Health Committee on May 23rd, 2024

[Celeste Theriault]

Not necessarily. We have done an extensive amount of work on talking to people about diabetes through some specific work on Bill C-237, the framework. NIDA is actually leading the indigenous engagement for diabetes in Canada regarding that bill, so we have been having ongoing dialogues ever since. I guess we signed with the Public Health Agency of Canada on July 7, 2022, I believe, and I got to NIDA in October 2022.

Ever since that day, we have been having those conversations and hearing about people and what our health care system can provide and what it is currently providing.

That information is on our website, and it is a report. That is a first step. We need more, and we're working on that.

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

I appreciate that.

When was your association first consulted on this bill?

[Celeste Theriault]

We were not first consulted on this bill. I actually had to make sure that I had a spot at this table to raise my voice, and I will make note that we do have gaps, but I can't comment on all the other pressures on people who want to have their voices heard. I think it's a privilege to be here.

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

I'm grateful that you are here and I am grateful that you are raising your voice. It's always wonderful, to me, to have a Prairies voice at the table. We don't often have them here in person.

I'm trying not to say anything negative. I'm more trying to figure out.... You had to fight to get here. The government didn't reach out, even though you guys are the leading voice when it comes to indigenous people with diabetes in this country. You had to fight to be here. Is that correct?

[Celeste Theriault]

Yes, but we also have indigenous politicians, leaders and governments doing some political work that our organization doesn't necessarily do. We come from that grassroots perspective to make sure that we're not leaving anyone behind.

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

Mr. Arango, when was your association first consulted by the government on this particular bill?

[Manuel Arango]

Admittedly, we reached out to the departments—the Canadian Drug Agency and Health Canada—to discuss this issue well over a year ago. We initiated the contact, but I think, as members of civil society, we often have to initiate it ourselves.

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

Could you share whom in the department you reached out to a year ago?

[Manuel Arango]

We reached out to some of the folks who appeared earlier on. I'm sorry; I wasn't here.

We reached out to Michelle Boudreau and her colleagues, and others. We've had quarterly meetings with them. Once again, as I mentioned, we initiated the contact, but that's usually our job, as members of civil society.

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

Minister Holland often talks about his experience with the Heart and Stroke Foundation. Did you work with him when he was at the Heart and Stroke Foundation?

[Manuel Arango]

Yes. It was many years ago. It was in 2015, briefly, for maybe two years.

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

Okay. Have you talked to him specifically about this bill?

[Manuel Arango]

I haven't talked to the minister. I've talked to people within the department. I've talked to people in the minister's office and I've talked to MPs, but I haven't talked to the minister directly.

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

Wonderful.

Ms. Walker, I'll ask you the same question. When was your association first consulted on this bill by the Department of Health?

[Joelle Walker]

I would probably share some of the same observations. We engage regularly with the department and we reach out when we see certain areas. We have been active on this file for many years, and we have discussed it regularly with officials at both the political and department level.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Walker. Thank you, Mrs. Goodridge.

Next is Mr. Naqvi, please, for five minutes.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Thank you very much, Chair.

Thank you to all the witnesses for being here. I really appreciate your testimony.

I'm going to start with Dr. Francoeur. Thank you for being here.

One of the things I'm hearing a lot about in my constituency—I represent Ottawa Centre, here in downtown Ottawa—is contraceptives. This bill ensures that contraceptives are available for women and gender-diverse people who need them, and it takes that cost barrier away. I recently had a conversation with Planned Parenthood here in Ottawa as well, and they raised some really important issues.

From your experience, can you talk to us a bit about the importance of making contraceptives available in the way we are proposing, and the kinds of impacts it will have on the lives of women in Canada?

[Dr. Diane Francoeur]

Thank you for that question.

We have been lucky, in that B.C. started earlier. They have been covering contraception for a year now. From all the good news we hear about it, it's obvious that it's making a change, so we're eager to know all the numbers and the results associated with this coverage.

Obviously, money is a big issue. We were talking about the Quebec model. As someone mentioned in a prior group, we see women delaying when they get just a part of it, because it's still a lot of money. Nothing is free. In Quebec, don't have any expectations: Nothing is free. They still have to pay for a part of it when they go on a monthly basis, and sometimes they wait. They postpone. They want to make sure that they are going to take all the medication at once so that they pay for just the minimal coverage.

All of these actions are a burden that makes contraception less effective and promotes unintended pregnancies, and there's a cost to that. There's a cost to the future of Canadian women, because we know that when young people have a baby at a younger age, they are more likely to stop going to school. This has an impact on all of us, because there's a cost associated with that, which we all pay.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

We have been talking a lot about the social impact of having contraceptives available to women and girls. We have talked about the example of a young woman who may not want her parents to know that she's using contraceptives, and using private insurance creates a notification, so the parents may find out. I think we have a good understanding of those impacts and the freedom this type of measure will give women and girls in Canada.

Can you speak from your experience on the health side about what this access, by breaking down this barrier, means for the health of women and girls in Canada?

[Dr. Diane Francoeur]

Well, 15% to 20% of women have many problems related to their period. There could be a hemorrhage or bleeding problems that they experience. It could be endometriosis, with which they have pain. When they are using a hormonal contraceptive method, these symptoms are all alleviated. It's a good side effect of these drugs, and we can use them.

Unfortunately, sometimes they're not going to be able to afford them. In the last year, we have had a lot of new immigrant women who have not been covered by all of our refugee coverage, especially in Quebec. I can tell you that it is a burden. They have no money—none at all, not even to pay for the cheapest method they could get. An IUD is going to be at least $450 or $500. That's a lot of money. If you keep it for seven years, it's going to be cheaper, but it makes a big difference.

That's why we want to make sure these newcomers are going to be able to settle, learn the language, become Canadian and then plan their family and their pregnancy instead of being surprised by an unintended pregnancy because they were not able to afford the contraceptive they wanted.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Do you see a lot of stigma—cultural stigma and social stigma—around the sexual health of women?

[Dr. Diane Francoeur]

Absolutely. We are afraid of what's happening to our neighbours down south. We have to make sure all Canadian women will have the right to question and to engage in their sexual reproductive rights.

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

That's a really good point, because we are so influenced by what happens in the United States. Sometimes people think that's the reality in Canada. When we saw Roe v. Wade being overturned in the U.S., I heard from very many people who thought that was the case here in Canada as well.

We have a lot of hard work to do in creating that education, that safe space for women where they can be free sexually, from a health perspective. Hopefully this bill will do that.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Blanchette‑Joncas, you have the floor for two and a half minutes.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Mr. Chair.

Dr. Francoeur, thank you for joining us this evening. I would also like to thank you for your commitment to the health and well‑being of the people in our area. I know that you served for almost seven years as president of the Fédération des médecins spécialistes du Québec, and that you're now taking on new challenges. Congratulations on all your hard work.

I would like to understand the process that led to the proposed national pharmacare program. When you were president of the Fédération des médecins spécialistes du Québec, you supported the Quebec government's calls for increased health care transfers. The agreement reached with the federal government stipulated that it would cover 50% of the costs. However, it currently pays roughly 22% of the bill. We were realistic and reasonable. We asked the federal government to cover 35% of the costs. For Quebec, this meant an increase of about $6 billion. We received $900 million, which isn't even one sixth of the amount requested. In my opinion, this isn't enough.

A pharmacare program is being proposed. However, without increased health transfers, there isn't any hope of revolutionizing the system and solving all the problems. It seems that the next logical step is missing.

If the goal is to improve health care and provide a better pharmacare program, like our program in Quebec, shouldn't health transfers be increased?