Canadian Medical Association's 134th AGM
Speaking Notes
for
Allan Rock
Minister of Health
Quebec City, Quebec
August 13, 2001
Check against delivery
Index
Introduction
Thank you Dr. Barrett, Mr. President, members of Council, distinguished guests, ladies
and gentlemen.
I'm delighted to have this opportunity again to bring greetings and warmest best wishes
to this annual meeting of the Canadian Medical Association on behalf of the Prime Minister
and the Government of Canada.
I am very pleased to see so many of my colleagues, members of Parliament, senators and
federal government ministers here today. I would like to thank my colleague and friend,
Minister Gilbert Normand, and members of Parliament Hélène Scherrer, Jean-Guy Carignan,
Jeannot Castonguay and Dr. Carolyn Bennett of Toronto for being here.
I'm also delighted to see members of the opposition party here today - Rob Merrifield,
Jim Lunney and senators Yves Morin and Mike Kirby. Welcome to Quebec City, one of the most
beautiful cities in the world. I hope you will get a chance to take advantage of your visit
to see historic sites here in the old city.
This is the fifth time that I've had the opportunity to address your annual meeting. I
noted last year that Hugh Scully was threatening to charge me annual dues and I understand
that Peter Barrett now wants to go further - he wants to make them retroactive. I just
hope they're deductible!
The fact is that the relationship between the Government of Canada and the Canadian Medical
Association has never been more constructive, never more positive. I believe that is a
testament to the commitment and the spirit of public service shown by the leadership of
this Association.
I want to personally thank Dr. Peter Barrett for his outstanding year of service at a
time of great challenge in health care. He has made an extraordinarily positive contribution
to the public discussion, always speaking from the high ground, always stressing that the
bottom line for him is quality care for patients. Peter, thank you so much for your year
of service.
And Dr. Haddad, I look forward to working with you. The difference between us, I suppose,
is that you know you're going to be in your job for the next year. I'm not so sure that
I am, but for as long as I have the privilege of serving the public in this capacity, I
do look forward to working with you. I see from your CV that you like Jazz very much. I
think we're off to a good start already!
Values
This year your Association has chosen "values" as the theme of your conference and that's
fitting because Canada's health care system is all about values. Indeed, medicare, as we've
come to call it in Canada, is a tangible expression of shared values in this country. It
reflects a commitment that Canadians have made to each other that they'll be there in times
of need, regardless of wealth or of privilege. It seems to me that these values bring out
the very best within us as Canadians - they transcend provincial borders and regional interests
because at its heart, medicare reflects something essential about the Canadian identity.
You know if you stop a Canadian on the street and ask them that most difficult question
about self-definition - what is the Canadian identity - nine times out of ten, they'll
refer to our health care system. Because it's a Canadian project it belongs to all of Canada
and that's why it's so important to have the Government of Canada continue as the custodian
of its national principles.
One of the reasons that it was so important for us to restore and build on the cash transfers
to the provinces for health, was so that the Government of Canada would have the moral
authority to be at the table and to enforce the principles of the Canada Health Act. And
that's why I will never agree with those who argue that the annual cash transfers from
the Government of Canada to the provinces should be replaced by a simple transfer of tax
points. I strongly believe that there should always be a robust federal presence in this
truly national program.
Overview of Accomplishments
I well recall, although it was four years ago now, my first address to your Association's
annual meeting in Victoria, British Columbia. One of the principal issues back then, not
surprisingly, was the question of funding. The question was how much is enough. At that
time, I undertook to be the advocate for appropriate levels of funding for the health care
system from the Government of Canada and we've come a long way.
Since 1999, more than $35 billion in new federal money has been committed to the Canada
Health and Social Transfer. The annual cash transfer in 1997 was $12.5 billion from Ottawa
to the provinces. As a result of agreements reached since that time, those transfers will
grow to $21 billion a year - almost double what it was when I first spoke to you.
But I want to emphasize that we've done more than just increase the cash transfers to
the provinces in our efforts to improve access to quality health care. This morning, let
me touch upon just some of the steps that we've taken in partnership with your Association,
in consultation with your members over the last four years.
You may recall that when I appeared before you last August, when the debate about the
level of federal funding was raging, I made the point that for us it was not just a question
of more money, but it was also the need for a plan. Because the goal is not simply to have
the most expensive health care system in the world, the goal is to have the best health
care system in the world.
Together with the money we needed a plan, and last September we got one. I urge you to
read the Agreement that was adopted by all the Premiers and the Prime Minister last September
11th. It deals with eight key areas setting out concrete commitments. Yes, significant
amounts of more money, but the work plan agreed upon by all governments was of equal importance
and we're actively pursuing it.
I can tell you for example that agreement was reached on Monday, September 11th.
And on Tuesday, September 12th, at 8:30 in the morning, my first meeting was
with your Association to talk about how we move forward from agreement to action to making
a difference on the ground in the health care system.
Last fall, the Government of Canada also accepted your recommendation that we earmark
a billion dollars for new medical equipment - new MRIs, CT scans, new generations of diagnostic
and treating equipment. We established a targeted fund of a billion dollars and we put
it in the hands of the provinces as of last October.
You may have read that I've written to my provincial counterparts and I've asked them
to tell the public how they've spent that money, so that we can all know where it went
and that indeed it will produce newer equipment for you to use in your work. I think it's
important that you know, that I know, and that the public know.
At the same time we targeted funding to key areas of the health care system that require
renewal or change. I think if you ask any observer of Canadian medicare, they'll talk about
the need to look at new approaches in delivering front line services of primary health
care. Well, we've had a number of interesting models proposed for change from your Association,
from its provincial branches and from the College of Family Physicians.
Ways that might make it easier to provide 24 hours a day, 7 days a week coverage. Ways
that make it easier to fully use the potential of health care providers including nurses
and nurse practitioners. Ways that will help encourage the development of partnerships
to share practices, to focus on prevention and promotion as well as treatment. And frankly,
to provide physicians and other health care providers with different models of how to spend
their professional time - how to develop more flexible working lives or methods of compensation.
But we recognize that the transition to a new system requires transitional costs. For
that reason, we targeted $800 million available as of now to provinces. And we're working
with you to fund changes in the system, to make it easier to adopt some of these flexible
new approaches.
Another crucial part of improving health care is accountability to Canadians. You spoke
of it this morning, and the excellent work that was done in the Report Card. That's a lasting
contribution I think to the understanding of public attitudes toward the health care system.
Real accountability includes measuring and reporting - telling the public how we're spending
the $95 billion a year we spend on health care in this country. And so now we have an Agreement
among all the provinces and territories and the Government of Canada, to apply common indicators
to health and health care information and to use common methods of reporting to the public
on a regular basis, about health outcomes and about the performance of the health care
system. We will no longer have to rely on anecdotes - we'll be able to point to facts.
In September of 2002, we'll publish the first of those reports and, again, if you read
the Agreement from last September, we set out the areas that we'll be reporting on. Everything
from access to 24/7 primary health care coverage, access to home and community care, patient
satisfaction, the state of waiting lists, re-admission rates to hospital - which might
tell us something about whether people are being discharged too soon - and to guarantee
some public involvement in that process.
We've also committed to creating the Citizens' Council on Quality Care. And in September
when I have my annual meeting with provincial Ministers of Health, we'll be talking about
how that Citizens' Council can be appointed and how it will function, and I welcome the
views of the Canadian Medical Association on that subject.
Information and Communication Technology
And there's so much more that's been done. We recognize that one of the ways to modernize
Canadian medicare, to make it more efficient, more responsive and to integrate the services
is to modernize the system, by making full use of information and communication technology.
Electronic patient records hold such great promise for avoiding the duplication of expense,
especially tests. Making sure caregivers have relevant information that's up to date. Overcoming
inconsistent medications and saving the patients from having to repeat medical histories
whether it's in the emergency room, on the floor, to the home and community care worker,
or to the pharmacist.
I know there are privacy issues and we have welcomed your views on that question. We're
going to have to continue working on those privacy issues to make sure we can guarantee
confidentiality to Canadians. But the electronic patient record is going to be a tool of
enormous significance in modernizing and making the system better, indeed more cost-effective.
Tele-medicine - you know Canada itself has pioneered some of the technology - allows us
to defeat distance and to bring the opinions and services of physicians including specialists
to the more remote and rural areas of Canada. Just in the last couple of months, I've taken
part in the inauguration of some of these new services. For example, Prince Albert on July
25, Saskatchewan 10 days ago, southwestern Ontario in May, and northern British Columbia
in April.
Tele-psychiatry, tele-radiology, tele-consultations - technology which allows specialists
to observe the patient with high definition real-time links that are going to truly reduce
the cost of travel, make it more convenient for patients, and improve the quality of care.
We've committed $580 million to that process - $80 million to the Canadian Health Infostructure
Partnerships Program grants which are already in place, and $500 million that we're using
through a corporation to develop national approaches to the electronic patient record and
tele-medicine.
Progress
In recent years, we have acted to improve the health care system in other ways as well.
For example, we have created the Canadian Institutes of Health Research. This is an innovative
way of organizing, coordinating and subsidizing health research in Canada, an approach
that has earned worldwide praise. In addition to more than doubling annual funding for
health research here in Canada, we also intend to increase these amounts substantially
in upcoming years. We have also made progress in other areas.
We have developed a National Children's Agenda to understand and address the factors which
contribute to healthy, happy children and youth. We have established a Centre of Excellence
for Children's Well Being which focuses on the social and emotional development of children.
And we've committed, through initiatives such as the Community Action Program for Children,
Canada's Pre-Natal Nutrition Program and the Aboriginal Head Start Program, to providing
young people with the best possible start in life.
We have increased funding of these approaches and I am convinced that they are effective
and will be a success.
We've acted to improve the availability of human organs and tissues for transplantations.
We've spent years working with the Canadian Medical Association, among others, to develop
a national strategy which is now in place. We've appointed a national council to make sure
it happens. We've set aside $20 million to finance that work.
We've established a goal of making Canada the number one nation in the world when it comes
to rates of organ donations in the next five to seven years. We have a headquarters in
Edmonton that's drawing from best practices in Canada and around the world, so that we
can save the lives that are being lost every year on waiting lists because no organs are
available for transplantation.
We've acted to regulate assisted human reproduction. Four months ago, I introduced Committee,
draft legislation - a law that would provide a new framework for research, create a regulatory
body for clinics that deal in assisted human reproduction and introduce prohibitions on
practices such as human cloning, germ-line alteration, gender selection and commercial
surrogacy.
Now the draft bill would permit the use of embryonic stem cells for research within a
framework that we believe includes reasonable controls, but that would allow research to
continue to open the door toward new treatments and hopefully cures for serious illness
and the consequences of serious injury.
We have also passed legislation on natural health products so that Canadians will have
better access to the natural medicine of their choice and be assured of their effectiveness
and their safety. Canada is a world leader in this area, making way for the regulation
of products that are neither food nor drugs but that constitute a new category.
And whether it's new regulations providing for nutritional labelling to bring Canadians
relevant information about the nutritional content of packaged foods, or whether it's new
legislation on pesticides that we're poised to introduce which will quicken the re-evaluation
of pesticides on the market, provide more information to the public about the contents
of pesticides, and establish sensitive standards for vulnerable populations including children
and seniors - it's legislation that will make a difference in terms of public health.
So it's clear that we have made progress together since 1997 whether it's in levels of
funding or specific action to encourage and to speed the pace of necessary change in the
health care system - but you know better than I do that so much remains to be done. You
know better than I do that we're still afflicted with the chronic conditions, the waiting
lists, the shortages, the difficulties in getting access to care.
In some cases, the best way to address these problems is to follow through on the very
plan that's now in place adopted by all the governments last September. We know the solution.
We've now agreed on the priorities and the level of funding has been increased. It remains
now for us to roll up our sleeves and get the job done.
There is a plan in place, let's work it. To a great extent, the answer to the chronic
problems is in that plan if we follow through with the targeted funding for the changes
in primary health care and modernizing the health care system through information and communication
technology.
But in other areas the issues are more complex. One place where we simply have to do better
is when it comes to the health of First Nations and Inuit. It's simply not acceptable in
a country like Canada that First Nations and Inuit continue to suffer chronically low health
status. It's simply not acceptable in a country like Canada that we're seeing signs of
Type 2 diabetes in four-year old children in Aboriginal communities, that we're seeing
signs of lung disease in four-month old children.
It's simply not acceptable in a country like Canada that the rate of suicide, particularly
among young people and women, is vastly higher in Aboriginal communities than in the general
population signalling a hopelessness that comes from their economic and physical circumstances.
With the fastest growing population in the country and an overall demographic much younger
than Canada as a whole, the Aboriginal community should be a place of hope, a place for
the future - and it's anything but. These issues are not just my concern or theirs, they
must be the concern of all of us.
It's also a place where the Government of Canada has a unique role to play. And I accept
my responsibility, and I commit again today to working with those communities and with
you to try to address those concerns.
Home and Community Care
And while we're on the subject of unfinished business, there's home and community care
which can make health care more accessible, more humane and less costly. It can also relieve
the often unbearable burden on family caregivers, most of which are women. It's a pressing
need and we have not done enough in this area.
And then there are the longer-term issues looking out 10, 15, 20 years from now. How do
we keep a health care system that we can continue to be proud of? How do we respect the
values that we celebrate - values of compassion, of fairness, of equity and of access 10
or 15 years from now? When the aging population begins to peak with the rising costs of
pharmaceuticals and technology, with the expectations of people of my generation who are
used to good health and immediate access to the best of care - how do we define coverage
to fit our means and develop a public consensus? These are some of the very issues that
were touched upon this morning.
Well it's those questions that prompted us to appoint Roy Romanow, a former Premier of
Saskatchewan for 10 years. Mr. Romanow is a person who believes strongly in the values
of Canadian medicare, but who also understands clearly the pressures that we face. He'll
be speaking with you tomorrow.
And I know the CMA has already met with him, you'll no doubt meet with him again, he'll
be anxious to have your views, and he'll look to you for advice and for insight.
I believe Roy Romanow is the ideal person to conduct this inquiry, and we're confident
he'll ask provocative questions, conduct a thorough consultation and provide us with a
report of enduring value.
In the time remaining to me this morning before I invite your questions, let me touch
briefly upon three particular items, all of which were mentioned in the Agreement among
governments last September and which continue to be high on your agenda.
More Doctors and Nurses
The first has to do with the distribution and supply of doctors and nurses. The second
deals with the management of pharmaceutical costs and the third involves promotion of good
health and prevention of illness, particularly in relation to tobacco.
First the supply and distribution of doctors and nurses. I've read with interest and appreciation
the commentaries that you've produced recently and over the past year about the chronic
shortage - especially in access to family physicians.
I see it for myself in communities, as I travel the country. Places such as Kitchener,
Waterloo where 20,000 people are reported to be without a family physician, and in Windsor
where 40,000 people do not have access to a family doctor. And in some parts of the West,
particularly in rural and remote Canada where access to a family physician is rare.
We've watched this situation over the past number of years and we are very fortunate to
have received the report of Task Force One, produced by the Medical Forum, of which the
CMA was an active participant. A task force co-chaired by your own Dr. Hugh Scully, who
did an outstanding job in helping us understand the needs and some of the short and long-term
solutions.
I remember the meeting we had in November of 1999 with Dr. Scully and the team, where
we were presented with the hard facts and asked as governments to see to increasing enrolments.
Indeed the provincial governments have listened.
The number of new under-graduate and post-graduate physicians is on the rise. Since 1998,
more than 353 new medical school places have been created nation-wide for under-graduate
studies. That represents a 22 percent increase in under-graduate places since 1998. There
have also been increases in post-graduate positions. According to the most recent information
published by the Canadian Institute on Health Information, which was published yesterday,
the number of doctors in Canada has increased by more than five percent since 1996.
And since 1996, the number of physicians leaving the country has declined by over 42 percent,
while 17 percent more are returning from abroad. These are encouraging numbers. Although,
they don't tell the whole story. They don't explain why those Canadians in the centres
I mentioned don't have access to family physicians, but at least they're a glimmer of good
news in the overall picture.
As you well know, your Association is a member of the Canadian Medical Forum Task Force
Two, co-chaired by Dr. Hugh Scully. He intends to present a plan to my colleague, Jane
Stewart, Minister of Human Resources Development. A plan to conduct an occupational study
in medicine to broach the issue of new health care models and to develop medical resource
planning strategies.
Health Canada is working jointly with provincial governments on this project and I congratulate
your Association for the leading role it is playing. I happen to know that Minister Stewart
is as enthusiastic about the project as I am. I'm certain that we will have other good
news on this matter for you in the near future.
Let me say a word about nurses. You know better than most that Canada's nurses make a
remarkable contribution despite very difficult working conditions. As a result, nurses
continue to report more illness, more injury, and more disability than any other profession
in Canada and these pressures take their toll.
Despite the excellent work done by the executive and membership of the Canadian Nurses
Association, the Ordre des infirmières et infirmiers du Québec and the Practical Nurses
Association, the profession continues to lose too many members. Those who remain continue
to face daunting challenges and our health care system has been slow to adopt the kind
of structural changes that will make a long-term difference.
One thing that would help is meaningful primary health care change. Where nurses can be
a key agent of that change, where nurses can feel that they can use their professional
training to its fullest and participate in providing front-line services to Canadians.
This nursing shortage is an acute problem. As I travel the country and speak to hospital
administrators who are closing wards or closing beds, they're telling me it's not because
of a lack of money, or equipment, or even because of a lack of physicians. It's a lack
of nurses that's causing those changes.
At our upcoming meeting in September, I intend to raise with my provincial counterparts
the idea of setting targets to increase the number of nurses in Canada - targets which,
if achieved, could contribute to sustaining a healthy nursing workforce over the coming
decades.
Last fall, after the Premiers adopted the plan and asked us to work on it, we discussed
and adopted a national Nursing Strategy in consultation with the nursing profession. And
part of that discussion was to try to end the "poaching" between provincial governments,
where one tries to hire away nurses working elsewhere in the country. We'll have to continue
to work together to resolve this issue.
Pharmaceutical Management
On the subject of pharmaceutical management, the Agreement among governments last September
recognized the importance of getting a handle on medical drug expenditures and the cost-effectiveness
of pharmaceuticals.
This matter is of concern to all provincial ministers and I am very pleased to find that
during their meeting, held two weeks ago in Victoria, they committed to finding a solution
together. In many respects, the pharmaceutical issue is a microcosm of all our discussion
topics.
It touches on issues of utilization, the appropriateness of the prescription, the sharing
of best practices, access to reliable health records as well as relieving pressure on the
primary health care system.
As the Fyke Report in Saskatchewan pointed out, adverse drug reactions account for a substantial
number of hospital admissions, particularly among seniors and many pharmaceuticals are
over-prescribed. If we're to make real progress managing drug expenditures, improvements
will have to be made in these areas and I welcome suggestions of the Canadian Medical Association
as to how we might do that.
As a first step, I'm going to invite the provincial ministers to talk with me in September
about a number of measures that we might be able to take together. These include taking
a hard look at the cost-effectiveness of drugs that we're approving. In many cases, drugs
are approved without consideration of the additional cost they impose on the health care
system. It seems to me we need to consider, when we approve the safety and efficacy of
drugs, that at some point there should also be an assessment of cost-effectiveness in a
systemic way. There are a number of models to consider and I'll be raising them with the
provincial ministers.
Provincial ministers come to me every year and say their drug budgets are going up by
15 and 17 percent a year. They use the word unsustainable to describe that trend. And they
tell me that Ottawa approves a new drug based only on safety and efficacy, and then the
pressure shifts to the provinces immediately to add the new product to the formulary. And
they tell me sometimes the new drug is only marginally more effective in the outcome but
is vastly more expensive in cost and they try to grapple with these issues province by
province sometimes in a way that's not coordinated.
So, sharing information, developing reliable information about these factors is crucial
and we need to see if we can find a way to do that together.
You know, I looked at the example of Australia, it's not a completely analogous situation
because the constitutional distribution of authority is somewhat different. They have a
systemic way of looking at, not only whether the drug is safe and effective, but also comparing
it to what's already on the market. They decide as a matter of public policy, whether it
is an appropriate expenditure to bring in another drug which is that much more expensive.
And they use an arm's length group of patients, clinicians, health economists and ethicists
to look at those factors and make a recommendation. Perhaps that's something we should
look at in Canada as well.
I'm also going to be talking with the provincial ministers about putting in place a strong
post-approval surveillance system so that physicians and others in the health care system
can get better information about the performance of the drugs they prescribe after approval.
I'm indebted to the Ministerial Council on HIV/AIDS for their insight in this regard.
We also need to look at patterns of utilization by sharing information, working with pharmacists
and physicians.
Promotion and Prevention
Finally, let me touch upon health promotion and the prevention of disease and particularly
in relation to tobacco which continues to be public health issue number one.
You are well aware that smoking kills 45,000 Canadians every year - more than car accidents,
homicide, suicide and alcohol combined. Think of the lives that could be saved, the savings
that could be made and the hospital beds that could be emptied if we could convince smokers
to quit smoking.
We are making progress. If you look at the numbers that we published just a few months
ago, for example, they show that 24 percent of the Canadian population smokes cigarettes
regularly. This is the lowest rate of smoking since reporting began in 1965, and it's because
we finally have most of the right elements in place.
Taxes have been increased on cigarettes and will continue to rise. We've required tough
graphic labels on the packages. We've imposed reporting requirements that are reasonable
but important on the tobacco companies. And we've got a substantially increased budget
for tobacco control, which we intend to use to increase the awareness among Canadians -
and especially young people - of the direct connection between smoking and life expectancy.
In April we launched the largest federal tobacco control program that Canada has ever
seen - a five- year, $480 million effort that includes preventing young people from starting,
assisting smokers to stop and protecting the rest of us from second-hand smoke in public
and in the workplace.
As part of our Strategy, we introduced a system of accountability. We've set targets.
We want to reduce by 20 percent over the coming 10 years the number of smokers in Canada,
and to reduce by 30 percent over the coming 10 years the number of cigarettes sold in this
country.
And I'll be reporting annually to Canadians as Minister of Health, on progress we achieve
from year to year.
As physicians, you can play a significant role in preventing Canadians from taking up
smoking and in encouraging and supporting smokers who wish to quit. Canadians are listening
to you and you have the necessary credibility to change things. I am relying on you. We
are using all reasonable means to inform all Canadians of the dangers of smoking. It is
the government's choice to ensure that the public is aware of the facts but it is the tobacco
industry's duty to tell the whole truth in its ads and public statements.
And that is why on May 31st, which is World No Tobacco Day, I issued a challenge
to the tobacco industry to remove the words "light" and "mild" from their products. And
I promised that if they didn't respond in a meaningful fashion, that no later than 100
days later, I would act if they didn't. I believe the public is entitled to know the facts
about so-called "light" and "mild" cigarettes.
Fact number one: cigarettes labelled "light" and "mild" are as lethal as any other cigarette
on the market and the tobacco companies knew this when they introduced and promoted them
- and they continued to mislead the public for decades. Fact number two: cigarettes branded
as "light" and "mild" have the same ingredients as all other cigarettes. And fact number
three: in some cases, smokers inhale the same amount of toxic materials from a "light" or "mild" cigarettes
as they do from any others.
Now the industry's marketing practices deliberately disguise and ignore these facts. They
imply that "light" and "mild" are safe alternatives. Well, the evidence is clearly to the
contrary. Labelling cigarettes as "light" and "mild" offers smokers a false sense of security
based on slick marketing and the misuse of words.
Clearly, the tobacco industry, despite its promise to change its ways, has once again
chosen private profit over public health. But the writing is on the wall. The European
Union and several other countries have now adopted a ban on the use of these misleading
words.
Make no mistake, there's nothing "light" or "mild" about the lies of big tobacco.
And that's why I am re-affirming today my commitment to hold them to account and I'm taking
the next step. I'm announcing today that we will ban these deceiving labels. Predictably,
the industry will challenge us - let them argue for their so-called right to deceive rather
than voluntarily doing what we asked them to do in May.
I believe it's my responsibility as Minister of Health to ensure that Canadians have the
facts, and we'll make sure they do through mass media campaigns and by holding the industry
to the same standards in advertising as all other businesses.
The fact is, we're making progress in bringing down the smoking rates. We're not going
to lose the momentum, we're going to continue.
And I know that this Association has been an active and supportive partner in those efforts.
I thank you for your encouragement, I thank you for your involvement, and I look forward
to continuing in this effort together to save the lives of our children.
Conclusion
Let me conclude today by returning to the place from which I started, and that's speaking
about values. Because doctors in this country have always valued our health care system.
You place a value on patients' care, you place a value on the quality of that care, and
you place a value on the relationship that you have with those patients.
As I see it, the role of the Government of Canada is to ensure that our health care system
remains strong by providing appropriate levels of funding. By providing leadership, as
Dr. Barrett has said, on key issues requiring changes in the system. By encouraging those
changes and supporting them throughout the country.
I see the Government of Canada as having an important role of partnership with this Association
and with its members. I'm proud to be your partner in these continuing efforts. I learn
from you always when I speak with you. You have made it far easier for the Government of
Canada to address these issues by providing your help.
I would like to extend my sincere thanks for all that you have done in the past four years
and I look forward to continuing in that partnership toward achieving quality care for
all Canadians in the months and years ahead.
Thank you all very much for your help.
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