The government unveiled some funding details of the first-ever national dementia strategy its latest budget, but already it’s getting heat from critics, who say that while it’s a step in the right direction, the $50-million over five-year investment isn’t going to have the impact needed to address the growing public health issue.
Dementia is an umbrella term for a decline in mental ability, but Alzheimer’s is the most commonly diagnosed form of dementia.
According to the Alzheimer Society, about 600,000 Canadians currently live with dementia, and that number is expected to grow to about one million over the next decade. Canada is the only G7 country that doesn’t have a strategy, said McGill University doctor Serge Gauthier. But while that puts Canada behind the game, it also gives the government a chance to learn from other’s mistakes, he said.
The budget committed $50-million over five years for the strategy, which is aimed at increasing awareness of dementia through targeted campaigns to increase prevention, as well as reduce risk and stigma; develop treatment guidelines and best practices for early diagnosis; and improve the understanding of prevalence and effects of dementia on communities.
The funding is in addition to the 2018 budget’s $20-million five-year commitment for dementia community supports, which had a particular focus on senior women. The 2018 budget also announced $4-million per year ongoing.
Details on the strategy are expected to be announced in late May or the first week of June, as is required by Bill C-233, which became law in June 2017. The Public Health Agency of Canada didn’t have any more specific timelines when asked.
The details are expected to surround a few key pillars, including those announced in the budget document, but also improving the skills and knowledge of staff working in health-care settings, integrating supports across primary, community, and home care, developing better data, and investing in research and innovation.
The provinces and territories are key partners in making the strategy a success, say observers, but all seemed to suggest they know it’s a pertinent public health issue and are on board to work together.
Alzheimer Society CEO Pauline Tardif, who c0-chairs the ministerial board on the strategy, said there is a federal-territorial-provincial table set up to discuss that aspect of it. Overall, she said the society is supportive of the strategy, calling it a “very important first step.”
The society asked for $150-million over five years in its pre-budget consultation, but Ms. Tardif said she wasn’t discouraged by only receiving $50-million. She said she believes the government will make further investments once it starts to see the strategy’s outcome.
“I often hear people talk about the tsunami of dementia,” she said. “What I like to remind people is that if you want to use that analogy, fine, but please recognize that the wave is on the beach at this point.”
Conservative MP Marilyn Gladu (Sarnia-Lambton, Ont.), her party’s health critic, agreed the need for action is urgent, but called the strategy “too little, too late”—pointing out specifically that the Alzheimer Society received only one-third of its ask. A national strategy isn’t that helpful or concrete, she said, and the Alzheimer Society is already doing work on the issue across the country.
NDP MP Don Davies (Vancouver Kingsway, B.C.), his party’s health critic, said while he’s supportive of the strategy, he agreed it’s underfunded.
In terms of funding, a 2016 Senate committee report on the strategy suggested $30-million in annual federal commitments.
Health Minister Ginette Petitpas Taylor (Moncton-Riverview-Dieppe, N.B.) said in an email Q&A with The Hill Times that the government is committed to making a difference on the file, which is why it launched the first-ever strategy, hosted the first national dementia conference, and launched the ministerial advisory board, among other initiatives.
“These are big, unprecedented steps and we will continue the work to better understand dementia and support Canadians living with it,” she said.
No matter what the outcome of the fall election, it seems that dementia will continue to have some kind of support.
Mr. Davies said that an NDP government would not only continue the strategy, but improve it in key areas, such as home care and prevention strategies.
Ms. Gladu was more vague, but noted that the Conservatives yet-to-be-released platform would include supports for mental health, which includes dementia care.
Doctors interviewed by The Hill Times said the strategy is a step in the right direction, but also said the investment is modest, given how many people are expected to be impacted by dementia.
But the $50-million doesn’t include provincial funding, said McGill University doctor Howard Bergman, who also said that it’s not so much the money figure as targeted intent and investment that will make a difference.
Dr. Gauthier said one aspect that Australia seems to be missing is targeted outcomes to determine if the strategy is working.
Ms. Tardif suggested that measures to track outcomes of the strategy are in the works—a move that is consistent with other national strategies the current Liberal government has introduced.
While the government is overall taking some heat for the strategy’s funding numbers, critics say the government is really missing the mark when it comes to federal research dollars on dementia.
According to the 2016 Senate Committee report, the government should be investing about $100-million annually into dementia research — a number that would be it into compliance with a World Health Organization recommendation that says about one per cent of health spending should go into research.
One can really see how underfunded the strategy is when they consider that the global number should be about $100-million for research alone, yet the strategy in total is capped at $10-million annually.
“The more that we understand about it’s causes, and potential ways that we can either slow…or eliminate it entirely [the better,]” he said. “Research is an investment, not a cost.”
Ms. Gladu said there is definitely room to improve on dementia research funding front. Some research is currently being done on delaying the onset of dementia, which she said she’s supportive of.
“While we’re spending a lot of time on prevention to make sure people live longer, so much more…we need to make sure that they live longer without dementia,” she said.
In 2015-16, the government invested $42-million over five years to establish the Centre for Aging and Brain Health Innovation (CABHI). It “funds projects to develop, test and scale up products and services to support brain health and aging, including dementia,” said department spokesperson Anna Maddison in an emailed statement. She reiterated the government’s $50-million and $20-million commitments too.
“Between 2013-14 and 2017-18, the Government of Canada, through the Canadian Institutes of Health Research, invested close to $200-million in dementia-related research,” she added. “This funding has supported a broad range of research, covering the biomedical, clinical, health services, and population health aspects of dementia.”
That works out to about $40-million annually, which Dr. Gauthier said wasn’t enough in a 2017 opinion piece, especially when compared to what other countries are spending.
Responding to the idea that the government needs to more heavily invest in dementia prevention care, Health Minister Ginette Petitpas Taylor (Moncton-Riverview-Dieppe, N.B.) said in an email interview with The Hill Times that the government is giving $20-million to the Public Health Agency to support community-based projects.
“I understand that a project proposal was submitted by the Alzheimer Society of Canada and is under consideration. I look forward to hearing the results,” she said, adding that the government also funded the Centre for Aging and Brain Health Innovation.
Ms. Tardif didn’t directly criticize the government for not making the $100-million research target, but said broadly that her organization supports the WHO’s recommendation.
When money is invested into research and innovation, it helps countries get the outcomes they need, she said, as in the case of cancer, heart disease, and HIV/AIDs.
Dr. Gauthier said he strongly supports the $100-million research recommendation. There’s no cure for dementia, he said, but preventative care could use more study.
For example, that money could go into helping stroke research, he said, as those who have strokes are more likely to develop dementia.
Queen’s University doctor Chris Simpson said he’s not sure why the government has backed away from a specific commitment to research, especially given dementia has no cure.
That being said, the government has made substantial increases in research funding in general, he said. The government committed $354.7-million over five years, and about $90-million per year on going, to the Canadian Institutes of Health Research.
“If individual researchers who are … successful in getting some of that funding, then that may suffice to be counted as government investment into dementia research,” he said. “This particular announcement in this budget does seem to be more about supporting the patients and caregivers, and not into research, per say.”
The Hill Times
Correction: This story has been updated to reflect that it is the Alzheimer Society of Canada, not the Alzheimer’s Society of Canada, that Pauline Tardif c0-chairs the ministerial board on the national strategy, and that the enacting legislation was Bill C-233, not Bill C-322, as previously reported.
How is the strategy for patient-oriented research Canadian data platform going to shake up the healthcare research landscape? How do you think it will change the opioids crisis response, for example?
“For the first time in Canada, we will have a single platform that allows health researchers to get access to data from various researchers, institutions, and jurisdictions across the country—all the while respecting patient privacy. In the context of the opioid crisis, this means that researchers may be able to get and compare data showing new patterns among affected populations or in treatment approaches—findings that might not be apparent in isolated data sets or studies. Comparing data from across the country could provide valuable insight that will help us address this crisis.”
Low vaccination rates that result in disease outbreaks have been in the news lately. Do you think there should be some kind of reprimand, such as a fine, if people are not immunized and they don’t have any medical reasons preventing them from being so? Why or why not? Alternatively, should governments pay people to be immunized?
“Vaccination is an important issue. I was just in Surrey, B.C., during National Immunization Awareness Week to confirm funding for projects that will help get more Canadians vaccinated. It is important to repeat it: vaccines save lives. These new projects are building on our commitment of $25-million over five years to improve immunization rates in Canada and make sure credible information is easily accessible.”
I understand that the government is working on revamping food nutrition labels, but there hasn’t been much coverage of it since February 2018. What’s the latest on it?
“We continue our work on Canada’s Healthy Eating Strategy; with two pieces already in place and two in progress. We recently unveiled the Canada’s new Food Guide and banned industrial trans fats, and remain committed to improving nutrition labels for Canadians. We also look forward to the Senate’s final passage of Bill S-228.”
The Pan-Canadian Database for Organ Donation and Transplantation was announced in the budget. What is the next significant step in this process to getting the project running, and when will it happen? Additionally, there’s been some talk about presumed consent for organ donation. What do you say to those who think the federal government should be taking a role in pushing the provinces to move toward a presumed consent system?
“Organ donation saves lives, and we encourage all Canadians to talk to their loved ones about this important issue. Make sure that they know your wishes and that you know theirs. The new database announced in Budget 2019 will help more Canadians who need a transplant get one. On presumed consent—it is up to each province and territory to decide.”
The interim report on pharmacare said the government will need a robust IT system to make national pharmacare a reality. How do you plan to do that? Do you plan to start with upgrading provincial systems, as the report suggests, or do you plan to develop an entirely new plan? When do you expect to have news to share on this front with the public?
“We continue to work hard reduce drug prices for all Canadians. Having laid the foundation for national pharmacare in budget 2019, our next step is receiving the final report from the council.”
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