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

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

For Sport Canada, I'm interested in how you're going to reach out towards or integrate with school sport. I don't know exactly how that works, and we probably don't have time at the moment to get into it, but I'm interested in how a national or federal agency can impact school sport, which tends to be totally provincial or territorial.

[Andrew Campbell]

In fact, very quickly, it's through making presentations to ministers of education and when they get together at—

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

It's about collaboration and partnering with them.

[Andrew Campbell]

Yes, absolutely.

[The Chair, Liberal, Peter Fonseca]

Thank you.

Now we'll go over to the Conservatives and Dr. Kitchen.

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

Thanks to all of you for being here.

I'm going to stay a little bit on Darren's line here, because you gave me questions that I wanted to ask.

On that aspect of taking it to the provincial areas and the school bodies besides the national sport organizations, you've talked about education. That's what we heard a lot of from Mr. Stringer. We heard “education, education and education” and how it's important.

The mandate letter talked about a strategy to “raise awareness for parents, coaches, and athletes” on concussions. The trouble is that I don't see education for parents and coaches.

We hear a lot about it. In my professional career, I went to a lot of meetings. I sat through great meetings and learned an awful lot, but when I walked out of them, I always asked myself what I could take back to my office. In this case, what can we take back to the parents and to the kids who need to learn this at a young age?

I'm not hearing it, so I'm wondering if you can give us some examples of what you're doing. What I'm hearing is that you're talking to the administrators. You're not talking to the coaches and the parents.

[Andrew Campbell]

I'm sorry if I didn't bring that out to a bigger piece. Certainly, Gerry and our friends over at the Public Health Agency of Canada also have pieces, but one of the big groups that we've been working through in order to get that into the hands of both practitioners and athletes—and then from the practitioners getting it into a broader area—is to do that through the Sport Information Resource Centre and the Headstrong campaign.

Doing that is actually creating tools. I don't want to say that as the federal government we sort of jump that federal-provincial boundary, but if we're going to get people in and involved, we need to work through groups such as the federal-provincial-territorial committee that just spoke and have everybody using that same harmonized approach.

The key is that harmonized approach and being able to take that to organizations such as the sport information research groups and the national sport organizations. If you are Hockey Canada, Rugby Canada or a number of the people who have come before you, that harmonized approach has really helped, because they can push that out to players, coaches and parents. You start to see that more and more in those types of national sport organizations.

In fact, we're seeing more requests coming in for that information, which is great news, because it means that we're now seeing it go out. That's why, with the Public Health Agency of Canada, we've done the apps, the web products that people can take and then move into their particular sport organization.

[Gerry Gallagher]

Thanks for that, Andrew.

Just to add to that in regard to the notion of putting all the information in one place, that was not the case a number of years ago. This is information to go onto the concussion page on Canada.ca in terms of what is a concussion, understanding the new resources that are available, and having the surveillance data in one place, along with all of the resources that Parachute has developed, including return to sport and return to school protocols as well.

Second, we do know that intermediaries matter. Student athletes and parents will go to the school, to the coach and to their physician to get that advice, and the consistency of the advice and that information is really important. It's a problem that we were trying to solve. A lot of that has been improved with the new tools that are available. Again, working with those organizations that have the audience of the professionals in those different sectors is a really important piece.

Again, the last is practical tools based on where people live, work, learn and play. As an example, for the mobile app, you don't need to be sitting behind your computer. It's on the field if you're at a game, so you can be starting to look at some information, as well as monitoring the signs and symptoms.

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

I appreciate your presentation here because you talk about online training for health professionals, which aims to increase awareness, recognition and management of concussions. In my previous life, I was a regulator for a profession. I can mandate people to sit in a chair to listen to things but I can't mandate them to learn from that. I can't mandate them to go online. What sort of tracking system do you have to say that people are doing this? If so, can we find out a way such that we have everybody doing it? If they are not interested in it, they aren't going to do it. When we deal with rural parts of the country where we don't have an overabundance of doctors, how do we ensure that it's also in those parts of the country?

[Gerry Gallagher]

First, I will say that the training is now accredited by the College of Physicians and Surgeons of Canada. Other accreditation is in progress with other professional organizations, so it's good for CME credits.

Second, with respect to the tracking, that is something we're working on as far as being able to understand “pre- and post-” as well as the numbers taking the training.

[The Chair, Liberal, Peter Fonseca]

We're just going to move over to the NDP, and Ms. Hardcastle.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Thank you very much for your presentations.

I want to link this idea of funding and funding requirements to responsibilities. Maybe there is another opportunity as we create a requirement to adopt a concussion policy, which I'm really surprised hasn't been done yet. I'd like to come back to that. Could we also have reporting mechanisms so that we're making data collection a funding requirement? I guess I just want to better understand the status quo. If certain things are not being required now that I would have assumed were required, there are probably some other considerations that it would benefit our committee to know about, when we're doing recommendations.

I'm just going to get it out front and then we can use up the rest of my time, because I would imagine you have some strong opinions about concussion guidelines not being required yet for funding from the Public Health Agency. I almost feel like we're at—I don't want to say cross-purposes, but we don't have this momentum. We're not all rowing the same way right now. If there is something the government can be doing to facilitate that, and I mean the federal government specifically, even if it means using certain terminology or something specific when dollars are rolled out or requiring some kind of accountability or transparency. I would like to hear about that from you.

[Andrew Campbell]

I'll turn it over to Gerry in a second. I hate to sound like a broken record on some of this, but in the five years moving towards a harmonized approach, this has been very important. Now everybody can, as you had said, start rowing in the same direction. Before that point, there were different ideas at the provincial and territorial level, at the community sport level, among federal and national sport organizations and in provincial sport organizations. Through the community of health care professionals, there were many different approaches that people were taking. The harmonized approach has actually moved things forward fairly dramatically.

As you see in budget 2019, with the investments of $30 million over five years towards making sport safer, there are opportunities within that to start to look at how we tie some of that funding. We always, at Sport Canada, say there are two sides to the ledger. There is one side of the ledger that is how sports are developing their sport: What are the coaching practices? What are the rules practices? We have measures and judging for that side of the ledger, but we also have the other side of the ledger, which is how people are doing as far as safe sport, governance, gender equity, the other sides that are about the governance of sport and the safety of sport and not necessarily the technical advances of that sport.

As we start to look at prevention, that's one of the areas where the two sides actually get together in being able to say what rules of the game we need to change, what behaviours of the game we need to change and what practices within those need to be changed to make safe sport just part of the culture of sport. We certainly are making headway in those areas.

I'll turn it over to Gerry for more on the health side.

[Gerry Gallagher]

My comment would relate to the harmonization of guidance and the products that we're referring to. Our role is not to fund national sporting organizations. That lever is with Sport Canada, so I will decline on that.

I will mention as well that the Canadian guidance was adapted from the international Consensus Statement on Concussion in Sport. Again, that harmonization between the international best views on this, informed by evidence, carries into the Canadian context, so that does address some of the concerns you have raised as far as ensuring consistency of not only how that plays out in the sporting arena, but also in recreational settings, on the playground, in the school or at home.

Maybe I will stop at that.

[Cheryl Hardcastle, NDP, Windsor—Tecumseh, ON]

Do you think it has been too early up to this point to require a policy?

[The Chair, Liberal, Peter Fonseca]

A yes or no, please, because we're going to move over to the Liberals.

[Andrew Campbell]

It's a difficult yes or no—sorry.

I think up to this point we have been requiring it. Can we make it more stringent now? Yes.

[The Chair, Liberal, Peter Fonseca]

We go over to the Liberals and Dr. Eyolfson.

[Doug Eyolfson]

Thank you all for your testimony.

We had a witness on the previous panel, Dr. Bishop. You were in the room. You heard this. He talked about how in sports and particularly in hockey there was a broad classification of how head injury would occur. I believe he used the terms “inadvertent” and “advertent”: “inadvertent” being a fall; whereas something more “advertent” being a bodycheck, an elbow to the head or even fighting.

For the Public Health Agency, is there data as to the incidence of concussion due to one or the other, whether it's due to simply an accidental fall, or whether there's some actual action, or some part of the play or a deliberate act that's doing this?

[Gerry Gallagher]

I will turn to my colleague Andrew to answer that.

[Andrew MacKenzie, Director, Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

We have information coming out of the emergency departments that provides a narrative explanation of what happened, and what caused the accident. You would have to go back and manually review to do such a detailed search. It's not automatically structured that way, but that information does come into the Public Health Agency. Analysis is possible, but it's not analyzed in that way at this time.

[Doug Eyolfson]

Thank you.

Mr. Campbell, this goes to the point I want to get to on this. Of course, being from Canadian Heritage...hockey is considered part of the Canadian identity.

We've heard from some witnesses that there is some influence of what goes on in professional hockey to some of the behaviours in children's hockey, junior hockey. There are certain ages that they can do certain things—no bodychecking before a certain age. Again, in some of the testimony we've heard, as children get older, there's more influence of what they see in pro hockey.

One of the contentious issues, of course, is fighting in hockey, particularly in the NHL. It's technically against the rules, but it's tolerated. It's tolerated in a way that you don't see in other sports. In the NFL, if there's a fist fight on the field, that can be a career-ending incident because the sanctions are so severe.

Have there been any attempts to lobby the NHL to take more concrete steps and actually get the fighting out of hockey?

[Andrew Campbell]

From the Sport Canada perspective, we don't lobby professional sport organizations. I think what we would say on those, and where we look at the prevention piece coming forward with national sport organizations, of which Hockey Canada would be one, is that they are actually looking very closely at the rules. What are the rules within minor hockey and within hockey that the government, in fact, is funding that could actually change and allow for prevention?

You have seen things in minor hockey, and Hockey Canada has brought forward a longer sanctioning of players who do get into these types of—whether it's a fight, or whether it's some sort of illegal, concussive type of behaviour. There are longer suspensions, and they are looking at how that plays against the rules.

We have that in lots of sports, and I think some of the witnesses perhaps talked about that and how they are looking to change the rule of the game to have it safer from a concussion perspective.

[Doug Eyolfson]

I've talked to some other witnesses, and there seems to be a common theme where no organization says that they do any lobbying of professional sports. Who would lobby an organization like the NHL to say that what they are doing could have an impact on what younger people are doing and that perhaps they should look at taking concrete steps to get this out of their sport?

[Andrew Campbell]

I think what we've seen in professional sport is that lawsuits and public opinion are the two elements that have driven some professional sports to change the behaviour within their leagues. I think you continue to see that. As well, there are workmen's compensation claims that go against sport organizations and certainly some professional ones where the players are paid, as opposed to leagues where they're not. You do have workmen's compensation claims, and workmen's comp will come out and talk to people about the assessment they've done around that. You have to look at it as a professional environment. It's a work environment, so those same people who would come out in any work environment would come out in that case.