Health Care
Population Health Policy
Date: 2008
Chair: Hon. Wilbert Joseph Keon (ON)
Deputy Chair: Hon. Lucie Pépin (QC)
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Summary:
The Senate's Sub-committee on Population Health has undertaken a study to examine
* the impact of social determinants of health, including their
effects on disparities and inequities in health outcomes that
continue to be experienced by identifiable groups of Canadians;
* government policies, programs and practices that regulate or
influence the impact of social determinants of health on health
outcomes across different segments of the Canadian population;
* ways in which governments could better coordinate their activities
in order to improve health outcomes; and
* international examples of population health initiatives under-
taken either by individual countries, or by multilateral inter-
national bodies such as (but not limited to) the World Health
Organization.
Four interim reports have been issued to date (International Perspectives; Maternal Health and Early Child Development in Cuba; Federal, Provincial and Territorial Perspectives; and Issues and Options). The Sub-committee (of Social Affairs, Science and Technology) is currently working to finalize its study.
Out of the Shadows at Last:
Transforming Mental Health, Mental Illness and Addiction Services in Canada (The Kirby Report on Mental Health)
Date: 2006
Chair: Hon. Michael Kirby (NS)
Deputy Chair: Hon. Wilbert Joseph Keon (ON)
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Summary:
Report 1 is a fact-based study providing historical background, an overview of service delivery, respective roles of federal and provincial/territorial governments, assessments of policies and programs based on public testimony and a literature review. Report 2 includes an international comparative analysis of mental health care systems, including Australia, Canada, New Zealand, the United Kingdom, and the United States. Report 3 is an issues and options paper summarizing issues to be addressed in the final report and raising options for addressing these issues. Report 4, the final report, includes a total of 118 recommendations which focus primarily on mental health (rather than addictions) issues.
Impact:
In 2007, the Mental Health Commission of Canada was created. A non-profit national organization, it is designed to focus attention on mental health issues and to work to improve the health and social outcomes of people living with mental illness. The federal government seeded the Commission with $55 million over five years, $30 million short of the Senate’s recommendations. However, an additional $110 million was pledged in February 2008 for research projects to help Canadians with mental illness who are homeless.
The Senate's Social Affairs Committee which authored Out of the Shadows at Last received 3 awards in 2006:
* Special Recognition Award from the Canadian Psychiatric
Association "for its leadership and for giving voice to the mental
health needs of Canadians";
* CM Hincks Award from the Canadian Mental Health Association,
its highest award, for "the outstanding individuals or organization
that has advanced mental health in Canada"; and
* an award from the Toronto Branch of the CMHA "in recognition
of outstanding public service in the interest of mental health."
Reforming Health Protection and Promotion in Canada: Time to Act
Date: 2003
Chair: Hon. Michael J.L. Kirby (NS)
Deputy Chair: Hon. Marjory LeBreton (ON)
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Summary:
This report resulted from a combination of events in the early 2000s. For example, outbreaks of SARS (Severe Acute Respiratory Syndrome) occurred in the Greater Toronto Area and Vancouver in 2003; BSE (Bovine Spongiform Encephalopathy) was diagnosed in a single cow in Alberta; cases of human infection with the West Nile Virus (WNV) were confirmed in Ontario and Quebec; and threats of biological terrorism were reported in the United States. The Committee therefore explored Canada’s ability to respond to public health emergencies arising from outbreaks of infectious disease. In particular, the report focuses on
* the state and governance of public health infrastructure in
Canada;
* roles and responsibilities of, and coordination among, various
levels of government responsible for public health;
* the monitoring, surveillance and scientific testing capacity of
existing agencies;
* the globalization of public health;
* adequacy of funding and resources for public health infra-
structure in Canada;
* the performance of public health infrastructure in selected
countries;
* the feasibility of establishing national public health legislation
or an agency as a means for better coordination and integration and
improved emergency responsiveness; and
* the Naylor Advisory Group Report and recommendations.
The Senate's report recommends establishing a new agency, the Health Protection and Promotion Agency (HPPA).
Impact:
The Public Health Agency of Health Canada was duly established in the fall of 2004 (Bill C-5). Design of the Agency was based on both the Naylor and Senate reports, although Senators had explicitly avoided the term “public health”, as they felt it was too closely associated with “publicly funded health care”
The Health of Canadians – The Federal Role (The Kirby Report)
Date: 2001 – 2002
Chair: Hon. Michael J.L. Kirby (NS)
Deputy Chair: Hon. Marjory LeBreton (ON)
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Summary:
This report was designed to meet four objectives:
* formulate a detailed, concrete plan of action rather than dwelling
on governance issues or intergovernmental structures;
* attach a cost to the Committee’s recommendations and propose
a specific revenue raising plan;
* specify clearly the changes that each of the major stakeholders
– individual Canadians, health care professionals, provincial and
federal governments – would have to make in order for the
reform plan to be successfully implemented; and
* make clear the consequences of not changing, and hence of not
reforming, the health care system.
Impact:
The Senate’s inquiry into health care preceded the government’s Commission on the Future of Health Care in Canada chaired by Roy Romanow. Many of the Romanow Commission’s recommendations echoed those of the Senate. The Canadian Psychiatric Association outlined the similarities in its February 2003 bulletin, in a featured article called The Scoop on Kirby v Romanow:
* both want publicly-funded systems;
* both would limit private partners to ancillary roles;
* both say more money is needed to buy change;
* Kirby recommends no change in the Canada Health Act, but
Romanow wants to re-open it;
* both cite the need to gather information and report to Canadians;
* health promotion is mentioned in both reports, but more often
by Kirby;
* both reports feature research;
* both discuss health care human resources although Kirby
focuses on specialists; and
* mental health is not mentioned in Kirby (it is to be dealt with
separately).
An Act to amend the Patent Act (Generic Drugs)
Date: 1987
Bill: C-22
Sponsor: Hon. Michael Cogger (QB)
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Summary:
Bill C-22 banned generic drugs for 10 years after a new brand-name drug was introduced in the marketplace. It also obliged industry to double its Canadian research and development (R&D) within ten years; levied royalties on generic drug companies for redistribution to researchers; created a board to supervise the cost of drugs in Canada; and paid $100 million to provincial governments to offset increased drug costs.
A Special Senate Committee was created to study Bill C-22. A majority of the Senate supported its recommen-dations, and passed the bill with 10 amendments including provisions to
* reduce the patent protection period from ten years to four;
* increase royalty rates paid by generic drug companies from 4 to
14%;
* link research grants from the Pharmaceutical Royalty Fund with the
level of Canadian R&D conducted by drug companies;
* delete provisions creating a Prices Review Board, since the shorter
patent protection period would more effectively increase competition
and moderate prices; and
* remove retroactivity provisions.
The House of Commons was recalled in August to deal with the amendments. It rejected all but three minor procedural items. The Senate thereupon met to determine whether it would insist on its own amendments. It decided to do so, and sent the bill back to the House where all but one of the amendments were again rejected. The Senate considered the bill once more, and for a third time sent it back to the House, this time insisting on just one amendment. The House at last concurred. Accordingly, the final version of the bill required the Patented Medicine Prices Review Board to investigate matters whenever a patented drug’s price was raised by more than the Consumer Price Index.
Impact:
The government stated Bill C-22 strove to achieve two goals: (1) to ensure that Canadian researchers who discover a new drug participate in its commercial success; and (2) to ensure that patent protection did not result in excessively high prices for the Canadian consumer (Senator Cogger (QC), page 997, Debates). Finding a balance between these somewhat contradictory goals caused considerable debate.
When the Senate passed the bill on November 19, 1987, Liberal Senate Leader Allan MacEachen told the Globe and Mail that the Senate had succeeded in exposing the bill as being against the public interest. Although several people criticized the Senate, being an unelected body, for obstructing government legislation, the Globe and Mail reported that polls showed massive public support for the Senate’s action and others upheld the process as an essential aspect of Canadian democracy.
