Health Committee on Dec. 14th, 2010

[Megan Leslie, NDP, Halifax, NS]

Thank you.

Ms. Forbes, I know that helmets do a good job and we should make sure kids wear helmets. That's not the only thing. Skating was a very good example.

How can we have tangible results when it comes to reducing injury in sport? Is it just mandating “Hey kids, wear helmets; hey kids, take skating”? What are some of the things we actually need to put in place?

[Dr. Susan Forbes]

Thanks for the question, Megan.

I'd like to start to answer that by saying when we look at the mandating of helmets in ice hockey, we have to recognize two things. Kids are still getting concussions. Helmets were actually designed to prevent what we refer to as focal injuries, which are pinpoint injuries that can lead to skull fractures and things like that. While they can lessen trauma to the head and minimize concussions to a certain point, they cannot prevent concussions because of the way the brain sits inside of the skull. Louis is probably much more articulate at describing that than I am.

That said, the question I always ask when I look at this data is why is this stuff happening in the first place? Why is it a kid takes a shot to the head? What is happening behind the scenes that's leading to that type of action? Can education prevent that? It can't necessarily, because once athletes get on the playing field, stuff happens. We can do our best to try to prevent that, and education is probably a critical piece.

I think by going back to the fundamental question, why these things are happening, which Paul has asked, and understanding that more fully, then either we can develop new best practices or we can work with the existing best practices. The outcome is changing the behaviour that leads to injury. That's true of anything. We've seen that around seat-belt use. We've seen that around drunk driving. If we start to change people's behaviours, we can see a reduction in injuries. The outcome is fewer visits to the emergency room.

The other piece that quite frankly frequently gets lost in issues around youth and sports, especially with head trauma, is that we're not just talking about kids getting hurt playing a game of hockey. We're talking about kids who are also students getting hurt playing a game of hockey. What are the consequences in terms of their academic capabilities or advancement? If their brain injury is sufficient, do we lose them—

[The Chair, Conservative, Joy Smith]

Dr. Forbes, could you wrap up, please?

[Dr. Susan Forbes]

Sorry.

Do we lose them out of the education system? Are they now an additional burden on society?

[The Chair, Conservative, Joy Smith]

Thank you, Doctor.

Now we'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank all the witnesses for being here.

I don't think this has really been looked at the way we're starting to look at it now. I do appreciate your comments, and I also appreciate that you're going to recommend things to us as a committee.

I have three little kids, and I encourage them to get out and exercise as much as possible. We've had a broken arm at a playground, and a certain number of things that have happened—some of the rites, I guess, of growing up when you're active as a small child.

I was listening, Dr. Forbes, as you talked about your program, Play it Cool. You talked a little bit about communication, and it's really focused on coaches learning to teach skills. You also commented about changing behaviours. I was wondering if you could comment to us around the table here, if we look at it from the point of view of parents. From your experience, what would you say parents need to know, and what can parents do to help decrease injuries, starting around the house and what we do with our kids?

[Dr. Susan Forbes]

First of all, I suggest you let them go out and play. Let them learn how to use their bodies and move. Don't just immediately strap them into hockey skates or soccer cleats or something and have a singular focus.

There's not a lot of research on this, but the research that's out there suggests that kids who engage in a variety of activities at a level that's enjoyable for them develop better body awareness and have stronger capabilities to deal with bumps and falls and things like that, which can help minimize and potentially prevent injuries. That broader experience is huge.

So as parents, just let them get out, enjoy life, and play. But also help them understand that there's a right way and a wrong way to do things, so that they are equipped with the skills they need to engage in these activities.

Parents can take a role with that but also can ensure that coaches have the opportunity to understand how to take that approach as well.

I think almost all of us to a person have said that awareness of all the potential factors associated with injury needs to be first and foremost in our minds. Raising awareness is another piece I would recommend.

[Colin Carrie, Conservative, Oshawa, ON]

Does your program Play it Cool focus mostly on coaches, or does it go directly to the...?

[Dr. Susan Forbes]

The initial part is with the coaches and helping them understand how they can teach the game of hockey differently from a safety perspective, but we also are engaged in raising awareness, particularly concussion, because two of our partners are the Canadian Spinal Research Organization and the Ontario Neurotrauma Foundation, and we raise awareness among athletes as well as parents as to the symptoms of concussions, for example.

We have a community partner, which is supported by the CSRO, that goes out and does community awareness days and has a website. The whole idea is to elevate awareness around what the risks are, what the factors are that contribute to injuries, and what you should do if you even suspect that your child has any type of an injury.

[Colin Carrie, Conservative, Oshawa, ON]

My next question is for Dr. Francescutti. You did mention that this topic is really all-encompassing. There are a lot of different factors involved.

What have been some of the successful injury prevention initiatives? You mentioned Australia and New Zealand. You said “Why bother reinventing the wheel?” You also mentioned different statistics in different silos.

It's kind of a two-part question. What have been some successful injury-prevention initiatives, but also, are there statistics out there? How many of these are motor vehicle? How many are sports injuries? How many of these are “injuries”, slips and falls, and things like that? Could you enlighten me on those two questions?

[Dr. Louis Hugo Francescutti]

Yes, that is not a problem.

If you take a look at unintentional injuries, 38% of those injuries are falls. And those are not just falls of seniors. Those are falls of kids, occupational falls, all over the place. About 25% are motor vehicle-related, 5% are poisoning, 2% are fire burns, 1% is blows in sports, and 1% is drowning. You could pretty well say motor vehicle-related, suicide, and falls are the leading causes.

There is a new area I'm getting more interested in. The third leading cause of death in Alberta is so-called accidental poisonings. These are overdoses; they are not accidental poisonings. They are related to substance abuse within individuals of both prescription and non-prescription medication.

It's a new area that's rapidly growing as one of the problem areas, but we do know where the problems are. As a matter of fact, every medical examiner or coroner, by law, has to be told about every sudden, unexpected death. The trouble is that nobody is keeping track of the score. We have all these injuries and they're all being parcelled out, but there is no one central agency that actually looks at the numbers.

If you look at the numbers, as I said, it translates to a fully loaded 767 crashing every five days. It is a major problem. Remember, those are the ones who die. The ones who don't die are even more costly to the health care system: the spinal cord injuries and the brain injuries.

In the past, these people used to die. They're not dying now and so there are many long-term care facilities in any community for people who have serious brain injuries from which they are never going to recover, or serious spinal cord injuries as well.

[Colin Carrie, Conservative, Oshawa, ON]

Do you have some examples? The second part of my question was what have been some of the successful injury-prevention initiatives? You mentioned Australia and New Zealand.

[Dr. Louis Hugo Francescutti]

That's probably the one that everyone talks about. Australia has been able to reduce carnage on their roadways through aggressive enforcement. The enforcement on their roadways is 24/7 and they are constantly looking for speeders. They are constantly looking for people talking on cellphones.

Let me just give you a good example. In Canada, provinces are passing legislation banning hand-held phones. While all the evidence in the world.... There are only 600 studies that tell us that it doesn't matter whether it's hand-held or hands-free, it's the conversation that's the distraction. That's why all these provinces passing hand-held legislation is going to have no impact whatsoever, because they're just going to hands-free, which is just as dangerous. It's the conversation.

That is because there is a lack of unity across the country and there is no repository house for people who are passionate about injury. We've been diluted, and they're competing against each other, actually. They have to come under one roof.

Paul Kells has been a leader trying to get some of those NGOs in injury to come under one roof.

[Paul Kells]

It's quite odd. On the hand-held, there is actually some emerging evidence that it is actually more dangerous. What people are doing is it's now going down here instead of holding the thing up, so they can't be detected. In fact, their eyes are going off the road.

[Dr. Louis Hugo Francescutti]

Just to give you an example, 7% of all fatalities in France on roadways are directly related to cellphone use, so that's how big a problem it is.

[Colin Carrie, Conservative, Oshawa, ON]

Well, I've actually seen the videos that Australia put out for driving. I have a 17-year-old. I thought the new media, you know, the Facebook, the YouTube, stuff like that, was very impressive, so I got him to watch that. I think that's made him—

[Dr. Louis Hugo Francescutti]

Just go to YouTube and Google “25th anniversary TAC”, Transport Accident Commission, and there's a five-minute video that pulls 25 years of commercials together. You'll see how it's done.

That's why I'm saying Canada could leap-start ahead by just asking people who know what's happened around the world successfully, and let's just steal that and use it. The first target group I would go for is our aboriginal community, because this is truly an epidemic within that community.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Francescutti. Thank you, Dr. Carrie.

We'll now go to Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you to the witnesses.

[The Chair, Conservative, Joy Smith]

She's been doing sign language all morning.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I would like to address suicide, particularly in the military. I am very concerned about the suicide rate among Canada's soldiers. Based on military police records, the average suicide rate among Canadian Forces military, both regular and reserve, between 1994 and 2000 was found to be about 16 per year. The number of suicides among members of the military rose to 20 in 2006, and then jumped to 36 in 2007, or double the rate of the previous year. The 2007 numbers put the military's suicide rate at triple that of the Canadian population.

And just this month we now have another study. This is a new study. It's the first time they've looked at suicide among female military veterans, and this is from the United States. What they found is the suicide rate among this group is nearly three times higher than that for civilian women.

I'm wondering if you have done any work in this area.

[Tim Wall]

The short answer is no. We don't have the resources to do that. What you're sharing with the committee is not new to CASP. I would simply say that in the U.S., the two primary partners in suicide prevention on the national level are their Department of Health and their Department of Defense, or the military. The U.S. acknowledged that suicide within the military was an enormous problem years ago.

I can only say I'm glad that in Canada we're now beginning to recognize that within the military it's a huge issue, which is also very much related to the issue of trauma, post-traumatic stress. I think those are two big challenges for the military today.

Thank you.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

You've raised PTSD, and I wholeheartedly agree. There is concern that the rise is linked to the intensification of Canada's mission in Afghanistan.

Are you aware of measures being undertaken in other countries to reduce suicide? Are there any recommendations you would like to make here?

[Tim Wall]

Within the military specifically?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Yes.