InJune 1996, the Liberal government allocated $12 million over six years to establish five research Centres of Excellence for Women's Health in Halifal<,Montreal, Toronto, Winnipeg, and Vancouver. Also that year we required that women be represented in clinical trials fornew drugs and announced three research studies relat-ed tosenior women's health as part of the Canadian Study on Health and Aging. Researchers at Health Canada have also launched an extensive study of the health effects of breast implants.
The Liberal government is helping women to maintain and improve their health bysupporting programs, ser-vices, and laws that reduce health risks to women. Wehave introduced legisla-tion prohibiting thirteen unacceptable uses of new reproductive and genetic technologies. Our Canada Prenatal Nutrition Program hasfunded nearly
300 projects across the country. These projects provide food supplements, nutritional advice, and counselling on
lifestyleissues such as drug and alcohol use, stress, and family violence to preg-nant women in high-risk situations.
Aspart of ourTobacco Demand Reduction Strategy, we have launched strategic initiatives on tobacco use by women, particularly pregnant women and new mothers. We have also brought forward legislation to regulate the manufacture, sale, labelling, and promotion oftobacco products.
In August 1996, we held the first-ever Canada-U.S. Women's Health Forum to examine health issues com-mon to women inboth countries -issues such as breast cancer, smoking, stress, and violence against women.
A program of cooperation on women's health, including joint initiatives ona range of women's health concerns, was agreed upon at this forum. A new Liberalgovernment will sustain this level ofcommitment to helping Canadian women maintain and improve their health.•
beyond the net income threshold for dependants.
In accordance with the recommendations of the National Forum on Health, a new Liberal government will support the shift to home care by creating a caregiver tax credit that will provide new or increased tax relief to Canadians caring for infirm family members - including seniors receiving OAS or GIS - at home.
Prescription Drugs
New drug therapies have replaced many earlier forms of treatment, making it possible to reduce the amount of time that patients spend in hospi-tals. Our current system provides full coverage for institutional care, including all drugs admin-istered during a hospital stay. Once patients go home, however, they are not guaranteed public coverage for medically necessary drugs.
Although some public coverage isprovided for specific groups and situations, prescription drugs have yet to be fully incorporated into provincial health insurance schemes. Many Canadians have limited drug coverage through their employers, but a full 12 percent of Canadians have no coverage at all for prescrip-tion drugs.
This situation is plainly inconsistent with the values upon which Canadian medicare is based. It is both unfair and illogical to guarantee access to medical diagnosis but not to the associ-ated treatment. Neither does it make economic sense. Those who cannot afford to fill their prescriptions tend only to get sicker and require more costly treatment later from the public system. The Liberal government is committed to maintaining a universal health care system, in which Canadians are assured equal access to appropriate, quality care as needed.
Public coverage of medically necessary prescription drugs, as recommended by the National Forum on Health, would not only ensure universal access to treatment, it would also reduce the amount of money that Canadi-ans are already spending on drugs by extending the proven advantages of the single-payer system. These advantages include simplified administration, volume discounts for bulk
purchasing, and improved monitoring of best practices in prescribing and dispensing.
Public coverage would thus help to control overall drug costs, which are rising faster than the costs of any other part of the health care system. It would also reduce the amount of money Canadians spend on premiums and co-payments at the pharmacy, and on private insur-ance and employee drug plans. These reductions would in turn extend the competitive advantage that medicare offers to Canadian employers in the global marketplace.
The Liberal government endorses pharma-care as a long-term national objective. Some provinces are already developing a system of drug coverage. We will work with our provincial partners to ensure that all Canadians have access to medically necessary drugs within the public health care system. The federal government has a role to play in bringing together its provincial and territorial partners and a range of other interests to develop a national plan and
timetable for introducing prescription drugs into our medicare system.
A new Liberal government will pursue a strategy - together with representatives of provincial and territorial governments, health service providers, private payers (employers and unions), and consumers - to address the fact that drugs have become an essential component of health care. We will develop with these groups a timetable and fiscal framework for the implementation of universal public coverage for medically necessary prescription drugs. When this plan and timetable have been devised, and when a sufficient number of provinces have agreed, a new Liberal government will be able to make a significant financial contribution to bringing pharmacare into reality.
Promoting Good Health
The health gains that Canadians have made in recent years are attributable in large part to an excellent health care system built on sound prin-ciples and strong partnerships between federal and provincial governments. But health care is just oile of a much broader set of factors that
have aprofound influence on the health status of individual Canadians and the population as a whole.
There are many non-medical determinants of health that we cannot choose or change:
things like our genes, our natural environments, and our early childhood development. But we can make choices about other factors that influ-ence health. These include lifestyle decisions on diet, exercise, hygiene, smoking, alcohol and drug use, and sexual activity.
Canadians have also come to recognize that social and economic factors playa significant role in determining health. Employment, educa-tion, income and social status, self-esteem, and sense of control over one's life are often closely related to both health status and life expectancy.
The social safety net that successive Liberal governments have created in Canada provides income support, employment insurance, social assistance, and arange of other programs designed to even out social and economic disparities.
A range of initiatives designed to address these broader determinants of health are outlined in more detail on pages 58-61 and 80-81. These include early intervention programs to foster healthy child development inCanada's Aboriginal communities and non-Aboriginal families at risk, increased support for commu-nity-based prenatal nutrition initiatives, and significantly enhanced income support for low-income families with children, to be accompa-nied by greater provincial investments in services for children.
Over the past few decades, Canadians have succeeded in building a health care and social support system that is one ofthe best in the world. Now we need to set our sights on an even higher goal: developing the healthiest popu-lation in the world. To achieve this goal, we must work in close partnership with provincial and territorial governments and incooperation with other sectors.
The federal government works every day to help Canadians maintain and improve their health in a variety of ways that are easily taken
Together with key partners,a new Liberal government will develop a national plan and timetable for introducing universal public coverage for medically necessary prescrip.
tion drugs.
for granted. These involve looking after the safety of foods and products; the regulation of drugs, cosmetics, consumer products, and the environment; prevention and control of diseases;
funding of public health research and policy analysis; health promotion activities among vulnerable groups; and delivery of health services to First Nations and Inuit people. An additional and increasingly important way for the federal government to help Canadians main-tain and improve their health is by encouraging the widest possible dissemination of reliable health information.
Developing a Health Information Infrastructure
Decisions in the health sector, whether they concern product regulation, resource allocation, or clinical practice, have important consequences for us all. We cannot make wise investments in our health without improving the way we collect, spread, and use health information.
Public policy-makers, caregivers, and medical practitioners must draw upon the latest information about emerging health issues, advances in clinical research, and best practice models in health promotion and illness preven-tion. They also need access to quality informa-tion about evidence-based innovations in the delivery of health services.
Governments need information that gives them the tools to assess the health impacts of their policies. Health care providers and admin-istrators need timely, accurate information to make informed decisions that lead to better outcomes for people intheir care. Indeed, every Canadian should have quick and ready access to reliable information on health and health care.
Recent advances in information technology have made it possible to develop a comprehen-sive national health information infrastructure that responds to these needs. The construction of such an infrastructure is already well under way through provincial initiatives. Bypooling our resources and sharing our knowledge, we will all benefit.
Anew Liberal government will work with
provincial and territorial partners to develop a national strategy for the creation of a Canadian Health Information Network, as recommended bythe National Forum on Health and as announced in the February 1997 budget. This strategy, to be developed incollaboration with key industry and health care stakeholders, will support decision-making inclinical settings, in policy development, and in health services management by giving Canadians access to stan-dardized, high-quality information about health and health care. It will also protect the use of personal information in accordance with estab-lished privacy standards. In addition, we will establish an independent National Population Health Institute, as recommended bythe National Forum on Health, to report to the public on national health status and the perfor-mance of the health system.
Meeting Urgent Health Needs
The federal government's role also includes taking action on major health threats to Cana-dians. The growing rate of breast cancer, the high mortality rate associated with tobacco use, and the HIV/AIDS epidemic are three areas we have identified as critical health issues and targeted for national action.
Breast cancer is a disease that affects an estimated one in nine Canadian women over their lifetimes. As our population ages, the number of cases of breast cancer is expected to rise dramatically. Although the causes of this disease are unknown, we do know that early detection and treatment significantly increase the life expectancy of those who are affected.
This government currently dedicates
$5 million annually to the Canadian Breast Cancer Initiative, a program to inform Canadian women of the importance of early detection and to educate physicians on communicating with and counselling patients. This program enhances research into the causes and effective treatment of breast cancer, and into ways ofmanaging the psychological and social dimensions of the disease to improve the quality of life of its survivors.
This investment has helped to further breast cancer treatment and to build community support networks for thousands of affected women throughout Canada. A new Liberal government will expand the Canadian Breast Cancer Initiative to $35 million over the next five years.
Smoking-related diseases also present a major health threat. Each year 40,000 Canadi-ans die prematurely from tobacco-related illness, costing Canadians $3.5 billion in direct health care costs. In response, this government has advanced an aggressive tobacco reduction strat-egy to regulate the manufacture, sale, labelling, and promotion of tobacco products.
In addition, we have continued the anti-smuggling initiatives launched in February 1994, extended the surtax on tobacco manufacturers' profits, and allocated $50 million over five years to enforce new tobacco legislation and provide public health education. Still, smoking remains the number one cause of preventable death in Canada.
Tackling the sale and promotion of tobacco is one facet of the Liberal government's strategy.
The other is stopping smokers before they start.
Young people today constitute the fastest-growing market for cigarettes. Ifwe can prevent them from becoming smokers, or help them quit early on, we will significantly reduce the inci-dence and cost of smoking-related disease and death in Canada.
More intervention isneeded at the commu-nity level to educate young people about the risks associated with smoking and to help the two-thirds of smokers under the age of 19 who have tried quitting to succeed in doing so. A new Liberal government will double funding for the Tobacco Demand Reduction Strategy from
$50 million to $100 million over five years, investing the additional funds in smoking prevention and cessation programs for young people, to be delivered by community organiza-tions that promote the health and well-being of Canadian children and youth.
The HIV/AIDS epidemic is a third critical health challenge facing Canada today. An
esti-mated 20,000 Canadians now suffer from AIDS, while close to 45,000 Canadians are infected with HIY. The bulk of the AIDS epidemic lies ahead of us, not behind us; another 10,000 to 20,000 Canadians are expected to contract AIDS by the year 2000.
In 1993 this government launched Phase II of the National AIDS Strategy, providing
$40.7 million annually for five years to combat the AIDS epidemic. This investment - together with the efforts of provinces, the medical and research community, community organizations, and people living with HIV and AIDS - has led to tangible progress in research, education, prevention, care, and treatment. Canada now has an effective community support network, while research and fast-tracking of drug approvals has led to improved drug therapies and new hope for those living with HIV and AIDS.
As the incidence of HIV and AIDS contin-ues to increase, however, it isclear that we must continue our efforts. Anew Liberal government will extend the National AIDS Strategy at current funding levels for an additional five years.
A new liberal government will:
• expand the Canadian Breast Cancer Initiative to
$35 million over the next five years;
• double funding for the Tobacco Demand Reduction Strategy from $50 million to
$100 million over five years;
and
• extend the National AIDS Strategy at current funding levels for an additional five
78