Health Committee on April 11th, 2019

[Gerry Croteau]

For example, if a trans person goes to a hospital in our area and their health card, from birth, indicates “Michael Smith”, but their preferred name, which is not a nickname, is “Michelle”, many health care providers will not use the preferred name of “Michelle”, even though the person presents as female, and they will say “Michael”.

The patient could be in a waiting room and they're called “Michael Smith” and they're presenting as female and their preferred name is “Michelle”. That's triggering many in the trans community to walk out of that environment, whether it's in a private office of a doctor or a clinic or a hospital waiting room or an emergency room.

[Sonia Sidhu, Liberal, Brampton South, ON]

You mentioned the transportation challenge of accessing health care. The health committee went to Quebec and met with Quebeckers. They have mobile vans. Do you think it's a good idea?

[Gary Lacasse]

For mobility, of course. Look at Saskatchewan. There is no public transport in Saskatchewan anymore, and it's the same in all rural areas across the country. They're not all at the same level as Quebec. B.C. has very good transport for inter-rural areas for health, if I'm not mistaken. Even northern Ontario has some really good transport for going down south, but it's not equal across the country.

That's where, in my testimony, I spoke about the fact that every province has its own jurisdiction, which is perfectly okay, but if the federal government is not going to nudge, nudge, tap, tap down, saying that these are the best practices, we're not going to get anywhere.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you, guys, for being with us today.

I am not a regular member of on this committee, but I am happy to be here for this particular study today.

I am a former high school teacher. I taught quite a bit on gender education and would try my best to be as inclusive as possible in my teaching. Right now I'm working on my master's degree to hopefully get gender education implemented across Quebec from K to grade 11—because I'm from Quebec—and hopefully give that idea to other provinces as well.

Can you please speak to the importance of including this type of education in the classroom. I know this is the health committee, but obviously education is an extremely important preventative measure. Not only does it influence the kids who are experiencing certain issues, such as kids in the LGBTQ2 community who are learning about things that are important for them, but it also educates cisgender, heterosexual children on diversity and learning about differences.

Can you please comment on that?

[Dr. Mark Gilbert]

Sure. I'll start the comments.

I fully agree. The research has been quite clear that comprehensive sexual education that talks about all the nuances of gender identity and other aspects of sex and mental health is a benefit both to youth who are sexual, and gender minorities and heterosexual youth. It's extremely valuable.

The Adolescent Health Survey in B.C. done by the McCreary Centre is a really powerful source of statistics on youth in schools. Certainly in the work they've done on sexual health, all youth they survey have been very outspoken about the fact they want to get this information into schools, which clearly speaks to the demand for it. But it's often not there, so they're getting information from their peers or from the Internet and feeling that they don't know where to go for that piece of work.

I think the other example that's important within the school environment is thinking about other structural interventions, like gay school alliances and policies around homophobia and bullying, which research has again shown to have positive impacts on mental and physical health among LGBT youth. I think it's critically important for us to intervene in the school environment.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

As you know, education is not part of federal jurisdiction. However, we sometimes do fund programs and organizations that work with schools. Through that we can introduce certain programs or some parts of curriculums, even though it's not official. Where do you think the focus should be if the federal government were to intervene in this, such as with CanCode, which works with organizations to introduce coding to the classroom? How do you think the federal government can play a role here?

[Dr. Mark Gilbert]

I'm not aware of all the options around that. For example, I know there's been funding for SIECCAN to develop the comprehensive sexual health education guidelines that are being reviewed. I think there are ways the federal government is seeking that. I think it's important that kids have access to sexual health education in and out of schools, because we know that while we want to get that comprehensive sex education in every school for every child across Canada, it's going to take a while until we get there. That's why I think that thinking about funding agencies to do online resources or campaigns for youth is also.... Again, it can be within the federal jurisdiction to do that work, which can have that broad national reach.

[Emmanuella Lambropoulos, Liberal, Saint-Laurent, QC]

Thank you.

[The Chair, Liberal, Bill Casey]

The time's up.

Now we go to Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you all for your testimony.

Mr. Chair, I'm just trying to remember the name of the eHealth palliative care place we toured in Manitoba. What was it called?

[Nadia Faucher, Committee Researcher]

The Canadian Virtual Hospice.

[Len Webber, Conservative, Calgary Confederation, AB]

The Canadian Virtual Hospice was strictly a hospice for palliative care.

Dr. Gilbert, you talked a bit about eHealth and the health initiative that is going on in B.C. right now. I didn't quite get the name of that particular eHealth initiative. What was it called again?

[Dr. Mark Gilbert]

The service that we have is called GetCheckedOnline, which is an online testing service.

[Len Webber, Conservative, Calgary Confederation, AB]

Okay. And it's strictly for B.C. residents?

[Dr. Mark Gilbert]

As you can imagine, the testing service has to be integrated within labs. People have to submit specimens, so it is geographically bound, but it is a model that potentially could be used elsewhere. We have a CIHR research grant right now that's looking at the feasibility of the model in Toronto as one option around that.

[Len Webber, Conservative, Calgary Confederation, AB]

I think that's incredibly important. It would help a lot of individuals, especially in rural and remote communities where they can easily go online rather than having to see a doctor, who would perhaps be their neighbour too. I think we should be looking into national initiatives for that.

Dr. Moore, you talked a lot about PrEP. You got a lot of questions about it. One in particular was the cost, and you didn't have an answer on that. Is anybody here able to provide information on costs for outpatients on PrEP?

[Gary Lacasse]

In the generic formulary in Quebec, it is about $237 for PrEP or ARVs.

[Len Webber, Conservative, Calgary Confederation, AB]

Two hundred and thirty-seven dollars?

[Gary Lacasse]

Per month.

But we have to also include the copay that people have to pay on that, which could be prohibitive depending on your revenue. The name brand is about $879 a month.

[Len Webber, Conservative, Calgary Confederation, AB]

So it's dropped significantly since the generic....

[Gary Lacasse]

In Quebec, to use my example, when you get your prescription for the brand name, you go to the pharmacy. The pharmacist offers you the generic or the brand name. You choose.

[Len Webber, Conservative, Calgary Confederation, AB]

Okay, I see.

[Gerry Croteau]

Excuse me. I might add that there are PrEP clinics. For example, in Simcoe County now you don't have to have a referral from your GP. You can go directly to, in our case, Dr. Colin Lee, who is an associate medical officer of health for Simcoe County, and he will prescribe PrEP without any type of referral. That makes PrEP a lot more accessible, as opposed to going through your general practitioner for a referral.

[Len Webber, Conservative, Calgary Confederation, AB]

There's still a cost involved, depending on—