Evidence of meeting #138 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was gay.
A recording is available from Parliament.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Mr. Salway, you come from Vancouver and the Lower Mainland, and I represent Vancouver Kingsway. Of course, we know it's a very ethnically diverse and very rich cultural mosaic in the Lower Mainland. I'm just wondering if you have noticed in your research any special considerations that have arisen from having a multiplicity of cultures come together.
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
Yes I have, absolutely.
Tristan alluded to this when he talked about the effects of intersections of multiple social positions.
Since my work has mostly focused on suicide, I'll comment on one that really stands out. That is the experience of indigenous Canadians, who also experience a rate of suicide four times greater than the non-indigenous population. Not surprisingly, indigenous sexual and gender minorities experience both of those forms of oppression, stigma and historic injustices at the same time.
Very often in health care—and maybe in a lot of our institutions—we think of one population at a time, so the people who fit in those intersections often get left behind. When we talk about a queer-focused suicide prevention strategy or queer-focused services, sometimes that implies we mean it primarily for individuals who are part of the white majority, and that's unjust. For that reason, I would encourage the committee to invite speakers who have expertise working with indigenous and two-spirit LGBTQ people.
NDP
Don Davies NDP Vancouver Kingsway, BC
My friend Mr. McKinnon talked about conversion therapy. There was a recent petition tabled in the House by my colleague from Saskatoon West, Sheri Benson, calling on the federal government to amend the Criminal Code to ban conversion therapy.
That request was rejected by this government. The reason given was that this was largely a provincial and territorial issue and the practice can already be addressed through existing provisions of the Criminal Code, for example, kidnapping, forceable confinement and assault.
In your view, does this answer satisfy you, or would you like to see an explicit Criminal Code provision to ban conversion therapy? Do you feel that the current Criminal Code is strong enough in its present form?
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
I do not, and the reason is the practice itself is very hard to categorize as one of those offences that you mentioned. Very often, the practice is a little subtler in how it's initiated, but in a way, it's more pernicious because it goes on, sometimes for years, sometimes for months, and the effects last for decades.
I believe it needs its own category of criminal offence. I'm not sure if I'm using the right terminology. I disagree that the current situation is sufficient, in particular with regard to health providers.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Mr. Oudman, I know that Health Initiative for Men provides services primarily to gay men. Are your services also available to bisexual, transgender, two-spirit, or other men who have sex with men?
Executive Director, Health Initiative for Men
Yes, definitely. We use the term “gay”, but we use it in the broadest possible sense. We're engaging in a process organizationally where we're looking at that definition and looking at how we present ourselves. We talk about the GBT2Q group of individuals that we work with, and definitely we know that guys who attend all our programs, whether it's our health centres or our social, physical or mental health programs, identify across the entire spectrum.
NDP
Don Davies NDP Vancouver Kingsway, BC
Do you see any differences in the mental and physical health needs of those different populations, say, between gay men and compared to bisexual, transgender, two-spirit men?
Executive Director, Health Initiative for Men
No, I think we see that for gender and sexual minorities generally the presenting issues are typical. My colleagues prior to me spoke to the marginalization that people who identify as a gender or sexual minority identify with. We see those issues across the board in all the individuals we work with. No, I wouldn't say there are significant differences among those categories.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Mr. Abramovich, in your view, should the federal government develop a Canadian sexual health promotion strategy that would provide comprehensive information on sexuality and sexual health and encourage its use in school curriculums across the country?
Independent Scientist, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, As an Individual
What would that look like, exactly?
NDP
Don Davies NDP Vancouver Kingsway, BC
I was hoping you would tell me.
I guess the idea is gender and sexual identity emerge at very young ages, and I'm not sure that our school system in this country is responding at a young enough age to give positive expression to kids when they're first starting to experience their gender and sexuality. I'm wondering if you'd see a role for the federal government in helping.
Independent Scientist, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, As an Individual
Absolutely, I think that's really been missing, especially with the population I work with.
A lot of these young people are quite young when they come out. They're still in school, and their families are not prepared to deal with and to support them and they don't have the resources. I think many of these families would want to support their young person, but they don't have those resources. They don't have the tools. They don't have the education. I think there's a place for the education system to help those young people when they come out. They're in school. They're coming out. They're living with their families. I think there's a place for a lot more support in that type of a situation.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Chair.
We heard a lot about LGBTQ2. My colleague Don Davies just pointed out you're facing lots of discrimination in the health care system. What kind of education on inclusive training is needed in the health sector? You said that at YMCA Sprott House they're giving inclusive training to staff. Do you think you need some type of training in the health sector? What kind of training needs to be done?
Independent Scientist, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, As an Individual
Yes, absolutely, I think that's a very good question and a very important point.
Currently in medical school there is really no training around LGBTQ2S awareness or inclusion; that's really lacking. Perhaps they might sometimes have a guest lecturer, but that might not happen for everybody. I do think this needs to be part of the curriculum. It is extremely important, given the issues around access to health care, especially for transgender individuals.
One of the comments made me think about a lot of transpeople who, for example, might end up in the emergency room for an ear infection, and somehow the physician finds out that the person is trans. All of a sudden there are inappropriate and invasive questions that have nothing to do with the ear infection. I think that's a common experience for a lot of transpeople, unfortunately. I believe that with more education and training perhaps we could avoid situations like that in the future.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
Dr. Salway, re lack of education, what kind of tools are needed to educate our kids in the schools and at what age?
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
I would agree with everything that Dr. Abramovich said. I think we need more education about providing sexual and gender-affirming care at multiple levels, so I think it can begin in the schools so people can have an early general sense of the power and the sense of self-confidence that comes from acknowledging and embracing diversity in sexuality and gender.
Then, yes, we do need these very highly trusted, really critical gatekeepers, whether they're health care providers or teachers. They need to understand as well, and we need to catch them up so they understand how not to ask questions that will then deter that person from seeking care again. We know from the work Greg Oudman referred to that in the sexual health clinics and in the community-based organizations we have people showing up for concerns that aren't necessarily specific to, let's say, HIV or sexual health. That's because there's a feeling of trust there.
I think we can learn from organizations like his, from other LGBTQ2S organizations, on how they've created safe and inclusive environments, and create standards or guidelines that would then transfer to other health care settings across the country.
Liberal
Sonia Sidhu Liberal Brampton South, ON
What do you think is the best age for kids to know about sexual health?
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
That's beyond my area of expertise, but the earlier the better.
Independent Scientist, Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, As an Individual
I think as early as possible, so perhaps even in preschool we can start talking about identity in different ways.
Obviously, the way you explain this to a child in preschool would be quite different, but if you look at the books that are offered in day cares and in preschools, a lot of them are quite heteronormative and cisnormative, so a lot of times the examples that many of these teachers use are examples of families that have a mother and a father, and those are the only examples they have. For example, I have a child in preschool and the comments are really heteronormative, so if she makes friends with a little boy, all of a sudden that's her boyfriend, but if she's friends with a girl, that's her best friend.
I think that education piece can start very early because we're modelling that to really young children. Many LGBTQ2S books are available for children as young as preschool, and they're brilliant. I believe those books should be available in the school system.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
What recommendation would you make to ensure the online or telephone intervention methods are effective in preventing suicide attempts? Do you think online is—
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
Absolutely, I think as we move forward we need online and offline approaches. I think that's the best way to reach the maximum number of people. I have experience working in a crisis centre, and there we found a very different type of person will reach out online for support. I think it holds a lot of promise for people who are living in a rural and remote region, so I think we need both. Similarly, at the end of the line, there is still either a source of information or a counsellor. There's someone you need to create an environment of trust. We still need LGBTQ2S-inclusive approaches to those interventions as well.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Why is there the high rate of problematic substance use in gay men? Is it the homelessness?
Post-doctoral Research Fellow, School of Population and Public Health, University of British Columbia, As an Individual
One research model that Greg alluded to as well is the syndemic theory. Syndemic theory suggests that the reason we see multiple health problems arise in the same population—and you mentioned substance use, but we could also talk about anxiety, or many of the other health issues we're referencing today—is a confluence of two things. One is a history of feeling stigmatized and feeling different. Sometimes when those feelings get internalized a form of coping becomes substance use. It also becomes a way to connect to other people.
In syndemic theory one of the suggestions is that these populations will get together in the same geographic space. That's what has happened historically with gays and lesbians and other sexual and gender minorities. We've gathered together in certain places so we could connect with one another in community. That means sometimes if there's already a high rate of substance use, that becomes a form of connection. It also decreases inhibitions. If I've been told all my life that my sexuality is wrong, I might feel a natural rejection when I see another man, but using substances helps to relieve some of that inhibition and some of that fear.
The other piece of syndemic theory is that because these populations or these groups who disproportionately experience these health outcomes may have been excluded historically from some health services, as we were discussing today, it just might take a little extra effort to reach them and bring them through the door, given that they might avoid going to the ER or they might avoid going to a health clinic because they're not quite sure how that provider is going to react to their sexuality.
Liberal
The Chair Liberal Bill Casey
Okay. The time is up.
Now we're going to go to our five-minute rounds, starting with Ms. Gladu.