Health Committee on Feb. 11th, 2014

[The Chair, Conservative, Ben Lobb]

Okay, that's good. We just want to make sure that all the time is fair and equitable around here.

Go ahead, sir, five minutes.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Mr. Chair.

I would also like to thank the two witnesses for joining us today.

In your presentations, you talked about financial needs, about what investments should be made to improve the health of first nations and, more specifically, to fight this scourge of prescription drug abuse.

With that in mind, what are your thoughts on the fact that, according to its report on plans and priorities, the federal government wants to cut $653.8 million, or 17.3%, of Health Canada's budget, over the next three years?

Do you think there is some hope that the federal government will provide you with financial assistance to help you carry out your projects and, potentially, develop new programs or ways to improve the health of first nations? Do you rather believe that those cuts unfortunately mean that first nations will have to wait, as they have been doing for a very long time, to get what they deserve?

[Peter Dinsdale]

Trying to sidestep the minefield here a little bit, I don't think there is any question it certainly is problematic.

The kinds of cuts that are being sustained now by regional and national organizations as a result of budget 2012 cuts will absolutely have an impact. Our core funding has gone down by about 50% in the last six years. Our project funding will probably take another 30% cut next year, so the ability to hire staff to prepare these briefings and engage with organizations will be greatly diminished.

It's not just us. That's my personal example I can speak to. It's even worse for some of the regional bodies that have gone from about $2 million budgets down to $500,000. We've seen massive layoffs in Saskatchewan recently and I think we will see that across the country.

It's absolutely going to have an impact on our ability to analyze, to participate, and to advocate in the way that we have.

We get asked all the time why continue to push and engage in an environment where on one hand they're offering to work, and on the other hand they're taking away your basic capacity to do anything. It is a real challenge.

The national chief made a decision that we need to work hard on the work. There are all these challenges around us. We're going to continue to focus on our priorities. We are seeing some results in the education, or we believe we'll see some results in education. This is another example where we need to push to be very clear.

There is no question, we operate in a challenging environment. It is not going away. This isn't really a partisan thing. The 2% cap, frankly, which froze education funding and froze funding to other health areas and other recreation and housing areas, was implemented by a different coloured government than the one that's here today. In our view, we need to work with whatever government is there, and work in whatever challenging environment is there.

Yes, it's problematic, but we're going to do the best with what we have.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

How about you, Carol? Have you anything to add?

[Carol Hopkins]

Yes, I would say that the current trend is toward collaboration among first nations and federal and provincial governments so that there are pooled resources and coordination across federal government departments. There are many federal government departments that have responsibility for wellness in first nation communities and the limited flexibility in the way the funding authorities are currently applied can be addressed by coordinating spending across federal government departments. For example, first nations and Inuit health branch, in addressing mental health, and ANC, on its family violence initiatives, both focused on community development. These are opportunities where we can make some gain with collaboration and coordinated efforts.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you for that answer because it leads to my next question.

Peter, you mentioned in your presentation that it is important for first nation organizations to be actively involved in decisions affecting the people you represent. Is it the case now? Do you think that, even though the money might not be there, you are at least part of the decision-making process, or not?

[The Chair, Conservative, Ben Lobb]

Just a brief answer, Mr. Dinsdale, we are right up on the time—

[Peter Dinsdale]

On this issue, that's absolutely where we're pushing. The meeting with the minister will be important in this regard. We talked about different areas....

Things like the first nations mental wellness continuum are areas where there are opportunities to collaborate in the ways you are talking about. The First Do No Harm project as well is another example of the collaboration. We need more of them.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up is Mr. Lunney, please, for five minutes.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you, Mr. Chair.

I thank our witnesses, Carol and Peter, for being with us today. It's a very important subject that obviously we're all concerned about.

I just want to go back to the beginning of your presentation, Carol, where you said something about first nation communities seeking to embrace wellness. I think there is a lot of this concept of wellness in traditional native herbal remedies and traditional knowledge of stuff out of the woods that was around a ways back that could bear some further investigation today. I know we have it where I am on the west coast. There is a lot of interest in that, and some of the elders are quite well versed in some of the traditional remedies.

Anyway, I wanted to follow up with that. I would suggest it is probably something we could all look into, remedies that culturally would fit better in a first nations setting than some of the other strategies that have been developed for other communities.

The national chief is from the area that I represent, or I'm from his traditional territory, depending on how you want to look at this. His family is from Ahousaht on the west coast. Their Nuu-chah-nulth first nation language has a word that we sometimes think about. It's called hishuk ish tsawalk. If you are familiar with the Nuu-chah-nulth language, it simply means everything is one; we are a part of nature and nature is a part of us. So looking at a more holistic approach and a natural approach, there may be some remedies here that would be helpful. I think there are perhaps some things that could bear some investigation.

We had some discussion earlier about programs that are in place, strategies that have been developed that were discussed by some of my colleagues. But looking at the national anti-drug strategy in a general sense, at the grassroots level we look for support in community groups, youth groups, and others in providing kids with information about the dangers of drugs. Building on this approach to include prescription drugs could likely be done very efficiently. I'm wondering if you could speak to the level of coordination with community groups working to keep youth off drugs and how prescription drugs relate to other drugs.

[Carol Hopkins]

That's actually another void, a great absence. That was actually one of the key items identified in national discussions on the first nations mental wellness continuum framework, where first nations people across Canada were talking about the absence of literature and information, whether it be social media or otherwise, in first nation communities to educate young people about the harms associated with prescription drug use.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Just on the policing side of things, then, what challenges do the leaders and enforcement agencies face in preventing the illegal diversion of prescription drugs?

[Peter Dinsdale]

Certainly this is a whole other area of first nations policing and the ability of band constables through the various agreements we're seeing across the country. Again, there is a reduction of funding in these areas and fewer band constables being available in first nations, so it's a real challenge around the policing side.

I think it's something we need to look at, and I think the enforcement of it will have to be multijurisdictional, of course, because they are not being produced on a first nation. They are being delivered through various mechanisms on the first nations. So I think it's about cooperation and coordination as much as anything.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Let's come back to a line that my colleague Mr. Young was on earlier. You mentioned teams going out to help, and I think you were talking about professional teams going out to reserves to talk.

I'm thinking of a different type of team involvement, and it's young people being involved in terms of sports capacity and so on. I know on the west coast, some of the young people where the reserves are not so far from the rest of the community really engage in basketball initiatives, for example, hockey initiatives, team sports with some very positive role models from the professional realm. We have a former Globetrotter working with people on the island now. It really has young people engaged in developing skills. I'm wondering about those programs. Are you aware of programs like that, which offer good role models and just getting kids involved in the kinds of activities that keep them away from drugs and into more productive things that other young people benefit from?

[Peter Dinsdale]

In fact, that's part of what I was referring to.

We're very fortunate to have as an ambassador for something we call IndigenAction, Waneek Horn-Miller, to go out and talk to youth about the importance of how she became an Olympian and the level to which sport was important to her in her upbringing. She talks quite openly about how it prevented some of the other challenges in the community that she grew up in. The national chief really wants sport to be something we do a lot of work on. We'll have a national sports summit coming up soon to bring us together. There are a couple of national organizations, the Aboriginal Sport...and the other one I can't remember their name. They are doing some work in this area and want to bring together and coordinate a national strategy. There used to be a national physical activity and recreation strategy coordinated through the Department of Canadian Heritage through their sport authorities. What it didn't do, in my view, was to provide the funding to do exactly what you're talking about, to provide those outlets. If we had more schools on reserve we could use those gymnasiums to do those kinds of things and simply have programming to put in place. In part, that's the more holistic conversation we need to have.

I want to touch on something very briefly. I don't have a lot of time and I'm not trying to take it all. But when you talked about the importance of traditional healers and medicines and the different ways we approach things, often we speak in code. I don't even realize that we do it sometimes. When we say “local community-based approaches” that's really what we're talking about. It's the ability for an elder from that community or from a neighbouring committee to come in to meet with them to bring them together around issues, to be available for a specific kind of healing of this nature.

There are many traditional societies doing this kind of work. How do we cooperate with western-based methods? We hear a lot about people getting diagnosed for cancers, diabetes, and other things. It really works best when there's a blend of western medicine and traditional concepts. It's about merging them together because both have values and different approaches and each work for different people in different ways. When we say “community-based approaches”, because there are so many different cultures and approaches, it's the ability to support them to do what's really going to work best.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Briefly, Ms. Hopkins.

[Carol Hopkins]

Thank you, Mr. Chair.

Youth who are leaving the youth solvent abuse treatment programs have had a greater understanding about colonization. We call it decolonization. They now understand that the ills they face in their communities are not there simply because they're native. They understand the context of those. They engage in culturally-specific types of activities, for example, sweat lodge ceremonies and other activities. They find ways to be able to sustain that when they go home. The youth who continue to practice cultural interventions at home in their community maintain their wellness more long term.

[The Chair, Conservative, Ben Lobb]

Very good.

You're going to need your earpiece for this round of questions.

Ms. Morin, you have five minutes, please.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

Thank you very much, Mr. Chair.

I want to thank both of you for your testimony.

I really liked the fact that you did not just talk about health, but also about well-being, which is not something we have heard discussed since the beginning. This is a very good sign for me because it reflects the will to not only be healthy, but also be in a state of well-being.

Ms. Hopkins, you said that a significant portion of health care spending goes to travel. Since health professionals are not on site and community members always have to travel far, leave the reserve or community to have access to care, I assume that they must constantly feel that using that care is only for emergency situations. Sometimes, I even wonder whether I must really go to a clinic or whether I can wait. If I also had to travel far for that care, I would be facing an additional obstacle. What you said really affected me.

Do you have any potential solutions when it comes to this? How can we ensure better accessibility so that this health care can be provided closer to your communities? When people are in a state of well-being, they don't need illicit drugs because they feel good. What can be done to improve the situation?

Perhaps both of you have some solutions to suggest.

[Peter Dinsdale]

We're seeing some interesting headway being made in telehealth or use of other technologies to diagnose early, to stabilize prior to having to leave. Absolutely, it's a challenge not having health care professionals in the community to stabilize whatever is required remotely and to diagnose and treat. Frankly, it's a disincentive to even go in the first place—why am I going to go to the nursing station, they're just going to tell me to get on a plane or go; or they can't do anything for me, the nurse doesn't know how to deal with this; or maybe they will not even be here today, they'll be here in two days, depending. Certainly, access is a critical issue.

[Carol Hopkins]

Where there have been partnerships between provincial health authorities and first nation communities, they have been able to provide opiate substitute maintenance therapy in the first nation community, and it has worked well. Other communities, though, with the formulary changes, with the introduction of generic OxyContin, the formulary didn't keep up in terms of opiate replacement therapy. Access to Suboxone buprenorphine didn't match. There is definitely a need because that, as I said earlier, has shown promising results in remote and isolated first nation communities. It's easy to manage, and it's easier to store than methadone.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

I would like to see some relevant figures. You said that travel costs account for a large portion of your health care budget. Do you have any figures to share with us? How much money do those costs account for?

[Carol Hopkins]

For first nations people who are on methadone maintenance therapy, that requires daily travel outside of a first nation community to the local pharmacy. The health transportation budget has limits in terms of medical transportation for first nations clients. Communities have come up with creative strategies to pool resources to support that daily travel for people to access opiate replacement therapy. I don't know what the numbers are, however.

[Peter Dinsdale]

We simply don't get access to those numbers at our office.

[Isabelle Morin, NDP, Notre-Dame-de-Grâce—Lachine, QC]

I have one last question for you.

You talked a lot about the impacts of colonization. You also talked to my colleague about decolonization. Can you tell us more about the direct impact of all that on the illicit use of subscription drugs?