44th Parl. 1st Sess.
May 31, 2023 02:00PM
Madam Speaker, I am pleased to rise to speak to Bill C‑284. As members know, this enactment provides for the development of a national strategy to support the prevention and treatment of eye disease to ensure better health outcomes for Canadians. It also designates the month of February as age-related macular degeneration month.
The preamble of Bill C‑284 reads as follows, and I quote:
Whereas vision loss in Canada is associated with a number of causes, including macular degeneration, cataracts, glaucoma and diabetic retinopathy;
Whereas millions of [Quebeckers and] Canadians live with eye disease that could lead to vision loss or blindness if not treated;
Whereas it is estimated that vision loss costs [Quebeckers and] Canadians billions of dollars every year, both in financial costs and in loss of well-being;
Whereas the loss of central vision can severely impact a person's independence and quality of life;
Whereas coordination and information sharing between the federal and provincial governments is needed to ensure new treatments are made available, to prevent and treat eye disease and to prevent health inequities among people with vision loss;
It also states, and I quote:
And whereas Parliament considers that it is desirable to be proactive in the fight against vision loss and to implement a national strategy on eye care
In the same vein as many bills introduced over the past few Parliaments calling for autism, cancer or diabetes strategies, this bill calls for a strategy in the form of a report on eye health. Not surprisingly, the bill has the support of the Canadian Ophthalmological Society and the Canadian Association of Optometrists. In the wake of the introduction of the bill and World Sight Day on October 13, these groups published a survey that highlights the lack of understanding among Canadians about this important aspect of our health.
As we know, the strategy proposed in Bill C‑284 is built on four pillars:
identify the training, education and guidance needs of health care practitioners and other professionals related to the prevention and treatment of eye disease, including clinical practice guidelines;
promote research and improve data collection on eye disease prevention and treatment;
promote information and knowledge sharing between the federal and provincial governments in relation to eye disease prevention and treatment; and
ensure that Health Canada is able to rapidly consider new applications for treatments and devices used for macular degeneration, cataracts, glaucoma and diabetic retinopathy.
The Bloc Québécois will vote in favour of the principle of the bill, because eye health is important for people's quality of life.
All in all, the bill itself does nothing. It only forces the government to produce a report that will establish a national strategy for eye care. Furthermore, designating the month of February as age-related macular degeneration month is a symbolic measure.
Although health services, including eye care services, are the jurisdiction of Quebec and the provinces, this bill gives the federal government a role by funding research and approving medications or devices.
The bill overall respects Quebec's and the provinces' jurisdictions. That is why the Bloc Québécois supports it. However, the Bloc will take the time to study the bill to ensure that the federal strategy is complete and complements the actions of the Quebec government.
In Quebec, optometry services are available to people under 18 or over 65, and emergency services are covered for everyone. There is also a visual aid program, which allows any individual with a permanent visual impairment who is covered under Quebec's health insurance plan to obtain visual aids such as magnifiers, an optical system, a calculator, a Braille typewriter, a white cane, an electronic obstacle detector, night vision goggles, and the list goes on.
The program also offers financial help to get a guide dog, as well as resources for students. Speaking of guide dogs, I am going to talk about a fantastic Quebec organization that does remarkable and indispensable work. I am talking about Mira.
In his childhood, founder Éric St-Pierre developed a passion for raising dogs. He trained dogs on the family farm, following his father's advice. His ease and natural talent with the animals led him to undergo professional training in order to have a career training guard dogs and sniffer dogs.
In 1975, Mr. St‑Pierre built a kennel in Sainte‑Madeleine. He spent most of his time training dogs. One day, a friend who worked as an orientation and mobility teacher at the Nazareth and Louis Braille Institute asked Mr. St‑Pierre for advice about the behaviour of a guide dog from the United States. Back then, there were no francophone guide dog schools in Canada. Éric St-Pierre quickly realized that these dogs were not raised or trained in conditions that worked in Quebec. He realized that there was also a language barrier limiting many people's access to the services of these dogs. He therefore promised the institute that he would train dogs for them, and that is how Mira came to be. It was the first francophone centre for guide dogs in Canada.
Mira was founded in 1981. It is a non-profit organization that provides free guide dogs and service dogs to people with visual or mobility impairments, as well as to young people with autism spectrum disorder.
All of Mira's services and activities are based on the principle of body equality, meaning that what is accessible to everyone must also be accessible to people with disabilities. Within this framework, the organization's mission has the following objectives: increase the autonomy and promote the social integration of people with disabilities through the use of guide dogs and service dogs; provide services freely to all beneficiaries, regardless of their income; improve the mobility and orientation of people with disabilities so that they can move about freely in their daily lives; create an individual intervention plan adapted for each beneficiary that takes into account the beneficiary's level of autonomy, social and professional context, and mobility needs; and promote the benefits of service dogs in public places, in schools and on public transport.
Mira is known for its innovative programs, dog training techniques and fundraising activities. Since it was created, Mira has provided more than 3,700 dogs free of charge to people living with one or more disabilities. Much of this success is due to public support and concern. Without this help, Mira would not be what it is today.
I am now going to talk about two people I knew well and who lost their sight because of macular degeneration and diabetes. When I was finishing high school, a friend of mine found out that in a few years she would lose her sight to a genetic disease, early-onset macular degeneration. Diane Lamarche had a bright future ahead of her. She was a serious student who got good grades in high school. She enjoyed walking, basketball and tennis. She was also an avid reader.
We got to know each other better when we worked together as playground monitors in Lebel‑sur‑Quévillon. In our senior year of high school, she told us that she was losing her sight and that she was already learning Braille. The news left us gutted. She was so young, and had such a promising life ahead of her as an adult.
Our eyes and vision are indispensable for acquiring information from our external environment. They make it possible to coordinate all our movements, in particular those of our hands. Vision has three roles: perceptual, sensory and cognitive.
Another person who was even closer to me, my uncle Germain Boyer, lost his vision in his 70th year because of his diabetes. I remember that he enjoyed Yule logs so much that he would stock up every year. He has since passed away, but I will always remember his kindness and cheerfulness. I want to send my love to my aunt Denise and my cousins Sylvain and Mélanie in memory of him.
Ultimately, prevention remains an effective way to avoid vision loss, unless it is caused by macular degeneration, poor health or genetics.
If passed, this bill will help ensure better eye health and better vision for Quebeckers and Canadians.
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Madam Speaker, it is a great honour to stand in this House today and speak in support of Bill C-284, an act to establish a national strategy for eye care. I am proud to say that New Democrats will be supporting this bill and, in fact, as I will point out in my remarks, this is something we have been championing since the 1960s.
This legislation, in general, would provide for “the development of a national strategy to support the prevention and treatment of eye disease to ensure better health outcomes for Canadians.” The bill states:
The national strategy must describe the various forms of eye disease and include measures to
(a) identify the training, education and guidance needs of health care practitioners and other professionals related to the prevention and treatment of eye disease, including clinical practice guidelines;
(b) promote research and improve data collection on eye disease prevention and treatment;
(c) promote information and knowledge sharing between the federal and provincial governments in relation to eye disease prevention and treatment; and
(d) ensure that Health Canada is able to rapidly consider new applications for treatments and devices used for macular degeneration, cataracts, glaucoma and diabetic retinopathy.
This legislation would also designate the month of February as age-related macular degeneration awareness month.
I want to pause and thank my hon. colleague from Humber River—Black Creek, who has been an energetic, spirited and passionate sponsor of this bill. It would not be right to proceed any further without noting her energy and great work in promoting this overdue policy.
Eye health has been underfunded and deprioritized in Canada for too long. As a result, millions of Canadians are being put at unnecessary risk of vision loss because they lack access to eye care. A national strategy on eye care would ensure better access, better outcomes and quality of life for Canadians. It would also support Canadian leadership in vision research that can be exportable to the world.
Canada's New Democrats believe that our public health care system should cover us from head to toe, and that includes comprehensive eye care. Currently, access to eye care varies widely from province to province, resulting in variable health outcomes and exacerbating inequalities in our health care system. Over eight million Canadians are living with an eye condition that puts them at significant risk of blindness. An estimated 1.2 million Canadians are currently living with vision loss, with many facing a lack of investment in services and supports that impacts their living life to its fullest potential. That number is expected to grow to two million people by 2050. It underscores the need and the appropriateness of acting now so that we can arrest that alarming development.
The leading causes of vision loss in Canada are the following: Cataracts affect some 3.5 million people; age-related macular degeneration, 1.5 million people; glaucoma, about 300,000 people; and diabetic retinopathy, almost a million people or some 800,000.
Routine eye exams play a crucial role in the prevention of vision loss. If certain eye diseases are diagnosed early enough, they can be effectively managed through different invasive measures and before expensive and more invasive procedures are required. According to a recent report by Deloitte, the cost of vision loss to our economy, both directly and indirectly, was some $33 billion in 2019. That is projected to grow to some $56 billion by 2050.
If diagnosed early and if people have access to regular screening and treatment, most vision loss can be prevented: in fact, in about 75% of cases. Seventy per cent of existing vision impairment in Canada is estimated to be correctable with prescription glasses. The sizable proportion of correctable vision impairment is related to the barriers to access to vision care in Canada. Most guidelines recommend having an eye exam once a year for people aged six to 18 or 65 and older, as well as for those with diabetes or with an existing eye disease. For healthy people aged 19 to 64, one visit per two years is considered sufficient. However, this very basic diagnostic health need is not being met.
I will give a few examples. Starting September 1, free annual eye exams paid for through the Ontario health insurance plan will no longer be available to seniors. Manitoba and Nova Scotia currently only insure eye exams every 24 months for every senior, which is twice as long as is recommended. Millions of Canadians without extended health benefits do not have their eyes checked or cared for, due to cost.
As I said, the NDP has been advocating for universal public optical treatment since its founding convention in 1961. I am going to quote from that convention, which reads, “Believing that a country's most precious possession is the health of its citizens, the New Party will introduce a National Health Plan, providing benefits to those who need them without regard to their ability to pay. The plan will cover a full range of services: medical, surgical, dental and optical treatment, as well as prescribed drugs and appliances.”
It is a little over 60 years since that statement was made, and here we are in a G7 country and we are not making sure every citizen can get their eyes checked every year, never mind have the relatively inexpensive correction done that would prevent them, in many cases, from getting vision loss and even blindness. That is a national shame and it is time it was rectified.
More recently, the NPD's 2019 election platform committed to achieving head-to-toe public health care for all Canadians, and we specifically included eye care. In the 2021 platform, we committed to a long-term path to providing public coverage for eye care, along with other health services. In May 2021, the New Democrat member of Parliament for Algoma—Manitoulin—Kapuskasing, who I note is in the chair today, introduced Motion No. 86. That motion called on the federal government to work toward the creation of a national strategy for action on eye health and vision care. One can see not only that our support for this bill is there because of the need and the overdue nature of this, but that New Democrats have been playing a key role in placing this issue on the national agenda for decades.
I have to point out where the Government of Canada has simply failed to meet its commitments in this regard. In 2003, the Government of Canada made a commitment to the World Health Organization to develop a vision health plan for Canada by 2007 and to implement that plan by 2009. To date, no plan has been developed.
As recently as July 2021, the Government of Canada voted in the UN General Assembly for the first agreement to be adopted at the United Nations designed to tackle preventable sight loss and ensure that eye health is part of the United Nations sustainable development goals. In this resolution, the establishment of a national vision health plan was endorsed again by Canada.
As much as I credit the hon. member for taking this overdue measure, one has to wonder why this had to take the form a private member's bill, why the government is not meeting its own obligations and why it is not actually introducing government legislation using the full force of its control of the Order Paper to meet its own commitments, which it has made not only to Canadians but on the world stage.
It is important to note as well that this legislation has the support of stakeholders across this country. Several organizations, including Fighting Blindness Canada, the Canadian Council of the Blind, the Canadian National Institute for the Blind, Vision Loss Rehabilitation Canada, Diabetes Canada, the Canadian Association of Optometrists, the Canadian Ophthalmological Society and the Canadian Association of Retired Persons, have all advocated for a national eye care strategy for many years.
I want to pause for a moment to talk about the particular impacts this has on marginalized groups, including its gender impacts. When gender differences limit access to proper eye care services, women are at greater risk of developing eye diseases that are otherwise treatable and preventable. Recent studies published in The Lancet Global Health in 2020 revealed that women carry the greater burden of visual impairment globally. More women than men have impaired vision due to cataracts, age-related macular degeneration and dry eye disease. One in four women is at risk of vision impairment, compared to just one in eight men.
I will conclude by thanking the hon. member again for introducing this bill and let her know that the NDP will enthusiastically support it at all stages.
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Madam Speaker, I am happy to rise today to speak in support of Bill C-284, an act to establish a national strategy for eye care, presented by my friend and colleague, the hon. member for Humber River—Black Creek. I know this is something the member has been working on for quite some time and I would like to recognize her extensive work on this issue.
This piece of legislation would not only ensure better health outcomes for Canadians, but also recognize the month of February as Age-Related Macular Degeneration Awareness Month, bringing awareness to the leading cause of vision loss in people 50 years or older.
More than eight million Canadians are presently living with one of the four common eye diseases and more than one in 10 older adults have some degree of vision loss, which places them at serious risk of losing their vision. Vision loss can be harmful to many elements of daily life, impacting the way a person works, participates in activities and interacts with the world around them. That is why it is our duty to take proactive measures to prevent and treat these diseases effectively.
Routine vision care can help to reduce the risks of blindness and vision loss later in life and improve the outcomes associated with eye diseases like cataracts and glaucoma. Unfortunately, the COVID-19 pandemic worsened the issue of vision loss in Canada as eye surgeries were cancelled or delayed and wait times to see vision care providers also increased over the course of the pandemic. That is why a national strategy—
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Madam Speaker, I am pleased to rise to speak to Bill C-284. As my colleague from Abitibi—Baie-James—Nunavik—Eeyou said so brilliantly earlier, the Bloc Québécois will be voting in favour of this bill.
I see no reason why we would oppose a national strategy to support the prevention and treatment of eye diseases, just as I see no reason why we would oppose an age-related macular degeneration awareness month.
The Bloc Québécois will be voting in favour of this bill because, and I mean no offence, it is, in my view, an apple pie bill. Indeed, no one could oppose such a strategy, especially since the health services outlined in the bill—as we will perhaps see when it is studied in committee—are more the responsibility of the federal government. Research funding and the approval of certain drugs and medical devices fall under federal jurisdiction. I do not see any problems with jurisdiction either, but we do reserve the right to take a closer look at the ins and outs of this bill in committee.
What concerns me a bit more about having a better strategy to support the prevention and treatment of eye disease is how to do it. A strategy is fine, but it needs to be accompanied by action. That is what I want to focus on as I discuss this topic.
The essential point here is that there is still a lot of work to be done. The work to improve the eye health of Quebecers and Canadians will require more services. For me, first and foremost, the best solution for more services is to have coverage under the Régie de l’assurance-maladie du Québec, which means an increase in health transfers. If we want better services, we need more resources.
Let us look, for example, at new treatments like the Luxturna gene therapy, a treatment that makes it possible to treat Leber congenital amaurosis. That is a significant and very costly illness, with just one treatment costing $1 million. That is an enormous cost.
In that regard, on March 23, the federal government announced $1.3 billion over three years to help the provinces cover those treatment costs. We know that gene therapies are treatments that herald small revolutions in medicine and health, but they are very costly treatments. If the past is any indication, we know that the federal government is not always there for health funding.
Now it is clear where I am going. The best way to have the best health care and to fight against eye disease is to combat one of the problems that plague the Canadian federation: I am talking about the fiscal imbalance. I would note that, last week, the mischievous member for Mirabel held a symposium here in Ottawa on the fiscal imbalance to study the phenomenon in depth. It was a non-partisan symposium attended by the Parliamentary Budget Officer—I do not think the Parliamentary Budget Officer is partisan—and Mr. Benoît Pelletier, a former Liberal minister from Quebec, who is not a Bloc supporter, but who came to speak to us about the fiscal imbalance.
Why am I talking about the fiscal imbalance? It is to remind members of the demands made by Quebec and the provinces on health care funding. Quebec and the provinces estimated their health funding shortfall at $28 billion per year. The goal was to increase Ottawa’s health transfers from 22% to 35%.
What did the federal government offer? Members will recall that it was far less than $28 billion. What the federal government offered was $4.16 billion. The difference between the provinces' demand for $28 billion and the federal offer of $4.6 billion is not just about money. The difference between the two means that vision care will never be provided for lack of resources. There is no doubt about that.
For example, in Quebec, year after year, health resources generally represent approximately 42% of Quebec's total budget. That means that there is 58% left for all of the government's other responsibilities such as education, fighting poverty, child care—Quebec was a pioneer in this field, as it created the child care model—infrastructure, roads, public transportation and bridges. There is 58% left for that, for funding municipalities and also for supporting Quebec businesses. If we wait for the federal government to support Quebec businesses, we will be waiting a long time, as we saw again with the announcement that Volkswagen is building in Ontario. Therefore, 42% of the Quebec government's budget goes directly to health care. That considerably reduces its budgetary margin. That is known as the fiscal imbalance.
I can give a very simple definition. It is a definition that everyone agrees on, the definition from the Séguin report. I am talking here about Yves Séguin, the former Liberal minister, not the guy who had a goat. Yves Séguin said that the provinces' spending structure is such that expenditures grow faster than the economy, while those of the federal government grow at roughly the same pace. Furthermore, when the federal government wants to adjust its spending, it can just unilaterally cut transfers to the provinces, without any political fallout.
That is the fiscal imbalance rule.
That means that the federal government can make promises like it did in March when it said that it was going to inject $1.3 billion over three years to help the provinces with new gene therapy treatments. However, nothing prevents the government from eliminating that funding down the road. In so doing, the government strangles the provinces and the provinces are then stuck having to deliver services that they do not necessarily have the funding for. That is completely objective, ideologically neutral information. Take, for example, the Conference Board, which published a report showing that the Canadian federation is not viable in the long term and that the provincial economies are not viable in the Canadian federation, given the fiscal imbalance. That is also a recurring theme in the Parliamentary Budget Officer's reports, which document how the fiscal imbalance is wreaking havoc, particularly when it comes to health care.
I am saying all of this because, if we want a strategy that will really give us a robust health care system that can provide treatment for eye disease, then the we need more funding for health care.
I want to make my colleagues aware of something that happened this week.
On Tuesday, Liberal and NDP members once again joined forces to remove an additional $2 billion for health care from Bill C-47, an act to implement certain provisions of the budget tabled in Parliament on March 28, 2023. The NDP and Liberals got together to ensure that $2 billion was cut from health care funding. The Liberal-NDP coalition had an opportunity to partially correct the federal government's lack of investment in health care and to take concrete action, which is what people are calling for, to relieve the overburdened and exhausted health care system. They also had an opportunity to offer treatments for eye diseases that met Quebeckers' expectations, but they decided otherwise. All they have managed to do is disappoint people.
Liberal and NDP members voted in favour of an amendment to remove $2 billion in additional health provisions for Quebec and the provinces when Bill C-47 was studied in committee. The amendment was proposed by the Liberal Party and removes additional support for health care in Quebec.
I think we should forget all the fine words and promises made by Liberal and NDP members who claim to be concerned about the state of our health care system. Indeed, when it comes time to invest more, they are nowhere to be found. Worse, they are actually cutting billions of dollars from health care, even when those billions were invested unintentionally.
I repeat, the best way to have better eye care is to have a robust health care system and health care funding that lives up to the expectations of Quebeckers and Canadians.
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