Health Committee on July 7th, 2020

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

I want to thank both of our witnesses for the very powerful information they've given us. I was particularly interested in the recognition that intergenerational wealth transfer was a root cause of systemic racism, so I thank you for that.

My first question is for Dr. Siddiqi. It's my understanding that the Dalla Lana School of Public Health has a self-directed, student-led organization called the Infectious Disease Working Group that has created a community resource navigation tool. I'm hoping you can share with the committee a little more about the tool. What does the group hope to achieve with it, how was it developed and what has the group discovered from the information it's obtained in the development of the tool?

[Dr. Arjumand Siddiqi]

Yes, I'm very proud to say that the tool has been developed by a couple of our doctoral students. Taking the lead were Isha Berry and Jean-Paul Soucy. As well, David Fisman, Ashleigh Tuite and others of our faculty have been integrally involved in developing that tool.

Essentially, the backdrop of that tool was to make up for the fact that there was not routinely available data on COVID, and we were in a crisis in which we desperately wanted information and needed desperately to get information out to the public. With the ingenuity of this team and their colleagues, they took the media reports that were coming down the pike of who was dying from COVID, what their characteristics were and where they lived, and they essentially assembled their own database. You can imagine that it is painstaking work to put together a database that's not in any way automated but really requires the blood, sweat and tears of people extracting information from wherever they can find it.

In terms of what they found, there was a variety of things, really, that came from that data. They were able to tell us how the pandemic was proceeding, where we were seeing hot spots and whether things were getting better or worse as days went on. What they weren't able to tell us is something about the inequities in terms of socio-demographics, so they tried to collect information on things like occupation and so on, when it was available from a media report. Because they weren't relying on a source that has a standard information collection set-up, they really were at the mercy of whatever they could find. Usually, that involved where people lived, what age they were and, of course, their COVID-19 outcomes.

This was really able to tell us a lot, but what's sort of remarkable is the fact that they did this in such short order and with their own ingenuity and initiative, but also that they had to do this because we didn't have a government system of routine data collection that was publicly accessible.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you. Would the outcome of that information be made available to this committee?

[Dr. Arjumand Siddiqi]

Yes, sure.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

That's great. Thank you.

My next question is for you, Dr. McKenzie. First of all, I really found enlightening your comment that it is important for us to understand what's “under the curve” as opposed to bending the curve, and a lot of that reflects some of the social disparities that we've heard about. What changes would you like to see in the minimum wage, income supplements and social assistance and supports to start putting some equity into the system?

[Dr. Kwame McKenzie]

As you know, I was the research and evaluation chair for the Ontario basic income study. I like the idea of a basic income. I like the outcomes of a basic income. I like the fact that it does improve equity, and I like the fact that there are health and mental health outcomes as well as dignity. Dignity and social inclusion are very important.

When thinking about these things, I also like the idea of us trying to think of how.... When we're thinking of income supports, we tend to think about a level of money that we're giving people, but we never link that necessarily to the level that's needed for health. When we're thinking about how much EI people get and how much CERB people get, I'm very interested in whether that package actually allows people to be healthy, because that will help to decrease disparities.

I also think that the accessibility of the packages like the CERB and others is important. I have noticed a number of studies coming forward now and showing, for instance, that in the black population about 40% have lost income or their jobs over the pandemic, but a lower proportion of the black community than others have come forward for social assistance and have the CERB. I think there are equity problems in the accessibility of things like the CERB. Some of it is due to people not knowing their rights and some of it is due to the digital divide between people, but it's definitely there.

The big things, I would say, are the following: When when we're thinking about social assistance, can we link it to health and work out what people need to be healthy? Can we think of how we make sure it reaches the right populations and that they actually get it?

There are other things that I would suggest.

[The Chair, Liberal, Ron McKinnon]

Thank you.

Dr. Kitchen, please go ahead for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair, and thank you, Dr. Siddiqi and Dr. McKenzie for your presentations.

I greatly appreciate hearing that from you. A lot of what you talked about is that data is lacking, and the fact that we need to have ongoing data. We've heard that throughout this committee. There is a big challenge in collecting and disseminating data, whether it's because of provincial barriers, federal barriers, etc.

You did talk about social inequality when you touched on the issue of income, you talked about housing and you talked about race, etc. I've noticed, in doing a little bit of research on you beforehand, that both of you have mentioned issues of persons with disabilities.

I'm wondering if you both could comment on that in this particular demographic. I'll start with Dr. McKenzie, and then Dr. Siddiqi you might be able to throw in some input on how this is having a big impact on dealing with that. You talked about how we need to hit the hardest hit group.

[Dr. Kwame McKenzie]

I think it's really important to be thinking about disability.

I think I've mentioned before the analysis of comparing Germany to Canada. The big difference between Germany and Canada with regards to lives lost has been that 80% of people who've lost their lives in Canada are from long-term care, and only 34% of people who lost their lives in Germany are from long-term care. They sorted out long-term care and that made a difference.

In the end of this wave, and in the next wave, I believe it's going to be vulnerable populations such as people in congregate living situations, people with disabilities, who are going to be the next frontier for producing a quality and equitable response along with the racialized populations.

I think focusing on their needs, sitting down and working out what they need to be able to protect themselves is going to be important. As I said before, I agree with Dr. Siddiqi about the fundamental causes. I also think that we need to sit down and say to people with disabilities, “What do you need in order to be able to use the tools we've got? We have the tools of testing, physical distancing and tracing. How can you do this? What stops you from doing this?”

If we could start working those things out and finding innovative interventions, we might be able to protect a whole bunch of people in those groups because that's what happened in long-term care in different countries. Those countries had really good policies on prevention of infection in long-term care and they launched them at the same time as their lockdown, they protected their elderly—we didn't do that.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Dr. Siddiqi.

[Dr. Arjumand Siddiqi]

I'll just add one which is from a data perspective.

I think, as Dr. McKenzie said, it would be important to understand what people with disabilities face and to engage with them about their needs.

It's also important to understand how this is an axis of vulnerability at the population level, and what the kinds of patterns are of things people are facing.

I'll just add that in relation to the earlier question about the infectious disease working group, there is a group.... I misspoke because there are two groups at our school. One group led by Kahiye Warsame, Yulika Yoshida-Montezuma, and others is looking into socio-economic issues and they may also be able to look at disability.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

The precautionary principle is the idea that there is “a social responsibility to protect the public from exposure to harm, especially when scientific investigation has found a plausible risk.” This means starting with the highest level of protections for society and whittling that down as new information about the risk posed, or lack thereof, comes forward.

Both of you indicated that certain demographics in communities within Canada face greater risk with respect to COVID-19, yet the Public Health Agency of Canada chose not to utilize the precautionary principle in dealing with the virus.

Do you feel that if we'd used the precautionary principle, we could have helped to quell the spread of COVID-19 amongst some specific demographics in Canada?

[Dr. Kwame McKenzie]

For me, that's the simplest question I've had all day. Yes, most definitely, Dr. Kitchen; I completely agree with you.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you.

Dr. Siddiqi?

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

Please give a very quick response, Dr. Siddiqi.

[Dr. Arjumand Siddiqi]

[Technical difficulty—Editor] in some ways, yes, but in some ways, the fundamental issue is the increased risk for exposure, for being out there. That's an issue as well.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to Dr. Jaczek.

Please go ahead. You have five minutes.

[Helena Jaczek, Liberal, Markham—Stouffville, ON]

Thank you very much, Chair.

As a public health practitioner for so many years, it's been so refreshing for me to hear the emphasis from both of you on the social determinants of health. This is vital, and you've brought it to the fore. Both of you have dug so much deeper within what were originally considered the social determinants of health, digging into the data to certainly analyze much further, with Dr. Siddiqi emphasizing racialized problems in that community in terms of susceptibility and so on.

My first question is for you, Dr. McKenzie. It's great to see you again, if only virtually. I'm wondering if you could tell us a little bit more about the basic income pilot in Ontario. I note that the Wellesley Institute on May 6 conducted a survey with a number of stakeholders to look at vulnerable people in particular. One of the most common responses to that survey, in terms of the recovery from COVID-19, was potentially the need for a universal basic income.

For the benefit of the committee, could you tell us a little bit more about your role on the basic income pilot in Ontario, which of course was terminated after only one year, and whether there were some learnings in that one-year time period that were collated and that we could think about going forward?

[Dr. Kwame McKenzie]

I was lucky to be part of the basic income pilot project as the research and evaluation advisory group chair. I advised directly the running of the basic income pilot and the link between the basic income pilot and the third party evaluators, who were a consortium of academics. In some ways, as you probably remember, I was a translator between the academic language and the bureaucratic language in order to make it work.

The basic income project had two different bits. It had a randomized control trial in two areas, Hamilton and also in Thunder Bay in the north of Ontario, where people were randomized through either the basic income or not the basic income. It then had a saturation study in a different place, Lindsay, with 22,000 people in a predominantly farming area to see whether there would be a change in the economy in that area if all low-income people were offered the basic income. The basic income or essentially the amount of money you got was based on a tax rebate, which worked very well.

We learned loads of things. One, you can do it. Two, people love it. They find it a much more dignified way of getting their social assistance. Three, entrepreneurs take risks and build businesses if they have backing and they know they have at least a basic income. Four, people change their lives and go back to college. They get into better housing and give themselves a fundamental chance in order to move forward if they have a basic income. People move themselves out of poverty if they have a basic income.

It was a travesty, in my mind, that it was stopped. You can't start a research project, say to people that they have three years in order to revolutionize their lives and then take the money away. It's bad for their health. It's bad, obviously, for the country not to have that information. It made us look bad on the world stage, because people all over the world were looking for these results. When there were follow-ups of some of those people, such as in Hamilton, people who'd gotten even one year of basic income had done better than people who hadn't.

For people, I think it's about time that.... There are rights and responsibilities from being a citizen. Maybe there has to be a deal with the citizens that they have rights, and those rights are for a basic level of income that befits a high-income country.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Jaczek.

Mr. Desilets, you have the floor for two and a half minutes.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

Thank you, Mr. Chair.

Good afternoon, Ms. Siddiqi.

[The Chair, Liberal, Ron McKinnon]

Pardon me, Mr. Desilets. Your microphone seems to have been disconnected.

[Luc Desilets, Bloc, Rivière-des-Mille-Îles, QC]

My apologies, Mr. Chair.

Ms. Siddiqi, you quite rightly alluded to the wealth inequities and gaps between black people and white people, and to a kind of baby bond that might exist elsewhere. Can you quickly tell us what that is?

[Dr. Arjumand Siddiqi]

Yes. Thank you very much.

As I mentioned, one of the most unfortunate aspects of inequity is that it starts at birth before anyone has a chance to do anything, and that is a result of prior generations having more socio-economic resources among whites and fewer among blacks. In the United States, the disparity in family wealth is tenfold, so if a median white family has $170,000 in wealth, a median black family has more in the order of $17,000.

In order to combat that, they have talked a lot about strategies that would reduce wealth inequality. One of those strategies is what they refer to as “baby bonds”. The idea is that you provide children, when they are born, with a sum of cash that is actually something that can mature over time, so it's not intended as cash to be spent right away. There are many needs that do need immediate attention, but this particular proposal is the idea that you provide a sum that can mature over time and that in adulthood can be used to buy the kinds of things that rich families buy for their kids when they become adults. They often pay for education. They often provide them with down payments for homes. This kind of a baby bond would function in that same way. There are economists who have made estimates that suggest that a proposal like this may be able to close the wealth gap in a couple of generations if it were big enough and done well enough.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Desilets.

We go now to Mr. Davies for two and a half minutes.