May 24, 1984 ALBERTA HANSARD 1027 LEGISLATIVE ASSEMBLY OF ALBERTA Title: Thursday, May 24, 1984 2:30 p.m. [The House met at 2:30 p.m.] PRAYERS [Mr. Deputy Speaker in the Chair] head: TABLING RETURNS AND REPORTS MR. WEISS: Mr. Speaker, it is my privilege to table five copies of the 1983-84 annual report of the Northern Alberta Devel­ opment Council. Copies will be available for all members of the Assembly. head: INTRODUCTION OF SPECIAL GUESTS MR. NELSON: Mr. Speaker, it's my pleasure today to have the opportunity to introduce to you and to members of the Assembly 26 grade 7 students from Dr.

Gladys Egbert com­ munity school in the constituency of Calgary McCall. Dr. Egbert community school is probably one of the finest com­ munity schools in the province. The efforts that are put into this school by the students, teachers, and parents of the com­ munity exemplify the attitude of that particular community. I would also like to introduce two teachers accompanying the students, Donna Pyle and Shelly Schmidt, along with a couple of parents who have made the trip, Betty Forward and Maureen Molnar. At this time I'd like to ask that they rise and receive the accord of the Assembly. MRS. LeMESSURIER: Mr.

Speaker, I'm pleased today to introduce to you 25 members from the Alberta Vocational Centre situated in Edmonton Centre. They are studying current affairs. They are seated in the members gallery, and they are accompanied by their leader Mrs. Nikolai. Would they please stand and be recognized by the Assembly. MR. HIEBERT: Mr. Speaker, it's my pleasure this afternoon to introduce to you and to members of the Assembly 30 grade 5 students from Fulton Place school in the constituency of Edmonton Gold Bar. They are accompanied by their teacher Adele Wygera and by parents Mrs. Stetsko, Mr. Bjalek, Mrs. Lohnes, and Mrs.

Geddes. They're situated in the public gal­ lery, and I ask them to rise and receive the cordial welcome of the House. head: ORAL QUESTION PERIOD Health Care Premium Arrears MR. MARTIN: Mr. Speaker, I'd like to direct my first question to the Minister of Hospitals and Medical Care. Did the minister ask his officials to implement a policy of revoking the Alberta citizenships of those who are in arrears with their health care premium payments, or is this a proposal that the minister has been asked by officials from his department to review? MR. RUSSELL: Mr.

Speaker, I think I know what the hon. member is getting at with that question. It refers to statements I made earlier in the House with respect to passage of the Canada Health Act, in which I indicated that the province would have to bring in amendments to our existing legislation in order to comply with the requirements of the Act with respect to the health care insurance program. I believe that is what the hon. member is referring to. MR. MARTIN: A supplementary question, Mr. Speaker.

Can the minister confirm that as of June 30, it will be government policy that those who owe a premium debt will be placed in a doubtful residency category even if they have a perfectly valid permanent address? MR. RUSSELL: Mr. Speaker, I'm not quite sure of the intent of that question, but there is notice on the Order Paper of legislation dealing with that matter. It will be introduced very soon, and I'm sure the hon. member's questions will be addressed at that time. MR. MARTIN: A supplementary question, Mr. Speaker, just for clarification.

Is it the intention of the government to intro­ duce legislation regarding this matter at this late date in the spring session? MR. RUSSELL: Yes, Mr. Speaker, it is our intention. I've indicated that on earlier occasions in the House. It goes back to the matter of the changes we made last fall with respect to the health care premium program, in which persons whose coverage was not up to date were responsible for their own medical bills. Despite the very good success of that program, the Canada Health Act requires us to go back to the system that was in effect before then.

That is the nature of the legislative amendment I'll be bringing to the House shortly. MR. MARTIN: A supplementary question, Mr. Speaker. Has the minister received legal advice on this matter? I want to know specifically how the minister knows this would not violate the Canada Health Act. MR. RUSSELL: Mr. Speaker, I'm a little surprised by that question. The whole intention of the amendment is to make sure Alberta does comply with the Canada Health Act. As far as legal advice, the amendments are being drafted by officers of the Legislative Counsel office, and that is the objective of the amendment. MR.

MARTIN: A supplementary question, so there is no con­ fusion at this moment. Will the minister provide the House with his department's

definitions of residency and doubtful residency as they apply to medicare coverage? MR. RUSSELL: Again, those kinds of details will be addressed by the legislation and the regulations that follow. MR. MARTIN: A supplementary question, so there is not a great deal of confusion among Albertans. Would the minister indicate to this House what other measures the government has in store for Albertans when the Canada Health Act comes into force on July 1? MR. RUSSELL: Mr.

Speaker, I can only repeat that if the hon. member can wait to look at the legislation which is given by way of notice on the Order Paper, I'm sure his questions will be answered very shortly. Perhaps it would be useful if I repeat in the House today what I've said on several previous occasions both in the House

1028 ALBERTA HANSARD May 24, 1984 and outside the House. With respect to the health care insurance premium plan, it's essential that 100 percent of the residents receive coverage under the Canada Health Act. That is what the amendments are all about. In essence we're bringing in amendments to revert more or less to the system that was in effect prior to the changes we made last October, which were initiated in order to collect escalating arrears. MR. MARTIN: One final supplementary, Mr. Speaker.

Would the minister confirm to the Assembly that people who haven't paid their medicare premiums will not be cut off medicare, as has recently been reported in the press? MR. RUSSELL; Mr. Speaker, I can say that all residents of Alberta will receive coverage under the Canada Health Act, as is required by that Act. The premium system will remain in effect, and people with premiums in arrears will be followed by the usual collection methods to get those arrears brought up to date. Alberta Wildlife Park MR. MARTIN: Mr. Speaker, I'd like to direct my second question to the Minister of Recreation and Parks.

I would like to continue with the line of questioning dealing with written questions and answers. The government information listed a $35,000 loan from the RPW Foundation to the Alberta Wildlife Park for a project described as: to assist in offsetting payroll deficits. That was in reply to my Motion No. 148. We now have word . . . MR. DEPUTY SPEAKER: Perhaps the hon. member could come to the question. MR. MARTIN: I have to explain it first, so he understands it. We now have word from Mr. Jerram . . . [interjections] MR. DEPUTY SPEAKER: Could we please have the question. MR.

MARTIN: Many people are asking questions, and I will continue to do so. Thank you. The government information says that . . . MR. DEPUTY SPEAKER: Would the hon. member come directly to the question, please. It is not permitted to have a long

preamble to a question. MR. MARTIN: On a point of order. I'm trying to explain a written question that was given in this House, in 148, and trying to explain that some people think that information is wrong, so the minister knows who I'm talking about. MR. DEPUTY SPEAKER: Perhaps the hon. member could direct his question in such a manner as to elicit the necessary information. MR. MARTIN: Okay. Mr. Jerram says that this information is wrong and that payroll deficits were really for animal feed. My question to the minister: is Mr. Jerram correct?

In this case, has the government filed incorrect information to an opposition written question? MR. TRYNCHY: Mr. Speaker, I'm not aware of the question as put, because I can't quite understand it. The answers I provided to the question were those provided to me by the Recreation, Parks and Wildlife Foundation, which is a Crown corporation and answers to the department in an annual report. I'd have to check further to see if that was correct or not, and I don't know the answers Mr. Jerram is contesting. I wouldn't have any idea whether it's factual or not, and I'd have to check it out. MR.

MARTIN: A supplementary question to the Minister of Tourism and Small Business. It deals with information from the Alberta Gazette of September 30, 1982, which lists two AOC loans totalling $570,500, for the purpose of refinancing existing debt. Mr. Jerram says these were for construction purposes, linking the loans under question with earlier AOC loans. My question to the minister: is Mr. Jerram correct, and is the government filing incorrect information, in this case public information through the Alberta Gazette? MR. ADAIR: Mr.

Speaker, the information that was filed was information that was gazetted, as were the terms of the loans made by the Alberta Opportunity Company to the client, in that case the Alberta Wildlife Park. MR. MARTIN: A supplementary question. Then the minister is saying that Mr. Jerram's information is wrong. MR. ADAIR: I'm not necessarily saying that. But I'm not sure what question was posed to the hon. member whose name was mentioned, and then how it was reported. I assume you're talking about the report that was in The Edmonton Journal, and they're not necessarily always right. MR.

MARTIN: It's a very serious matter if we're getting incor­ rect information in this House. My supplementary question to the minister is, will the min­ ister look into this and report back to the House? MR. ADAIR: Mr. Speaker, I'll confirm again the information that was in the Gazette. I read it back in 1980, I believe, and again when it was filed. MR. MARTIN: A supplementary question, back to the Minister of Recreation and Parks.

The reply to Motion 148 also advised that . . . the Alberta Wildlife Park received no "concessions, privileges or financial benefits" . . . other than what is afforded every other big game farm through the current programs or operations. My question to the minister is, has the government received any complaints from other wildlife operators about alleged favouritism to Alberta Wildlife Park by this government? MR. TRYNCHY: Mr. Speaker, it should be remembered that the Recreation, Parks and Wildlife Foundation is not part of government.

What they do in their day-to-day operations is outside the purview of the minister or the government, so I don't know how I can respond to that. I've had no inquiries from anybody that we were dealing with one firm in favour of another. MR. MARTIN: A supplementary question. What assessment has the minister made of the statement of Mr. Al Oeming, who runs the rival Polar Park, that he has received absolutely no money from the government and that he can't understand why the other park gets this money? MR. TRYNCHY: I guess the hon. member isn't listening, or he doesn't understand. The government did not provide any

May 24, 1984 ALBERTA HANSARD 1029 funds to the Alberta Wildlife Park through Recreation and Parks. MR. MARTIN: It's taxpayers' money. MR. TRYNCHY: No, it's not taxpayers' money; it's funds from lotteries. There's quite a little difference. If Mr. Oeming would make the same request as these people did, he might receive consideration. MR. MARTIN: I'm sure we'll pass that on to Mr. Oeming. He will be glad to know that he will get this money too.

My concern is the total amount of government money appar­ ently used to develop Alberta Wildlife Park, through a com­ bination of roadway expenditures, AOC loans, recreation grants, and the like. It now totals over $5 million. My question to the minister is, has the government made this expenditure on the basis of extensive study of the tourist potential for a wildlife park in Bon Accord? Or was any independent study at all made to guide the government on this development, especially a lot of money in a time of restraint? MR. TRYNCHY: Mr.

Speaker, I can't comment on Trans­ portation or the Alberta Opportunity Company. I want to say again that the government provided no funds to that wildlife park through the Department of Recreation and Parks. I want that very clear. The funds were provided through the Recreation, Parks and Wildlife Foundation, which uses lottery funds for distribution. So it's not public funds or government funds. The question by the hon. member in regard to transportation should go to the Minister of Transportation. MR. M. MOORE: Mr. Speaker, I'd be pleased to respond.

The road in question was built not just for the Alberta Wildlife Park. In fact I believe I outlined in the return the amount of traffic that travels on that road, the other industries it serves, and the people it serves. It's quite ridiculous for the hon. mem­ ber to suggest that all the cost of developing that road should be tagged to the Alberta Wildlife Park. This government builds roads to all kinds of industries and for all kinds of people throughout the province, and the utilization of that road is similar to many that are utilized by other industries. There are examples all over the place in that regard.

MR. ADAIR: Mr. Speaker, possibly I could supplement some of that too. It may take a moment to refresh some of our memories about the time when the owner of the then wildlife — I'm not sure what it was called at that time; Mr. Oeming's park before it was Polar Park. He was trying to sell it because he had reached the stage of operating a park when he was no longer interested in that. He wanted to sell it to anyone, outside the province or the likes of that.

At that time we as a government suggested we were prepared to help someone in the private sector, whoever that might be, who would come forth with some suggestions. The two gentle­ men that now own the Alberta Wildlife Park came forward, put up some of their land, put a great deal of their own money into that particular operation, and purchased a great number of the animals from Mr. Oeming.

Unfortunately, in the long term, you now have a Polar Park which is still being operated by the gentleman who at that time said he was not interested in con­ tinuing; who in essence did receive some of the wildlife of this province; who, if my memory serves me right, at that particular point in time was also provided with a quarter

section of land for a very nominal sum of money, as long as it was to remain a wildlife park. Should it not remain that, it reverted to the county, I believe it was at the time. Those things should be taken into consideration when you're talking about what is out there. In essence, the Alberta Wildlife Park received some funds in December from the Department of Tourism and Small Busi­ ness to assist in winter feed. In the process, we also conducted a study to help and ensure the transition of that park from the owners as they are now to a foundation. That has been public knowledge for some time. MR.

MARTIN: A supplementary question to either the Minister of Tourism and Small Business or the Minister of Recreation and Parks, whichever one feels like jumping into the breach. I'm trying to figure out what kind of small business we have here. The AOC loans list the kind of business as Red Barn dine and dance/wildlife park, while the RPW Foundation loans cite the recipient as only the Alberta Wildlife Park. Is primary business development, for which loans total $5.6 million, being directed to a dine and dance or a wildlife park? What are we into specifically? MR.

ADAIR: Just to show how confused the hon. member is getting . . . [interjection] You've got to uncross your eyes. Mr. Speaker, the $5.6 million is a total of everything. I stand to be corrected, but I believe the Alberta Opportunity Company loans are — I'm not sure whether it's $2.1 million or $2.2 million. I believe those loans were initially made to the Lily Lake Ranch — and I stand to be corrected on that — and the Alberta Wildlife Park. That can be substantiated, and I will do that and bring it back to this House. MR. MARTIN: Mr.

Speaker, I would just say to the hon. member that reading government propaganda is enough to uncross anybody's eyes. I can assure you of that. Agricultural Assistance MR. R. SPEAKER: Mr. Speaker, my question to the Minister of Agriculture is a follow-up to questions on May 22 with regard to the production credit arrangement, and the minister's reply: we are looking at it. I am wondering if the minister could indicate what the time frame is with regard to that program. Will there be introduction of the program this spring?

Or are we looking at the fall or, say, 1985 before a program such as that could become effective? MR. FJORDBOTTEN: Mr. Speaker, I have some difficulty in assessing just what the time frame will be. First of all, there's no model within Canada, to look at how effective it would be. The department, in co-operation with the Alberta Cattle Com­ mission, has been working to develop the production credit concept to see what merit it does in fact have. Before it could go further, it has to have an accurate assessment to see whether or not that proposal would meet the challenges we feel it must.

There would also have to be consultation with other farm organ­ izations in the province to be clear on whether that is the vehicle we want to support. In addition to that is the agribond concept that is now being worked on with the federal government. That may or may not change the time frame. But by the fall, I hope to have a clearer assessment of how this would work and if in fact we have an intention to do it or not. MR. R. SPEAKER: Mr. Speaker, a supplementary question to the minister. In terms of the needs of farmers, a lot of assistance

1030 ALBERTA HANSARD May 24, 1984 is needed at the moment. I am wondering whether, in the interim, while this other program is being developed, the min­ ister is considering extension of the interest shielding program. MR. FJORDBOTTEN: Mr. Speaker, that answer has been clearly defined in the House by the Minister of Tourism and Small Business, and I refer the question to him. MR. ADAIR: Mr. Speaker, the program itself has not been extended.

The basic reason was that the interest rates were lower than the protected rate in the interest shielding program, although we did extend original applications until May 31; in other words, a person who is eligible and has not applied for the first time for one of those four quarters. That still applies; it's extended till May 31. MR. R. SPEAKER: Mr. Speaker, a supplementary question to the Minister of Agriculture, with regard to the small business equity program.

I am wondering if the minister has had dis­ cussions with the Minister of Tourism and Small Business with regard to that type of program being extended into the area of agriculture. MR. FJORDBOTTEN: Mr. Speaker, I refer that question to the Minister of Tourism and Small Business. Initially I would say, yes, we had discussions on that subject. To an extent, agriculture is in fact covered in that program. I ask the hon. minister to respond. MR. ADAIR: I'm sorry. Would you repeat the question, please? MR. R. SPEAKER: Mr. Speaker, to the minister.

It's with regard to the small business equity program announced on May 15 by the minister. Could the minister indicate what parts of that program could apply to the field of agriculture, in terms of assistance to a number of farmers who need help now? MR. ADAIR: Mr. Speaker, what we've done — hopefully with the approval of this Legislature, and we're now at second read­ ing of that Bill — is provide as broad a base as possible, to include agriculture and agribusiness in the broad sense. There are some restrictions, and I don't have them at my fingertips.

Relending funds, speculation or purchasing land for speculative purposes, investing outside Canada: those are ineligible areas. But from the standpoint of eligible areas, agriculture and agri­ business are eligible. MR. R. SPEAKER: For clarification, Mr. Speaker. Is the min­ ister saying that through the small business equity program, a farmer in the province could have funds available for operating an agricultural venture as well as for capital expenditures? MR. ADAIR: Getting back again to the operation of the fund itself, basically yes.

In the one broad sense, the funds could be used to stabilize the business, in this case the farm business. I should point out that it's equity, new share purchase. It's a maximum of 49 percent that an equity company or corporation could purchase in a farm business in this case or, for that matter, any other business that's eligible. It has to be at arm's length. In essence, if any member of the equity corporation has a share in that particular company or farm business, they would not be eligible to purchase up to 49 percent of that particular busi­ ness.

It's new equity, new shares — equity rather than debt, to relieve the pressures of the debt situation we have — and in essence, the maximum of 49 percent plus the arm's length provision. MR. R. SPEAKER: Mr. Speaker, is the minister saying the farmer would have to be registered as a company in order to qualify for the benefits under the small business equity pro­ gram? MR. ADAIR: The qualification under the small business equity program — if I can just take a moment, Mr. Speaker.

First of all, as either an individual or a group of citizens within the province, you must raise a minimum of $100,000 in capital for reinvestment in small or medium-sized businesses in the province. Once that is done, you register. Once you register, we require you to put 30 percent in a jointly held trust account in the Crown's name as well as the corporation's name. Then the shareholders of that small business equity corporation, will receive the 30 percent incentive by way of a grant if you're an individual, or a tax credit by way of a document that is an indication you have purchased the shares.

I haven't got that term with me right at the moment. Once you have done that, then obviously where the incentive goes is to the corporation and not to the business. The incentive is to the corporation to then look at investments that may be of a lesser, longer term investment return than the normal, because they would be getting the 30 percent incentive to invest in Alberta's small or medium-sized businesses.

So the thrust is to the corporation, to assist it in making corporate decisions as an equity corporation to invest in the business, be it agri­ culture-oriented or, in the sense of small business, business- oriented. The maximum amount that can be invested by a private corporation is $5 million, and by a public corporation $10 million. The minimum investment in any one year is 40 percent in the very first year and 70 percent after that. I'm getting into some of the detail of it, which becomes somewhat confusing. MR. ALEXANDER: Mr. Speaker, a supplementary on these small business equity companies.

I wonder if the minister could comment. I notice that press reports a couple of days ago indicated that, through this strategy, small business develop­ ment corporations in Ontario had created about 11,000 jobs in Ontario. Does the minister or his department have any projec­ tions as to what kind of employment might result from the new initiative on the minister's part? MR. ADAIR: Mr. Speaker, I have that figure in my office; I don't have it with me. It was prorated down to our population, based on the Ontario situation.

To give you a bit of an aside on the Ontario one, the investment capital that was put together for reinvestment in small and medium-sized businesses in Ontario was roughly $210 million that was put into the corporations. They then had reinvested about $200 million of that in small and medium- sized businesses over the last four or four and a half years. MR. ALEXANDER: A further supplementary, Mr. Speaker. It seems to me the Ontario experience also was that the jobs created by this program were at something less than half the cost of jobs created by publicly funded programs.

I wonder if the minister might have any comparable statistic. Has he had any indications from his department officials about the effi­ ciency in job creation? MR. ADAIR: Mr. Speaker, I don't have that figure with me, but I would be delighted to get it.

May 24, 1984 ALBERTA HANSARD 1031 Chiropractic Profession Legislation DR. ELLIOTT: Mr. Speaker, my question to the Minister of Education deals with Bill 54, the Chiropractic Profession Act. I would like to ask if there is any doubt in his department with respect to getting this legislation under way as soon as possible. MR. KING: Mr. Speaker, there has certainly been extensive discussion within the chiropractic profession about some spe­ cific sections of the Act, and clearly there has been some dis­ agreement within the profession itself about some specific sections.

But it is important to emphasize that the disagreement is found among members of the profession; it is not between the profession and the government. As sponsor of the Bill, my information is that the vast majority of the practising chiropractors in the province favour the legislation. Clearly the government would not proceed with the legislation if we had reason to believe there was significant opposition to the Bill, either in terms of the number of prac­ titioners opposed or in terms of the opponents identifying any substantive defects, deficiencies, or limitations in the legisla­ tion.

I don't believe there's a problem. In any case, the government deals with the association. The association has the means of resolving internal disagreements. The government would only be concerned if it appeared that a minority of the members of the association were being denied any opportunities which the bylaws of the association grant to them. In other words, at the present time I expect we will proceed with the different stages of the Bill this spring. ORDERS OF THE DAY MR. HORSMAN: Mr.

Speaker, I move that the question and the motion for a return on the Order Paper stand and retain their places. [Motion carried] head: MOTIONS OTHER THAN GOVERNMENT MOTIONS 204. Moved by Mrs. Koper:

Be it resolved that the Assembly urge the government to review the current phenomenon of one dollar home sales and foreclo­ sures, and undertake legislative action to eliminate this problem. [Adjourned debate April 3: Mr. Anderson] MRS. KOPER: A point of order, Mr. Speaker. I am pleased to rise and speak on a point of order to Motion 204, introduced in the Legislature on Tuesday, April 3. As hon. members are aware, since that time the Attorney General has introduced Bill No. 50, an amendment to the Law of Property Act, which is intended to reduce the incidence of dollar sales of homes.

I wish to commend the government for the introduction of this Bill, and hereby request unanimous consent of the House to withdraw the motion, as the intent has been realized. MR. DEPUTY SPEAKER: Does the Assembly agree to give unanimous consent? HON. MEMBERS: Agreed. MR. DEPUTY SPEAKER: It is so ordered. 218. Moved by Mr. Woo:

Be it resolved that the Assembly urge the government to con­ sider the implementation of a preventive medicine program. MR. WOO: Mr. Speaker, in speaking to Motion 218, I would like to begin by making a number of observations. Firstly, I think all hon. members recognize that the motion itself reflects subject matter that is fairly complex and certainly provides a very wide-ranging view. The second observation I would make, Mr.

Speaker, is to the effect that for purposes of this particular debate, members take into consideration that the use of the term "preventative medicine" is synonymous with that of prev­ entative health services. In that regard, I think it will afford hon. members a greater opportunity to talk about the differing dimensions involved within the context of the motion. Hope­ fully this will not be perceived as constraining them in terms of the types of issues they would like to raise. Mr.

Speaker, we as Canadians and Albertans are constantly praising our health care systems and our highly sophisticated and efficient delivery mechanisms for health care and hospital services as the best in the world. I personally have no quarrel with what is being said, simply because I happen to be in total agreement with such statements. We do in fact have one of the highest levels of health care services of any of the industrialized nations of the world. It also happens to be one of the most costly.

I think it is important to recognize that those glowing state­ ments about the state of medical care in this country and in this province represent what may well be a very narrow way of thinking. When we consider these statements within the general context of the health of Canadians and Albertans, it sort of reminds me in many respects of Nero merrily fiddling away while Rome burned. What these statements and the bills that come with them mean to me, Mr. Speaker, is that perhaps we have our priorities a little backwards in terms of the health care system in this country and in this province.

It suggests to me that the positives of our otherwise excellent health care systems really reflect the negatives and deficiencies in the man­ ner in which we deal with the health of people from a philo­ sophical point of view. Mr. Speaker, I read with considerable interest an account of the public proceedings concerning the new Canada Health Act during its early stages preceding enactment in the House of Commons. There were a number of points raised by wit­ nesses testifying on this Bill. I would like to share some of them with hon. members, because I believe they are relevant to this motion.

Firstly, the point was raised that hospitals throughout Canada were jammed to overflowing and that patients often faced lengthy waits for elective surgery, which is operations that are vital to health but do not have to be performed immediately. Secondly, the health care system is still centred almost exclu­ sively around doctors. Nurses, public health nurses, and com­ munity services in the field of public health and welfare are not fully utilized in terms of their potential. The third point I raise is that health services provided by governments do indeed vary greatly from province to province.

It is interesting to note that all provincial medicare plans cover visits to doctors and hospitals but that not all provide coverage for the lesser costs of alternative services. The last point I wish to raise with respect to these public committee hearings, Mr. Speaker, and the one that I think is most important to this debate, refers to our health care systems being preoccupied with sickness and paying only lip service to wellness. Yet getting people to stop smoking,

1032 ALBERTA HANSARD May 24, 1984 lose weight, exercise regularly, and watch their diets were needs that were cited most often. Without question, the federal Minister of Health's statements regarding the new Canada Health Act boil down to one purpose; that is, to discourage or eliminate balance billing by doctors and the use of hospital user fees. I'm not about to reopen the debate on that particular issue.

But in many ways I can't help but think that this sort of action removes any incentive on the part of the general public to look at alternatives to its own health and well-being and say to itself: hey, maybe this perfect health care system of ours isn't all it's cracked up to be; it's getting costlier to get sick than to stay well. And there's a lot of truth in that, Mr. Speaker.

At the conclusion of the committee's hearings on the Canada Health Act, the Ontario Minister of Health made the remark that this may be the very last time in this century that governments have the opportunity to shape the health care system for the future. That may well be, and it is all the more unfortunate that the Act does not contain any of that stated reference to preventative medicine or preventative health care. Mr.

Speaker, it is my opinion that government programs in the areas of health care services are somewhat similar to some of the commercial advertising that we hear on radio and see on TV and in our local newspapers. At times they are perceived to be a contradiction in terms. On the one hand, we present health care programs as accessible and as all-encompassing as possible, and suggest that because of that, don't worry too much about yourself: we'll look after you free of charge, whether you get sick or have an accident. To me, this removes the incentive for many to do exactly the opposite.

In that respect we have another government department that comes forward with a program to encourage people to do the opposite: keep fit, keep healthy, and keep the doctor away. When I made reference to the manner in which we speak about our health care system, I initially made the statement that perhaps we have our priorities backwards. There was a time when physicians — and I think of the general practitioner, the image of the family doctor that I remember best — used to put prevention of disease, relief, and cure of disease in that order.

Somehow or other it seems to me that we have our priorities reversed today. Now the emphasis is on the costlier end of the scale of our health care system, and that has to do with curative medicine, remedial, and rehabilitative aspects of health care. The reversing trend has occurred in a very subtle way and over a long period of time. I think we can argue the pros and cons of our system in terms of the broader benefits it provides to our citizens, and certainly a lot of that argument would be on very specific and technical terms. But I suppose two ques­ tions remain.

What is a preventative medicine program, and how do we reverse the present trend, our priorities? And per­ haps a third question: why? The last question is easy to answer, Mr. Speaker. All one has to do is look at the billions of dollars attached to all government health care plan budgets and ask oneself the question: who pays for all this? The first question is also fairly simple to answer. A preventative medicine pro­ gram would place the prevention of illness and disease on a level parallel with the treatment aspects of sickness and disease. The ultimate aim is to keep people healthy and out of hospitals.

The second question will be a bit harder to respond to. I think it has a lot to do with attitude and a shift in philosophy in our present life-style, and that covers a lot of territory. An overriding concern that I have when I talk to people about preventative medicine or health care is the perception that the subject matter deals only with hospitals and medicine, sickness and disease. Certainly these are central elements. But if one were to equate preventative medicine to personal health and well-being, I think one can get a broader picture of what is meant here.

I mentioned attitudes and life-style as being a couple of aspects which contribute to a preventative medicine program's success or failure. I'd like to give you a couple of examples. They have nothing to do with being sick in the sense that we understand the meaning of the word. But just as surely, the final destination will be a hospital. For the majority of us, our present-day life-style and attitudes are shaped because we find it easy to be told what to do, perhaps because in that way we feel we don't have to take responsibility for what happens.

As a first example, let's take the image of the macho Canadian male. Generally speaking, he is between the ages of 25 and 35, at the peak of his health and in top-notch physical condition. One of the first things he does is go out and plunk down $16,000 for a sports car, because the ads tell him that's the Canadian way of life and the way to do things. Once he gets into the car, his next stop is the local candy store to pick up a couple of dozen brews and a bottle of rye, because the ads tell him this is the in thing. So off he goes, totally disre­ garding belting himself in.

It's while trying to light his favourite el ropo and popping a brew in the other hand — that's something else the ads said he should do — that he has his accident. Who comes along but a chap in his jogging suit and jogging shoes, doing his bit to keep fit, keep well, and stay out of hospital. He's the Good Samaritan. His first thought is, I'm my brother's keeper. But sometimes I wonder if, as our brother's keeper, we are supposed to pay his hospital bill also. When you look at this in terms of a balance sheet, I don't believe there are any winners.

Yet there is the other side of the picture, the ads that say to us: keep fit, ride a bicycle, jog, run, drink milk, and so on. But I think our commercial priorities tell us that it is better to drink such and such a brand of beer or liquor and that this brand of cigarettes or tobacco is better or best. Certainly such commercials far outweigh all the others in terms of numbers and the amount of dollars behind them. We spend more on promoting those things which will put us into hospitals than those which will keep us out of them.

Alco­ hol and drug abuse, for example — and by drugs I include all the pills we pop, from aspirins to what have you — and tobacco usage account for more deaths in North America in one year than the total casualties in any one of the major theatres of operations during the Second World War. Cigarette smoking alone was cited by the United States Surgeon General as the cause of 90 percent of the 60,000 deaths associated with lung disease in the United States in 1983. Mr. Speaker, I will admit that in this instance, I suppose I am one of the worst offenders.

A Toronto report indicated that weight lifting would improve the breathing of smokers, so I went out and bought myself a set of weights. It sort of makes you wonder at which end of the arm is the real dumbbell. Speaking of weight lifting, Mr. Speaker, I wonder how many members of this Assembly or of the general public have at one time thought of purchasing a set of weights to keep fit, stay in shape, get muscle-bound.

Six months later, I wonder how many of us and how many of the general public have yet to take those weights out of the cartons they came in, I think simply because it is much more fun — and our attitudes tell us that rather than waste our time on lifting weights, we should run down to the corner pub and join the rest of our friends. Then there's the other side of the coin, Mr. Speaker. How many of us have indeed taken those weights out of their cartons and spent about half an hour reading the instructions and putting them together? Then because we couldn't lift them, we shoved them aside and let them gather dust.

How many of us in this Assembly have gone out and bought a brand-new pair of Adidas

May 24, 1984 ALBERTA HANSARD 1033 or jogging shoes? We take them out of the boxes and the wrapping, put them up on the shelf in our closet, and look at them for 364 days of the year, waiting for that 365th day when we have our annual MLA/media ball game. That's the only time they come out of the closet. Mr. Speaker, I chose this way, perhaps in a lighthearted manner, simply to get a point across; that is, when we talk about preventative medicine programs, we are indeed covering an extremely wide range of some very serious considerations. This includes not only the areas of disease and medicine.

We are talking about safety in the work place, the use of seat belts, proper nutrition, accident prevention, how to deal with present- day stress, and general hygiene. We are talking about promoting physical well-being, healthy life-styles, exercising, guarding against everything from the common cold to malaria, alcohol and drug abuse, and so on.

We are also talking about attitudes, not only of the general public but also of the professionals in the health care field, from the role of the public health care units to a reaffirmation of the philosophy of the general practitioner, the family doctor whom I know best, whose first priority is prevention. Thank you, Mr. Speaker. MR. DEPUTY SPEAKER: Before the next member enters the debate, I wonder if the Assembly would agree that the Minister responsible for Workers' Health, Safety and Compensation might revert to Introduction of Special Guests? HON.

MEMBERS: Agreed. head: INTRODUCTION OF SPECIAL GUESTS (reversion) MR. DIACHUK: Mr. Speaker, it is my pleasure today to intro­ duce a class of students from the constituency of Edmonton Beverly who, because of the interest in visiting the Legislature, could not come in at 2:30 but are here after the first shift of students has left. I want to welcome them here, and ask the members of the Assembly to welcome them after I've intro­ duced them. They are a grade 6 class from Rundle elementary school, accompanied by teachers Mrs. Anne Sadelain, Mrs. Stephanie Kyselitzia, and Mr. M. Edwards, and by parent Mrs.

Dorothy Massey. They are seated in the members gallery, and I ask them to rise and receive the usual warm welcome of the Assem­ bly. head: MOTIONS OTHER THAN GOVERNMENT MOTIONS (continued) MR; PURDY: Mr. Speaker, in rising this afternoon to make what I hope will be a contribution to Motion 218, I have some thoughts on it that may be contradictory to what I'm going to say and contradictory to the intent of the motion put forward by the hon. Member for Edmonton Sherwood Park.

We know that today our leading health hazards are heart disease, strokes, cancer, accidents generally, motor vehicle accidents, and then mental health. They don't necessarily go in that order. AN HON. MEMBER: What about senility? MR. PURDY: That's the last step. In all the information that has been gathered over the years, there are many statistics we can look at regarding health prob­ lems of many individuals and what could have been done to prevent those health problems.

A lot of health problems are brought on by the individuals themselves, such as heart disease, strokes, accidents — because there are no preventative meas­ ures out there — and motor vehicle accidents. I look at the resolution and I say to myself, how much further can this government and other governments become involved in preventative health matters? In various areas of the province right now, many, many health units have been set up to look after our preschoolers, children in school, and adults, right down the line. All children have to be immunized now before they start school or when they get into the system.

The health units also help mothers who are expecting children. They will come in and spend time with them. We also have a prev­ entative dental plan through the health units, and I think that preventative dental plan has worked quite significantly in this province since its inception a number of years ago. Other pro­ grams, such as Meals on Wheels and others, are there for our senior citizens. We talk about the individual in society, what he or she can do for preventative medicine, and how much further government can get involved in it.

We have a health care system in this province and in the Dominion of Canada that is the best in the world as far as I'm concerned. It gives people the priv­ ilege to visit their medical doctor whenever they wish. There is no particular limit on the number of times you wish to visit a doctor. Maybe one problem with our health care system is that we allow so many visits, and then have to start charging for other visits unless it's a continuing disease or a continuing problem. The famous thing our doctors do right now is, you can go to them with a bit of a cold.

They'll look at you, give you a couple of pills and say, come back in five days and see me again. I have gone to a doctor a number of times for those types of things. But when he says to come back to him in five days, he doesn't see me. I don't believe in the system that each and every time I visit a doctor, I have to go back to him for another checkup or follow-up to see how well the medication has worked. If it continues, then I think the individual should return.

But if it has cleared up, I don't think we should be adding that extra cost to our health care system and the extra dollars to the doctor's pocket just because I want to make a return visit. There are a number of items that could be more vigorously put forth in this province and in this country. One of them is smoking. We say that smoking is hazardous to health. Canada Health also has small printing on packages of cigarettes, saying that smoking is hazardous to your health. However, we are still not going into the wishes of the non-smokers in this country.

Sure, we've set up places in restaurants and other facilities. There might be 15 percent of that restaurant for people who don't smoke. I look at the members of this Assembly. I think that probably 15 percent of the members of the Assembly smoke, and 85 percent don't. What I'm trying to get at is that there should be a larger area available for nonsmokers than for smokers. Maybe the word would get out that smoking isn't that conducive to good health. Why don't the individuals who smoke think of quitting and helping their health out?

I thought the prices we have with the taxes on tobacco — looking at some of the vending machines. I understand that a package of cigarettes is $2.25 — would be a deterrent, but they haven't been. The member moving the motion is one of the 15 percent I talked about. If he was going to put forth a motion with real

1034 ALBERTA HANSARD May 24, 1984 confidence in it, he should have made the statement during his presentation that he was going to give up the habit of smoking and start there. But I don't think the hon. Member for Edmonton Sherwood Park will take that challenge. I think he enjoys the weed too much. He's told me that. Another cause on the system is excessive drinking. Some people will say that drinking any drink is hazardous to your health. However, I don't see any warning saying that on any bottles of liquor that are available.

At the same time, many of our senior citizens have been told by their doctors that they should have a shot of brandy or whatever they choose before retiring at night. I guess overindulgence in drinking is bad for you. But in moderation it may help you; it may not. That's a person's own conclusion. Another area in preventative medicine that can be looked at is stress, and it's one of the largest killers we have right now in this country. It causes heart disease, and it also causes strokes by having high blood pressure and the like.

I don't know how we do it with the society that we have today, where people are always on the go. You look at downtown Edmonton, downtown Calgary, or Toronto, or wherever you want to look. Everybody is always on the move all the time. People are rushing here to do this and that and doing various jobs. They aren't, in many instances, taking time out for themselves. I look at this partic­ ular job that I fulfill as the MLA for the Stony Plain constit­ uency. The other 78 hon. members of this Assembly are in the same predicament I am. We put in a lot of long hours, and the stress is there.

Anybody that says it isn't is definitely wrong, because we know it. I think something's got to be done in the overall long term to cut down on the stress that is evident in many different occupations in this country right now. Another preventative measure is occupational health. Under the department of Workers' Health, Safety and Compensation, I believe there has been quite a redirection in occupational health. We've seen some new directions in that. We've seen new directions at our worksites, which have a lot fewer hazards than they did a number of years ago.

Having grown up with the industry, I can see the substantial changes in occupational health that have been made over a number of years to benefit the worker. I reflect on the particular role I play as an employee of TransAlta Utilities, some of the directions taking place in our own company, the expansion through the safety branch of our company, and also the expansion taking place through the department of Workers' Compensation. It appears that there are various elements in the occupations that are hazardous to your health. We heard a while ago about the asbestos scare.

Many of these areas are now being cleaned up, because we know asbestos is a real health concern. Another area the government could certainly become involved in — and I think we've done some work on it, but as far as I'm concerned, not enough. I'm going to get disa­ greement on this statement from many hon. members in this Legislature, but many of them know where I stand on the compulsory use of seat belts.

We know that in the province of Alberta alone, there could be a substantial health care saving not only in dollars but in hospital stay time, recuperation, and physiotherapy time if we had compulsory seat-belt legislation. I estimate — and these are figures I have from various sources — that there could have been in excess of 300 lives saved in Alberta last year, out of the 600-plus that were killed in auto­ mobile accidents, if they had been buckled up. Statistics show us that 13 to 15 percent of Albertans are now wearing seat-belt restraints. That's not high enough, Mr. Speaker.

If seat-belt legislation were introduced, the total saving to the province could be in the neighbourhood of $40 million in one year. If we had brought in mandatory seat-belt legislation last year, I think it would have been a substantial contribution to other government departments that had to cut back their 1984-85 budgets. We discussed this on many occasions, but the discussion hasn't gotten very far. As a director of the Alberta Safety Council and the Canada Safety Council, I maintain that we should be moving for compulsory seat-belt legislation in this province.

You would certainly see a real change in the attitude of individuals regarding seat belts, and it would cer­ tainly help in the preventative measures we're talking about today. In concluding, Mr. Speaker, I think there are a number of ways individuals can help themselves to attain a better physical condition. In many areas, I don't think we have to worry about preventative medicine programs. One is jogging. I must say I do quite a bit of that, and I do a lot of walking. I think I feel better for that.

What we have to look at generally are good health habits, the correct amount of sleep, and the correct eating habits. I think a person can attain a better preventative medicine program with those than with any legislation this Legislature may pass. Thank you. MRS. FYFE: Mr. Speaker, I'd like to commend the Member for Edmonton Sherwood Park for initiating the motion on the implementation of a preventive medicine program. Prevention has not always received the greatest priority from people in our country and our province.

Specifically the medical profession has concentrated on the curative aspects of medicine and, I think, hasn't given a great deal of consideration and support to prevention. Obviously the structure we have in place now does not place a lot of emphasis on prevention. We simply have to look to public health, which has sometimes been termed by others the Cinderella program. It has not been fully accepted by the medical profession or by many people within the medical community. [Mr. Purdy in the Chair] One of the difficulties in any preventive program is almost the impossibility of assessing results.

Unless there are strict, controlled studies that would take one group of people and compare them to another who received a certain treatment or were influenced by a certain advertising campaign or an influ­ ence in some other form, it's most difficult to try to assess the effectiveness of prevention. Yet common sense tells us that many things we could do in our life-style, in our communities, would be preventive, effective in reducing health care costs, and effective in serving us as individuals in having a better life-style, in that we would remain healthy for a longer period of time.

There are many things we could do, yet it's very, very difficult to prove. We have some very effective programs that would fall in the category of a preventive program. Those that stress pre­ vention in every community in this province centre on our health unit programs, which are basically preventive medicine. It initially started with immunization programs and has grown dramatically to a large variety, a host of programs that are offered across our province. I think we could be justly proud of the accomplishments we have made in the preventive health field.

Diseases that in our grandparents' days wiped out entire families are now barely to be found in our society as a whole. Diseases such as smallpox have been eradicated in real terms from our society. Other diseases, such as tuberculosis, that have been identified and treated in past years no longer run rampant or take the toll of entire families as happened just two generations ago.

May 24, 1984 ALBERTA HANSARD 1035 We have made dramatic strides in preventive health. In fact there are some studies and some comments from medical pro­ fessionals that say we have extended the life of members of our society more through effective public health programs and education than we have through any curative programs. There have been some effective treatments, but they have not sub­ stantially contributed to the longevity of our human race.

Yet the improved statistics related to infantile mortality and the deaths of young children have primarily been improved by preventive health and a few very significant discoveries such as antibiotics. Public health has to take very large credit in the improvement of health conditions in our country. Even with the benefits that have accrued through preventive health programs, public health still remains a Cinderella and is still the subject of cynical comments by some who feel that maybe it's just the do-gooders and maybe it's not really effec­ tive.

I think it's imperative to look back at the history of public health to see how successful we have been and to take that as an example and a building block for the future. Other areas that contribute to programs in this area have been touched on by the Member for Stony Plain, who covered a wide range, and by the mover of this motion. There are other programs that have been effective but for which we still have a distance to go before we reach an acceptable level. Areas in occupational health and safety have been the subject of study by members of this Legislature in a number of select commit­ tees.

Those of us who have participated on that committee realize that it's not just the impact on the worker and the savings of the cost to the taxpayer but also the contribution to a cost- effective program that benefits industry, the economy as a whole, and the life-style of each person who is involved in a workplace. We cannot legislate people. We know that. But we can provide effective leadership.

Some of the leadership has been provided by the Member for Lethbridge West through the AADAC program which, in my opinion, has provided extremely effective leadership in influencing the attitudes of our young people in this province. We just have to think back over the years when we grew up and the ads we saw. It was macho, brave, and the in thing to smoke. You were with it if you smoked, you were really with it and cool if you drank, and you really had arrived if you drove a big, fancy car. Obviously if you drove a big, fancy car, it was really cool to speed.

These are attitudes that are built in over a number of years and over the decades till finally it becomes like gambling. I can smoke, I can drink, I can drive fast, and nothing will happen to me. You know that the odds maybe aren't that great that you're going to die young or be smashed up in your car. It becomes a risk, and that becomes part of the game. I think what's happening with AADAC is that the ads are turning some of that around. Maybe it isn't so macho to have a smoker's cough, and maybe it isn't so great to be drunk and lying down in the street.

I hear some of the young people saying, that doesn't look like so much fun. They see the results of someone who has had alcohol poisoning or is lying on the park bench with no future. Those are the other sides of the things that at one time were accepted as being the in things. I think a lot of young people today have a lot more sense than maybe some of the young people of my generation. I guess I include myself in that group. I think my kids are smarter than I am, and they are influenced by the turnaround. SOME HON. MEMBERS: Agreed. MRS. FYFE: That's right; great genes were passed on from the other side.

I think they're influenced, that they're more realistic, and they see that life-style and their attitudes towards some of these factors that affect our health are things they want to seriously consider. By accepting that moderation will give them a happier life, I think they will have a happier life. As I said, we can't provide leadership, but we certainly can provide funds. We can legislate programs that will assist in providing that knowledge and information. One of the things I think the federal government has done well — and they've probably done the odd thing — is the PARTlCIPaction pro­ gram.

They've done the PARTlCIPaction program with some humour. People who previously didn't think about running, jogging, walking, swimming, or exercising — you just have to look around, and you see it's a trend that is growing and changing. We went through an agrarian society where most people exercised either in the house when they did their housework or out on their farm, or they were labourers. There weren't many sedentary jobs. But today we have a very sedentary society. Unless we become involved in the PARTlCIPaction program, we are probably all beneficiaries.

I'm still working on myself, but I now know I can walk a block. I have managed to make that level. In fact I participated in a bike-athon last week and didn't disgrace us too badly by representing our Assembly. I found out I could do just a little bit better than I thought I could. I guess that's a stepping stone, but it's attitude and it becomes habit. It's like wearing seat belts. It's not so bad to buckle up. You find that when you go to another province where there's a law that says you have to buckle up, after a few days you stop thinking about the fact that maybe you are uncomfortable.

You just do it, and you don't think about it. Usually for a few days after I get back to our province, I continue to buckle up just because it's a habit. But it's one of those things we have to continue to work on. That is the area government can influ­ ence. As I said, I don't think we legislate, but we can influence and provide the leadership. I consider all of these aspects a periphery to the intent of the specific motion today, the implementation of a preventive medicine program.

One area where I have specific knowledge of a preventive medicine program was a project that was funded through Health and Welfare Canada in the city of St. Albert. It was a project whereby the two medical clinics involved hired a counsellor and a nutritionist, as I recall. I think they had different professionals involved.

These people were to work with the physicians, so if a physician had a patient whose main problem was not medically oriented, if the pains in the legs or arms or chest really couldn't be treated medically but could be treated by a better diet or by counselling, the physician referred the patient to that person, who could then spend time. With the fee schedules in our system of remuneration, a physician doesn't have as many precious minutes as often are required to sit down with a patient and give some guidance, assistance, counselling, a diet, and some of the things that may be required.

I believe that at first this project was resisted by the phy­ sicians involved. I don't think they were too enthusiastic about it. But by the time the three-year period finished, they were extremely enthusiastic, and at that point the funding ran out. It was most unfortunate, because it's the kind of thing we can do through our private medical practitioners. I know they can be motivated to work with other professionals, and I think they could be incorporated into a program that could be designed in co-operation with government and with private practitioners in the field.

I think we can incorporate many medical profes­ sions, not just the physicians. There are other medical profes­ sions that are also concerned about the treatment of people, not

1036 ALBERTA HANSARD May 24, 1984 just the broken legs and the curative aspects, and are interested in participating and providing leadership. I know some work has been going on. I know there has been an interdepartmental study between Hospitals and Medical Care and Social Services and Community Health for some time, looking at the possibility of implementing a program. Any preventive medicine program would have to be interdepart­ mental and would require a great deal of co-ordination between the departments. But I think it's something that should be considered carefully and seriously.

I think it makes sense eco­ nomically. I think it's an investment we can make in our future. I commend the member for bringing this forward, and I urge members of this Assembly to seriously consider this motion and to give it support. Thank you. MR. WEISS: Mr. Speaker, I'm pleased to participate in the debate with regard to Motion No. 218. I'm very pleased that the hon. Member for Edmonton Sherwood Park has raised it. I think it's very timely and that we should make citizens of Alberta and all of Canada aware of health care and what it is. After listening to the previous speaker in particular, the Member for St.

Albert, with her expertise as a nurse, I won­ dered what I would have to do in participating in this particular motion. I don't have any expertise. I've not been a doctor; I'm certainly not a nurse. I'd much rather have her nurse me. But I think back to some of my habits in past years. I guess I'm what's called a convert, Mr. Speaker. I'm a nonsmoker and nondrinker, not for religious factors but by choice. I have to go back a couple of years again. [interjection] I chew gum. About two years ago, my doctor said to me: Nor­ man, you have a problem. I'd gone through a series of tests.

I used to have a problem with lack of sleep, interest, health, tired, things of this nature. I found out I'm a borderline diabetic. Mr. Speaker, I like to attribute those tests — and I thank my doctor for taking the time to go through the extensive testing process to diagnose me as a borderline diabetic. I think I'm more aware of it. I believe in the preventive cure now. I accept the fact that proper eating, good diet unfortunately, some­ times our hours in the Assembly prohibit the proper rest one should have for their body. But I believe that things can be done.

My doctor has shown me the way; it's up to me to prove I believe in it and believe in preventive care. I wanted the opportunity as well to say a few words about the particular motion. I believe it's very timely because, as I said earlier, we must make people aware of health care. People say health care is free and that it's part of a basic system that we should have throughout Canada and North America. It is free to a degree, but everything is free if we want to pay for it through our tax dollars. In particular, I'd like everybody to know that health care is big business.

It's in excess of $30 billion a year, both public and private. That's the number of dollars spent on health care in Canada, Mr. Speaker. Those are 1982 figures. I'm sure if we were able to update that to '83- 84, we'd find it's much more than $30 billion a year. The proportion of total health care expenditures financed out of the private sector in Canada was about 26 percent in 1981: that's down from 75 percent in 1960. Those are Health and Welfare Canada statistics. Some 40,000 physicians and 400.000 health care workers practise in Canada.

Alberta alone spent some $3.2 billion a year, in both the public and private sectors. Once again, Mr. Speaker, those are 1982 figures. In Alberta some 23.3 percent of Alberta health care costs were financed out of the private sector in 1981. Expenditures include funding for general care and allied hospitals, mental hospitals, facilities for the aged, physically handicapped, mentally hand­ icapped, alcoholics, drug addicts, unwed mothers, and emo­ tionally disturbed children.

Professional services are provided by physicians, dentists, chiropractors, osteopaths, optometrists, podiatrists, physiotherapists, and nurses. Drugs and other goods and services, such as through the public health and capital expenditures, all cost money. These are the various agencies and departments that all contributed to the total expenditure. The single most expensive category in the health care field is institutional funding. Some 50 percent is attributed to the fund­ ing as well as the balance broken down into professional fees. Our health care system has had many successes.

Canada's standard of health, when measured by the usual yardsticks of life expectancy and infant mortality, rates very well interna­ tionally. It should be noted that Canada is very high in the life expectancy at birth with regard to males and females. In Canada 70.2 is the age factor for males and 77.5 for females. Just compare that to Sweden, the highest of all, with an average of 73 years for males and 79.1 for females. The infant mortality rate, measured before the first birthday per 1,000 live births, rates us very high as well — some 9.6 in Canada.

The lowest is Sweden at 6.8, and the highest mortality rate is in the United States at 11.3. Life expectancy at birth for the population as a whole has climbed more than 10 years since the early 1930s, from 60 years for males and 62.1 years for females. Mr. Speaker, I believe it's primarily the result of the more effective control of many diseases through medical science. For example, 69.4 of every 100,000 Canadians contracted tuberculosis in 1931. By the end of the 1970s, the TB rate was 11.8 per 100,000.

Looking at it another way, some 7,675 Canadians died of TB in 1924, while the number has been reduced significantly to some 220 in 1978. The interest in preventive medicine is rooted in three objec­ tives of improving cost control, efficiency, and equity in the health care system. The cost — very, very costly. Health care costs remained fairly stable through the 70s at about 7 to 7.5 percent of the gross national product. From '79 to '82, costs surged from 7.1 percent of gross national product to almost 8.5 percent.

In Alberta alone the costs rose from 4.87 percent of the provincial gross domestic product in '79 to 5.63 percent in 1981. In dollar terms, expenditures on health care in Alberta increased from $1.7 billion in 1971 to $3.25 billion in 1982. This is why we are concerned, Mr. Speaker. Possible reasons for the current cost could relate to such things as inflation in certain medical practices. They have risen perhaps much faster than general inflation. The population is aging, and the aged and the very young consume more health care services. I believe we all are responsible and should be responsible.

The ratio of doctors to citizens, particularly in urban areas, has increased. The demand for their services seems to have increased as well to match supply. There has been a tremendous expansion in the number of expensive and new clinical technologies. People are consuming more health care services than before. Hospital boards have lacked proper incen­ tives in the past to control costs. Greater numbers of the aged and dying are being institutionalized than previously. I say "than previously", because of course when we think back many years ago, they were being cared for by the family or the family unit.

It is more than likely that any one of those instances I referred to helped relate to the push in the costs. A number of solutions have been proposed. Mr.Speaker, and I would suggest that some of the following could be used. I suggest that turning the management of hospitals over to the private firms could be explored; user fees, the hospital incen­ tive; extra billing, the utilization control; working with pro­ fessionals to control use of expensive tests, admissions, and duration of stay in acute care hospitals. In particular, I'd like

May 24, 1984 ALBERTA HANSARD 1037 to note that the Saskatchewan government estimates each new doctor adds about $500,000 a year to the provincial health care budget. I believe that emphasized that there should be more emphasis on preventive medicine. I believe the key is effi­ ciency. The cheapest cure is prevention. Despite increase in expenditures, some diseases have declined. The seriousness of others has increased, particularly those related to life-styles. For example, the rate of venereal disease has increased from 81.9 per 100,000 persons in 1931 to some 231.5 per 100,000 persons in 1979.

The rate of hepatitis has increased from 1.1 per 100,000 persons to some 7.1 per 100,000 persons in this same time period. The rising causes of death as measured by potential years of life lost tend to be chronic, degenerative, or partially self-inflicted by life-styles. In particular, Mr. Speaker, I note that the years of life lost per 1,000 population was some 84 percent for all causes in 1950; in 1978 it declined to 56.9.

If we relate that to the reasons: motor vehicle accidents, for example, in 1950 were some 6 percent and rose in 1978 to 8.7; heart disease has declined significantly due to research, from some 10.3 to 8.4. Some of the other factors increased: suicide at 1.9 is now up to 4.7; lung cancer, from .9 to 2.4; cirrhosis of the liver, from .6 percent to 1.6. Very conservatively, some 30 percent of total health care costs relate to alcohol abuse and smoking. If we added such others as obesity and poor eating habits, Mr. Speaker, I'm sure we'd find that this list would be much higher.

It's interesting to note that low-income, less educated Canadians have poorer health and shorter lives than high-income, more educated Canadians despite universal and accessible medicare. Smoking is more common among lower income persons and less edu­ cated groups. Physical activity and fitness tend to be more common among upper income, better educated Canadians. Regular medical checkups, Pap smear tests, and breast exam­ inations are among the better educated and higher income groups.

I'd suggest then that we have a job as members of this Assembly to see that all Albertans, all Canadians, are aware of what can be done to help improve their health care and prevent health care costs from rising astronomically. Preventive medicine will not eliminate the need for hospitals and health care professionals dedicated to curing disease. Considerable effort is already being put into preventive medicine in Alberta by government, health care providers, and individual citizens.

We have many, many areas — such as the Provincial Board of Health, the Alberta Alcoholism and Drug Abuse Commis­ sion, doctors, and nutritionists — working very hard in the communities. I like to think of one particular community, Fort McMurray and Lac La Biche, where they've had health fairs showing very responsible aims at trying to educate people and make them more aware of the need. In particular, Mr.

Speaker, I'd like to mention that I support the motion and believe preventive medicine should be rooted in the ideas and minds of every individual, showing greater responsibility for his or her own health and for the health of his family or their families. At a minimum, as a government we have a legitimate role to play in making sure the individual is adequately informed and unnecessary impediments don't exist to the individual making rational choices in the medical marketplace. There are no quick fixes or cure-alls, but I believe that as legislators we should make more people aware.

I com­ mend the member for bringing the motion to the Assembly. In view of the time, Mr. Speaker, I move to adjourn debate. MR. ACTING DEPUTY SPEAKER: There's no constraint on the time today until 4:30. MR. WEISS: Mr. Speaker, I then wish to sit down and allow another member to participate in the debate. MR. LEE: Mr. Speaker, I want to acknowledge the previous speaker for permitting me to carry on the debate, although I'm sure other members may not agree once I've concluded. I appreciate this opportunity to participate in this important debate on an important motion. I too would like to acknowledge the hon.

Member for Edmonton Sherwood Park in his spon­ sorship of this motion. The hon. member has presented many very stimulating, challenging concepts to this House, and I believe this is one of them as well. Mr. Speaker, the case for preventative medicine is quite clear. Any delays by our society are surely only forestalling the inevitable, for preventative medicine is an idea whose time has come.

It is interesting to note that only 4 percent of the $18 billion spent on health care in Canada each year is spent on prevention, despite the fact that the leading causes of pre­ mature death and disability are no longer infectious diseases but are related to where and how we live. Mr. Speaker, in entering this debate, I particularly want to make reference to the fact that I had the honour this morning of representing the provincial government at the opening of the swimming pool at the Alberta Children's hospital. Many mem­ bers were asking me about this T-shirt I was wearing.

It was kind of hard to read, but I want to assure all members that it reads: "ACH — Alberta Children's Hospital — Honourary Lifeguard". Here we have an example of a facility in Calgary just opened today, thanks to the sponsorship of the Minister of Recreation and Parks, the Alberta Minister of Hospitals and Medical Care, the downtown Rotary Club in Calgary, the Chil­ dren's Hospital Aid Society, and many, many other community groups. All have come together to ensure financially that this pool could be created. Mr.

Speaker, I'm sure it will be a very important part of the community for the next 20, 30, or 40 years. Here we had a group of citizens who said, here is a practical way that people can remain healthy by continuing to exercise. Whether they're elderly, disabled, or young, it doesn't matter; regular exercise is a very important part of prevention. Mr. Speaker, two of the leading causes of premature death are motor vehicle accidents and heart disease. In both these cases the maxim "one ounce of prevention is worth a pound of cure" is proven out.

Rather than deal with the aftereffects, it makes much more sense to prevent either situation from occurring in the first place. In the case of motor vehicle acci­ dents, studies have shown conclusively that the use of seat belts greatly reduces the incidence of fatalities and serious injury. In the instance of heart disease, the link between nutrition and diet and heart disease is very well established. Proper diet could reduce the incidence of heart disease in Alberta. Both these causes of death cost society a great deal of money and the victims and the families a great deal of pain and sadness.

For example, a coronary bypass today costs in the neighbour­ hood of $20,000. Last year over 800 Canadians had these operations, yet in only 15 to 20 percent of these cases will the patient live any longer than would be expected if they had not had the surgery. I don't wish to make a case either for or against coronary heart bypass operations. But I wish to simply point out, by that one small example, the incredible cost of health care today, not a subject that is strange to members of this House, I'm sure. Another leading cause of death in Canada is cancer.

To treat a person with cancer is very trying both on the patient, in terms of suffering, and on the health system, in terms of cost. For example, take smoking. Each year in Canada, there are 270,000

1038 ALBERTA HANSARD May 24, 1984 deaths directly attributable to smoking. Again, I am sure it's a subject that we're all aware of. Mr. Speaker, I know that I too once had that habit. In fact I didn't smoke cigarettes; I smoked, of all things, cigars. People used to complain to me about this disgusting, smelly habit. In fact I remember my girlfriends would get in my car and wonder if it was a hearse, because it always smelled like a dead body. I can recall that during those years, my secretaries would close my door so they wouldn't have to detect the odour.

Some members of this House complain about people smoking cigars. I used to hear it from everybody. Never mind that; I had to put the thing in my mouth. For years I could never understand why I did it, until I quit. Then it felt so darn good after all those years. I recall attempting to go back on one or two occasions after I had started jogging, and I could really feel the effect. You know how every once and a while, you like to have a good cigar after a good meal. Well, the next morning I could feel it. So I've left that behind. Mr. Speaker, it's interesting to note that smokers today are in a minority.

We have always thought of it as being the in thing to do, but nonsmokers are in the majority. Isn't it inter­ esting that as the male sex is giving up smoking and as women are beginning to take their rightful place in society, ascend the ladder in the areas of management, earn greater incomes, and take greater charge of their lives, they are beginning to smoke in greater numbers, as men are leaving it behind? Isn't it inter­ esting that to be truly liberated, they are smoking in even greater numbers? A very sad commentary on our attitudes and beliefs. Mr.

Speaker, to give some perspective to this figure of 270,000 deaths a year, it's interesting to note that this figure represents more deaths attributable to smoking than Canadians who died in World War I and World War II. Smoking costs about $2 billion a year in health care spending. A recent study done in Massachusetts determined that each smoker costs the public $525 dollars a year in extra health costs. Every member of this Legislature who smokes is costing every other member $525 a year. That has been estimated at roughly 5 cents for each cigarette smoked.

I saw an even more recent study that demonstrated that if you added up the lost income from not being able to work, the cost of purchasing the cigarettes, the cost of the shortage of your life — all of the costs associated with smoking — it costs every smoker $2 per cigarette. If we were all clearly aware of that, how many smokers would continue at a cost of $2 a cigarette? I wonder. I see I have the attention of the hon. Provincial Treasurer. It's interesting how some people relate to these dollar figures. If only the rest of society could relate to those figures. Mr.

Speaker, strictly from a financial perspective, prev­ entative medicine makes a whole lot of sense — dollars and cents, I might add. With the increasing financial drain of med­ ical services on taxpayers in Canada, preventative medicine looks to reduce those costs by making us all more healthy and therefore less dependent upon expensive health services. Sci­ entific and medical advances in surgery and chemotherapy have centred attention and resources around medicine's curative powers.

The question which must be asked is whether some of the resources presently utilized in curative medicine could not be put to better use in preventative medicine. While curative medicine has a great deal of glamour surrounding it, preven­ tative medicine programs are somewhat more low key. Who can get excited about preventative medicine? It really doesn't have that sex appeal that complicated new machinery, new processes, and famous surgical experiments attract. But in an area where financial resources are at a minimum, results and not appearances are what are most important. In my view, Mr.

Speaker, preventative medicine is the key to a new approach to health care in Canada. This is not to discount the need for the curative element in medicine, but rather to emphasize the need for a twin focus: the effective utilization of curative and preventative strategies. Because many causes of death are life-style or behaviour related, the domain of preventative medicine is in changing or modifying people's attitudes. How many of us have given speeches on various subjects and said: if only we could change people's attitudes, if only we could get people to take a look at their beliefs.

Attitudes and beliefs play such a very vital role in our lives. Based on our attitudes and beliefs, we decide everything about everything we do. Based on my beliefs and attitudes about what I want in life, I determine who my friends are, where I wish to work, what political party I want to be asso­ ciated with, what kind of furniture I want to have in my home, the size of my house. My attitudes and beliefs aren't related just to those things. They relate directly to our health. How interesting to note that when people start missing work, they're unhappy with the work they're doing.

When they end up in the hospital, how interesting it is to note that they're attempting to avoid a difficult time they're having in their private relationships or in their occupation, or their financial resources may be limited. Being ill, being sick, is a very effec­ tive form of avoidance. There is no greater way of avoiding anything than dying. But what great lengths people go to, to miss or avoid dealing with a particular problem in their life. One very quick way is to believe that you're not well. I guar­ antee that if you believe you're not going to be well, you're not going to be well.

The hospital is full of people who have beliefs. Mr. Speaker, our mind is very much like a computer. We are living in an era of computers and high technology, and we now have these massive computers. We can take the work that used to be done on a computer that was produced 10 years ago and combine it into one little chip the size of a fingernail. But there isn't one computer of all the computers in the world that compares to the power of the brain and our beliefs and attitudes.

Isn't it interesting how often we hear of the very sad case where an elderly person dies, a husband or a wife, and a month or two later the other spouse dies because they've lost their reason for living. Their beliefs are so strong that they've simply given up. Perhaps our whole focus and debate really ought not to be on the mechanics of preventative medicine but on our attitudes and beliefs about ourselves. While the arena of curative medicine is in the doctor's office or the hospital, Mr.

Speaker, the battleground where preven­ tative medicine will be fought will be in community health centres, classrooms, health clubs, spas, the community halls where jazzercise takes place, and the streets where people go out and jog every day. I've heard so many doctors say to me that jogging isn't healthy. I think it's unhealthy if you don't wear proper shoes, don't exercise beforehand, or don't stretch and properly get ready. But I know many doctors who say it's healthy because it gets people out physically exercising; it's a form of preventative medicine.

I recall that I took my own personal interest in jogging about three years ago as a member of the Calgary Police Commission, when the Calgary police came forward and said they would like the police commission to agree to sponsor a 13-mile half marathon. I said: that's a great idea; in fact I'll even run in it — not realizing what it would take to properly prepare and exercise. Mr. Speaker, during the next four months — the first thing I did was go down to the police station and take a half- hour physical. I have never been so physically exhausted in my life, just doing the physical. That's how bad a shape I was

May 24, 1984 ALBERTA HANSARD 1039 in. Thanks to the advice of the local phys ed officer in the Calgary police department, I began to exercise and to slowly walk. Then I began to walk and run. I began jogging, and by golly, if I didn't actually enter and finish a 13-mile run three years ago. During that process of getting ready for it, I was never so well. I didn't get ill, catch a cold, or get sick, because I was actively participating and exercising. So I began jogging and began to enjoy it. Some people say jogging's kind of boring. I agree — boring. But do it with a friend if you don't like your own company.

If you're interested in learning a little bit more about jogging, drop by the University of Calgary this weekend. Beginning at 6:30 Friday night, Edmonton will be hosting the first annual Molson's 24-hour marathon run. I'm really excited about the prospects of a team called Team Alberta, comprised of some five members of the Legislature and 15 members of the Leg­ islature staff, that has entered this competition. We have researchers, interns, executive assistants, pages, MLAs — what a team.

For 24 hours we're going to demonstrate our varying levels of physical fitness and, I suppose, our commitment to preventative medicine. I'm looking forward to that. If you haven't participated in this before, come on down and join in the party. I understand there's going to be a dance Saturday night. It'll be interesting to see how well people dance, having been up for 24 hours. MRS. CRIPPS: Brian, you said University of Calgary. MR. LEE: Did I say University of Calgary? I guess that was just a Freudian slip. The University of Alberta in Edmonton. Mr.

Speaker, it never fails to amaze me how people tend to neglect their health. People take better care of their cars than they do of their own bodies. If they hear a noise in the car, they take it to a mechanic, because they know that if they wait too long there's going to be an expensive bill. Yet we as human beings fail to recognize those same signs our bodies are telling us, and we shrug it off. Mr. Speaker, we boast of the best health care system in all of Canada.

I'm convinced the future of health care lies in preventative medicine, so it follows that as a province we should be on top of this trend toward preventative medicine. To some extent we already are. I believe one fine example is the excellent work being done by the Alberta Alcoholism and Drug Abuse Commission in their drug and alcohol education programs. I'm sure the Member for Lethbridge West would concur with me in saying that their programs are of the highest calibre. I want to close by saying I support this motion. I commend the member for introducing it.

I believe there's a need for a radical change in our attitudes and beliefs, because if people started believing, picturing, imagining, and dreaming that they're going to be well, they would be well. We wouldn't need this massive health care system to constantly fix people up and repair them when really their attitudes are a major source of illness. In some respects, I've often thought we should pay doctors when their patients are well and not pay them for treating them when they're ill.

Wouldn't it be interesting if we gave medical doctors an annual fee per patient, and they'd get the same amount whether they're sick or well. I wonder how many medical visits there would be in a case like that. Mr. Speaker, I support the motion. I invite all members of the Legislature to support it, and I look forward to continuance of this debate. MRS. EMBURY: Mr. Speaker, I'm very pleased to begin a small part of my talk today on this very important subject. I do commend the Member for Edmonton Sherwood Park for bringing this before the Assembly.

Unfortunately I'm afraid time is only going to allow me to start making my comments. I hesitate actually to bring out a couple of my concerns with the motion before I can, first of all, quickly assure everybody that of course I am very supportive of preventive health, par­ ticularly since I am a health professional. As I said, I want to commend the member for bringing this motion before the Assembly because today, more than ever, it's extremely important that we spend as much time as possible in this Assembly debating health care issues. There are so many concerns before us that we must consider.

Primarily with the passing of the Canada Health Act, we're going to need to look very seriously at all the issues that confront us. Of course ironically a lot of those have to deal with dollars and cents. One of my concerns with this resolution — while everybody has certainly stated that they support the intent of the resolution, I really ask the members of this Assembly to look at the res­ olution as it's worded.

I suggest we will have to consider very seriously whether or not we can pass this, primarily because the resolution should really read "urge the government to con­ tinue" with the preventative health programs. I urge the mem­ ber to consider amending it. I think there's been a serious lack of recognizing how much is actually being done at this time, not by one department but by so many departments in our government. We've had some identification of the odd program that has been available with regard to preventative health.

But at another time, I certainly want to go into a lot more detail on how many departments — I haven't listed them, but I'm sure there are at least eight or 10 — are spending thousands and thousands of dollars already. Hopefully there's a lot more that can always be done. There's no doubt about that, but I think we should look at rewording the resolution. First of all, I really want to ask what our primary goal would be. Would it be to simply prevent premature death, or do we really want to promote health?

If health is defined by a fairly acceptable definition in the past — complete physical, mental, and social well-being — what actual measures do we have at this time to identify what is complete physical, mental, and social well-being? Because of the concerns before us in regard to our health care system, I think it's such an easy panacea for us to all stand here and say, let's do more in the preventative field. If you look back over the last 100 years — and in two minutes, I'm obviously not going to be able to identify many of the things we have done over the last 100 years.

I think it's worth looking back a little, particularly for the Member for Calgary Buffalo. Being a young member of the Legislature, he obviously isn't aware of what preventative programs we have had, why a lot of people have not been able to concentrate on their attitudes and change them. First of all, there was actually not a lot of knowledge on what it takes to change attitudes. Over the past many years, a lot of people have been busy just trying to eke out a living, to earn enough money for the basic human needs: food and cloth­ ing.

So they haven't always had time to sit around and con­ template their attitudinal changes, which of course should happen. One of the most common causes of death in Canada is what is known as ischemic heart disease. This causes 30 percent of all deaths; cancer, 14 per cent of all deaths; cerebrovascular disease, 9 percent; and accidents, 6.7 percent. Basically there are three kinds of prevention. In this dis­ cussion, I think we need this basic background information before we look at what programs would be appropriate in prev­ entative health.

The three kinds are primary, secondary, and tertiary types of prevention. Of course under primary prevention

1040 ALBERTA HANSARD May 24, 1984 is what has been alluded to so often in the Assembly today, and that's primarily helping patients quit smoking. The sec­ ondary prevention is detecting presymptomatic disease. This is a much more controversial type of primary prevention. In this particular case, it would be the detection and treatment of hypertension, which members probably realize can ultimately result in stroke. The last kind of prevention is tertiary preven­ tion, and this involves managing established disease to avoid or limit disability and handicap.

The long-term management of diabetes and chronic respiratory and cardiovascular disease are examples of tertiary prevention. MR. ACTING DEPUTY SPEAKER: Next order. head: PUBLIC BILLS AND ORDERS OTHER THAN GOVERNMENT BILLS AND ORDERS (Second Reading) Bill 218 Hospital Elections Act DR. CARTER: With regard to the Bill before us this afternoon. Bill No. 218, the Hospital Elections Act, I must confess that I put the Bill forward so we might have dialogue and discussion with regard to the whole matter of whether or not hospital trustees should be elected.

I have put the Bill forward hoping to hear, in the course of the debate in the next hour, of the experience of other members of the Assembly who have at one time or another functioned as hospital trustees, either by way of election or by appointment. I assure all members of the Assembly, Mr. Speaker, that I am very much interested in hearing the pros and cons of the argument with respect to election of hospital trustees. [Mr.

Deputy Speaker in the Chair] The purpose of the legislation as put forward is to require all members of a district hospital board, an auxiliary hospital board, or a nursing home district board to be elected. By requir­ ing all these said persons to be elected, this would then be dealing with three very fundamental principles. Firstly, it would further entrench the responsibilities of the boards. Secondly, it would hopefully make the board more aware of public opinion, public issues and pressures with regard to the whole matter of health care costs.

Thirdly, it would loosen the perceived control the provincial government may have in some hospital districts. I'm sure members have read through the Bill. The Bill itself calls for amendments to the Hospitals Act, the Nursing Homes Act, and the Local Authorities Election Act. The Bill has certain ramifications for various departments of the provincial government — obviously the Department of Hospitals and Medical Care and the Department of Municipal Affairs — and also with respect to all hospital boards across the province and municipal councils themselves.

I'm given to understand that a number of hospital boards and also some of the municipal councils have had some discussion with regard to Bill 218. So they themselves are having to examine whether or not it would be a step forward or a retrograde step to call for the election of all trustees for these various boards, as mentioned previously. I really believe, Mr. Speaker, that Canada as a whole, and Alberta in particular — because we're here in Alberta — are faced with the real issue of what is happening to health care costs throughout the country and the province.

I believe this provincial government has been very much concerned about the whole issue of the excessive use of the system and also the matter of the terrifically escalating costs of health care. And so it is that I would define what is happening to the system at the moment as really being a financial hemorrhaging. We indeed have a very fine health care system throughout Canada. I also believe that within the province of Alberta, we have probably the best health care system in Canada.

By way of example, that can be illustrated by the tremendous com­ mitment this provincial government has given to the construc­ tion of very fine hospital facilities throughout the province. Again, the province has not seen fit to concentrate new hospital construction in the large urban areas but has indeed developed the very innovative architectural concept of modular hospitals in rural areas of the province.

This modular concept of hospitals is such that they have the central core of a very efficient oper­ ating theatre and also have the capability of having one, two, three, or four wings added to that central core. So if perchance the particular community does indeed grow, the ability is there to add to the existing hospital without having to go to tremen­ dous, unwarranted expense in terms of having to redesign and construct a complete new facility. The usage of the system which is in place: I know that other members have the statistics with regard to how much the system is in use.

It has been interesting to listen to various comments and to hear the stats supplied in the previous hour this afternoon by colleagues in the Legislature. Along this line, the provincial government again has made the move whereby hospital boards, if they so desire, may indeed implement user fees as an effective means of cost control or an effective means of raising additional funds which they deem to be absolutely necessary for the func­ tioning of their facility. But it is also very interesting to note that to date none of the hospitals in the province has seen fit to make use of that provision of user fees.

With respect to the financial hemorrhaging of the system, it is also interesting to note that following the lead of the provincial government with regard to zero budgeting as a means of pushing back responsibility upon hospital boards, in actual fact a considerable amount of fiscal reality has taken place, especially in terms of the last year.

Various Members of the Legislative Assembly have come forward with information that for the first time in some areas, the medical advisory boards have finally gotten around to adding to their agendas the whole issue of just how much the hospital facility is indeed costing and how that operation can be deemed more fiscally respon­ sible, rather than just talking about sending a list of articles or a list of names they would really like the provincial government to give unlimited funding to. So I believe that in the course of the last year, Mr.

Speaker, the responsible attitude of this provincial government has been seen and worked to great effect with a considerable number of the hospital boards, so they in turn are indeed dealing in a much more fiscally responsible manner. It is interesting to note that a number of hospital boards throughout the province will now be reporting the fact that they have balances in their bank accounts. They are obviously work­ ing in very innovative fashions; nevertheless they are working in a very responsible way with respect to the horrendous costs that are involved with the medical system.

The present situation with respect to the election or appoint­ ment of hospital trustees is this. Throughout the province there is a total of 103 boards. On those boards there are 629 members; 354 are appointed and 275 are elected. For the sake of the record, Mr. Speaker, I think it is appropriate to break down the five categories so hon. members may be able to allude to that in terms of the debate. There are 41 municipal and general hospital districts. Nine of these have appointed boards only, nine have elected board members only, and 23 have a com­

May 24, 1984 ALBERTA HANSARD 1041 bination of appointed and elected members. In total, in these 41 municipal and general hospital districts, there are 239 board members, with 140 being appointed and 99 elected. In the second area, general hospital and nursing home dis­ tricts, there are nine. Of these, five have appointed board mem­ bers only, none have elected board members only, and four have a combination of appointed and elected board members. In total, in these nine general hospital and nursing home dis­ tricts, there are 52 board members, of which 44 are appointed and eight are elected.

With 41 general and auxiliary hospital and nursing home districts, five have appointed board members only, eight have elected board members only, and 28 have the combination. In total, there are 269 board members, with 117 appointed and 152 elected. In the fourth category, which includes 10 auxiliary and nursing home districts, six have appointed board members only, none have elected board members only, and four have the combination. There are 60 board members, of which 49 are appointed and 11 are elected. In the final category breakdown, there are two nursing home districts.

One has appointed board members only; one has elected board members only. In total, there are nine board members, with four appointed and five elected. So you can see that throughout the province, we certainly have all manners of permutations and combinations. But it works out that, in effect, there are more appointed board mem­ bers, in a ratio of approximately two-thirds to one-third, the one-third being elected. In all of this, the basic issue is whether accountability to the electorate or accountability to the taxpayer is really of prime importance.

In terms of the operation of the hospital boards or the other nursing home districts or what have you, how is that dealt with or how is that served? Mr. Speaker, it is interesting to note that in November 1983, the city of St. Albert proposed a resolution to the Alberta Urban Municipalities Association annual conference. It had a fair number of

whereas's in terms of the

preamble — and I would like to briefly cite two or three of those — and then there was a resolution which was carried by the Urban Municipalities Association by a vote of 98 to 65.

WHEREAS a Hospital Board is a governing Board which has full control over its hospital and absolute and final authority in respect to all matters pertaining to the operation of the hospital, subject only to [the] Act of the Legislature and regulations thereto; and

WHEREAS the most effective, efficient, and respon­ sive hospital operation requires direct accountability of the trustees of the Hospital District to the citizens thereof; and

WHEREAS the accurate measure of such accountability is the election by these citizens of their trustees . . . and

WHEREAS there are Boards in Alberta composed of trustees representing more than one municipality, some of whom are appointed and some of whom are elected . . .

WHEREAS the result of such a mixture of appointed and elected trustees is that the Board in total is still not accountable to the electorate, particularly if the elected trustees are in the minority compared with appointed trust­ ees. . . .

BE IT RESOLVED that the Government of Alberta be requested to make it mandatory that all Hospital Board trustees be elected in accordance with the Local Authorities Election Act. As mentioned, Mr. Speaker, that resolution was carried 98 to 65. It is interesting and certainly not surprising to discover that the Alberta Hospital Association conventions passed a series of motions in the years 1971, '75, '76, and '78, which take the exact opposite approach. Of course that makes for part of the dialogue. The urban municipalities have their perspective on this matter.

They don't like to have hospital boards passing certain resolutions that call for financial obligations which the municipal officials in turn have to carry out, in terms of the collection thereof. I'm given to understand that in April of this year, Wetaskiwin hospital district No. 81, having examined Bill 218, the Bill we're discussing at the moment, decided they would put forward to the Alberta Hospital Association con­ vention a resolution which basically calls for maintenance of the status quo in the province, whereby there is the option to have either elected or appointed officials.

So there is that kind of dialogue. That brings to this debate a certain element of considerable interest to me, to see what the background experience of col­ leagues in the Legislature is, what their preference is from their experience in the rural areas or in the larger urban centres. I find there is considerable attraction to the concept that all the trustees should be elected. I realize that brings into play a number of other technical difficulties.

The technical difficulty of course is that some municipalities put forward the argument: we've sometimes had the experience that people won't stand for election, and therefore we have to maintain this stance whereby we can appoint hospital trustees. That may well be true, but the difficulty with that argument is: does that also apply to election to a municipal council; does that also apply to Members of the Legislative Assembly or to the people who would like to represent in the House Commons?

At any level there is always the question as to whether someone will file papers, whether there will be acclamation, or indeed whether there will be an election contest. I think one is more persuaded by the fact of having persons seek election because of the accountability factor, the instance where you, Mr. Speaker, or other members of this House have to stand on the hustings and are accountable, people can chal­ lenge us, especially at election time.

They certainly challenge us all the time, but at election time they can challenge us as to what the programs have been, what our input has been, and where we really stand. The electorate can take that into con­ sideration come election day.

With respect to this issue of having appointed trustees or people who go in for election, other people make the case that oftentimes with some of the boards with appointed members, the council which makes the appointment can reach into various professions, various areas of expertise throughout the com­ munity, and request certain people who have that expertise to take their places on a hospital board and thereby give a better balance to the administration of that board. That is an argument which has a certain attractiveness as far as I'm concerned.

Other jurisdictions throughout the country have situations similar to ours. That's pretty well the same in British Columbia. In Saskatchewan, for example, only Crown hospital board members are appointed, and the remainder throughout the rest of the province are elected. In Manitoba the situation is very similar to ours, where you can have either appointed or elected, and in Ontario that is pretty much the same situation as well.

With regard to Bill 218 and the technical requirements, if the Bill were to pass — and I think all of us in this Assembly are realistic enough to realize that the passage of this Bill is not really too likely, especially this afternoon — the changes would really take away the power of the municipality to nom­ inate members of the first district board. At the same time, it would take away the authority of the minister to appoint mem­ bers to a hospital district board.

1042 ALBERTA HANSARD May 24, 1984 The Bill raises other technical questions that would come into force on proclamation, if the Bill were to pass. That would raise another question which is: what effect would this new legislation have on incumbent members who were nominated or appointed to a first district board? Would immediate elections have to be called in order to meet the new provisions requiring elected boards? At the present time, of course, municipalities have the option to appoint or elect. So would all vacancies require replacements by election only?

What would happen at election time if, as we mentioned earlier, no one decided to run for office? There would have to be the provision that if no one ran, we'd still have to have an appointment made. There is one thing to keep in mind, and it takes us back to the fiscal responsibility of boards. If local requisitioning for deficits does indeed have to be put into effect at some future time to be able to deal with the escalating costs of health care, then it may well become a requirement for us to have hospital district boards elected. Mr. Speaker, I appreciate the opportunity to bring forward Bill 218.

The basic philosophical issue with regard to the Bill is simply this: what is the most effective, efficient, and respon­ sive method of the boards' representatives with respect to the issues? Perhaps the most accountable way of dealing with fiscal responsibility is to let the trustees know that they, like Members of the Legislative Assembly, members of municipal councils, or Members of Parliament, can carry out programs, make requisitions, and deal with the issues.

Nevertheless that difficult hour comes when one still has to face the electorate to determine whether one continues to hold the responsibility of the particular office, in this case a hospital trustee. Thank you, Mr. Speaker. MR. HYLAND: Mr. Speaker, it's a pleasure to take

part in Bill 218, the Hospital Elections Act. I served for between four and a half and five years on a hospital board — not a big hospital, the local hospital in Bow Island. During that time, I also served for a couple of years or more as one of the executive members of the southern Alberta regional hospital association. I'm going to speak in support of this Bill, in support of elected board members for hospitals. Mr.

Speaker, if I could just briefly review the hospitals in my constituency and the makeup of their boards, the Bow Island General hospital and nursing home has two county appointees, both of whom are elected councillors; two town of Bow Island appointees, one of whom is an elected member of council and one of whom is appointed from the public at large; one elected member from Burdett; and one elected member from Foremost. In many cases in small towns, they seldom receive any oppo­ sition for these positions, but in some cases they are open for election.

When I was on town council, we decided at that time to have one of the councillors appointed to the hospital board all the time. We felt that previously, when the council hadn't appointed somebody from their own, there was no way some­ body could come back and report to council on what has hap­ pening. Mr. Speaker, that was back in the days prior to 1972- 73, before the provincial government took over 100 percent of hospital funding and the boards were allowed to put a four mill maximum requisition, I think it was, to the municipalities.

We thought there should be a tie-in to the community council so someone could come back and explain why that money was needed. At that time, we started appointing one member of council to the board, and the other member was a member of the public who was interested in health care and interested in serving on a hospital board. I should say that for many years that additional member from the town was the chairman of the board of the hospital. I think the situation I used as an example, Mr.

Speaker, of the reason we on council at that time decided to put a member on the board, is really the reason we should consider passing this Bill. We thought there should be a tie-in to the general public, a tie-in of explanation when one could explain and answer to the public for one's actions on such a board and in support of such a board. In the town of Redcliff, they still hold an annual meeting. The school board and the town generally hold this meeting co­ operatively, and they invite members of other bodies to attend this meeting and answer questions.

Normally the elected mem­ ber of the Medicine Hat hospital board attends these meetings. If there are questions on health care or the hospital in the Hat, which he's responsible for, he is there to answer them, to answer to the people. When you have directly elected people or elected people appointed to boards, I think they take an interest and they answer to the people. I think this is a necessity of such

an Act. I realize there will be problems in some areas where you may have provincial hospitals, and it may get a little tricky to design areas for board members to run in when you get to major regional hospitals, such as some we have in the province. I realize there may be problems with this, but they may not be insurmountable problems, Mr. Speaker. They may be problems that can be worked out, whether it's a combination of elected or we have to consider partial appointment for these to make sure certain areas are represented.

Or maybe we need to design some sort of ward system that may overlap municipal bound­ aries, et cetera, in order to attain proper representation in these areas. But with the members we have in this Assembly and the many civil servants, local municipalities, and others that could become involved in designing these boards, I'm sure somebody would be able to give us a system or a map of how this sort of situation could be overcome. I also realize there may be problems in the larger cities, where there are many hospitals and many areas overlap.

I guess anything we do creates some problems in certain areas, but some of these problems, as I said previously, may not be totally impossible to overcome. When I started, Mr. Speaker, I used just one hospital in my constituency, the board I myself sat on. That is really the only hospital inside the boundaries of my constituency, but there are other hospitals that serve the constituency. There's a hos­ pital in Taber. The member that serves the board from Taber is elected. There's a Medicine Hat hospital board that has, I guess, three members from my constituency.

One is the coun­ cillor appointed from the county of Forty Mile, another is a person who is elected from the improvement district, and the third is the one I mentioned before, one elected person from Redcliff. The fourth hospital that serves part of the area is the hospital at Milk River, and I believe that member is appointed. So as you see, there is a mix of appointed and elected members in the constituency.

I noted that in his opening debate on the subject, the Member for Calgary Egmont made note of the resolution of the Urban Municipalities Association relating to the election of hospital board members and the passing of that resolution by a sub­ stantial margin, and then of course the resolution being turned down at the Alberta Hospital Association's annual meeting or convention, whichever you wish to call it.

One can ably see that the voting members of the Urban Municipalities Associ­ ation are totally elected people from the province of Alberta who are used to answering to the public for their actions, who have to answer to the public every three years, if not sooner, when they stand for re-election. They obviously feel there is

May 24, 1984 ALBERTA HANSARD 1043 nothing wrong with that system. But when you get into an association like the Alberta Hospital Association, where your voting members are not only board members, be they elected or appointed, but are also certain administration personnel of the hospitals, you get a different vote. You get resolutions and a vote that reject the question of whether members should be appointed or elected. Mr.

Speaker, I wonder what the vote would be if it were just hospital board members voting on that motion or even just hospital board members that are elected personnel, whether appointed from boards or elected directly. I really wonder what the result of that motion in that organization would be then. I think these people would take their responsibility differently. That is not to say that those presently are not taking their responsibility seriously. Probably they are taking it seriously, but they are not prepared to explain to people why they feel there is a problem with their being elected to that position.

As I remember when I was on the town council in Bow Island, Mr. Speaker, one of the things that had to be done by a certain time was that council had to pass a motion saying they wanted the election of their hospital board members. If this motion wasn't passed, according to the Municipal Government Act, after the fall election you'd automatically be in a position of having to appoint the hospital board members of that area. I suspect that power is now probably in another Act, maybe even in the Local Authorities Election Act, where there is that direction.

So I think the first thing that would have to be done would be to change that Act to say that hospital board members would be elected, period. Another approach that might be tried would be to have the wording changed to say that hospital board members would be elected unless a motion or a bylaw of the local municipality were passed. Mr. Speaker, the latter suggestion might be a move halfway between the present situation and the desire of the mover, in bringing this Bill to the Assembly, to put on the local municipal body the emphasis of what they want to do with the election.

I believe the only way to do that would be to change the Act to require them to pass a motion saying they would be appointed, rather than the existing legislation saying that if you don't do anything, then automatically something will happen. I think the key would be to trigger that something needed to be done previously, instead of having it done automatically. That might be a middle-of-the-road approach one might look at. Mr. Speaker, I would like to read part of a little verse. Maybe it's applicable to the content of my speech this after­ noon. I'll try reading it.

If you decide it's not in order and I get cut off, so be it. The little cabbage in the field was consulting its mother about life. "Life," said the mother, "is a gamble; you've got to withstand storms, drought, wind, animals — not to men­ tion bugs, lice, mold, rot. But, if you don't give up, you'll thrive and grow." "Life certainly is a gamble," agreed the little cabbage, "but there's one thing you haven't quite made clear: when do I quit growing?" "As in any other gamble," said Mother Cabbage, "quit when you're a head!' MR. MUSGROVE: Mr.

Speaker, I also would like to make a few remarks about Bill 218, elected hospital boards versus appointed hospital boards. There are some pros and cons on both sides of the argument. My first experience with this type of service was an appoint­ ment by the county council to the Brooks nursing home board. At that time there was a requisition to the municipalities for both nursing homes and hospitals. After the province took over the total cost of funding, the Brooks hospital and nursing home became amalgamated and known as the Brooks hospital and nursing home board.

At that time the town of Brooks had some of their trustees elected and some appointed. The county I represented appointed all their trustees, but all were not nec­ essarily elected county people. Some of them were from the general public. Because the boundaries were not coterminous, there were people that sat on the Brooks hospital and nursing home board that were not in the Brooks hospital district. So they only represented the nursing home portion of the com­ mittee. In my opinion there's some merit to this kind of appointment.

First of all, the municipal councils hear a direct report of what is happening in the hospital; secondly, as Alan suggested, at the annual meeting of the town or council, there was always a report about the operations of the hospital. It generally brought as much interest as the report on agriculture or the road pro­ gram. Without them being involved in the municipal districts, they wouldn't be required to have a hospital report at the annual meeting.

It's agreed that when the hospital took over the total cost of health services, the hospital trustees tended to take a little less interest in the budget and were more inclined to leave it to the administrator to run the