Back to top
April 15, 2010
House Committees
Meeting topics: 

[Page 215]



4:27 P.M.


Mr. Gordon Gosse

MR. CHAIRMAN: Good afternoon, the Committee of the Whole House on Supply will now be called to order. Before we start today, I see we have some guests in the gallery. I would like to explain to the guests today that this is not the way that business is done in the Legislature on a regular basis. We are in the Committee of the Whole House on Supply in which we debate estimates. So I do welcome all visitors to the gallery, and enjoy, but this is Budget Estimates and this is the way it proceeds today.

The honourable member for Cumberland South.

HON. MURRAY SCOTT: Thank you, Mr. Chairman and thanks to the minister and her deputy and staff for being here today. I just have a very few short questions and then I know we're going to move on.

There seems to be something more prevalent all the time here in Nova Scotia and it actually was raised here a week or so ago, I believe, by a member from the Liberal caucus and that is with regard to Lyme disease. I've heard from three different people who've said that their doctors have suggested to them that they have Lyme disease but they don't seem to have the ability to address it beyond that or where they should go. I am wondering if you could tell me, maybe from the department's perspective, what advice I should give them other than obviously going back to the local doctor, of course. They're saying that their local doctors are confused as to where to send them to be treated for Lyme disease?

HON. MAUREEN MACDONALD: Mr. Chairman, a couple of things. If the honourable member would permit me, first, before I answer that question, to table some documents that I committed to when we were discussing Budget Estimates earlier in the week.


[Page 216]

I think, maybe this was a question asked by the honourable member's colleague, the member for Hants West, about the collection rate for ambulance fees. He asked what percentage we're able to collect when we billed for ambulance fees and in 2007-08 it was 81.5 per cent; in 2008-09, 81.9 per cent; and projected for 2010, 82.2 per cent. The dollars amounts are there as well and I would table that.

Then I know that the honourable member for Cumberland had questions for me about the transfers of ambulance - New Brunswick/Nova Scotia, Nova Scotia /whatever. So I have here a statement of what the policies are with respect to Nova Scotians in another province, New Brunswick hospitals, non-residents and residents in Nova Scotia and exceptions. I would table that.

The honourable member has asked a question about Lyme disease and oddly enough, one would think that Lyme disease would be the Department of Health but it is actually not. Lyme disease is in the Department of Health Promotion and Protection as a public health issue. We can talk about it further when HPP is up. I can take a little stab at it because it is certainly something that I've been asked a lot of questions about, I've had briefings on, and I've had many questions about myself with Dr. Strang; I've had these discussions.

Lyme disease, interestingly enough, there isn't really any diagnostic test that can establish Lyme disease. As I understand it, it's hard to determine whether somebody has Lyme disease or not unless their symptoms are really pronounced at the point when perhaps they have been first bitten and they have that bull's-eye kind of rash reaction around the bite, et cetera. I'm told that they do blood work for so many tests but it's hard to determine through blood work, whatever the testing mechanism is. I met with a physician in the Strait of Canso, a general practitioner, a family doctor, who has been developing a bit of a specialization in the treatment of Lyme disease . A lot of people go to see him not only from Nova Scotia but from New Brunswick, and I think he has even seen people from Maine. He told me himself that it's very difficult to establish that someone has Lyme disease and this is an area where a lot more research, I believe, needs to be done.

Now, that's a very crude layperson's understanding of the situation. I'm sure if Dr. Strang was here, he is so much better versed in these matters as a medical doctor and as our chief Public Health medical officer. There have been 48 cases of Lyme disease in Nova Scotia since 2002 and, interestingly enough, we get a couple of cases every year, but 13 of these new cases have occurred over the past year.

The honourable member for Bedford-Birch Cove raised in Question Period the other day some concerns that she had. There has been, I think, a bit of push on to get some kind of deer bait stations in parts of the province. I made an inquiry into the department about this because I knew that the Public Health Agency of Canada is really the agency that's conducting the preliminary deer bait test study in Lunenburg County, and I think I made reference to that. I've since been told that this test does not use pesticides as the pesticides for this study have

[Page 217]

not been approved for use by Health Canada. So we're into a new area in the way of medical science in terms of being able to accurately get a diagnosis of somebody who has been infected with Lyme disease. Then, of course, there will be questions about what constitutes suitable treatment and, additionally, what we have to do with respect to prevention.

Mr. Chairman, there are so many emerging sorts of public health scares. The member for Cumberland South will remember probably West Nile virus and the whole concern about West Nile virus; finding dead crows in parts of the province and concerns around the mosquito population. In parts of the country West Nile virus has been a fairly serious problem with Public Health taking a very active role in trying to deal with the possibility that a lot of the population could be exposed to West Nile virus. So we always have to be very vigilant. One of the things that I recalled Dr. Maureen Baikie saying - when we talked about the H1N1 virus, and my and other people's feeling of some sense of relief when large segments of the population wanted to be vaccinated, and were getting vaccinated, when we said, well, gee, we might not even have a flu season this year if this is an effective public health strategy - Mother Nature has a way of filling the void and I think when I think about some of these new things that we all get concerned about, and they have substantial health hazards associated with them, Lyme disease, as I understand it, can be a very debilitating disease. People can develop very serious arthritis-type symptoms, it is like having rheumatoid arthritis and many difficulties.

So, we're very aware of the issue of Lyme disease in the department. Dr. Strang stays very well informed. He discusses this with his medical counterparts across the country. He stays up to date on the current medical literature and takes these matters very, very seriously. We are always on the look out for what could prove to be a public health hazard and we look at ways to mitigate the risks associated with these public health hazards. That is why it is so important to have a strong public health system, which I believe we do have.

When HPP comes up for examination of the budget, we will have an opportunity to talk about some of these things that we're doing in HPP to ensure the public health protection of Nova Scotians.

[4:45 p.m.]

MR. SCOTT: Mr. Chairman, I thank the minister for the answer. (Interruption) Yes, up until probably two or three years ago I had never heard about it myself. But I even know people in my own area - one person went down to the Boston area somewhere for treatment and another lady who I believe ended up taking her daughter to Germany for some sort of treatment. But we're saying that they couldn't find treatment, couldn't get people, I guess, to acknowledge the fact that they had Lyme disease. I just heard what you said about the difficulty to actually determine that is what the medical problem is.

[Page 218]

Again, I appreciate your answer and I will wait until Health Promotion and Protection is up and maybe to ask you a few more questions around that. I just have one more question, but before I ask it, I'm wondering, does the province still have a provincial recruiter, a doctor recruiter?

MS. MAUREEN MACDONALD: Mr. Chairman, yes, indeed, in the Department of Health we have a person who has responsibility for physician recruitment. All of the DHAs, as well, have people who do physician recruitment as part of their HR strategy. My understanding is that there is a bit of division of labour, rather than a duplication of services, between the department and the DHAs on physician recruiters. The person in the department takes a leadership role with respect to specialty services and specialists, whereas at the district health authority level, the recruiters play a role around a whole variety of local needs, including family physicians and family practitioners, but not only family practitioners but also the needs within their regional hospital, let's say, and that could have some form of specialization.

There is certainly collaboration between the department and the districts as well. The districts are not left out there to fend for themselves in terms of recruitment. There's a very active collaborative relationship between the district health authorities and the Department of Health. It works very well in terms of the work that we do.

Now, I'm advised that in 2009-10, the GP recruitment and retention efforts in the Department of Health were supported with a budget of $200,000 but the actual forecast was for $350,000. So there was actually an expenditure of $150,000 more than we anticipated. Our budget for next year on that line is for $500,000.

We are, like many other areas of enterprise and work activity and initiative, facing a demographic crunch. I know when I look at some of the numbers around family practitioners, GPs that are intending to retire over the next, let's say, five to seven years it is frightening. I have had discussions with Doctors Nova Scotia about this. Dr. Ross Leighton who is the current president of that association, says that this is for them certainly, one of the major concerns that they have, thinking about succession planning and replacement of physicians because the likelihood of retirements of large numbers of physicians is very high. As it is in other health professions, we have kind of that demographic baby-boomer bubble inside the medical profession, just as we have it in nursing, just as we have it in terms of the people who are in our x-ray departments and our labs around the province.

We're going to be, I think, very much challenged in terms of having an adequate supply of health human resources over the next number of years. Doctors Nova Scotia has talked about having a very good plan for replacing physicians and for looking toward the future in terms of the numbers of people who are going to be retiring.

[Page 219]

Some of that $500,000 is to be used for return of service agreements and for rural retention. We're also very clear that it's not just about the numbers but it's about where those numbers of people are, how they're distributed so that we don't end up with all of the retirements being in rural and small-town practices without having planning in place; incentives to get people into those rural areas and retaining people in the rural communities. It's a very significant issue and it's one that we're working on and we've beefed up the financial supports in the department to be able to do that.

I think it will be a challenge. The Province of Nova Scotia added a number of new seats to the Dalhousie Medical School back in, I think, 2003-04 and those folks that came into the program following that particular expansion have now completed the four-year baccalaureate program and are entering their residency. We have additional funds in this budget to be able to follow them through their residency and we've maintained those seats. Then there was an additional number of seats added to the medical school a couple of years ago, I think, during the minority government of the last government. We, of course, see no change in the number of medical school seats in this budget. There won't be an expansion, but there will be a maintaining of what we have - no cuts.

It's an interesting question, how do you plan for the number of physicians you will need. It's always a very fluid situation, Mr. Chairman, as you would know. I have talked a bit about the difficulties we've had getting good coverage of the province as people's lifestyle choices, I suppose you could say, change in the medical profession. You see more women graduating from medical schools and maybe a decision not to work full-time or to take some time out of the workforce to raise young children, and these kinds of things.

We're dealing with a very different set of characteristics in terms of, we don't have those old country doctors who worked from dusk to dawn, every day of the week. People want a different lifestyle, they want a different quality of life, they want to be well themselves, they want quality time with their families, so we need to constantly evaluate the way that we plan for our medical seats.

MR. SCOTT: Mr. Chairman, I want to say thank you to the minister. I don't know if - I believe it used to be Frank Peters who was the provincial recruiter. The reason I asked the question was because I know at the time it seemed to me that Mr. Peters would be kind of the person who people from outside the province would make the initial call to the department, to him. Then he would bring in the DHAs, or folks in the community around, for example, my area, whether it was Oxford or Springhill or Parrsboro, where they would then try to court the individual who was interested in coming to that area.

I didn't know if that changed or not because it seemed to me that over the last few years that the district health authority has assumed a lot of that responsibility and they're doing a good job at it, they really are. I know Mr. Quigley up in our area - they are on top of vacancies in my own area and doing everything he possibly can, humanly possible, I know,

[Page 220]

to try to get those filled. It just seems like they get someone lined up to fill a spot when maybe another one opens up or maybe the individual changes their mind. I know they are quite mobile now, doctors, the days of doctors living in a community and growing in the community and educated and staying their whole lives is kind of not the norm now, although there are a few that are left, mostly not, at least in my area they're not.

I think the district health authority does a very good job with the resources they would have locally to do that. The only reason I asked about the provincial recruiter, I was wondering if that position was still in place and if, in fact, that person was still there to actually take the phone call from wherever it is in the world that Nova Scotia was open and then kind of be the person who would bridge that to the district health authority and then move the process from there.

I appreciate that and I just want to say to the minister as well that it's always an ongoing issue in my area, as I know you've heard it from many others, vacancies of doctors and obviously emergency room closures. That's one thing that seniors are always concerned about, their files and what happens when a doctor leaves and while they're waiting for a new doctor, do they have the ability to find another doctor? A lot of times it means travelling for them, which they don't have the resources for, or maybe their health doesn't allow it.

This is the last question from me then I'm going to pass my time over to the member for Cape Breton West. I think I may have asked you this the other day, but in the event I didn't, I'm going to ask you again anyway. In Advocate Harbour, for example, where there is not a physician and hasn't been for quite some time, there's a nurse practitioner there and the nurse practitioner is doing a very good job; River Hebert, doing a very good job; Springhill, doing a very good job; and in Parrsboro. There's a collaborative practice that has been set up between River Hebert, Advocate and Parrsboro, so that the doctors and the nurse practitioner work together. I think the doctor in Advocate would visit on a regular basis a day or two a week.

A patient asked me this question, so the patient does not have a doctor in Advocate but has a doctor, for example, in Bass River or Truro. Are they still able to - and keep in mind, it's not their fault, they go to where they can get a physician - access the same services from that nurse practitioner in their home community of Advocate no different than if their doctor was there. Keeping in mind and I think that what is coming into play here is the fact there's a collaborative practice where the doctors and nurse practitioners are working together as a team, but because they can't get a doctor, they end up going to a community outside of that collaborative practices to have a doctor.

Do they still have the same ability to access services through that nurse practitioner or does that present a challenge where they are in an agreed collaborative practice?

[Page 221]

MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. It's an excellent question that the member raises. Nurse practitioners work in collaboration with a family physician but they have a scope of practice. There are certain kinds of tests that they can order, but there are tests that they can't order, only a family doctor can order those tests.

There are drugs that they can prescribe, certain prescriptions, but there are things that they can't prescribe, only a family physician can do this. So if you have a resident of an area that requires diagnostic tests or medications that are outside of the nurse practitioner's scope of practice, they would have to see a family physician to be able to do that.

[5:00 p.m.]

Now it's interesting, from to time there are so many programs now on radio and television that you hear about medical practices all over the country, you start to get the sense that there are a lot of differences between our provinces. I know that in Ontario that the scope of practice of nurse practitioners is a little different than the scope of practice here, to the extent that some nurse practitioners there have - essentially they practice alone.

I can see on the one hand why that might be an attractive proposition, but on the other hand, I can also see why it wouldn't be. I think one of the things that we're very keen on here in the Department of Health, and certainly this government, is primary health care teams. To have a full spectrum of health care providers, all with their own unique scopes of practice that collaborate with one another and support each other and ensure that the person gets a very thorough set, a basket, I guess - not to use every cliché in the book - of services that spanned different scopes of practice.

I like the model that we have in Nova Scotia of a collaborating physician and a nurse practitioner, but it does not have to be the only model. We have in this budget, $15 million for DHAs for collaborative teams. I think that in the coming years of this government's mandate we will be doing as much as we can to support and expand primary health care. It is probably the best way to ensure that people with chronic disease are being well managed and it is the best way to ensure that there are any kind of preventative kinds of work. It is also takes a lot of pressure off acute care facilities, emergency rooms. So, the collaborative approach is a very good approach and different collaborative teams have different health care providers. In some areas it might make an enormous amount of sense to have, in addition to a doctor and a nurse, a pharmacist, particularly if you have a population that is using a lot of medication as a method to manage a chronic disease. It also may make sense to have access to a nutritionist in populations where we see quite a rise in diabetes now around the province. So to have people who can help in this way; in some areas perhaps it would make sense to have access to have mental health counsellors, for example, maybe a clinical therapist, a social worker. So collaborative teams will really have a lot offer in various settings.

[Page 222]

We have a number of primary health care and collaborative teams around the province but we certainly could use a few more and there is money in this budget to do that kind of work, Mr. Chairman.

MR. SCOTT: Mr. Chairman, I thank the minister and her staff for the answers, I really appreciate it. I know that a lot of those questions I asked were more local than toward your budget or globally, I guess, but it is very important and I know that my constituents - and I do thank the minister for the answers and I'm going to turn the rest of my time now to the honourable member for Cape Breton West.

MR. CHAIRMAN: The honourable member for Cape Breton West.

MR. ALFIE MACLEOD: Mr. Chairman and Madam Minister, it is my pleasure to have this opportunity to ask you a few questions. I welcome your staff here today as well as yourself for the marathon that you have been running and hopefully I will touch a few subjects that may be a little different.

As the minister is probably aware, MS is a disease that affects a number of young people and younger people in Nova Scotia; there are some 3,000 people who are affected by MS. I was just wondering if you could outline some of the programs that the province is offering to sufferers of MS and where we stand as far as funding for MS?

MS. MAUREEN MACDONALD: Mr. Chairman, that is a very good question. MS has certainly been in the news a fair amount in the last few days, as people are more and more interested in this experimental treatment that is being discussed. But there are a couple of things, I would say, about MS. One of the things that I would say is that here at Dalhousie University, and I don't know if everybody knows this, but Dalhousie has been the site of various significant research around MS. Led by Dr. Jock Murray, who was a former dean of the Faculty of Health Professions at Dalhousie and is a very well-known (Interruption) Oh, and the honourable member for Halifax Clayton Park indicated that he received the Order of Nova Scotia and that's right, not so long ago. He has been doing research into MS with a team over there for a long time and that research continues.

When I was first elected to this Chamber, not so many years after I was elected, probably within the first two years, there was a new drug came on the scene for MS patients and I actually know a few people who were candidates for that drug. Not everybody is a good candidate for the drug. One of the things that they do in the research program over at Dalhousie is they do assessments and they assess who are good candidates for this drug and if this is a drug that is anticipated that can help in terms of slowing the progress, I think, of that particular disease and then they qualify for this drug. I know people who have been on this drug for some period of time and find it very useful.

[Page 223]

So, I'm told that there are more than 2,000 residents in Nova Scotia living with MS. I also have been advised that the numbers of people who have been enrolled in the small drug program that I just talked about as candidates for this particular drug, that the number of people who are enrolled have grown slightly. So, in March 2009, the number of people who were enrolled in the program were 311 and 159 were actually assessed for the program. In February 2010, the number of people who were enrolled had grown to 366 from 311 and the number of people who were assessed had grown from 159 to 172.

[5:15 p.m.]

As you can see, Mr. Chairman and honourable members, that is a very small proportion if we have 2,000 people in Nova Scotia who have MS. It is a very small proportion. But there is a kind of medical assessment that is done in terms of who might benefit and at what stage. I, frankly, don't know enough about the medicine to be able to give you much more information than that.

I know that the MS Society has been very much involved in supporting and encouraging research and looking for drugs that will either alleviate the symptoms of this disease or will slow the acceleration of this disease. Kudos to those folks. It has been a long, hard slog for them and I know that they are a very active society. We fund the MS Society. Last year we funded them at $242,000 and it is forecast that they will receive $242,000 again in the coming fiscal year. They provide awareness, support, public education, these kinds of things. They are an organization that will provide a voice for people living with MS. If I'm not mistaken I think they have a walkathon annually and many people are involved and supportive of that.

So MS is a very interesting disease and I think now with this all of the information that we're getting about this controversial new experimental treatment that the Italian doctor has been talking about, we're seeing lots of reports on MS. One of the things that I've noticed in the report is that most of the individuals who have been interviewed who suffer from MS are women. This is one of the things about MS, not just women get it, but way more women than men have MS. It tends to hit women at a particular age. It's not an old person's disease. It's a disease that hits women in the prime of their lives. It's a disease that we need to learn more about. We need to continue the research that we're doing, and hopefully someday there will be a cure for this disease.

When I was a teenager, my dad's oldest sister was diagnosed with MS. It turned out that it wasn't MS. Years ago it was a hard disease to diagnose and it gets confused with a lot of autoimmune diseases like rheumatoid arthritis and scleroderma, and there are many different diseases that have some of the same characteristics in terms of the symptoms and how it shows itself up.

[Page 224]

We hope for a cure. We support the research on this in whatever way we can. I understand, watching the accounts of what's going on in this experimental treatment, why people would have such hope for this.

[5:15 p.m.]

I'm just advised that in addition to those numbers I gave the honourable member on the numbers of people who are enrolled and have been assessed for the Small Drugs Program for MS, we also have a program that is dispensed by the Capital District Health Authority for people who live in the community with exceptionally high-cost medication because of their multiple sclerosis and their drug needs. Last year, there were 597 patients enrolled in that program, and this year we're projecting, or there were 629 patients - a substantial number of people. I would say that between those two programs, then, probably 60 or 70 per cent of the people who are residents of the province with MS have involvement in some form of insured drug program in the Province of Nova Scotia.

MR. MACLEOD: Mr. Chairman, I want to thank the minister for her answer. She is quite correct, from what I understand, women between the ages of 25 and 35 seem to be the category where MS strikes most often, although it has been in older people, and certainly there are cases where the males of a population are subject to this disease.

In her answer, the minister talked about the drugs that are used, and I believe Betaseron and Copaxone are two of the drugs that are used on a fairly regular basis to help treat patients with MS. Like all drugs, of course, they're quite expensive and the length of the time that they have an effect and they're able to help a patient sometimes gets limited.

You mentioned Jock Murray and the very successful clinic here in Halifax. There's another doctor there, Dr. Virender Bhan, and Dr. Bhan is one of the leading MS specialists in the province and in the country. The work that he does and the research that's being done in that institution is quite interesting, and there's been a lot of research projects over the last number of years testing new drugs and trying to find a cure. May 30th is the day that they're going to have the MS Walk, and coincidentally it happens to be my wife's birthday, who is a sufferer of MS. It is a disease that can be quite debilitating and mobility and range of motion becomes very challenged. You mentioned about the new procedure that may or may not be working out there, that Dr. Zamboni has come up with this belief that the blockages in the veins in your neck are slowing the blood flow to the proper functions of the brain.

My question I guess to the minister is that there has been a lot of work being done across our country and Dr. Murray was actually involved in a conference last Wednesday with the teleconference across the country and they talked a fair amount about this subject.

One of the things that I hear from a lot of people in Nova Scotia who have this disease is they would like to at least be able to have the ability to get the tests on their necks to find out if there is that restriction there and then from that, build on something else.

[Page 225]

I wonder if the department has had any thoughts or any consideration about the ability of having that test done and I, as yourself, Madam Minister, am a layman, but my understanding is that it's a test that's much similar to what people would go through if there was blockage in the different arteries and those types of things. So I'm just wondering if there has been any talk in the department or if there would be any consideration of looking at that kind of a procedure to at least give people a sense of, if indeed, they who are affected with MS might have a chance at this procedure?

MS. MAUREEN MACDONALD: Mr. Chairman, certainly, in the department we're always very proactive, looking at all of the new information for treatments that are coming forward, and we're always looking at what the best practices are and what the medical information and evidence tells us. This particular treatment is very much an untested treatment, as the honourable member would know. It's untested; it's unproven; it's experimental and in Canada and in Nova Scotia we have very high standards in terms of what we will allow the medical profession to embark on in terms of treatment.

I've listened to numerous physicians in the last few days on television and in radio interviews talk about why the kind of rigorous medical standards have been developed and why we need to maintain those to ensure that we're only providing medical treatments that have been tested and that there has been a control group. As I understand, there are a number of difficulties with this new work, but one of the things that hasn't really happened is there hasn't been the kind of scientific process that's used when you have two groups of patients receiving treatment, one of them being a control group that you can follow over a period of time to determine whether or not, in fact, there has been an effective outcome.

The other evening on CBC they followed a woman who went to a clinic in Poland. I don't know if the honourable member saw that piece. It was a very interesting documentary and I'm assuming that over the next little while we'll hear more about what the outcome has been for that particular lady, but as I understand this, this is experimental. It is untested. Dr. Zamboni himself now is kind of slowly pulling back from some of the initial things that he has had to say about this treatment, recognizing that there still needs to be a fairly rigorous process to evaluate the effectiveness of the process. So research is occurring in various sites and Nova Scotia is not one of those sites where this particular procedure is being tested, not as far as I know.

We do have the research that is going on over at the medical school. They do have expertise, as the member has acknowledged, but we cannot be authorizing procedures that are experimental and are untested. The liability issues would be huge and I think that the prudent thing to do is to use the tried and true methods that we have to ensure that when new medical treatments, whatever kind of treatments they may be, when they are adopted, that we can have confidence that they have benefit for people and that people will not be harmed. I think that's kind of the Hippocratic oath - do no harm, make sure that your medical research supports the procedures that you are implementing. At this stage, the medical practitioners, the research

[Page 226]

community in Canada, and the medical practitioners in this field are not recommending that we go this route until adequate research is done to establish that this is a useful procedure.

MR. MACLEOD: Mr. Chairman, I want to thank the minister for her answer, but the question was not about whether we could do the procedure. The question was whether we could do the testing to see if indeed there is blockage in those veins. I would say to you, Madam Minister, that if we could find out if there was a blockage in the veins, it would help to give some of the MS patients some hope. On the other side of that coin, if there is blockage, that blockage is probably going to lead to some kind of a health condition anyway so that we would be doing some studies to help people with their health.

When we talk about the ability to see research, there is a group here in Nova Scotia that are advocating that we become active in the research. I want to share, and I will table this with the minister, but it's a resolution that was passed by the Cape Breton Regional Municipal Council on February 16th and it says a number of things, but I'll just quote one area:"A group from within Atlantic Canada has formed a site and are inviting others to join the group to gather support to have Dr. Bonn partake in a research study for MS studies here in Atlantic Canada.

There have been studies in Buffalo, there have been studies in other parts of Ontario. The people here in Atlantic Canada would like to see a study done here and it would be very helpful if the Department of Health and the Minister of Health would help to see that such a study was done. We have, as you noted, Madam Minister, I'm told it's 3,000, your numbers were over 2,000, but whatever the number is, it's a lot higher than it should be. What we need to do is to reach out to those people who have this disease and try to find a way to help them all because it is a disease that is very crippling. What happens is that the individuals who suffer from this disease will become more and more reliant on our health care system when we already know the strains that are there.

So I guess I'll go back to my question, one is if indeed at least they could get the procedures done. It's a Doppler procedure and, again, I'm a layman so I don't know all the terms with the veins or if that can be done. It would be at least a beginning for people to understand because, yes, there have been over 20 Canadians in less than a month who have gone to Poland to have this procedure done, and there are people who are going to Italy and other parts of Europe to get it done. What I'm looking for, and I think what the people who have been writing to me and talking to me are looking for, is could this test be done so that they have a sense of whether they should be going further or, is it indeed an issue that is not relevant to the disease? Yes, there is always a cost associated, and I understand that, but what the cost is here of giving hope to people may be something that would help the health care system and the people who are suffering from MS.

[Page 227]

So, I will table the resolution and the letter that came from the Cape Breton Regional Municipality, passed by their council, for you to have a look at and look forward to hearing your answer on that.

MS. MAUREEN MACDONALD: Mr. Chairman, I just want to indicate that money is the furthest thing from my mind on this issue, and I didn't indicate that there was a cost problem with getting access. What we're concerned about is the safety issue and whether or not people will, in fact, benefit and that there aren't any adverse effects in treatments that are unresearched, unproven, untested, very experimental. There is a danger if we don't make sure that we have the proper protections for people. So that really is our concern.

[5:30 p.m.]

I will leave it to the experts in this field to determine what path they want to follow with respect to research. We have a group of strong researchers here in Nova Scotia. They develop their research plans and we assist in the funding of research, sometimes through the Nova Scotia Health Research Foundation. They develop the proposal, they make the application. The decisions about funding that research are made by a group of people who are scientists, who review the scientific merit of a research proposal, it is not really an area that lay people, bureaucrats, and politicians really involve ourselves in. The funding of research is a very rigorous process, it is generally peer reviewed, and I leave it in their hands.

I understand why people would have a real hope that this experimental treatment is an effective treatment, and I understand that research is now going on around the world in various places on this particular approach, and we will look forward to the results of that research and it will inform whether or not this is something that we can move forward on in the future. But we don't have those results right now. That work has to occur.

So, yes, I think we have to be prepared to invest in research to give us better treatments, better outcomes, and maybe this will be one of them, but we don't know that now.

MR. MACLEOD: Madam Minister, I did not mean to, if I did, indicate that this was a cost issue in your mind, because at no time did you say that. What I am still concerned about, what I still would like to see happen, is that this test take place. This is a proven test, and it is a proven test because it is the test that is done to see if there is blockage in the veins anyway.

Just to add to the minister's information, Kuwait has become the first country in the world to offer this treatment to all of its patients with multiple sclerosis who have blocked veins in their neck. It is a procedure that is getting recognition in more and more places. Because it is being done somewhere else doesn't automatically mean that we're going to have it here. But I will tell you, that those who have MS and those who suffer with MS, they are looking for hope and they are looking for help. The Province of Nova Scotia - my experience

[Page 228]

has been very good in helping MS patients, especially with the drug treatments and with the clinics and the people who are available. We have a very good doctor, Dr. Maharaj in Sydney, who is a great neurologist and he's working toward bringing as much knowledge of MS to Sydney as he can.

So I would just ask the minister, if there are any things that come up in the future, if there is the opportunity to help promote the research that needs to be required for this, when you attend conferences as the Minister of Health from Nova Scotia with your colleagues across Canada, the hope that this procedure may get - and we may find out after the testing is done, it's not there, but people would need to know. If you just saw the e-mails and the barrage of information that's out there because of this, it would reach to you.

So with that, Madam Minister, I want to thank you for your time and your co-operation in this matter. I will table that item there that can be shared with you and I would move that we close debate on the Department of Health.

MR. CHAIRMAN: I would now invite the Minister of Health to make some closing remarks, please.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank you for the opportunity to discuss the budget and the priorities of the Department of Health for 2010-11. Over the past few days I've received a number of thoughtful, important questions from members of the House and I've been glad to have the opportunity to address a number of important issues.

As was pointed out by one of the members, health services account for a significant portion of government's annual budget and as such warrants a full and detailed discussion. I am sure, Mr. Chairman, that it is difficult for many people to understand how, during a time of reduced government spending, we can increase our Health budget by $212 million. So I want to take a moment to reiterate how and why these increases are required. To begin with, about 60 per cent of these increases represent wage increases. Some of this is captured in a $63 million contractual increase in the master agreement for doctors. We also had over $56 million in obligation for the ongoing construction of new long-term care beds.

I believe it is important to note that the commitments made by this government during the election campaign have resulted in just $7 million in increases to our $3.6 billion budget for 2010-11. I believe it is also important to reiterate, Mr. Chairman, that our plan to get back to balance must be realistic and reasonable, and not result in reckless cuts that would hurt our economy or needlessly burden families. I believe that this year's budget for Health is making the right investments to provide better health care for Nova Scotian families.

Mr. Chairman, I know we have touched on a broad range of topics during these debates. However, in making some closing remarks, I would like to focus on three key themes

[Page 229]

that I believe came through the strongest, that is emergency care, quality in-patient safety, and access to services. On emergency care I was glad to have the opportunity during these debates to provide further detail and clarification on some of this government's initiatives to address and improve emergency services for Nova Scotian families. With the release of an interim report from Dr. John Ross, we are starting to see a road map emerge to help address the issues of chronic closures in rural areas and over-crowding and long waiting lists in our urban centres.

As I noted in my opening remarks, Dr. Ross points out four important themes from his initial work. First, the need for clear provincial emergency room standards to support quality patient care. Second, the need for increased access to primary health care services to provide better care to people with non-urgent medical and chronic care needs. Third, the need to collect and share reliable data on emergency services in order to provide safe quality care. Finally, the need to address emergency services as a provincial system so that all Nova Scotians can have equal access to quality care.

We have inherited a difficult challenge when it comes to emergency rooms, however, I believe that with hard work we have the ability to turn the situation around. I am encouraged by the fact that Dr. Ross also believes that we can do this. I know that Dr. Ross said he thought we could do this with very little money, which is encouraging given our current financial situation. However, we do know that if investment is needed, we are prepared, as we have dedicated $3 million through the Emergency Department Protection Fund to ensure we will have the needed investment to address this important work.

We talked over the past few days about the chronic closures experienced by a few of our smaller hospitals and how there is much difference from time to time and facility to facility when it comes to the reasons behind those closures. I look forward to providing even more information and clarity on this issue when I release our first annual report on emergency room closures later this Spring. The annual report is a requirement through the new Emergency Department Accountability Act, which I am pleased to say, has also ensured a number of productive community consultations have taken place in those communities experiencing problems. I certainly look forward to these initiatives together with other initiatives like the Rapid Assessment Units for Pictou, Cape Breton and the Valley, and new medical beds at Capital Health, all coming together to support some much needed improvement in emergency care in this province.

On quality and patient safety, I was also glad to have the opportunity to address some questions because a health system that puts quality and patient safety first is better managed, more effective and more attractive to health care providers. There were some very thoughtful and important questions raised here over the past few days on pathology, for example, pointing out the serious situations that have come up in other provinces. I am pleased to say that in looking at these issues, we have found the situation to be different here and yet we know we must remain ever vigilant.

[Page 230]

We currently have in our department two individuals, one who the Leader of the Official Opposition made reference to when he was talking, Dr. Ken Buchholz, that is, leading an initiative on quality in the department. He is joined by Evelina Dunlap in this quality initiative. The quality initiative will act on existing quality reports and look at inter-provincial quality issues.

For example, if an issue with pathology reports emerges in one province, we will immediately do a double check here in Nova Scotia. The quality initiative will provide leadership on initiatives to improve patient safety throughout our health care system, but it goes beyond being reactive. The Department of Health has hired a manager of quality and patient safety because there was a gap in this area that existed at the department since 2007, and that gap was filled in December 2009.

Last Fall the Department of Health created, in the middle of H1N1 - purely coincidental, the timing - the Infection Prevention and Control Centre, which is developing standards and providing support to the DHAs and our regional and other hospitals when it comes to infection control. We very carefully watch the information that we get from the various national bodies that compare the outcomes from province to province.

[4:45 p.m.]

We are also implementing a drug information system which will link pharmacies and hospitals in a province-wide system to improve the tracking of medication. This system will allow doctors to send prescriptions to pharmacies electronically, which will improve safety by taking handwriting and the interpretation of handwriting out of the process. It will result in better safety, better patient care, less opportunity for error.

The whole issue of quality and quality control is one that is very important to our department and to our government. I'm glad for the questions that I received during estimates. In fact, I might have anticipated a few more questions in this area, because I have to say that I think quality and patient safety is the top priority for any health care system.

I want to tell the members that this morning there was the Nova Scotia Leadership Prayer Breakfast and I attended. I sat beside a person who I had not met before, who is originally from Ireland, living in Rwanda - very interesting background. He told me his wife had had surgery in South Africa and it was not a happy experience. They came here to Nova Scotia, where they've been living for a period of time, and the quality of the medical system here probably saved her life.

I felt very, very good about hearing this, but it's not the first time I've heard stories like this. We have a strong health care system and we need to keep it strong. We need to ensure high standards: good quality, great patient safety.

[Page 231]

As I said during the debate, we will ensure that our quality program carefully reviews and acts upon all existing national and provincial reports on patient safety as required, starting with pathology and diagnostic imaging. Quality and patient safety will be the lens through which we will consider all of our work.

Finally, improving access. Seniors, mental health and primary health care, these were all programs, issues that we talked about during estimates. Access to better services for seniors, access to mental health and addiction services and access to more primary health care services in communities are all important priorities for me and for this government. I look forward to providing more detail in the coming months on our Mental Health Strategy, which will identify and address the gaps we have in these services, particularly for children and youth. We know that there is great pressure for these services and that we need to do a much better job providing better mental health services for families. I know by the number of questions that were raised that my colleagues on all sides of this House share my desire to see these issues addressed and services improved.

I also want to take a moment to acknowledge the great dialogue we had on a number of important primary health care issues, including midwifery. Improving access to collaborative teams and a variety of health care professionals is a key to addressing some of the population health challenges we face here in Nova Scotia like high cancer rates and obesity to name just two. I look forward to building on some of the great primary health care services that already exist across the province and ensuring families have better access to the care they need when they need it and closer to home.

In closing, I would be remiss if I didn't thank my staff and I want to start first by thanking Linda Penny who is here and just does a phenomenal job on a very big portfolio. She's an awesome person but she has a very awesome team behind her, she'd be the first to acknowledge that. I'd also like both to thank my deputy, Mr. McNamara but as well I'd like to wish him happy birthday. What a way to spend your birthday. (Applause)

I know that these debates can be gruelling at times and for staff in a very big department that has many things to do, I can't tell you how appreciative I am of how knowledgeable these people are. How well prepared they are and how they help and support me to be able to come here and be accountable through you to the people of Nova Scotia for the privilege that I and we have been given to serve in this capacity. With that, I would like to move that Resolution No. 11 stand.

MR. CHAIRMAN: That concludes the debate on the Estimates for the Department of Health.

Shall Resolution E11 stand?

Resolution E11 stands.

[Page 232]

On behalf of all the committee members, we wish to thank the honourable Minister of Health and your staff for your presentations here today.

The honourable Government Deputy House Leader.

MR. DAVID WILSON: Mr. Chairman, we'll now allow for some time to change staff and we'll be calling the Estimates of the Department of Health Promotion and Protection.

MR. CHAIRMAN: The motion before the House is to allow staff to leave and then we will start back with E12.

Would all those in favour of the motion please say Aye. Contrary minded, Nay.

The motion is carried.

The honourable Minister of Health.

HON. MAUREEN MACDONALD: On an introduction, Mr. Chairman, I was very remiss in not thanking Valerie Bellefontaine who is in our east gallery, who is the Director of Communications in the Department of Health. She also does an awesome job and prepares me very well with my briefing notes, and behind her she has an incredible team. So I want to thank you and your team as well for all your help. It's greatly appreciated. Thank you. (Applause)

MR. CHAIRMAN: We will now recess.

[5:53 p.m. The committee recessed.]

[6:32 p.m. The committee reconvened.]

MR. CHAIRMAN: Order, please. The Committee on Supply will now be called to order.

Resolution E12 - Resolved, that a sum not exceeding $88,383,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health Promotion and Protection, pursuant to the Estimate.

MR. CHAIRMAN: I will invite the minister to introduce her staff to the members of the committee, and to make some opening comments if she so wishes.

The honourable Minister of Health Promotion and Protection.

[Page 233]

HON. MAUREEN MACDONALD: Mr. Chairman, I'm very pleased to be here tonight to discuss the 2010-11 budget for Nova Scotia's Department of Health Promotion and Protection, also fondly known as HPP. I'm joined here this evening by Deputy Minister Duff Montgomerie who would be known to everyone, I would think, and as well I'm joined by the department's capable Finance Manager, Tanga Roche. So I welcome both of them.

I will be pleased to answer your questions about our budget, but first I would like to take some time to talk about all the good work being done at HPP, as well as to celebrate some of our accomplishments to date and to highlight what you can expect from us in the coming months. When talking about HPP, you will hear me say often that we are working to make life healthier and better for families in every region of this province. I welcome the opportunity to elaborate on this very important message from my government so you can understand its relevance and importance for you and your constituents and, in fact, for all Nova Scotians.

The last time I appeared before you in estimates, the province was in the midst of a pandemic. The second wave of H1N1 had hit and we were working hard to get the people most at risk vaccinated and provide care for those who were ill. Public Health and health care professionals and volunteers worked tirelessly to operationalize the largest immunization campaign this province and this country has ever seen. They immunized hundreds of thousands of Nova Scotians, cared for those who were sick, and educated all Nova Scotians about how to protect themselves and their families.

Staff throughout HPP, the Department of Health, the district health authorities, and the IWK were pulled from their regular duties to invest all their energies into protecting the health and the well-being of Nova Scotians. They took care of one another under extenuating circumstances. They met each and every task with a remarkable level of determination, commitment and passion. The H1N1 pandemic gave us the chance to demonstrate the strength of our Public Health and health care system and professionals.

I was particularly impressed with the province's Chief Public Health Officer, Dr. Strang, and his teams. Time and time again they demonstrated their solid commitment to the people of this province. We were also very fortunate to have the government support during the response work. All along the way we had the ability and the approval to do what we needed to do to protect Nova Scotians. That was always our number one priority.

As a result, we distributed enough vaccine to immunize 65 per cent of our population, and inform and educate Nova Scotians about how they could protect themselves and their families. In addition, we had the capability to operationalize a massive response across the health system, a response that involved securing human resources, equipment, vaccine, and facilities to house flu assessment centres, vaccine clinics and much more.

[Page 234]

The priority now is to evaluate our successes and to identify areas of improvement. To that end, HPP has been involved in a comprehensive lessons-learned exercise. It covers everything from logistics, communications, finance, and federal-provincial-territorial work to the vaccine program, and surveillance.

The various departmental and provincial working groups and committees organized as a result of H1N1 have been meeting to identify what worked well, areas for improvement and recommendations for next steps. The goal is to make any and all necessary changes to help us do an even better job of responding to the next major public health event. Many staff have also been involved in the lessons-learned exercise at the federal-provincial-territorial levels.

At the same time we continue to respond to the findings of the Auditor General's Report on pandemic preparedness. As we said at the time of the AG's Report release, the report is about our pandemic plan, it was not about how we managed the outbreak. As I've said before, we support what the Auditor General has said about the plan and we appreciate the guidance and direction as to how we can improve our efforts.

We are in overall agreement with the Auditor General's recommendations, and in many instances the report validates what both HPP and the Department of Health had already identified as areas for improvement. We have already incorporated many of the Auditor General's recommendations in preparation for the H1N1 second wave.

Mr. Chairman, I am very proud to be the Minister of Health Promotion and Protection. That couldn't have been more true than during the height of H1N1. All too often much of our good work, particularly in the area of health protection, goes unnoticed. Our response to the H1N1 pandemic is just one example of our success in our efforts to protect Nova Scotians.

Our provincial communicable disease and immunization programs are designed to prevent communicable disease outbreaks. We're working with our partners to inform people about how to protect themselves and their families from food- and water-borne diseases such as salmonella and E.coli. Today's vaccines are safe and effective in protecting people of all age groups from a wide variety of illnesses like the measles, chicken pox, and meningitis. We're also working to control insect- and animal-related diseases like West Nile virus and Lyme disease. Sexually transmitted diseases continue to be among the most common transmittable diseases, and the work we do helps reduce the numbers.

Environmental health also involves protection measures as well as prevention and promotion. Our interactions with the environment are complex and have the potential to negatively affect our health, whether through the water we drink, the food we consume, or the air we breathe. Environmental health protection professionals work hard to protect the public from hazards in our environment. In Nova Scotia, environmental health protection measures for water, air and food are shared between the Departments of Agriculture, Environment, and

[Page 235]

Health Promotion and Protection. In order to strengthen this partnership, there is a joint Environmental Health Protection Committee to address the gaps and identify areas of mutual interest and collaboration among the member departments, and HPP chairs this committee.

In March 2009, an important initiative was started on behalf of this committee to move toward a renewal of the environmental health system. The purpose of this renewal initiative is to identify a shared vision and direction for environmental health services in Nova Scotia, while looking at the strengths and areas for improvement in our system. Through this work, which is being led by HPP, we are moving toward a more comprehensive and collaborative approach to protecting the public from existing threats within our environment and also from new and emerging issues as they arise.

Our work in communicable disease prevention and control and environmental health is indeed helping more Nova Scotians to be healthier and safer. It's a good example of how we are making life healthier and better for families in every region of our province.

The Department of Health Promotion and Protection is leading the development and implementation of an integrated and strengthened public health system. For the last few months, staff have been consulting with our partners, community members, and many others to talk about public health renewal. Our goal is to see how we can make public health better in this province and how we can become more relevant to communities.

[6:45 p.m.]

We're looking to evolve our work in public health. Hundreds of people have been consulted so far. The discussions have been honest, passionate and informative. The findings will be critical to our overall public health renewal efforts and our quest to better serve the needs of our population.

In addition to our work in public health renewal, we are currently strengthening our ability to protect Nova Scotians by building capacity within the department, capacity that will bring further expertise and support to public health. As an example, we are moving along in our recruitment of epidemiologists and medical officers of health. The need for these qualified professionals became very apparent during the H1N1 pandemic and I hope to have an update on our success in those recruitments very soon.

Mr. Chairman, the department is also responsible for monitoring our collective health status and working across government, across sectors, and with communities to create policies and environments that protect and promote the health of all Nova Scotians. We strive toward four strategic outcomes: one, improved health outcomes for children and youth; two, more Nova Scotians take an active role in promoting and protecting the health of individuals, families and communities; three, safer citizens, populations, and communities; and four, reduced health disparities.

[Page 236]

HPP provides leadership in the community and within government in addressing issues from a determinant of health perspective, looking at how things like income, education level, and where people live, impact their health. We also work to help influence policy decisions in other departments and across sectors - suffice to say, it's a very busy department.

Responding to the health needs of children and youth will be one of our key priorities going forward in 2010 and 2011. We will make the healthy choice the easy choice for families. We are going to tackle childhood obesity by focusing on the twin epidemics of unhealthy eating and physical inactivity, and we will continue to tackle the issue of youth tobacco use and begin to advance a comprehensive approach to changing our culture of alcohol use. We are also going to support the healthy development of our children from the first day of life. (Applause)

We're striving for a future where children and youth in Nova Scotia will be tobacco- alcohol-injury free. They will be active, they will eat healthy food, they will have better overall health and every opportunity for a successful, healthy future. All of this will contribute to the future prosperity and sustainability of our province. Again, all examples of how we are working to make life healthier and better for families in every region of our province.

Mr. Chairman, let me first set the context for you. Our research and the research of some of our key partners says the following: In 2001, 49 per cent of Nova Scotians between the ages of 12 to 19 years reported having a chronic condition, and that's from the Chronic Conditions in Nova Scotia 2004 report. In Grade 11, 9.7 per cent of boys and less than 1 per cent of girls were active enough to achieve the moderate physical activity recommendation - that's from the Pacy 2005 report.

Students in a survey sample consumed, on average, about one-quarter, or 26 per cent, of their total energy intake from the "other foods" category - for example, pop, chips, and processed snacks, et cetera - of Canada's Food Guide to Healthy Living. That's taken from the Pacy 2005 report.

Almost 8 per cent of Nova Scotian households with children 18 years and under reported moderate to severe food insecurity and that's from a Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) report. Our 2007 Atlantic Student Drug Use Survey showed over a 30-day time period 5 per cent of Grade 7 students in Nova Scotia - Grade 7 students in Nova Scotia - were drunk at least once, and 46 per cent of Grade 12 students - 46 per cent of Grade 12 students - were drunk at least once. That source is the Atlantic Student Drug Use Survey 2007.

So, Mr. Chairman, health care as it exists now in our province is not sustainable. Health care spending has been rising faster than provincial revenues, and we're living beyond our means. Health care costs have been allowed to increase faster than our economy is growing and, as I said during my opening remarks for the Department of Health Estimates

[Page 237]

debate, health spending has doubled in the past decade. Nova Scotians spent $1.8 billion on health care in 2001 and today our budget is $3.6 billion. This is an unsustainable path and this government will bring these costs under control in order to ensure reliable publicly-funded health care for the years ahead. This government will manage health care spending better to ensure a strong public health care system for the future.

Addressing the health challenges facing our population therefore is key, and starting with the early years is the most effective approach to turning things around.

So now that I've depressed everyone thoroughly, we'll have a little good news. Now it's time for the good news.

Mr. Chairman, we're not alone in our quest. You will often hear, by many of the HPP staff - in all we do, we do nothing alone. The Department of Health Promotion and Protection works very closely with many different partners from government departments and agencies to not-for-profit organizations, schools, municipalities, volunteer groups and many others. We respect and value the role that all of these groups and organizations have in creating the environment that makes the healthier choice the easier choice for Nova Scotian families.

The opportunity for government is to provide leadership in this collaborative approach and this government will lead the way in making Nova Scotian families healthier and safer with a focus on children and on youth. We will continue to invest in the programs and services we know are making life better for Nova Scotian families and improving the health and well-being of our children - the future of our province rests on the health of our next generation.

Mr. Chairman, HPP is joining its partners to do its part to champion the health and the well-being of our children and youth. We need only to look to the success this province has had with the 2001 Tobacco Control Strategy to realize the benefits of keeping healthy public policy at the forefront, supported by government departments working together to achieve a common goal. Our youth smoking rates went from worst to first in six years - and if we take the same approach with physical activity and healthy eating we will realize the same successes.

Nova Scotians are ready for government to take a stand to support families in their efforts to raise healthy children. They need more help and more support to improve the future of their children, and we also know by focusing on our children and youth we will influence their parents and grandparents to make healthier choices as well, just as we saw with tobacco and with recycling.

I suspect that at this point you're likely wondering how we plan to tackle such an enormous challenge. Well, Mr. Chairman, we will develop and launch a comprehensive strategy to fight childhood obesity and unhealthy weights in our children and youth. It will

[Page 238]

require skillful development and deployment of a full range of policy levers all aimed at making the healthy choice the easy choice. We've just started work on the strategy and plan to share it widely with our partners and others for comments.

The strategy will have two major thrusts - healthy eating and physical activity. I look forward to keeping all of you up to date on our work and I look forward to your support. We have every confidence that in working with our partners we will be successful in our work to reduce childhood obesity in this province. The strategy will build on much of the work already underway - for example, we already have in place an Active Kids Healthy Kids Strategy, this strategy is being actioned collaboratively with key stakeholders. We will examine ways to ensure existing programs continue to be effective and produce solid results, while examining new and innovative ways to get our children and youth more active.

We will work with our partners to explore our communities and our transportation systems so it is easier for our citizens to be active in their daily lives - this is also key to environmental sustainability. We'll also continue our work at the community level. A great example is the Municipal Physical Activity Leadership Program - HPP and municipalities work together to implement local plans that are tailored to the needs of a certain community. The goal is to increase participation in physical activity and, to date, 27 municipalities have come on board, with five more in the upcoming year.

[7:00 p.m.]

In addition, we will continue to meet our commitments under the B-FIT program. Announced in 2006 as a $68 million program, B-FIT was introduced as a 10-year initiative to fund major sport and recreation infrastructure. Although all B-FIT dollars have been committed, it does represent a significant investment that has been made in sport and recreational facilities across this province. People will benefit from this for many years to come and, while we recognize that there are more worthwhile projects, the fact is that money, intended to last ten years, was committed in four. That is not sustainable or responsible, and we must realistically face our challenging financial realities and live within our means. Community groups and municipalities will continue to benefit from another program at HPP, the Recreation Facility Development Grant Program.

Earlier I mentioned that we share the responsibility of a healthier Nova Scotia with many partners. Before I move into our healthy eating initiatives, I want to give you an example of some of the great work being done by one of the province's provincial school boards. The Annapolis Valley after-school program knows first-hand that providing physical activity to students outside of school hours will help to improve the health of students but also set the stage for healthy living into the future. A cost-shared program between the Department of Health Promotion and Protection, the Annapolis Valley Regional School Board, and the municipality covers the cost of a program leader. At a minimum contribution of $500 per

[Page 239]

partner, the benefits of the program in the lives of these students outweighs any cost associated with hiring the leader.

The group leaders come from all walks of life, some are physical education teachers, others are educational assistants, university and high school students also teach programs, along with parents and classroom teachers. Involvement in the after-school program is a true community effort, and an after-school program allows schools to have flexibility with their programs to best meet the direct needs of their students.

With most programs running two to three days per week, participants are selected with the help of principals and teachers to ensure that students who are inactive or normally do not have access to sport outside the school have an opportunity to increase their physical activity levels. From yoga to kick-boxing, ballroom dancing to step classes, students have the chance to learn a new activity while becoming fit. As many of these students begin to get involved, they begin to notice changes in their body shape - they look good, they feel good and this is a natural outcome of physical literacy, which the program hopes to instill as a lifelong activity.

Going one step further, the Annapolis Valley Regional School Board partnered with Acadia University to offer some accessible programs for children with disabilities. This partnership also provides children without disabilities the opportunity to experience Paralympic sports. The success of the program means it's expanding. In 2009-10, the program expanded into 37 schools with an expressed interest, which sees approximately 1,900 students every week. We are very proud of our involvement in this program and the real difference it is making in the lives of children and families in this region.

Under our Healthy Eating Strategy, an excellent start has been made with the introduction of the first school food and nutrition policy in Canada. This means that every child attending public school has healthy nutritious food and beverage options. We're now turning our attention to other publicly funded settings like licensed child care facilities and health care organizations. We will work to make nutritious food the norm rather than the exception. We know that a healthy diet rich in vegetables and fruit means better health overall and helps to prevent many chronic diseases, including heart disease, stroke, type 2 diabetes, hypertension, cancer, and obesity.

We also know that illness due to nutrition-related causes is costing our province vast and growing amounts of money every year. Under the Healthy Eating Strategy we are working to increase the amount of vegetables and fruits that Nova Scotians consume. As part of that, we're considering affordability and access to healthy food. Mr. Chairman, I don't know if you've seen any of the commercials "Fresh. Frozen. Canned", but they're quite snappy, they really do get your attention - if you've seen one, you'll remember it.

Our work in schools and child care centres is about access, ensuring people have access to healthy food where they are - home, school, and work. We know affordability is an

[Page 240]

issue. Right now a social marketing campaign and work at the community level with partner organizations and grocery stores will educate Nova Scotians about how they can get more produce in their diets. As I mentioned, fresh, frozen and canned are all nutritious options that are available at a variety of price points at a variety of locations.

This campaign is part of a larger effort to improve the health and well-being of individuals and families in our province. It's one of the many things we've done to support Nova Scotians to eat healthier and be more healthy overall - yet another example of working to make life healthier and better for families in every region of our province.

The social marketing campaign is an excellent example of how we work with partners like the Canadian Cancer Society and the Nova Scotia Heart and Stroke Foundation. I'd also like to highlight a recent example - I was very pleased last week to learn the Cape Breton District Health Authority is working to make the healthy choice the easier choice for staff, patients, and the public by revisiting its healthy food policy. This summer the district will begin work on a three-year plan to create healthier menus for staff, visitors, and patients within their facilities. This work is part of the district's focus on healthy workplaces, healthy communities, healthy policies, and it is also in keeping with the work of HPP to increase access to healthy food and beverages in schools and child care settings - it's very impressive.

Another healthy eating initiative will be our work to address regulatory options, that are the responsibility of Health Canada, such as sodium, food labelling, and marketing. Ongoing support for our provincial breast-feeding program is another key piece. It's the healthiest food for babies and it gives them the best possible nutritional start in life. In Nova Scotia, 74.8 per cent of women start breast-feeding, but those who are exclusively breast-feeding at six months drops to 15.8 per cent.

Our statistics are among the lowest in the country - this needs to change. Breast-feeding has been shown to cut a baby's risk of infections, breathing problems, gastrointestinal illnesses, and allergies; it may also lower a mum's risk of breast, uterine, and ovarian cancers; breast-feeding can decrease a child's risk of obesity and chronic disease later in life; and on top of everything else it helps mums bond with their babies. With all of the benefits to mums, babies, families, and communities, breast-feeding can have a significant impact on early childhood development and improved health outcomes, and this leads to decreased health care costs.

The goals of the provincial breast-feeding policy is to promote, protect and support breast-feeding in Nova Scotia. There are 10 directives in the policy - one of them being the development of a social marketing campaign, which is currently underway, and I'm sure many of you have seen the ads on buses and on TV and in the newspapers. Initiatives outlined in the policy that are currently being implemented include: breast-feeding social marketing campaign to increase breast-feeding initiatives and duration rates; a provincial breast-feeding surveillance system; developing resources; educational training programs; strengthening

[Page 241]

community supports; breast-feeding peer support groups; workplace breast-feeding support programs; implementation of the baby-friendly initiative in hospitals and public health services; and education at universities, colleges and in the public school curriculum.

The policy supports stakeholders to work together to build capacity at provincial, district, and community levels to support women and families, normalize breast-feeding in Nova Scotia, and improve breast-feeding initiation and duration rates in this province. All of this work in the area of healthy eating will ultimately contribute to a more healthy population by reducing rates of chronic disease and improving the quality of life for Nova Scotians.

Through legislation and taxation we've already had great success in reducing tobacco use rates - smoking rates dropped from 30 per cent to 20 per cent between 2000 and 2008 and our youth smoking rates went from worst in the country to the best in the country. This year we will introduce a renewed Tobacco Control Strategy that focuses on at-risk groups, particularly youth. There has been extensive consultation with our health care colleagues and community partners. We will work to make a culture of not smoking the norm and further reduce smoking rates, and we will turn our attention to the tobacco industry and hold them accountable for their actions.

Despite all of the advantages made in improving the lives of Nova Scotians, injury remains the leading cause of death and disability during the first 45 years of life, and it costs Nova Scotians $518 million each year. Injury especially impacts on our youth, causing more deaths than all diseases and other threats to health combined for those aged 1 to 19. It is also the leading cause of hospitalization - injury places great stress on our emergency departments and other health care resources.

We just finalized a renewed Injury Prevention Strategy, it was developed collaboratively with stakeholders and creates a shared agenda for the next three to five years. While HPP leads the strategy, its success is driven by the collective efforts of many government departments, community organizations, and partners. The strategy reflects the necessity of building resilient populations and focusing on those factors which lead to poor health and a lack of safety. This approach will reduce injuries and improve all aspects of the health of Nova Scotians.

[7:15 p.m.]

To begin to address the impacts of our culture of harmful drinking we need to examine ways, based upon best evidence, to help ensure our youth are in an environment where they can make informed decisions regarding the possible use and consumption of alcohol. The way we currently use alcohol in our province creates many harms and generates significant costs for government in our society. Learning from our success with the Tobacco Control Strategy, we plan to take a comprehensive policy-based approach to changing alcohol use in our province. I am pleased to advise you that the Second Annual Alcohol Research and Policy

[Page 242]

Forum will address the issue of alcohol as a public health concern, increase knowledge of the current Nova Scotia Alcohol Strategy, and share knowledge regarding best practices in the field.

Invitees include addiction staff from all the nine DHAs, representatives of our key government partners including Justice, Community Services, Health, and Education as well as the police and the IWK. As an internationally recognized leader in alcohol policy, Dr. Tim Stockwell, Director of the Centre for Addictions Research in British Columbia and co-leader of B.C. Mental Health and Addictions Research Network will join us and speak to the impact of evidence-based best practices on policy decisions regarding the health of our population and the over-consumption of alcohol. Through the forum, Mr. Chairman, participants will have an opportunity to gain a greater understanding of the role that alcohol plays as a public health concern.

There are 43 youth health centres across Nova Scotia. The centres provide health promotion services, on-site clinical services, and make referrals to additional supports, as needed. The centres are another excellent example of how we work together with our partners. In this instance we work with the DHAs and the schools. In 2009 a provincial evaluation of youth health centres assessed the impact of these centres on the health of youth. The results were very positive - 86 per cent of youth in schools with youth health centres are aware of the centres, and almost half of these students have used them. More than three-quarters of these students gave high marks, A or B, to the centres for treating them with respect and providing helpful information and support to improve their health. Today's youth deal with very challenging issues and youth health centres provide them with programs, services and supports to meet their needs.

This brings me to the early years. We will invest in the early years to lay the foundation for lifelong health and well-being, and the Enhanced Home Visiting program is a great example of a program that helps Nova Scotia's most vulnerable families and children. Launched in 2004, at any given time there are approximately 800 active families in the program. A community home visitor supports families during the child's first three years of life, focusing on supporting parents, promoting healthy parent-child relationships, fostering healthy childhood development, and linking families with additional community resources.

There have been 98 per cent of parents say the program is working, that it has helped them be better parents, have more healthy family relationships, and helped them return to school and get better jobs.

Mr. Chairman, I want to thank you for your attention while I spoke to some of HPP's many accomplishments and the exciting challenges and opportunities that lay before us. I hope you and all members have a better understanding and appreciation of why I am so confident to say that we are working to make life healthier and better for Nova Scotian families in all regions of our province.

[Page 243]

Before I close and turn it over for questions, I would be remiss if I didn't mention three final items that HPP is closely involved in - Canada Games, the Olympics and the United Way. In February, Nova Scotians and all Canadians were captivated by the 2010 Vancouver Olympics. Our athletes, Sidney Crosby and Sarah Conrad, performed well and made Nova Scotia proud. For us, the Olympics were about much more than just the performances by talented athletes, it was an opportunity to introduce our small but mighty province to the world. Atlantic Canada House, shared among the four Atlantic Provinces, was named the number-three must-see pavilion at the Games. Atlantic Canada House had approximately 45,000 visitors in the 15 days of the Games - 3,000 visitors per day. Nova Scotia had 24 artists, 80 performances, and Nova Scotia Day had three major Nova Scotia performers featured in a 30-minute presentation in B.C. Place before an audience of 25,000 people. Ashley MacIsaac performed at the opening ceremonies of the Olympics and at Atlantic Canada House for both the Olympics and the Paralympics.

Being present at the 2010 Vancouver Olympics was also the biggest opportunity that our province has ever had to meet leaders and influencers from around the world. The people who attended the Games will not forget that there is a progressive province on the East Coast of Canada that welcomes investment, values good ideas, builds for success, and works hard to make sure that all Nova Scotians have the life they deserve.

Mr. Chairman, on the heels of the Olympics will come to Halifax, in 2011, Canada's Winter Games. In less than a year Nova Scotia will host the Games and inspire and unify communities across Halifax, across Nova Scotia and across Canada, building pride and spirit as we come together over 18 days in February 2011 to showcase our sport and our culture. As the largest multi-sport event ever to be held in the history of our province, the Games will serve to stimulate the economy, create jobs and increase tourism. Building on Nova Scotia's strong tradition of volunteerism, 5,000 volunteers will get involved in the Games and become ambassadors for the province.

The Games will also provide many long-term benefits for the people and communities of Nova Scotia through leadership and community engagement, capital construction and upgrades, health and fitness promotion, and amateur sport development. The Games present us with a rare opportunity to do something incredibly special, something that leaves a lasting legacy for all.

Finally, I'd like to thank the member for Halifax Clayton Park for her recognition of the United Way Campaign. The provincial government again exceeded its United Way fundraising goal, raising more than $528,000, far exceeding the target of $475,000. This is due only to the commitment of government employees to help make a measurable difference for people in our community, and that initiative was led by this small but very mighty department and acknowledged by the honourable member - I do want to thank her very much for that.

[Page 244]

With those opening remarks, I welcome an opportunity to take further questions from the members. (Applause)

MR. CHAIRMAN: The honourable member for Halifax Clayton Park.

MS. DIANA WHALEN: Mr. Chairman, I really appreciate having a copy as well of the minister's opening remarks because she did give us a good walk through the entire department, a lot of your priorities, and it is good to have it because I'm quite a note-taker and I'm usually busy scribbling down the notes as I hear these different stats and figures mentioned, so it's very helpful and I want to thank you for that.

I want to welcome Ms. Roche and certainly the Deputy Minister, Mr. Montgomery, who join us today and I know they provide good advice to the minister as we go forward. I'm going to give the minister a little break and talk a bit myself, if I may. I know that she has been on her feet an awful lot in the last few days. So maybe she'll bear with me because I have about 35 minutes and I did want to signal some of my interests in this. I do have some questions as well but I would like to just kind of perhaps respond a little bit to some of the points already raised by the minister because there's an awful lot in that opening statement.

To begin with, I'm very pleased to see the minister again, as she did in Question Period, reiterate her support for the Department of Health Promotion and Protection. I know we're in a climate of cost cutting and looking for savings and that there will be a discussion about which departments belong where and how best to manage government. But I draw her attention again to the quote that I used in my question which comes from, I believe, a World Health Organization study that said that when there is a separate entity or a separate department that looks at health promotion and protection, it actually keeps that on the agenda much better than when it gets added into acute care and becomes part of a big basket of all of the very big emergency needs that we have in health care.

So in order for us to move forward I think that's important and I think it's important for me to go back a little bit in time and not long before I came here to the Legislature, I was elected in 2003, but just shortly before that the Office of Health Promotion and Protection was established. It wasn't a full-blown department at that time, but this had been a particular interest of our Leader Danny Graham who was the member for Halifax Citadel at that time. He had pointed out that whole idea of let's try to look long term and make the sort of policy and decisions that we need to make that will help our population in the long run.

I believe that he had a role to play in urging government at that time to establish the office. Initially there was very little budget, it has grown now to what I see as an $88 million budget for this year, and it's down slightly from last year and we can talk about that a little bit. It's not down much but there may have been some transferred to another department or to Education, so we can talk about that. An $88 million budget is sure a lot better than where we began and it allows us to put our emphasis on a healthy population which is what we really

[Page 245]

need. So I did want to mention that and indicate my support for a stand-alone Department of Health Promotion and Protection.

The minister finished on a high note about the Canada Games and I have to say, as the member for Halifax Clayton Park, we are absolutely delighted to see the $40.5 million centre. I don't know if it has changed in its budget, we might get there but we know it as a $40.5 million centre being built right now on Lacewood Drive, creating a complex really for us on the Mainland Common with a beautiful community library, a high school. I know a number of people here know that area well. We have a beautiful high school that was just opened in 2002 and we feel that this is going to support the health and fitness of our young people who are studying so nearby. It's going to be a tremendous asset for the families in that area.

The deputy minister will remember that I have visited him. I'm not a member who frequently visits ministers' offices, I have to say, and maybe based on my question the other day to the Minister of Transportation and Infrastructure Renewal, I should be doing it more often. I normally don't present myself at the doors of the ministers but I did with the previous Minister of Health Promotion and Protection because building the right sized centre for Clayton Park meant an awful lot to me, that we not, you know, look in a narrow-minded short-sighted way and build based just on the available budget, which is what we were being told.

I mean initially in 2005 our community was presented with a plan that would have been about an $8 million replacement pool and it would have been incredibly small and inadequate for the thousands of people who live right there in that community. So, you know, we wanted to do whatever we could to help leverage a situation where there would be more money available. At the time we were still looking at the Commonwealth Games and that was a possibility that there might be an opportunity to build a centre leveraged around those games. Then there was also the Canada Games which at that time we were not sure where it would be hosted in Nova Scotia. I can tell you that we are absolutely delighted that there was a delay in making that decision so that the Canada Games was able to dovetail with the facility needs in Clayton Park.

When I speak about Clayton Park, I think it's important to mention because it is such an urban riding that really we're talking about a community of over 100,000 - not all of whom I represent - people who are very close to that location of where the Canada Games Centre is being built. So the legacy will be well used and we have the population base right on the doorstep of that facility to ensure that it's going to have I think a very stable funding as it goes forward because there are people there to use it and to support it. I do hope as we go forward there can be help for families who can't afford fitness memberships and charges and so on. That's something for us to discuss as we go forward.

[Page 246]

[7:30 p.m.]

I wanted to talk around the B-FIT and other programs. It's a bit of history too, but in 2003, when I was elected, the Province of Nova Scotia had only $3 million a year that they were putting into facilities. That really meant that they were just making small contributions toward municipal projects. Unless they were really designed for athlete training or some sort of higher-level training, we regarded recreation and sports facilities as a municipal concern.

What has really happened is the cost of construction has just overtaken the capacity of all of our municipalities. Even HRM, which is our largest and arguably our best-off municipality because it has the largest tax base and property base, couldn't afford to provide the facilities and the needs that would meet our needs.

The member's own riding has the Needham Centre, which I know is so important to the people in that area - I know some people living in the North End. There's talk in HRM that it's an aging centre and we can close that and build something big somewhere else, but what people need, especially low-income people, is they need to have a facility close to home. You don't want to build something big and regional far away from where those children are. If they don't have much money in the home, they're not going to be able to afford the transportation. The parents want to have a safe place where their children can go and be physically active and be close to home, and the Needham Centre is really well located for that. I think we need to try and protect those kinds of facilities where they exist now. That may mean the province has to be there. I understand B-FIT is now fully committed - we could say it's exhausted, then.

I was starting with the $3 million, which meant that when we first starting talking in Clayton Park about what kind of facility we could build and where the money would come from, we weren't really able to leverage anything from the province because we were told at most you'd get $300,000 or maybe $400,000 and that would be it. We were talking about a $20 million centre at the time. It was immaterial, almost - not to ever turn up your nose at any contribution, but it wasn't going to get us to the point of having that facility.

We've made some strides. I have asked questions over the years of the Minister of Health Promotion and Protection, asking that they do more. I take some pleasure and pride in feeling that I may have helped to push that envelope and get us to the point where the B-FIT program was announced and there were some substantial dollars to invest. I'm sorry to see that it is pretty well fully expended, because I don't believe that I should stop being concerned about it just because my community is now going to be very well served. I'm delighted, as I say, with the Canada Games Centre coming.

I know the need is there and in order for us to keep the kids active, which the minister spoke eloquently about, we need to be able to invest even in small facilities or we need to leverage money with school boards so they'll open up those schools and let the existing

[Page 247]

facilities be used. We can't have people - again, if you get to a more rural - or towns and villages, they don't really have anywhere to go and be active.

My mom has a cottage in Parrsboro, so I go there in the summer. They'll walk around the fire hall - get inside and just walk around this little square building. I'm thinking of the older women who just want to get out and walk in all weather, summer and winter, if it's raining and snowing. That's just not very effective, yet you can see the people trying to keep active. We need to try and just help them and make it appropriately sized, but try to give every community the opportunity for good health.

Of that huge Canada Games Centre, I'll bet you one of the facilities that will be most valued will be the walking track. That's not the most complex of all the components of it, but people want a safe place to walk and older people want to avoid those injuries and falls that you referred to. They need a safe place. I've heard of a place in Newfoundland, at Memorial University, where they have a turnstile. People don't have to belong, but they put a toonie in it and off they go on their walk. They go through the turnstile and they use it, and they collect so much money from that turnstile because that's exactly what people are looking for, just the chance to walk. They don't want a lot of fancy equipment.

I really did want to thank the provincial government for being a partner in that Canada Games project. I know that we will have a lot to discuss as it goes forward. As the MLA for that area I hope that I can be involved and be of any help that is possible with the government as that comes forward, and I guess without asking a question, I would like to just mention that I'd love a tour of the centre when it becomes time. It looks like it's all ready to go, and I'm sure the minister will go on a tour, so perhaps we could dove-tail and I'd be happy to have her come and visit my community. I am anxious to go through the doors and have a look at it in person, I know you'll have made a note of that.

During my questioning today I have, really, a line of questioning around alcohol. You had a long opening statement and I kept thinking, well we're talking about food and fitness and a lot about youth and obesity, but I wasn't hearing anything around youth and alcohol and women and alcohol and just the damaging alcohol culture that we have in this province. I'm sure that is on your agenda because you did have it there at the end of your comments, we did touch on that.

I know the minister gave us some disheartening figures during part of her opening statement. They weren't all depressing, there are certainly some great news stories, the Annapolis Valley School Board and what they're doing and the after-school program with leaders is a wonderful thing. I wanted to give just a few facts that I think should have every member of this House - and I know we're not all paying great attention during this debate, it's not really a debate, it's budget - but I guess I'm signalling this is an area that we need to be aggressive in. I was happy to hear you say that there's an upcoming alcohol policy research forum and that's May 7th. I'm actually registered to attend as I hope to be there all day and

[Page 248]

participate in that. With that in mind, that's good, and it's our second annual, it's not the first, so I'm glad to see that.

Here are some figures, and we've just come through practically a week of Health estimates so we've been talking about the cost of health, these come from the Nova Scotia Alcohol Indicators Report and I'll even table this, you probably got them all but I have them on one sheet, which is kind of nice. Here it is: 42,000 hospital days attributed to alcohol; 3,100 alcohol-related hospital admissions; $78.1 million in law enforcement costs, well that takes us out of health but it's still very important to us; one of every four highway deaths in the province related to alcohol. We have over 9,000 people living with Fetal Alcohol Spectrum Disorder.

The minister herself talked about the number of young people drinking heavily. One out of four Nova Scotians reported drinking heavily in the last 30 days; 52 per cent of Nova Scotia drinkers between 19 and 24 reported drinking heavily in the last 30 days; and it goes on, including, I think, a figure that the minister used, 46 per cent of Grade 12 students report being drunk in the last 30 days. As a mother of a 20-year-old and a 23-year-old, I can tell you there's a lot of anxiety for parents who have children just under the legal age. We should still be worried when they're over the legal age because they're still drinking in an unhealthy way. (Interruption) You fall into that age group, do you? We have one member in the House who is self-identified. Thanks, Mat, we'll talk later.

These figures though, when they were presented to me and somebody had brought this to my attention - and again, as the minister knows, I've often said, some of the very best ideas that I've taken the reins and run with have been ideas that people bring to me. I don't just stumble across these things generally, but somebody else who has been closely related or had an issue has brought this to me. I'm sure the minister has all of these, I'd be happy to table them if - maybe I will, I'll just table them for the record.

Those figures are so startling and so worrisome and, as I said, on a personal level, parents are worried. There was a study done by your department about youth and child alcohol consumption where you did focus groups and, I guess, roundtables talking to people and I had a look at that study and what it did say was parents were upset and wringing their hands but feel it's inevitable, feel that this is some kind of rite of passage.

I know, just speaking from my own neighborhood and anecdotally, the age of the kids who are getting seriously drunk is younger and younger. I'm hearing of kids like in Grades 7 and 8 who are being brought home or passed out in the parks or whatever. They're normally drinking in parks or public places. They certainly are the cause of a lot of calls to the police non-emergency number because that's how we respond.

[Page 249]

I wanted the minister to know that I'm very concerned about that and so I want to talk a lot about where we're going to go on the youth drinking strategy and what we might do policy-wise to try to address this.

I'm told that New Zealand is one country, and Australia too, I think, to a degree, that recognized that they had a pervasive drinking culture and they had to do something. They looked at - and I see one of the members who knows Australia giving me a nod - because they had a very macho kind of culture which included a lot of heavy drinking, they sat back, looked at the sort of statistics I've given that doesn't show the productivity loss, the wage loss, the cost to employers and so on in the economy. I was talking health really, but when we look at it all, it's tremendously damaging to our society.

I know the minister spoke about the success we've had with tobacco and our tobacco strategy, and I believe we can do the very same thing. You've talked about how we can change the social cost and some other issues, that if we change the societal aspects of this, we will change behaviour, and that will help us all. So I really do want to go to that, and what I've seen in the New Zealand strategy was they have five things that they looked at, and perhaps it's similar to what we did with cigarettes. They looked at increasing alcohol prices, reducing its accessibility, reducing marketing and advertising, and increasing impaired driving countermeasures - we've done quite a bit of that here in Nova Scotia - increasing treatment opportunities for drinkers. Those were their five points that they had as a best practice.

I would ask that we incorporate those and look at the experience in other provinces. I really want the members of the House, as well - I think we should be debating this, probably in some form here in the Legislature so that this issue comes out from behind closed doors, or wherever it's being silenced, and we really start to shine a spotlight on it because I'm not a prohibitionist by any means, and I'm sure that neither is the minister or others in this House, but it's just talking about a balance.

When I spoke to somebody - it was in Health I think - but they had said that our consumption is pretty much, on a per capita basis, fairly standard in terms of the Canadian average. We're not really above, but our pattern of drinking is binge drinking. We have much more of that and 20 per cent of Nova Scotians are really binge drinking and drinking in an unhealthy way. So we need to really look at that, and I would ask now, I guess I should get to a specific question because the minister is - mind you, you needed a break, I have to say. I really did feel that we've been putting a lot of stress on your voice lately.

I wanted to talk about women and drinking for a minute. I've signalled my concern about youth drinking, but there was also a report done on women and drinking. Women do not drink - at least at the moment, we're not consuming as much as men, although they said girls are drinking more than boys, just in general. What I'm concerned about is a comment - I'm going to try to find it directly - in this report on drinking here which was "Women and Alcohol in Nova Scotia - An Analysis of information in the 'Culture of Alcohol Use in Nova

[Page 250]

Scotia'", it's June 2009. At the back, one of the recommendations, in fact the first one, is the findings from this report and the 2008 Culture of Alcohol Use in Nova Scotia Report should be communicated to key stakeholders throughout the province.

I would like to question whether or not the Nova Scotia Liquor Corporation has been very much a stakeholder in that discussion, and we can go to it directly, but their annual report spoke very directly of targeting women. There was a little bit of news about it in the newspaper at the time, but they said, guess what, men are drinking lots, let's target women because that's our best marketing opportunity.

I'm sorry these aren't in colour, but I would like to just put in a couple of other things to table, and that's a picture of a shelf in our NSLC store selling a product called Girl. It's some sort of hard liquor that's called Girl, it's pink bottles, and it wouldn't appeal to me, so this is target marketing young women because I don't want to buy a pink bottle called Girl. It's obviously designed to get young drinkers and young women to buy that alcohol. There are more coolers, there are more things that taste like pop, less things that taste obnoxious. They're adding lime now to beer and women will buy it. Women don't like beer but women will drink lime beer. So there was another article in the paper about how nice lime beer is. (Interruption) Oh, oh, maybe people under 25 like lime beer as well. I'm getting that cue. It must be that hour of the night. Perhaps I should just go until eight o'clock.

[7:45 p.m.]

It concerns me and what I would like is that the minister would look at that. I am sure the minister is aware of the report and I'm trying to find it here, the NSLC report. It is on Page 15 where they talk about their marketing and I guess I will add it in here as well for the record - we have to find where women are. It talks about how we're all segmented but they definitely want women here. Anyway, I can't find it precisely because my copy that is highlighted isn't in front of me. It is on Page 15 where they have sort of sliced and diced the market.

They give various age groups, interesting age groups and types of drinkers. They have the Adventurers - they give us little names - the Adventurers, the Loyalists, the Discoverers, the Maintainers. The Maintainers buy the same product and they shop occasionally and spend less on average, so they would be ones to go after. The Discoverers as well, spending less on average, buying different products across categories and shop only occasionally. Adventurers, which I would say is not a very good word to describe somebody who buys different products across categories, shops more frequently and spends more on average. I don't know that that makes an adventurer but when we're talking about the consumption of alcohol they very clearly said women are our best market and young women at that.

They are looking at younger women's consumption and that seems to say to me we didn't communicate what we've just learned, and I know it's recent, you've only got that report on women and alcohol in 2009. We need to communicate with the Nova Scotia Liquor

[Page 251]

Corporation because it is very similar to what we've got with gambling and somewhat with tobacco. Although we've changed the culture so much that we don't really like to look at tobacco at all as a revenue generator. We're getting taxes from it but we're not - we know that if we increase the taxes we just have more illegal tobacco, so we're not going that way.

With gambling and with alcohol we really look for the revenue, I guess we call them government business enterprises, we want the revenue. It's kind of a dichotomy, we want to be socially responsible but, at the same time, we want to market more. If there's one department in the whole government that can speak for this and try and help us, it is the Department of Health Promotion and Protection because that is your mandate, to try to step in and bring in some policies that will not normalize and encourage the consumption of alcohol for women and young people. So I'm going to turn it over to the minister to see if she has some stats or some figures or some costs that she can associate with this effort.

MS. MAUREEN MACDONALD: Thank you very much. The honourable member has initiated the estimates debate with a really important topic, without any question and we can't really do it justice in the time that we have left. Let me start first by telling you just a little bit in a broad, general way. In a recent discussion I had with Dr. Strang I believe he said to me that the data suggests that10 per cent of all hospital admissions in Nova Scotia are alcohol-related. That is a tremendous proportion of hospital admissions. If we could make even a small dent in that, we would be having quite an impact on our health care system, not that that is the only reason why we should tackle this but I use this as an example.

The honourable member tabled some stats and those stats actually, I am told, come from our own prevalence study at HPP, which we co-led with B.C. I understand it's kind of a national initiative and we do it separately but we are two provinces that do this. This has been on the department's radar for some time, the need to develop and have good public policy to start dealing with - of course one of the first things - I shouldn't say first things, there's not really a first thing - but one of the tools that you need in your tool bag is some hard evidence and data that give you a good picture of what you are dealing with.

We know that we are dealing with underage drinking, for example. Underage drinking is a problem and I think the honourable member is absolutely right, the data suggests that kids are drinking at a younger age. I not only see this in data that is presented to me by my department when they do these studies but as Minister of Health, I have people who write letters. School principals have written letters to me asking if there is anything that can be done for a child who is nine years old who has an alcohol addiction. I mean that has to - it just rips your heart out when you read stuff like that and you think how can this be - a child that is that young. I've worked for many years with children and adolescents and I, myself, see the enormous change that has occurred over a 10- or 15- or 20-year period.

Binge drinking, we know binge drinking is a problem and we know that binge drinking is a problem that cuts across age groups, too, I think. It's not necessarily peculiar to

[Page 252]

young people. We know that we have to strike a balance. I look at the Nova Scotia Liquor Corporation, they have been running kind of a social marketing campaign around responsible drinking, which I think is very much aimed at young people. We can certainly talk more about some of the issues specifically around marketing to our young women that the member raised.

I want the member to know that the department has certain initiatives. I know you've registered for the second forum on alcohol that is coming up in May, which I think will be a very exciting opportunity to really hear from people across quite a broad spectrum.

In addition to that, I want to mention for the members that we have a road safety advisory work group or committee and it involves a number of ministries; it involves the Minister of Justice, it involves the Minister of Transportation and Infrastructure Renewal, it involves Service Nova Scotia and Municipal Relations, as well as the Minister of Health and the Minister of Health Promotion and Protection. Certainly this is an issue that is on the radar of that particular working group. Something that we will be doing some work on in the coming year will correspond to some of the concerns around drinking and driving and underage drinking and driving and these issues. So there are many initiatives, there are many things that are going on.

The staff in the department and HPP are very much on top of doing scans, in terms of what are the best practices from around the developing world. I know that the member made reference to New Zealand and Australia and their alcohol strategies. I think the U.K. has more recently initiated a strategy as well because binge drinking in particular has been an area of great concern there.

We try to not reinvent the wheel but look at what is occurring elsewhere, this is very important. I have a particular interest, in terms of women and addictions. I have been interested in women and addictions since my very first summer job in the quasi-social service field, I guess. I worked at that time for what is now Health Canada on a project one summer that involved going out and doing group discussions with women, using a tool that was called "It's just your nerves" and it was a tool that really helped women talk about alcohol and drug use as well. When I say "drug use," I mean prescription drug use, the mood-altering drugs like Valium and what have you. At the time we were seeing a great increase in the numbers of women who were really sort of cross-addicted. They had alcohol and prescription drug addictions with these mood-altering substances.

You know, I don't know if people recognize it, but alcohol is a depressant, and for many people who think if they drink they'll feel better - they're a little down, it will make them happy, make them forget their troubles - well, alcohol as a physiological compound is actually a depressant. It contributes to people's depression. For a short time you might feel a little better but in the long term this isn't the case. There is a lot of work we have to do, educational work and other work, to address what is a serious problem, a great cost to the

[Page 253]

individual, to their families, to our health care system, and ultimately to our society, Mr. Chairman.

MS. WHALEN: I didn't realize we had a few more seconds for me, but I'm glad to hear the minister's interest in looking at women and addictions as well and women and alcohol consumption. I had some other figures I was going to go to as well on that, which talk about some of the other societal problems around women drinking and the incidence of violence against women, sexual assaults and so on, and they are certainly well documented as well. I'm hoping that we'll learn a lot from the other studies that have been done and the other changes that have been adopted in other countries, because I think that we need to tackle this. I would say to the minister - and we can talk about it in more detail - I think some of this is low-hanging fruit, which is an area where we could start to make some changes and make people healthier and see some financial results right away.

MR. CHAIRMAN: The time allotted for Committee on Supply has expired.

The honourable Government House Leader.

HON. FRANK CORBETT: Mr. Chairman, I move that the committee now rise and report progress.

MR. CHAIRMAN: Is it agreed?

It is agreed.

The motion is carried.

[The committee adjourned at 7:58 p.m.]