Health Committee on March 25th, 2010

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair.

I want to thank the witnesses for being here today. I also want to echo what my colleague Mr. Malo said earlier about one of the key problems being the lack of funding for aboriginal communities. Similar to the problem of dealing with H1N1, without basics such as drinking water, the matter of developing students and encouraging them to have dreams and the desire to pursue them is more complex.

What I find fascinating is that, instead of giving up and being negative, you are extremely optimistic and you continue to fight, day after day, for the ability to instill in these young people the desire to pursue meaningful careers in medicine. That is very much to your credit, and I want to commend you.

That being said, I would like to talk about initiatives. A little earlier, we heard about some real initiatives that successfully captured the interest of young people in communities and engaged them.

First, I would like each witness to give us a tangible example of an initiative that was successful at the local level in terms of encouraging and engaging youth. At the same time, I would like to know if you have methods for communities to share information on initiatives that work so as to promote their implementation—I know that there can be cultural differences.

[Michel Deschênes, Policy Analyst, First Nations of Quebec and Labrador Health and Social Services Commission]

Perhaps I can speak for the Quebec region. Last year, in terms of doctor training, for example, we set up a program in conjunction with four universities that have a faculty of medicine. The purpose of the program is to give the most successful aboriginals—those who have managed to overcome all the barriers but who are still lacking in a few areas, curriculum or otherwise, in terms of meeting the requirements for university—access to a university program reserved for aboriginal students.

That is one measure that makes it a little easier for these students to access a university education. A mentoring program is then set up to support them throughout their studies, because obviously, in the end, they will have to meet the same licensing and certification requirements as other doctors. That is an initiative that was developed in Quebec and that has been in place for a year and a half.

In association with that, there is an officer, here at the commission, who is responsible for visiting communities and explaining to youth how they can access medical training in Quebec. The officer explains the prerequisites and the procedure, and takes students—starting at the high school level—to visit the campus and meet with people who explain to them what university studies involve and what their future could look like.

I think this is an example of an initiative that can be developed. Again, it is based on initiatives undertaken by aboriginal partners, who themselves decided that this was a way to interest youth, that it was possible, obviously, as a result of financial support from the federal government and the cooperation of the universities. So this is a type of partnership and approach that can be used to give young aboriginals a dream—as someone said earlier.

Imagine the impact that this can have. A young aboriginal who follows this path, who successfully becomes a doctor and who goes back to his community to show that it is possible to have a dream and to make that dream come true in Quebec—or anywhere in Canada, for that matter. That is a very powerful incentive. The same could be done in other fields.

[Dr. Marcia Anderson]

If I might comment, I appreciate both your and Monsieur Malo's comments about H1N1 and the underlying social determinants of health, and I believe I referenced them when I was here speaking at the H1N1 meeting.

What I think is really important that we all make very clear is that the underlying social determinants of health are also the underlying determinants of educational success. In order for us to make really broad steps here, we need a broader understanding that in society at large, in education, in health, and in government... In order for us to move on that, a lot of the funding decisions and policy decisions that need to happen have to happen at that level.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

It's now Dr. Carrie's turn.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank all the witnesses for being here today.

My biggest problem I'm going to have is where do I start. There's really not a lot of time in a situation like this, but I would like to focus on solutions. If you don't get a chance to speak, could you put it in writing for us, because we are looking to you for leadership.

When you talk about solutions, I thought Madame Dedam-Montour had a great comment talking about wellness versus illness care, and if we were able to implement that across the entire health care system, how would we go about doing that?

Dr. Anderson talked about high-quality, culturally sensitive care. My colleague here said this seems simple to fix, but if it were simple to fix, I think it would be fixed by now. I, myself, as an observer, look at the challenges, and they seem almost insurmountable. You look at the federal government bureaucracy, then you're looking at the provincial government bureaucracies, then you're looking at municipal bureaucracies and first nation political bureaucracies. Then we have professional bodies and their bureaucracies. I don't know any simple solutions to this, but I am looking forward to your input, especially since we're studying human health resources.

The federal government has money out there, and I think, Valorie, you mentioned the problem with the resources to follow through at schools. Is there support for things like, for example, voucher systems, where money goes directly from governments to the students so you bypass a lot of that bureaucratic garbage that the students have to find their way through? You mentioned programs. The kids should be allowed to follow through with the programs. If it's a three-year program and they don't have the funding to follow through, how do you go about doing that? What are the solutions?

I hear there have been some successes with the aboriginal student nursing mentorship program. I was wondering if you were able to comment on that, and even on using the online mentorship forum, the technology that's available today.

With those comments, I'm going to be quiet, and hopefully we can give you at least some time to comment on that, because I'm looking forward to your input. Thank you.

Where do we start?

[Audrey-Claire Lawrence]

As everyone has pointed out, there is no simple solution, and going for simple solutions won't help. But there are things that can be done, and we should be moving ahead and supporting all of those initiatives and looking at them—keeping the big picture in mind but supporting the smaller ones.

One of the big things that has happened is the cultural safety work that has been done by the physicians' association and with the Aboriginal Nurses Association. Not only is it a benefit to the recruitment and support of aboriginal nurses, but it also educates the non-aboriginal population on the issues concerning aboriginal health and aboriginal people. When you have that mutual respect and understanding, it fits in there. The work that's being done and bringing that culturally safe curriculum into place is going to be very important in the future.

Work is just starting on that. Pharmacology courses will be addressing issues concerning traditional medicines. That's a benefit not only for aboriginal people but also for people of Chinese and other ethnicities.

All of the work that's being done in the cultural safety aspect primarily benefits aboriginal people because of the constitutional recognition, but it also suits the other diversities of Canada. That work needs to be continued and supported throughout the schools. The work that the schools are doing in education, such as saying “let's start working more in interdisciplinary and partnership teams so that we can look at and identify the things to keep moving forward”, I think is going to be paramount.

You had asked earlier about one example. One thing that was done was the University of Manitoba would tell their students in the transition year that if you could get your grades to a certain point, we will take you in, you don't have to reapply. That was very motivating and part of their success. Plus there were supports in there. Those are the kinds of small things to build on, while at the same time other work is happening.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Ms. Whetung.

[Valorie Whetung]

I think one of the things we always need to keep in mind is self-determination. As long as the decisions on education, health, and entrance are determined by non-aboriginal people without input from the people who know best how to solve these things, they're not going to be solved.

If I could give any feedback to this committee, it's that we need more ability to influence how these things are rolled out, how funding decisions are made. It's all about self-determination and giving control to us. I was in a meeting this week on food security. There were probably 40 people in the room. It was food security for aboriginal folks, and there were two aboriginal people in the room. I was one of them. How can these decisions be relevant if we're not key people in how it rolls out?

You mentioned jurisdiction. That's a huge problem. We need to find a way we can address jurisdiction by maybe giving some of the authority for decision-making back to the aboriginal people, who have solutions. We have solutions if we're in a position to make decisions.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you. We have to move on to the next question.

Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you, everyone, for coming.

I am struck by the links with education and health. We talked about how in high school students are struggling with math and science and we probably have to go back earlier to figure out why. I'd love to address that, but I'm going to start with the universities and colleges.

Do we have data on what percentage of our university and college population is aboriginal?

[Dr. Marcia Anderson]

No.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

None.

[Dr. Marcia Anderson]

Very little. First, you should understand that most of the universities do not collect any self-identified aboriginal information, and when they do they are very reluctant to release it externally, so we don't have any access to that data.

We have tried to address that by starting to survey indigenous physicians and medical students directly to try to count how many there currently are, but as Audrey mentioned previously, there's no systematic way to do so right now.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

That's what I wanted to know. Okay.

How many spots are there for aboriginal students in universities and colleges, and what is the level of funding for students?

[Dr. Marcia Anderson]

Again, the number of spots is going to vary by university and by province and by program. I think what's important to realize is that an aboriginal student can apply to any university through the general programs and get admitted, but I think what you're probably referring to is the number of designated seats that are specific for aboriginal programs. In medicine it ranges from zero in some of the schools to as high as...I believe B.C. would probably be the highest, and they're upwards of ten now per class year.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Zero to ten.

[Dr. Marcia Anderson]

More than ten. I can't remember the exact number.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What's the funding structure? I had medical students come to my office and they were talking about how it is so difficult. Medicine costs now, and they were saying that in Toronto, unless you're from Rosedale, it's challenging. What's the funding available?

[Dr. Marcia Anderson]

It's variable. The registered first nation students may have access to band funding, depending on if their band has rules about the maximum number of years they're eligible for funding, or the maximum number of degrees, since everyone has to have a prior degree. Then there would be the bursary programs that are available that may be federal, such as through the National Aboriginal Achievement Foundation or provincial or local or directly through the university. It's extremely variable across the country.

Then of course there are student loans. We know that aboriginal students are less likely to want to take on student loans than other students, so that's not always seen as the same option.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What is the average debt load for a medical student or a nursing student when they leave, and how does that compare to the non-aboriginal population?

[Dr. Marcia Anderson]

We don't have evidence-based numbers on that; it's anecdotal. For the general population we know it's over $100,000 now for a medical student. Anecdotally, and because I've been in a position to see some scholarship applications and stuff, we often see numbers that are higher than that, but I can't give a firm answer.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

Ms. Lawrence, you had started to talk about the funding that was available. You said originally it was 100% and it's now down to 10%. Could you talk about that, please?

[Audrey-Claire Lawrence]

As with NIICHRO and IPAC, we have been moved to project-based funding. If you don't have any core funding it's very hard to take on projects or have sustainability of staff. While we're not necessarily looking for 100% funding--though that would be ideal--even having a certain base capacity so we retain a certain core staff that is able to continue and then go for additional funding for specific projects and things...

One of the concerns we have is we are not accrediting bodies. Our nurses and our physicians must get their accreditations and licences from other regulatory colleges and nursing associations.

We're an interest group, so asking our members even for an additional $50 or $60--we just raised our rate because we have to get some funding--only drives out the number of nurses who will be members, because that's a third tier. Some of them are already paying over $900 for their regulatory association and nursing membership fees, so that little bit, when they're single parents, is too much more. So we cannot really continue to sustain that.

I think the fact that we work in a very effective and cost-efficient partnership, bringing in that voice that's needed about solutions, as Valorie says, means there is some responsibility to help support the associations that can help work on these: what are the priority areas, how can we have some successes, and how do we work on those long-term issues to bring effective change?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Ms. Lawrence.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Mr. Brown.