June 7, 1940

NAT

Douglas Gooderham Ross

National Government

Mr. ROSS (St. Paul's):

Last night the hon. member for Renfrew South (Mr. McCann) referred to the grant to the Health League of Canada. I mention the matter at this

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time so that before we come to a more detailed consideration of that organization, and while we are still discussing administration, the minister might very well ask his colleagues to reconsider the grant to the health league, with a view to increasing it.

I am familiar with the wonderful work that organization is doing to-day, and the difficulties it has to face. If we can afford to give $100,000 to the city of Ottawa, as has been done in years past; if we are not going to ask the city of Ottawa to economize a little bit, and if we are doing that at the expense of the Health League of Canada, then all I can say is that I am sorry I was not more vocal in my observations about the $100,000 grant given to Ottawa. I would ask the minister kindly to reconsider the vote when the supplementary estimates are presented.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

I believe up until last year the health league received only $5,000, but last year the second $5,000 was added. I agree entirely with everything the hon. member has said in connection with the valuable work carried on by the organization in question, and I should be very glad indeed to try to meet the request, if I can.

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CCF

George Hugh Castleden

Co-operative Commonwealth Federation (C.C.F.)

Mr. CASTLEDEN:

I was pleased to hear many hon. members sitting on the government side of the house speaking in favour of national health. It seems to me that makes it just about unanimous. Let us do something about the matter.

With regard to this matter of tuberculosis, I should like to draw attention to the splendid work being done in this field by Doctor Ferguson, head of the anti-tuberculosis league in Saskatchewan. That league has done splendid preventive tuberculosis work. I understand this work is so well advanced now that they can almost predict the stamping out of the disease within a fairly reasonable time in Saskatchewan.

In the dental field we are facing considerable difficulty. If a man has bad teeth, and that is all that is wrong with him, he finds trouble in having them attended to. But if he happens to have tuberculosis, then he can go to a sanatorium and have his teeth treated. They circulate a story out in our part of the country about a poor man who had been unemployed for some time. He was unfortunate enough to contract appendicitis. When he went to a hospital they told him it was impossible to operate because he had no money. Not feeling in a kindly frame of mind toward society in general, he went down the street and threw a stone through the nearest plate-glass window. He was arrested and sentenced

to thirty days' imprisonment. When he was taken to gaol they found he had appendicitis, so he was sent to the hospital and attended to. He got out in thirty days, a free man and with his appendix out.

I should like to ask two or three questions. What proportion of this amount is being spent on educational work throughout the dominion? It seems to me that educational work is the foundation of the whole scheme. Someone made the remark the other day that the proper way to treat these matters of health was to get after the grandmothers. I would point out that the women living to-day will be the grandmothers of to-morrow, so how about getting after their health now? What cooperation is there between the provinces and the dominion? What is the attitude of the medical association with regard to the nationalization or socialization of health? How do the various provinces rate in health standards? Is there a connection between the standards of education and the standards of health?

Mr. MACKENZIE (Vancouver Centre) r There is nothing in this particular vote for education work; that is provided for in other votes which will come up later. As far as health standards are concerned, I think there is no doubt that Saskatchewan leads the rest of Canada in the work it has done. The question of health insurance was discussed at considerable length last year. Several hon. members who are again in the house will remember the resolution moved by the hon. member for Fort William (Mr. Mclvor). I believe he has a similar resolution on the order paper this year. At that time the former minister went most thoroughly and exhaustively into the question of health insurance, not only as it might apply in the Dominion of Canada but with reference to other countries of the world. Hon. gentlemen will find on page 1573 of Hansard of last year, the report of a most valuable discussion of the whole question of health insurance. That debate was excellent in every way, and since that time we have received the report of the Sirois commission. I am sure most hon. members present have read their conclusions in regard to national health insurance. Their conclusions are that national unemployment insurance is and should be a federal responsibility, but they state most definitely that health insurance must be considered a provincial responsibility, with of course all possible cooperation by the federal authorities. The report of the commission states this at page 34:

This brief survey of the health activities of the _ municipalities, the provinces and the dominion indicates that despite the chaotic

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situation as regards jurisdiction, each level of government is performing functions consistent with its proper role in the government of the nation. Jurisdiction may overlap, but there is in fact little overlapping of functional activities. Indeed, we were impressed by the inadequacy of health services, considering the need, rather than by the existence of duplication.

And again they say this:

Finally, there are pronounced regional differences in Canada in social philosophy which are bound to affect public health legislation. Centralization of jurisdiction might not, therefore, conduce to progressive action in public health, or to national unity in general.

And again:

We think, therefore, that the present jurisdictional situation should not be disturbed, and that the public must rely on the good sense of public health officials and of political authorities concerned to effect cooperation and to work out an efficient and economical division of functions between the dominion and the provinces.

And further:

Whereas it is considered practicable in the case of unemployment insurance to adopt a uniform scheme that will apply to all provinces, it is not considered practicable in the case of health insurance, as the problems to be met are different.

A scheme of health insurance applicable to the large industrial provinces of Ontario and Quebec would not be applicable in provinces which are chiefly agricultural.

In contemplating a system of health insurance, consideration must be given to:

The topography,

The distribution of population,

The various age groups,

Distribution of members of the medical and nursing professions,

The location of hospitals,

Transportation facilities,

Number and class of industries, and a variety of factors that have a direct bearing on the type of health insurance that is practicable.

Doctor Weir, provincial health minister of British Columbia, appeared before a meeting of the dominion health council. That province has a national insurance act on its statute books, as has Alberta, but they are not in operation. He had this to say:

It would be a grave error for the dominion government, by amendment to the British North America Act to relieve the province of the major responsibility in health matters. The true role of the federal government in the health field, it seems to me, is to supply leadership, to assist in the promotion of significant health movements, to correlate-but not to legislate in health matters now falling within provincial jurisdiction.

The Right Hon. R. B. Bennett, had this to say in 1935, as reported on page 1156 of Hansard:

A national health policy involves consideration of several factors, among them being, first, the position of the individual himself-not the question of the municipalities or the provinces, but the position of the individual himself and herself.

Later in the same debate, he said:

We cannot, with one stroke of the legislative pen, wipe out of existence all the provisions made by the municipalities and the provinces to deal with this problem-their hospitals, medical service, taxation to maintain them in cities, towns and villages.

You cannot to-night, with all the power in the world, scrap the provincial services and impose upon them a federal service without the loss of millions of dollars.

That is as clear as anything can be. The difference between a national and a provincial scheme is quite simple, and I think the hon. member realizes that. The provinces have gone ahead and exercised their jurisdiction with respect to health matters, hospitalization and so on. Commenting upon Mr. Bennett's remarks, Doctor Weir had this to say:

In a word, I quite agree with the position of the present Prime Minister that the dominion government now has all machinery necessary to enable it to participate effectivelv with the provinces in the promotion of public health.

Those who have most strongly advocated health insurance in Canada have directed their representations to the provincial authorities. Just a few minutes ago the hon. member asked about the attitude of the Canadian medical association. The committee of economics of that association, on page 32 of its report on health insurance, expresses the following opinion:

The Canadian situation is such that social insurance legislation, of which health insurance is a part, must be initiated by the provinces. The dominion is free to make grants of money to the provinces adopting such legislation. This has been done in the matter of old age pensions.

The dominion could exercise considerable influence, if making such a grant, to secure the inclusion of the same desirable principles in all provincial legislation. The dominion, if contributing, would give supervision through the department of national health. Practically, health insurance in Canada will be provincial in legislation, organization and administration.

Several labour organizations made representations to their respective provincial governments. The British Columbia executive committee of the Trades and Labour Congress said this on November 2, 1937:

The government was strongly urged to give immediate effect to the health insurance act of 1936. The committee also recorded its favour for an act covering all persons irrespective of salary or other limitations.

The recommendation of the Saskatchewan executive committee of the Trades and Labour Congress, under date of November 30, 1937, is as follows:

The enactment of health insurance legislation was requested by the committee, the delegation endorsing the objectives of the state medicine league in this connection.

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From the Manitoba executive committee of the Trades and Labour Congress and railway transportation brotherhoods, on January 4, 1938, I quote:

The committee expressed its view that the time was opportune "to recommend action looking to the establishment of a system of health insurance," and urged the government to "immediately take the necessary steps to formulate and adopt legislation to this end."

The Alberta federation of labour, on January 25, 1938, stated as follows:

In dealing with subjects of health, the federation's memorandum requested the bringing into operation of the section of the health insurance act providing for medical aid and hospitalization.

The Ontario executive of the Trades and Labour Congress recommended on February 8, 1938:

Enactment of legislation "to ensure full benefits of curative and preventive medicine to all citizens of the province irrespective of their ability to pay."

On February 8, 1938, the Ontario joint legislative committee of railway transportation brotherhoods, asked:

. . . favourable consideration to a health

insurance measure.

It is evident from the foregoing that in the provinces these organizations realize that any scheme of national health insurance in Canada must be based upon provincial jurisdiction, and the most effective contribution which should and will be made by the federal government is by financial grants to the provinces who must be responsible under our constitution for health insurance in Canada.

All that is exactly what is happening to-day in the United States in the scheme of social security which President Roosevelt has commenced in that republic, the essential jurisdiction of the states being recognized, and federal grants being conditioned upon the actual needs existing in the various states.

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CCF

Major James William Coldwell

Co-operative Commonwealth Federation (C.C.F.)

Mr. COLDWELL:

I was going to ask the minister about another branch of activity of the department. Several years ago, I believe, the child and maternal welfare branch was reestablished. Could the minister give us some idea as to what is being done in the department to reduce infant mortality and the death rate among mothers in childbirth?

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

Would my hon. friend wait until we come to that special vote, because I can then give him all that information.

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CCF

Major James William Coldwell

Co-operative Commonwealth Federation (C.C.F.)

Mr. COLDWELL:

Very well. I will ask the minister at that time.

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LIB

Jean-François Pouliot

Liberal

Mr. POULIOT:

The minister has just

quoted some remarks made by Mr. R. B. Bennett. I remember that, of course as a

/

Knight of the venerable Order of the Hospital of Saint John of Jerusalem he thought fit, every time the estimates of the department of health came up, to make a speech. I recall dear old Doctor MacLaren, whose hands were shaking and trembling as he had his book before him, while Mr. Bennett was speaking fluently on the matter of health and of medicine. Mr. Bennett made a great speech on these estimates, either in 1935 or 1934, a speech which struck me as showing very clearly how superficial the man was. He made a lengthy address, speaking for forty minutes or an hour, as was the privilege of the Prime Minister and the leader of the opposition. He did not forget Florence Nightingale. He related the history of medicine throughout the world, but he forgot two names, those of the most eminent figures in the history of medicine in the modern world-Pasteur and Lord Lister. Mr. Bennett knew Florence Nightingale, but he ignored Pasteur and he ignored Lord Lister. I do not see what weight can properly be attached to any quotation from any speech of Mr. R. B. Bennett on matters of health and medicine.

I have just one question to ask of the minister. Would he be good enough to tell me who are the two gentlemen who are in front of him at the present time on the floor of the house?

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?

An hon. MEMBER:

Quite right.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

Mr. Chairman, I do not believe it is customary to answer such questions. They are eminent and distinguished public servants of this country.

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LIB

Jean-François Pouliot

Liberal

Mr. POULIOT:

Eminent as they are, 1

want to know who are these strangers. I do not know them. I should like to know who they are. I ask with politeness and with all deference, but I wish to know who they are. They are not members of parliament. 1 should like to know who is coming here on this floor.

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LIB

Thomas Vien (Deputy Speaker and Chair of Committees of the Whole of the House of Commons)

Liberal

The CHAIRMAN:

Shall the resolution

carry?

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LIB

Jean-François Pouliot

Liberal

Mr. POULIOT:

No. I want to know

that. I do not wish to be disagreeable to the minister, but I want to know who are these two goodlooking gentlemen.

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?

An hon. MEMBER:

Carried.

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LIB

Jean-François Pouliot

Liberal

Mr. POULIOT:

No, it is not carried;

and if I do not get that information, I am sorry, but I shall have to ask more questions. They must be officials of the Department of Pensions and National Health;

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otherwise they would not be here, but I should like to know who they are. I do not know them. I should like to know them, and I ask the minister kindly to tell me that.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

The request is, I think, unusual. But the gentlemen are the deputy minister, Doctor Wodehouse, and the secretary of the department, Mr. Dixon.

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LIB
NAT

Gordon Graydon

National Government

Mr. GRAYDON:

There is one matter which was discussed by the minister last night. It is reported on page 594 of Hansard. I was out of the chamber at the moment. It was in connection with the rationing of the active service forces in Canada. This is a matter in which I personally am very much interested, because during last fall and last winter in the armouries at Brampton, the Lome Scots, many of whom are now on active service with the first infantry base depot at Aldershot, conducted for a time what is known as a cooking school for the soldiers. They had out there a number of prominent dietitians from Toronto, on loan from the board of education there, and according to newspaper and other reports which were prevalent at the time, and from my own observation, a good deal of progress seems to have been made towards a better type of rationing for the troops. I believe that a good deal of work was done by way of research and otherwise, and I was wondering if the minister could tell me whether the department had taken any cognizance of it, so that the valuable progress made in army dietetics at the time could be applied to the rationing of the active service forces at present.

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LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

Yes, there were discussions. As my hon. friend is aware, this matter, again, pertains to the Department of National Defence.

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NAT
LIB

Ian Alistair Mackenzie (Minister of Pensions and National Health)

Liberal

Mr. MACKENZIE (Vancouver Centre):

As regards the question of rations. I mentioned just incidentally yesterday that some of the studies and surveys which were carried out in this department by some of the officers had been very useful from the point of view of analyses of the contents of rations used in the great war. As a result of the experience, certain recommendations were made. The Canadian council on nutrition and the national research council were consulted, and an officer, who I believe is Doctor Tisdale, has been appointed as adviser on nutritional matters to the Department of

National Defence. As a result of these discussions the rations were varied and increased, and in some respects fairly materially altered. Broadly speaking, that is what happened.

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June 7, 1940