Health Committee on Dec. 2nd, 2010

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Yes, but I would also like to know if the communities are directly involved in these activities.

[Dr. Alison Macpherson]

Yes, of course.

[Dr. Philip Groff]

All right, first, to answer the question you had asked about whether data was collected as part of the economic burden research on aboriginal communities--first nations, Inuit, Métis, and non-status Indian communities--the answer is that unfortunately, for this project we were not able to do that level of analysis. The challenge is that the economic analysis we conducted here was conducted based on administrative data sets collected provincially and then rolled out federally across the country, specifically the discharge abstract data set on hospitalizations across the country, vital statistics for death data, and, in the two provinces where it's available, the ambulatory care or emergency department care data.

In a number of jurisdictions across the country, including some of the largest jurisdictions, there are no indicators of aboriginal status in those data sets, so there is simply no way to break down the data to show which members of the populations we were surveying were of aboriginal origin and which ones weren't, and thus we weren't able to do that level of analysis with this report.

Having said that, a number of years ago we partnered with the first nations and Inuit health branch as well as with a number of key NGOs, including ITK and some of the first nations, to do a small cost-benefit analysis in a couple of jurisdictions such as B.C., Alberta, and Saskatchewan, where we did have indicators of aboriginal status, about the cost of injuries in those communities and the potential benefits from some interventions, specifically around falls and motor vehicle injuries in those areas. That report is now quite dated, unfortunately, but I could provide some of those numbers and that information to members of the committee at a later date, if you wish, or I could simply forward the report to the clerk of the committee.

To make a long story short--and I realize I probably already missed that opportunity--the fact remains that when we're able to collect information, we do see a disproportionately high burden of injury among first nations and Inuit population--

[The Vice-Chair, Liberal, Kirsty Duncan]

Dr. Groff, I'm sorry, if I could stop you there, we've run out of time on that question. But if you could send those reports, we'd be grateful. Thank you so much.

Ms. Leslie.

[Megan Leslie, NDP, Halifax, NS]

Thank you, Madam Chair.

Thank you all for being here. This has been very interesting.

My first question is for Dr. Groff. This report is fantastic. I'm wondering if you have presented it to the federal government, and if so, what has been their response?

[Dr. Philip Groff]

The short answer is we've not formally tabled it in the House of Commons. This is the first opportunity, through a House committee, to present the report. We did send copies of the report in advance of its publication to every member of cabinet in the summer of 2009. That is the way we got it to the government.

We do know that our partners at the Public Health Agency of Canada have made some use of the document and have been in contact with us about it.

I thank you for your compliment on the report, and I hope the committee does find it useful in its deliberations.

[Megan Leslie, NDP, Halifax, NS]

Have you gotten any response from any members of cabinet?

[Dr. Philip Groff]

We have not as of yet.

[Megan Leslie, NDP, Halifax, NS]

My next question is along these same lines, and it's for everybody.

Yes, we need an injury prevention strategy, I agree, and Nova Scotia can learn a lot from Quebec, apparently. I'm very happy that we could have a pan-Canadian strategy where we could learn from each other.

I'm wondering what the federal response has been to your calls for a national strategy for injury prevention.

[Rebecca Nesdale-Tucker]

One thing we're all celebrating is the announcement in the Speech from the Throne regarding the child and youth strategy. As Dr. Groff and others have said, the NGO sector and the Canadian Collaborative Centres for Injury Prevention and Control are looking forward very much to contributing to that and making that a reality.

[Megan Leslie, NDP, Halifax, NS]

You say looking forward to contributing, so that hasn't happened yet--you haven't been approached yet?

[Rebecca Nesdale-Tucker]

We have had some conversations with the Minister of Health. We submitted some plans or suggestions to move forward.

Our organizations have participated with product safety renewal, so that's an area we're excited about. And we're delighted that $10 million was awarded by CIHR, but we would like to get further than that, obviously. We'd like to see a centre of excellence for injury in Canada. We'd like to see strategies apply to all ages.

We're very concerned about the vulnerable people in our society, as has been addressed by other members, namely aboriginal and Inuit communities, but we are also addressing the social determinants of health.

[Dr. Philip Groff]

I would just add that a number of us also sit on a federal-provincial-territorial committee, which is task group of the public health network. It is the expert committee on chronic disease and injury prevention, the injury prevention and control task group. It has also made recommendations to the government through that vehicle, and by invitation we were asked to form this task group.

I guess what we'd like to see is injury getting a higher profile in some of these situations, so that it's not always the add-on, so it's not chronic disease and injury, or substance abuse and injury, but rather that injury would have a home within the government and that there would be people there taking direct responsibility for it and solely for it.

[Megan Leslie, NDP, Halifax, NS]

Ms. Heatley, did you want to add something?

[Jennifer Heatley]

I can only echo what my colleagues have said. We are definitely in agreement that there is a need to go a bit further. We have a very strong network nationally of collaborators and we work together quite frequently, but we would like to see a formalization and a strong commitment to injury prevention nationally.

[Megan Leslie, NDP, Halifax, NS]

You all have talked about specific risk groups, and thank you for bringing in social determinants of health. It's incredibly important, any time we look at injury prevention.

What are some of the techniques or some of the measures that you use to actually reach youth that are hard to reach because they live rurally, they maybe don't have a computer at home to access the website, or there's no local chapter in their neighbourhoods or in their towns, or anywhere near them? What are some of the strategies that you use?

[Jennifer Heatley]

In Atlantic Canada we have been working with school-based programs, which we are currently evaluating. We're also looking at expanding those, because we know that they don't necessarily reach all high-risk youth. We are looking to expand into other community programs, such as community-based programs that may be for youth with mental health issues or addictions, or substance use issues, and working to get in those doors and working with them as well.

We all are also partnering this year with first nations and Inuit health branch as well as several of the Mi'kmaq, Malachite, and Inuit communities in Atlantic Canada to hold consultations with those communities in January. We want to hear directly from them. We want to create stronger partnerships between those groups and the injury prevention NGOs, and move forward in that area specifically in our region.

[Rebecca Nesdale-Tucker]

I'll give one example from our chapter in Winnipeg. We deliver, across the country, educational programs. ThinkFirst for Kids and Brain Day are two examples. They've been getting a lot of invitations in Winnipeg to go to aboriginal communities, rural and remote communities. There has been fantastic enthusiasm for the presentations they've been able to deliver there. They've had an excellent reception and keep being invited back. It's a problem they're happy to have. What we're trying to do now is make sure that we have the resources to accommodate that kind of travel and that sort of thing. I know that something our colleagues are interested in doing is making sure that we're really reaching the kids most at risk. Every Canadian is at risk for injury, but there are groups that are more at risk.

[Megan Leslie, NDP, Halifax, NS]

Dr. Groff, you described the pillars: coordination, education, policy, research, funding. Can you tell us a bit more about surveillance? What does that look like to you? What would that pillar look like?

[Dr. Philip Groff]

Thank you, yes.

As I'm sure members of the committee are aware, unfortunately, we're in a situation where a lot of the data on injury we have to work from is out of date. It is a couple of years lagging behind.

I think one of the things that needs to happen in surveillance in the immediate term is to really support the finalizing and development of the national coroner's data sets so that we can have comparable death data across the country.

Second, I think there's a real opportunity to collect information in the emergency departments that's useful for injury prevention. We need a national collection of emergency department data, and if we're going to do that, we need to structure it so that we're actually getting more than just administrative information about what resources are being used. We also need key information on what's landing the people in the emergency departments to begin with.

So I would like to see an emphasis on those two areas for immediate development in terms of a national injury surveillance system.

[The Vice-Chair, Liberal, Kirsty Duncan]

Thank you, Ms. Leslie, and thank you, Dr. Groff.

Now we'll go to Ms. McLeod for the final round.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

Thank you to all the witnesses. Certainly your focus and energy is on something that's hugely important to Canadians. It's a great area to be focused on.

I have a number of things. First of all, I have to say, as a mother of three children who are involved in lots of sports, I always thought that if I could have developed a universal helmet, it would have been great, because between bike helmets and snowboards and hockey.... Certainly for me it was just part of buying the equipment for my children so that they could participate. I think for some families it must be an incredible stretch to have the appropriate helmet for every sport a child might participate in. Anyway, I thought I could design and patent one, but maybe it will be in my next world.

I have two things, and I'll perhaps put them both on the table and then I look forward to the comments.

My first question will be to Tyler. I want to understand a little bit about what he's doing when he goes into the schools and talks to the students.

Could you just tell me a little bit about what you do and what kind of difference you think it makes?

[Tyler Lisacek]

Most of them are Catholic schools. The public school board hasn't quite wanted us to do them there yet.

When I go into a school, after the other presentations, I step up to the microphone, and I basically talk to the kids and say that you should wear your helmets. I was like you once upon a time, and this is my story. And then I tell them basically everything I told this committee at the beginning about all my injuries and everything. I tell them that this was a four-second decision. I took my helmet off on a hot summer day when I was really close to home, and this is what changed my life forever. That's basically my presentation.

The doctor does his, from a doctor's point of view, on the brain and everything. I do mine. And then my stepfather, Bob, comes up and tells it from a parent's point of view. He tells them how it was, the whole experience of being called by the police, telling him to go to CHEO, and about the wait and what it's like for the parents and everything.

When we go there and we do all that, usually, at the end, for most of the kids--you can see them when they first sit down--you can really tell that you've given them a piece of information and that they'll think first before they go bike riding, which is the objective of our group.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I don't know if formal evaluations have been done, in terms of the two students' perspectives, but it sounds like you're really changing how they think about safety through the presentations.

Next I'd like to focus, as Ms. Leslie did, on what an ideal surveillance system might look like. Tell me about your ideal surveillance system.

[Dr. Alison Macpherson]

I think I could take that one on. I think the ideal surveillance system is a system that captures injuries close to their real times so we could react quite quickly if we saw something happening.

The ideal surveillance system would include the demographic information we would like to have to help us plan injury prevention programs such as those in Atlantic Canada, Quebec, and across the country. It would include all emergency department visits in every emergency department across the country. For rural and remote communities, where people do not have access to an emergency doctor at the time of the injury, it would include information from the nursing stations and other places.

I think what Dr. Groff mentioned about the national coronial database is extremely important. It's only through the richness of data like that and in-depth death reviews that we can really understand what happens.

I'll give you a brief example. British Columbia used the coronial database to look at pedestrian injuries, and they found that drivers who killed child pedestrians were seven times more likely than other drivers to have had a previous driving infraction on their record. So the potential for intervening with the drivers, instead of trying to teach kids how to cross streets, is huge.

To sum up the injury surveillance system, it would be from the emergency department and the health unit, all the way up to the death data.