Evidence of meeting #31 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pandemic.
A recording is available from Parliament.
April 23rd, 2021 / 1:55 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
I have a question for Mr. Mitchell as well. I certainly understand what he's talking about. I have two little kids over there online as we speak.
What can we do right now to help kids to make sure they stay in the system?
1:55 p.m.
Focus Education Consulting
I want to invite everyone to our commission's meeting. We're having one next Friday. It's a Canada-wide summit at which we're going to come up with a plan. Basically it's all hands on deck.
We're going to try to look at the students who are living in the “third bucket” and, over the summer, re-engage them, reconnect with them and revitalize them. By September, all teachers should be vaccinated. We're hoping we can have a transition informed by what they knew from the previous system, what they know from the current system and what they want moving forward.
It's a child-informed process, along with the experts in the building, but we had our chance. Let's see what the kids want now.
In September we hope there will be a place that's welcoming. It could be as easy as having a welcomer at the door to say, “we want you back.” We want it to be that granular.
1:55 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Dr. Powlowski.
Mr. Thériault, you have the floor for one minute.
1:55 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
I'd like to thank the Canadian Cancer Society representatives. We talked earlier about waiting lists. So in this case, we're talking about patients who are already known, but there are also invisible victims right now. Cancer prevention involves screening.
In your experience with the prevalence and development of cancers, how many invisible patients—the ones who aren't talked about, but who are nevertheless victims of this disease—do you currently estimate are affected each year?
1:55 p.m.
Executive Vice-President, Mission, Research and Advocacy, Canadian Cancer Society
David, would you like to take this?
1:55 p.m.
Analyst, Advocacy, Canadian Cancer Society
Thank you again for your question.
It's difficult to put a number on it because every health care system is different and the activities that have been offloaded aren't the same everywhere. That said, we're probably talking about thousands of people with undiagnosed cancer. In Quebec alone, the ministry estimates that about 5,000 people are in this situation.
One study has shown that this could lead to 8,000 to 10,000 deaths over the next five years in Quebec alone. This is in addition to the ones we already have.
1:55 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Thériault.
Mr. Davies, please go ahead, for one minute.
1:55 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Leslie, if you could give your best recommendations to the federal government on how it could best promote the inclusion of people with Down's syndrome in society, what advice would you give?
1:55 p.m.
Chief Executive Officer, Down Syndrome Resource Foundation
In simple form, pay more attention to them. I'll again use the Down syndrome community as an example. We recognize that federally there might be challenges with making attention to this granular enough, but this is a good example of how vulnerable groups, because of their size.... Proportionately speaking, even the larger disability community population is still smaller relative to the size of the overall population, so you need to pay more attention.
To be frank, this needs to be more than lip service. It needs to be more than just political solutions. We need to be thinking about how to bridge the gaps. Even though DSRF and I recognize that a lot of the issues we're talking about are under provincial jurisdiction, there's a role to play federally. There are opportunities to create partnerships and leverage.
A good example of that is some of the funding rolled out as part of the emergency response, which DSRF was able to leverage through United Way. It helped us support the development of mental health programs. While those are great, the risk we have now is that they're short term. They're emergency. They will go by the wayside, we expect, at some point, and then you have those gaps. Some of my colleagues spoke to them.
There are opportunities and roles to play, but this is the catalyst we're talking about. You can use what you're learning through this particular crisis to really draft a better way of supporting persons with disabilities in Canada, in general and in the future.
2 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
Thanks to the witnesses for sharing your time and expertise with us here today. It's most helpful to our study.
With that, we will suspend and bring in the next panel.
We are suspended.
2 p.m.
Liberal
The Chair Liberal Ron McKinnon
The meeting has now resumed.
Welcome back to meeting number 31 of the House of Commons Standing Committee on Health. The committee is meeting to study the emergency situation facing Canadians in light of the COVID-19 pandemic. More specifically, today we are examining the collateral effects of the pandemic.
I'd like to welcome our witnesses. As an individual we have Dr. Gary Bloch, family physician at St. Michael's Hospital and Inner City Health Associates, and professor at the University of Toronto. With the Canadian Medical Association we have Dr. Ann Collins, president, and Dr. Abdo Shabah, Quebec board member and French spokesperson. With the Canadian Federation of Nurses Unions we have Pauline Worsfold, secretary-treasurer. Finally, with The Mustard Seed we have Mr. Stephen Wile, chief executive officer.
Thank you all for attending today and for sharing your time with us.
We will now start witness statements, with Dr. Bloch.
Doctor, please go ahead, for six minutes.
2 p.m.
Dr. Gary Bloch Unity Health Toronto and Inner City Health Associates, As an Individual
Thank you so much.
Good afternoon. I'm a family doctor, a professor at the University of Toronto and a senior fellow with the Wellesley Institute. I have experience in social policy development as a member of Ontario's income security reform working group.
Over the past year, I have spent most of my working hours on the medical frontlines of the pandemic in my clinics at St. Michael's Hospital and the Good Shepherd homeless shelter, in a COVID-19 homeless recovery site and recently at a COVID-19 vaccination centre for indigenous people in Toronto.
This infectious disease pandemic has been challenging, but every day I battle social pandemics. I work with communities that are disproportionately affected by adverse social conditions, including poverty, homelessness and systemic injustices caused by racist and colonial social structures and policies. The scientific evidence is powerful. These social pressures have a massive impact on health, including higher rates of chronic and acute illness, adverse childhood outcomes and death.
In COVID-19, the communities I work with have faced greater hardship than most. This infectious disease pandemic, placed on top of the long-standing social pandemic, has created what is termed a “syndemic”, a synergistic pandemic in which the spark of COVID-19 has ignited the tinderbox of social inequity built into the structures, policies and institutions of our society.
We have known since the first months of the COVID-19 crisis that the people getting sick and dying live in poverty and without adequate housing, work in high-risk frontline jobs without adequate employment protections and are racialized, disabled, women, indigenous, and, more often than not, impacted by intersections of multiple identities.
I ask you to urgently call for health, public health, and social resources to be redirected to neighbourhoods and communities with the highest burden of illness and with the fewest protections. This includes extending emergency income benefits, guaranteeing employment supports like paid sick days and facilitating access to health supports such as a safe supply of opioids.
Deeper structural changes to our health and social systems will be required to prevent this situation from recurring, and I have three recommendations for this committee.
First, strengthen social support programs to provide a foundation for health. This week's promise of a national child care program is an important step. I suggest that this committee examine income support programs to ensure that all Canadians have access to an adequate income to attain and maintain good health. This could include extending basic income programs beyond those currently in place for seniors and children, with particular attention to the needs of people living with disabilities, indigenous people and others who face historical and structural barriers to living above the poverty line. I also suggest that this committee call for a commitment to end homelessness through increased funding for affordable and supportive housing and housing first programs.
Second, collect data to make social pandemics visible. We must improve social disease surveillance systems. To properly understand health and social outcomes, we require access to disaggregated data on race, ethnicity, income, disability, housing status and other key determinants of social inequity. Public institutions and community agencies should be directed and supported to gather, analyze and report on social data on a community and individual level. I suggest that this committee demand specific health and social outcomes targets for those who have been socially marginalized, with regular reporting and accountability to those targets.
Third, empower those who have been most impacted by adverse social conditions to lead these changes. I have been giving vaccinations at the Auduzhe Mino Nesewinong clinic, a program created and governed by indigenous people. Using their knowledge and community connections, they have provided extensive services to an urban indigenous community that has long been hidden from view.
I suggest that this committee advocate for this approach, which is often called “nothing about us without us”, to be replicated for other projects and other communities, putting those who are most impacted by inequitable social policies in the driver's seat of efforts to redress those inequities. These changes will set the foundation for a recovery that aims to address the disastrous inequities that have characterized the COVID syndemic.
Thank you.
2:05 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We'll go now to the Canadian Medical Association. I believe Dr. Collins will start.
Go ahead, please, for six minutes.
2:10 p.m.
Dr. Ann Collins President, Canadian Medical Association
Thank you, Mr. Chair.
It's my honour to appear before you today. My name is Dr. Ann Collins. I am a retired family physician. I taught family medicine. I ran a full-time practice. I've served with the Canadian Armed Forces, and I've worked in nursing home care. Just yesterday, I was called back into service to administer much needed vaccines to people in my rural home community.
Mr. Chair, I am honoured to appear before you at this time in the pandemic representing the physicians of Canada and the people they care for. I am joined today by my colleague, Dr. Abdo Shabah, CMA board member and emergency physician serving on the front line during the pandemic in Quebec.
As president of the Canadian Medical Association, I am gravely concerned about the state of the pandemic in Canada today. In particular, in hotspot regions where we are facing extreme circumstances, I applaud the federal government for its unrelenting leadership and unprecedented action in leading our national response.
The pandemic has been unrelenting in challenging the physicians and health providers on the front lines, and the third wave is hitting hard. The CMA is deeply concerned about the toll COVID-19 has taken on the people who will steer us out of this health crisis. Emergency doctors are working 12-hour shifts and then being required to work another four hours, day after day. Fatigue and anxiety are high, threatening burnout, yet there is no relief in sight.
Medical professionals are being trained on critical care triage protocols, which may be enacted to respond to the lack of resources. If enacted, physicians will be in the untenable position of making the difficult life-and-death decisions about who gets care and when. The moment we have dreaded and feared, when the pandemic's grip is surpassing resource capacities in some regions, is here.
The CMA implores provinces and territories to continue to act in the spirit of collaboration to ensure that our resources are deployed where they are needed. We must work together for the common good to prevent loss of life wherever possible. Some areas of risk have already benefited from the aid of resources shared by the premiers—most important today is critical care staff. To call these actions laudable is an understatement. The CMA commends the federal government for its leadership in encouraging and facilitating this deployment of national resources.
Canada's recovery is contingent on the recovery of our health system. We vigorously applaud the recent commitment of $4 billion to resolve the backlogs of the first and second waves. I cannot stress too profoundly the incredible urgency for Parliament to pass Bill C-25 without delay.
Still, more is needed. Today, five million Canadians do not have access to a family doctor or a family care team. That's 13% of the country. If our health care systems are a house, primary care is the front door. The drafts are increasing. There's no security when the front door is off its hinges.
Primary care is affordable, it fosters equity and it will be the cornerstone of health care supporting the people of Canada through and out of the pandemic. Expanding primary care will help ensure every single Canadian has access to a family doctor. The right to access health care must not be subject to our status or postal code. Every marginalized and susceptible person in Canada deserves the attention of a primary care team.
Our nation has never been in more dire need of health security. The CMA appeals to Parliament to deliver this critical health care resource. There's still time. The pandemic has exposed the weaknesses, the shortages and the lack of capacity of Canada's public health care systems. We must begin to chart the course in reimagining public health and health care. The long-term mental health impact of COVID-19 on frontline health care workers is coming. We must prepare for it.
All of this will require a commitment to increased and sustained funding from the federal government. The CMA welcomes the Prime Minister's pledge to engage the provinces and territories in a continued and collaborative plan to address the future of our health systems.
The financial commitments the federal government has made to support Canada's pandemic response are exemplary. Investments to date will improve lives. They will save lives. But there are still some missing steps that lie before us. Completing them will allow all Canadians an equitable opportunity at health security. Completing them will sustain our frontline health care workers in the fight they face today and in the care they must provide in the future.
In conclusion, Mr. Chair, let me thank the committee for the invitation to share the convictions of Canada's physicians. The CMA and its 80,000 members will be there to fully support the government in addressing the stability of Canada's health systems.
Thank you.
2:15 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We will go now to the Canadian Federation of Nurses Unions.
Ms. Worsfold, please go ahead, for six minutes.
2:15 p.m.
Pauline Worsfold Secretary-Treasurer, Canadian Federation of Nurses Unions
Thank you.
I want to acknowledge that I'm speaking to you from Treaty 6 land here in Edmonton, Alberta. I give thanks to the fore peoples taking care of the land prior to our arrival.
My name is Pauline Worsforld and I'm a registered nurse. I'm here today to speak on behalf of Canada's nurses.
I serve as secretary-treasurer of the Canadian Federation of Nurses Unions, CFNU, which represents approximately 200,000 nurses and nursing students across the country. This is an elected position, and I've held it since 2001. I also work as a staff nurse in the post-anaesthetic recovery room at the University Hospital in Edmonton. In fact, I got off work this morning at seven o'clock, and I have been requested to work overtime, from 7 p.m. to 11 p.m. tonight, ahead of my next night shift.
As a registered nurse for 40 years, I can speak first-hand of the collateral effects of COVID-19 on our health care system and the people within it. I see my colleagues, fellow nurses and health care workers across the country, struggle to manage psychologically with crushing and unsafe workloads. While health care staffing shortages have existed for far too long in this sector, COVID-19 has brought an already overstretched workforce to its breaking point.
In 2019, the Ontario Nurses Association said that the province would have to hire over 20,000 nurses to reach the country's average staffing ratio. The nursing shortage is so bad in Ontario, and you've all seen the news, that the Ford government is pleading for nursing support from other jurisdictions. It breaks our hearts. We all want to help. The reality is that throughout the country we're all experiencing shortages.
It's time to sound the alarm, and these staffing shortages will have dire consequences for our nursing and broader health workforce beyond COVID-19.
The CFNU conducted a study before the pandemic, and we already knew nurses were suffering mentally, in part because of staffing shortages. One-third screened positive for major depressive disorders and suicidal ideation, and more than one-quarter screened positive for generalized anxiety disorder and clinical levels of burnout. One in two identified having a lack of staff to adequately cover their unit as the number one source of extreme stress in their job.
Burnout has worsened dramatically over the course of the pandemic with nurses being unable to take leaves and working ceaseless hours of overtime on virtually no rest. A StatCan survey of 18,000 health care workers found that 70% reported worsening mental health during the pandemic, and nurses are the hardest hit.
Without urgent and comprehensive action, we risk an exodus of frontline nurses and other health care workers when we emerge from the pandemic.
Our “Outlook on Nursing Survey”, which was nationwide, was conducted just before the pandemic. More than 66% of nurses rated their work environment as fair or poor, and 60% said they intended to leave their job within the next year, with one in four of these same nurses saying they intended to leave nursing altogether. In fact, I work with people who were on the cusp of retiring in one, two, or three years, but they're going in the next six to 12 months for sure. Unfortunately, I'm not one of them.
A recent survey of nurses in Ontario found that 13% of nurses in early career, aged 25 to 35, were considering leaving the profession permanently after the pandemic. According to a report from La Presse, 4,000 nurses have already left their positions in Quebec during the pandemic, which is a 43% increase over previous years.
How will be able to manage with a growing number of nurses leaving the profession when we have an enormous backlog of surgeries and procedures? How will we fill the ballooning vacancies of nurses and other health care workers, with over 100,000 vacancies in the health and social assistance sector at the end of 2020? How?
What is needed now more than ever is federal leadership to address critical nursing shortages across the country, through targeted transfer of funds to the provinces to immediately begin hiring more staff. To ensure a sustainable supply of nurses and other health care workers to meet growing demands, we need the federal government to help us address health workforce information gaps, which would enable adequate health human resources planning.
The federal government could address this through establishing a health workforce agency reflecting international leading practices, and in particular, in Australia. This could fill the data gaps that limit our ability to retain and recruit the workers required, giving us the tools we need to manage the frightening shortages and vacancies we are currently experiencing.
We have the opportunity to ensure nurses and other health care workers have the supports they need going forward, but we have to act, and we have to act fast, for the sake of our nurses and the health and safety of our patients, residents and clients.
2:20 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Worsfold.
We go now to The Mustard Seed, with Mr. Wile.
Mr. Wile, please go ahead. You have six minutes.
2:20 p.m.
Dr. Stephen Wile Chief Executive Officer, The Mustard Seed
Hello, and warm greetings to all in attendance, including the members of the committee and the chair.
My name is Stephen Wile. I'm chief executive officer of The Mustard Seed. Thank you for having me here today.
The Mustard Seed is a Christian non-profit organization that has been caring for individuals experiencing homelessness and poverty since 1984. Operating in five cities across Alberta and British Columbia, The Mustard Seed is a supportive haven where people can have their physical, mental and spiritual needs met and can grow toward greater health and independence. Our vision is to eliminate homelessness and reduce poverty where we serve.
Currently we serve in Calgary, Edmonton, Red Deer and Medicine Hat, in Alberta; and Kamloops in British Columbia. Our mission is to build hope and well-being for our most vulnerable citizens through Jesus' love.
Through this past year of the pandemic, our vision and mission remained unchanged, but how we do this has required creative adaptation, resilience, flexibility and grace to respond to the ongoing changes while staying focused on serving those in need. This dramatic transformation in our world has provided an opportunity to expand our reach and find creative solutions to help even more of our vulnerable neighbours.
In times of need, when our clients have no one to care for them or a place to call home to provide safety, we are there with open arms and a welcoming spirit. The pandemic has changed many things, but our clients' and staff's well-being, health and safety have always been our main focus.
The trends we have seen this past year are, first, increased numbers of unique individuals experiencing homelessness. In some of our locations, the overall numbers in our shelters were down, and yet we saw the number of unique individuals experiencing homelessness increase. In Edmonton, for example, the number of unique individuals using our shelter services increased by 15%.
Second, those who experience homelessness have increased risk for COVID due to barriers in following public health directives. While we were able to provide a space in Calgary for those experiencing symptoms to isolate, many who experienced homelessness in other cities were unable to easily isolate as a close contact or as being symptomatic. During the beginning of the pandemic, many public spaces were shut down, causing increased challenges for accessing spaces for individuals to remain warm, or bathrooms in which to practise appropriate hygiene.
Third, we have seen significant collaboration between health and social service agencies in the cities we serve, resulting in increased partnership and collaboration to providing wraparound supports, not only in relationship to COVID but to improving the overall health of this population. This has resulted in deep, rich partnerships with other homeless-serving organizations. This has been essential in containing the spread of COVID in the shelter system, but also in creating a coordinated effort to provide vaccinations to our populations.
Fourth, vaccinations have been a challenge, as our overall homeless population in Alberta, for example, has only been eligible for vaccinations since April 19. While many individuals were eligible prior to that due to their complex health concerns, transportation and booking for these vaccinations were significant barriers to their accessing them. The rollout in Alberta, for example, has not been optimal, because of a lack of understanding, in particular by Alberta Health Services, of those experiencing homelessness.
Fifth, we have seen increased numbers of overdoses, substance use disorders and acute mental health concerns. We have seen an increase in maladaptive coping strategies to the social isolation, the lack of comprehensive and available services, and the general anxiety due to the pandemic. For a period of time, we had to close our wellness centre due to public health restrictions.
Moving forward, my recommendations are the following:
First, provide funding for a significant increase in affordable housing. The current and proposed funding for affordable housing barely touches the need, as demonstrated by the rapid housing initiative this past year and the overwhelming response to that initiative.
Second, provide funding for health supports in the shelter system itself. This not only includes primary care, but also allied health professionals, who can target the multi-faceted health needs of this population and the increasing acuity of mental health and substance use disorders, which this pandemic has not only revealed but exacerbated.
Mental health is highlighted in the literature related to this vulnerable population and the pandemic, and for good reason. We have seen the acute effects in our shelters. There is a dire need to provide increased mental health supports, and it is difficult to provide these during the pandemic.
Third, ensure that vaccine supplies are targeted to this population and an effective strategy of care is created to ensure that all who consent to it receive their second dose in a timely and efficient manner.
Finally, after the focus on vaccines and triaging the current public health crisis ebbs, we encourage you to consider a longer-term strategy for approaching and funding the wraparound supports that The Mustard Seed embodies across the sector—all of this in addition to housing.
This pandemic has laid bare the need for increased mental health and substance-use disorder supports in the long term, where individuals are moved out of homelessness not only into permanent housing but also into a system that ensures multi-faceted care to address their social determinants of health and prevent future homelessness.
Thanks again to everyone, the members of the committee and the chair of the committee, for having me here to speak about the work we do at The Mustard Seed. As we say at The Seed, hope grows here. Thank you.
2:25 p.m.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Wile.
Thank you to all the witnesses for your statements.
We will start our questioning now with Ms. Rempel Garner.
Please go ahead, Ms. Rempel Garner, for six minutes.
2:25 p.m.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Thank you, Mr. Chair.
Mr. Wile, thank you for everything you do in our community. What has really struck me throughout the pandemic has been the lack of dialogue on the impact of the pandemic and related restrictions on Canada's homeless populations. I know a lot of us are growing weary of stay-at-home orders and stay-at-home restrictions, but we're very privileged in that we have a home to stay in. I think you've given the committee some very concise recommendations.
I wonder if you could expound a little, perhaps in a bullet-point format, on some of the impacts of COVID on the homeless community in Calgary.
2:30 p.m.
Chief Executive Officer, The Mustard Seed
I would be pleased to. One of the really positive things about Calgary, to start with, is that the number of people using the shelter system across Calgary is down significantly. I think the reason for that is that many of our clients have been motivated to move out of the shelter system into homes. For example, in Calgary alone, we have placed almost 450 people this last year into permanent supportive housing.
There have actually been some positive outcomes. The negative outcomes, however, are things like lack of access. Our shelter systems have certainly expanded from overnight shelters to being 24-7. Of course many in the homeless community do not want to spend their entire day in a shelter, so they're wandering around. Especially throughout the winter's difficulties, our Plus 15s were typically havens of warmth for them, and those weren't available to them any longer. It caused them to face more of the difficulties that you have with the elements.
Those are some of the restrictions. The ability to find food has been an issue as well. Many of the people in the shelter system are bottle collectors. Of course people aren't throwing away as many bottles. In Calgary, for example, I don't know what the percentage is, but we're down by at least 50% in the number of people who come downtown during the day or stay around the downtown core. That impacts them as well.
2:30 p.m.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Just following on that, I'm concerned about ensuring that the homeless population in Canada is adequately thought about in terms of the vaccine rollout. I would imagine that some of the challenges would be access, information getting to people, booking appointments, and then giving your clients tools, like a vaccine card or something.
Are there any challenges that you're identifying right now that you think need to be rectified in short order, in order to ensure equitable access to vaccination for your clients?