Subcommittee on Sports-Related Concussions in Canada Committee on April 10th, 2019

[Dr. Patrick Bishop]

Mouthguards are good for protecting the teeth. Other than that they don't do much.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

What you're saying is there isn't anything new along those lines.

[Dr. Patrick Bishop]

Nothing.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

One of the things we've seen throughout the study is the issue of the SCAT5 and the value of the Child SCAT5 and the on-site issues.

I'm going to bring this to the public health aspect of it. Are you stepping up to educate on that in the school systems with school sports?

[Greg Guenther]

On SCAT5, we are not doing any education. For any kind of SCAT5 training or education for us we have the Sport Medicine and Science Council of Manitoba, which is made up of medical practitioner membership. Within that group, they oversee the delivery of SCAT5 training. Most of the SCAT5 training is taking place with athletic therapists, medical therapists, nurse practitioners, etc. It's more on the medical practitioner side.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Minor hockey put trainers on all minor hockey teams. When I took that course many years ago, compared to my background, I saw a very limited value from my point of view. But education, as we heard from Mr. Stringer too, is an important thing. Do we need to expand that with the training programs that are provided, recognizing that it could inhibit people volunteering?

[Greg Guenther]

I had an athlete at a tournament who had a suspected concussion. We were fortunate that there was an athletic therapist on site, which in not normal for your typical high school volleyball tournament. That athlete went to the athletic therapist, who conducted SCAT5 and suggested she go to emergency.

We were very lucky that we had an athletic therapist there.

[The Chair, Liberal, Peter Fonseca]

Thank you.

We want to thank our first panel for the information. For anything that you would like to submit to the committee, like recommendations or any other information that you feel would be vital and useful for our report, we'd ask that you do so.

We're going to suspend now.

[The Chair, Liberal, Peter Fonseca]

Welcome, everybody. Thank you to our witnesses for your patience as we got through a number of votes. We're going to be starting with our second panel.

With us today we have, from the Department of Canadian Heritage, major events and commemorations, Assistant Deputy Minister Andrew Campbell. As well, from the Public Health Agency of Canada, we have Gerry Gallagher and Andrew MacKenzie.

We look forward to hearing your statements or testimonies and then the members will have an opportunity to ask you all their questions. It's a full government panel here.

We'll start with Andrew Campbell.

[Andrew Campbell, Assistant Deputy Minister, Canada 150, Sport, Major Events and Commemorations, Department of Canadian Heritage]

Thank you, Mr. Chair.

Ladies and gentlemen members of the committee, good evening.

My name is Andrew Campbell, and I am the senior assistant deputy minister at Canadian Heritage for the sport sector. Sport Canada falls under my responsibility and continues to be a key component of Canadian Heritage where our mission is to ensure Canadians participate and excel in sports. Within this mission, the health and safety of all participants in sport, not only high-performance athletes, is a key priority for us.

Over the years, I have been seized by the issue of concussions and impressed by the strong engagement not only of Sport Canada, but of the sport sector as a whole, along with the health and education sectors, and the provinces and territories, which are indispensable, as it has been said.

Indeed, five years ago, concussions were not a priority. However, let me be clear in saying that, while we have made many strides in addressing this public health issue, there is still work to be done. But today, I would like to highlight some of the accomplishments made by Sport Canada in order to help you identify remaining gaps and recommendations for moving forward.

First, I'm pleased to report that Sport Canada has been monitoring this issue since 2009, and we're seeing increased consciousness throughout the country around the scope of the concussion issue. In 2009 it seemed to be just within the professional sport sector. Shortly thereafter, in 2011, during the sport leadership conference in Toronto, Sport Canada was involved in the organization of a workshop with Dr. Charles Tator and another one around our 2010 Vancouver games Olympic medallists. This represented our first initiative to sensitize the sport community as a whole to the issue of concussions and to highlight the need for action.

At this point, Sport Canada embarked on a robust collaborative work with provinces and territories. The federal-provincial-territorial sport committee and the sport, physical activity and recreation, SPAR, committee allow us to work closely with all provincial and territorial governments and experts in addressing issues in the sport sector, as you saw earlier today.

Sport Canada is the co-chair of the federal-provincial-territorial sport committee and the sport, physical activity and recreation committee, and through this mechanism, in addition to managing Canada Games, we also address matters that emerge regarding our sport governance, including harassment, abuse, and in this case, concussions. We're very proud of the solid, multi-sector partnership that we've developed in managing concussions, and it is within these fora that the vital decisions on nationwide policies and their relevant implementation are made.

To support the work of this federal-provincial-territorial coordination, Sport Canada hosted the first multi-sector consultation in January of 2015. 2015 also marked the issuance of respective mandate letters for the Minister of Sport and the Minister of Health, who respectively indicated the importance of directing efforts towards the development of a pan-Canadian strategy on concussions.

I'd like to underline that our collaboration with the health sector, represented by the Public Health Agency of Canada, has been crucial in helping us to move this yardstick in both sport and society. My colleagues from PHAC will highlight the important work they have supported.

I also want to highlight that we are working with the education sector through the joint consortium for school health, and that we are building stronger collaboration to reach the school sport system to disseminate required information.

Further, during the 2017 conference of the Council of Ministers of Education, Sport Canada provided a presentation in which we showcased our work on concussion management in sport.

Another foundational event that represented outreach to the wider public was the 2016 Governor General's conference on concussions in sport hosted at Rideau Hall. This event represented a huge success in raising awareness and outreach to communities across the country to emphasize the importance of working together to harmonize our work in this area.

Sport Canada's work also includes a close relationship with 56 national sport organizations and several multi-service sport organizations, some of which have appeared in front of this committee.

Since 2016, Sport Canada has been working alongside Parachute Canada to facilitate their work with the national sport organizations in developing and refining their return-to-sport protocols and to ensure that they are aligned with the Canadian guidelines on concussion referenced in previous sessions.

To ensure dissemination of this extensive work, in 2017 we hosted another conference to highlight the work on management and detection of concussions. This work was done with the support of the Sport Information Resource Centre. During that event, we also launched with the SIRC the “We Are Headstrong” national campaign. That campaign, aligned with the Canadian guidelines from federal-provincial-territorial work, was designed in consultation with the sport sector ranging from those at the national level to those in smaller communities. These stakeholders underscored the desire to ensure that the communication on concussion management remains clear, simple and instructive on crucial steps to follow, from the moment an athlete or player receives a blow to the head to the return to sport activity. The “We Are Headstrong” campaign focused on four key general principles to apply to a suspected concussion: recognize, remove, refer and return.

I just presented a list of different activities that Sport Canada has taken on, which demonstrates the scope of Sport Canada's contribution to the wide-ranging management of concussion in sport, including the areas of awareness and detection. Resulting from discussions on pan-Canadian harmonized approaches, which you have heard about already at the committee and in the previous presentation, we have identified that we still have work to do in the areas of surveillance and prevention of concussions.

On the surveillance front, the sport community has indicated that it will be difficult for them to conduct thorough data collection since the type of personal data resides in the health domain. The sport sector has also identified to us a lack of capacity to sustain data collection due to the limited capacity of those who undertake the work. I think, as highlighted earlier, the sector is primarily voluntary.

This is not to suggest that the sport sector should have no involvement in the surveillance component, but at this point the federal-provincial-territorial SPAR ministers have indicated that Sport Canada should discuss with the Public Health Agency of Canada how to enhance the existing systems that my colleagues from the Public Health Agency will describe to you shortly.

We will also explore with the sport community how they can contribute to enhance the surveillance within their reality, given the constraints of the sport system. This will be part of the work that Sport Canada does moving forward.

At the federal-provincial tables, and with Sport Canada, consensus around the next focus for the sport sector has emerged, and this focus is that of prevention of concussions. We have come to a point that the next big logical step is one that the sport sector does own, and that is prevention. It's also an area in which the sport community can show a huge amount of leadership throughout society.

As you heard from my colleagues from the Federal-Provincial-Territorial Working Group on Concussions, we must turn our focus to prevention and consider this through the vectors of rules of the game, training methods and behaviours.

As part of our next steps, all federally funded sport organizations will be required to incorporate a concussion policy in their operations, covering all components of the harmonized approach. This policy will include the return-to-sport protocols developed with Parachute Canada.

As you can see, collectively and with a significant amount of coordination at the federal-provincial-territorial level and across government organizations, we have done a lot to address concussions, but we still have work to do. This work is mainly in the area of prevention and in ensuring the sharing of knowledge from the national level down to the club level.

Let me thank you again for inviting us here today. It's a privilege to share with you these facts and to answer your questions.

[The Chair, Liberal, Peter Fonseca]

Thank you.

Now we're going to move to the Public Health Agency of Canada with Ms. Gallagher and Mr. MacKenzie.

[Gerry Gallagher, Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Mr. Chair and honourable members, thank you for the opportunity to address this committee regarding the role of the Public Health Agency of Canada on sport-related concussions. As mentioned, I'm pleased to be joined by my colleague, Andrew MacKenzie, who is the Director of the Behaviours, Environments and Lifespan Division team with the Centre for Surveillance and Applied Research in the Public Health Agency of Canada.

As we've heard, playing sports is part of a healthy and active lifestyle. Regular activity in childhood develops physical and mental health and reduces the risk of chronic diseases later in life. Those include type 2 diabetes, cardiovascular disease, as well as some forms of cancer. However, there are risks.

Concussion in sport is a recognized public health issue because of the frequency of occurrence, as well as the potential short- and long-term consequences, including sometimes tragic outcomes.

Our role is to: support Canadians to be more physically active in safe and responsible environments; conduct surveillance of chronic diseases and injuries, including traumatic brain injury and concussion; invest in the development of guidance, protocols and tools; and, increase concussion awareness among Canadians.

In 2015, the Minister of Health and the Minister of Sport and Persons with Disabilities were mandated to support a national strategy to raise awareness for parents, coaches and athletes in concussion treatment.

Budget 2016 allocated $1.4 million to the Public Health Agency of Canada to harmonize concussion guidelines in collaboration with provinces and territories, focusing on helping students and athletes return to school as well as to sport.

In June 2016, the federal, provincial and territorial ministers responsible for sport, physical activity and recreation acknowledged concussions as an important public health issue that requires collaboration between sport, health and education sectors.

Ministers asked officials to develop a plan to harmonize the efforts of governments and stakeholders, leading to the creation of the federal-provincial-territorial concussion working group that you heard from earlier. The Public Health Agency of Canada has been a member of that group.

In July 2017, ministers endorsed the framework for action in five key areas: awareness, prevention, detection, management and surveillance.

Here is a bit more about what PHAC's role is in this. From a surveillance perspective, to help us understand the scale and scope of the problem, the Public Health Agency of Canada collects data on traumatic brain injuries—including concussions—and monitors changes over time. This includes data from an emergency department surveillance system from 11 pediatric and eight general hospitals across Canada. We know that children and youth suffer a disproportionate number of these injuries, particularly while participating in sports and recreational activities.

Our recent surveillance data indicates that there are 46,000 children and youth between the ages of five and 19 diagnosed in emergency departments with concussions in 2016-17. Boys typically have higher rates of concussion for most sports in an age group as compared to girls. Among them, ice hockey, rugby and ringette are the sports with the highest proportion of traumatic brain injuries, including concussion.

Now I'll speak a bit about tools for Canadians.

In 2016, we recognized the need for better and consistent information, tools and resources for athletes, their parents, their coaches and teachers, as well as the health professionals who care for them.

To help address this gap, the Public Health Agency of Canada funded Parachute to convene experts to develop guidance and tools to prevent, identify and manage concussions. These include the “Canadian Guideline on Concussion in Sport”, published in July 2017. It outlines parameters for prevention, identification and management, as well as return to activity.

Return-to-school and return-to-sport protocols were released in spring 2018 to support the safe return of students and athletes to their learning and sport environments.

It also includes online training for health professionals, which aims to increase their knowledge of the awareness, recognition and management of concussions. Links to these materials are available on our website, as well on Parachute's website.

The guideline and related protocols form the foundation for subsequent awareness tools and resources. After that guideline was developed, the Public Health Agency of Canada also conducted public opinion research to better understand what Canadians know about sport-related concussions. We learned that there were significant knowledge and awareness gaps about concussion among parents, coaches and teachers, as well as health care professionals.

For example, half of respondents indicated they had little or no knowledge about concussion. One quarter of respondents did not know how concussion was treated. Only 15% could correctly identify the best treatment.

Only four in 10 respondents were aware of available concussion resources such as the Canadian guideline on concussion in sport, and the return-to-school and return-to-sport protocols.

Budget 2016 also provided funding to support the development of additional practical tools and resources for parents, coaches, athletes, teachers and health professionals.

A few more examples include the “SCHOOLFirst” handbook, which is a concussion tool for teachers and school administrators on how to support students and athletes in their return to school, and the Progressive Activation and Concussion Education app, which is available for use on Apple or android phones. It outlines step-by-step instructions for children and youth, parents and coaches on how to identify and manage a suspected concussion, as well as how to manage the safe return to school and to sport.

The Public Health Agency of Canada has worked closely with Sport Canada to create a website on concussions on canada.ca. It includes easy to read information, an infographic, basic information on concussion and links to other online tools, like the ones I mentioned earlier, all in one online location.

In terms of results to date and looking ahead, I'm pleased to say that over the last few years our partnerships with the sport, health and education sectors across Canada have led us to create a suite of harmonized concussion tools for parents, coaches, athletes, teachers and health professionals. Building on our ongoing surveillance work, we will continue to work with these sectors to increase awareness of these tools and monitor their use.

In the coming months, the Public Health Agency of Canada looks forward to working with Sport Canada, as well as other partners, to share results from a second round of public opinion research that included a focus on understanding what youths' views were in terms of awareness, knowledge and access to resources; enhanced concussion prevention and management in primary and secondary schools; strengthened concussion prevention, identification and management in sports by working with Sport Canada and others; and further increasing the uptake of those resources and tools for parents, coaches, athletes, teachers and health professionals in communities across the country.

I believe that, through collaboration and harmonized concussion approaches, we will be in a position to provide better support to children and youth where they live, learn and play.

I'd be pleased to answer your questions.

Thank you very much.

[The Chair, Liberal, Peter Fonseca]

Thank you.

We're going to move over to question and answer time, starting with Mr. Fisher from the Liberals.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Thanks, folks. I appreciate your being here. I appreciate your expertise in this subject as we are starting to wind down our report.

I'll start with Mr. Campbell for Sport Canada.

Sport Canada funds national sport organizations. Is there a plan or has there been a discussion to tie funding to performance outcomes or participation outcomes in concussion programs, as you do with harassment? I think it was Dr. Frémont who had suggested that would be something we should look at.

Is that something you would recommend this committee consider?

[Andrew Campbell]

Within the sport funding framework, we have a number of different things that we tie back. The sport funding framework provides the core funding for all the national sport organizations, multi-sport organizations and the Canadian sport centre.

One of the things we are continuing to do and look at is how we update our scorecarding on that. We scorecard organizations on many different elements. Obviously the harassment, abuse and discrimination pieces that the minister announced in June are an important part of that. We have begun that work on concussions, and we will continue on in that work on concussions.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

When you say you're continuing with that work, are you continuing to consider holding those groups—those national organizations—to account, that they must participate in programs and then respond and report back with outcomes?

[Andrew Campbell]

That's exactly what we would be looking at, yes.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Okay, good.

Do you have a time frame on when that might happen?

[Andrew Campbell]

There are plans afoot. In short order we'll be looking at that.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

But there were no plans of tying it in with the harassment announcement in June.

[Andrew Campbell]

In the general area of safe sport, it is one of the areas we had looked at in the previous funding framework, but specifically on concussions, we are looking at it and moving that forward.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Good. That is good news.

The subcommittee has heard about the need or the desire for a concussion awareness week. I'm interested in your thoughts.

I'm also interested in the Public Health Agency's thoughts on something like that, concerning bringing it to the forefront for public awareness, but also what type of role both of your groups may have in a week like that, a national concussion awareness week.

We could start with Mr. Campbell.

[Andrew Campbell]

As you probably saw, the other part of my portfolio deals with national celebrations and that type of work. We see how those types of weeks and months do work in bringing attention to other types of activities that we have, whether it's promoting something on the Canadian heritage side or whether it is in doing things around sport. I think those are definitely good pieces to look at.

As you see, this issue is so complex because of how many players are involved, and it may in fact give a focus to those players on how to all come together. You could get everybody—from professional sports down to communities to health care professionals to schools—all being able to do something in a very coordinated fashion. Certainly we see the effects when efforts like that are made.

[Darren Fisher, Liberal, Dartmouth—Cole Harbour, NS]

Gerry or Andrew?

[Gerry Gallagher]

Similar to my colleague at Sport Canada, we do see the value of awareness-types of events like this as a way to galvanize people and bring attention to the new tools and the suite of resources available, both for the parents of the children and youth, but also for what we call the “circle of care” folks around these students and athletes, their coaches and their education settings as well. It's an opportunity to put those pieces together.

We also see that in different parts of the country it can play out quite differently because the contexts are different. It's an opportunity to adapt some of the messaging—as appropriate—to what those contexts might look like and to the use of those tools.