Health Committee on April 23rd, 2021

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

Thank you for all of the good things you do for our community.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Van Bynen.

Now it's Mr. Thériault's turn.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

First of all, I'd like to thank all the witnesses for helping us understand the collateral effects of the pandemic.

I'll begin by addressing the Canadian Cancer Society representatives.

When we began our study on the pandemic, at the very start of the first wave, many witnesses told us that chronic underfunding of health care systems had weakened our systems and that it would have catastrophic effects in the future. At the time, we had two hopes: to find a vaccine quickly and to ensure there was only one wave. We're now in the third wave.

Your comments echo those of Dr. Mélanie Bélanger of the Association des gastro-entérologues du Québec and Dr. Martin Champagne of the Association des médecins hématologues et oncologues du Québec. These specialists have told us that the COVID-19 pandemic has claimed and will claim other victims, namely patients who don't have COVID-19.

We know that the fight against cancer is a fight for early intervention. If you can no longer detect cancer early enough, you're going to have an explosion in costs and increased risk of mortality. Experts have even gone so far as to tell us that the collateral effects of the pandemic would be felt, particularly in the area of cancer control, for 10 years, which would increase the mortality rate by 10% more than the annual rate.

The government didn't include anything in its budget to help health care systems, even though the provinces and Quebec were calling for a catch-up of 35 cents, rather than 22 cents, per dollar. We could have invested $28 billion, either gradually or in full. But there was nothing. No announcement was made. Nothing is planned for the next five years.

That can change, but the political decision not to intervene to help health care systems recover, to allow them to care for patients and to ensure predictability makes no sense from a health perspective.

If you had to convince the Prime Minister to change his mind today, what would you say to convince him to put money back into the health care system on a recurring and predictable basis, particularly in the area you're concerned about, which is cancer control?

[Dr. Stuart Edmonds]

Obviously, we share the concerns that you expressed about the future state of cancer control over the next few years. Certainly there are things that governments across the country can do right now in maintaining surgery procedures and also in promoting screening programs as safe programs to encourage patients to make the most of the programs and to get checked out when they have concerns.

I'll turn it over to my colleagues Kelly and David to see whether they have any comments about how we'd bring this up to the federal government.

[David Raynaud, Analyst, Advocacy, Canadian Cancer Society]

Thank you for that question, Mr. Thériault.

Basically, we can look at this issue from two main perspectives.

The first is how to deal with the impact of the pandemic in the short and medium term. The different health care systems across the country will certainly need to operate at higher capacities than they did prior to the pandemic to make up for the backlog in surgery but also in cancer screening. To do this, they will certainly need new resources. Increasing capacity includes hiring staff, upgrading equipment and creating new infrastructure. So new resources are needed for the different cancer departments across the country.

Then we can also look at the issue in the medium and long term, considering the aging population and the increase in the number of cancers. It's often said that nearly one in two Canadians will be affected by cancer. A concerted approach with a long-term vision and predictable funding is needed to address these future challenges so that Canadians can enjoy the best possible quality of life and health care systems can reduce their costs, including through better prevention and screening.

We certainly encourage the federal government to take a concerted approach involving all governments, charitable organizations, the private sector, researchers, and even citizens, in order to find the best possible solutions to develop this long-term vision and predictability.

[Luc Thériault, Bloc, Montcalm, QC]

Dr. Bélanger said that there were 150,000 patients waiting, 63% of whom were out of time, which is about 97,000 patients. She said that a colonoscopy costs $1,000, but if it isn't done in time, the patient is at risk of developing cancer, which can become a chronic disease creating not only diminished quality of life and even risk of death, but also an explosion in health care costs.

So a decision from an allegedly economic perspective not to invest in health care right now is to perpetuate the explosion of costs and reduce the ability to treat patients properly, improve their quality of life and save the health care system money now. Do you agree?

[David Raynaud]

Is it okay to give a short answer?

[Luc Thériault, Bloc, Montcalm, QC]

Yes, absolutely.

Do you agree with me?

[David Raynaud]

I agree with the general idea, yes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We'll go now to Mr. Davies for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to all the witnesses for their excellent testimony.

Mr. Leslie, I'd like to direct my questions to you, if I may. I know that you have been a champion for raising the particular vulnerabilities of people with Down syndrome, and particularly the need to make sure they're not forgotten in terms of prioritization for vaccination.

I'm wondering if you could expand on the reasons for your call and, in particular, if you have any comments on the federal guidelines on vaccine prioritization and whether you think they should be amended specifically to recommend priority access to people with Down syndrome or other developmental disabilities.

[Wayne Leslie]

DSRF is primarily a service provider, but this issue very quickly became a pressing issue for our community. We took the opportunity to use our leading voice to assist our community, and a population, as I mentioned, that's often overlooked, to raise attention to the fact that it's a uniquely vulnerable population. Even within the general developmental disability community, it's a smaller subset because of the comorbidities that go hand in hand with the genetic condition that is Down syndrome. As I mentioned, they're four times more likely to be hospitalized and 10 times more likely to die if they contract COVID-19, and because of their associated disabilities they're increasingly more likely to contract the disease.

The challenge we identified very early on was that the focus was simply on people who were dying, understandably, and that's who needed to be protected. But we quickly tried to shift the focus to the fact that if we didn't do something to prioritize uniquely vulnerable groups, and if they weren't unusually isolated in a way that many families would say, as it extended, bordered on cruelty, they would eventually be the next victims in a second, third or fourth wave. The only reason, again, we haven't seen that is they've been extremely isolated. We need to shift how we are viewing these priorities.

One of the key issues we've had is that despite Down syndrome being a very well known but smaller disability, there's often this gatekeeping that comes up. Persons with disabilities find this problem a lot, where they have to do an unusual amount of proving that they have a disability. There were unique vulnerabilities that we felt, at the beginning, should have been easily identified by the medical community and national leading organizations that focus on immunization priorities, and a recognition that some of the larger questions were more complicated. I would describe it, frankly, as low-hanging fruit; and Down syndrome would be one of those disabilities that could have easily been identified long before it was. The community should not have had to fight for the vulnerability that was so obvious, not just to people in the communities themselves, but in the broader community as well, generally speaking.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm very familiar with the wonderful work that DSRF does for our community, specifically focused on people living with Down syndrome; but I also happen to know that DSRF activities and supports extend beyond that to the broader developmental disabilities community at large. I'm just wondering if the comments you made specifically about those living with Down syndrome are more broadly applicable to people living with diverse needs typically. What can you tell us about the impact of COVID on the broader developmental disabilities community as well?

[Wayne Leslie]

Thank you.

It's a very good question. The simple answer is that the same things we're talking about extend through the broader community. I'll touch on my colleagues from the education, from the cancer, and from mental health sectors. The important thing to remember, whether you're talking about those with a developmental disability like Down syndrome, or other disabilities like cerebral palsy or autism is that along with their disabilities, they have mental health issues, health issues, cancer and education issues. They're the vulnerable of the most vulnerable. This cuts across all of the populations, which underscores one of our key recommendations.

We understand in a priority crisis management, putting-out-a-fire situation, why you need to focus your efforts on people who are literally dying. But in taking the opportunity to think further forward, we need to approach the recommendations from the perspective of: here's an opportunity to make sure we're taking care of the most vulnerable.

Persons with disabilities, as a larger group, are not an insignificant part of our population. We need to start emphasizing the need to take care of them, whether it's federally, provincially or locally. Down syndrome has a unique set of comorbidities that ramp up the vulnerabilities in health. But in in everything we're talking about with Down syndrome, we share a lot of the risks and vulnerabilities across the entire development disability perspective.

[Don Davies, NDP, Vancouver Kingsway, BC]

This may be an unfair question, but to help us get a bit of a quantitative scope on this, I'm wondering if you know roughly what percentage of the Canadian population would identify as having a developmental disability, generally speaking.

[Wayne Leslie]

I don't have the exact number. Part of that is because, respectfully, the Down Syndrome Resource Foundation works more directly with, obviously, Down syndrome. But it would be a significant part of the population when you consider the simple fact that it includes those who are on the autism spectrum, which now we've recognized, after years of research—and the medical data backs this up—that people we thought had no development disability, do in fact do. I don't have an exact number, but I don't think I would be exaggerating by saying it is significant.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I see that I'm getting the red card.

Thank you for your answers, Mr. Leslie.

[Wayne Leslie]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, all.

That brings our questioning to a close for this panel.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

We actually have eight minutes left, Mr. Chair. Can we have a brief second round?

[The Chair, Liberal, Ron McKinnon]

Sure. We'll have to shoehorn that in. Do we want to have a one-minute round for every party?

That being the case, we'll go with Ms. Rempel Garner.

Go ahead for one minute.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Mr. Chair.

I just want to direct an additional question to Mr. Mitchell.

I read a CBC article in which you were quoted talking about the difficulty in reaching students in virtual class.

In the time I have remaining, could you expand on the forecasted impact you think this is going to have on the high school dropout rate across the country?

[Dr. Kirby Mitchell]

The most recent closure, I believe, is having a cumulative effect on students. With the first closure, there were some students who resisted and stayed in the system, but some left. The second time a few more left the system. At this point, I believe—as with teachers in the system—they're tired. They're tired of the promise of being back in school versus looking forward and seeing an actual end to this.

I see the summer coming and the weather changing, and especially since in high school we have the quadmesters—and there's a quadmester starting next week—I'm concerned that this may be an easy exit, as I was saying, for a lot of students to kind of disengage or leave school in the upcoming weeks.

So every day counts. Every day we're going to lose 100 to 1,000 kids as they feel less engaged and less connected to what they formerly knew as school, family and community.

[The Chair, Liberal, Ron McKinnon]

Thank you, Ms. Rempel Garner.

We'll go now to Dr. Powlowski.

Please go ahead for one minute.