mandates and programs of other federal agencies. Some are within the reach of provincial and territorial governments and still others lie totally outside of the public sphere. This is the reality of health. It is the reality of Canada's health system. It is a reality that requires partnership and co-operation. It is a reality that places a premium on the evidence about determinants of health and the outcomes and effectiveness of health policies and programs. Most importantly, it is a reality that does not require any expansion of the federal health mandate.

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Once this focus on partnership for well-being is put into practice, we see it as the practical concept that it is. Let me use the example of Canada's drug strategy. The ultimate aim of federal programming is to minimize if not eliminate the human tragedy that is the common consequences of drug abuse.

Looking at the problem of drug abuse in these terms allows us to also consider contributing factors in the context of a much broader array of health determinants.

Many here will recall the ``Really Me'' message that Health Canada coined for Canada's drug strategy. This message is meant to capture in two words the sense of confusion over identity and destiny that often contributes to a young person's decision to experiment with dangerous substances as well as the positive imagery of a drug free life.

Canada's drug strategy obviously encompasses a great deal more than slogans and messages but is aimed at addressing what physical, mental and emotional well-being is all about.

Let me offer a current example, the Canada prenatal nutrition program. This initiative arose from the red book commitment. Its goal is to promote the development and growth of healthy babies. However, the route to that goal means addressing the factors that can harm that development.

Clearly, a child in a mother's womb is no healthier than his or her mother to be. If the woman is eating poorly or in an abusive relationship or using drugs, the risks to the baby are very high.

This program, as members are well aware, supports comprehensive community based efforts aimed at reaching these high risk, pregnant women. At one level it includes food supplementation, nutrition and lifestyle counselling and related information. At another level it gives them more tools to take better care of themselves and their babies.

The mothers to be targeted by this program are usually poor. They are often underweight themselves. They may smoke, drink or use drugs. They also may be in abusive relationships. They often live in poor areas of our communities. They are often young, single and uneducated.

Such conditions are the determinants of health that lead to 40,000 low birth weight newborns a year who begin life at less than full capacity. These are the factors that this program is working to correct.

The focus on well-being goes far beyond many health promotion efforts by Health Canada. It extends into health care delivery. The phrase quality of care clearly means more than clinical outcomes.

Whether or not quality is the result will inevitably vary between individuals, not because the results vary in clinical terms but because identical health states may be valued differently by different people.

Take for example a surgical procedure for which there is a good chance of a known side effect. For some the side effect may imply a lower quality of life than living with the disease in question. For others the reverse would hold true. In both instances the aim of the clinical decision is to achieve the health states of greater value to the individual.

This is a choice that every one of us wants to have. Yet it is a choice that is not available if health is conceptualized in a way that sees it only as the presence or absence of disease. We are talking holistic medicine here.

At another level it is obvious that there remains much to be learned about the factors that underlie and shape a person's fiscal, mental and social well-being. I am reminded that health concepts in medical terminologies and technologies have evolved greatly since 1867 yet at no point has Canada's Constitution been a bar to the effective pursuit of health.

We are now at a point in which provinces and the federal government understand and accept the need to build well-being as a part of the overall health strategy. Governments work together. I am not aware of any province that seriously sees the Health Canada mandate for well-being as a threat to its responsibilities. If anything, it underlines the shared commitment to addressing the basis of good health and well-being. It underlines a longstanding commitment to the co-operation that has served us so well.

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In terms of health status, we are second only to Japan in terms of neonatal deaths. In terms of our record in the development of health concepts, Marc Lalonde's 1974 ``A new Perspective on the Health of Canadians'' is still regarded internationally as a breakthrough, 21 years after its release. The record of our health care delivery system speaks for itself, a source of pride for all Canadians and the envy of the world.

The inclusion of section 4(2)(a) in the enabling legislation conveys a message about who we are and what we stand for. We stand for a commitment to the physical, mental and social well-being of Canadians and a readiness to work with others to achieve that end. This section simply recognizes the complex range of factors that influence health and that they deserve consideration as we promote health.

In short, this section tells us what we already know to be true. A department charged with promoting the health of Canadians needs to see its mandate in terms that reflect the reality of peoples' lives and all the elements that lead to good health.

[Translation]

Mrs. Pauline Picard (Drummond, BQ): Mr. Speaker, I am pleased to be able to speak once again to Bill C-18, which was introduced as Bill C-95 before the recent prorogation of the Houses. The bill's purpose is mainly to establish the federal Department of Health. It also amends and repeals certain other acts.

Such a bill is absolutely unjustified. There is no reason to pass such a measure since health is exclusively a provincial jurisdiction. It is crystal clear in the very constitution the government wants to impose on Quebecers. I said it before, I say it again and I will go on saying so. It seems hard to understand, but health is an exclusive provincial jurisdiction.

With its spending power, the federal government retains the possibility of interfering in all areas of provincial jurisdiction as it pleases and without consideration for the distribution of powers guaranteed in the Constitution. To prove my point, I quote Alexander Galt, one of the Fathers of Confederation, who stated that the distribution of jurisdictions as described in the British North America Act of 1867 did not give provinces enough money to enable them to properly administer their areas of jurisdiction.

Alexander Galt's comments leave no doubt as to the initial intentions of the Fathers of Confederation as well as of another author of the 1867 act, who said that eventually the provinces would become nothing more than big municipalities under federal supervision and largely dependant on the central government.

It might be difficult for some to admit today that this might have been the goal of those who thought up the British North America Act. Difficult to believe that the act which gave birth to Canada provided, even at a very early stage, for an increased centralization of powers in Ottawa.

The point of my little aside was to show that, contrary to what some would have us believe, nothing has changed. We can see that the same centralized approach giving the present central government an overwhelming importance is permeating not the discourse, heaven forbid, but the actions of today's main federal leaders. The best example of this can be found in the health care area in which the federal government has continuously interfered in an increasingly more persistent way. Bill C-18 before us today is a case in point.

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The Constitution Act gives the provinces general jurisdiction over health care by including generally all matters of a merely local or private nature in the province. Anyone can read this under subsection 92.16. Moreover, subsections 92.7, 92.13, and 92.16 of the same act give the provinces exclusive power over hospitals, the medical profession and the practice of medicine as well as health care in general in the province. I might add that this is an area of exclusive provincial jurisdiction because it pertains to property and civil rights.

Accordingly, it seems clear that health is under provincial, not federal jurisdiction. However, the federal government has been intruding in this area for many years now, and in various ways. The Hospital Insurance and Diagnostic Services Act, the Medical Care Act and, more recently, the Canada Health Act, which combines the other two and sets so-called national standards, show clearly what this federal government thinks about shared jurisdiction.

The will or temptation to intrude on health is not new. It goes back to the end of the second world war. The federal government

had taken over all main taxation areas to make sure it would control most of the taxes normally levied by the provinces.

At the end of the war, the federal government had a bright idea: instead of returning powers of taxation to the provinces, why not redistribute the money through grants subject to standards it would set. This was a clever way to intrude even more in aareas under provincial jurisdiction, at a time when it seemed that the Privy Council in London, which then played the role now assigned to the Supreme Court, wanted to limit the federal government's centralizing tendencies.

Since then, the federal government has been using established programs financing to transfer money to provinces for health and post-secondary education. The amounts given to provinces under that program are transferred partly in cash and partly in tax points.

Transfers were computed from expenditures for a base year, 1975-76, and were supposed to be indexed on the average GNP per capita over the last three years. Basically, since its implementation in 1977-78, established programs financing has been characterized by a unilateral partial withdrawal on the part of the federal government.

Implemented in 1977, the established programs financing structure has remained unchanged. However, for the last ten years or so, its intended rate of increase has not been respected. This is where the shortfall for provinces and Quebec in the area of health comes from. This is a good example of the damage that a government can do when it refuses to acknowledge that it cannot substitute itself to other levels of government everywhere.

In 1986, the federal government reduced the growth rate of transfers by 2 percentage points, which means that health expenditures had to grow 2 percentage points less than the GNP. That was the start of a long series of cuts in payments.

In 1989, there was another cut in the indexing factor of 1 percentage point, which meant that by now growth in health expenditures had to be 3 points below the growth of the GNP.

In 1990, Bill C-69 froze transfers at the 1989-90 level for an anticipated period of two years, regardless of inflation, when actual health costs were continuing to rise.

In 1991, the federal government announced that it was extending the freeze for another three years. During most of this sad period for health care, the opposition party was outraged. It clamoured that this could only lead to ruin for the heath care system. Yet, that same party, now the government, continues to weaken the system.

The result is that between 1977 and 1994, the federal contribution to health care went from 45.9 per cent to 33.7 per cent, a drop of 10.6 per cent that Quebec and the provinces had to deal with to the best of their abilities. Unfortunately, forecasts for 1997-98 indicate that the federal share will drop to 28.5 per cent.

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Over the years, as Ottawa withdrew from health financing, it is almost $8 billion that Quebec alone did not get, that the Quebec government had to manage to find elsewhere. We can add to that amount the cuts expected in the Canada social transfer, that is $308 million for 1995-96 and more than $587 million in 1997-98.

According to a study by the C.D. Howe Institute, from 1988 to 1992, while spending for transfer payments remained unchanged, spending for other federal programs increased by 25.5 per cent. Consequently, cuts in health transfers to the provinces went to reduce the federal deficit. The federal government went on spending too much, while telling the provinces to tighten their belts.

The leeway the Canada social transfer is supposed to give is in fact nothing but an opportunity for Quebec and the provinces to decide for themselves where they will make cuts to make up for this unilateral withdrawal. That is the vision the present Liberal government has of decentralization. That is what it means when it talks about flexible federalism. Thanks, but no thanks. We are not interested.

Last Spring, the National Council of Welfare, an organization whose mandate is to advise the federal health minister, had this to say to the minister: ``It would be extremely hypocritical to reduce contributions to the provinces while increasing the requirements they would have to meet''. Yet, the National Council of Welfare is not known for its sovereignist leanings.

As I mentioned earlier, sections 92.7 and 92.16 of the British North America Act state that health and social services are exclusively under provincial jurisdiction. Yet, the federal government also has a health department.

Next year, it will cost taxpayers more than $1 billion, $1 billion wasted to do what the Government of Quebec and the governments of other Canadian provinces could very well do by themselves.

Moreover, this redundant department that employs more than 8,000 public servants allocates significant amounts for programs and projects that already exist in Quebec and in the other provinces. I can give you some examples from Quebec, where there is duplication in programs. Here are a few examples: the strategy for the integration of persons with disabilities, the family violence initiative, the new horizons program, the seniors secretariat, the program to reduce smoking, the anti-drug strategy, the strategy against AIDS, the pregnancy and child development program, the children's bureau, and so on.

It is this kind of duplication the federal government should have cut, instead of stubbornly trying to have its say in every area; the disastrous impact of this on government finances does not seem enough to make it face reality. It shifts the deficit onto the provinces by cutting transfer payments for health care, and people are paying the price.

There is another federal initiative shows the government's determination to meddle in health care without the provinces' consent: the national forum on health, aimed at taking a critical look at our health care system as a whole and proposing ways to compensate for the ever increasing costs in this area. According to several analysts, the federal government could even take this opportunity to tighten the criteria and requirements in the Canada Health Act. Moreover, every single province openly criticized the federal government's attitude, which in this instance is pushing aside those with legal jurisdiction over health matters.

In this regard, on September 27, 1994, the current Minister of Immigration told La Presse: ``The federal government's actions make no sense. How can it contemplate a review of health care plans without the participation of the provinces, which are responsible for providing services? This is clearly unacceptable''. I would be curious to hear the Minister of Immigration's current position on the national forum.

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Another extremely wise comment on this Liberal government's failure to honour provincial areas of jurisdiction was made by Thérèse Lavoie-Roux, who, when she was still a member of the other place, asked why the provinces had not been invited to participate in the forum. ``Are they not the main players in the area of health? Does the government leader think it is appropriate for the government to act unilaterally in an area that comes under provincial jurisdiction?''

Now, looking specifically at Bill C-18, it is clear that, instead of showing good faith by withdrawing from this area over which it has no jurisdiction, the federal government is doing its best to encroach little by little on provincial jurisdictions for its own benefit. This bill was not presented as a bombshell, as a megabill; it was presented to us as an innocuous and inconsequential bill, while in fact it is definitely not so.

Paragraph 4(1) sets out the powers, duties and functions of the health minister. It suggests that the powers, duties and functions of the minister extend to and include all matters over which Parliament has jurisdiction relating to the promotion and preservation of public health. There certainly is room for clarification here.

The following clauses are more subtle. Paragraph 4(2) lists particulars concerning the minister's powers, duties and functions, including the promotion and preservation of the physical, mental and social well-being of the people. The people in question are the people of Canada. This clause would give the federal government the authority and right to interfere in an area under exclusive provincial jurisdiction.

Paragraph 4(2) goes on to include the protection of the people against risks to health and the spread of diseases. There was nothing to that effect in the original act that Bill C-18 seeks to replace. This opens the door to the federal government stepping in to protect the health and ensure the safety of the people by invoking the national interest or peace, order and good government.

Paragraph (c) of the same clause provides that investigation and research into public health, including the monitoring of diseases, come under federal authority.

This creates a problem, since later on, in clause 12, it is stated that nothing in the act or the regulations authorizes the minister or any officer or employee of the department to exercise any jurisdiction or control over any health authority operating under the laws of any province.

How does the Department of Health intend to monitor diseases without having access to the necessary information? Under the Health Services and Social Services Act, health care institutions are governed by provincial legislation.

Is this a real problem? Does clause 12 adequately restrict federal involvement in the health care sector, or is it just a front to reassure the provinces, one that the federal government will easily remove at will, as it has done so effectively in recent years?

Clause 4 can certainly be interpreted in a very wide and generous way. We definitely have to wonder about the real meaning of this clause, which can be interpreted in several ways, and which may reflect a number of intentions.

It is typical of the federal government to use a seemingly simple and inoccuous bill to intrude on fields that come under provincial jurisdiction. However, nobody is gullible to the point of not seeing what is going on.

Bill C-18 is another typical example of the federal government's sneaky and quiet way of doing things, without making waves. It acts like this because it knows full well that no one agrees with its way of doing things in the health care sector. Instead of admitting that it is in the wrong and taking corrective action before it is too late, the federal government persists in a sneaky way, so that no one will realize what is going on until it is too late.

Clearly, federal interference in the health care sector has a very negative impact. It is also obvious that the federal government stubbornly refuses to recognize the fields that come under provincial authority and also continues to reduce transfers without

making national standards more flexible. We are headed towards the death of the health system as we know it.

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No more sad claims that Canada holds the only insurance policy for a health system such as ours. Yes, we are proud of our health system; yes, we want to hang on to it and even to improve it; no, Canada is not an insurance policy for this system, far from it; and no, Quebec's sovereignty will not spell the end of our health system, quite the contrary.

The only real threat lies in the lack of vision of a federal government that no longer has the money to match its centralist ambitions and that should, as soon as possible, turn over full authority, including financial authority, in matters of health to the provinces, at least to those which have asked for it. The health of Canadians and Quebecers can only improve.

It goes without saying that for all these reasons, and for many others that I will raise at a later time, it is impossible for the Bloc Quebecois to support Bill C-18 in any way.

Mr. Paul Crête (Kamouraska-Rivière-du-Loup, BQ): Mr. Speaker, I wish to congratulate my hon. colleague on the clarity of her address. I think that salient point in it is that attempts have been made in recent years to clearly demonstrate the considerable amount of waste and duplication there was between the two levels of government.

Often people ask for concrete examples of such waste. The various strategies in the different programs my colleague has listed, for example to integrate the disabled, the campaigns against family violence, drug use or AIDS, can readily be seen as worthwhile from the political point of view. The reason for federal involvement in these is obvious, particularly because it gets involved through its spending power.

In today's Canada, we cannot necessarily afford such things. The hon. member's presentation has made that abundantly clear. I therefore feel that it would be in the federal government's best interest to think once again about whether it is advisable to get involved in this area, before adopting this bill.

I would like to ask the hon. member where the national forum on health fits into this. I was looking at its mandate just now: ``to improve the health of Canadians and the efficiency and effectiveness of health services''.

Mr. Speaker, what I would like to find out from my hon. colleague is which of the responsible governments is the one most capable of ensuring efficient and effective health services? Is it the federal level, which does not provide front line services, or is it the provincial level, which does provide such services, which has the responsibility for them, which is always on the firing line? Is it the provincial governments, all of which are being faced with difficult choices at this time?

Mrs. Picard: Mr. Speaker, I thank my hon. colleague for his question.

We have reviewed the history of the national forum on health time and time again. Where does it fit in here? I see it as nothing more than smoke and mirrors.

At this time, and it can never be repeated too often, the provinces arre the ones managing health programs within their borders. As I have always said, I do not in any way question either the quality or the experience of the people on the national forum, but what use will their expertise be put to? There is not a single provincial representative on the forum.

All of the provinces are busy restructuring at this time. We can see that in Quebec, where the minister, Mr. Rochon, is in the process of reviewing and restructuring, with a view to managing the health system in a new way and to ensuring quality health care, while taking into consideration our aging population, technological innovation and drugs costs.

The provinces are the ones who know what their needs are. What can the national forum contribute in addition? Once again, the federal spending power is being used to start up new things, to waste time and money.

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This is not the first time we in the Bloc Quebecois have said that the national forum on health is, in our opinion, just smoke and mirrors with which to convince the people of Quebec and of Canada that this is a good government.

Mr. Crête: Mr. Speaker, I think the demonstration was quite clear. I would ask the hon. member for more details about an example of direct concern to her. We are told the government has a strategy to integrate people with handicaps, whereas in Quebec there is the Office des personnes handicapées du Québec, whose head office is in the member's riding, I believe.

Would the federal government not be better advised, rather than putting in additional funds necessitating even more money for administration purposes-there must be administrative costs in a strategy to integrate people with handicaps-not to spend this money on a program that competes to some extent with action taken by the Government of Quebec? Would the Office des personnes handicapées du Québec not benefit significantly more from the federal government's withdrawal and thus provide a better and more complete service to Quebecers with handicaps?

Mrs. Picard: Mr. Speaker, I thank my colleague for his question. This is not the first discussion of duplication.

It is true, the Office des personnes handicapées du Québec is to be found in my riding. Rather than take into account what is

happening in each province and the programs each has set up, as I was mentioning earlier, the federal government steps up with its spending power and, in the name of good government, says: ``There seems to be a problem with seniors-or with people who have a handicap''. And it assuages its conscience by putting money into a program, setting up a program that already exists in some provinces.

Why not support the programs the provinces have already set up? The provinces know the health care requirements in each of their regions. After needs have been assessed, programs are set up to help people, with the help of experts in health care. Seeing that the program is running well, the government, as I mentioned earlier, injects money into the program to justify itself and to assuage its conscience.

And if it is such a good government, why does it not support these programs by paying subsidies instead of cutting transfer payments, instead of tightening things up, instead of dumping its deficit onto the provinces and cutting transfer payments?

[English]

Mr. Lyle Vanclief (Prince Edward-Hastings, Lib.): Mr. Speaker, I am pleased and proud to address the House today in support of Bill C-18, an act respecting the Department of Health.

We have all heard allegations that the federal government has no role in health. Some contend that the government should leave health issues to the provinces and territories which actually deliver the services to Canadians. The government fully appreciates the provinces have constitutional authority for health care.

The provinces are responsible for health care delivery which generally encompasses hospital and medical services. The provinces plan, manage and operate Canada's health care system. These systems operate however under the framework of Canada's national health insurance system which we all know as medicare. This national system ensures that all Canadians, regardless of ability to pay, have access to well trained doctors and well equipped hospitals.

I do not wish to lend credence to the myth that the federal role in health is limited to its financial and other support of Canada's medicare system. At the same time we have every reason to be proud of the system and of this government's support for medicare.

Canadians justifiably take great pride in our national medicare system and the quality of medical services available to all of us. They know that regardless of where they live, what language they speak or what their employment status may be, they are all assured of access to high quality medical and physician services whenever they are needed.

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Medicare also has economic benefits that accrue to Canadian businesses. Business supports medicare because it provides it with competitive advantages in the global market. Canadian businesses do not pay the costs of providing private health care insurance for necessary hospital and medical services.

Even after taking Canada's taxes into consideration, the cost of providing employee benefits is significantly lower in Canada than in the United States. This is certainly one of the factors that helps to attract multinational corporations to Canada.

The national character of the system also enhances labour force mobility. Workers do not need to fear health insurance coverage for themselves or their families because they change jobs or move to another province in search of employment. Canadians retain their coverage even if we move and become unemployed.

By guaranteeing Canadians access to quality health care, medicare helps to ensure a healthy and productive labour force. I believe our health care system has also helped to foster a sense of unity among Canadians. Canadian society is multicultural and diverse, as we all know. At the same time, it is strongly tied to North American culture.

It is sometimes difficult for Canadians to define ourselves apart from our neighbours to the south, but health care is certainly an exception. Our universal health care system is closely tied to our Canadian identity. It is valued as an outward manifestation of fundamental shared values, justice, caring, compassion and equity. Not only is there more to health than health care, there is also more to the federal role in health than upholding the principles of the Canada Health Act.

There are only about 25 employees who administer the Canada Health Act. The department's other employees support uniquely federal roles and responsibilities, work which is not carried out by the provinces and in which the federal government has a clear jurisdiction.

I will briefly outline for the benefit of everyone the vital work of this department. The department's work is clearly focused on four business lines. The first of these involves supporting and renewing the health system. Health Canada works here to maintain universal access to appropriate health care while helping to ease financial pressures on the public and private sectors.

In support of these goals, the department administers the Canada Health Act and makes transfer payments to support provincial health insurance systems. It also promotes collaboration and consensus on options for involving the effectiveness and efficiency of Canada's health system.

A good example is where the department works closely with the provinces and territories to evaluate the quality and effectiveness

of how health services are managed and delivered across Canada. This information is shared by all jurisdictions and helps shape the renewal of our health care system.

The federal government has statutory responsibilities to protect the health of Canadians. The Department of Health carries out this responsibility by monitoring and assessing risks to health from emerging infectious diseases and other public health threats. All the provinces and public health agencies in Canada rely on the department's public health intelligence.

The second line is risk management. The department manages national disease control strategies and ensures the quality and safety of foods, drugs and medical services for all Canadians. It also regulates human and veterinary drugs, oversees the safety of biologics and cosmetics and ensures the safety and nutritional quality of Canada's food supply.

I cannot emphasize strongly enough the vital federal presence in this area and how important it is to the health of all Canadians. Canada currently has no capacity to identify and analyse potentially lethal infectious diseases such as the Ebola virus. However, the Department of Health is now constructing a level four laboratory in Winnipeg which will do just that. When it opens, this facility will employ 100 scientists. Their work will further enhance the health and safety of Canadians from coast to coast.

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The department's third business line involves collaborating with partners on strategies related to the health of the population. These strategies include health promotion, illness prevention and public education elements. They mobilize efforts to address national issues such as cancer, family violence, AIDS and prenatal nutrition. These strategies address the factors that lead to ill health. They provide much needed support to vulnerable groups at risk including children, single parents, poor families and seniors. They help prevent and combat heart disease, breast cancer and many other illnesses.

These strategies complement but do not duplicate the work done by Canada's many national volunteer health organizations. We owe the many volunteers a big debt of thanks for the work they do on behalf of the health of all of us. We are recognizing volunteer week in Canada and the number of people in all our communities who work so hard for the benefit of all of us.

At the same time, these health prevention and illness prevention strategies of the Department of Health reduce demands on Canada's health care system, thus contributing to reduced health care costs.

Prenatal care is a good example. The cost of neonatal care for a low birth weight baby is about $60,000. The health promotion and prevention activities aimed at ensuring a healthy birth weight on average costs about $400 per child.

The Department of Health's fourth business line involves providing health services to First Nations and other groups such as Canada's military personnel. It is not generally well known that Health Canada provides community health services to status Indians on reserves and to residents of Yukon through 600 health facilities across Canada. It also ensures that registered Indians and eligible Inuit receive a range of medically necessary goods and services not available from the provinces.

Apart from transfer payments to provinces, two-thirds of Health Canada's budget is devoted to the health of natives and native health issues. This is the only area in which Health Canada is directly involved in the health care delivery system.

The department is responsible for assessing and sharing the health of special groups such as civilian aviation personnel. It ensures the safety of the Canadian public in cases of national civilian disasters.

Together these four business lines include a range of activities designed to maintain and improve the health, safety and well-being of Canadians. Without a strong federal role in health we would have no national standards or processes to ensure the safety of Canada's food supply, its medical devices and drugs. There would be no national public intelligence to protect us from the emerging infectious diseases which are becoming increasingly common and increasingly complex.

The Department of Health is certainly vital to the fabric and daily life of the nation. It helps ensure the safety and well-being of Canadians from coast to coast and makes important contributions to the nation's productivity, competitiveness and prosperity.

I am proud to go on record in supporting this bill.

[Translation]

Mr. Paul Crête (Kamouraska-Rivière-du-Loup, BQ): Mr. Speaker, I listened with interest to what my hon. colleague just said. I appreciated the listing of the various mandates of the federal health department but just the same we must wonder what it is doing there. Why is the federal government once again interfering in an area of provincial jurisdiction?

Incidentally, I would like to quote two women who can hardly be accused of being sovereignists. Mrs. Robillard is currently a member of the federal cabinet but she was Quebec's health minister in 1994. On September 27, 1994, she was quoted in La Presse as saying: ``The federal government's conduct is appalling. How can they consider changing the health system without asking the provinces, which are responsible for providing the services, to participate? That is just not acceptable.''

The other woman is Thérèse Lavoie-Roux, who, on May 31, 1994, said that the government was wrong in disregarding the role played by the provinces. She added: ``Why were the provinces not invited to participate in the forum? Are they not the main players in the area of health? Does the government leader think it is appropriate for the government to act unilaterally in a matter of provincial jurisdiction?'', she asked.

(1255)

I wonder why the federal government keeps on interfering stubbornly in this particular area. This is obviously an area which could pay handsome dividends, come election time. Some areas are more important, more strategic than others and health is one of them. If only the federal government was responsible, as it should, it would recognize from the start that it has no spending power in that area and would therefore not spend money there, but rather let the provinces look after these matters, thus preventing the kind of duplication we are currently experiencing. So, how can the hon. member justify that his government's interference in this area, if not because of purely political motives?

[English]

Mr. Vanclief: Mr. Speaker, it is certainly not something to win votes. The hon. member needs to recognize it is a Canada health act. The role of the federal government is to ensure all Canadians are treated the same way, that all Canadians have access to the same treatment as anyone else.

If the provinces in some cases wish to duplicate or add to those services as far as informational services are concerned, that is certainly up to them to do so. I would question whether that is necessary all the time.

If we look at the intelligence, the information the federal government makes available to Canadians, the government certainly feels it has an important duty to inform Canadians. No matter what the issue, all Canadians want to know from the same source if possible what the health and safety standards are in Canada, what the medicare standards are, what they can receive for medicare if they move from one province to another province. That is the role.

We have shown very clearly over the years this is the wish of Canadians. We in the government are determined to maintain that for all Canadians so they know its full value.

[Translation]

Mr. Crête: Mr. Speaker, the purpose of the forum on health is to improve the health of Canadians and to increase the efficiency and effectiveness of health care. Can the hon. member, who believes the Canada Health Act requires the government to ensure that Canadians across the country enjoy the same quality of health care, tell us if, in light of its systematic withdrawal amounting to millions and billions of dollars, the federal government is not managing an empty shell?

Despite imposing national standards and gradually withdrawing financial support, the government now requires the provinces, which are providing the services, to comply with national standards without giving them the means to act in this area. If the federal government really wanted to carry out its mandate in this regard, should it not stop collecting the taxes allocated to health care and allowing the provinces to act in this area, thus giving them access to more money so they can provide adequate services? Will the health forum help improve in any way the quality of health care provided to the people of Quebec and the other provinces? I doubt it.

[English]

Mr. Vanclief: Mr. Speaker, the hon. member and some of his colleagues should realize and admit that as a country, whether on health issues or any other, we will continue to be strong by working together.

If the hon. member is saying federal dollars for health should be handed over to each province and each province should do its own willy-nilly thing as far as health care is concerned, I am sorry, but he is speaking to the wrong government. He is speaking to Canadians who do not want to hear what he is saying.

Canadians have made it very clear to all of us that they recognize we do not have as many dollars as we once thought we had. We have to be doing more with less or at least as much with less in the future.

Only by sitting down and talking in forums such as the national health care forum with representatives of the federal government, the health care industry, the health delivery service and people in the provinces can we put our heads and available funding together, federally and topped up if necessary from the individual provinces, to provide what all Canadians have made it clear they want and having it made available to them in every corner of the country.

(1300 )

Mrs. Sharon Hayes (Port Moody-Coquitlam, Ref.): Mr. Speaker, I rise today to speak to Bill C-18, which would formalize the reorganization of the Department of Health.

As Reform's deputy health critic I will speak in support of the bill but before I do I would mention that the bill in our minds is simply just another shuffling of bureaucrats. It is taking up the expense and time not only of Parliament but more important, taxpayers' dollars, as signs are shifted on doors and offices are relocated. This is another example of phantom legislation the government will say is actually doing something, rather than making substantive changes for Canadians.

Of course, every member of the House would admit that health care and our health system is of very real importance to all Canadians. Health Canada is under the scrutiny of Canadians. A

very real concern to Canadians is the sustainability of our health care system.

The federal role in the health care system is very real. A part of that role is federal funding to the provinces. I would say that the government has failed Canadians in that role. Canadians are feeling the effects of the cutbacks from this place. For instance in Manitoba, health care workers are on the streets protesting changes which have been deemed necessary and are a direct result of decreasing and unpredictable federal funding. This place has offloaded its debt to the people who will be hurt the most.

The current health system is not working and it will continue to worsen. The government refuses to recognize this fact. It refuses to hear about it.

The Reform Party wants to assure Canadians that they will have a sustainable health care system. All Canadians should have access to health care services regardless of their ability to pay. We in the Reform Party care about the system and we are prepared to work with Canadians to find ways to make the system better.

I have a broad concern that surrounds the bill and the functioning of our government. Fundamental to our system of government is the principle of ministerial accountability and responsibility. Not only is the recognition of this principle vital, the practice of it is crucial to another principle, that of good government which our system is intended to provide for the betterment of all Canadians.

Even though the bill is housekeeping legislation, Reformers support it because it has been amended to take this principle into account. At report stage we supported an amendment which instilled this principle in the bill. It was not contained in the previous version which the government drafted and presented to the House for its consideration.

There is a litany of examples demonstrating the need for the principle and practice of ministerial accountability and responsibility which are specifically related to Health Canada and the health of Canadians. I will mention a few.

Recently we heard of the mismanagement within the health protection branch of Health Canada. The mismanagement of our national blood system by the bureau of biologics has led to a tainted and compromised blood supply which has infected thousands of Canadians with HIV and hepatitis C. An issue related to this is that of the Krever inquiry which is examining the failure of the management and oversight of our national blood supply system.

(1305 )

Last week in a statement to the House I criticized the government and the health minister for failing to uphold his ministerial responsibilities. It was revealed that the federal government is paying the legal bills of two former ministers involved in this tragedy while giving very minimal legal support to victims and their families who are trying to pursue the truth in the courts on this matter.

What has been the response of the government and the health minister? He has joined a chorus of those who are legally challenging the legitimacy of this inquiry. Instead he should be safeguarding the mandate of the inquiry and facilitating a full report on all matters relating to this most important issue. By doing so he could actually fulfil his responsibilities to the crown, the House and most important, the Canadian people. He has chosen to do otherwise.

A third and final example of where the practice of ministerial responsibility is required is related to the fiscal management of the department and the allocation of our increasingly scarce health care dollars.

Since I was appointed Reform's deputy health critic, one observation I have made is the imbalance and inequity in the department's and the government's health care spending priorities. This became clear to me when I was on the subcommittee on HIV and AIDS which studied the national AIDS strategy. I discovered an imbalance in federal funding for diseases in relation to the incidence of various diseases and the toll they inflict on our society.

For instance, in 1994-95 the federal government spent $43.4 million on the national AIDS strategy while only spending $4 million on breast cancer research. Compare those funding levels with the incidence rates of these diseases and the deaths inflicted on society. Since 1980 there have been approximately 10,700 HIV cases with 7,400 deaths from AIDS in Canada, while in 1995 alone almost 18,000 families will have a loved one affected by breast cancer and a total of 5,400 dead.

I have received letters from across Canada on that very issue. The government must be held responsible for how it allocates health care dollars. The imbalance of those figures speaks volumes in this place and across Canada.

It is clear this government and the health minister must be held accountable for their decisions, the management of our health care system and the health care policies which have been their track record to this date. The principle of ministerial accountability and responsibility is so fundamental to our democratic system of government that we must all remain vigilant and uphold it. I intend to hold the government and the minister accountable for his ministerial responsibilities.

Mr. John Murphy (Annapolis Valley-Hants, Lib.): Mr. Speaker, Canadians and Nova Scotians in my area continually want to know what the third party's official platform position would be on health care.

In September 1993 we heard the leader of the third party say that his party supported user fees and deductibles and would eliminate universality. He said that in Canadian Living. Then in October

1993 the Toronto Star reported that Reform was opposed to private health care and user fees. The member for Macleod said in the House on October 17, 1995 that medicare was bad for everyone. On November 23, 1995 he said that medicare was important to all Canadians.

Where does the hon. member feel the federal government has a responsibility with regard to our health care system?

Mrs. Hayes: Mr. Speaker, as a member of this House and as a public figure, my response to items I read, particularly in some papers, is not always reflective of the actual thrust or intent of what was written. It is good to have the opportunity to say straight out what positions we hold without having it go through the sieve and the contortion which can happen in the media.

(1310)

I will repeat what I mentioned in my speech. Reform's bottom line is that we would like a medicare system which guarantees access to needed health care for all Canadians regardless of their ability to pay. That is our bottom line and it is what we are seeking to find. The system right now is crumbling and the federal government refuses to recognize this fact.

People are on the streets striking because of federal funding cutbacks. We say that the federal government does have a place in funding medicare and ensuring the health care of Canadians. The funding should be predictable and constant. It should not be, as it has been, something that is being continually eroded through time so that the provinces cannot themselves make the plans and create the necessary approaches for proper health care. There should be a place for federal government funding but it should be predictable and sustained over time so that it becomes what is needed by the provinces to make their plans to meet the needs of the public.

Beyond that, we believe that health care needs to be looked at and certainly opened to public scrutiny through discussions with the various stakeholders and the provinces. In that way we can find the means that will actually create a system that will be there for all Canadians not only today but in the future. Right now that is not the case and it will not be the case unless we open up health care to the scrutiny of those people who are involved in it.

[Translation]

Mr. Osvaldo Nunez (Bourassa, BQ): Mr. Speaker, I listened very carefully to the speech of the Reform Party member. Sublauses 4(1) and 4(2) of Bill C-18 give the minister extended powers to act in every area related to the promotion and the preservation of the heath of Canadians.

These two provisions give the federal government the authority to interfere in an area which comes under the exclusive jurisdiction of the provinces. As everyone knows, when the federal government gets involved in areas of provincial jurisdiction, it is very costly and it results in waste.

For example, the national forum on health, which the government decided to hold without the provinces' participation, is a useless effort, precisely because the provinces are not participating in it. I want to ask the hon. member what she thinks of these two provisions which grant extended authority to the minister. As I said, this is a source of waste which we cannot afford right now.

[English]

Mrs. Hayes: Mr. Speaker, certainly a great concern of Reform is duplication of federal and provincial powers. We agree with our Bloc colleagues that any costs incurred in doing the same thing twice is not worth the doing. There has to be a clear delineation of federal and provincial powers. As I look at the estimates for this year-we are now in the process of looking at the estimates within the health department-I see very great problems and greater encroachment on provincial jurisdiction in the name of health.

(1315)

For instance, in the estimates there is an indication through the health window that the federal government is encroaching on the education system in the area of sex health education. The federal government has guidelines for kindergarten through to grade 12.

What my colleague has suggested is of great concern to me. I go back to what I referred to in my speech, and that is ministerial accountability. The minister is responsible for what is done, how it is done and who pays for it. If it is a duplication of service, I would be the first to say that it is not an appropriate expenditure or effort for this place if it is a provincial responsibility. Certainly jurisdiction has to be taken into consideration and should be a very real concern for members of Parliament.

Hon. Roger Simmons (Burin-St. George's, Lib.): Mr. Speaker, I am pleased to speak on the third reading of Bill C-18. This bill is not earth shattering in what it does. It does something which is very important nevertheless.

Mr. Thompson: It is typical Liberal legislation.

Mr. Simmons: My friend from Wild Rose is informed, as usual.

I say to him and others that this bill will create the new Department of Health. The old department was called national health and welfare and this bill together with the one dealt with the other day affects the change.

This bill confirms the mandate of the minister regarding the promotion and preservation of the health of Canadians. Health is a matter that affects Canadians very deeply. Our medicare system has come to be part of the way in which we see our country. We

believe that the federal government has an essential role in medicare and in safeguarding the overall health of the Canadian population.

In this time of change to our health system, many people want to know where the federal government stands on health issues. Canada's health system will continue to rely on the interlocking responsibilities of federal, provincial and territorial governments. That is why in the recent budget of March, the government went a long way toward providing provincial and territorial governments with stability and predictability in health funding and other social services of $25.1 billion each year over a five-year period, comprising a tax floor that had been requested by the provinces and tax transfer points.

(1320 )

Health Canada bears the overall responsibility for protecting and encouraging the health and safety of Canadians through promotion and prevention activities at the national level. It assesses the safety of drugs and medical devices. It deals with issues such as the potential impact on Canadians of exotic viruses or the re-emergence of public health threats such as tuberculosis. It encourages healthier lifestyles and active living.

The federal health department also supports the health system through funding for research as well as financial and technical contributions to provincial health systems. The federal health department arranges health care programs and services only for specific categories or groups of people who are a federal responsibility such as status Indians and the Canadian Armed Forces. Otherwise, the federal department is not a delivery agent for health care. That lies with the provincial and territorial governments. They have the primary responsibility in the area of health care delivery. They design and manage the system that most of us as Canadians use. However, the federal department does play an important national leadership role in health that Canadians see as essential.

Health issues figured very prominently in the Liberal Party's red book in the last federal election campaign. For example, a head start program for children of aboriginal families living in urban centres and large northern communities was promised. A number of projects under that program have already been funded.

Action on prenatal nutrition programs was also promised in the red book. They are being delivered through the community action program for children.

There are other commitments on which the government is acting but I will talk about them a little later. What is common to all of those initiatives is their national scope and the value of national action on each of them.

Of course this work also involves financial support for the health care system for the provinces and the territories, as I said a moment ago.

Federal health contributions have evolved over the last four decades from cost sharing arrangements to block funding transfers to the provinces and territories. Since 1984 the Canada Health Act has set out the five criteria that provincial and territorial medical insurance plans have to meet to qualify for federal support.

These five criteria are worth repeating here today. The first principle is universality. The Canada Health Act supports provincial health insurance systems that cover all eligible residents.

The second principle is accessibility. Services must be available without financial barriers. People must be given health care on the basis of need, not on the basis of how much they can afford to pay.

The third important principle is comprehensiveness. If a province defines a service as medically necessary, that service must be covered completely.

The fourth principle is portability. Canadians with coverage in their home province or territory maintain that health plan coverage when they travel or when they move. This is a very important principle, like the others, given the mobility in this country at this time, the number of people who move from jurisdiction to jurisdiction, from province to province and from province to territory.

The fifth principle, together with the ones I have mentioned, universality, accessibility, comprehensiveness and portability, is public administration. It means that the health insurance plans of a province must be administered and operated on a non-profit basis by a public authority. That, to me, is the one some of the provinces either have difficulty understanding or difficulty wanting to live with. That is one of the five principles that we on this side of the House are committed to continue to enforce, the principle of public administration.

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The government takes these five principles very seriously. It has resisted the false claims that watering down the act is the only way forward. Canadians want the health insurance system they have built during our lifetime to continue. They do not want to see a two-tier system and I do not want to see a two-tier system either.

Canadians understand that medicare has been a great social benefit. It has been one with very strong economic benefits as well. It is an efficient, effective program for providers, hospitals and for

Canadians. In fact, the average man or woman knows this reliability better than some commentators. We are better off thanks to medicare. That is why the federal government has defended the Canadian system of health insurance so strongly.

The government has been equally clear that it believes the health system needs to be reviewed. Canadians know the economic issues facing the health system. Make no mistake, they are the same issues in the United States and in other developed countries around the world. Many countries face issues such as rising costs of care, the emergence of new health needs, aging populations, the appearance of new medical technologies, drugs and other factors. We are all asking where the money goes.

As a country we face more challenging health issues. For example, all Canadians agree that tobacco is a major health issue. The Supreme Court of Canada has affirmed that smoking consumption in this country causes deaths of the order of nearly 40,000 each year. Remember that smoking is a costly exercise to the Canadian economy. The estimated cost to the Canadian economy is $11 billion a year. This figure incudes the costs to the health care system and the overall loss of productivity for Canadians as a whole.

The federal government is determined to work with its provincial counterparts as stakeholders to bring forward a comprehensive and focused package to address the tobacco issue.

There are other concerns. I have mentioned the tobacco issue. There are women's health issues for example. It is an important priority for the government and I am sure it is for provincial governments and stakeholders alike. It is time to address key issues surrounding women's health.

There is the issue of new reproductive technologies. Some who may have followed this issue will recall that the previous administration sponsored a Royal Commission on New Reproductive Technologies which contained numerous recommendations. This administration is now considering these recommendations. The government hopes to be able soon to move on a number of those recommendations in a substantive way. Members from all parties in the House have called for action on the issues of new reproductive technologies, of women's health, of tobacco. There have been calls from all over and the government is acting on those issues.

We must begin to consider what will become of the health system down the road. We know that spending more on the status quo is unlikely and that direction would not give us much better health outcomes than we now have.

The international evidence is clear that spending more on health care does not mean better health results by itself. Why? Health care is not the same as health and people often wrongly equate the two.

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The status of a person's health is determined by many factors which are in place long before he or she sees a doctor or is admitted to a hospital. Some are as basic as genetics. Others involve the economic, the social or the environmental conditions in which we live. Still others are grounded in lifestyle choices. All these are determinants of health.

Progress in improving health may owe far more to living in an economy which produces good jobs or programs that help people live in proper housing surrounded by a clean environment. They are reasons for us to invest in effective health protection and promotion measures, ones that result in people making better health choices.

Health care is not enough, but it is important. Our question is how to achieve the best health results possible with the money that we have. This renewal process has been under way now for a few years. The challenge for all of us is to break out of the traditional box of health thinking. It will mean change. Community based health service centres and multidisciplinary team approaches to health care are changing the landscape of health care delivery.

The increased awareness that good health begins long before a visit to a doctor will mean an increased emphasis on the education of health consumers and preventive medicine. People will need to learn what physicians can and cannot do for them. People will need to learn how much they can take charge of their own lives. These steps are each part of a broader evolution of our health care system.

Canadians trust their health care system. They expect the federal government to support and defend that system, especially the fundamental principles on which medicare is based. That is why we need a strong federal Department of Health and why I am encouraging members of this House to support the bill before us today.

I mentioned a moment ago the issue of determinants of health. We in the Standing Committee on Health which I have the honour to chair are doing a study on the determinants of health as they relate to younger children. It is an important issue.

We in this Chamber and elsewhere are aware that poverty for example is a real determinant of health for people. We have direct correlations between poverty levels and such matters as the rate of suicide among people. Poverty levels and achievement in school are two areas where poverty impacts on other outcomes. The all-party health committee of the House is now undertaking a rather in depth study of this issue to see what needs to be done and is not currently being done in the area of children's health.

The bill before us is not one that is terribly earth shattering but Bill C-18 is an important piece of legislation. In the jargon of the House it is considered only a housekeeping bill to put in place the necessary statute to allow the department to function.

I am rather delighted that the current Minister of Health is my good friend from Cape Breton. Already in the short time he has been in the portfolio I have watched with some satisfaction his commitment to the serious challenges we face in health care and his determination to do something about those issues. He is a good spokesperson for the issues. I certainly wish him well, together with his parliamentary secretary from Eglinton who has just taken on that responsibility.

(1335)

[Translation]

Mr. Paul Crête (Kamouraska-Rivière-du-Loup, BQ): Mr. Speaker, on first looking at the bill to establish the Department of Health, one might think that it was a housekeeping bill, that it was quite ordinary, since there was at one time a department that looked after social affairs, welfare and such things. One might also tell oneself that the federal government had already played a role in this field and that this was probably just an update.

But it is also an opportunity to look at what the federal government has to do and what its responsibility is in the health sector. For this, we must look back at the origins of our health system. In the past, because of its spending power, the federal government contributed to the development of programs that, while they must be recognized, often parallelled those run by the provincial governments.

Today, these prosperous times are pretty much over and we are facing a completely different situation. The federal government is reducing its spending on health by billions of dollars, but insists on maintaining national standards. It is determined that the rules should be the same throughout Canada.

The way the government has found to ensure this is by creating a department, by means of the Canada Health Act, which sets these standards. But it is like anything else: to keep the thing going, you need the corresponding funds and an effective way to put them to use.

I think that the best example of very inappropriate interference by the federal government in this sector is the creation of the National Forum on Health. What is the National Forum on Health? It is a group of specialists appointed by the federal government with a mandate to improve the health of Canadians, increase the efficiency and effectiveness of health services, and formulate related recommendations for the government. It is a forum with a multi-million dollar budget.

The problem is that this forum is looking at a provincial field of jurisdiction, because in Canada the everyday management of health is a provincial responsibility. When there is a problem in a hospital or community health centre or any other kind of health problem, it is the provincial government that is responsible. It is to the province that people must address their questions and inquiries as to why things are not working or their praise when things are working as they should.

The federal government, meanwhile, gives itself the right to meddle in this area by assigning to the forum the very general mandate of improving the health of Canadians and increasing the efficiency and effectiveness of health care. Unfortunately, the provinces were not invited to participate in this forum as full-fledged members. How can the federal government assess the quality of Canadians' health without allowing the main players to participate and have their say in this? This forum has a budget of several millions of dollars and, when we see how difficult it is to fund health care across Canada, we cannot help but think that these millions of dollars could have been better spent elsewhere.

I know that if the people in my region had received any of this money, they would have known exactly what to do with it. Given the need to restructure the system, to reduce the number of beds for seniors, to convert hospitals, if money had been available, if the federal government had withdrawn from health care and allowed the provinces, including Quebec, to act in this area without increasing taxes, interesting solutions could surely have been put forward.

Why is the federal government stubbornly meddling in this area even though it does not have the money to do so? One cannot help but wonder if this has anything to do with the significant impact of health care on voters. Of course, a government with the power to spend as it sees fit, a power only limited by its capacity to borrow, may be tempted to meddle in areas likely to improve its chances of re-election, in areas that may improve the government's image but are none of its business.

For instance, the federal government has a strategy for the integration of people with disabilities, while Quebec has the Office des personnes handicapées du Québec. This is an obvious case of duplication since it is impossible to act in an area like this without part of the budget going to administration. Had the money allocated to the strategy for the integration of people with disabilities been transferred to the provinces, all the money could have gone straight to the handicapped, since most of the administrative costs would already have been borne by the existing bureaucracy.

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At the same time there is a federal strategy on violence, an anti-drug policy, an AIDS strategy, the children's bureau, an anti-smoking strategy, all areas in which provincial government take similar action and that require dialogue between the two levels

of government, if duplication is to be prevented. Interface committees have to be established, which involves operating expenditures, but these committees do not provide services directly to the public.

This is important, especially since individual citizens are wondering these days why the system costs so much to operate. Are doctors, the nursing staff or those providing services on the front lines in the hospitals overpaid? Or are there not clearly savings to be made at the administrative level?

When the federal government acts in exactly the same areas as the provinces, we must ask ourselves who is responsible for these areas under the Constitution. It is clearly stated that health matters come under the jurisdiction of the provinces. So, under the cover of an innocuous bill, the federal government is once again meddling in the provinces' affairs. In that sense, it is not playing the role it was intended to play, it keeps interfering in an area over which it does not necessarily have jurisdiction and it could even take conflicting action in certain areas.

There is also an element that is more tendentious, in a sense: federal interference in the form of national standards. This leaves the provinces, who are facing budget cuts, with the unpleasant task of making choices, taking into account population dynamics and ageing. They deal directly with clients and have to make choices in terms of direct service, but at present they do not have all the leeway they could have on behalf of those clients, because spending power in this specific area is in the hands of another level of government, which interferes indirectly.

We are also faced with a somewhat absurd situation. In past decades, the federal government invested a lot of money in that sector and a number of programs were created. Now, we no longer have the means to fund these programs. However, the federal government would never say that it is because less money is being given to the provinces.

It invokes the need for national standards to justify telling the provinces that they must somehow find a way to meet these standards. This puts the provinces in situations which can sometimes be absurd, given that they have no money for certain programs, while spending could be reduced in other sectors, but is not.

Imagine a federal government that would only get involved in those areas for which it is responsible. Imagine the latitude that provinces would have from a taxation point of view, to look after their own areas of jurisdiction. The federal government would then simply have to assume its own responsibilities.

In such a situation, federal cuts affecting national defence could be used by the central government to fulfil its responsibilities. However, withdrawing from an area such as the health sector could also be a way to reduce the size of the federal government, which spends about $1 billion in that sector, even though it does not come under its jurisdiction.

Let me stress my point by mentioning again the areas in which the federal government is involved. There is the issue of family violence. As you know, family violence is the result of a whole set of situations. The Government of Quebec, among others, has implemented policies to deal with this issue. However, federal initiatives do not necessarily complement these policies and there is room for improvement in that regard.

The Bloc Quebecois' position on these issues is not necessarily held only by Quebec sovereignists, or like minded proponents of independence.

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As an example, I give you Lucienne Robillard, now a federal minister. At the time, she was Quebec's health minister. On September 27, 1994, she told La Presse, and I quote: ``The behaviour of the federal government makes no sense. How can the health system be overhauled without involving the provinces, which are responsible for the delivery of services? It is quite simply unacceptable''.

I think that says it all. These are the words of the minister, who was a minister in a provincial Liberal government, a federalist provincial government, in reference to the national forum on health on September 27, 1994.

In the same vein, Thérèse Lavoie-Roux, a senator, told the Senate on May 31, 1994 that the government was wrong to neglect the role of the provinces. She asked the following questions, and I quote: ``Are the provinces not considered major partners? Why were they not invited to participate in the forum? Does the government leader find it appropriate for the government to be acting unilaterally on a matter of provincial responsibility?''

We must remember how it was that the national forum on health came about. The Prime Minister invited the provinces to take part in the creation of this forum. Talk about hard to believe. Here we have a provincial field of responsibility, and the provinces are relegated to a position of listening to what is going on but not allowed to voice their views, to make suggestions for improvement. Perhaps it was feared that the provinces might indeed make some suggestions. Perhaps the provinces ought to have joined forces to state that the best thing would be for the federal government to pull out of this area and to turn the available funds over to the provinces for their own use.

Despite provincial opposition, despite opposition from such people as the senator, despite submissions from everywhere in Canada, the federal government has decided to continue, to go ahead with its project, to create the national forum on health, solely

for the purpose of meeting the campaign promise that had been made.

How effective was the forum? Are there many people who have seen concrete solutions offered by the forum? Are the millions of dollars spent in this sector being used to improve Canadians' health, as the mandate given it by the federal government would have it?

What more needs to be said to make it clear that the federal government is involved in an area it does not necessarily have any business being involved in? In the bill it is indicated that it could not intervene in areas that are already governed by the health authorities, yet these are described elsewhere in the bill as authorities with which it may have dealings.

In the last budget, the government decided to create a research centre in this area, once again an action that appears totally praiseworthy at first. We are told that health research is really very important, will lead to the develop of new drugs, will help people be healthier.

But if we look a bit further, we see that the provinces have the same mandate. There will be overlap in spending at a time when we cannot afford to do that.

When asked where to cut, we answer: ``Eliminate overlap''. Health is a case in point, a clear case where the federal government should be made to withdraw from this area. Before passing a bill establishing the health department, in its present form, before granting the minister, as in clause 4, extremely wide powers to take action, we must question the real scope of the clause.

Clause 4 deals with the powers, duties and functions of the minister with regard to health, including:

(a) the promotion and preservation of the physical, mental and social well-being of the people of Canada;

Paragraph 4(2)(b) says:

(b) the protection of the people of Canada against risks to health and the spreading of diseases;

In this case, the federal government can always invoke the national interest and the federal power related to law and order, and good government to step in to protect the health and safety of the people of Canada.

The concept of good government is an interesting one, but one which is open to abuse. Perhaps this bill should have been better framed, better defined, to state clearly in which fields the federal government is allowed to take action and to limit it to those.

For instance, when we talk about health care for natives, we realize that the Constitution provides the legal basis for action. But when we talk about getting involved in people's health in general, we realize that under the Constitution, this is under provincial jurisdiction, and we question whether it is legitimate to keep on interfering in this area.

As a matter of fact, had it not been for the possibility, in the beginning, in the sixties and seventies, to use the spending power, that is to tax citizens to provide them with services in order to make the federal government more visible, it is unlikely that such interference would have occurred.

After the second world war, the federal government realized that with the power to levy taxes it had increased through income tax, it weilded great political power. So it tried to implement a universal, Canada-wide health system to provide the same services all over the country. However, there are different regions in Canada and, since there are two levels of government, different provinces can make different choices according to what their citizens want.

The power the federal government wields, through national standards, allows it to try to impose the same behaviour to all provincial governments, but this is not necessarily good. If Quebecers and Canadians had wanted that, they would have said so and the Constitution would provide for this area to come under federal jurisdiction, but it is not the case. This is not what is in the Constitution.

For many who are involved with federal programs the reality is always the same. Take, for example, the new horizons program. The orientation of that program has changed from year to year, at the whim of successive governments. There were years where seniors' clubs in various municipalities were able to buy very useful equipment. Suddenly, last year, the program changed direction, but the connection between that change and the needs of the people was not at all clear.

Today, the new horizons program is aimed at specific clients who would be in a difficult situation. I do not know it members see the direct link there is with the local implementation of CLSC policies. Local community service centres have mandates to help seniors, but they do not have the financial resources of such programs as the new horizons program; they see this as federal involvement that, often, goes against their own action. There are fields of activity where the action of the federal government may go directly against the action of the provinces, and it is very difficult to understand exactly what the federal government's objective is, in that regard.

There are other fields of activity. For instance the fight against AIDS and drug enforcement. In the past, there were different approaches according to different governments. The federal government might prefer a more punitive approach. The provincial government might prefer an approach that will correct behaviour patterns. In the case of young offenders, for example, we have seen

provincial governments-the Quebec government, among others-put in place systems such as the Direction de la protection de la jeunesse, and different sectors where crime has been greatly reduced in Quebec. This has a direct link with to the health issue.

If the federal government chooses a totally differing line of action, then it is a disservice to the people, and services are not as efficient as possible.

(1355)

In conclusion, I think that, in this era of dwindling financial resources that calls for very wise choices, the federal government-instead of creating a department like the Department of Health and meddling in areas of provincial jurisdiction-should consider withdrawing from health care and transferring the money to the provinces so that each of them can provide services that meet the needs of the people.

A province with a widely scattered or a sizeable rural population and one with large urban centres can make very different health choices. It might be unwise to try to impose the same standards on both.

This is also directly linked to the provinces' respective policies regarding development and other matters. Health is not simply a matter of spending money on drugs. It is the result of the actions taken by the various stakeholders in society.

I think that, in the past, the federal government's actions in the area of health, because of the amount of money available, led to the development of some worthwhile programs. Today, however, its attempt to impose very high standards while at the same time reducing the amount transferred to the provinces so they can provide these services puts people before a difficult choice, as the federal government will be assessed on the basis of its programs.

People put pressure on the governments to develop programs against family violence, for instance. Yet, the provinces, which are responsible in this area, cannot afford to take action, because the federal government does not give them the means to do so. Taxpayers are stretched to the limit. In the end, people are in no position to assess the quality of health care. They tend to blame the government providing the services, when the cuts are made by the government that continues to collect the taxes without providing the expected services.

[English]

The Speaker: It being almost 2 p.m., we will proceed to Statements by Members. I know full well the member for Calgary Centre is itching to get to his feet, and he will be the first speaker when we resume.