Health Committee on Feb. 28th, 2019

[Dr. Lori E. Ross]

I would just add that many of the really important determinants of health within LGBTQ2S communities are social determinants of health such as poverty, housing and employment, areas where there's federal jurisdiction and federal opportunities, such as the national housing strategy and the new poverty reduction strategy. There's definitely room there. Even though those are not directly health policy directions, there is room there to have a major impact on health through acknowledging LGBTQ2S-specific issues within those areas.

[Devon MacFarlane]

If I could add a little more, my understanding is the federal government is the fifth-largest health care provider in the country, so there may be some action that the government itself can take and also be a model for others.

[Ben Lobb, Conservative, Huron—Bruce, ON]

One example, which I know pretty well everybody has mentioned, and some of my colleagues have mentioned it as well, is around the mental health component.

I'm a rural member of Parliament, and we're in dire need of mental health support at all levels, every which way. Obviously there's a finite number of dollars for any government, and so on, so how would you propose that provincial governments make the best use of the mental health dollars so they help everybody? The rural people would say, “We need this”, and others would say, “We need that”, but you want to try to make sure that everybody is getting the help. How do we do that?

[Devon MacFarlane]

I think part of it is that there are rural folks who are LGBT. Whenever you're looking at any particular element of it, how do we do this best?

In Ontario, for instance, there is a northern Ontario health equity strategy that Health Quality Ontario led, and we helped engage folks from LGBT communities in that strategy.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Is it something that should be general for everybody, or should there be a specific component for this community? That's what I'm trying to say.

[Devon MacFarlane]

I think some universal component is needed, but if we're going to be most effective, you need to delve into the communities that are struggling the most in order to actually have the impact.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Is there anybody else?

Do I have any time left?

[The Chair, Liberal, Bill Casey]

You have 28 seconds.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's good, I think.

[The Chair, Liberal, Bill Casey]

Okay.

We'll move along to Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you, all, for coming.

I'm very proud to be part of this study. I think it's a very important topic.

Dr. Ross, I agree with you completely that they need to be putting more of this kind of material in medical school curriculums. I can remember in 1990, as a second year medical student, talking about adolescent mental health. I don't remember the exact wording of this conclusion, but they said that a mark of good adolescent development was something to the effect of having long-term goals, a work ethic and the ability to develop heterosexual relationships. This was actually taught to us by a psychiatry professor in 1990 in a medical school class. I am glad we've come a long way since then. Even that long ago, we walked out of that class shaking our heads.

One question I have is one you mentioned—and maybe you can all chime in on this—in regard to the health care barriers this community faces. There is sometimes a controversy about the kinds of care that would be permitted or denied in health care facilities or long-term care facilities that are faith-based. For instance, it is well known that Catholic hospitals will not allow abortion services to be provided. There are religiously affiliated hospitals and personal care homes that do not allow medical assistance in dying, will not even allow the consultation to take place on their property.

Do you know of any data that shows there are more of these barriers for LGBT people in these kinds of health care facilities? Have any trends been noticed?

[Devon MacFarlane]

In one province there was a physician who had been trained to do many transition-related surgeries who was affiliated with a Catholic hospital and was not allowed to perform those surgeries there.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Does anyone else have any other experience or things they have heard?

[Devon MacFarlane]

There's sometimes considerable fear in LGBT communities around accessing services provided by faith-based organizations, as also for addictions and in some other areas. There's a lot of fear and a lot of concern.

[Dr. Lori E. Ross]

I'm not that familiar with the data on experiences accessing health care, but more familiar with data about the impact on people's mental health of challenging relationships with faith communities—coming out in the context of a faith community and not having a supportive reaction and the impact that has on them, or conversely, their coming out to a supportive faith community having a very positive impact on people's mental health. I think it's important to also recognize that in some cases these could be supportive spaces for people as well.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Sure. Thank you.

One issue we talked about that is tremendously hard on someone's physical and mental health is homelessness. We talk about it a lot. From what I understand, LGBT youth are overrepresented among the homeless—

[Dr. Lori E. Ross]

—and adults as well.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

—and adults as well, yes.

From what I understand, many of them are simply young people who, on coming out to their parents, were literally expelled from their homes, shockingly.

Are you finding any trends among various demographics? Are young people from families of recent immigrants or different cultural or faith groups more represented among these, or do we have enough data to say?

[Devon MacFarlane]

I would talk to Dr. Alex Abramovich about that. Alex is one of the leading researchers on LGBT housing and homelessness.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

I guess I'm running out of time on this now, so I'll just say that I wish I had more time.

Thank you to all of you for coming and for offering your testimony.

[The Chair, Liberal, Bill Casey]

Now we go to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Ross, if I understood your testimony, you mentioned that Canada is not comparing well to other countries in terms of how we are gathering and processing data. Is there a country that you could point us to that we could use as a model to better improve our data collection?

[Dr. Lori E. Ross]

Mostly we are using U.S.-based data. There are a number of U.S. population-based surveys that have excellent data on sexual orientation, and more recently, on gender identity as well. There's the behavioural risk factor survey in the United States. The national survey of family growth is another one that has very good data. There are a number of surveys there that we tend to use to answer the questions that we're unable to answer with Canadian data.

[Don Davies, NDP, Vancouver Kingsway, BC]

Would you recommend that we take some of those surveys and then just adapt them to Canada and implement them in Canada?

[Dr. Lori E. Ross]

Yes. I think there are opportunities to do that, definitely. I think we'll need to look carefully at the specific questions. They'll probably require some revision for the Canadian context because there is some difference in language between the two countries, but the overall constructs that they are assessing in those surveys would be very valuable in a Canadian context.