Health Committee on Feb. 28th, 2019

[The Chair, Liberal, Bill Casey]

Now we'll go to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Matern, one of your recommendations, which are very helpful by the way, is to eliminate the blood donation ban on men who have sex with men. We know in the last election there was a promise by the current government to eliminate the ban. It was for five years, but they've reduced it to one year.

I'm aware that Egale Canada Human Rights Trust has launched an online campaign calling for an end to what's referred to as the “discriminatory” ban on blood donations from men who have had sex with men in the past year, noting on its website that “Gay is not a blood type”. It goes on to comment that there's a real discriminatory element to it. The current plan is very outdated.

To your knowledge, Mr. Matern, is there any scientific basis to retaining this one-year ban on blood donation from men who have sex with men?

[Richard Matern]

From what I understand, there are studies being done to confirm the safety of it. I understand that there's already data that exists. There is no scientific evidence.

[Don Davies, NDP, Vancouver Kingsway, BC]

It's my understanding that heterosexual men can engage in extremely high-risk behaviour and there is no automatic ban on their donating blood because of their identification. Many suggest that there should be a behaviour-based exclusion, if anything, but not a rank discriminatory stereotype view.

Do you agree with that?

[Richard Matern]

I agree with that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

There's been so much rich testimony here that we need to keep you here for a few days, I think.

It strikes me that there are a lot of elements and layers to the issues that we're about to explore. One of the common ones is the mental health element. That seems to be pervasive across....

I want to start at the very beginning, Mr. Matern. You commented on this troubling issue of non-consensual gender assignment surgery upon infants—young people who have ambiguous sexuality—and I'm just curious. If I have your recommendation correct, you were suggesting that there be a wide consultation about how best to handle it. Do you have any suggestions to give the committee about how we should better handle the issue of infants or children who are born with ambiguous sexual organs?

[Richard Matern]

The first thing is addressing the Criminal Code, which has the exception in section 268 that enables that to occur. The initial step, we think, aside from the consultation, is amending that Criminal Code element.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. MacFarlane, by the way, most things about me are not as good as they used to be, including my ability to speak French.

I want to ask you a question about intersectionality, which also seems to be a very common theme here. We can have a woman who's lesbian, who's indigenous, who's poor, who's a woman—

[Devon MacFarlane]

She may be a parent.

[Don Davies, NDP, Vancouver Kingsway, BC]

—who may be a parent. There are all sorts of elements. I'm just wondering if you can unpack that a little bit for us and maybe tell us how we could address this as a federal government.

[Devon MacFarlane]

I think it is in taking that lens of the complexity of what goes on with people's lives. Sometimes when people think about a population, they tend to think about who they see and who they're most familiar with. Part of it is thinking about who may have the greatest barriers, because if we can improve the situation, access the care and so on, for folks who have more barriers, it'll raise the bar and open the doors for everybody.

For me, I'm a transperson, but I'm white and I get read as a man. My ability to move through the world and navigate things is a lot easier than folks who may be trans but not white, who are dealing with racism because we also know that, for instance, around cardiac care, about speed of care, for folks who are indigenous or racialized it's often delayed, often poorer. Being aware of all this, when we're looking at data, for instance, being able to get this aggregated data, we can look at what's going on specifically in different populations. We can see where we are doing well and where we can do better. It's critical.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Ross, if I have this correct, you said that in the GLBT community the rates of suicidal ideation were three to four times that of the general population, but among bisexual Canadians, it would be six times. Do I have that correct?

[Dr. Lori E. Ross]

That's correct, yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Basically, suicidal ideation among bisexual Canadians is higher than for heterosexual Canadians and gay and lesbian Canadians. Do you have any idea why that is?

[Dr. Lori E. Ross]

We've been doing some research to try to understand why, not only for suicide, but for other mental health outcomes as well, we see the same pattern where bisexual people have the poorest health outcomes. There does seem to be a major role for discrimination and associated lack of social support.

Many bisexual people are isolated in terms of lacking a community of support from other bisexual people. Many bisexual people face discrimination, not only from heterosexuals but also from gay and lesbian people, and so may not feel that they have a welcoming source of support within the broader lesbian and gay community. As a result of that, many are quite isolated with respect to their sexual orientation, and they lack support in that way.

Also, the data suggest that in terms of economic disparities, bisexual people also fare the poorest relative to other sexual orientation groups, so it's also very likely that the economic stresses that bisexual people are dealing with are also contributing to those mental health outcomes.

[Don Davies, NDP, Vancouver Kingsway, BC]

You commented on the community health survey, and we know that it includes a question on sexual orientation and that the results of that survey have been used by researchers to assess health inequalities in Canada.

A study in 2017 tested the sexual orientation question posed in the CCHS and estimated that approximately 14% of sexual minorities would not be identified through that question. Do you agree that the question should be changed to better measure health care inequalities experienced by sexual minorities? If so, what would be your recommendation on that?

[Dr. Lori E. Ross]

I do recommend that it needs an update. It has three options using language that is not necessarily the language that the community would use.

I would suggest that some consultation would probably be warranted before deciding on specific wording, but we should look at adding additional options to that question in order for people to identify. We also need to disentangle it. Right now, the way the question is worded is primarily identity-based, but the definition that's used for clarity is behaviour-based. We're actually conflating two different dimensions of sexual orientation, which is problematic in terms of interpreting the data. We really need to tease those apart and ask separately about one's self-identified sexual identity and one's sexual behaviour.

[The Chair, Liberal, Bill Casey]

The time is up.

We now go to Mr. Ayoub.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

Dear witnesses, thank you for your testimony.

I am the member for Thérèse-De Blainville, a riding in the northern suburbs of Montreal. I have been involved in my region for a very long time. Recently, I invited my colleague Randy Boissonnault, who is the Prime Minister's special advisor on the LGBTQ community file, to come and see what was happening in my community. I had the impression that the LGBTQ community did not exist in my region. Of course, I knew that this was not the case, but the lack of statistics, knowledge and cohesion between organizations is clear. Each organization has a certain specialization and those organizations are often based in Montreal. Since there is little assistance, young people in the suburbs are redirected to the big city. Basically, they find themselves disadvantaged and become easy prey, subject to all kinds of pressures, good and bad.

How do you see that situation? How do you see cohesion between organizations to ensure that service is provided outside major centres? How do we start? What directions should we take, as a federal government, to change that?

Monsieur Matern, perhaps you could start.

[Richard Matern]

We've noticed a lot of gaps in service between rural and urban organizations. Indeed, with any strategy—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I'm not in a rural area. I'm in a suburban area. It's not very far from the—

[Richard Matern]

If there's any type of capacity building that the federal government could support, that would be of assistance. For instance, for seniors organizations, at Egale we're trying to link them together because there are a lot of organizations throughout the country doing different work. We're trying to help coordinate them and refer people accordingly.

Many agencies are likely stretched and don't necessarily have that outreach or coordination capacity, so any federal support that can enable coordination or have a role such as we do at Egale that can help coordinate organizations across the provinces or across the country where linkages can be made and have a person responsible for that would be a great assistance.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Mr. MacFarlane.

[Devon MacFarlane]

I think there are a number of ways of approaching it.

At Sherbourne Health—we're based in Toronto—we've been providing LGBT health and a range of community services and supports for quite some time. Recently we got some funding for a black queer youth mentorship program that is not downtown Toronto-specific. Yes, some of the groups are running there, but we're also running groups in suburbs like Scarborough and Etobicoke outside the downtown core, in part because not only is getting to the downtown core so difficult but also people need supports where they are so that they aren't forced to move, even just from the suburbs into the cities.

There are a range of ways. Part of it is through funding. Part of it is through organizing.

Here in the Champlain region—the greater Ottawa area, for those of you who aren't from Ontario—geographically we have some mechanisms for organizing. There's something called the regional planning table for trans health, which looks at how we organize trans health services in Ottawa as well as in the suburbs and through Hawkesbury and Cornwall, and up through Petawawa and Pembroke. Sometimes it's also about how you look at things, and provide some funds and infrastructure for organizations to look at that region from that perspective and say, “What's already happening, and how can we grow it?”

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you.

The other topic I want to specify is the statistics. If you don't have statistics, it's very hard to have funding. How can we get those statistics? What is the trigger? What is the challenge? What can we as the federal government do to change that?