"Shared Responsibilities, Shared Vision": A Critique

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by Joel Lexchin

The discussion paper, Shared Responsibilities, Shared Visions: Renewing the Federal Health Protection Legislation, released by Health Canada July, 1998, is the first step in a process that, according to the Federal Minister of Health, Allan Rock, will "reassess, integrate and update the laws that safeguard our health."

This fall will see the second step a series of cross-Canada hearings starting early September in Halifax and finishing in Toronto at the end of October.

Consumer product and workplace substance safety, and air and water quality are overseen by Canada's Health Protection Branch. Among other things, the branch regulates the quality, safety and effectiveness of drugs, medical devices and pesticides.

The reason for updating Canadian Health Protection legislation, according to the discussion paper, is that some laws no longer reflect reality. The paper points out that legislation has become fragmented and inconsistent and governments need to be able to respond faster to new and emerging hazards.

Discussion documents such as this one set the tone for any following consultation. Highlighted issues and concerns usually become the focus, while those not mentioned are sidelined or ignored.

A close reading of the document shows that its title Shared Responsibilities, Shared Visions is clearly the wrong name. The visions and responsibilities are only "shared" by those holding a particular point of view one that ignores the history and politics of health protection legislation.

Any response to this document needs to highlight what has been left out and to point out what this implies to the consultation process and any legislation that may follow.

Ignoring History

The document offers no concrete examples of where outdated legislation has led to serious problems. There is no recognition of the fact that limitations in legislation may be less important than the political will to enforce legislation, reflected by the money the government allots to monitoring and enforcement.

There is a conspicuous absence of any discussion about how the recent actions of the government in downsizing and contracting out to private parties have affected our health protection legislation.

If the end result of the renewal process is a decision to give Health Canada additional responsibilities, is there a commitment from this government to provide the money necessary to deal with these responsibilities?

Social and economic determinants of health are mentioned superficially, but the paper doesn't make the link between health problems and the lack of effective federal policies in areas like unemployment or child poverty. No link is made between these problems and previous government policies such as obsessions with inflation and deficit reduction.

The discussion also ignores the fact that certain unhealthy behaviours, such as smoking, are much more widespread among poorer people. To not be straightforward about these types of links makes it highly unlikely that they will be explored in the consultation process. Nor will they be reflected in future legislation.

Ignoring Politics

The document fails to point out serious power imbalances between the various people and groups affected by the legislation. Legislation, the document says, should "favour cooperation among all stakeholders". Cooperation is definitely a desirable goal, but is also difficult to achieve when one side has more power and money than the other; think of environmental groups and logging/mining companies, or critics of prescription drug advertising and the pharmaceutical industry.

Small public interest groups and large corporations, some of the "stakeholders", have both been given 3-5 months to respond to this discussion paper in time for the fall consultation.

Does Health Canada seriously believe there will be an equal response? Is there any offer to help provide resources?

Inequality among different stakeholders can explain why some groups have a greater influence on government priorities. Think of the tobacco companies allowed to sponsor sporting and cultural events, and last year's review of prescription drug patent and price legislation that sided with multinational drug companies.

Different access to the corridors of power means different access to information. Many of the governmental health protection decisions take place behind closed doors. For example, when companies apply to get a new drug on the market they submit studies on its safety and effectiveness. If people want to see these studies, it can take the government up to two years to show them, and only if the drug company in question agrees.

With this secrecy comes a lack of public input into governmental processes. The United States guarantees public input into the drug approval process, while in Canada these guarantees are minimal to nonexistent.

Both questions of secrecy and public input are ignored in the paper.

The document also refuses to recognize areas of serious disagreement in how information or legislation should be interpreted. Risk management is presented as an exact science where in fact decisions about risks and benefits are often based on limited information and/or biases.

Approval of new drugs is a prime example of the uncertainties in risk management for example, the controversy around whether the use of calcium channel blockers (drugs used for heart problems and for high blood pressure) causes an increase in deaths.

According to the discussion paper another one of the principles of any legislation is that it needs to "meet Canada's international obligations including free trade agreements". Just what exactly are our obligations under NAFTA (North American Free Trade Agreement) or GATT (General Agreement on Tariffs and Trade)? Listening to presentations at last year's parliamentary committee hearings on drug patents we heard vastly different interpretations.

There is one striking exception to the document's bias of not recognizing differences in power, resources, and analysis. When it lists all the groups and organizations that will be consulted about the proposed changes to legislation, the discussion paper places the opinions and priorities of provincial and territorial governments above all others.

But while the reality of the need for cooperation between levels of government is not in question, it is also a fact that provinces are often willing to sacrifice health protection for financial or ideological reasons. If the paper is going to recognize the need for cooperation with the provinces and territories it also needs to recognize the nature of problems that come with this kind of cooperation.

Raising Questions

This discussion paper sets a very limited agenda for the consultation process this fall. While groups may want to focus on the questions posed at the end of the paper, it is more important to raise issues that were ignored and to tell the government what the priorities should be, not to accept the ones that it has set.

Joel Lexchin is an emergency doctor at The Toronto Hospital and a member of the Medical Reform Group of Ontario.

Further Reading

Transition = abdication: a citizens' guide to the Health Protection Branch consultation from the Canadian Health Coalition:

2841 Riverside Drive    Ottawa,ON K1V 8X7    Tel: (613) 521-3400 ext. 308 Fax: (613) 521-4655

E-mail: mmcbane@clc-ctc.com

Blurring the Boundaries: New Trends in Drug Promotion, by Barbara Mintzes (see review page 12).

Unshielded: The Human Cost of The Dalkon Shield, by Mary F. Hawkins,Toronto: University Press, 1997.

Safety Last: The Failure of the Consumer Health Protection System in Canada, by Nicholas Regush, Toronto: Key Porter Books Limited, 1993.

Health Protection Branch Consultations: Your immediate input is needed! To provide comments and receive more information: Transition, Health Protection Branch, Health Canada HPB Building #7 Tunney's Pasture, AL 0700B1 Ottawa, Ontario K1A 0L2

E-mail: Transition_Dialogue@hc- sc.gc.ca

Join a consultation meeting in your region.Contact: 1-888-288-2098