Bill C-284

National Strategy for Eye Care Act

An Act to establish a national strategy for eye care

This enactment provides for the development of a national strategy to support the prevention and treatment of eye disease, as well as vision rehabilitation, to ensure better health outcomes for Canadians.
It also designates the month of February as “Age-Related Macular Degeneration Awareness Month”.

National Strategy for Eye Care Act

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The hon. member for Shefford on a point of order.

[Andréanne Larouche, Bloc, Shefford, QC]

Madam Speaker, I have a little reminder. The member's notes are touching the microphone, which is making a noise that interferes with the work of the interpreters. Members just need to be careful.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

I also noted that.

I would ask the hon. member to ensure that when she is moving her pages, she keeps them away from the microphone because it creates a problem for the interpreters.

The hon. member for Brampton South.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I will be careful of that.

Unfortunately, the COVID-19 pandemic worsened the issue of vision loss in Canada, as eye surgeries were cancelled or delayed. Wait times to see vision care providers also increased over the course of the pandemic. That is why a national strategy for eye care is essential. It would provide a comprehensive road map, laying out a common direction and shared leadership. It would build collaboration among researchers, medical professionals and community organizations to develop innovative approaches to combat eye diseases and preserve sight.

In 2021, the CNIB opened a new centre in Brampton South, providing access to innovative technology and training for Bramptonians with sight loss. It is doing incredible work, and I am confident that Bill C-284 would bring us one step closer to empowering Canadians impacted by blindness with an integrated approach.

As members in this House know, Bill C-237, the National Framework for Diabetes Act, passed unanimously in 2021. I want to touch on how blindness can be a serious complication because of diabetes retinopathy, and I also want to recognize Diabetes Canada's work on this issue as well.

Earlier this year, I met an advocate named Ryan and his dog named Joe. Ryan lives with diabetic retinopathy. He told me about the challenges Canadians with vision impairments face using their insulin pumps. He and many other Canadians are experiencing these hardships, so we need to work together to remove those barriers.

Living with blindness, especially as a result of chronic disease, is an experience that is difficult for people without visual impairment to truly understand. This further underscores the need to have a coordinated strategy so that we can work together with provinces and territories, indigenous peoples and other partners to improve health outcomes. Through this approach, we can proactively identify and intervene in cases of diabetic retinopathy, mitigating the risk of vision loss.

We know that with early intervention and coordinated care, vision loss can be preserved. Of vision loss cases, 75% can be prevented if patients are diagnosed early and have access to treatment. We know that providing hope and better health outcomes for individuals affected by eye diseases is transformational. Already, the Government of Canada is leading and supporting a range of activities related to eye disease prevention and treatment.

I would like to talk about the investments announced in budget 2023 to strengthen our public health care system.

Budget 2023 commits $196 billion in funding to support our health work force; reduce backlogs; expand access to family health, mental health and substance use services; and modernize our health system. This is to ensure provinces and territories can provide the high quality and timely health care Canadians expect and deserve.

We see the surgical backlogs and the impacts on our systems, and we are addressing that need. Surgical backlogs, including vision-related surgeries, are a key part of this plan and are a health system priority of this government. Budget 2023 includes a $2-billion one-time top-up to provinces and territories to address urgent pressures in emergency rooms, operating rooms and pediatric hospitals. In addition, Indigenous Services Canada’s non-insured health benefits program also provides vision care to eligible first nations and Inuit beneficiaries where they are not otherwise covered by other plans or programs.

The government has also made significant investments in vision loss prevention and research. Over the last five years, the Canadian Institutes of Health Research has invested approximately $61 million in vision-related research. This research spans the spectrum of prevention, diagnosis, treatment and management of various vision-related conditions.

These investments contribute to the evidence base needed to improve health systems and health outcomes for Canadians experiencing vision loss.

Finally, I wish to highlight that medically necessary vision care services are covered by provincial and territorial health insurance plans. Any vision care service that must be performed in a hospital is covered and supported under Canada’s public health care system. The federal government is committed to continue working with provinces and territories on our shared health priorities, including those related to vision care.

In conclusion, Bill C-284 would allow the Minister of Health to develop a national strategy to support the prevention and treatment of eye disease. It would facilitate engagement with provinces, territories, key stakeholders and partners to ensure that we are all pursuing common objectives in the vision care space, along with sharing best practices. This bill would complement existing work and research efforts, supported by provincial and territorial governments, and the Canadian Institutes for Health Research.

Once again, I wish to thank the hon. member for Humber River—Black Creek for putting forward this important bill. I know that my residents in Brampton South and, indeed, all Canadians are counting on us to act quickly to prevent and treat eye diseases. I encourage members to vote in favour, as we continue to strengthen our efforts on vision care in Canada.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, it is an honour to rise today and speak to Bill C-284, put forward by my colleague from Humber River—Black Creek. The question before us today is fundamentally about ensuring that Canadians receive a coordinated response regarding their health care needs, particularly eye care.

The proposed national eye care framework intends to promote information sharing and knowledge sharing between the federal and provincial governments in relation to eye care disease prevention and treatment, all the while ensuring that both levels of government respect their roles within our national health care system. To quote the bill directly, a key component intends to “promote research and improve data collection on eye disease prevention and treatment”. Doing so would enable eye care health providers a centralized resource to access the status of their own patient base and make sure that they share their expertise across the country, all the while ensuring that only the best and newest technologies are used going forward.

According to the Canadian Council of the Blind, due to an increase in surgery wait times caused by the lockdowns during the pandemic, there has been a $1.3-billion increase in the cost of vision health over the past two years. All of this is compounded by the fact that 75% of vision loss cases in Canada can be prevented if patients are diagnosed early and have access to treatment. Furthermore, 70% of existing vision impairment in Canada is estimated to be correctable with prescription glasses.

This proposal from my colleague is not only very commendable, but is being put forward at a very timely moment. A national framework would allow all provinces and the federal government, as well as health care practitioners and researchers, to sit down at one table and jointly develop and implement the measures necessary to make sure that all Canadians from coast to coast have access to eye care and the best practices available in a timely manner.

Developing an effective framework is now more critical for the future of our children due to the prevalence of electronic devices. They release blue light, which can reach the retina, the inner lining of our eyes. Studies have shown that this light can damage cells in the retina, leading in some cases to early age-related macular degeneration, a unique concern of the modern age that is far more likely to impact our children. Children may not even know that their phones could be permanently damaging their eyes due to a lack of educational awareness.

Some might resist getting an eye care exam due to the belief that glasses are not “cool”. I will admit that it was hard for me, some 10-plus years ago, to admit that I needed glasses. This is a pressing challenge, as a long list of diseases and health care problems can only be discovered through a regular eye examination. Many eye diseases do not have any preceding symptoms and cannot be treated without a professional assessment.

The concern of vision loss in Canada requires a coordinated response, in both education and organization, between the provinces and the federal government, especially since there is a high percentage of seniors and school-aged children who have undiagnosed eye care issues. Very few children had their eyes tested during the pandemic, and as previously mentioned, many spend a great deal of time in front of a computer screen.

Referring to Canada as a whole and for a better understanding of the gravity of the situation, here are some of the numbers. Over eight million Canadians, or one in five, have some form of eye disease. Some 1.2 million Canadians live with vision loss or blindness. It is estimated by the Canadian Council of the Blind that vision loss and blindness were likely associated with 1,292 deaths in Canada in 2019. These deaths would have occurred due to factors such as increased risk of falls for the elderly and isolation experienced by those with vision loss.

Vision loss has a profound impact on our society and economy, costing an estimated $32.9 billion a year, $4.2 billion of which is attributed to reduced productivity in the workplace. Over half of the cost, $17.4 billion, is attributed to reduced quality of life, which is primarily due to a loss of independence, especially among seniors.

Many of us have a personal connection to someone experiencing vision loss. My own mother struggles with age-related macular degeneration, or AMD, which is one of the top five causes of blindness. The other four are cataracts, diabetic retinopathy, glaucoma and uncorrected refractive errors. Of these, all but two, AMD and glaucoma, can be prevented through proper care if caught at an early stage, or treated with modern tools such as laser eye surgery and/or prescription glasses.

While glaucoma has no present cure, there are treatment options that, if begun early enough, can prevent an individual’s loss of vision. Even in the case of AMD, a healthy lifestyle and regular eye exams can help delay the loss of vision as one grows older. Also, new recent accredited medical devices provide the hope to even reverse AMD, at least temporarily. In the case of cataracts, we have been able to treat this condition, I am told, as far back as the time of ancient Egypt.

There should be no excuse in the modern world to fail to provide Canadians with the knowledge about what treatments they can access in our provincial health care systems. Losing one's vision increases mental, financial and social hardships on an individual. It can lead to a loss of mobility and an inability to live independently, to drive, to read or to participate in physical activity. It can result in a loss of social interaction or even lead to social isolation, which can often lead to depression and other mental illnesses.

Through being proactive and taking preventative measures now, we can not only save individuals and families from a great deal of grief, but also help maintain the solvency of our health care system by helping provinces avoid spending even greater resources down the road in both treatment time and costs. Through proper education and awareness campaigns, Canadians can potentially save themselves from great heartache and financial costs by reducing smoking, having a healthy diet, getting regular eye exams and being informed of family genetics.

It must be stressed, however, that a health care strategy and delivery remain in provincial jurisdiction. The intent behind this national framework is for the federal government to serve as a centralized communication hub between eye health care providers in different provinces and federal regulators, allowing them to share their expertise and knowledge with each other. The requirement of regular reporting should also spur faster responses from Health Canada in reviewing and approving new technologies for the benefit of all.

This program must be a team effort led by professionals, in conjunction with the provinces, with the federal government keeping its involvement in proper scope, namely participating in this national framework. As long as these concerns are respected and decisions on strategies and spending priorities remain within provincial jurisdiction, as stipulated in the Canada Health Act, I can support this bill and look forward to doing so.

By passing Bill C-284, not only can we help millions of Canadians struggling with vision loss, but we can also be proactive and reduce the number of children who could face vision loss in the future. Eye care is but one part of our comprehensive health care strategy in Canada.

In my remaining time, I wish to speak more personally. At some point, I believe we will need a larger discussion on how health care is funded and how accountability in that funding is measured. Both levels of government provide dollars to health care, and it is clear that, while partially federally funded, health care is delivered provincially. The topic of health care funding and delivery comes up often when I hold round tables and town halls in Chatham-Kent—Leamington, where constituents often blame one or the other or both levels of government for the inadequacies in the system they experience.

I am reminded of Saturday mornings two decades ago in my own household. During the week, we had four daughters, but on Saturday mornings, when it came time to take out the garbage, we had five: Alyssa, Carina, Brenna, Kiana and “Not Me”. It was always Not Me's turn to take out the garbage. Health care accountability often reminds me of those Saturday morning discussions when people point at two levels of government and both levels of government point at each other.

Former provincial treasurer Darcy McKeough, who is in his nineties and still lives in my riding, mused in a biography that the level of government that does the spending should do the taxing so as to be held accountable. That will be an interesting discussion one day, but it is not for today.

Today, I encourage all members of this House to support this legislation put before us by my hon. colleague.

[Mario Simard, Bloc, Jonquière, QC]

Madam Speaker, I am pleased to rise to speak to Bill C-284. As my colleague from Abitibi—Baie-James—Nunavik—Eeyou said so brilliantly earlier, the Bloc Québécois will be voting in favour of this bill.

I see no reason why we would oppose a national strategy to support the prevention and treatment of eye diseases, just as I see no reason why we would oppose an age-related macular degeneration awareness month.

The Bloc Québécois will be voting in favour of this bill because, and I mean no offence, it is, in my view, an apple pie bill. Indeed, no one could oppose such a strategy, especially since the health services outlined in the bill—as we will perhaps see when it is studied in committee—are more the responsibility of the federal government. Research funding and the approval of certain drugs and medical devices fall under federal jurisdiction. I do not see any problems with jurisdiction either, but we do reserve the right to take a closer look at the ins and outs of this bill in committee.

What concerns me a bit more about having a better strategy to support the prevention and treatment of eye disease is how to do it. A strategy is fine, but it needs to be accompanied by action. That is what I want to focus on as I discuss this topic.

The essential point here is that there is still a lot of work to be done. The work to improve the eye health of Quebecers and Canadians will require more services. For me, first and foremost, the best solution for more services is to have coverage under the Régie de l’assurance-maladie du Québec, which means an increase in health transfers. If we want better services, we need more resources.

Let us look, for example, at new treatments like the Luxturna gene therapy, a treatment that makes it possible to treat Leber congenital amaurosis. That is a significant and very costly illness, with just one treatment costing $1 million. That is an enormous cost.

In that regard, on March 23, the federal government announced $1.3 billion over three years to help the provinces cover those treatment costs. We know that gene therapies are treatments that herald small revolutions in medicine and health, but they are very costly treatments. If the past is any indication, we know that the federal government is not always there for health funding.

Now it is clear where I am going. The best way to have the best health care and to fight against eye disease is to combat one of the problems that plague the Canadian federation: I am talking about the fiscal imbalance. I would note that, last week, the mischievous member for Mirabel held a symposium here in Ottawa on the fiscal imbalance to study the phenomenon in depth. It was a non-partisan symposium attended by the Parliamentary Budget Officer—I do not think the Parliamentary Budget Officer is partisan—and Mr. Benoît Pelletier, a former Liberal minister from Quebec, who is not a Bloc supporter, but who came to speak to us about the fiscal imbalance.

Why am I talking about the fiscal imbalance? It is to remind members of the demands made by Quebec and the provinces on health care funding. Quebec and the provinces estimated their health funding shortfall at $28 billion per year. The goal was to increase Ottawa’s health transfers from 22% to 35%.

What did the federal government offer? Members will recall that it was far less than $28 billion. What the federal government offered was $4.16 billion. The difference between the provinces' demand for $28 billion and the federal offer of $4.6 billion is not just about money. The difference between the two means that vision care will never be provided for lack of resources. There is no doubt about that.

For example, in Quebec, year after year, health resources generally represent approximately 42% of Quebec's total budget. That means that there is 58% left for all of the government's other responsibilities such as education, fighting poverty, child care—Quebec was a pioneer in this field, as it created the child care model—infrastructure, roads, public transportation and bridges. There is 58% left for that, for funding municipalities and also for supporting Quebec businesses. If we wait for the federal government to support Quebec businesses, we will be waiting a long time, as we saw again with the announcement that Volkswagen is building in Ontario. Therefore, 42% of the Quebec government's budget goes directly to health care. That considerably reduces its budgetary margin. That is known as the fiscal imbalance.

I can give a very simple definition. It is a definition that everyone agrees on, the definition from the Séguin report. I am talking here about Yves Séguin, the former Liberal minister, not the guy who had a goat. Yves Séguin said that the provinces' spending structure is such that expenditures grow faster than the economy, while those of the federal government grow at roughly the same pace. Furthermore, when the federal government wants to adjust its spending, it can just unilaterally cut transfers to the provinces, without any political fallout.

That is the fiscal imbalance rule.

That means that the federal government can make promises like it did in March when it said that it was going to inject $1.3 billion over three years to help the provinces with new gene therapy treatments. However, nothing prevents the government from eliminating that funding down the road. In so doing, the government strangles the provinces and the provinces are then stuck having to deliver services that they do not necessarily have the funding for. That is completely objective, ideologically neutral information. Take, for example, the Conference Board, which published a report showing that the Canadian federation is not viable in the long term and that the provincial economies are not viable in the Canadian federation, given the fiscal imbalance. That is also a recurring theme in the Parliamentary Budget Officer's reports, which document how the fiscal imbalance is wreaking havoc, particularly when it comes to health care.

I am saying all of this because, if we want a strategy that will really give us a robust health care system that can provide treatment for eye disease, then the we need more funding for health care.

I want to make my colleagues aware of something that happened this week.

On Tuesday, Liberal and NDP members once again joined forces to remove an additional $2 billion for health care from Bill C-47, an act to implement certain provisions of the budget tabled in Parliament on March 28, 2023. The NDP and Liberals got together to ensure that $2 billion was cut from health care funding. The Liberal-NDP coalition had an opportunity to partially correct the federal government's lack of investment in health care and to take concrete action, which is what people are calling for, to relieve the overburdened and exhausted health care system. They also had an opportunity to offer treatments for eye diseases that met Quebeckers' expectations, but they decided otherwise. All they have managed to do is disappoint people.

Liberal and NDP members voted in favour of an amendment to remove $2 billion in additional health provisions for Quebec and the provinces when Bill C-47 was studied in committee. The amendment was proposed by the Liberal Party and removes additional support for health care in Quebec.

I think we should forget all the fine words and promises made by Liberal and NDP members who claim to be concerned about the state of our health care system. Indeed, when it comes time to invest more, they are nowhere to be found. Worse, they are actually cutting billions of dollars from health care, even when those billions were invested unintentionally.

I repeat, the best way to have better eye care is to have a robust health care system and health care funding that lives up to the expectations of Quebeckers and Canadians.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The hon. member for Humber River—Black Creek has five minutes for her right of reply.

[Judy Sgro, Liberal, Humber River—Black Creek, ON]

Madam Speaker, I want to sincerely thank all of my colleagues in the House. All of their comments were so sincerely delivered and so accurate on all of the issues that matter to us in this particular issue that we are trying to move forward.

My colleagues mentioned that our colleague from Algoma—Manitoulin—Kapuskasing introduced Motion No. 86 some years back, trying to move this issue, trying to get vision onto the radar screen here at the federal level. Countless times, whether it was 2007 and 2009, we have talked about it, but nothing has been done about it. I can say that I think the closest we have come to it is where we are tonight.

We have reached this point here tonight because of all of the members who are here. From last June, when I introduced the bill, the Conservatives, the Bloc and the NDP were right there, standing together with Liberal colleagues to support something that we knew was important.

One of the things that we heard about tonight was the number of organizations and the number of people who were anxiously waiting for this to happen. Some of them have said that they have been waiting since 2003 for the federal government to take some sort of leadership on this issue. I am glad to have had the opportunity to be able to get it this far.

There are so many organizations that are watching this discussion tonight, including the Canadian Council of the Blind, the Canadian Association of Retired Persons, the Canadian Association of Optometrists, the Canadian Ophthalmological Society and Waterloo University, which is doing outstanding work in the area of eye care.

There is a lot of emphasis on what we are doing, and there is a lot of hope. The millions of people who are suffering from various categories of vision loss are counting on us tonight to send this bill off to committee so that the health committee can have a look at it. They are counting on us to ensure that it is not going to end up as just a whole lot of talk by elected officials, as happened before, with nothing delivered.

I think it is imperative that we move the bill over to the committee so that we can truly get some serious work done on something that is way overdue. We all know someone who is suffering from macular degeneration or blindness or various other eye diseases. I, for one, do not want to see them disappointed, and I know none of the members want to see them disappointed either.

The earlier we get the bill to committee and move it along there, the better. Listening to the excellent comments that were made tonight and the speeches from members, who all spoke so well, there is no need for me to reiterate anything. It has all been said.

The question becomes, what do we do with it? Do we waste another two weeks or so? I do not think we need to do that. Time is too valuable in the House. We only have three weeks left. If we could get the bill moved to committee this evening, we could get started doing that work. It would be a sign of hope and of sincerity from all of the members in this House.

I hope members will appreciate the urgency of the need to move the bill along. We do not have six months ahead of us; we have three weeks. It would really be a great bonus to all of those in the vision loss community if we could simply move it over with a voice vote and not have to waste another two weeks of House time, which is very valuable, especially at this particular time.

I thank all of my colleagues who spoke so very well. I appreciate their support. More importantly, the vision community appreciates their support immensely.

I look forward to our finishing off this discussion this evening.

Madam Speaker, I thank you for being the one who introduced this initially, and I thank you for all of your assistance in moving it forward, along with my other colleagues.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

The question is on the motion.

If a member of a recognized party present in the House wishes that the motion be carried or carried on division or wishes to request a recorded division, I would invite them to rise and indicate it to the Chair.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Madam Speaker, I look forward to every member having the opportunity to support this bill and would request a recorded division.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Pursuant to order made on Thursday, June 23, 2022, the division stands deferred until Wednesday, June 7, at the expiry of the time provided for Oral Questions.

The hon. parliamentary secretary to the government House leader.

[Kevin Lamoureux, Liberal, Winnipeg North, MB]

Madam Speaker, I suspect if you were to canvass the House, you would find unanimous consent at this time to see the clock at 6:30 p.m. so that we can begin Government Orders with Bill C-35 at report stage.

[The Assistant Deputy Speaker, NDP, Carol Hughes]

Do we have unanimous consent to see the clock at 6:30 p.m.?

It is agreed.