Veterans Affairs Committee on March 30th, 2023

[Churence Rogers, Liberal, Bonavista—Burin—Trinity, NL]

Thank you very much.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Mr. Rogers.

I will now give the floor to Luc Desilets for the next six minutes.

The floor is yours.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

I would like to welcome our witnesses.

Earlier, Colonel Jardine referred to the need to do more research, and particularly comparative studies or analyses between the sexes, so that we can better understand the specific needs of women.

I imagine you share that opinion, Mr. Svenson. Yes? Okay. That's an easy question to answer.

What I want to get at, more specifically, is this: in your experience, and given that we have to do more research, collect more data about the more specific experience of women, what would the role of Veterans Affairs Canada be in this regard, in order to have increase it overall?

[Nathan Svenson]

I think a few new opportunities have been presented to Veterans Affairs on how we can engage with the women veteran community and subpopulations within that community. One of the key takeaways for me from the most recent women veterans' forum in February 2023—just last month—was the need for inclusion of under-represented voices in research.

VAC has come a long way in broadening the available data, and we are able to disaggregate our analysis in many measures, but we want to push that closer to what we would call “participatory research”. For this purpose, our research staff will be engaging with the veteran community in the coming months to fill in the human narrative that isn't captured in our statistical data.

Perhaps, Dr. Garland Baird, you want to add a comment.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Great, thank you.

Colonel Jardine also alluded to a literature review published by her office in 2021 about the experience of women and men veterans in the Canadian Armed Forces and the RCMP. She talked about 84 primary and secondary sources that were cross-tabulated in order to produce her analysis.

Obviously, it contains information you are familiar with: women are underrepresented in the military hierarchy; women are at higher risk of suffering joint injuries and chronic injuries and of having more suicidal tendencies, and so on. It isn't really a very pretty picture.

Based on your knowledge and expertise, are there readily identifiable causes that might justify this?

[Nathan Svenson]

I would say we need to be careful when we're working with the kind of data we have available. It's not data that supports easily establishing relationships between cause and effect.

While we can measure differences and determine differences and the prevalence of many different conditions, it's difficult to tie that back to specific experiences unless we have a full history of their military occupation. That's a set of information we generally don't have access to when veterans come to work, when they come to VAC for services, when we're talking to veterans or when veterans are filling out questionnaires that provide data to VAC or to Statistics Canada. We don't have that full military career history.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

So you don't look at the underlying causes of the problems.

Is that correct?

[Nathan Svenson]

The majority of our research does not try to establish causality of the conditions or trends we see.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

I understand that this is not your mandate and I accept that.

However, when you have avenues or data that are very interesting and relevant, do you communicate with the Canadian Armed Forces to let them know?

[Nathan Svenson]

I think we have a very strong relationship. As Colonel Jardine mentioned, there is a joint steering committee that brings the two departments together in a very deliberate way so that we can solve problems we encounter, including on the research front. We're working with the Department of National Defence and their multiple research groups.

Perhaps Dr. Garland Baird wants to say a bit more about that. She's been involved in those discussions.

[Dr. Lisa Garland Baird]

Some of the collaborations we are embarking on with other researchers in the community are to explore some of the pointed, targeted areas that have been identified and how they become identified. There are multiple collaborations with veterans' groups, including women veterans. We hope to build on those collaborations as we move forward.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you both.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you, Mr. Desilets.

Thank you both, as well.

Now the floor goes to Ms. Rachel Blaney for six minutes, please.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you so much, Chair.

I thank the witnesses.

My first question is whether there's a VAC women's health research strategy. If so, is it publicly available? How was it developed? Who is involved? Does it exist?

[Nathan Svenson]

We have research priorities identified for women veterans that, for us, are shaping the direction we're taking going forward with research.

We're finding that there are many more opportunities and directions we can go now, following the identification of veterans in Canada through the 2021 census. Before, we had a very limited scope of information that we could tap into. Now we're finding that we can expand the types of research we can do, including data linkages with other federal administrative data sources from other departmental programs. Of course, that's in partnership with Statistics Canada, so we're building our relationship with Statistics Canada. They have access to—

[Rachel Blaney, NDP, North Island—Powell River, BC]

Okay. I'm sorry to interrupt. I really apologize.

Is there a strategy? I hear that you're linking with other people and other departments, but is there a specific strategy you can point to in which you can have some measurable outcomes?

[Nathan Svenson]

We have a women veterans research plan focusing on specific areas, such as aging, sex-specific cancers, occupational exposures, health care access and opioid use. We don't publish the specific initiatives coming up, partly—

[Rachel Blaney, NDP, North Island—Powell River, BC]

Is it public? Is it something the committee could look at, just to see what the plan is?

[Nathan Svenson]

Yes, we can certainly share our research priorities with the committee.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you. That would be helpful.

I know the first women veterans' forum was held in P.E.I. in 2019, which was about four years ago. “Research” was mentioned in the summary, I think, 24 times. Obviously it's an essential theme and a priority area.

I'm wondering if you could talk about what has been done on health issue-specific research for women veterans since then. There are a couple of things I'm particularly very interested in.

We know that women veterans who served in the Middle East and experienced burn pit exposures are now experiencing higher rates of breast cancer. Do we know if those rates of breast cancer are different among women who did not serve in the Middle East and experience that combat exposure? Around that, do we know if veteran women see higher rates of breast cancer compared to civilian women?

The other part is uterine prolapse or stress incontinence related to military duties. These are the issues I hear about the most. Has any research been done on this?

Since this happened in 2019, what is the direction of the department in researching these important issues specifically for women veterans?

[Nathan Svenson]

There were a few different pieces in there. I'll start with the breast cancer item.

All of the cancer prevalence or cancer incidence-type studies require a large population set in order to have reportable results with any confidence. The cohort of veterans who served in the Persian Gulf, for example, was a fairly small number. It's only around 5,000 to start with. If you isolate that down to the women veterans who were part of it, it's a much smaller number and it becomes very difficult to produce reliable or robust statistical estimates about cancer prevalence and comparisons against the population. There's that caveat.

I will say we are now able—again thanks to the census—to conduct a data linkage study, which we're now just embarking on, looking at cancer prevalence among veterans. That's thanks to the existence of the Canadian cancer registry, which has all primary cancer diagnoses since 1991 in Canada. We can link that with all living veterans in Canada. As of just the past few months, we have the data components that make that kind of analysis possible.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Okay. I'm feeling a little frustrated—not at you, but just at the fact that we obviously do not have a lot of data about women veterans. This is very concerning to me.

My next question is, how does this department, VAC, meaningfully include the voices of women veterans in its research? Would a woman veteran advisory committee be helpful for research prioritization and development? I'm concerned that the focus isn't there. Would it be wise to make women veterans part of that advisory committee for research?

[Nathan Svenson]

We are eager to engage in and discuss our research plans and research methods with women veterans in the community in whatever form that takes.

I mentioned in my opening remarks that some new community-level groups are coming together and are providing input into the department's perception and perspectives on how we should engage in research. Some of those groups include the women veterans research and engagement network, the Canadian military women's health research interest group, which includes members or representation from VAC, DND and the medical community, and the Military Sexual Trauma Community of Practice. These groups—

[The Chair, Liberal, Emmanuel Dubourg]

Mr. Svenson, I'm sorry to interrupt you. The time is up.

I have to give the floor to Mr. Terry Dowdall for five minutes.

Go ahead, Mr. Dowdall.

[Terry Dowdall, Conservative, Simcoe—Grey, ON]

Thank you, Mr. Chair. I love the way you say my name.