Health Committee on March 9th, 2023

[Dr. Caroline Quach-Thanh]

Yes, that's it exactly.

[Luc Thériault, Bloc, Montcalm, QC]

In your presentation, you said that one of the cornerstones of infection prevention is ensuring that the measures introduced do not cause significant collateral damage, that the subtleties are often difficult to communicate to the public, and that research and evaluation are essential.

You also talked about the POPCORN platform. Could you tell us more about the work being done by the members of this network to ensure that we can become better at conveying public health messages to the population?

Public health means mass medication. If the message doesn't get through, there's no more medicine.

Is that it?

[Dr. Caroline Quach-Thanh]

That's it exactly.

In that kind of context, you need to have supporting data to explain things so that people understand the repercussions of our recommendations.

Let's use Quebec as an example. On March 3, 2020, a decision was made to close all schools, and most of us wondered whether that was the right thing to do. Of course, at the time, there were no other options. We didn't have any data; there was no reliable information that would allow us to know whether it was serious or not, and the schools were closed.

But then without knowing what the impact of closing schools would have on students, how long can they be kept closed? How do we make up for the lost time at school afterwards?

The POPCORN platform includes all of the 16 pediatric hospitals in Canada except for the one in Thunder Bay. The members of this network can look at administrative data to see the impact of public health measures on the mental health of children following the pandemic.

They could potentially provide convincing data and make recommendations to decision-makers, who in turn could take steps to ensure that if there were a future pandemic—and there will be one—with people wondering what to do, it would be possible to assess the risks and benefits. Based on the assessment, decisions could be made about what has to be done, not only to prevent transmission, because we certainly don't want to clog up the hospitals, but also to address the potential consequences of the measures.

To get back to the educational side of things, tutoring would appear to be a highly effective option for making up the missed time at school. Professor Catherine Haeck may have spoken about this to you.

Being able to understand what's going on would allow us to make such recommendations.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Quach.

We'll go to Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you to all three witnesses for your extensive experience and wisdom.

Dr. Blackstock, I'd like to direct my questions to you to begin.

Broadly speaking, how do indigenous children rate in major health categories compared to non-indigenous children in Canada? Can you give us a couple of examples?

[Dr. Cindy Blackstock]

Unfortunately, first nations, Métis and Inuit kids are often at the top of every list you don't want to be at the top of and at the bottom of every list that you want to be at the top of.

We're seeing everything from higher rates of death due to accidental injury to death as a result of mental health issues. It really is crosscutting. Those inequalities put these families and these children in a difficult spot.

First of all, because you don't have clean drinking water and you have overcrowded houses.... For example, during the pandemic, a lot of the public health measures we were taking advantage of weren't available. Only 35% of first nations homes have broadband access, so even remote learning or telemedicine isn't an option in those kinds of circumstances.

It really is, unfortunately, a crosscutting disadvantage, and I think that part of the solution was mentioned by my colleagues. The other is addressing the fire that leads to all of those health disadvantages, which is largely the inequality.

[Don Davies, NDP, Vancouver Kingsway, BC]

In your written submission to this committee, you noted that “Jordan’s principle is working to advance formal equality, but is not achieving substantive equality.”

This is a two-part question. Has the federal government fully implemented Jordan's principle to date? Also, could you explain the difference between formal and substantive equality and outline why Jordan's principle is only achieving the former?

[Dr. Cindy Blackstock]

All right. I'll start with the second part.

There's a great quote from 1955 in the U.S. Supreme Court on this question. It says that “there is no greater inequality than the equal treatment of unequals”. Really, substantive equality is recognizing the disadvantage that's been foisted on first nations, Métis and Inuit children that is not experienced by other children. Therefore, you need to invest more to make up for that. That's what substantive equality is about. It's giving them the opportunity to have the same outcome that other people have, people who have not experienced those hardships.

In terms of.... I'm just thinking of the other part of your question, which I've lost track of—

[Don Davies, NDP, Vancouver Kingsway, BC]

It's whether the government has fully implemented Jordan's principle.

[Dr. Cindy Blackstock]

It's much better than it used to be, but it is not full compliance, in our view. That's what we need to work toward before the tribunal will end its jurisdiction in this case.

That's something we're hoping will happen soon. We'll be able to get these matters addressed and have a long-term approach for Jordan's principle that will meet the criteria that the tribunal legally requires, which is to stop the discrimination happening to first nations children and, most importantly, to make sure it doesn't happen again.

[Don Davies, NDP, Vancouver Kingsway, BC]

On that point, the Canadian Human Rights Tribunal has issued 24 procedural and non-compliance orders against Canada following the landmark decision in 2016.

Is the federal government currently in compliance with all tribunal orders?

[Dr. Cindy Blackstock]

No. That's why we're still in front of the tribunal.

Again, I would say there is greater progress, but no, there is not full compliance.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to shift a bit to access of indigenous children to culturally competent care.

Can you give us your thoughts on whether indigenous children are getting such access, and if not, what can the federal government do to address that?

[Dr. Cindy Blackstock]

I think this is one of the critical areas where there needs to be further work done. That would include, for example, ensuring that the good work done by Dr. Kent Saylor, a Mohawk pediatrician who developed training programs for pediatricians on working with first nations, Métis and Inuit children, is not only just provided to pediatricians but is rolled out writ large to every health care provider in the country so that people are better prepared to meet the distinct needs of these children.

The other, of course, is to ensure that in the communities there are primary health care providers and other secondary care that's culturally appropriate so that children can actually get services in their language. This is something that's very important across the country and something that is possible to do here.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll focus on one particular ailment. I know indigenous people in Canada continue to be disproportionately affected by tuberculosis. That's a disparity rooted primarily in factors such as poverty, and you mentioned crowded, inadequate housing and food insecurity. Children are especially vulnerable. They're more likely to develop disease and experience life-threatening conditions such as TB and meningitis.

Can you give us a flavour of what a culturally competent and community-driven TB elimination strategy would look like?

[Dr. Cindy Blackstock]

I think the Inuit Tapiriit Kanatami have really done a great job in documenting what that kind of intervention would look like. This is the good thing about these things: There are solutions on the books that just need to be mobilized and implemented.

As you're pointing out, the TB rate particularly for Inuit is just skyrocketing, but that's also the case for some of the first nations in the country. It was actually tuberculosis that Dr. Bryce raised the red flag about in 1907 that drove those children into the unmarked graves. Not all the children, but many of those children died because of tuberculosis. That's why he was calling for that inequality to be addressed too.

That's the opportunity we have right now. It's to not make those headlines happen. It's to actually keep those children well, because we can.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, how much time do I have?

[The Chair, Liberal, Sean Casey]

You have about 15 seconds. Do you want to make a closing comment?

[Don Davies, NDP, Vancouver Kingsway, BC]

I'll give you the 15 seconds.

[Dr. Cindy Blackstock]

I would just say that Jordan's principle is one of the top TRC calls to action. When we look at the survivors' work plan for the country, which are the TRC calls to action, the top six are all about addressing the inequalities for their grandchildren. They wanted their grandchildren to not have to go through what they went through and they wanted the country to be better for it too. It's about the TRC as well.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Davies and Dr. Blackstock.

Next is Ms. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair, and thank you to all the witnesses.

I'm going to continue a little bit along the vein of Mr. Davies. This is for Dr. Blackstock.

Canada has had a long-standing policy around birth evacuations in many of our isolated communities of moving, at very high cost, indigenous people away from family centres into urban centres to be able to just have a baby, which to me is insane.

I'm wondering if you could speak to that a little bit and how that impacts both the mom and the baby and their health.

[Dr. Cindy Blackstock]

This is a very important topic.

Imagine when you're having a baby. You want your family around you. That's the whole thing around the baby. It's a beautiful celebration of this new addition to the community. Traditionally, the birth of a child was not only very spiritual but a very important community moment as well. Removing that child and that mom from all their social support systems so that she can give birth to a baby hundreds of miles away, often without that support network, makes no sense to me.

I think this gets back to ensuring there's proper funding for health care services so that people can do the basic things, like have a baby in their home community, and not have the band-aid solution, which is the medical transportation. In fact, when we look at Jordan's principle, one of the top categories that Jordan's principle is funding is medical transportation. That to me is a symbol of how short we are in medical care in different communities.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I thank you for that. I live in an urban centre, in Fort McMurray. If I were deemed to be high risk at any point in time, I would actually have to go to Edmonton, 500 kilometres away, which is insane, because we simply don't have a NICU. Every single pregnant woman in my riding who lives in Fort Chipewyan is having to go to either Fort McMurray or Edmonton, away from family structures, just to have a baby.

I'm wondering if anyone on this panel has any idea or any thoughts around midwifery services potentially playing support and having some of that culturally sensitive care to help bring babies into the world in their communities.

[Dr. Cindy Blackstock]

I think they're really essential. I think having more schools that promote midwifery services and making them available in different communities is really, really important. That includes all elements of prenatal care and making sure that it's available.