[ Page 5863 ]

CONTENTS

Committee of Supply: Ministry of Health estimates. (Hon. Mr. Nielsen).

On vote 37: minister's office –– 5863

Mr. D'Arcy

Mrs. Wallace

Ms. Sanford

Mr. Hanson

Mr. Davis

Mr. MacWilliam,

TUESDAY, APRIL 30, 1985

The House met at 10:05 a.m.

Prayers.

MR. MacWILLIAM: If I may be allowed an introduction this morning, Mr. Speaker, in the House today are 47 grade 7 students from BX Elementary School in the Vernon area. I would like to welcome these young people to the House, as well as their host, Mr. Bob Ingersoll, a colleague of mine.

Orders of the Day

The House in Committee of Supply; Mr. Strachan in the chair.

ESTIMATES: MINISTRY OF HEALTH

(continued)

On vote 37: minister's office, $206,025.

MR. D'ARCY: Mr. Chairman, I have just a few questions to the Minister of Health. The first and most immediate one is that his ministry last year made a decision to consolidate the two health units in the West Kootenay — Selkirk and West Kootenay — into a new administration called Central Kootenay Health, with its headquarters to be located in Castlegar. The health unit in Castlegar was built in the 1950s when the population of the area was about a third of what it is today, and at that time it had no administrative requirements out of it.

I understand that a lease arrangement for property has been concluded between B.C. Buildings and the Castlegar and District Hospital, and I would like the minister's assurance that his ministry will, shall we say, urge or encourage B.C. Buildings to get on with the job of the expansion of that health unit, in order that it can accommodate the administration which his ministry decided to move into it from both Nelson and Trail during the last fiscal year. Clearly there's a great deal of pressure on all of the staff involved as long as the present situation exists.

The second point I want to make regarding the two health units in the area — indeed I suppose with all the 11 health units within the new Central Kootenay region — is that while the professional complements are pretty well up to standard — and I want to thank the minister and his deputy for that — there is a severe shortage of clerical staff. This has resulted in much professional time being spent doing what is essentially paperwork. This cuts down on the effectiveness of service to the public. The reason for the acute shortage in clerical staff in terms of the usual requirements of such a region is the large number of health units in the region –– 11 of them. I would like the minister and his deputy to seriously consider increasing the number of clerical positions in the region by at least two. As I said, professionally we're quite well served. I want to thank the administration for that, although I am told they could use a couple more dental hygienists.

There's another thing I would like to make a point of. I know the minister and senior officials of his ministry have met with representatives of the Trail Regional Hospital board, and as the minister well knows, there has been strong demand from the public, let alone from the hospital board in Trail, for a computerized tomography scanner. This is a regional hospital. The public feels that they are paying for this up-to-date, diagnostic service, and they feel that they should have it. I believe they should have it as well. I would like the minister and his deputy to seriously consider releasing the funds for this. The public has already contributed $350,000 over and above the commitment of the regional hospital board from property taxation. So the local taxpayers have not only put in their share as taxpayers under the formula laid down by the government, but they have also shown their preparedness to put up S350,000 more in charitable donations for a fund to provide the region with a computerized tomography scanner. I hope the minister will seriously consider acting on this request. People up there in my riding, within the region, have shown that they are more than prepared to put their money where their mouth is. I would hope that the minister would act fairly quickly on this, with a modern up-to-date piece of equipment — we certainly don't want a used model. I would like to hear the minister's comments on all three of the topics that I have raised here.

HON. MR. NIELSEN: The consolidation of those two health units has gone along quite well. Even after consolidation, it still represents the smallest unit in the population base. My understanding is that BCBC has advised that they are underway to make the necessary renovations to the Castlegar building. The shortage of clerical staff the member mentioned is being remedied. Apparently there are a number of vacancies which are now being filled, so we'll have that resolved.

I'd like to discuss the CT scanner for just a moment because there are some very real problems associated with the desire of some smaller facilities to enter into this technological age. I think what was unfortunate in Trail was that there was a public campaign started to raise money for a CT scanner before it was really agreed upon that that was the right equipment to go for. The CT scanner itself is a very useful instrument, but there are many other aspects which must be met to make proper use of a CT scanner.

We have to have the proper staffing; we have to have the proper medical specialists who can make use of the information. There are other professionals and other specialists that should be available to make use of such information at that location. The population was aroused by a campaign. I think the radio and newspaper started the campaign; they really backed it, and they raised $350,000. The cost for the equipment probably would be close to $1.5 million.

We met with the Trail board. We told them that we would not be approving the acquisition of a CT scanner for this fiscal year, but we would give consideration to the possibility of such a unit sometime in the future — perhaps in a year's time we would at least give it consideration. The people in Trail felt that perhaps the main stumbling block was the cost. We assured them that while the cost was certainly a consideration, it was not the main difficulty. The difficulty would be to locate a CT scanner in an area where it is going to be utilized and serve the population.

The representatives from the hospital did suggest that perhaps if dollars were the problem, one was available from Alberta; a used scanner was available from Alberta. We recommended that they not really consider that because they are buying old technology. Far better to purchase something new on the market and have a much longer life. But it's a bit of a problem we've had in other hospitals in the province, where

[ Page 5864 ]

local people have decided on a medical issue and have really got the public going to get the money for a certain type of instrument. Frequently it is not necessarily what that hospital may require at that time.

[10:15]

So we have a good association with the Trail hospital. With respect to that, I think they fully understand our position, and we have assured them that there is no question that at some point in time that area of the province will require such technology — a CT scanner or perhaps something which follows, because the technology is changing very rapidly. We didn't even suggest to them some of the newer models that are coming out, but I would think that in the not-too-distant future the Kootenay area will be served by that type of technology. We've got a lot of loose strings to get together to make sure that should the unit be installed, the proper technicians, the proper specialists and the backup will be available to make use of the information the scanner can provide.

MR. D'ARCY: I appreciate the minister's comments, and I do support him, as I already said in my first series of remarks, in that we certainly don't want a used model. I think the minister is absolutely correct in saying that when this be made available to the people in the West Kootenays, it be the most modem piece of equipment that is available at that particular time.

I do want to impress the minister, however, with the fact that we are looking at a bit of a chicken and egg thing. He says some of the other services and staff are not there to support this. The fact is, Mr. Chairman, that the reason they're not there is that this particular piece of equipment is not there. For instance, neurologists have been resident in Trail from time to time, but eventually they leave simply because the diagnostic equipment is not available for them to practise their profession in the way that they feel they should.

A second point, Mr. Chairman. When it comes to cost, yes there will be additional operating costs. It's also true, however, that the ministry right now is incurring additional operating costs by having to transport people to Kelowna, Vancouver or Victoria, where this particular equipment is available. In some cases, the ministry is even incurring significantly higher medical costs in order to treat patients than would have been necessary had those patients been diagnosed with this particular equipment as soon as they might have been had it been in the area.

I want to repeat that even assuming the initial capital cost is $1.5 million, I believe the formula — and the minister can correct me — is 60-40 at the local level, 40 percent local and 60 percent provincial. If we look at a $600,000 commitment at that point — the local level — plus the $350,000, this has taken a significant chunk already out of the province's responsibility directly to the area. I'm not saying: "What is $1.5 million?" Obviously, $1.5 million, even in today's terms, is significant. But the fact is they're not asking for millions, Mr. Chairman, either in capital costs or in operating costs. They're asking for something that they feel they have in part paid for and are paying for through their tax dollars and deserve as a region of the province which is contributing significantly to provincial revenues.

HON. MR. NIELSEN: Mr. Chairman, I just wanted to make sure the member understood that we feel the citizens o that area who did contribute to that fund exhibited tremendous community spirit, and we certainly haven't discouraged them. It's a matter of trying to tie it in to the right time schedule, and I'm sure they will have similar equipment in the near future. But we certainly have not discouraged the people of Trail. I think they've done a tremendous job in backing that project.

MRS. WALLACE: I have a few varying areas that I would like to discuss with the minister. The first one relates to the closure of the rehabilitation ward at the Nanaimo General Hospital, a problem that has affected many of my constituents. While the Nanaimo hospital is out of my constituency, a great many of the people who live in my constituency and are suffering from continuing health problems, particularly arthritic and rheumatic problems, used to use that centre. Now it is closed. It has been closed for some time, of course, and I've raised this before, but I want the minister to realize that this is a continuing problem. The only rheumatologist there has gone. This has put an overload on the Victoria centre where these people have to go for treatment, a longer and more expensive trip than going to Nanaimo. Because there is no facility to provide that kind of service at the Duncan or Cowichan Regional Hospitals, local people are not able to avail themselves of this service if they're not able to travel.

Also, there seem to be some pretty long waiting lists as far as the rehabilitative facility in Victoria is concerned. One instance brought to my attention is a chronic-case patient who has been waiting three months to get into that treatment centre, suffering pain through that three-month period and still no word about admission. She's been on the waiting-list at Nanaimo General for four months for shoulder surgery and five months for cataract surgery. There is a patient who is really in grave difficulty and not able to get any rehabilitative treatment to relieve some of her pain and distress in the meantime, and she is still waiting for these more acute-care things. I think that it's rather in line, Mr. Chairman, with the lack of preventive measures.

The rehabilitative programs are, by their very nature, partially preventive, because they prevent people becoming acute-care patients. They are able to function on their own in their own home and not be a charge on our institutional establishments. Intermediate care and extended care are certainly good methods of caring for patients, but we should ensure that we keep as many of those patients as possible in their own home for as long as possible. The way to do that, I would submit, is through the home care program and the home nursing program, whereby those people have the help that is required to keep them in their own home.

I know that at Cowichan Lodge, the intermediate-care facility in my area, there is quite a long waiting-list of people needing to get into that facility. The difficulty is that our home care and home nursing facilities are so cut back that the people waiting to get in are not being provided with the kind of attention that they should have in the home. If there were more facilities of that nature, they could very probably stay in their home for longer periods of time. I think that is the desired direction we should be going in — to try to keep people in their own home for as long as possible. It's much cheaper from the taxpayer's point of view, and it's much more desirable from the point of view of the person who is incapacitated.

There are many instances that back up this need for prevention. The minister gives lip-service to the idea, but when it comes down to doing it, it doesn't happen. I don't know how many times I've talked about the problem with the

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audiologist in my area. We finally have one audiologist in Nanaimo; none in Duncan. What we should be looking at is at least two. The waiting-list is like 940 people waiting to get that audiologist service. There is a priority system whereby babies and young children are seen within three months, but older people are still waiting for a long period.

One of the things that has made this more difficult and more complicated, with longer waiting periods, is the fact that the Workers' Compensation cases have now been referred to the Ministry of Health. They've been turned over there with no addition in staff, where we already had a shortage of help, a shortage of audiologists, for example; and now the workload of the Workers' Compensation Board placed on top of that is creating an intolerable situation. It's just not good enough to have a waiting-list of 940 people.

I have one WCB case, and I wrote to the Minister of Labour (Hon. Mr. Segarty) about this, because I thought he might be concerned about the kind of service that was happening. In this instance he wrote me back and told me that this particular patient was referred to the Central Vancouver Island Health Clinic on November 29, 1984. The Workers' Compensation Board was not aware of any problems there. He went on the waiting-list in November 1984, and he's still waiting. The man has one side of his hearing-aid that is not functioning. He has extreme difficulties trying to hear, and he's still waiting. He had a problem with the earpiece and was told that if he came in they would make a new mould for him. But he feels that he needs more than that. Do you know what the Minister of Labour told me? He said: "It seems to me the Ministry of Health has been very efficient in handling Mr. Heyd's case." That doesn't appear efficient to me, Mr. Minister. I think that that is just an outstanding example, from November 1984. Here is a man with half of his hearing-aid not functioning and a difficulty with his earpiece, and he is still waiting; no word of ever getting in there with these 940 people waiting.

So that added load of Workers' Compensation cases, while it may be perfectly all right to put them all under one umbrella.... I don't quarrel with that idea, but I certainly quarrel with doing that without providing the manpower to do it. Before WCB ever came into there we needed an audiologist in Duncan. We needed a full-time audiologist in Nanaimo, which took a long time to get. Those people are just not getting the service, and that concerns me very much. I think it's most unfortunate that this is the way we're treating the seniors in this province, that they must go around with inoperative and inefficient hearing-aids because of these long waiting-lists and lack of staff. It's just not good enough, Mr. Chairman.

[Mr. Ree in the chair.]

Of course, I couldn't speak in the Health estimates without talking about smoking. Certainly there has been a great deal of evidence that both firsthand and secondhand smoke are causing severe health problems. I have a submission here put out by the B.C. Health Association, which goes into some of the problems that they have turned up relative to smoking. They are talking about chronic obstructive lung disease, which they call COLD. They have found that cigarette-smoking is the major cause of COLD morbidity in the United States, and 80 percent to 90 percent of the COLD in the U.S. is attributable to cigarette-smoking. It is clinically significant that emphysema occurs almost exclusively in cigarette-smokers. They go on to talk about secondhand smoke and the problems that occur with passive smoking. It's a contribution to the level of indoor air pollution. It causes eye irritation and changes in pulmonary function, and the children of smoking parents have an increased prevalence of reported respiratory symptoms and an increased frequency of bronchitis and pneumonia in early life.

[10:30]

I would like to see this minister take some positive steps, much more so than he is doing, relative to smoking and regulations regarding smoking. Certainly it is a problem that is causing us a great part of our health care costs. When I think of children being exposed to smoke and developing those kinds of problems at an early age, it doesn't bode very well for their future health or the costs that the taxpayer will pay on their behalf because they have had to breathe air polluted with smoke. I think we need more positive programs explaining to people in no uncertain terms the harm of smoking, the effect on children, unborn and born — make that very clear to parents. Perhaps an educational program is the thing this minister should be embarking upon in dealing with the health problems that occur from smoking. Certainly our hospital costs are much higher because of smoking. I think we have to get into a very definite educational program and perhaps some firmer regulations relative to smoking, which may make the situation easier to deal with.

I want to turn to another subject, the B.C. Medical Services Plan. I had a letter from the minister some time ago, in response to a request of mine, outlining what happens with the B.C. Medical Plan. What it said in essence is that eligibility is a federal responsibility, but payment is a provincial decision for B.C. Medical. You tell me that premium rates and levels of premium assistance are set by the Medical Services Plan of British Columbia and that the eligibility criteria for premium assistance are prescribed by the Medical Service Act. You also say that regulations concerning the eligibility for medical benefits must be identical throughout Canada, but the cost of the program — the premiums — is set by the province.

Now I believe it was yesterday that the minister was talking about the constitution and this free flow between provinces; that people should be able to move around from province to province. If you're going to do that, certainly you shouldn't be penalizing people who move to British Columbia as far as their medical premiums go. I have a couple of instances, Mr. Chairman, that I would like to deal with.

The first is a couple, aged 71 and 73; they would now be a year older than that because this was almost a year ago. They came to B.C. from Ontario on August 29, 1984. In Ontario, senior citizens pay no premium. They paid nothing; they had free medical coverage. These people are now paying $30 a month in B.C. and will pay it for a full year, from August to August. I'm not sure that's in line with the constitutional standards you were talking about yesterday, Mr. Minister — penalizing seniors for moving from one province to the other.

The other instance is the case of a woman who has spent all of her life in British Columbia. Her husband died some years ago, and she remarried last year. The man she married lived in Quesnel from 1979 to 1981. In 1982 and 1983 he lived in Ontario; he came back to B.C. in January 1984 and they were married. She now also has to pay a premium. Before, she paid $16 and he paid $11.50. Now that they're married they have to pay $30.

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We'll leave it at that. I'll continue with my other items later.

HON. MR. NIELSEN: On some of the issues, Mr. Chairman, I'm trying to gather the information on the waiting lists for rehab in Victoria. I don't have the specific numbers at the moment. But generally, as I mentioned in my opening remarks, the most recent statistics provided to us in February from 14 of our largest hospitals show that 76 percent of inpatient surgery patients had their operations less than eight weeks after surgery was booked — four out of five patients waited less than eight weeks for surgery.

The member mentioned this one person who has been waiting three months for shoulder surgery and five months for cataract surgery. I would have to wonder if there is perhaps something with respect to the individual's condition that prevents surgery from taking place. It would seem strange that in both instances the patient has been waiting what appears to be a length of time inconsistent with the average wait for B.C. citizens. We would have to look into that individual case. Frequently we find, when we do look into an individual case, that certain factors have not been mentioned.

The home care concept of keeping people at home as long as possible certainly sounds reasonable when you're talking of costs. But in some situations there are very real difficulties in persons maintaining themselves at home. They can be offered assistance; they can be offered homemaker care; they can be offered nursing care. But even then there are certain instances where the person requires far greater monitoring than what would be available. It's not practical that they stay at home, even though many of them strongly voice the desire to do so. We have legions of instances where elderly people, particularly, are unable to maintain a regime of medication on their own; they simply are not able to discipline themselves to that point. So if they are to be treated, they require almost constant monitoring.

We are recruiting for audiologists throughout the province. The member would be well aware that audiologists are very hard to come by. We don't train enough in B.C. In my opinion, the university does not train enough. We've suggested they could train 20 more and dump 20 political scientists, or some other equally valuable persons. We think our universities should be training more speech pathologists, more audiologists, more of these paramedical people. If they need the space, they can get rid of the people, as I suggested, in political science or public relations, or whatever. Let's start producing some of these technical people we require in the province. It's awfully difficult to recruit audiologists. There is a tremendous demand for them right across North America. I believe we are interviewing audiologists in Ontario and elsewhere, and in the United States, to try to recruit them to come to British Columbia. Unfortunately it takes a long time to get audiologists in place.

Workers' Compensation Board amalgamation. We actually wound up with a greater number of audiologists available for general practice, if you like, by working with the Workers' Compensation Board. I believe the Workers' Compensation Board had more audiologists on staff than the provincial government did. So we have been able to make use of their audiologists. We are expanding the program, we are encouraging more training and we are encouraging more recruiting. We recognize the very real difficulties in that area.

The member mentioned the impact of lifestyle on our health system — smoking specifically; but there are many others as well. Education certainly is a key to this problem, which leads me to something I think is rather ironic: that schools would set aside smoking areas for students. There's no question that the education approach is the one which will be most effective eventually. For a period of time in our society, when I think we have educated people — not in the formal sense of education, but in the way of influence through entertainment and through performances of various kinds.... We have convinced a lot of people that some of these lifestyle habits which are actually detrimental to good health are very attractive. I believe we have reaped the reward of that type of subliminal advertising, primarily through our entertainment media.

I do agree with the member, of course, that the costs in our health care system reflect very much on lifestyle, including smoking, excessive use of alcohol and other drugs, obesity, driving habits, and, in many instances, just simple lifestyle habits: nutrition, diet and the rest of it. There's no doubt that we have people in our hospital system who are in there because they have contracted a communicable disease or broken bones, or some other disease has developed. But the majority of the cost is certainly related to lifestyle at some point in time. It is shocking, even today, to see the diets of children in the very early stages of life — by mothers who perhaps have not had the opportunity of proper counselling when it comes to nutrition, or who have simply continued on as has been the custom in the family for some period of time. There are still a tremendous number of common beliefs with respect to diet that people adhere to which prove to be detrimental.

While we have one program to try to increase the birth weight for new-born children, it is not to be interpreted that we want 12-pound babies. We're trying to increase weight in cases where children are so small that they can suffer serious consequences. We're trying to bring up that weight. But there is still a strong belief in certain parts of our society that the larger the child at birth the healthier the child, and the larger the child during its very early years the healthier the child will be; but this is not necessarily so.

There's also a strong belief in some parts of our society that certain alcoholic beverages provided to a child at a relatively early age will teach the child how to handle alcohol. A survey we conducted a few years back showed that the people with serious alcoholic problems were introduced to alcohol at the average age of 13, most frequently within the family. There is a strong belief by some people that if you start off teaching them how to drink at an early age they'll be able to handle it later. Statistics don't seem to prove that theory.

So I agree: education, of course, is the primary responsibility.

There is no shortage of regulatory authority in the province with respect to the prohibition of smoking in public places. Municipal councils may do this, regional districts may do this and certainly private corporations and public institutions may do this should they choose. It's interesting to hear the medical arguments about it, because they seem to take both sides — with respect to some institutions, at least.

The premiums. They are under the authority of the province. The Medical Service Act is also under the authority of the province. The Canada Health Act allows a period of time for eligibility. Our period is three months, as you know.

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I think in most instances a person leaving a province continues their coverage from their province for that period of time. A person leaving Ontario, I believe, should be covered by the Ontario medical plan for the following three months. So there shouldn't be a lapse in their coverage, one province to the other.

We do charge premiums. Ontario also charges premiums. They may offer relief to senior citizens, as we do and as we do to any person with respect to their eligibility on an income test. If senior citizens are paying full cost for premiums, it means that they are receiving a certain level of income — and they would also be paying income tax— but if they are below that level, then we offer assistance up to 90 percent of the premiums.

[10:45]

I might mention that we get virtually no complaints about the premiums. The complaints we get come when there is some type of inadvertent technical problem where the person's contribution and premium payment was not registered and they find themselves perhaps faced with medical costs; these I think in all instances are resolved. But the seniors certainly have the opportunity, as does anyone under the Medical Services Plan, for a considerable subsidy.

At one period of time one of our sister provinces was encouraging seniors to move to B.C., pointing out to them the benefits of our long-term care program. I believe they were offering some assistance in relocating, because of the eligibility situation. We have a higher than average percentage of our population who are in that category. British Columbia is a very attractive area for retirement. We also have probably the most extensive long-term care program in the country. Some provinces simply don't have such a program. We have continually upgraded and expanded our program, serving many thousands of people in long-term care, along with the other programs we have. We think on balance we have good numbers — good ratio. It's always going to improve. It will always be changing because the demographics will demand that.

But the seniors who may be paying $30 a month must be in receipt of income which would make them subject to income tax. So they are not strictly on OAS and GIS.

I think that covered most of the topics the member brought up, Mr. Chairman.

MRS. WALLACE: Just in comment on the minister's remarks relative to the last item, why is it that a senior who comes from Ontario and has three-month coverage from their home province has to wait one year before they're eligible for any assistance in British Columbia? This is what these people were told — that they must wait one year before they are eligible for assistance — when they came to B.C. That seems to be a nine-month period where they are discriminated against because they have made that move.

Relative to the audiologists, how many years have I been raising this? Year after year, almost since I first came into this House — we're looking at maybe ten years. Now I know it wasn't the same minister, but what kind of communication is there between the Ministry of Health and the Minister of Universities, Science and Communications (Hon. Mr. McGeer) if we're still trying to recruit audiologists from across Canada and the United States? Surely to goodness they must talk to each other, and if this demand is there, then why hasn't this minister taken some action to ensure that those courses are available?

We've seen the health-related courses being phased out in recent years. The therapists and the physiotherapists — those courses are being phased out at the university. Young people who have given one, two or three years of their life and course of study to taking that course now find it's not going to be available to them. Why are we phasing out those courses when there are job opportunities? Certainly in the case of physiotherapists there is a crying need, just as there is for audiologists. Why are we not only not adding to the audiologist course but phasing out those physiotherapist courses?

There is just one other item that I wanted to raise with the minister, and that has to do with the quality of water. I know that the Ministry of Health, under the Health Act has some responsibility, theoretically, for the quality of water. I think of areas like Shawnigan Lake, where the people take their water out of that reservoir for drinking. Another case that's come to my attention just recently in my role as environmental critic is an area up around Golden — the Parson watershed people take water from that particular watershed.

The problem seems to stem from the fact that both the Ministry of Forests and the Ministry of Environment have more control over what happens to water than does the Ministry of Health. Theoretically the Minister of Health is supposed to be able to have input and have some authority in assuring that water is protected — water that's used for domestic purposes, for drinking; potable water — and that it is maintained in a good quality. But what seems to be happening is that the Ministry of Forests, which is probably one of the major policy-makers as far as the management of watersheds on Crown land goes, is either ignoring or overriding the Ministry of Health's recommendations. The Ministry of Environment, which also has a great deal to do with it — an expanded role in watershed management — is not responding adequately to the concerns of the public health people relative to watersheds.

I have seen this happen in the case of the forestry, where one of the local forest companies went in and clearcut a watershed that provided water for a whole community up around Lake Cowichan and Youbou — just ruined that watershed, absolutely ruined their drinking water. They had to abandon it and get another source. Where is the Minister of Health in all this? Because they do have a responsibility. I don't know whether it's a weakness in the legislation, in the regulations or in commitment, but the Ministry of Health involvement in the protection of watersheds is simply not adequate.

In the case of the Parson Watershed Alliance, for example, where there is a plan to put in Crown pasture land on the McMurdo Benches, there has been a great deal of concern expressed. There are 94 households that get water from that area. There is such concern about the water, in fact, that the committee that was reviewing this whole matter set up a subcommittee to deal with this — specifically with water. Who is on that subcommittee of five? There is one from Environment, one from Forests, two of the water licensees, and — I guess it's a committee of six — one or two ranchers from the area. There's no one from Health, not one; no input from Health. Why not? They surely have a right to be there, when you're looking at the water quality of 94 households that may be affected. I don't know if the minister is remiss in his responsibilities relative to the quality of water, or whether he's just overridden by the Minister of Forests (Hon. Mr.

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Waterland) and the Minister of Environment (Hon. Mr. Pelton). I somehow can't imagine that minister being overridden by those two individuals. Surely he has as much clout as they have. The Minister of Environment is a very nice, gentle little person, and the Minister of Forests is.... well, he has quite a temper, but I don't think that would frighten the Minister of Health.

I'm just wondering why we're not getting something better as far as the quality of water goes. I submit that that minister has a responsibility to ensure the quality of drinking water. Pure water, clean air and the ability to produce food are the three crucial elements to the continuation of life and health in this province. As such, that minister has a definite responsibility for the quality of water that people drink. We've seen all kinds of conflicts, and the Minister of Health always seems to come up just a little bit short in his input into the regulations over our drinking water. I would certainly like to hear his comments on that last question.

HON. MR. NIELSEN: I'd like to go back to the audiology question in central Vancouver Island. The waiting list is apparently now 815. The list rose because of the vacancy in Nanaimo. Additional audiology time is being dedicated to Nanaimo in May to bring the waiting list down.

The gentleman the member mentioned is a Workers' Compensation Board client. My information is that he was referred in November and seen in December. At that time one of his two hearing aids worked well; the other did not. In view of the waiting list he was asked to return later to have his other aid repaired. He apparently agreed and then complained to the Workers' Compensation Board. When he was then contacted to come in again, he refused.

Bits and pieces about the number of grads were mentioned again. Under the University Act, I believe the senate of the university is responsible for the curriculum and size of classes, basically — that is, the governing body of the university. The minister responsible for universities and myself have had a great deal of discussion about the practicality of certain courses and what can be done to encourage the universities to expand such courses as audiology and others — whatever may be required. My understanding is that it is the senate of the university that must make that decision. I don't know how you persuade them to change their ways. Beyond political scientists, I imagine there would be a great number of other categories that I think we could trade off and probably benefit society as a whole.

The public health inspectors and the medical health officers spend a great deal of time with respect to water quality. There are some problems which do arise. Most of the time the medical health officers or inspectors are actually inspecting water quality after it's received. They spend a great deal of time conducting tests on the actual water quality.

[Mr. Strachan in the chair.]

The system we have in this province works reasonably well for almost all areas. There will be individual situations where obviously the quality is being affected by competing requirements, such as forestry, as the member mentioned. That is being considered as to how that might be improved. We still in B.C. have one of the best water supplies anywhere in the world, but the system is certainly not perfect and complications arise. It's a constant question being addressed by various ministries to see how the system could be improved.

I think the medical health officers do respond when any kind of a problem arises, and respond as quickly as possible. The system can be improved, and I have every reason to believe it will be improved. The member is quite correct: perhaps a far greater degree of influence prior to certain events taking place might be the proper approach.

[11:00]

MR. MITCHELL: Mr. Chairman, could I have leave to make an introduction?

Leave granted.

MR. MITCHELL: I would like the House to join with me in welcoming the 14th Girl Guides from View Royal who are here to find out what we do every day and to listen to the minister on his health estimates.

MRS. WALLACE: Very briefly, I thank the minister for his comments on the water situation. I hope we will see some reorganization there, as he's indicated, that will give the health people more clout in dealing with waterways. Relative to the WCB gentleman — I just want to get it on the record — the appointment he turned down was to get new ear moulds. He refused it because his hearing aid wasn't working. He still doesn't have a hearing aid.

MS. SANFORD: Mr. Chairman, I wanted to do a followup with the minister on some of the statements he has been making with regard to Ethiopian aid. The minister has indicated that the moneys which British Columbia might come up with would be funnelled through the federal government. The requests for these moneys were first presented to the government last fall, and as I understand it, the government still has not come up with any moneys to assist the Ethiopian famine relief program. I would like to point out, Mr. Chairman, that the need is as critical now as it was then, and that that need will continue for some time in the future.

A number of provinces have made contributions by matching the funds raised within their provinces. Quebec, for instance, matches every dollar raised in Quebec. The federal government has put up a significant amount of money — some $30 million — to match the moneys raised in Canada, yet the provincial government has been dragging its feet on this issue. It has not been willing to assist the program to aid the Ethiopians, even though the people of British Columbia have shown an extreme generosity. Through the mayor's campaign and the various agencies in British Columbia, nearly $4 million has been raised to date. The only thing the government has announced, as far as I can determine, is that it's willing to forgo the B.C. sales tax on the sale of a particular record which was produced to assist in the famine relief.

Some excellent agencies are involved in this B.C. federation of international agencies. They have been appealing to government. They have worked hard to raise funds to aid the famine relief in Ethiopia. Organizations like the Red Cross, Oxfam, the YM-YWCA, a number of churches, including the Catholics, the United, the Lutherans, Mennonites, Anglican — they've all banded together to raise money. The

[ Page 5869 ]

Salvation Army is another. The Rotary Club is another organization that's involved and has been pleading with this government to join them in assisting the people in Ethiopia, who are still facing a very critical situation.

I would like to ask the minister about his earlier statement that any moneys that might come from British Columbia would be funnelled through the federal government. What that means is that the money then would be matched dollar for dollar through the federal program that already exists; in other words, it would not result in additional funds being raised for Ethiopia. Saskatchewan, a very small province that has never had a very large source of funds, has come up with $8 million worth of grain to assist in Ethiopia. Surely we in British Columbia, a much larger province with much better resources, could come up with half that amount to match what's being raised here in British Columbia. I would like to ask the minister at this stage what the position of the government is, when a decision will be made and how that money will in fact be directed.

HON. MR. NIELSEN: Mr. Chairman, the position of the government is that whatever aid may be forthcoming from the province of British Columbia will be funnelled in conjunction with federal aid, not necessarily funnelled through the federal government but in conjunction with the federal program.

I think it is commendable that the people of British Columbia have raised $4 million or whatever amount they have raised. I hope they raise more. I wish the emphasis were on individual acts of charity rather than automatically knocking on our door and saying to government, come up with these bucks. I think it's fantastic that the people of British Columbia have raised over $4 million on their own — the various organizations who have worked very hard at raising those funds.

The request we received originally was a very quick appointment and a request for $2 million, which has not been acceded to. But I think the citizens are to be commended for getting behind such a program and putting their money up. The government of B.C. may, at some time in the future, advise what our participation may be. The member mentioned that the need in Ethiopia will continue for a long time, as it has been a fact of life for many years. I don't believe there is the necessity to produce all of the money at one point in time when obviously it will be required over a period of time.

Again I emphasize that I think it is tremendous that the private sector has been able to gather as much as they have from citizens in our province and see that it goes to the various organizations, of which there are a multitude, who are attempting to offer some relief in Ethiopia and other parts of Africa. Mr. Chairman, the provincial government will, I am quite sure, announce in due course what its contribution will be, what form it will be in, how it will be expended and at what time. We are not indifferent to the difficulties in Ethiopia and elsewhere. We will be considering that program and what our response will be. The decision has not yet been made, but when it is made, of course it will be announced to the citizens of our province.

I hope that the citizens of B.C. continue to contribute to some of this international relief, along with the many other programs which are national or provincial in nature, such as the Steve Fonyo run, which is also calling upon the people of B.C. to assist.

There are many worthwhile charities, worthwhile organizations and worthwhile causes which are being responded to by governments and citizens alike. The Ethiopian situation will be considered, and presumably we will reach a resolution at some point in time. But the decision has not been made at this time.

MS. SANFORD: I thank the minister for his answer. But based on the answer just given by the minister, I fear.... So do the agencies; they're beginning to fear that this government will continue to drag its feet on this issue, that no decision will ever be made to assist the people in Ethiopia, and that the government instead will continue to say yes, it's all very well; we'll be considering this at some time in the future. Why is it that this government takes that long to make up its mind on an issue as important as this, Mr. Chairman? Other provinces across Canada have been able to make up their minds and have been able to bring forth moneys totalling $8 million for a small province like Saskatchewan alone, and yet this government is sitting here saying: "A very worthy cause, but it's something we'll consider at some time in the future. If we do make a decision we will make an announcement."

I don't think it's good enough, Mr. Chairman. I think the minister should indicate to us today: "Yes, we will be making money available. Yes, we will be making it available within the next X number of months." Let's have something more definite and more definitive from government on this issue than we have received from the minister this morning. I don't think it's good enough.

MR. CHAIRMAN: Hon. members, at this point the Chair recognizes the seriousness and the magnitude of the discussion before us, but I would ask if the committee could be advised if this is appropriate to the administrative responsibility of the minister whose estimates are before us. I say this not to diffuse the particular debate that's going on at this point but just to maintain relevance during these estimates.

MR. HANSON: Mr. Chairman, today I'd like to direct my remarks basically to three of what I see as preventive programs that could be built upon and developed properly in British Columbia. Looking to Washington state and looking at the cardiopulmonary resuscitation program that is present in King County and the Seattle area, I think that here in British Columbia we could benefit from their experience.

For the benefit of the members in the House, the program began in Washington in 1971, and it receives funding from the city of Seattle, the Heart Association and the Rotary Club among other private donations. In 1973 they received grants from the United Way. What I'm saying, Mr. Chairman, is that this particular program, which calls for quick intervention when a person has a heart attack.... Oftentimes the damage that is done in terms of the absence of oxygen and so on leaves a person technically or legally dead, where that person could be resuscitated and could, if quick action is taken, lead a relatively normal life.

The structure in Washington state is that the actual training is done through the King County Fire Department, again, with supporting funds from the city of Seattle. We could here, provincially, fund such a program and involve the firefighters of the province and other groups interested in participating.

[ Page 5870 ]

They teach through community colleges, libraries and other public facilities, and the facts are very, very impressive. Currently one-quarter of King County residents — 400,000 people — are trained to provided quick-intervention cardiopulmonary resuscitation. That is the highest level in the United States and it's one-fifth of the population of the state. That's incredibly impressive. It's the most impressive, as I said, in all of the United States and North America.

This has far-reaching preventive and cost-saving measures, clearly, for any kind of health delivery system — if there can be quick intervention not only does the patient benefit immensely, but in terms of per-day bed hours, occupying acute-care hospitals, and so on, and all of the medical support network that's required, clearly if we could train British Columbians in the same fashion that they're being trained in Washington state we would save enormous amounts of money here in British Columbia by a very positive preventive program that would help people. There are something in the order of 600 individuals since 1970 who not only have been resuscitated and gone to a hospital for check-up but have been sent home immediately. That's how effective quick intervention is. I think we should be looking to them and learning from that experience south of the border.

In addition, their new program is concentrating on seniors and spouses of people who have heart conditions. They've found that few seniors in the past were trained, so they've targeted the spouse or family member of a heart patient. So they train them before the patient leaves the hospital. As they've indicated, 66 percent of heart attacks occur in the home. So if a spouse is trained in CPR they can quickly provide that resuscitation that is so important in those initial few minutes before the emergency response teams can arrive.

So that is my first comment. On a preventive basis we would be well served in British Columbia if we could look to Washington state and follow their guidance in providing a comprehensive CPR program — perhaps expanded through the school system, through physical education programs. We could make it a part of our education system and then people out of the education system perhaps could receive this training through cooperation with the firefighters' organizations or other individuals who would be willing, such as St. John's Ambulance and so on.

The second item I raised a few years ago, and I've dragged it out of my files again, because nothing much has changed. I think that this province is very weak in its epidemiological research and capability. We know that, again, in Washington state it's far more developed. Some years ago they produced an occupational mortality report for Washington, the result of studies of 300,000 deaths of males between 1950 and 1971. They came up with the kinds of occupational diseases and accidents and causes of death that apply by occupation. It seems to me that if you know in detail what the hazards are in the workplace for a working person, whether an electrician, a dentist, a public employee or whatever — what kinds of hazards and what kinds of diseases they contract — surely in a preventive model of health care it would make a lot of sense. Then you could take remedial action to prevent these diseases.

Let's take, for example, the mortality atlas that is produced by Health and Welfare Canada. It has various kinds of epidemiological maps, and so on, for the country. It does indicate — and I've raised it in the House before — that there are regions of British Columbia that have higher than expected incidences of certain types of disease. It would seem to me that if we had a well-developed epidemiological section of the ministry, supported and funded through the universities or some other agency, we could ameliorate the situation that we find in certain areas.

Let me just go through a couple. In the Thompson-Nicola region, male mortality rates are significantly high for bronchitis, emphysema and asthma. What would the cause be? As the minister knows, the epidemiological figures are calculated almost like an actuarial examination of the number of people they expect to die of a particular disease. It has a certain rating; it's a proportional calculation. Then they look at that particular region, and they find the actual number dying. I'm not going to get into all the difficulties of what is on the death certificate, and how detailed our medical records are and so on. One suggestion, as an aside to the minister: on the Medical Services Plan records, a person's occupation should be included in one of the computer lines. I think that would help the medical profession in tracking certain diseases that occur among certain occupational groups.

Here in central British Columbia there are certain kinds of respiratory hot spots, places where there seems to be an unduly high epidemiological figure, in actuarial figures, for certain types of diseases, respiratory and so on. Vancouver is extremely high for males and females in cirrhosis of the liver. In suicide and self-inflicted injury, Vancouver again: for males in particular it's very high. I think that some of the diseases that occur.... It is being demonstrated more and more, as research is conducted, that cancer has a very high environmental component to it, and clearly man's ability to make chemicals that human tissues can't deal with is a factor. The minister's comments earlier about lifestyle.... It's more than lifestyle. If he's including in lifestyle what a person does for a living and the kinds of gases or substances or heat or noise or dust, or whatever it happens to be, then we should be looking more carefully at those factors. People doing cancer research.... Again, the mention of Steve Fonyo. Cancer research isn't just finding a cure for cancer; it is managing to keep human beings from exposure to agents that cause cancer. We recently saw in northern Ontario the transfer and the spillage of PCBs, known cancer agents.

We have that whole facet of our life in British Columbia, the movement of toxic and carcinogenic materials around in our communities without proper control. So it's a very broad question, but all of these factors impinge on the mandate of this minister. As the minister in charge of the health and well-being of our citizens, many of the things in the jurisdictions of his colleagues impinge on his mandate.

So what I am saying, Mr. Chairman — and I know it's a very large and involved discussion — is that when we look at a particular disease frequency among orchardists or farmers or dentists, then we should have the capability in British Columbia to take some action to reduce those frequencies. If orchardists and orchard workers are being exposed to pesticides or to some other kind of agent that's causing respiratory disease, then we should be dealing with it.

Let's just take paper and pulp mill workers in Washington State. It says men in this group show a very interesting pattern of mortality. "Cancers of the small intestine and cancers of the lymphatic and hematopoietic tissues show excess deaths." I'm not a doctor, so I took a stab at that one. "Hodgkin's disease showed a significantly elevated PMR,

[ Page 5871 ]

and lymphatic and monocytic leukemia showed PMR elevations which did not achieve statistical significance...." It says here as an explanation: "It is possible that the excess of fatal anemias is related to the increased mortality from cancers of the lymphatic...tissues. Increased PRRs for Hodgkin's disease.... These may be due to exposure to various kinds of chemicals and substances in the pulp process.

If that's the case, then clearly an epidemiologist could make recommendations to the Minister of Health that steps must be taken to minimize or exclude exposure from these kinds of work-related and occupational hazards. It's very straightforward.

Not only do we have preventive and quick intervention as a health preventive and cost-saving measure in CPR, but I think if we were to expand our epidemiological capability in British Columbia, we could save lives, save dollars, be more preventive in our orientation and just generally provide a more sophisticated level of health care.

With the advent of computers and information technology, it would be very easy to provide small public health clinics in all regions of the province access into epidemiological information so that we could become far more sophisticated in our reading of what is happening to the overall health patterns of the citizens of British Columbia. At the moment, I think that capability is very limited.

The third item in preventive health care that I'd like to just briefly comment on is the whole orientation in gerontological research. I know that in this community, with the high percentage of senior citizens and retired people, it's very clear from conversations and from what I've been reading about health maintenance for seniors that there are a number of very low-cost things that can be done to keep people out of acute-care facilities or even other kinds of facilities for long-term care. These things surround keeping people at a level of activation and social interaction with their peers so that they don't have to rely on acute-care facilities.

I will conclude my remarks, Mr. Chairman, just by saying that many of the steps taken by the minister's colleague in Human Resources are resulting in increased costs in his ministry, because as she cuts back in her mandate, the lack of activation, the over-medication and the other kinds of steps that are taken by seniors result in costs in his area of concern. I think that he should have a good heart-to-heart talk with her shortly in terms of cutbacks in her areas.

HON. MR. NIELSEN: A great number of studies have been conducted with respect to the last topic, and that is gerontology and the difficulties in costs associated with an aging population. I think the most common conclusion reached by the researchers is not unlike what the member just said, and that is that it is a matter of activity level for seniors. Seniors certainly respond poorly to inaction — physical and mental.

I hope to have the opportunity of visiting an organization in the San Francisco area who have taken it upon themselves to work with senior citizens in a continuing education program which not only permits the seniors to continue their education, but also has them acting in the role of teacher in certain areas of society, such as English as a second language for foreign students. I've been advised that the average age of their students is 70-plus. They have advised me that the statistics indicate that their students in their college or university — whichever they call it — are virtually without reported cases of health care during the time they are in the program.

There's no question that some senior citizens develop more dependency upon the health care system, either on the medical side or on the hospital side, because it provides them with interaction. Frequently a doctor or hospital may be the only people they really come in contact with. So I would agree that activities — social activities and other activities — can to a very large degree displace some of the medical or health activities that seniors are involved in now. I would agree with the conclusions of many of the researchers that it is far better to keep senior citizens active than to try to treat them medically when the results of the inaction may become a health problem.

CPR. We do have a fairly active organization working with respect to CPR. Our paramedics are very much involved in that, and a great number of people in the province have gone through the course — nowhere near enough. Washington state is an amazingly community-oriented state, with unbelievable support from the media and other organizations. If you are in the habit of watching television from Seattle, very frequently you see a tremendous amount of support for such programs as CPR. Our paramedics have tried to gather the same support and have had limited success. We are working with them. We are also working with the firefighters.

I agree that it would be most useful if virtually a quarter of the population had the expertise necessary for CPR. We have been promoting it, and we intend to expand it. I would like to see it as an optional program in our schools, particularly in high schools. The member referred to the Washington state program, and I think it would be most useful and rather obvious to perhaps have our cardiologists, and others associated with heart ailments, prepare a list of the relatives of people known to suffer from heart disease, and perhaps notify them and see if we couldn't put a program together where they could enrol. It is not a very difficult course at all. The paramedics are doing an excellent job, and I agree it should be expanded and should become commonplace in our schools, colleges and universities; as common, perhaps, as first-aid programs were at one point.

[11:30]

[Mr. Ree in the chair.]

Epidemiology. I thought we were doing a pretty reasonable job in B.C. It could be that we are emphasizing certain areas which come under our specialists. Perhaps the member mentioned other areas which have not received as much attention. We do, of course, pay attention to the information carried out by the epidemiologists. The ministry's branch works very closely with federal, provincial and international agencies as well as our universities and researchers to try to determine the incidence of morbidity and mortality in the province. They then analyse the information and provide advice to our preventive service branch concerning what could he done and which areas could be targeted.

We do carry out intensive research in hot spots throughout the province. We work closely, as I said, with the federal government. We have three epidemiologists on staff, I'm told, and they carry out their work quite effectively. There are many areas of analysis and research on trends in health care that are covered by these specialists.

[ Page 5872 ]

Much more could be done, I agree, in certain areas which can be identified. Certainly the value of that science is precisely as the member stated: to observe where your basic statistical data seem to be contrary to the actuarial table. Obviously, if you eliminate all else, such as some hereditary aspects of the population, then it would appear to be environmental in some way. If it is not environmental from a point of view of water supply or other conditions, then perhaps it is industrial. When it can be identified that people who are confined to a working space of some kind have a much higher incidence of a particular ailment, then I think the evidence suggests very strongly that it is very much a local problem and should be able to be identified and then controlled. Much has been done, of course, over the years because of that type of statistical determination and work by those scientists.

So on the three points the member made, Mr. Chairman.... I certainly agree with the points he was making. I think each of those three areas of prevention is worthy of consideration. I would say that a great deal is being done in that area. I think it is where the emphasis for the future should be. I particularly appreciate the concept with respect to gerontology and the need to activate seniors and perhaps society to develop quite a different attitude about how an older person should interact with the balance of society. I look forward to, as I said, looking closely at the San Francisco experiment, because if indeed the information they provided me with is correct, it's certainly a major step forward in our attitude toward seniors and health care.

MR. DAVIS: Mr. Chairman, the minister has said repeatedly, and certainly others in the medical profession have said it as well, that health care coverage in British Columbia is as comprehensive as anywhere in the world. We know also that the costing of individual cases leaves something to be desired. However, I have real difficulty with some of the statistics which we hear from time to time. They are essentially international comparisons.

In Canada personal health care in total costs between 6.5 percent and 7.5 percent of the gross national product. In the United States, where there is less coverage — certainly less coverage of lower income groups — where there has been a good deal of boasting about cost containment, where hospitals operate for profit and where there has been a determined attempt to contain health care costs funded by the national government in the United States, the figure is 9 percent or of the order of 9 percent. Some Scandinavian countries report numbers somewhat higher — of the order of 10 percent. But here is Canada around 7 percent and British Columbia with around 7 percent of the gross provincial product committed to health care.

Are we so much more efficient than other countries? Certainly our total delivery is more comprehensive. More people are covered. We cover, as far as I can understand, the entire gamut of illness, surgery and so on, yet we're reporting that only 7 percent of our total substance is devoted to health care, whereas, as I mentioned before, the United States is around 9 percent and in other countries — Sweden, for example — it's around 10 percent. There are a few countries which report a lower figure than 7 percent. The United Kingdom is of the order of 5.5 or 6 percent. But looking at western Europe generally, with the exception of the United Kingdom and Greece, all the OEEC countries report percentages higher than Canada: Italy, Holland, France, West Germany. Japan reports a higher figure. Belgium's is a comparable figure to Canada's, as is Australia's.

My basic question really is this: how is it that we're devoting a smaller proportion of our total income? Our income per capita is certainly less than that of the United States. On OEEC ratings it's less than that of half a dozen of the western European countries nowadays. Are we that much more efficient?

I was surprised to read of the concern with which the Reagan administration now views its so-called runaway costs. Premiums are high in many United States hospitals. The entry charge into hospital is in the order of $300 or $400 at the very outset. There is a period during which there is no further fee charged to the individual under medicare there; but after 60 days costs are shared 50-50. There is certainly a deterrent to staying in hospitals in the United States. Down there several million people have no coverage whatsoever. As I mentioned, the profit-making hospitals — and there are many of them; roughly a third of the hospitals in the United States operate on a break-even or better-than-break-even basis — operate largely under privately insured schemes where the annual contribution is in the order of $1,500 or even $2,000 a year by those who have coverage with these insurance schemes. They boast about their management, about the fact that hospital stays are much shorter than they are up here, and that they get people out of hospitals and into their homes more rapidly.

Why is it that we're devoting a lesser proportion of our national income to health Canada-wide and particularly in British Columbia? Can the minister shed some light on that apparent conundrum?

HON. MR. NIELSEN: Mr. Chairman, that question has been asked frequently, and there seem to be a number of possible reasons for the differences in percentage of gross national product representing health care costs. To some degree it's a matter of accounting. In all instances, that which is attributed to health costs is not necessarily the same. I believe that the system in Canada and British Columbia, because it is primarily under the control of government, is probably more efficient overall in this instance with respect to cost.

I know that as an example — there are so many aspects to that which make up health care expenditures — in British Columbia the average length of stay for an acute-care patient is about 8.7 days. In West Germany it is 17.7 days. West Germany I know has virtually no control over health care costs. In fact, when I was speaking to the minister from Bavaria, he was unable to advise me how much money they spend on health care. They were unaware of what the medical practitioners earned. In that instance it is so fragmented and there are so many people involved that no one seems to really keep track.

Many of these other countries also provide, I think, very extensive dental and pharmaceutical coverage, which adds to the cost. I think, on just a basic comparison system, our system across the country is probably somewhat more efficiently run, and perhaps slightly more heavily controlled. Our costs per services on average are somewhat lower than many other countries — what we permit to be charged. The Canadian average.... The members' numbers are about what is agreed to: up to 7.5 percent, with the United States

[ Page 5873 ]

around 9 percent, Scandinavia 10 percent approximately, and the U.K. 5.5 percent to 6 percent. The duplication of services, I'm advised, in Canada and B.C. is considerably lower than in many other countries, and hospital costs are generally lower. I can't buy that line, I'm sorry. In addition I would think, Mr. Member, that if you were to check the amount billed by doctors in British Columbia perhaps with a comparable state in the U.S., you would probably see that their billing is considerably higher.

There's no quick answer to why the numbers seem to favour us, but perhaps we should just appreciate that indeed that is happening.

MR. DAVIS: On a specific matter and going back to a subject I raised yesterday — that of visitors to Canada — there are a substantial number of people who come to this country on a temporary basis. They come under the auspices of a personal guarantor, an individual Canadian citizen — in our case someone living in B.C. — who signs a piece of paper which is a statement to the effect that the Canadian citizen, the resident of B.C., takes responsibility for this visitor, and that the visitor will in no way impose a cost on the public treasury, national or provincial or local.

In the ordinary course of events, some of these people — I'm advised over the years a sizeable number — do in fact have health problems. Either they're involved in an accident or they otherwise require the services of a doctor or hospital facilities, and so on. Can the minister say whether his ministry has records of claims made on the guarantors; whether guarantors are in fact called upon to foot the bill in instances such as I've outlined? I've been told there is a significant number of — I'll call them aliens — in the country who, when they are in difficulties, go to one of our professional people, usually a doctor. The doctor has a billing number. The doctor asks them for their health plan number and they don't have one; yet the doctor is able to phone the health plan and, with little difficulty, get a number for these people. Rarely in the kinds of incidents I'm specifically referring to does the guarantor foot the bill.

I'd like the minister to comment on that problem area, if he would.

[11:45]

HON. MR. NIELSEN: I'll check into the last comment made by the member with respect to a doctor phoning and obtaining a number.

The guarantor concept really does not work at all. A citizen of Canada who guarantees the cost for a visitor can, we are advised, simply walk away from it, because it's not a responsibility of citizenship. It becomes a problem then for the federal government as to what to do with the visitor. So in effect, the personal guarantor really will not work. I don't know of any instances where a guarantor has been called upon to actually cover the costs, but I do know of many instances where somebody has said they will put up money. We've discussed some, I think, in the House, where we've simply been advised, usually by a family who says: "We can't cover the cost; what are you going to do?" Or they walk away from it. Of course, when the visitor establishes residency in the country, they're in effect eligible for the coverage themselves. We've had many requests where people say: "Would you please allow us to bring in a certain person? We will guarantee." We will not accept that as legitimate. Unless we are prepared to pay the cost, their personal bond or performance bond or guarantee really is, in our opinion, worth absolutely nothing.

MR. MacWILLIAM: I have some general comments I'd like to make to the minister, and then some specific comments in terms of questions as regards the health care situation in the north Okanagan.

I think we're all very concerned in regard to the rapidly escalating costs of health care in the province. I can sympathize with the minister in his attempts to hold the line on a situation where the costs and the demand keep escalating, and we have some realities that we have to face. I think, though, that we continue to make the mistake of dealing with the whole problem of health care at the wrong end of the issue, because our whole focus on health care in the province has been in the direction of the curative aspect: in other words, making people better after they've become ill. That's very costly, and the health care budget reflects that cost. We have to do something about it. Curing people after they're sick is very expensive and is getting more and more expensive.

I think when we look at how rapidly the health sciences have moved in the last 50 to 100 years, we've made some incredible advances. Really, our problem in health care is no longer the acute infectious disease; we've pretty well got that under control. Technological and scientific advancements have pretty well solved those problems of infectious diseases. The major problem we face is how to deal with chronic disease.

Chronic disease, as we know, is very much one of lifestyle. We're looking at very high costs in treating cardiovascular disease, the development of cancer, alcohol-related disease, diseases that are brought on by diet — or the lack of — diseases brought on by occupational stress and occupational health hazards. We have some very significant concerns in how we address the problem of chronic disease. The minister may be aware of a book brought out recently by Kenneth Cooper called The Aerobics Program for Total Well-Being, in which he documents very clearly the extremely high cost of occupationally related stress disease. His basic thesis is that disease is often caused by chronic stress in the workplace and that we can do much to prevent stress-related diseases by instituting the appropriate measures before disease actually sets in.

I think that if we look more at the preventive side of medicine and at the educational side of medicine in order to assess problems in lifestyle before these chronic diseases take hold, we can do much to eventually reduce the health care cost. It's certainly not something that can be done overnight. It's a long-term issue, but I think we have to begin focusing our attention on the preventive side much more than we are at the moment.

I'd like to ask the minister, in terms of looking at the preventive side of health care, whether or not the ministry is considering expanding any programs — for example, in conjunction with the Ministry of Education. Really, when we look at what has happened in recent years in education — I know this is digressing somewhat, but it does relate — we see that because of educational restraint we've cut back, for example, on the number of hours for physical fitness in our schools. But when we look at the epidemiological evidence of children progressing through the schools, we find a significant reduction in the cardiovascular fitness of these children after they enter grade 1. What happens is that when they enter

[ Page 5874 ]

kindergarten and grade 1, suddenly, from a very active preschool life — running around and jumping and climbing — these kids are plunked into a desk to spend hours and hours sitting in a very sedentary fashion until they come out of the tube at the end of grade 12. I think our whole focus in education should be to also educate these children to develop healthful lifestyles. What I see now is that we seem to be going in a different direction, that we're in fact clamping down on the physical education programs. I wonder if the minister has consulted with the Minister of Education (Hon. Mr. Heinrich) about developing an educational program, in conjunction with Education, of preventive medicine for these kids.

Also, we might look at the development of programs, along with the Ministries of Health and Industry and Small Business Development, for employee fitness — again, as is outlined in Cooper's book, The Aerobics Program for Total Well-Being. These programs have provided extensive benefit throughout the States in developing fitness programs for employees. They have reduced not only the absenteeism of the employees but certainly the health care costs that those employees have incurred.

So at this time I'll sit down. I do have some specific questions a little later, but perhaps the minister would like to discuss the comments I just made.

HON. MR. NIELSEN: Mr. Chairman, the member's comments are consistent with the earlier discussions in the estimate. One interesting comment is that the medicare system as we know it in Canada really only responds to the curative side. The federal government, as one of our partners, only contributes to costs for medical services and hospitalization. There's no question that the entire program has been developed over the years to respond to the curative side rather than prevention.

Nothing prevents kids from running and jumping outside of school. I think one of the problems causing not enough exercise is youngsters having too much organization now. There's too much time preening in a uniform instead of running around the field.

But we encourage physical fitness programs. The Ministry of Health is responsible for the public employee physical fitness program, and it has been awarded a national award — or it will be — for the program we have. Nothing prevents any company from encouraging physical fitness.

Yes, of course, the long-term resolution to our health care costs is going to be prevention. The largest responsibility for prevention falls on the individuals themselves. We have traditionally channelled most of our resources in our system to the curative side rather than the preventive side, and perhaps just the onus obligation of the costs are, going to force our society to change and perhaps emphasize the preventive side.

MR. MacWILLIAM: Just a quick question to the minister with regard to his response before we move on. Yes, I realize that the medicare system does only respond to the curative side. I think that's part of the problem. I was wondering whether the minister has any plans to channel more funding into the preventive side of medicine, which really is part of the mandate of the Ministry of Health. Are there any long-range plans in switching the emphasis from the curative to the preventive side?

HON. MR. NIELSEN: Well, Mr. Chairman, we've discussed this previously in the estimates. Yes, we have taken on a lot of specific programs, and as long as the medical and the curative side consumes this vast quantity of money, by comparison, the preventive side seems to receive a relatively small amount, about $47 million. There are a number of specific programs. There are four major issues which we believe will be beneficial. We are working very hard at a program to raise the low birth weights; the smoking issues; reducing back injuries, in the workplace particularly; and encouraging self-care programs for senior citizens. There are many others we will be and can get involved in, but we are emphasizing a half dozen. We are working with respect to drug counselling for young people and also obesity in schoolchildren. So we are looking at that preventive side along with the traditional preventive programs such as immunization and other forms of counselling. We will be expanding that, as we are capable of doing.

The House resumed; Mr. Strachan in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. Mr. Gardom moved adjournment of the House.

Motion approved.

The House adjourned at 11:59 a.m.