Health Committee on May 2nd, 2024

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair. Thank you to all of the witnesses for being here. My question is to Dr. Gupta.

Dr. Gupta, I hosted the Celiac Canada breakfast this morning, and they mentioned that women are far more likely to have celiac disease than men. It was the same thing today with MS Canada. Dr. Valentine, you said that women are three times more likely to have MS than men. Given your extensive research, have you found barriers to health care for women more than men? If you find that, can you also tell us how women and men differ in the detection and the prevention?

[Neeru Gupta]

I do want to preface that I'm not a biomedical researcher or a clinical care researcher; I'm a social scientist. We bring a different perspective, perhaps, from some of the other witnesses who have spoken today and in some of the other sessions that I watched online.

My perspective is that on gender itself, one of the big contributions of social sciences to the health care research field is disentangling gender from a socio-cultural angle versus that biomedical or clinical angle. Absolutely, we know there are health conditions that are exclusive to biological women, and we know that others are understudied in women. That's often rooted in the power dynamics associated with gender. That dynamic then extends across the field from undervaluing research to undervaluing women as scientists, to undervaluing social science perspectives of how we can improve health care and access to health care services across the genders.

I'm speaking also as somebody coming from a more rural-dominated province—half of our population is rural. These barriers are all intertwined with the ongoing health care crisis, and yet the conversation around women being the majority of health care providers is itself absent from many of our discussions on improving access to health care for all Canadians.

I would suggest that if we are looking to improve access to health care, that means reducing the barriers to women accessing health care occupations. It also means reducing barriers to men entering into predominantly female health care occupations themselves, unconsciously or consciously.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[Neeru Gupta]

Understanding how the dynamic works in rural areas is completely under-researched and without any type of dedicated funding structure to look at this.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

The questioning goes over to MP Brière now.

[The Chair, Liberal, Sean Casey]

Ms. Brière, you have the floor.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

Ms. Gupta, during your presentation, you named four globally recognized objectives. Could you tell us more about them?

[Neeru Gupta]

Thank you very much for giving me the opportunity to give you a few more details on the subject. It’s a conceptual framework developed by the World Health Organization and it helps put a bit more emphasis on these four dimensions.

First, there is segregation, which I talked about earlier. We know that 80% of health staff are women, due to differences within professions. For example, surgical care specialists are still men for the most part, whereas most of the nursing staff are women. If we want to increase health personnel overall, we have to find a way to help women enter specialized professions, as well as encourage men to become nurses.

Second, it mentions a safe workplace for women working in the health system. As we know, women are more likely to be victims of violence, particularly at home. However, throughout Canada, there is no method for collecting relevant data to determine workplace safety for women working in the health sector. To do so, more research is needed. Lack of safety in the workplace affects not only women’s physical and mental health in the health sector, but also the health system itself.

Third, there’s the issue of women’s pay in the health sector. Canadian women earn less than men on average. In fact, our research shows that within the health system, which is supposed to be universal and fair, there are income disparities between women and men. Why? Is it because of payment structures? Are there other factors? For example, is money really what will encourage more women to work in this sector in a rural area, or is it instead factors like access to day care for their children? We have no—

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Gupta.

Ms. Larouche, you have the floor for six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Mr. Chair.

The witness testimony is really quite interesting. A lot of themes were raised, including many of those brought to our attention this week.

Since my question focuses mostly on the area of research, my questions will initially be for professors Money and Marrie. That said, other witnesses may answer my question as well.

Like Ms. Sidhu, I attended this morning’s interactive round table on the state of celiac disease in Canada. We were told that, to reduce gaps between women and men in the field of health, research work is the key.

Scholarship amounts for higher education and postdoctoral studies haven’t increased for the last 20 years, but finally, there was an announcement this week on the subject. We managed to increase scholarship amounts for graduate and postgraduate researchers at long last. We’re talking here about a significant win for research. In fact, I want to highlight the work done by my colleague, Maxime Blanchette‑Joncas, the Bloc Québécois critic for science and innovation and a member of the Standing Committee on Science and Research.

How did those 20 years of underfunding, during which scholarship amounts didn’t go up, undermine research? We must take into account the fact that a substantial health research gap between women and men must be addressed.

[Dr. Deborah Money]

I'm happy to start. I'll try to be brief.

I think that research funding has not emphasized the lifespan of women who are living with these different disorders that need to be studied. That's a granting of project challenge, but the piece that I think is also very much a challenge.... As much as it's wonderful to hear of additional funding for trainees, we have a great deal of difficulty with the way we fund research faculty. Young and mid-career faculty, who are often women coming up in this world, are not well funded. It's hard to get funding for them, and it tends to be—though not uniformly—women researchers who will prioritize women's topics, even within diseases like MS or celiac, and so on.

I think we really need to have a look at proportionality and the way we support investigators who are coming up.

[Dr. Ruth Ann Marrie]

I agree with Dr. Money. I think it's how we fund research. I agree that lots of support is needed for young investigators, but we need to adequately support trainees if we want to have a new pipeline of individuals to carry on that work. We need to be able to support people from training into their faculty positions and onward so that those early investments yield the results that we can then translate into practice. We need to make a better effort at funding research that takes us from learning about the results to actually making change at the policy level, because that's often where the important findings that we do have tend to fail.

[Andréanne Larouche, Bloc, Shefford, QC]

It could even make us more competitive and help us catch up at the international level.

Ms. Valentine, it’s multiple sclerosis awareness month. I don’t have my flower with me today, because I gave it to my daughter last night, and she really had a lot of fun with it. I’ll have to get another one.

You talked about the financial impact of multiple sclerosis. In my office, I’ve met with representatives of multiple sclerosis organizations in Quebec. For the most part, they told us that employment insurance should be reformed to reduce the number of work hours needed to access it. It’s the federal program we have to help people get through hard times because of health problems.

Why does employment insurance reform, which would also have great benefits from a feminist point of view, matter for people with multiple sclerosis who need to overcome financial obstacles?

[Dr. Pamela Valentine]

What we know about individuals who have MS is that they often present with what we call relapsing or remitting forms of MS. Somebody can be quite well in one period of their life, and the next month, it could be a totally different story.

We've been asking for a reform to reduce the number of hours to qualify for EI so that people can manage an often episodic form of their disease and get enough hours to qualify for EI. The request has been to drop the numbers of hours from 600 to 400.

It's a real challenge for individuals living with episodic forms of the disease because they don't need the same benefits all of the time. Some individuals will progress and pull out of the workforce. We also know that there's a very high percentage of individuals with MS who, at some point in their life, are going to be in need of support structures because they're just not well enough to contribute to the workforce, yet they don't want to come out completely. They don't want it to be a binary system in which you're in or you're out.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Valentine.

Next we have Ms. Kwan, please, for six minutes.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you very much, Mr. Chair.

Thank you to all of the witnesses for sharing your expertise with this committee.

I'm particularly interested in what work you think can be done and what the government should do, particularly in looking at the issues through the lens of under-represented communities, for example, in the racialized community, the LGBTQ2+ community and, I would even venture as far as to say, for seniors, who are often put on the back burner, especially as they age. What are some of the health concerns, both on the research side, as well as on the side of actually providing real supports?

That is to all of the presenters, please.

[Dr. Pamela Valentine]

I'll jump in. I don't know if anybody else will make the same comment.

We have a real problem with information and data in this country. I sit as the CEO for MS Canada, and I cannot answer what the diversity of our population living with MS in this country looks like. I can give gender—it's fantastic to know that there are three times as many women as there are men—but after that, it's really difficult to answer those questions.

To get data in this country that crosses provincial borders is exceptionally difficult. That will not be a surprise to you. That definitely costs us more time, money and energy to get the solutions that we have today, as Ruth Ann has suggested, into the hands of the people who are going to put that information to work.

It's a very real barrier for us.

[Dr. Deborah Money]

I'd like to pick up on that theme.

What we know is that with many diseases, particularly as they affect women, they're definitely overrepresented in racialized communities and in rural and remote communities. However, we have a terrible problem with getting accurate data, really, on any health condition in this country that covers the whole country and that tells us where people live, what their cultural or racial background is, what their first language is and so on.

The lack of ability to link data within health authorities across the province and across provinces and territories is an enormous barrier to moving the dial in this area.

[Jenny Kwan, NDP, Vancouver East, BC]

Thank you for that.

What do you suggest to address this issue? Should there be dedicated funding targeted toward this data collection and research in this area?

What would you say needs to be done? What is the number one priority that the government should undertake to address this?

Dr. Money.

[Dr. Deborah Money]

Funding is always helpful, but to be perfectly honest, the barrier is legislation. We are not permitted to share data without enormously complicated agreements. Every single time we try to look at another thing—be it COVID, syphilis, congenital syphilis or whatever—we have to go through new individual-level agreements to get permission to share what is actually de-identified data, but has some information on it around, say, rurality.

That's our biggest barrier.

[Jenny Kwan, NDP, Vancouver East, BC]

To that end, the federal government should take a national approach and coordinate this effort between provinces and territories through legislation or whatever is needed so that it doesn't become a barrier to addressing women's health.

I'm seeing nodding heads. We will make sure that....

[Dr. Deborah Money]

Absolutely.

[Jenny Kwan, NDP, Vancouver East, BC]

That's your recommendation for a priority item that the government should undertake.

[Dr. Deborah Money]

It's a big priority for me. That's for sure.

[Jenny Kwan, NDP, Vancouver East, BC]

Dr. Valentine, do you have anything to add?