Health Committee on March 25th, 2010

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you very much.

Thank you all for coming. You represent some of the most important organizations in our country at this time. This is a direct responsibility of the federal government, and you look after a population that has the worst outcomes in this country.

In trying to close the embarrassing gap in health status of our aboriginal peoples, we need to know what we have to do. To warn you, my question is going to be, if you got to write the recommendations in our report, what sentence would you want in there in order for you to have what you need to be able to do what you're doing?

We also want you to help us determine what would be the leadership role you would play to help us move the country, for non-aboriginal people, away from the medical model and towards the medicine wheel, because we know that your approach in terms of holistic and wellness is actually the way we have to move the whole of our health and health care systems. We want you to be able to have the resources to lead on that as well.

I was heartened two weeks ago, as I explained to the minister, to have been invited to an NWAC conference where they took 100 bright young 17-year-old women from across the country and tried to persuade them to become interested in health careers. I thought that was excellent, but it seems small if we can only do this little bits at a time. When you have only five positions for 80 applicants on various programs, and if people can't afford to go and do it, we have to have a long-range plan.

After the 2004 health accord, in the 2005 budget there was $100 million put into that. We're not quite sure what happened to it. What we're hearing from all of you is the need for stable, predictable funding is there, and the aboriginal health human resources initiative is a reasonable beginning. I'm quite shocked to hear that the community health representatives aren't part of that strategy, and yet in the remote and rural communities that's sometimes all you have. That doesn't seem quite right.

[The Chair, Conservative, Joy Smith]

Dr. Bennett, do you want time for them to answer? Half the time has been used up. Do you want them to answer and then you go ahead after? I just wanted you to get your answers.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Well, I am happy that they take away the project and send back exactly the language they would want in the report.

The point is, in terms of the homework we need from you, we need to make sure it's as broad as it can be, in terms of also the cultural safety, in terms of the curricula—not only in medical schools but in nursing schools as well.

At CIHR, I wanted to know does the Institute of Health Services and Policy Research deal with the different way of delivering care, or is that relegated to the aboriginal health institute in terms of both the traditional knowledge and cultural safety issues? Is that straddling both institutes, or is it just in the aboriginal institute in terms of health care?

I guess I would like to know how much money you need, how long-term should it be—a ten-year program—and what would we need to actually get on with this so that you're not scrambling, worrying whether your money is coming year by year?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

Maybe we'll start with Dr. Anderson.

[Dr. Marcia Anderson]

I will start.

In terms of how much money, our proposal will be for $850,000 for this year. That would be really helpful. That's not just from AHHRI. We're also working with the Health Human Resource Strategies Division, because this is not solely the responsibility of First Nations and Inuit Health Branch. This affects all of our physicians and all of our workforce, not just the aboriginal health human resources. What would be really helpful is if we could have multi-year funding agreements as well. Part of the big problem with AHHRI is that it is project-based, so it is not core operational funding for our organizations, none of us. And only last year were we able to get a two-year agreement, which means that every year in March, April, May we are trying to cash-manage to keep our programs going until we have secured funding and cashflow, which often doesn't begin until the summertime. It is very hard to run a national organization like that when we have employees too.

The other comment I would make in reference to that is it would be very helpful if there were a mechanism and funding by which our organizations could actually work together more effectively. Of the many common issues, one priority common issue is we need our students to stay in school, graduate high school, with the science and math skills that they need to enter further training. That applies to any health profession or para-profession. If there were a more effective way for us to work together and for the medical schools, the nursing schools, the undergraduate schools we work with to understand that is part of their problem too, it would be really key to advancing this agenda.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Does the strategy actually have targets--what, by when, and how, and how many aboriginal physicians, nurses, allied health professionals? Do you have a ten-year plan so that we could close the gap, including public health professionals who could obviously better customize a TB strategy from the bottom up?

[Dr. Marcia Anderson]

No. As you know, with the Kelowna Accord they set the target of doubling over a period of ten years, I believe. There is no current set target, at least not for the number of indigenous doctors, that's been federally endorsed.

[Audrey-Claire Lawrence, Executive Director, Aboriginal Nurses Association of Canada]

Good morning. My name is Audrey Lawrence. I'm the executive director of the Aboriginal Nurses Association of Canada.

Thank you very much for having us here and listening so openly to our comments.

I want to echo and say ditto to everything you have said. I just would like to add some other salient points. One, this is the 35th anniversary of the Aboriginal Nurses Association of Canada, which formed itself to address the issue of improving aboriginal health through improvements to nursing practices and through the support of aboriginal nurses.

As mentioned, with the fact of the uncertain funding structure we went from being operationally funded by Health Canada, which we had been working with in partnership over the 35 years on and off, from 100% funding down to only getting the 10% funding from submitting projects. We have to lay off staff and then possibly be able to re-hire--

[The Chair, Conservative, Joy Smith]

I'm sorry, I'm going to have to go to the next person. You're way over time.

Monsieur Malo--

[Audrey-Claire Lawrence]

Okay.

I have just two short points. One is the support--

[The Chair, Conservative, Joy Smith]

Perhaps Mr. Malo would like to continue; I don't know.

It's your turn, Mr. Malo.

I've gone over time for all of you.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Madam Chair.

I heard what Ms. Verret and Ms. Whetung said about the high school completion rate. This reminds me a lot of our hearings on H1N1 prevention measures. We were trying to solve a public health problem while a number of communities did not even have running water. The foundation was lacking.

We are talking about health human resources, but the foundation is not there. Ms. Anderson was clear: we cannot train people to become doctors and nurses, if, at a basic level, they are not able to complete the natural sciences, biology, chemistry and physics courses they need for that health training.

Before you tell us what we need to do for people who are in a position to go to school, I would like to know what we can do, at a basic level, to increase the high school completion rate. I think we need to address that issue before moving on to something else.

[The Chair, Conservative, Joy Smith]

To whom did you direct that question?

Ms. Verret.

[Isabelle Verret]

The problem is that young people drop out starting in their second year of high school. Some communities do not even have high schools. Sometimes, only junior high school is offered. That means that 13 and 14 year olds have to leave their communities to go to school in another community or in an urban area. We see the feelings of isolation and stress that this can cause for these students, who are dropped into another reality. In addition, the promotion of health careers is lacking. There is no motivation. First nations see these careers as unattainable. So we need to tell them that is not the case.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Why do they see these careers as unattainable?

[Isabelle Verret]

Because education in the third, fourth and fifth years of high school is extremely inadequate. Students are not very interested in completing high school. It takes more work, and the education system is not necessarily tailored to how first nations students assimilate the material. That is why students become despondent and drop out very early on. Furthermore, the socio-economic conditions are not conducive to the completion of high school.

Schools are underfunded, but teachers also need to adopt teaching methods tailored to first nations youth. Teachers need to be more motivating and to take an approach that is more hands-on than theoretical. First nations youth learn much better through practice than theory. Teachers need to be made aware of all these factors, which distinguish the communities where they teach, so they better understand them. Unfortunately, the majority of teachers working in our schools are non-native. They need to be educated so they do not end up leaving after two months because of overwork or unsuitable teaching methods.

[Dr. Marcia Anderson]

The other very important thing I would mention is that the vast majority of our students and physicians were the first people in their families, and often the first people in their communities, to go to university. So we need to consider what makes any child think that a career in nursing or any health profession like medicine is realistic for them.

Our targets cannot be just the students; we also need to look at their learning environment, both at home and in the schools, to ensure that their dreams are being nurtured and they're being inspired. We need to teach our kids to dream big, and then give them the tools they need to take action on those dreams.

[Audrey-Claire Lawrence]

Can I add very quickly to that? I used to work in aboriginal education and I am a teacher.

Some of these children come from areas where they've never even seen a three-storey building before. As you said, they transition into a high school that may have 2,000 students. The transition points are really key: better supports for them in high schools with aboriginal advisers, and that transition year Rhonda was talking about.

When they go to university, if there is funding for that transitional year they get used to the campus, get their sciences reinforced, and actually work in proper labs. Then they can start the training. Many universities have found they've really been able to increase the number of aboriginal physicians and nurses when the students are supported. But when they are funded for only four years and they have a transitional year, after year three of a university program their funding runs out and they quit. We just lost another student at the University of Ottawa because of the same thing--funding. You hear these stories time in and time out, and it's so frustrating.

They need access to multi-year funding. As long as they're in the program and doing well, they should still have access to funding. It shouldn't be arbitrary, where they have three years of funding and they're out. The student Rhonda was talking about was offered a grant of $500. How can you go for a full year of nursing training and buy textbooks? The textbooks alone would cost $500.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Ms. Hughes.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Good morning. Thank you for taking the time to speak with us regarding the issues facing first nations.

I want to touch base on this, because I actually have 17 first nations in my area alone, and I know that northern Ontario is actually quite populated with first nations communities. In particular, the United Chiefs and Councils of Manitoulin have six first nations under their umbrella on Manitoulin Island.

I've heard today that there are funding issues. Education is needed, starting basically at a very young age. There are a lot of inequities as well. I have a briefing note that was prepared in March 2008. I know the concerns have certainly increased.

The Noojmowin Teg Health Centre indicates that they have recruitment and retention issues with staff due to the inability to pay fair market rates for work. Again, not only are they not funded in the same way as non-aboriginal education centres, but there's also an inability to pay those professionals and to maintain them. They also say the staff leave due to the inability to provide a similar standard of funding that's comparable to non-aboriginal hospitals, family health teams, and community health centres.

Ms. Dedam-Montour, I also heard you speak about the fact that funding has been cut. In 2008 Noojmowin Teg was looking for $2 million in funding and appropriate increases. They talked about the 6% increases retroactive to 1997 that were given to non-aboriginal community health centres. We know those were actually under the previous government, the Liberal government, and now it's the Conservative government.

There are inequities. I would almost say it's a discrimination of some type. Could you elaborate a little more on some of the issues that surround this type of funding or the lack of funding?

[The Chair, Conservative, Joy Smith]

Valorie, do you want to take the first shot at that?

[Valorie Whetung]

Yes.

One of the issues for funding is the jurisdictional problem among the province, the federal government, and the regional health authorities. This has a dramatic impact on the ability of first nations, Inuit, and Métis groups to deliver competitive health care.

You don't want me to go into all the examples. They occur everywhere. There are examples of children dying in hospitals because of jurisdictional issues over who's going to look after them when they leave the hospitals, who's responsible for the health care costs, and who delivers it.

There's an example right here in Ottawa. The Wabano Centre operates on a fraction of the amount given by the province to the Sandy Hill Community Health Centre and delivers more services to more people. The inequities are enormous. It's a huge problem.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Audrey, you had begun to comment earlier, when Dr. Bennett had asked questions. Do you want to finish your thoughts on that? I want to give you the opportunity.

[Audrey-Claire Lawrence]

In addition to the comments that were already made about consistent funding and setting up a structure where the work of the non-profit organizations is supported in conjunction with that, rather than on a project-by-project basis all the time, one of the issues we have is that we really don't have a good handle on how many aboriginal nurses are actually in the country, nor do we know what impact the programs and supports have, because there's no consistent data mechanism across the country.

I have contacted every regulatory body across Canada to find out if they're making any move to do more self-identification on the registries. Because many are now online, some of them can do it. They say the regulation comes from the government or CIHR.

It might be a good idea for CIHR to start looking at the feasibility of collecting consistent data across the country on initiatives and things. It's not to assess one province against another. It's for the overall impact or where more support is needed. You can't note improvements if you don't know the numbers.

As is the case in Saskatchewan, because they were able to self-identify and see the numbers, they're at least able to see which programs are really working and have been able to put more funding and support into those areas.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

You do have two more minutes, Ms. Hughes.