IMMUNIZATION OF SCHOOL PUPILS ACT
The House resumed at 8 p.m.
HEALTH PROTECTION ACT
Hon. Mr. Grossman moved second reading of Bill 138, An Act respecting the Protection of the Health of the Public.
Hon. Mr. Grossman: Mr. Speaker, the new health protection act is designed to renew the public health system in this province and to bring our public health legislation in line with present day needs and requirements. Today, we see all around us growing numbers of people who want to live healthier lives with healthier life styles and family relationships. This new act will, we think, provide needed support for these concerns.
It will provide the counselling, education and health maintenance programs which individuals and families need. It will guarantee to all citizens of Ontario a basic core of preventive health services. The act places responsibility for delivery of public health services on the 43 local public health units, and it will clarify the roles of the units, the boards of health and the medical officer of health in each of our communities.
Specifically, this bill will establish a set of seven standard, or core, services in all parts of Ontario. Let me note the several areas that are specified: (1) community sanitation; (2) communicable disease control; (3) preventive dentistry; (4) family health; (5) home care; (6) nutrition; and (7) public health education. The bill will require boards of health to provide or "to ensure the provision of" these designated services. That will encourage the boards to work with other local agencies in planning and delivering programs and will give them a considerable degree of flexibility.
The details of the programs to be delivered to our communities in each of these seven areas of public health are now being developed. Over the past several years, we have set up a consultative process which includes representatives from the various health disciplines employed by boards of health as well as various ministry officials. Consequently, we will have a set of core programs designed by practitioners to reflect community needs. We have the endorsement and support of the association of Ontario boards of health.
As an example, I mentioned the strengthening of responsibility among medical officers of health for immunization levels in the community. You will be aware, Mr. Speaker, of the other bill before you through which I hope later this evening to introduce universal immunization as a companion piece to this legislation.
The health unit will have to ensure the provision of immunization services and information through regular clinics and links with family doctors. As well, family health programs will include a wide range of services from prenatal to geriatric. Local boards will ensure the evaluation of the hearing and vision of every pre-schooler, and they will identify and monitor the conditions of high-risk elderly people in their own homes.
The boards will serve as centres for the prevention and management of lifestyle diseases and the prevention of home accidents. To satisfy growing interest among many Ontario residents, all public health units will provide information about diet and nutrition. At the moment, only two thirds of the boards of health make available that essential support and information. The boards will be required to offer fluoride therapy, oral hygiene and dental education services to school children.
The core programs will be implemented over a few years in a steady and careful manner, giving those health units that need it the time to adjust. Phase one of the implementation will be introduced across the province in the first year or so. Subsequent phases will follow in order over a period of four or five years, according to local circumstances, needs and priorities.
This proposed legislation is the result, I would remind members, of suggestions and recommendations in literally hundreds of briefs and from thousands of interested parties who cooperated and held dialogues with our ministry. I look forward to the comments this evening, and also to the input of members of the public and people who are particularly interested in and affected by this legislation when it does reach committee stage.
On balance, I believe that this bill, when it is finally passed in whatever form, will ensure that citizens of our province will be offered the benefits of preventive health care, an objective that I am certain we can all support.
Ms. Copps: Mr. Speaker, I would like to start by congratulating the minister for acting very quickly in his new role as Health minister on an issue that has been literally festering for a number of years. I spoke today with someone from the board of health in Toronto who had been employed there for over 30 years, and during that whole period of employment this person was expecting a new Health Protection Act. So I think it is a step is the right direction.
Certainly, there are a number of areas that give me some cause for concern, and I would particularly like to bring to the minister's attention the fact that, as he may be aware, the Association of Municipalities of Ontario seems to have been in some confusion over the bill in the last few days. Because the Health Protection Act was introduced at a time so close to Bill 142, many members questioned whether the ministry was attempting to push it through very quickly. As critic for the Liberal Party, I did point out that it will be going to committee, where it will get an extensive airing.
I might add also that a number of board chairmen to whom I have spoken have been unable to acquire copies of the bill. However, it is interesting to note that most of the medical officers of health received copies as soon as the legislation was introduced. I think this is an area where we could be a little more efficient and effective, particularly since the chairmen and the chairwomen of the boards of health do represent the democratic input that is essential to keeping our boards of health operating in a fair and equitable manner.
We have some concerns over the bill, particularly with regard to the legalese. I spoke today with the chairman in Metro Toronto -- I believe the minister probably recognizes her as his eminent opponent in the last provincial election, Anne Johnston. The staff for the city of Toronto advised me that if the legislation were introduced in its present form, it would create virtual havoc in the city of Toronto simply because the legal wording of the bill states that the employees are employees of the board, whereas in the city of Toronto they are employees of the city rather than of the board. So there certainly is a need for some changes in the actual technical drafting of the bill in order to avoid the kinds of very serious legal problems it could create for municipalities such as the city of Toronto.
Other concerns I have heard aired across the province relate to a seeming and apparent shift in authority and responsibility from the boards to the medical officers of health. Certainly, I do not think the fact that the Ministry of Health itself is peopled by some former MOH employees would have nothing to do with the fact that the thrust of this particular bill seems to weigh more heavily on the side of the MOH than on that of the board as compared with the previous legislation.
8:10 p.m.
We have some other concerns. Specifically, the fact that a number of areas of health protection and certain health professionals were ignored in the legislation; especially the nursing profession, which to my mind at the moment plays the most extensive role in the area of delivery of public health across the province, has been virtually ignored in this particular piece of legislation. Certainly that is something we will have to make amends for when we go into committee with the bill.
In the main, I believe the administrative changes that have been wrought in the bill are to be supported. With some very significant changes with respect to the power of the Ministry of Health vis-à-vis the boards, I believe we will be able to work with the minister in trying to finally bring to fruition An Act respecting the Protection of the Health of the Public, which has certainly been a long time in coming.
I want to congratulate the minister for getting this act on the floor so early in his tenure. I would like to warn him that we, in our party, will be fighting to make some very significant changes in the new thrust of the bill, particularly with respect to the power structure within the boards of health and, I might add, with respect to the fact that the fines for individuals have been increased substantially while there has been absolutely no increase for the corporate sector as compared with the previous act.
If the minister were to take into account the number of years since the introduction of the last Public Health Act, he might be looking at some changes in this area as well and we will be making some of those amendments during the course of the discussions come September.
I am looking forward to it and I want to congratulate him on at least a step in the right direction.
Mr. McClellan: I will be brief, Mr. Speaker, but not quite that brief.
I should tell the minister right at the outset that we have not just concerns about the new Health Protection Act but very serious reservations about that act and we intend to express those by voting against the bill on second reading.
I want to spend a few minutes trying to set these concerns before the minister so he will understand them and perhaps he will even be moved to inch towards those concerns as we get to public hearings in the fall and the clause by clause deliberations on the bill.
I should start by stating the obvious, that public health is low on the totem pole in Ontario's health care system. In 1982, it has been relegated to a kind of subsidiary status, almost a kind of dustbin status. The evidence of that was before us once again a couple of days ago on the steps of the Legislature when the striking public health workers from the Niagara Regional Health Unit came here to Queen's Park.
I think there has been a major strike at a public health unit almost every year since 1975, when I was elected. What is characteristic of each of these strikes is not that they happen, but that they drag on for months and months and that there is always the same response from the local board of health: "Nobody is at risk; nothing is wrong; nothing is out of sorts; nobody is in any difficulty. Do not worry about these strikes." The medical officer of health will make statements reassuring everybody that there is absolutely no risk to anybody. They are saying almost: "It really does not matter if we shut down entirely, does it? There are no consequences."
Contrast that with the high drama that accompanies a strike of doctors or interns or hospital workers when the hospital sector of the health care system is temporarily disrupted by a strike. It is a moment of high crisis in the politics of this province. It is the kind of thing that tests the mettle of Ministers of Health and even, in a more peripheral way I may say, Health critics. It is a matter of enormous public consequence, which constrasts with the utter indifference that characterizes a strike at a public health unit. It simply speaks to the kind of irrelevance into which public health care has sunk in the latter part of the 20th century in this province. It was not always like that. Public health did not always receive the little itty-bitty share of the Health budget, between one per cent and two per cent of the total Health budget. It was not always like that.
In the 19th century, public health care was the leading edge of progressive medicine and medical reform. It was the component of the health care system that was publicly funded and supported, sponsored by the state, in contrast to the hospital care system which was private, philanthropic, charity medicine. In the 19th century, preventive medicine was state medicine and curative medicine was in a sense subsidiary. How ironic it is those roles have reversed so completely that we can shut down public health units and the leading officials disclaim any consequences of any kind whatsoever.
If the minister is really serious about restoring a balance between curative medicine and preventive medicine, he has many miles to go. It will take much more than rhetoric and statutory language to make that happen. The minister knows that. I am not saying anything the minister has not already given a great deal of thought to.
The problem is that from where we stand, Bill 138 appears to be good 19th century legislation. It would have been a good public health act if it had been implemented in 1882 or even 1922. I am not sure it is adequate for 1982. This is the principal concern I have. I do not see in the legislation the kind of focus on the social and community origins of disease that a 20th century public health act ought to have.
In his opening address, the minister spoke about preventive medicine for individuals and families as though the origin of disease was principally with the individual and the family. That is the traditional notion, but I am not sure we are at the leading edge any more by a long shot.
My concern is Bill 138 ignores the fundamental issue of occupational and environmental health. Occupational and environmental health are not core programs under this act. They are not enshrined in the act as mandatory for each and every public health unit across the province.
The language of the act is quite clever in that it permits a board of health which is already engaged in occupational or environmental health to continue its work. For example, the Toronto board of health took a pioneer role in environmental medicine in its crusade against lead pollution. The minister will remember that battle since it took place within his own riding.
The Toronto board of health has established as part of its mandate and part of its role that it is engaged in environmental health issues and is prepared to go through difficult paths to challenge environmental offenders, as it did with Toronto Refiners and Smelters Ltd. in the minister's own riding and with the other two lead refiners that were polluting the south end of the city of Toronto and causing much harm to children. That kind of board of health is able to continue, at least I think they are not prevented from continuing. I need some reassurance because I am not positive, but I do not see, and I am sure I am correct in this, that it is the mandate of each and every other board of health to adopt the same role vis-à-vis environmental health matters.
8:20 p.m.
My wife's family comes from the north end of Hamilton. I know a little bit of what I am talking about from personal experience. We know of the kind of environmental pollution from Stelco and Dofasco in the north end of the city of Hamilton. We know from the studies of Dr. Cecilioni that the incidence of lung cancer in the north end of Hamilton is five times that of adjacent areas. If I may say to the Minister of Health, I know that from personal experience. Members of my own family who lived in the north end of Hamilton have died of lung cancer. I know what I am talking about.
I have heard the deafening silence of the Hamilton board of health on this matter, and so have many other thousands of people. When they know there is a whole community living in the shadow of death because of environmental pollution from an industry and hear the silence of the public health function of the public health department, they ask themselves, "What use is it, what value is it, if it does not engage itself in these kinds of concerns; if it does not take the kind of role the Toronto board of health has tried to take with respect to exactly these same kinds of concerns?"
I am not satisfied, to the point I must vote against the bill, that the core programs lay down the requirement that at the end of the five-year implementation period each and every board of health in the province and each and every health unit will be engaged in the fight against environmental health hazards.
One would not have a sense from reading the act that cancer was the second leading cause of death in Canada, that we are in the midst of a cancer epidemic. One would not know that from reading this piece of legislation.
I may say, in parenthesis, that the minister lists virulent diseases under subsection 1(31) of the act. He does not include cancer and I understand why not. However, he does list smallpox. Did nobody point out to the Minister of Health that smallpox has been declared eradicated by the World Health Organization? The minister of everything may believe that the principal function of public health is to eradicate diseases like smallpox: the point I am trying to make is that in the latter part of the 20th century one of the principal functions of public health should be to engage itself with the cancer epidemic.
The National Cancer Institute in the United States estimates that 20 to 40 per cent of all cancer is caused by substances in the work place. A conservative estimate based on these figures indicates that cancer in the work place kills at least 10,000 Canadian workers every year. The former director of the US National Cancer Institute was quoted as saying, "Cancer in the last quarter of the 20th century can be considered a social disease, a disease whose causes and control are rooted in the technology and economy of our society."
It is just not good enough that the new public health act is either silent or completely ambiguous with respect to the mandatory nature of its engagement in this particular medical struggle. The relationship between occupational disease and environmental disease is not touched on by Bill 138.
The relationship is very simple. Environmental contamination is a result of work-place contamination. The breeding ground for environmental contamination and environmentally caused disease is the work place. The analogy between the malaria epidemic and the stagnant pond or swamp is a valid one with respect to the relationship between occupational and environmental disease. Yet, I may say, the act is entirely ambiguous and muddled on this most important question.
We know the record of this government. As recently as last week we had evidence that the Ministry of Health is not engaged in this kind of concern. The boards of health in some of our regional boroughs are not engaged in this concern. We learned on Friday that the radioactive soil deposited in Scarborough had produced radioactive lead levels 46 times higher than expected in children. We have known of that hazard for a couple of years, but neither the Ministry of Health nor the Ministry of the Environment have taken any action.
Once this act is passed and the implementation period is over, it is entirely unclear, at least to me, that any public health unit would have the responsibility to engage itself in the removal of that contaminated radioactive soil. I suspect it would be a matter of local option. If a local board of health felt its job was to pioneer in that area, it would respond in an appropriate way. On the other hand, if it did not it would not. There is no indication that the mandatory features of the act are binding.
A final example that comes to mind is Sudbury. After decades of neglect of occupational hazards, reflected in mining deaths and pollution diseases, suddenly we discover that the entire province is at risk from the environmental contamination that flowed out of that workplace hazard. Unless the public health units are prepared to deal with the contamination at source in the work place through some kind of liaison work with the occupational health and safety division of the Ministry of Labour and with the Ministry of the Environment, they will be as useless in this struggle as a health professional in the tropics without the capacity to spray malarial swamps or innoculate populations against traditional contagious diseases. I think that is where this act fails us and many people agree.
Let me deal quickly with some additional concerns. I would ask the Minister of Health, "Whatever happened to mental health?" Originally, it was one of the core programs. I believe there was even a core program committee. It seems to have evaporated.
I used to work for a public health unit in one of the old federally-sponsored community mental health programs. I thought pioneer work had established there is a valid and vital role for public health units in the provision of mental health care services and preventive mental health services. I do not however claim to be any kind of proof.
8:30 p.m.
Mr. Nixon: You used to work for John Yaremko.
Mr. McClellan: I have had all kinds of lousy jobs.
Seriously, the Toronto Public Health Board has done the best analysis that I have seen of the problems at Queen Street and the problems confronting ex-psychiatric patients. They are obviously engaged in this issue in a very constructive way. They will be able to continue that on the basis of local option.
There is nothing in the act that will lead and encourage, let alone require, other public health units to be engaged in preventive mental health work. That is a fundamental and serious omission from this act. It is even more tragic because originally it was seen as part of the core program.
Another point is regarding the elderly who are given such short shrift, a subordinate clause in clause 5(4)(iv), "Provision of health services to infants, pregnant women in high-risk health categories and the elderly." That is very helpful. One of the difficulties we have in assessing the role of public health units vis-à-vis the elderly is the fact that the new home support policy is still under lock and key in somebody's office safe.
Maybe it is in the vault of the Minister of Health. It sure is not in the vault of the Provincial Secretary for Social Development (Mrs. Birch). I think it has been stolen from the vault of Minister of Community and Social Services (Mr. Drea), who is in the invidious position of having to once again give a big piece of his turf over to the Ministry of Health.
The battle is between the Ministry of Health and Ministry of Community and Social Services for pre-eminence in the provision of services to the elderly. How competitive these ministries are in the interest of the public good.
Hon. Mr. Grossman: What do you think should happen?
Mr. McClellan: The Minister of Community and Social Services has lost and the Minister of Health has won, but the policy has been delayed by this territorial struggle between the two ministers for about one and a half years. I understand it will be released this fall. I understand the policy is virtually complete. It is at the policy field.
I am really pleading with the minister to have the policy released in time for the committee to have it as part of its deliberations. I do not know how we are supposed to assess the impact of Bill 128 on the elderly and to make intelligent decisions about the role of the public health department in providing services to the elderly when we do not know what the provincial policy is.
There are enough indications of its general direction that we rather assume that public health units will somehow be at the hub of the geriatric care system, but we would like to be able to discuss these matters intelligently. I think we can be helpful to the minister if he will share that policy with us. Again, I ask him if he will try to pursuade his colleagues to make that document available to us before we begin our public hearings on September 7.
My colleague the Liberal Health critic touched on the next set of concerns that I want to raise under the rubric of authority and responsibility. First, the public health nurse is given a mere mention despite the fact that the public health nurse has been the main service provider for most of this century. I gather the phrase "public health nurse" had to be added as an afterthought in response to protests from the nursing profession.
I would have thought that a public health act in the latter part of the 20th century would have spelled out the professional role of the public health nurse with some degree of clarity rather than ignoring it entirely and saying, as an afterthought, that the board may hire public health nurses inter alia.
Secondly, concerning the role of the public health board, I have to confess not to understand the role of the local board of health. I make that confession. I have no idea why anybody would want to serve on a local board of health under the terms of this statute. They have no authority and they have no responsibility; they are there as handmaidens of the medical officer of health, the chief medical officer of health and the Minister of Health.
All they are expected to do is forward names in nomination to the minister for ratification, as far as I can see. I do not see that the act confers on them any duties of any consequence whatsoever. The real authority and responsibility are vested in the medical officer of health, who is, of course, ultimately accountable not to the local board of health but to the Minister of Health, to the province of Ontario whose creature he or she is.
I do not think the kind of phenomenon I started to describe at the beginning of my speech with respect to these strikes, the expressed indifference on the part of local boards of health to whether or not their function is even carried out, will change until real authority and responsibility are vested in those local boards of health, until their relationship with their municipal councils is clarified, until their relationship with the province is clarified and until their relationship with the district health councils is clarified. Right now it is a complete muddle. The only thing that is clear in this act is that the minister intends to increase the number of provincial appointees.
Section 47(3), if I understand it correctly, increases the number of provincial appointees quite dramatically. Am I wrong? The minister is sphinxlike in his silence. I understood that in the old act there was a maximum of three provincial appointees; now we can appoint as many as -- I have temporarily lost track; my apologies, I have lost count. I understand it is possible to increase the number of provincial appointees but my notes elude me as to what the new numbers are. I understand there is a dramatic increase.
Hon. Mr. Grossman: An increase of two.
Mr. McClellan: An increase of two per board. At any rate, the previous ratio, I think, was seven to three. The new ratio is 50:50.
Hon. Mr. Grossman: No, it must be a minority.
Mr. McClellan: Am I wrong? At any rate, I may be off base on this; I am always the first to concede that I am off base.
I suspect, however, that there is an increase of provincial appointees which simply reinforces the trend I am expressing concern about, and the trend is the provincialization of the health departments.
This may be a matter of deliberate policy, and maybe the minister, in response again to the phenomenon I started my speech by describing, has chosen to take the route of centralizing authority in order to combat the phenomenon of indifference and neglect and malaise that afflicts our public health program, but it is absolutely clear that authority and responsibility within the public health unit are vested in the medical officer of health.
I do not understand why the minister has chosen to enshrine licensure by statute in the new act. I do not know why it is necessary for the chief executive officer of a public health unit to be a medical doctor. I do not know why it is necessary for the chief executive officer to be called the medical officer of health. I do not understand why section 61 of the act is in there: "No person is eligible for appointment as a medical officer of health... unless, (a) he" -- that is sexism there -- "is a physician" --
Hon. Miss Stephenson: It is a generic word.
Mr. McClellan: -- I understand that -- " possessing the qualifications prescribed by the regulations and the minister approves the appointment."
8:40 p.m.
I know there are a number of public health doctors in the ministry.
Hon. Mr. Grossman: Very fine ones, too.
Mr. McClellan: Yes, I admire their work. The minister knows that. But in 1982 it is not necessary to appoint a medical doctor as a medical officer of health. In fact, many people argue very persuasively that the whole notion of a medical officer of health as the chief executive officer of the health unit is a 19th century concept, rooted in the historical evolution of the public health movement, and that the requirements today are almost exclusively administrative. There is no guarantee that the appointment of a medical doctor along the traditional appointment lines will guarantee anything other than what we have seen in so many instances: it is a cushy retirement for a faithful medical servant. The minister knows what I am talking about. It is a serious mistake to continue the tradition of appointing doctors as chief executive officers of health departments, regardless of the true nature of their function.
Somebody suggested to me, after reading all the sections that set out the powers of the medical officer of health, that the act is almost silent on the powers or responsibilities of the board of health and that the act should really be entitled the medical officer of health protection act. The most interesting position in the act is that of the chief medical officer of health in section 78. This person seems to have more power than even the Minister of Health. I am sure these are errors of draftsmanship, but it may come as a surprise to you, Mr. Speaker, that the Minister of Health is required under the statute to appoint the chief medical officer of health. It does not say he "may" appoint. It says he "shall" appoint the chief medical officer of health.
Section 79 and subsequent sections give the chief medical officer of health the same extraordinary powers as were given to the trustees of the Toronto General Hospital in that extraordinary bill we passed, which we were assured was not a model for any future legislation. The chief medical officer of health can move into any health unit in the province and, as I understand it, put it in trusteeship, take it over and run it. I may be wrong, I may be misinterpreting the intent, but those are the powers that the language of the statute confer. We look forward to looking at this in clause by clause to see if this is the intention, and if so why.
On the issue of funding, the act is silent on the question of the provincial share. I assume it is going to remain at 75 per cent, but it does not say so in the statute.
Hon. Mr. Grossman: Yes, it is.
Mr. McClellan: But it does not say so, does it?
Second, there is complete ambiguity with respect to the funding of the core program. I understand that some of the core program will be funded at the level of 100 per cent in order to encourage boards of health to move into the mandatory aspects of the program. Again, we have absolutely no indication what the relationship is between 75 per cent funding and 100 per cent funding. The ministry has not spelled that out anywhere in the statute, and has left many public health officials in a state of considerable confusion as to how this act will be implemented financially. I do not intend to support a pig in a poke; we have enough experience with this government sticking it to municipal level governments.
I mean no particular aspersions on the incumbent, but our experience with this government over the course of the last eight years has been uniformly bad. We are not prepared to support legislation that imposes this level of obligation on a municipal level of government without spelling out the financial relationships in any detail whatsoever, except to say sotte voce that the 75 per cent relationship will continue and there are indications of some additional support moneys for implementation on a transitional basis.
That concludes the list of our concerns. We look forward to having hearings on this bill in committee. We hope we can persuade the minister to broaden the core programs. Our concern, simply put again, is this: the core programs represent the lowest common denominator of public health programs in this province, they do not represent the standard of excellence we have a right to expect. They do not represent the leading edge of public health reform we have seen operating in some boards across this province. They acknowledge a dismal state of the art in Ontario in public health in 1982 and try to drag the public health movement up to a minimal standard.
I suggest that standard is too low. We can set our sights higher. We have an obligation to confront the real causes of disease and not just to maintain the status quo with respect to 19th century traditions of preventive medicine. We need to engage ourselves in a serious way with occupational and environmental disease. It is the role of the public health unit to lead the way in that fight.
Mr. Van Home: Mr. Speaker, like my colleague I will attempt to be brief. I submit that every member of this chamber should have the same concern as was shown by the member for Bellwoods (Mr. McClellan), particularly as it relates to concern for citizens of this great province of ours in their work places and in their living places.
I want to direct the attention of the minister and members of the Legislature to one of two specifics reflected in comments to me by nurses in this province. As late as four o'clock this afternoon, I had one member of my riding submit to me that she was on the horns of a dilemma because she and her colleagues did not want to bug the minister too much about their lot in this legislation; on the other hand, they did not want it to pass without some comment.
They asked me to draw to the minister's attention -- and I am sure he will make right any error of omission; I am sure it could not be an error of commission -- that references have been omitted regarding public health nurses. It was pointed out to me that in section 1, the interpretation section, there is no definition of public health nurse. It is their feeling there should be.
In part II, health programs and services, section 5, they again indicate there is no mention of the specific role of the public health nurse in the various other areas mentioned. They feel strongly about that. I do not think there is a reason in the world for not identifying public health nurses in this legislation a little more specifically than has been done, and I am sure all kinds of representations will be made to the minister in this regard. I think enough has been said on that. The cut and thrust of debate in committee will see these areas clarified.
8:50 p.m.
I want to make reference to one other section which has not been spoken of yet in this brief debate. That is section 48 of part VI of the bill, dealing with agreements with councils of bands. A lot of concern has been expressed to me by some of the Indian people I have spoken to. They will want some kind of clarification. I cannot be more specific. They simply wanted it mentioned. When I get the further information I requested I will pass it on and share the concern these people have. I wanted that section pointed out as one where there may be additional comment, which the minister may wish to get ready for before the September meetings.
Having said those few words, I think I have added at least a little bit to the intent of what we are doing here in second reading, and I thank you for the opportunity, Mr. Speaker.
Mr. Renwick: Mr. Speaker, I want to speak briefly and with a considerable degree of humility about this particular bill before the assembly.
I suppose when one takes the trouble to read through a bill such as this even once, one realizes there is an immense amount of work by a large number of very highly qualified people that has gone before the introduction of the bill into the assembly. The process by which the bill finally comes before us is not something to be lightly considered or lightly criticized. I would not for one moment offer any comments tonight in the sense of overt or hostile criticism of the bill. I do not pretend to have any knowledge of the public health area other than as an uninstructed lay person in that field.
The humility I feel is something which must be shared by every member of the assembly, because once this bill is passed it will become part of the framework of the laws governing this province and will not be looked at again by this assembly for many years to come. I therefore think the assembly has a special and particular obligation to understand what the minister is saying to us. The minister is asking this assembly to grant to him and to the government of the province a total authority over the public health services of the province, with no response back to this assembly on any occasion.
I do not know what the modus is by which the response should be made and the accountability established in this kind of a bill to this assembly, but I think it is inadequate in this day and age not to have a specific provision in the bill providing for some kind of reassessment, an accountability to this assembly other than simply the attention it may attract when the estimates of the Ministry of Health are before the assembly in the routine way in which the estimates of this ministry and other ministries are considered.
We have not developed any really acceptable methods of accountability to the assembly for the immense grants of authority we give to the minister and to the establishment of the Ministry of Health when we pass such a bill. This applies to other areas of government as well as this particular area. We are very, shall I say, elementary in our views about accountability. We talk about perhaps an annual report. It would be at least worth considering in this bill whether there should not be provision for an annual report to this assembly about the bill.
It may not be possible to do this on an annual basis with a bill of this dimension which deals with province-wide concerns. It may well be that there should be an obligation on the Minister of Health once in the second session of each parliament to lay before the assembly a full report with respect to the operations of the public health act of the province or, as this one is designated, An Act respecting the Protection of the Health of the Public.
We do not have any method in this assembly of dealing with accountability other than through the traditional methods of the assembly. I emphasize that my remark is not made in any sense as a form of destructive criticism, but I do believe there has to be an accountability to this assembly for the immense authority we are being asked to grant to the minister.
I do not know what the modus is. I do not suggest for a moment that what I have just said is the way in which it should be done. I think there has to be established in this bill some method of periodic consideration by the appropriate committee of this assembly of the operation of the health protection system.
I say that because it is a grant of immense authority, and I need not refer in great detail to the provisions of the bill because it will be subjected, I hope, to intensive scrutiny in a committee of the assembly sitting when the House is not in session, and will have the benefit of a degree of input which I believe will be quite extensive because of the already evident concerns that a bill of this magnitude brings to many of the people of Ontario.
When we consider the kind of framework, and it is only a framework which the design of the bill puts before us, we realize what the minister is saying to us. He is saying that every board of health "shall provide or ensure provision of the health programs and services required by this act and the regulations to the persons who reside in the health unit served by the board."
That sounds fine, it sounds very good. It then goes on to say, "Every board of health shall provide or ensure the provision of health programs and services in the following areas," and it refers to the seven specific areas to which the minister referred in his very cursory opening remarks on second reading of the bill; all- embracing and very clear statements of the extent of the areas to be covered by the health protection.
But then we come to the crucial devolution of authority to the minister and to the government of the province, "A board of health is not required by this part to provide or ensure the provision of a mandatory health program or service referred to in this part except to the extent and under the conditions prescribed by the regulations and the guidelines."
I may say, by way of a minor aside, that we have not only provisions here for regulations, we have provisions for that modern extrapolation of a regulation in a form which is not nearly as clear or as enforceable as a regulation, namely the guidelines, which of course are equally mandatory and are not nearly as readily available to the public.
It is true it is possible for a board of health, with the co-operation of the council of the municipality, to have in place other health programs, but the basic health programs are under the control of the ministry, because when one turns away from the purpose of the act in that generalized statement to the provision of part VIII under the heading of "Regulations," then one realizes the extent of the devolution of authority which we are asked to give to the minister and to the government.
9 p.m.
In addition to the standard provisions with respect to the regulations, we find that the Lieutenant Governor in Council may make regulations relating to part II; that is, establishing the programs and services that are to be available to the public. Then we go on. The Lieutenant Governor in Council may make regulations relating to part III. Part III is the area relating to the community health protection. Then we find an extensive statement that the Lieutenant Governor in Council may make regulations relating to part IV, which is the communicable diseases area. We find further that the Lieutenant Governor in Council may make regulations relating to part VI, which from the index in the bill is the health units and the boards of health.
We find that for practical purposes everything we are being asked in this assembly is to be done by way of regulation. If it is not done by way of regulation there are no public health programs or services available in the province. That is the extent and the measure of my immediate concern about the bill.
There are a number of other provisions that have to be looked at. If we look at the structure of the bill and the immense powers the minister is asking that we give to him specifically in his capacity as minister, my concern about accountability and about a reference back at some point to this assembly for review and consideration is all the more dramatically brought home.
There is no need to go on at any length about the bill other than to say that in the committee which will deal with the bill I hope the minister will bring a reasonable degree of flexibility to the questions that have been raised by the member for Hamilton Centre (Ms. Copps) and my colleague the member for Bellwoods, and that other members will want to raise about the inflexibility inherent in this bill.
There appears to be a structure which is so set that there will be very little room for the government to be responsive to either innovative or imaginative suggestions about the whole area of public health, particularly when we juxtapose against the delivery of something called public health the whole question of community health services of one kind or another and the whole question of the private delivery of health care in the province.
Those remarks express as best I can the immense concerns I have about the devolution of authority. It is immense. This is not an exaggeration, but it is likely that there will be few, if any, members of this assembly sitting here when the next revision of this act comes before the assembly. It probably will be into the turn of the next century, and only myself and one or two others who are present tonight will be still here to recall this debate.
The concern I express is a valid one. I hope the minister is listening, because we are voting against the bill simply because it requires very extensive and intensive examination. It requires a very detached and opposed view to the bill in order that ultimately a reasonably good bill will emerge from the committee by way of report back to the assembly.
I ask the minister, when the occasion permits, if he will address specifically and directly the question of the way in which accountability will be established to this assembly.
Mr. Nixon: Mr. Speaker, I was interested to hear the explanation of the member for Renwick -- we might as well redesignate his riding since he expects to be here well after the turn of the century -- as to why he and his colleagues are opposing the bill. He has a philosophical approach to committee work, indicating that it only works if one is opposing the bill. It is sort of an interesting new concept. Actually, I like it better than the reason given by the New Democratic Party's Health critic for opposing it, which was even more obscure.
It seems to me when there is an effort like this, unless there is some opposition in principle to the state intruding into the assistance of the protection of public health, it does not make much sense to oppose it when it really is sort of a reworking of what has worked very well in the community over a number of years.
As a matter of fact, from my usual rather conservative approach to these things, I am darned if I can even see why we have the bill. I come from an area that has been extremely well served by boards of health and medical officers of health, certainly since I can remember and from reports well before. The system is working very well indeed.
There has been some substantial criticism that the government has not been fair in the distribution of its grants since Brant was a bit reluctant to enter into a regional system. There was a time when the grants to boards of health were based on their co-operation in the old McKeough processes of regional government. I believe those benighted approaches have now somewhat faded.
I also want to give the minister credit for bringing this forward. I suppose it has been in the works for some time and probably should be considered the Dennis Timbrell bill; or maybe even the Frank Miller bill or even the Matthew Dymond bill. Who knows? I am glad to see a few familiar faces under the gallery who have been around even longer than the minister. I am quite prepared to call it the Wysocki bill.
Knowing that some of the minister's, shall I say experienced advisers have been working on this, I have a little more confidence in saying I am very glad my colleague the member for Hamilton Centre, the chairman of the Liberal task force on health, has already announced that we intend to support the bill.
I wish the minister had taken a little more time with it, to apply his well-known initiative and his well-known concepts of putting his own stamp on things rather than just taking them in, saying, "That looks okay to me and I might as well ride this for all it's worth," and plunking it into the mill.
Once he checked to see whether or not Doctors Hospital was affected, I doubt if he even read it all the way through. That is probably a bit unfair.
I want to say again, the experience in our own area -- perhaps the member for Brantford (Mr. Gillies) would support me on this -- has been excellent. Dr. W. E. Page, who is well known to us all, has shown tremendously strong and independent initiative in our area, sometimes stepping on some sensitive toes but always leading the way in the protection of the health of the citizens.
The tremendous range of responsibilities he administers never ceases to amaze me. God help us if we should put an extra length of weeping tile in our rural facilities without his coming out, either personally or with one of his minions, to poke away at it with a stick and call for several more loads of gravel and what have you to make the thing work in our nonpercolating substratum.
They are responsible for the inspection of meat. Without raking over a lot of old straw, there was a time when there was some concern about this. I think we are very proud of what has been accomplished in this connection, in parallel with the government of Canada which, of course, has taken the lead in this matter over many years.
Mr. Havrot: Has it?
Mr. Nixon: The member has not had ptomaine poisoning lately.
Hon. Mr. Grossman: Have you been downstairs?
Mr. Nixon: Be careful. There are sensitive ears around here when it comes to what the minister calls "downstairs."
Interjection.
Mr. Nixon: All right. Quite seriously, I do feel that if the minister had put his own attention to the thing -- with the greatest respect for those people who have worked diligently and carefully, amending on the basis of their experience of what has gone before -- we might have had an approach a little more consonant with meeting the needs of the community for the next few years as referred to by the member for Riverdale (Mr. Renwick).
9:10 p.m.
For example, the minister's predecessor has imposed on most of us, and intends to impose on the rest of us, his famous health councils. They are sort of an arm of the community operated by the minister to shield him from the problems of imposing ministerial policy on local medical services. He and his predecessors have been very successful in co-opting many extremely capable citizens into what I have always suspected was a program to do what I have already said, shield the minister from the problems that accrue politically when we are on the downside of providing public medical services.
In the days when the government was granting money for expansions and new hospitals, we did not need a health council, because the minister's predecessors were always there with the sharp shears cutting the ribbon and smiling for the local press. Lately, when there has been a cutback in these services, it is normally said by the minister to be at the behest of the health council. Usually, the health council is simply told what it must do. It is given its piece of cloth and then instructed to cut it to the benefit of the local community.
I thank our lucky stars that, at least under the former Minister of Health, the draconian approach to the provision of hospital services in Brant county was at least amended to some extent. It may well have been the hardball politics this minister played with the former policy of reducing hospital services that meant Brant county and Brantford were not subject to the harsh directives that were attempted to be applied through the health council over the past few years.
My feeling is that there might have been a more imaginative approach to this. We could have established a procedure whereby we would replace the local boards of health, the local health councils, the various supervisory boards for senior citizens' facilities and various welfare or community and social programs with a more democratically established local board at the county level or whatever unit might be appropriate. It could be elected like a school board or perhaps, even better, directly responsible to the elected council, which would have an overall responsibility for the administration of health and social measures.
In this way, the minister and his various colleagues in other ministries would be relieved of the day-to-day responsibility for the supervision of these facilities as they are applied at the community level. They would have had the advantage of being able to preach local autonomy. At the same time, they would have been able to give the overall direction that is possible in other areas of public endeavour such as education.
There is a good deal of confidence in boards of health and various other administrative boards, but the minister might have moved into a new era of democratic control of the administration of these various services at the local level. That might have been interesting and productive. There are what politicians now call downsides to that proposal, but it is the sort of thing I regret has not been a part of the review of the bill or of the previous legislation.
From my observation, and as the representative of the county of Brant for 20 years, there has been uniform acceptance and approval of the work of the board of health, the medical officer of health and his staff. Thank goodness they have felt themselves independent enough not to worry about what the people here in Toronto, or even the minister, think about what they do. With the sort of independence I welcome and approve of, we in our area feel we have been well served indeed. I am not at all sure what this legislation will do to change or improve that.
I was interested to hear the Health critic for the New Democratic Party question whether the chief administrative officer has to be a medical practitioner. It seems to me that in a large jurisdiction that would not be necessary. In a smaller one, perhaps like Brant county and Brantford, one gains some additional service by having the person designated as the chief medical officer of health being a medical practitioner, but in a larger jurisdiction I am not at all sure that is really required.
Members will notice that we do not have a doctor as Minister of Health, for which I am very grateful. I do not even think a teacher should be Minister of Education. I can say that in the absence of some of my colleagues.
Mr. Van Home: You be careful.
Mr. Nixon: Or a general as minister of defence.
I think the role played by an individual as a civilian, if that is the proper term, is extremely valuable. Sometimes one cannot distribute the previous experience of various politicians to the optimum benefit of the community. Much as I would like to see the Minister of Education (Miss Stephenson), as she goes up the ladder of responsibility, emerge finally as Minister of Health, it would be interesting but a little bit tough for the people who would have to be under her supervision and, in her instance, control.
I simply say to the minister that I welcome the bill and will support it. Frankly, I do not see that it has any great breakthroughs, except for the removal of the Venereal Diseases Prevention Act, which may be a mistake. I do not know why the member for Brantford is applauding.
I can report to the House, on behalf of my constituents, that we have been very well satisfied with the services provided under the statute as it now is. I want to take this occasion to congratulate those on the local scene who have been responsible for this now for many years.
Mr. Swart: Mr. Speaker, the member for Bellwoods dealt with this bill for this party in a fairly comprehensive manner and pointed out the shortcomings. I do not intend to cover many items in this bill. There are three things, though, that I want to mention.
First, I want to emphasize what the member for Bellwoods said about the low priority given to public health nurses, in that they are barely mentioned in this act and as demonstrated by this government. Whether we talk about the public health nurses who are now on strike in Niagara or whether we look back to the year 1976 when the public health nurses were on strike, the indifference of the government to the withdrawal of those services was demonstrated, and certainly so if compared with what it did for the doctors in their recent threatened strike when they actually went out for one or two days.
The minister knows very well that for the sum of $2,000 or $3,000, or $4,000 at the most, he could bring the public health nurses up to the average for Ontario and have the strike settled in Niagara. Instead of that, he takes a hands-off position, even though the government has the primary responsibility for the protection of health for the people of Niagara. His indifference is clearly demonstrated by what is taking place. He gives a very low priority to the services provided by the public health nurses.
I know he will say to us here in this House, "The health unit is autonomous and we are not going to intervene." But it was rather interesting when the public health nurses met with members of the Legislature -- I think the member for Erie (Mr. Haggerty) was there at the time -- including the minister's parliamentary assistant and the member for Sarnia (Mr. Brandt). They were asked what responsibility or direction was given by the ministry to the members there. There was some difference of opinion among the members of the health unit appointed by the government. It is not known whether there was some real difference of opinion, whether they were really independent or whether they were acting, at least to some degree, as agents of the ministry. Whether they were or not the minister knows, and everybody else in this Legislature knows, he can influence the health unit in Niagara. He can provide the additional funds to get those nurses back to work if he wants to do it and if he really considers it important to have that service provided to the people of that area.
9:20 p.m.
Another point I want to make, and the minister may in his reply be able to point to sections of the new act that appear to be as strong as sections of the old act, is that from my reading of it there has been a substantial downgrading of the responsibility of the ministry and the responsibility of the health units for the condition of premises. Under the old act it was very clear. The minister will be aware that section 4 of the old Public Health Act states that it is the duty of the ministry and it has power -- a pretty strong statement -- among a great many other things, "to determine whether the existing condition of any premises ... is a nuisance or injurious to health." Another subsection of that same section says there is the power, "to enter into and go upon any premises in the exercise of any power," to correct the health condition.
Looking over the present act, except for vague terms and except for premises which are boarding houses or something of that nature, there is no similar power -- the minister can correct me if I am wrong when he gets up -- or not the same degree of power. I know section 2 makes some general reference to the responsibilities of the minister. It says, "The purpose of this act is to provide for the organization and delivery of public health programs and services, the prevention of the spread of disease and the protection of the health of the people of Ontario."
That is not nearly as strong as the clause in the original act. We could go on and look at subsection 10(1) of the act, which states, "Every medical officer of health shall inspect or cause the inspection of the health unit served by him for the purpose of preventing, eliminating and decreasing the effects of health hazards in the health unit." I presume that means in the health unit area. I think the wording there leaves a little to be desired.
Section 81 of the act states, "Where the minister is of the opinion that a situation exists anywhere in Ontario that constitutes or may constitute a risk to the health of persons, the minister may direct the chief medical officer of health to investigate the situation and to take such action as the chief medical officer of health considers appropriate to prevent, eliminate and decrease the risk to health caused by the situation."
Apart from those and the other clauses I mentioned applying to boarding houses and certain situations, it does not seem to me there is anything in this act which gives direct instructions and direct responsibility on the part of the minister and the health unit to deal with unhealthy premises. This, to me, has a very real application to the whole question of urea formaldehyde foam insulation. I have never figured out how the minister, under the existing Public Health Act, could refrain from intervening in this matter.
It must have been for one of two reasons. Either there was no health problem or hazard, and there is all kinds of evidence to contradict that, or else he somehow or other thought he did not have the duty and the power that the act states he has. The real situation was that he did not want to touch it with a 10-foot pole because of the costs he thought it might involve his ministry in, that is the real reason he did not touch it; but he had the obligation.
At this time we have another act before us which apparently weakens that obligation, that duty which the minister has and which the health unit has. God pity the people who have unhealthy premises, whether it happens to be urea formaldehyde foam insulation or some other chemical problem or whether it is just straight unsanitary conditions.
For these reasons, even if I were not in this group on this side of the House, I would have very real difficulty in supporting this bill. I suggest that when it does go out for hearings there will be people, very likely the Home Owners with Urea Formaldehyde Foam Insulation group, who will be coming before the minister asking him to accept the responsibility he has under this act, but, more, to assure that the new health act that is going to be enacted provides for the relief of those hazardous health conditions that exist for them and can exist for many other people in this very highly chemicalized society.
Mr. Haggerty: Mr. Speaker, I want to address myself to Bill 138, An Act respecting the Protection of the Health of the Public, and perhaps add a few comments similar to those that other members have already made.
I was looking through the explanatory notes of the bill itself, and I was questioning the part that says, "Medical officers of health are authorized to provide medical and public health nursing attendance and necessaries to persons in need of assistance who appear not competent to care for themselves."
I think of the present strike by health nurses in the Niagara district. I notice there is no definition of "health attendance" here, whether we are talking about nurses or whatever it may be that the minister through the act is going to supply or provide to the community.
I had some reservations a few years ago with my experience on council where a former medical officer of health for the county of Welland succeeded in implementing county health units. That was the late Dr. Sturgeon, who I remember visited council on a number of occasions trying to convince council members that we should dissolve or disband our local health unit at that time. We had, I think, two health nurses and a medical officer of health, a local doctor who worked part-time and did an excellent job in that community.
We always had excellent reports before council of any serious matter concerning sanitary facilities and food inspection in the urban areas. We had a detailed report coming to council every month, so we had an idea what was going on. But under the new regional health council and the health unit that is set up now, I know that local councils are not even represented by a member on the health council or health unit.
I notice that the bill says there should be 13 members. I think there are about 11 or 12 different municipalities in the Niagara region, and I find that two or three municipalities there today do not have representation. One is the town of Fort Erie, and another is the city of Port Colborne.
I suggest to the minister that when this new bill is introduced every municipality should have a representative on the health unit so that every area is represented and knows what is going on and so that full reports can come back to the local council, at least to let them know what is taking place.
I am concerned about the present health strike in the Niagara Peninsula, because I feel that is an area that is being neglected at present by the strike. There are a number of elderly citizens in the Crystal Beach, Fort Erie and Ridgeway areas who are not receiving the health care they should be receiving. The strike is now in about its sixth week, and there is no indication of when it is going to be settled.
I suggested on the front steps of the Legislative Building one way to settle it; now that there is an impasse between the health unit, the board of directors and the health nurses, a final-offer solution may be the answer.
9:30 p.m.
It is to be hoped the minister will step into it and give some assistance to get this strike settled. I think it is the second time within the last couple of years that the nurses have had to go on strike to indicate to the ministry and to the health unit their concern about their wellbeing as well as for society as a whole. I believe this is an area where they are seeking wage parity with other health units in Ontario.
In part III, the minister has indicated that community health protection requires medical officers of health and public health inspectors to provide for inspections in health units. I do not know if that would include a health nurse or not. I hope it would. Inspectors should be defined as to what category of personnel we are talking about.
They are authorized to make orders to decrease the effects of, or to eliminate, health hazards, as the term is defined in the bill. I notice it relates to environment areas of problems related to gases and other matters that may cause some health problems within a community. I would like to see that tied in with the Ministry of Environment and the Ministry of Labour so that we would have close co-operation between the three ministries. We would then at least know in what direction we are heading, instead of having ministries or agencies heading in different directions.
I am concerned about the Niagara Peninsula. I am sure the minister is well aware of the Niagara District Health Council's report. I understand a further study is being done in this area relating to the high mortality rate in the Niagara region. I think some answers are long overdue as to the causes of the high mortality rate in relation to cancer and respiratory diseases, and on the infant deaths and communicable diseases. There is a whole list of them. The Niagara region has the highest mortality rate in Ontario and across Canada, which should raise some serious concerns at the Ministry of Health about the causes.
Perhaps, if we had proper cataloguing of all deaths and the reasons for them, we would have an understanding of the cause. I do not have to tell the minister of the number of cases before the Workmen's Compensation Board relating to occupational health, particularly cancer of the respiratory system. The problem has existed for years in the Niagara region. The public has not had the answers. It is entitled to know what is causing these problems, whether it be environmental air contamination, water contamination, etc. Who knows what it is in that area? It is a high-risk area.
It does not help the area to have the health nurses on strike, because there is no follow-up on any communicable diseases. There is no follow-up on cancer patients or mental health problems in the region. There is a serious problem in the Niagara region as more persons are being removed from the institutions and the mental hospitals and put back into the community. There is no place for them. Or if there is, there is not sufficient quality of care in that region. That is an area the health nurses should be following up on. One field worker or social worker from the Hamilton Psychiatric Hospital is not sufficient to look after the regions of the Niagara Peninsula. That is causing some concern to a number of organizations and families in the community.
I am concerned also about the health care of elderly citizens in the Ridgeway-Crystal Beach area. I have written a letter to the minister concerning the phasing out of the Maple Brae Lodge Nursing Home in Ridgeway, which has 20 beds now. There is no indication where these 20 patients are going to be accommodated.
They will not find accommodation in the homes for the aged in the region because there is a considerable backlog of persons waiting to be admitted. They will not be admitted to Crescent Park Lodge Nursing Home in Fort Erie, the nursing home in Chippewa or anyplace in the region, because there are no facilities for them. There is a backlog of residents waiting to be admitted into nursing homes and there are no facilities available.
What disturbs me most about the phasing-out of the nursing home in the Ridgeway area, though I agree with the --
Interjection.
Mr. Haggerty: It is on health care.
The Deputy Speaker: I know, but come on.
Hon. Mr. Grossman: No.
Mr. Haggerty: Pardon? It is not public health? What is it if it isn't public health?
Hon. Mr. Grossman: It comes under the
Nursing Homes Act.
Mr. Haggerty: I thought that was covered in the bill. Let us go back to that page. It says: "Charitable Institutions Act, Child Welfare Act, Children's Institutions Act, Children's Mental Health Services Act, Children's Residential Services Act, Day Nurseries Act, Developmental Services Act, Homes for Retarded Persons Act, Homes for Special Care Act" -- I do not know what that would cover -- "Homes for the Aged and Rest Homes Act."
The Deputy Speaker: What are you reading
from?
Mr. Haggerty: From the act.
The Deputy Speaker: I know, but where?
Mr. Ruston: You have the wrong bill, Mr.
Speaker.
Mr. Haggerty: It starts on page 13 and covers several different acts including, besides those already mentioned, the Private Hospitals Act and the Nursing Homes Act. So certainly the bill includes those other acts.
All I am trying to convey is that there is a problem in that area. My colleague the member for Welland-Thorold (Mr. Swart) mentioned the problem of the follow-up on urea formaldehyde. I do not know what is being done in that area.
I have a letter from a doctor that I should read into the record. It tells of the problems four children have encountered in which there was no follow-up whatsoever from the public health nurses. It is not their fault; I think it is the director in the area who is not following up. But it is a serious problem, and only one of those that I have.
I support the bill in principle but I think we should define just what the public health nurse in the area is to do. At the meeting we had this past week with the Conservative and New Democratic members, I am sure we all felt that public health nurses should be considered an essential service. I suggest to the minister that should be put in the bill because they provide an essential service. I hope we shall see some amendments brought forward by my colleague the member for Hamilton Centre (Ms. Copps) in this regard.
The minister talks about the new bill, but one of the members said earlier that it was just a recycling of an old bill.
I have copy of a letter I referred to from the health services in the Niagara region and addressed to the Health minister. It reads as follows:
"About $140 million was spent on total health care in 1979 compared to about $3 million spent on prevention." You will have to convince me that you are going to do good health care prevention in the Niagara region when you are only spending about $3 million. "This is a great discrepancy in funding when only two per cent is being spent on preventive health care." And that is all it is; just about two per cent of the total budget to be spent on health care.
If this was tied in with all the other health units throughout the regions and counties and municipalities, probably the same amount of money is being spent, mostly on administration costs. I suggest that if the minister is going to put through a bill of this nature, he had better come forward with sufficient funding to carry out the preventive health care that is required in communities in Ontario.
9:40 p.m.
Hon. Mr. Grossman: Mr. Speaker, I have listened carefully to most of the remarks made by the opposition members. They raise some very valid concerns, most of which were covered in one way or another by the literally thousands of briefs that have come to the ministry over the past many years. Quite frankly, as my predecessors, whom the member for Brant-Oxford-Norfolk (Mr. Nixon) referred to earlier, and I and my staff reviewed these things and in some cases, the decisions were very difficult to make. In some instances it was not terribly clear in which direction to go, but ultimately we had to make some decisions, some choices, as we all must from time to time. Certain choices were made and this bill was brought forward.
It is because of some of the excellent points raised this evening and because of the points raised in many of the briefs that have come over an extensive period of years that we do intend to have a serious hearing at the committee stage. We will be listening intently to the briefs that are submitted and we will make any material we have on hand that has been submitted by the public available to the members of the committee. We will be listening with a view to seeing what alterations, if any, might be appropriate to the legislation to deal with some of the concerns that have been raised.
I shall not take the time of the House to go through many of the issues raised tonight, because so many of them did deal with what will be dealt with at the clause by clause stage. But in terms of the principle of the bill, I think, as the member for Hamilton Centre (Ms. Copps) pointed out in her remarks, this is an important updating of the legislation. It is a move in the right direction, as the member for Bellwoods (Mr. McClellan) pointed out too. It is just an early and small step towards full preventive medicine and we are serious about that area. I do think that while this goes only part of the way there, it is an important part of the way there.
I would acknowledge too, the contributions made by the Toronto board of health, among others, and the areas the member for Bellwoods referred to in regard to mental health and environmental health. However, I must say that from the standpoint of having clear lines of responsibility in the provincial government, in terms of the acts that give direct responsibility for occupational health, in the one case, and for environmental protection, in the other case, to sister ministries of ours, with the right and the freedom of the local health unit to play a role in emphasizing some problems in some areas and bringing them to the attention of the respective authorities, I think the current breakout of authority and separation of authority is appropriate. Any introduction of those responsibilities into this legislation would lead to duplication and the fogging of authority, which would not be productive to solving the concerns he raises.
Practically all the members who have spoken have raised the question of the role of the public health nurses. I think this ought to be addressed at the committee stage because they certainly have expressed their concern to me quite clearly. I believe they have heard some fairly reasonable responses and explanations from my predecessor and myself, as well as our staff. Still, there is no question that while they are, I believe, somewhat more reassured at this stage, there still is some concern in their minds.
May I say I understand, and I do appreciate the fact as I think the member for Hamilton Centre mentioned, that they have decided they should allow this bill to proceed at this stage, and make some substantial input at the committee level. But I hope they do not feel they were ignored at all in the process. A great deal of time was spent on trying to clarify their role and to make sure they were included in the legislation. I do appreciate the fact that they want this bill to proceed and are anxious to have the bill pass in whatever shape and with whatever sections in it, given their opportunity for input to a committee, which I know will be very sensitive to the concerns they raise.
Given the fact that this is approval in principle, I want to deal for a moment with the remarks of the member for Riverdale (Mr. Renwick) who touched on what I consider to be some important matters. In looking at the generally high standard of delivery of public health through the local health units throughout the province, acknowledged in Brant and other areas by some of the speakers this evening, the fact is that whether we are talking about salmonella in Peterborough or whatever, ultimately, by virtue of the Ministry of Health Act, the Minister of Health is responsible for all of these matters in one way or another.
Whether that responsibility is direct or indirect and whether the main responsibility lies elsewhere, ultimately, in a liberal reading of the Ministry of Health Act, the members of this assembly, as one looks through the history of question period, ask those questions of the Minister of Health.
It is the object of this legislation to increase the powers of the local health units, to equip them better to do their jobs, to give them clear responsibilities and clear lines of authority, and at the same time, to have a connection in there which allows the Ministry of Health to play a role where there are very severe problems with local health units. There have been a couple of occasions when the Ministry of Health has found itself strangled by its inability to deal with some very real problems with local health units which it did not have direct authority to deal with.
This is an attempt on the one side to increase the role, responsibility, authority, and independence of the local health units, while on the other side acknowledging the ultimate responsibility which lies back here in an emergency and overseeing sense.
I have thought about the question raised by the member for Riverdale regarding accountability and it goes back to the whole estimates process. I have often reflected upon the difficulties in the estimates process, and many of the issues he raises should be dealt with by others in this assembly under the general auspices of responsibility to the assembly. How can we get an effective form of review of ministerial responsibilities and grant of power and do it more effectively than the current estimates process?
As a minister who has taken five or six sets of estimates through the House or committee, I feel the current structure is one which, in my own view as one member of the assembly and one minister, neither allows real issues to be tackled with full and complete knowledge on behalf of the opposition parties, and enough honing down on the two or three issues that might most properly be addressed, nor is it one which uses the hours effectively enough.
I say that as a minister who has learned a bit from estimates and has listened to what the opposition said, and on occasion has changed some ministry policies on the basis of what has occurred in estimates. On the other hand, in this minister's view, the current length of estimates is rather extraordinary in some cases. Given the fact that we tend to wander around the map and touch a variety of constituency and local and smaller concerns, rather than hone down on policy matters which are fundamental to legislation such as this, I for one would be very supportive of a reworking of the entire mechanism to address that problem.
I share the concern of the member for Riverdale with regard to this kind of legislation and, in this regard, I would like to refer to the remarks of the member for Brant-Oxford-Norfolk when he talked about the fact that this is a piece of legislation that has been many years in the making. It is very much the Wysocki bill, and the Timbrell bill. My predecessor seconded this piece of legislation because of the hours he committed to this.
As a new minister, I had a decision to make with regard to whether I would put this over to the fall and spend extensive hours working through this bill, section by section. Let me say quite honestly, had I done that, I would have ended up with something a little different in a couple of sections. I do not know which sections.
We have been through the bill rather thoroughly. It is one of the things I did in my early days in the ministry. Ultimately, I made the decision, after having made a half dozen changes. There may have been more had I decided to defer this to the fall and to have the committee sit over the winter. Had the bill not then been passed until a year from today, it may have come in a different form. I like to believe though, having sincerely committed myself to open committee hearings and being determined to listen to the concerns that are raised that the public is better served by getting this bill in now; getting it to committee this September; giving me and my parliamentary assistant an opportunity to again review these things, and giving the public a chance to read copies of the bill as we think it should be passed at the present time. That is the best route to follow in getting this legislation into place as quickly as possible, yet having as full a public scrutiny as possible.
9:50 p.m.
We will be listening, partly because I have made a conscious decision not to do the kinds of things the member for Brant-Oxford-Norfolk said I might have done, that is, put my own stamp on it, as he put it. I have no pride of authorship on this. I just want the best piece of legislation possible. I believe the piece handed to me by my predecessor is a fine piece of legislation. We did make some changes to it, but ultimately I think the final bill should be the result of my review as a result of what we hear in the committee stage.
There are things I could add, but I think most of them properly belong in the clause by clause study. As I say, we want to reaffirm our commitment to having that done most carefully and sincerely by our ministry and to having these matters reviewed once again at that time.
The Deputy Speaker: Mr. Grossman has moved second reading of Bill 138, An Act respecting the Protection of the Health of the Public. Is it the pleasure of the House that the motion carry?
All those in favour will please say "aye."
All those opposed will please say "nay."
In my opinion the ayes have it.
Vote stacked.
IMMUNIZATION OF SCHOOL PUPILS ACT
Hon. Mr. Grossman moved second reading of Bill 142, An Act to protect the Health of Pupils in Schools.
Hon. Mr. Grossman: Mr. Speaker, as I indicated when I introduced this bill for first reading some weeks ago, it is our belief this legislation will virtually eliminate in our province, measles, rubella or german measles, diphtheria, tetanus, polio and mumps. To accomplish this, we will require that all people show proof of their immunization against these diseases or that they obtain the necessary immunization without delay. Naturally, exemption to the provision will be allowed for medical and/or religious reasons.
It is our hope, and it is the reason we wanted passage for this session, that the legislation can come into effect in September of this year. While we cannot realistically expect there will be total immunization by that time, we can expect within the first few months the program will be well under way.
We intend to proceed as follows. In the first few months our immunization priority will be the youngest and most vulnerable students, that is, those entering the school system for the first time. Afterwards, immunization will be directed towards the remaining students. We are asking the medical officers of health to make sure all students in the system be immunized as soon as possible since they are the ones who are in the best position to judge the circumstances within their own communities. They will also exercise the necessary discretion in any enforcement question.
The legislation also authorizes the medical officer of health to order the suspension from school of any pupil who is not in the process of being immunized and who is not exempt. In addition, during an outbreak or a threatened outbreak of any of the designated diseases, the medical officer of health may order the exclusion of any pupil who has not been completely immunized and who is not exempt because of natural immunity.
There is clear evidence that we are not able to control outbreaks through voluntary measures alone, even though we have now achieved 80 per cent coverage of our population. We think it is time now for more direct and comprehensive action. As has been indicated with the previous legislation, it is a priority of our ministry to put a renewed emphasis on public health and preventive medicine in Ontario. This also means we must establish maximum rates of immunization across the province or we will always face the danger of further outbreaks of contagious diseases.
In planning this legislation, we have had the full co-operation, working speedily, of officials in the Ministry of Education. We have their assurance of continued co-operation as the program is implemented as quickly as possible. The new legislation is a step which I believe will be greeted with enthusiasm by every person in this province, but especially by the parents of young children. Once enacted, this province will have the finest immunization program and procedure of any jurisdiction in Canada.
Mr. Van Home: Mr. Speaker, I am delighted to be able to say a few words on this piece of legislation and to note at the outset that the words just uttered by the minister were very different from those uttered by his predecessor approximately a year ago.
I do not want to quarrel with this bill, because I feel very strongly about mandatory immunization. I would remind the minister and members opposite that back in the fall of 1981 the question of mandatory immunization was raised in this chamber and was responded to not in a cavalier or offhand way but in a way that reflected something less than total concern with the problem.
That question was raised on October 15, 1981. Further to that, a point was raised in the estimates in November 1981, and I am going to take this opportunity to reflect for a moment on the minister's response. I am not going to bore members by reading reams of Hansard from those dates, but at that time the then minister, now the Minister of Agriculture and Food (Mr. Timbrell), indicated that we really could not overlook this business of personal choice. I submitted to him that the evidence of not only our province and our country but of the United States, where there was mandatory immunization, was such that the issue could not be ignored.
In my view the government has reacted, but it has reacted rather slowly. Although I am happy to see the legislation, I wish they had not done the silly thing they did some years ago when they suggested it was a matter of personal choice and the solution to the problem was to have a form that could be completed through the Ministry of Education for listing the history of whatever immunization the young person had when entering school, and that in fact immunization was a voluntary thing. It was silly and wrongheaded, and I could not agree more with the mandating of immunization that we now have before us.
The Globe and Mail, in an article by Orland French on June 16, 1982, entitled "The Needle That Saves Children," really directs the compliments and bouquets to the Minister of Education (Miss Stephenson) and to the former Minister of Health as the persons who are responsible for getting the present minister to act quickly on this matter. There is no reference there, of course, to the efforts of members in our party, or for that matter to those of the third party. We were attempting to speak not only on our own behalf; we are not that self-serving or self- seeking. We were responding to what I feel was an honest concern reflected through many organizations, such as the Association for the Mentally Retarded, who spoke with me and with people who preceded me as Health critic about their grave concern on this topic.
The ultimate winners in this whole process are going to be the young people in our community, and that has to be the underlying concern of all of us.
When it comes to the business of passing around bouquets, I would like to take this opportunity to commend such organizations as the Association for the Mentally Retarded for the work they have done behind the scenes. No reference was made to them in any press coverage or in any debate I have heard up to this point, but I submit that we need to commend such organizations for hammering away at something that should have been done a long time ago.
10 p.m.
I would point out that the victory is not that of the Minister of Health (Mr. Grossman), the Minister of Education and the Minister of Agriculture and Food. The victory is that of the taxpayer in this province. If one assesses the cost of trying to accommodate the physical needs of a young person who is afflicted with a severe case of measles or one of the other diseases listed in this bill, and the savings realized through not having to provide what otherwise would be a long and complicated service within the hospital setting, the big winner here will ultimately be not only the youngster but the taxpayer who pays that hospital bill.
I would remind the minister that last year I introduced a private member's bill dealing specifically with the theme of measles. When one deals with private members' bills we all know to try to keep them relatively simple. I learned that the hard way as a new member when I tried to deal with another theme, fiscal responsibility. I introduced a private member's bill that was far too complicated for members opposite to understand or appreciate. It was summarily blocked in the good old Tory fashion.
But last year had an example of a member of the opposition attempting to present to this Legislature a simple theme -- one ailment, one disease in this instance -- to draw to the attention of the government the concern that we have for this broader theme of mandatory immunization.
In a sense I have got a few things off my chest in the last few minutes, but I wish this had been done earlier. The fact is that it is before us. I support it totally and I would hope the bill would pass very quickly.
Mr. McClellan: Mr. Speaker, I am unabashedly delighted to be able to rise and say that I support this bill without any equivocation or reservations. As my colleague the member for London North has said, I think it is long overdue. It is something we have argued for with successive Ministers of Health. The incumbent is to be congratulated for bringing it forward so quickly.
It remains a mystery to me why the ministry did not do this a fair while ago. One of the things the ministry is to be commended for is the quite excellent compendium to the bill, which provides some background data on communicable diseases reported over the years going back to 1977. It is clear that the trend started to show up back in 1978. I do not have data prior to 1977 but I suspect that the trend started to show up even prior to 1977.
The reality has been that with 20 per cent of the child population not immunized, communicable diseases in some areas were starting to make something of a comeback. The ministry always argued that it was a question of parental responsibility rather than community responsibility. We argued this was an erroneous approach to preventable disease.
Today, we stand with a piece of legislation that will close that gap. I am quite convinced it will lower the incidence of vaccine-preventable disease significantly. At the same time, the bill does have very strong and good provisions to safeguard minority viewpoints and religious viewpoints.
I do not think there is a need for much ado about this piece of legislation that has long been awaited and is much welcomed. The minister is to be congratulated for bringing it forward today.
Mr. Van Home: Mr. Speaker, in my comments I neglected to draw to the attention of the minister a concern that I have with section 12, simply to clarify the role of the attendance counsellor, which is spelled out in section 23 of the Education Act in so far as authority to suspend.
I am just wondering -- the minister indicated that there was co-operation with the Ministry of Education -- if in fact the bill might have to be amended to make sure that proper authority is there for that right, if you will, to suspend a pupil.
Ms. Copps: Mr. Speaker, it certainly makes my heart warm to be able to stand twice in one night and throw plaudits at the minister.
I would like to remind the minister that at the time it was introduced for first reading, I stood up and suggested that perhaps in the absence of the Minister of Education (Miss Stephenson) the member from London North, who is the real driving force and proponent behind this legislation, could second the bill.
At that time if one checks the record, the minister indicated he would recognize on second reading the contribution made by opposition members. He said, and I quote, "Wait until second reading." Unfortunately, I did not hear that happen tonight.
The member for London North did point out the very fine contribution made by a number of private organizations across the country, and particularly the Canadian Association for the Mentally Retarded. I would like to take this special time to throw a few bouquets to the member for London North.
In his rather brief tenure as the Health critic, one of his main aims was this particular piece of legislation. That was very apparent last year when he introduced the private member's bill and it was very apparent in the reams of correspondence that I received on that subject when I took over his responsibilities.
Having experienced the joys, or lack thereof, of majority government in Ontario, I have to say there are times when members of the opposition get rather frustrated and feel their efforts are to no avail. This is one case where the member for London North can retire in the good graces and comfort of knowing that in fact it was his effort and the effort of a lot of other people in Ontario that will finally bring this legislation to fruition.
The minister pointed out that the voluntary approach effectively covered only 80 per cent of the children across Ontario, and I would have to agree with the comments of the member for Bellwoods (Mr. McClellan) and the member for London North that in fact this legislation was too long in coming.
It may perhaps be seen to be trite to say that if there is one child who has been struck by the effects of any of these communicable diseases as a result of the lack of this government -- and specifically the previous Minister of Health -- to move in this area, then the time has been too long in coming.
All of us on all sides of the House must agree that there should be a mechanism whereby this kind of legislation can be brought forward quickly. I would like to parallel another piece of legislation which is very near and dear to my heart and which I hope will be implemented at least in part by the end of this year, and that is the legislation respecting the paramedic service in the province. For any family or any child who goes through the pain of the after effects of a non-rubella vaccination, I think one day or one week or month is too long to wait, and I hope we can move very quickly to have this legislation brought into effect so that children all over Ontario can be immunized effectively this September.
Mr. Grande: Mr. Speaker, I want to stand in my seat and make a few very brief comments on this bill. It is obvious that the bill enjoys the support of all the House, of all three parties; there is no doubt about it. But there is one thing I would like the minister to address. It has been asked why it has taken so long for this bill to come to the fore.
As a teacher in the schools I am certainly aware of the problems with these kinds of diseases that afflict children year in and year out. I am just wondering what the stumbling blocks were; why at this particular time; why not before? It is as simple as that. Maybe it is that the medical profession finally has decided it should be done in a public way, or maybe there was not enough vaccine. I certainly would be very interested in the answer.
10:10 p.m.
Hon. Mr. Grossman: Mr. Speaker, the member for Hamilton Centre (Ms. Copps) is quite right. I thought I remembered promising to acknowledge the bill introduced by the member for London North back on June 11 when I introduced the bill. It did not make it into Hansard, but she is --
Ms. Copps: Selective deletions. They are a problem. You should do something about that.
Hon. Mr. Grossman: I never seek selective deletions; they are not intentional.
I say quite seriously that because I was rather anxious to get second reading this evening I did rush through my earlier remarks, as the members could tell by the speed with which I read them. Had I had a little more time I would have remembered to be fair and to acknowledge the contribution of the member for London North, who did have a bill and who has indeed been pressing this matter in estimates for some years.
I might say as a member of this cabinet that long before I became Minister of Health I have been party to several discussions where the member for Scarborough East, the Provincial Secretary for Social Development (Mrs. Birch), has spoken articulately and often on the need to move this program ahead as quickly as possible.
Mr. Laughren: Hardly likely.
Hon. Mr. Grossman: It is absolutely true.
Mr. McClellan: She could not budge Timbrell.
Hon. Mr. Grossman: I am about to be nice to
you; do not stop me now. I should also acknowledge the fact that the New Democratic Party has also been pushing for this legislation for some time.
Mr. Laughren: Most likely.
Hon. Mr. Grossman: No. Their party supported the Health Protection Act a moment ago, and you did not.
I want to encourage the member for Hamilton Centre to get into the habit of extending plaudits and supporting the Minister of Health's legislation. It is not a bad habit.
Ms. Copps: It will not happen very often, believe me.
Hon. Mr. Grossman: You could get to like it. Try it, you might like it.
Mr. McClellan: A communicable disease.
Hon. Mr. Grossman: Indeed, we may even continue to provide good compendiums, as the member for Bellwoods noted, if she is this supportive all the time.
In any case, I do want to say in fairness to my predecessor, who was a strong believer in this and urged it upon me when I took this job, that he was working, as was my ministry staff, with the boards of education, with their administrators and with those who have to make sure of the availability of serum in order to ensure that the program could be implemented.
One of the reasons I asked my good friend and colleague the Minister of Education to second this bill was that she was most cooperative in dealing with this from the time I indicated I really wanted to get this bill in during this session. She helped in getting the boards of education to work as quickly as possible in order to enable this bill to be passed this spring and to be implemented beginning this fall.
As I acknowledge the contribution of the member for London North, the support of the Health critic for the Liberal Party, the support of the NDP, the support of the member for Scarborough East on our side of the House and the work done by my predecessor, I also want to acknowledge the efforts made by the Minister of Education to ensure not only that this bill would be passed but that we could have it implemented and in place by this fall. This means a great deal of work for very many boards over the next couple of months, but, as has been indicated across the floor, I think it will go a long way towards --
Ms. Copps: How about Frank?
Hon. Mr. Grossman: He supported it as well. Just give me a list. All 70 members on this side have supported this bill and urged it upon me. The member for Niagara Falls (Mr. Kerrio) is against it, but the rest of us are all in favour of it.
In any case, I want to thank members of the House for their support of this important piece of legislation.
Motion agreed to.
Ordered for third reading.
Mr. Speaker: Mr. Grossman moves third reading of Bill 142.
Mr. McClellan: Mr. Speaker, normally we do not second and third readings at the same time, do we?
Mr. Speaker: Yes, you can.
Mr. Van Home: Mr. Speaker, just to remind the minister of what I said a few minutes ago about the section relating to the ability of the medical officer of health to suspend a pupil, I want assurance that there is co-operation with the Ministry of Education, particularly as it relates to the section of the Education Act dealing with the authority to suspend pupils.
Hon. Mr. Grossman: Yes, Mr. Speaker, that has been worked out.
Mr. Van Home: Thank you.
Motion agreed to.
10:30 p.m.
HEALTH PROTECTION ACT
The House divided on Hon. Mr. Grossman's motion, which was agreed to on the following vote:
Ayes
Andrewes, Ashe, Baetz, Barlow, Bennett, Birch, Boudria, Brandt, Breithaupt, Conway, Copps, Cousens, Cureatz, Dean, Drea, Eakins, Eaton, Edighoffer, Elgie, Epp, Eves, Fish, Gillies, Gordon, Gregory, Grossman, Haggerty, Harris, Havrot, Henderson, Hennessy, Hodgson, Johnson, J. M., Jones, Kells, Kennedy, Kerr, Kerrio, Kolyn, Lane, Leluk;
MacQuarrie, McCaffrey, McCague, McGuigan, McKessock, McLean, McMurtry, McNeil, Miller, F. S., Miller, G. I., Mitchell, Newman, Nixon, Norton, Peterson, Pollock, Pope, Ramsay, Reid, T. P., Riddell, Robinson, Rotenberg, Roy, Runciman, Ruston, Scrivener, Sheppard, Shymko, Snow, Stephenson, B. M., Sterling, Stevenson, K. R., Taylor, G. W., Taylor, J. A., Timbrell, Van Home, Villeneuve, Watson, Welch, Williams, Wiseman, Wrye.
Nays
Breaugh, Bryden, Charlton, Cooke, Di Santo, Foulds, Grande, Laughren, MacDonald, Mackenzie, McClellan, Philip, Renwick, Samis, Swart.
Ayes 83; nays 15.
Motion agreed to.
Ordered for standing committee on social development.
The House adjourned at 10:36 p.m.