Health Committee on Feb. 15th, 2024

[Dr. Ambreen Sayani]

If we look at it from an equity lens and consider who's falling straight through the cracks and who's being left out the most, it will be precisely those women who are not aware, who speak different languages and who don't have the cultural resources in their community.

The way I like to think about access is that, in terms of having your health care needs met, that's access, but access really does have five dimensions. The first is approachability. You know that care services exist. The second is acceptability. It's acceptable to you in a culturally appropriate way. It's affordable. Direct and indirect costs are covered. It's available at a time that works for you. If it's only available nine to five, that certainly won't be available for other people. Ultimately, it serves the needs it is supposed to serve. You have health care needs met at the end of all those things.

I think breaking down access into those five different dimensions and seeing how we can improve it all across those dimensions will allow us to work on each of them in a multipronged way.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much.

I have four seconds left, I believe.

[The Chair, Liberal, Sean Casey]

Thank you.

Mrs. Goodridge, you have five minutes, please.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you, Mr. Chair.

Again, thank you to the witnesses.

Helena, you talked about caregivers. We've talked about caregivers a lot. Do you have any stats on what the caregiver typically looks like? What is the female-male split on caregivers?

[Helena Sonea]

That's a great question. Caregivers make up approximately 35% of the total Canadian workforce, representing approximately one in three employees. Half of all caregivers are between the ages of 45 and 65. These are some of our peak earning years.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Understood. Do you have a gender split of male to female?

[Helena Sonea]

Women account for 50% of all caregivers, and 64% of those provide 20 hours or more of care per week.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic. I appreciate that. I think that's worth highlighting for this committee.

I'll go back to you, Dr. Anan, on some of the questions around reconstruction. We've been talking about breast cancer happening more and more often in younger and younger women. They'll often have families and young children at home. The requirement to now have two separate surgeries becomes that much more difficult for them, especially if they have young children. I can't imagine trying to keep a two-and-a-half-year-old from jumping on you after surgery, yet I know so many moms who have to do this exact same thing all the time.

I'm wondering if you could speak to that a little bit and what your suggestion would be to improve it.

[Dr. Ghadeer Anan]

Thank you.

In fact, I have had to deal with that in my own practice several times. A woman would have to go through treatment, surgery, reconstruction and radiation with kids at home and couldn't even afford child care. I think there should be policies in place with extra support for women who are undergoing treatment—any kind of cancer-related treatment, be it surgery, systemic treatment or radiation. They should have access to free child care. I've had women declining different types of treatments because of that particular reason, unfortunately.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I think it's worth also highlighting that a Monday to Friday, nine-to-five child care program probably wouldn't be sufficient for someone who is undergoing treatments like this.

[Dr. Ghadeer Anan]

That's correct. It's for respites as well, respites on evenings, weekends and that sort of thing—absolutely.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Exactly. Every mom can tell you that being a mom is a 24-7 job. The kids will climb on you even in the middle of the night—especially in the middle of the night.

Quickly, I want to go back to the Canadian cancer association around your recommendations. If we were to put a recommendation in this study regarding nicotine, and specifically nicotine pouches, what would you like us to have as a recommendation?

[Rob Cunningham]

Thank you.

We're urging in the short term that the health minister require that nicotine pouches be prescription only so that they will still be available for sale, or temporarily suspend their sale until federal and provincial regulatory legislative frameworks are in place. That's what we've asked the minister for.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you. I really appreciate this, and I appreciate the leadership you guys have taken in bringing this to light. I know that many parents reached out to me after you guys put out your initial statement. They simply weren't aware. They were very scared that their child could then access something like this and potentially end up developing an addiction to nicotine, which we know has long-term consequences.

Dr. Sayani, you talked quite a bit about access to care. In my home province of Alberta, Alberta Health Services has actually done a lot of work on providing the translation of many different health services directly on the Alberta Health website, so that patients can access and understand better in their home language what that looks like. Is that one of the potential options that you would see as a success? Can you point to any other jurisdictions that are perhaps doing well when it comes to things like that?

[Dr. Ambreen Sayani]

Having materials available in multiple different languages is important. It's also important that people see themselves represented within the materials in a culturally appropriate way. They see their gender identity. They see their racial and their ethnic—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I think I've run out of time. I'm sorry. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

The last round of questions for this panel will come from Dr. Hanley for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Thanks, everyone. This is a great panel with representation on really the whole spectrum of care.

With the Canadian Cancer Society, I want to focus on prevention. Thank you for coming.

First of all, Mr. Cunningham, on the fall economic statement and the tobacco cost recovery framework, could you comment on the significance of that and the need to actually carry that out?

[Rob Cunningham]

Yes. That is something that we've been urging for over many years. In the last federal election, it was in the platforms of the Liberal and Conservative parties and the NDP. It's a way to hold the tobacco industry accountable.

The $66 million for the federal tobacco strategy would be recovered from both the tobacco companies and the vaping companies. The sooner those regulations can be done, the sooner we'll have that accountability. We strongly support that.

[Brendan Hanley, Liberal, Yukon, YT]

Thanks.

We've talked about nicotine pouches. What else legislatively at the federal level should we or could we be doing, especially with regard to vaping and tobacco?

[Rob Cunningham]

With respect to vaping, while smoking among boys and girls has been going down, we've had a dramatic increase in youth vaping. What could be done by the minister is to finalize regulations to ban flavours in e-cigarettes other than tobacco flavour. There's a draft regulation that was published more than two and a half years ago.

I have some examples with me. There are flavours such as “Confusion” or “Love Pink.” These are things that are not even flavours. Here's an example: “Tutti Frutti Pineapple Strawberry” or “Mango Pineapple”. They're styled as potential flavours. They're attractive to kids. Banning those flavours will help to reduce youth vaping among girls and boys.

[Brendan Hanley, Liberal, Yukon, YT]

Yes, there's quite the collection.

Is there anything else you want to show off in terms of...?

[Rob Cunningham]

I do want to point out that there is a federal tax on e-cigarettes that helps reduce vaping among kids. The companies are undermining that with these disposable e-cigarettes that started out with 500 puffs. Then they brought forward 1,500 puffs, and then they brought forward 5,000 puffs. The price per week or per month goes down and undermines the tax objective. More recently, there are 9,000 and 10,000 puffs. That is an issue.

The flavours go on and on. Monster E or Caribbean Breeze are not even flavours, and that's a real concern. That's an easy action for the government to take.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I'm going to switch from tobacco to alcohol. I'm pleased that you mentioned that in your opening remarks. Could you talk about, maybe, the relationship between alcohol accessibility and drinking behaviour? Are we aware enough of the link to the harms, especially with some increasing efforts to make alcohol more accessible in some parts of the country?

[Ciana Van Dusen]

We know that about 75% of Canadians 15 years old and over consume alcohol, and 40% of Canadians have no idea that there's any link between alcohol and cancer. Alcohol is related to over 200 different chronic diseases, illnesses and injuries, and it's contributing to a lot of costs and social harms in Canada. It is a concern that as we continue to increase its accessibility.... There's plenty of research to demonstrate a link between more availability, more accessibility, more consumption and more harm. We think that it's really important that people have the availability of information to make informed decisions for their health.

Not having this information widely spread, for example, on labels is a failure to give people the chance to make that choice for themselves as to whether it's something that they're willing to take on.