Health Committee on Nov. 28th, 2017

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Can I just interject for a second? Before we get to that, I'm curious; you've said that and I believe that, and I think we've had experience with that before too. Are they just not telling us what the problem is? I'm getting some...from the dialogue we're hearing. Is the task so immense that it is impossible to accomplish?

I'm thinking of Iqaluit, for instance. I've been there. As I'm sure you're aware, there are about 5,000 people there. I don't think they have a dentist. I don't think they do, but if they did, if that's the situation, that they have twice the amount of dental issues you found in the rest of the population, is the task just so daunting that Health Canada has just kind of thrown their hands in the air and said, “Yes, we agreed to do this, and we said we were going to have something in place, but we just don't know how to do it”?

[Michael Ferguson]

I certainly wouldn't want to underestimate the complexity of what they're dealing with. Again, some of these people live in very remote locations. Getting access to any types of services on the health front, whether it's dental services or other nursing services, can be complex. Sometimes it requires them to leave their community to travel fairly long distances to get access to those services, so I wouldn't want to underestimate the complexity of the problem.

However, I think it is still incumbent on the department to try to establish what it is they want to accomplish through the program. They already have said that their role is to maintain and improve the oral health of these populations. If that's what they're trying to do, how are they going about doing it? How are they using the data that they have? What measures are they using to know whether they are making progress?

It would be a stretch to expect them to be able to totally close that gap in a short period of time, but you would like to be able to see some indications that at least they're moving in the right direction of reducing that gap, even though, again, they are faced with all of that complexity.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Next, are there any studies that show that the problem is getting worse, or have we planed out?

I have a second part to that question. Again, I've been there. I've witnessed what a lot of people, especially young people, are consuming. It's not healthy stuff. I see an awful lot of pop cans and bottles. Did Health Canada perhaps indicate that, you know, there just isn't any movement towards a healthy diet?

Mr. Martire, you're kind of nodding your head.

I'm trying to look for.... I'm a car dealer. If somebody comes in with a problem, we want to know what their driving habits are, where they have been, and that sort of thing.

[Michael Ferguson]

We identified that Health Canada had worked to try to do a couple of surveys of health outcomes. One was on Inuit oral health in 2008-09. One was on first nations health in 2009-10. However, there really haven't been enough of these types of studies over enough of a period of time for them to really know whether what they are doing is having an impact. They need to try to look at their data.

Of course, all we can really expect them to work with is the data they have on the dental services that they are providing or that they are making sure are provided. As soon as you get into things like people's eating habits and that type of thing, a whole different type of data needs to be collected. You get into personal information and all of those types of things.

We would expect them to be able to work with the data that they do collect on the services they're providing to be able to understand whether, for instance, if children are getting the services under the children's oral health initiative by the time they are age seven and as they get older they're coming back for regular dental visits, then there are better health outcomes. We would expect them to be able to look at it from that point of view.

In terms of the other issues, the access to nutritious food and those types of things, those are other activities that they would need to work on, perhaps outside of this program. We did an audit a while back on nutrition north and about how that program is intended to try to get access to that type of food. But that was a different audit. In terms of this particularly, we would expect them to use the data that they do have to try to identify some of that cause and effect.

[The Chair, Liberal, Bill Casey]

Your time is up.

Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you for your hard work in preparing this report. We all know that the first nations and Inuit populations have more dental diseases than other populations and that the barriers can be less access to affordable, nutritious food, or education levels, but in budget 2017 we utilized programs with first nations and Inuit partners to educate indigenous oral health workers. On top of budget 2017, there was an additional investment of $45.4 million for the children's oral health initiative over five years.

Do you think these programs are going to help with those barriers?

[Michael Ferguson]

I think that question is exactly the reason why the department needs to have information about what the status is of the oral health outcomes of the Inuit and first nations people and what activities actually will close that gap, because otherwise.... That's the type of information that can be used to make sure that any additional investment is going to be utilized in a way that will close the gap.

Again, I think that's what's important. Additional money is, on the surface, a step towards trying to get to better health outcomes, but there needs to be a way of actually knowing whether or not that's what's going to happen. Money on its own isn't going to necessarily result in better health outcomes. The department needs to know exactly what those health outcomes are, what things affect the health outcomes, and how we know whether they're improving. That would be a way in which they would then be able to demonstrate back to Parliament that any additional money they get for these programs has in fact had an impact on the overall results.

[Sonia Sidhu, Liberal, Brampton South, ON]

There's a nursing station out there, as Mr. Martire said. How can that money be focused to create the greatest benefit? Do you have any ideas? Should we have more school programs to educate them on oral health?

[Michael Ferguson]

I think that's sort of the crux of what we were getting at in the audit. The department needs to understand what types of activities actually will lead to better oral health outcomes, whether it's more preventative service or signing up more people for the programs and making sure that people are aware of the programs.

For any of those types of activities, it makes it more difficult for them to figure out what types of services or programs they should put the money into unless they have the information that helps them understand which of those activities actually lead to better results. I think that's really what we were trying to get at. They need to know what activities will affect those outcomes so that they can make those decisions based on that type of evidence.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Are you all done? Okay.

Now that we've finished that round, we'll go to Mr. Davies for three minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm still stuck on something you said earlier, Mr. Ferguson, which was that it took two years for Health Canada to inform patients of a change in the X-rays from six to 10 years. Is that correct?

[Michael Ferguson]

That's correct. The decision was made in 2014, I believe, and made public in 2016.

[Don Davies, NDP, Vancouver Kingsway, BC]

There's a fiduciary relationship between the government and indigenous people. One would think that there's an obligation on the government to inform their patients in a timely manner of significant changes to the services they're entitled to. Am I missing something there?

[Michael Ferguson]

Certainly, we felt that by not communicating the decision, it could create an inequitable situation. If one dentist applies for a pre-approval for one of their patients and gets approved, then they they know, okay, for other patients, they will apply for that pre-approval. Another dentist may not apply for it, so their patients wouldn't necessarily get access to it. We were certainly concerned that it could have created an inequitable situation, so we felt that the department did have an obligation to try to communicate. I mean, they made the decision in 2014 that they were going to increase the limit, so....

[Don Davies, NDP, Vancouver Kingsway, BC]

Did they explain why it took them two years to communicate a change in coverage?

[Michael Ferguson]

As I understand it, their reason was that they needed to update their system where they tracked the information and made the payments. I guess that in order for the system to treat those as regular payments that didn't need pre-approval, they needed to make that change in the information system, and it took that long to make the change.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have any concerns that there may be other changes in coverage, besides that example of the X-rays, that may also not have been communicated in a timely manner?

[Casey Thomas]

In the course of our work, we looked at 18 changes, and in three cases the changes were not updated in a timely manner. That would suggest that there could be others that also were not done in a timely manner.

[Don Davies, NDP, Vancouver Kingsway, BC]

That's three out of 18. Ten per cent of that is 1.8 so almost 20% of the time the changes are not communicated in a timely fashion. Would that be accurate?

[Casey Thomas]

I haven't done the math quickly in my head. I will ask the accountant to my left.

[Don Davies, NDP, Vancouver Kingsway, BC]

Don't check my math too carefully.

My other question is that in response to the 2015 AG report, Health Canada pledged to conduct a comparative analysis of access to health services in remote first nations communities and non-indigenous remote communities. Health Canada set itself a deadline of summer 2016, but we learned last spring at main estimates that this report was never, in fact, written.

In your view, would such an analysis help determine the degree to which geography presents a barrier to accessing oral health services, as was raised by Mr. McKinnon?

[Joe Martire]

At the time we did the report, we travelled to northern Manitoba and northern Ontario, and there are non-indigenous communities that are not that far from the indigenous communities. The objective of the program is to provide comparable services in a similar geographical area. That's the key phrase.

We asked how they knew whether they were doing this. At the time what we reported was that they didn't have the data, and they didn't have the information to know whether or not they were, in fact, meeting that objective. As you said, they committed to doing that. I'm sad to hear they haven't done it.

Definitely it's an issue we raised back in 2015. It's doable, because there is information there. Of course, that would mean working with indigenous people and the provinces to get that information, and that's what we recommended. The key is to make sure they work together, so they would have information as to whether or not they are trying to do that, because that is the program objective. It's not only for this program but also for many other programs for indigenous communities.

I would say something else, though, about the access issue in the remote communities. Again, we talked about the needs. We asked whether the indigenous people knew what services they could expect from those nursing stations. It wasn't until the end of the audit that the department had actually put together what services people could expect to receive when they visited a nursing station, so that was good progress. The problem was that the department didn't know whether each of those nursing stations had the capacity to deliver on those services. That was the outstanding piece of work. That's still an open question.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

That concludes our questions. I want to thank the Auditor General and the staff for coming again.

You give us the most succinct answers we get. I was just thinking you give succinct answers as does the RCMP. I'm not sure if there's a connection there or not, but we get very focused answers from you both. I think probably eventually we will do another study on indigenous health issues, but for now we really appreciate your bringing us up to date on this report and the information you gave us.

Committee members, we are going to go in camera for a few minutes because we're going to do a little committee business. It involves deciding on witnesses for our food guide study, and a budget, and so on.

Thanks very much. We'll suspend for a couple of minutes and then come back.

[Proceedings continue in camera]