If we want more evidence-based practice, we need more practice-based evidence.*

 

Chapter 18 - Archives of Headlines
World and National Context of Community Health Services

 

A picture of Health Canada's performance (Press Release, 23 November 1998) Health Canada's Performance Report for 1997-1998, tabled Oct. 29, 1998 in Parliament, outlines the Department's financial performance and highlights many of its accomplishments in promoting and protecting the health of Canadians. "The initiatives described (in the report)," says Health Minister Allan Rock in his introductory message, "will help individuals and communities improve their health, while supporting a health system that focuses its resources on meeting the needs of Canadians, now and in future.  "For more information, visit http://www.tbs-sct.gc.ca/rma/dpr/97-98/HCAN97DPRE.pdf  

Request for $58 million to Health Canada for priority initiatives (Press Release, Nov. 4, 1998)- Treasury Board recently asked Parliament to approve $58 million for Health Canada as part of a package of supplementary estimates for fiscal year 1998-1999 totalling $5.3 billion. The funds will be used for a number of priority health initiatives, including the public education component of the Tobacco Control Initiative, the development of a Canadian Health Info-Structure, strengthened blood safety and surveillance activities, and the implementation of the Aboriginal Head Start On-Reserve Program. For more information, visit: http://www.tbs-sct.gc.ca/news98/1029b_e.html

World health chiefs launch battle against malaria. WASHINGTON (Reuters,Oct. 29, 1998) - World health leaders announced they were declaring war on malaria, taking a whole new approach to fight the ancient disease. The World Health Organization, World Bank, United Nations Children's Fund (UNICEF) and the U.N. Development Program said they would take on malaria, which kills a million people every year, by strengthening the health services in developing nations and sweet-talking private companies into helping out. WHO Director-General Gro Harlem Brundtland said although malaria kills 3,000 children every day and infects upward of 500 million people, it has not received the attention that other diseases have.

To fight AIDS, help poor countries develop - experts. WASHINGTON (Reuters, Sept. 17, 1998) - Helping poor countries develop their economies is the key to fighting the spread of AIDS, experts told Congress late Wednesday. They admitted that the United Nations AIDS program, UNAIDS, had a slow start, but said that if the United States leads the way in stepping up funding it will be possible to make significant inroads against the HIV virus. "This is a problem we can never solve with only a medical approach," Dr. Peter Piot, executive director of UNAIDS, told a hearing of the House International Relations Committee. "It's a development problem. Countries have to invest in HIV care in the same way they invest in any other development goals," he said.

"US Report Blasts UNAIDS" Nature Medicine (Sept. 1998) Vol. 4, No. 9, P. 993; Birmingham, Karen The U.S. General Accounting Office (GAO) conducted a study of the Joint U.N. Program on HIV/AIDS at the request of the U.S. House Committee on International Relations (IR). The report stated that UNAIDS has made limited progress towards generating worldwide support for AIDS projects and that the organization failed to meet certain goals. In its defense, UNAIDS asserted that the evaluation began only 18 months into the group's first biennium and claimed that certain facts were presented from a negative standpoint. In the same report, the GAO praised the U.S. Agency for International Development (USAID). Benjamin Gilman, chairman of the IR committee, said "If our government, through USAID and the Centers for Disease Control can do a betterjob than the U.N. to combat [HIV/AIDS], then we should shift funding to the more successful programs." The United States supplied 28 percent of the biennial UNAIDS Secretariat budget for1996-1997.

Global panel suggests new body to monitor oceans. LONDON (Reuters, Sept. 14, 1998) - A high-level global panel, alarmed by increasing pollution of the oceans and the threat to marine life, called Monday for an independent body along the lines of Amnesty International to act as world marine watchdog. The call came in the official report of the Independent World Commission on the Oceans, which is to be presented to the United Nations General Assembly in November. The report said once-productive fishing grounds had become seriously depleted, marine pollution was getting worse, the rapid growth in world population was increasing pressure on the sea.

National consultations on Canada's health protection program launched (9 September 1998)  
The first of a series of nation-wide consultations on the future of the health protection program in Canada was launched today by Health Canada. About 3,000 stakeholders concerned with health protection issues were
invited to attend the consultations taking place across Canada in September and October. Issues being considered are based on the recently released discussion papers entitled "Health Protection for the 21st Century", which provides an overview of the redesign for Health Canada's health protection program, and "Shared Responsibility, Shared Vision", which outlines the legislative aspects of the renewal. The first consultation workshops are being held today in Halifax. For more information, visit: http://www.hc-sc.gc.ca/english/archives/releases/98_55e.htm

Minister calls for national report card on health care system (7 September 1998)  "We will never restore confidence in Canadian health care unless we have broader and better access to the facts," said Mr. Rock. "Canadians deserve a report card, not ritual rhetoric. This is the responsibility of all those involved in health care. I believe Canadians have a right to know that their health dollars are being spent wisely. A right to know if the system is getting better or worse. A right to know if the services they need are there, whether the gaps are being closed." The Health Minister emphasized that a report card is also a matter of responsible decision making. The people who deliver and manage health care need to know what is working, and what is not, if they are to act on an informed basis to allocate resources and adjust services based on clear knowledge. The Minister outlined his position, in an address to the annual meeting of the Canadian Medical Association in Whitehorse, Yukon.   For more information, visit http://www.hc-sc.gc.ca/english/media/releases/1998/98_53e.htm

AUGUST 31, 1998 (Health Canada). OTTAWA, ONTARIO--Letter to Health Minister Allan Rock from former members of the National Forum on Health. A majority of former members of the National Health Forum reconvened recently in Ottawa at Minister Rock's request. This letter summarized their observations about what has been accomplished since the National Forum released its final report in February 1997 and outlines new recommendations. The Forum's observations provide an important perspective from a group of people who consulted Canadians widely over the future of the health system.

A report on the following topic from Reuters news service may be found on the World Wide Web at:
http://my.excite.com/news/r/980814/19/news-tobacco

FDA CAN'T REGULATE TOBACCO: COURT
A federal appeals court ruled Friday, August 14 that the U.S. Food and Drug Administration (FDA) does not have jurisdiction to regulate tobacco products. The Justice Department announced it would appeal the ruling; tobacco companies issued a statement saying they are "pleased" by the decision, and that they would take unspecified "meaningful steps to reduce underage tobacco use."

By a two-to-one vote, three judges of the 4th U.S. Circuit Court of Appeals said the FDA overstepped its authority when it issued sweeping regulations in August 1996 that restricted the sale of tobacco products
to minors and limited advertising and marketing by tobacco companies. The court concluded that it was not the intent of Congress to give the FDA such authority.

The ruling reverses a lower court decision and hands the tobacco industry a huge victory while hampering Clinton Administration efforts to use regulation to reduce youth smoking.

On April 25, 1997, a North Carolina U.S. District Judge ruled that the FDA could regulate nicotine as a drug and tobacco products as drug- delivery devices, but had no authority to restrict tobacco advertising.

President Clinton, in a written statement, "confirming the FDA's authority over tobacco products is necessary to help stop young people from smoking before they start."

The ruling is likely to increase pressure on Congress to adopt tobacco legislation to reduce youth smoking, according to state attorneys general who are in continuing talks with the industry. Congress has all but given up on drafting a comprehensive tobacco bill before adjourning in October.

Appellate Judge Kenneth Hall, in his lone dissent, said the FDA should be allowed to regulate a product "estimated to cause some 400,000 deaths a year," especially since its rules were aimed at reducing youth
smoking.

"Inasmuch as cigarettes and smokeless tobacco are responsible for illness and death on a vast scale, FDA regulations aimed at curbing tobacco use by children cannot possibly be contrary to the general intent of the (law)," he wrote.

The FDA's rules, designed to reduce underage smoking, have been on hold while the case worked its way through the courts. The appeals court initially heard arguments in the case in August 1997, but a ruling was
delayed after the death of one of the original judges on the three-judge panel.


AIDS-Thailand: Crisis Inflicts More Pain
IPS Wire (06/18/98)
Health experts in Thailand say the country's estimated 1 million HIV-positive people are the ones most affected by the country's current economic crisis. On top of fighting personal and social problems, HIV-infected Thais are also feeling additional pressure from being denied subsidized medical care and financial support as a result of the trimming of health care budgets; health workers are concerned that the lack of government subsidies for expensive drugs like AZT may put the lives of HIV-positive citizens in danger. Since 1992, Thailand has provided AZT free of cost to all HIV/AIDS patients through a drug program initiated by the National AIDS Prevention and Control Committee; at the outset of the program, Thailand had about 50,000 HIV cases, costing about 35 million baht for AZT, but the number of infections has risen significantly since then. The health budget, already stretched due to the rising number of HIV-infected individuals, has been slashed even further under the economic crisis; health workers also note that Glaxo Wellcome's plans to lower the cost of AZT for pregnant women with HIV/AIDS in the developing world may have minimal impact on Thai mothers with the disease.

Science & Health Bulletin: Africa-WHO Urges Prevention PANA Wire Service (06/10/98); Ejime, Paul
The regional director of Africa for the World Health Organization, Ibrahima Samba, recently asserted that preventative measures must be increased in Africa. Samba noted that "with our level of poverty and the high cost of treatment, not even curing HIV/AIDS, the only hope for Africa is prevention." As of December 1997, there were an estimated 20.8 million HIV/AIDS cases in sub-Saharan Africa, which has a population of about 600 million. Samba said that countries should follow the lead of Uganda and Tanzania in bringing the spread of the virus under control. He also said that treatment costs are expensive pread of HIV. South Africa has bought 1.5 million female condoms, while Uganda bought 1.2 million and Zambia and Zimbabwe also made significant purchases. According to the president of Female Health, Mary Ann Leeper, one-fifth of Botswana's sexually active population has AIDS and the average lifespan has dropped by about 20 years. More women than men are infected with HIV in Uganda, with the most infected group aged 20 to 30 years old. While the female condom does not seem to be as popular as the male condom, studies with female sex workers in Thailand found that among women who had both options available to them, there was a 34 percent decrease in the rate of sexually transmitted diseases and a 25 percent decrease in the number of unprotected sex acts, compared to women who only had male condoms available to them. The female condom, a prelubricated, disposable polyurethane sheath that is inserted into the vaginal canal prior to intercourse, allows women to control contraception without male consent, providing another option for women with limited contraception choices.

"The Failing Health of Burma's People"  Boston Globe (06/15/98) P. A15; Chelala, Cesar
Burma's health status has deteriorated since a military junta in 1988. According to UNICEF, the infant mortality rate two years ago was 105 per 1,000 live births, versus 33 in Vietnam, 31 in Thailand, and 11 in Malaysia. Additionally, many children are born underweight and up to 12 percent of children are severely malnourished. Much of the problem is due to a lack of potable water; diarrheal diseases account for 18 percent of deaths in children under five years. Poor sanitation leads to annual cholera outbreaks and medication is scarce. Fewer than 60 percent of children nationwide are reached by immunization programs. Maternal mortality rates are 580 per 100,000 live births, more than seven times the rate in Malaysia and 58 times greater than in Singapore. Many of maternal deaths are due to induced abortion. There is also a lack of adequate health care providers in the country, and only 10 percent of rural women have access to a midwife. Furthermore, the World Health Organization estimates that half a million people in the country are infected with HIV-nearly 1 percent of the population. Some experts believe the actual number of HIV infections is much higher.

Over Two Million Ugandans Carry HIV Africa News Service (06/15/98); Namutebi, Joyce
Omwony Ojok, director general of the Uganda AIDS Commission, estimates that between 1.8 million to 2 million people in the country may be infected with HIV, about 10 percent of the total population. He also noted that 10 percent of children under 12 may be infected. Speaking at the conclusion of the Kampala AIDS Walk, Ojok said that while HIV rates have declined in the cities since 1992, rural areas need increased service. The official was joined by Janet Museveni, who encouraged programs to help rural communities learn how to care for AIDS patients and orphans.

Prisoners Should Not Be Condemned to AIDS Sentence Africa News Service (06/15/98); Inambao, Chrispin
In Namibia, the Deputy Minister of Prisons and Correctional Services, Michaela Hubschle, announced that the rate of HIV transmission in the country's prisons is very high and increasing at a substantial pace. Speaking to prisoners in Windhoek, Hubschle said, "The activities in prisons that spread HIV, notably sex and drug abuse, are widely considered as criminal within the prison environment. When these practices are discovered, they are usually met with disciplinary measures, not health measures." The official noted that problems in maintaining proper hygiene levels in prisons has contributed to the spread of HIV, and she called for the right to health, security, equality before the law, and freedom from inhuman treatment for the prisoners.

Health Department to Screen Johor Sex Workers for HIV" Star Online (06/14/98)
Dr. Rosli Ismail, head of the state health office's AIDS and sexually transmitted diseases division in Johor, Malaysia, has announced that sex workers in the region will be screened for HIV. The state Health Department and police will carry out the testing. Last year a similar operation was conducted when 31 workers were tested; all tested negative for HIV. Since 1991, 36 sex workers have tested positive for the virus, but Ismail said that current data does not reflect the scope of the disease and that many of the sex workers do not get voluntarily tested regularly. He noted that "there are those who go for screenings only once a year and think that they are safe from the disease after testing negative. They do not realize that at the time of the screening, the results only reflect their past lifestyle." However, he added that many of the workers took precautions because they were now aware of HIV and AIDS.

Health-Latin America: AIDS Increasing Among Poor, Rural, Heterosexuals, and Women IPS Wire
(06/14/98)
Argentinean sociologist and public health expert Mario Bronsman reports that HIV is increasingly prevalent among poor people, people in rural areas, women, and heterosexuals in Latin America. Additionally, vertical mother-to-child HIV transmission has been an increasing problem due to the increasing number of women infected. According to Bronsman-one of several Latin American experts working on an HIV/AIDS program supported by five United Nations agencies-the problem in rural areas is not due to a greater number of cases than in urban areas, but to a faster spread of the disease among the rural population, with HIV rates taking less time to double. Paulo Texeira, another member of the U.N. group, notes that homosexual and bisexual transmission were declining throughout the world, but that heterosexual transmission rates, particularly among women, were increasing. In addition, by year-end 1997, 19 percent of the 1.3 million people in Latin America with AIDS were female. Meanwhile, U.N. health experts have found that only 60 percent of the HIV-infected population in Brazil has a primary school education. Brazil has promised treatment for all infected patients, with $700 million pending in aid. Bronsman suggested that preventative efforts be aimed at the most vulnerable groups, particularly women and young people. U.N. statistics indicate that worldwide, there were 30.6 million people with AIDS at the end of 1997, with 90 percent of these people residing in the developing world.

Vietnam Reports Doubling in HIV Cases Since 1996 Reuters (06/17/98)  
An official at the Vietnamese National AIDS Protection Committee announced Wednesday that the country's HIV-positive population has more than doubled since 1996. The agency reports that there are now 8,708 HIV infections in the 78 million-person country, with over 1,200 cases of AIDS. Other estimates suggest that the HIV rate is much higher than officially reported, however. The Vietnam News has reported that 57 of the country's 61 provinces have reported HIV infections. Southern Ho Chi Minh City, formerly known as Saigon, was found to have the most infections, with 2,638 cases.

High AIDS Death Rate in Zambia Worries WHO Africa News Service (06/16/98)
The World Health Organization said that despite efforts to control the spread of HIV/AIDS in Africa, there are deep concerns over the high rates for morbidity and mortality rates for the disease in the region, which it deems unacceptably high. In response to the problem, the WHO launched a new initiative that aims to mobilize the African leadership, create more effective intervention strategies, and to foster stronger partner cooperation. Despite comprising just 10 percent of the world's population, Africa has over 70 percent of the world's HIV/AIDS cases, according to the regional WHO director for Africa, Ephraim Samba. Samba noted that the virus is most affecting the country's working population, aged 15 to 40 years old.


JULY 6, 1998

OTTAWA, ONTARIO-Health Minister Allan Rock released two discussion papers to initiate public consultations into the modernization of Health Canada's Health Protection Program. The two papers are part of a two to three year project to strengthen federal health protection programs for the next century through renewal of federal health protection legislation, improved tools for monitoring disease and managing risks to health, and providing the Department with the best scientific advice and health protection programs to meet its responsibilities.

The Honourable Allan Rock
Federal Minister of Health
Health Canada
16th Floor, Brooke Claxton Building
Tunney's Pasture, Ottawa, Ontario  K1A 0K9

Dear Minister Rock:

Thank you for inviting us to reconvene and for meeting with us to discuss our views regarding health and health care, 18 months after we have submitted "Canada Health Action: Building on the Legacy". Following up as requested, we hereby offer our major thoughts, organized to conform to the structure of our Report.

- Preserving our health care system by doing things differently (preserving and protecting Medicare; building a more integrated system)

We continue to feel strongly that the fundamentals of Medicare are sound and that the Canadian health care system must remain founded on the bedrock of the single-payer publicly financed model. We believe this model of health insurance to be under serious attack coming from two main lines of argument.

One argument opposes Medicare in principle and advocates privately financed health care as the superior alternative. The other claims support for Medicare in principle but concludes that it is seriously underfunded, and that its problems are only remediable by an infusion of money. Interestingly enough, these claims have
repeatedly surfaced at times of fiscal deficit and now in a time of anticipated surplus. While the fundamental objectives of advocates for these positions are diametrically opposed, both spread fear and create public anxiety; in effect, they are working together to generate public support.

Their arguments gain added credibility from the fact that the privately funded proportion of health expenditures in Canada is second highest among G7 countries, increasing from 24 percent to 31 percent from 1975 to 1997. Much of this increase has been driven by greater private financing for pharmaceuticals and community-based services. These figures contrast sharply with the current OECD average of 23 percent private financing. This overall trend parallels the federal government's declining share of public expenditures, from 42 percent (1978) and 38 percent (1988) to the current low of 29 percent. This trend also coincides with fiscal restraint and reductions in spending by governments, which have been particularly pronounced over the last several years. Among other factors, it would appear that these fiscal pressures are contributing to federal/provincial tensions surrounding health care. The reduction in the public share of funding in the health care system is serving to bolster the claims of those who state that an increasingly private system is
inevitable, and allege that governments have abandoned their responsibilities.

The Forum recommended that a cash floor be established under the CHST, specifying that to be $12.5 B. We maintained that this floor was essential to preserving the real and symbolic leverage held by the federal government to maintain the Canada Health Act and national standards. We were concerned that further reductions in the cash transfer would adversely influence the rate and perhaps the direction of provincial reforms. We advocated $12.5 B as a floor, not a ceiling. Moreover, neither we nor others appear able to determine, with any certainty, the absolute amount of money that Canada should spend on our health care system.
To the extent that the federal government intends to invest  additional resources in health care, it is the view of Forum members that allocating more money to Provinces should strengthen Medicare and should be invested where there is the greatest likelihood that it will produce tangible benefits. Recipients of funds should be accountable for their use. The accountability framework could take the form of federal/provincial agreements, in
which each province's priorities are taken into account, in relationship to national goals, standards and principles. There should be requirements for public reporting of achievements in meeting these goals and standards. For instance, report cards should be regularly available to the public on indicators of system performance, agreed to in advance by federal and provincial governments, and about which Canadians have expressed legitimate concern: quality of care, access to services, public- private funding and health of the population, etc.
Others have suggested that broadening public coverage for medically necessary pharmaceuticals or home care represents "boutique" programs. We respectfully and strongly disagree, and would point out that appropriate support for community-based services simply reflects the need to deal with the ambulatory
shift. The goal is to ensure that the public does not assume new burdens and costs, such as responsibility for services that were previously offered within institutions. In short, fund the care, not the site. Most other OECD countries provide greater public coverage for pharmaceuticals and home care.

We regret that in our Forum deliberations we were unable to spend enough time on the issue of physicians' relationships to the health care system, including their remuneration and models of practice. We believe these issues must be addressed much more fully. It is clear to us that without primary care reform, structural problems and inappropriate incentives will continue to constitute barriers to achieving greater system effectiveness and
efficiency, even if public funding for pharmaceutical coverage and home care expands. Substantial obstacles also remain to institutional reform in acute care, in part arising out of failure to integrate physicians more fully into the system. This,  together with restrained resources, is manifesting in growing anxiety about the system's capacities and continued, poor understanding of waiting lists and queues for service.

We feel that the Health Transition Fund (HTF) should be renewed as a very promising federal/provincial collaboration for generating evidence and evaluating innovation. While understandably the processes for adjudicating proposals and allocating funds can be fine-tuned, we are optimistic that the HTF can make major
contributions to areas such as generating standards and indicators of performance, and promoting successful examples of restructuring which may be generalizable.

- Transforming our knowledge about health into action

In broader consideration of the non-medical determinants of health, the Forum remains concerned that investments continue to be overly skewed towards health care services as the primary, indeed almost our sole, strategy for improving population health.
We reiterate our view that investments in non-medical health determinants, disease and disability prevention, and injury control will have greater payoffs than would otherwise come from comparable money spent in health care delivery.
Forum members support the work and policy to expand the Child Tax Benefit, and to make the tax system more equitable and advantageous to families with children. Additionally, we need to see other concrete supports for children at risk, such as greatly strengthened early intervention programs, more readily accessible to families in need. Continued and unabated attention must focus on efforts towards the elimination of childhood poverty and to buffering its effects.

Every occasion must be used to reinforce the notion that non-medical determinants of health are centrally important issues for governments. These should be given at least as much weight in policy decisions as is accorded to economic growth and enterprise.

- Using better evidence to make better decisions

Opinions and propaganda, much more than facts and evidence, appear to be governing Canada's health care debates and, in our view the battle risks being won by those who have an interest in undermining public confidence in Medicare. Regrettably, we often lack objective information to counter claims, alarmist scenarios
and frightening anecdotes of either those in favour of private medicine, or others who want governments to spend ever-increasing amounts on health care. We continue to be seriously under-served by an inadequate capacity to measure performance. This leaves the public to judge the impact of change through subjective
impressions and opinions, largely guided by the media and by those who stand to gain from not having clear evidence available.
Accordingly, the federal government must support development and active dissemination of fundamental tools to create a culture of evidence-based decision making. If we cannot or do not measure system performance, Canadians will remain unable to reliably evaluate the state of our health care system. Information systems
and the measurement and reporting of outcomes are key tools for the development of meaningful national standards. Momentum should continue on the development of the Canadian Health Info-structure and we should move expeditiously towards establishing the National Population Health Institute, as recommended. Similarly, action needs to take place with respect to developing the Aboriginal Health Institute, which remains as relevant and appropriate as when originally suggested.

Research drives evidence generation. We are generally supportive of proposals for increased research funding. However, for a renewed health research funding strategy to be successful in improving the health of Canadians, it must be broadly based. In addition to seeking biomedical understanding of diseases, we must
invest in understanding the broader determinants of health, in health services research which can help us better manage the system, and in policy research which will help transform our knowledge into effective action.

We continue to see a worrisome steering effect on health research by pharmaceutical manufacturers who have a direct and material influence on the research agenda, and how evidence is disseminated. Governments have underinvested in health research in Canada compared to other G7 countries and, correspondingly, have encouraged investment from the pharmaceutical industry. The federal government must ensure that expenditures are aligned with sound public policy and health goals.

These initiatives will help, particularly in the long run, to enlighten the debate and the public. But they will not solve the immediate problem of growing momentum among the anti-Medicare factions. We believe Canadians are looking for their federal Minister of Health to vigorously defend their most cherished social program. We would urge you to take every opportunity to counter the unfounded charges and fearmongering.

In summary, Forum members believe Canada Health Action: Building on the Legacy remains relevant and its recommendations have currency. We wish to re-emphasize the importance of federal leadership at what we believe to be a critically important and crucial point in time for Medicare, in order to insure that all Canadians continue to have appropriate access to good health and health services.

We believe that a campaign to support Canadian Medicare should not result in conflict with the Provinces. For years, Provinces have been pursuing substantially the same directions in health care restructuring. In many respects, we have indicated our support for these directions and we understand that the federal government
is also in substantial support. Consequently, given the current challenge to sustaining our health care system, we believe that alignment between the federal and provincial governments with respect to strategic directions and implementation is not only possible but also more important now than ever, in order to enable both levels of government to secure Medicare, which Canadians value so greatly.

Subject to our availability, Forum members reiterate and reaffirm their offer of assistance to you, Minister Rock, as and when you deem appropriate.

Respectfully submitted,

Former Members

National Forum on Health


The discussion paper Health Protection For The 21st Century provides an overview of the initiative and Shared Responsibility, Shared Vision describes the legislative aspect of the review and suggests many of the key questions that will need to be addressed.   These papers will be widely distributed to Canadians, including partners, stakeholders and other interested parties concerned about health protection issues.

A number of changes in the global environment affecting health risks have challenged Health Canada's health protection program in recent years. The threat of new and re-emerging infections, innovative drugs and medical devices, new technologies, and globalization have all had an impact on public health and the work of health protection.

Minister Rock said, "As Canadians, we place a premium on our personal health and our health care system. Many of the rapid changes taking place in science and technology means that we must modernize our public health system so it can effectively serve the needs of our children and grandchildren."

Health Canada's Science Advisory Board appointed by the Minister to provide expert, independent advice, was consulted on the consultation documents. Chaired by Dr. Roberta Bondar, the Board is made up of scientists, health professionals, consumer advocates and others with expertise in public health. Dr. Bondar said, "These documents are a good start for a dialogue about health protection in Canada. What they need now is to be fleshed out by the considered input of concerned Canadians from across the spectrum."

Because the outcome of the Transition project will touch the lives of all Canadians, the participation of citizens and stakeholders is crucial. Provincial and territorial partners will be consulted as well as health organizations, consumer associations, industry,   advocacy groups, professional associations and concerned Canadians. A number of consultation sessions to be held in cities across Canada are planned for this fall. Canadians who want to receive a copy of the two papers can call a toll free number at 1-888-288-2098. The Health Protection Branch Transition team also has a website where the two papers and other key documents can be found at: http://www.hc-sc.gc.ca/hpb/transitn/index.html

Copies of the two discussion papers on the modernization of Health Canada's Health Protection Program can also be obtained from:

Publications - Health Canada, Brooke Claxton Building
Address Locator 0913A
Ottawa, Ontario, KlA OK9
Tel: (613) 954-5995  Fax: (613) 941-5366


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