Health Committee on June 6th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 24 of the House of Commons Standing Committee on Health.

Today we will meet for two hours for a briefing from officials to begin our study on children's health. This meeting does not count toward the six-meeting minimum with witnesses, set earlier this year.

The meeting is taking place in a hybrid format pursuant to the House order of November 25, 2021. Per the directive of the Board of Internal Economy of March 10, 2022, all those attending the meeting must wear a mask, except for members who are at their place during the proceedings.

Please refrain from taking screenshots or photos of your screen.

In accordance with our routine motion on informing the committee that all witnesses have completed their required connection tests in advance of the meeting, I would now like to welcome our witnesses who are with us this afternoon for this briefing.

From the Department of Health, we have Jocelyne Voisin, assistant deputy minister in the strategic policy branch; Kendal Weber, assistant deputy minister of the controlled substances and cannabis branch; Alfred Aziz, director general of the office of nutrition policy and promotion, health products and food branch; Karen McIntyre, director general of the food directorate, health products and food branch; and Celia Lourenco, director general of the biologic and radiopharmaceutical drugs directorate, health products and food branch.

We have with us from the Public Health Agency of Canada, Candice St-Aubin, vice-president of the health promotion and chronic disease prevention branch. From the Canadian Institutes of Health Research, we have Tammy Clifford, vice-president of research, learning health systems.

Each organization will have up to five minutes for an opening statement. I'll ask the Department of Health to begin.

Ms. Voisin, welcome to the committee. You have the floor.

[Jocelyne Voisin, Assistant Deputy Minister, Strategic Policy Branch, Department of Health]

Mr. Chair and members of the committee, thank you for inviting Health Canada to appear today. We are pleased to be here. I won't introduce my colleagues, since the chair has already done so.

Children's health and wellness is a critical issue with potential life‑long impacts. Your study will help inform future work in this important area of public policy.

The past two years have been difficult for children and youth, with school closures, social isolation, and loss of extra‑curricular activities.

COVID‑19 has shown us the need to build more sustainable and resilient health systems.

The government is also concerned about substance use‑related harms. The government remains committed to leading a whole‑of‑society approach to address the overdose crisis.

The pandemic has caused the cancellation or delay of nearly 700,000 medical procedures, including for children. We also know there will be a shortage of medical professionals over the next 10 years, including a shortage of pediatric health care providers. In recognition of these challenges, a $200-billion, one-time top-up to the Canada health transfer was provided to provinces and territories to address backlogs for health care services this year, along with $4.5 billion in top-ups to the CHT provided during COVID previously.

Primary care providers play a meaningful role in children's physical, mental and social needs, and are really at the nexus of the health care system. However, we know that many Canadians have a harder time accessing this care in a timely manner. Budget 2022 provides funding to enhance student loan forgiveness for health professionals working in underserved rural or remote communities, where this access is even more difficult, to ensure that Canadians receive the health care that they deserve where they live.

The budget also expands the foreign credential recognition program to help 11,000 internationally trained health care professionals per year get their credentials recognized more quickly in Canada.

Dental health, as you know, is also a key aspect of Canadians' health, and it is especially important for children as they grow. To address gaps in access to dental care, the government committed $5.3 billion over five years, starting with children under 12. That will be implemented in 2022.

The pandemic has highlighted mental health and substance use issues in children and youth. The government has launched a number of free tools for Canadians, including the Wellness Together Canada online portal, which provides 24-7 access to mental health services for Canadians. We also provide funding through the mental health promotion and innovation fund to support community-based programs that promote mental health in children and youth. Improving mental health and addiction services for youth and young adults is also a priority of the common statement of principles, which sets the frame for the bilateral agreements that flow funding to provinces and territories to improve these services.

Public education and awareness efforts are fundamental to achieving the government's objective of protecting public health and safety, especially for youth. The government has invested in prevention campaigns that include engaging youth and young adults on the risks and harms of substance use, guidance on ways to reduce harms and ways to recognize and counter substance-use stigma.

We also recognize that, for many Canadians who require prescription drugs to treat rare diseases, the cost of these drugs can be exorbitant. Health Canada is working with stakeholders and health partners to develop a national strategy on drugs to treat rare diseases.

In addition, we recognize the important role that healthy eating and nutrition plays in preventing chronic diseases and contributing to long‑term health for children. Significant progress has been made on this issue, including improvements to nutrition labelling and the food supply, and releasing a new Canada Food Guide.

To conclude, I would like to thank the committee once again for the opportunity today to speak to these issues at the beginning of your study. Your work will help point the way to the supports needed to ensure that children and youth can thrive in Canada.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Voisin.

Next we will hear from the Public Health Agency of Canada.

Candice St-Aubin, you have the floor. Welcome to the committee.

[Candice St-Aubin, Vice-President, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Thank you, Mr. Chair.

Mr. Chair and honourable members, thank you for inviting me today for this important meeting and to have a conversation on what we're all very interested in seeing—the results of this study.

COVID-19 has had an impact on everyone in some way, regardless of age. This includes a significant and unique impact on children and youth. COVID-19 has also highlighted the resilience of communities across Canada. To support this resilience, our federal community-based programming in health promotion and chronic disease prevention demonstrated innovation on the ground in order to continue to offer a range of supports and services to promote positive health behaviours and build much-needed protective factors.

Key examples of this include our community action program for children and Canada's prenatal nutrition program. These two long-standing agency programs serve children and families throughout project sites located across the country. They are well established. They are trusted. They are family-centric hubs within their communities.

These programs were able to pivot and lead pandemic response efforts. The efforts included important things like addressing food insecurity through the provision of food hampers, providing advice on sanitary measures and vaccinations, and addressing social isolation through quick adaptation of programs, including parenting supports, to new virtual formats.

We know that the pandemic has had a significant impact on the mental health of children and youth. Across Canada, or at least most of Canada, approximately one in five youth aged 12 to 17 years self-reported that their mental health was somewhat or much worse in the fall of 2021 as compared with before the pandemic. The Public Health Agency is taking action to address mental health concerns in children and youth by providing $14.8 million over 36 months to Kids Help Phone. This funding is helping to directly provide surge supports for mental health crisis services for children.

Further, through the 2022 fall economic statement, the Government of Canada announced a $50-million investment to boost the capacity of distress centres across Canada. These mental health services and supports reach children and youth where they are at, including those who may be at greater risk—racialized children, children living with disabilities, indigenous children and 2SLGBTQ2I+ children and youth.

It is not just the mental health of our children and youth that has been impacted. The recent Statistics Canada survey of COVID-19 and mental health indicates that some of the risk factors for adverse child experiences, child maltreatment and family violence have also increased during the pandemic. These risk factors include depression, stress, and alcohol consumption within the household.

Throughout the pandemic, families may have encountered issues accessing much‑needed services that support both the health and well‑being of their children and youth. For example, people on the autism spectrum and their families and caregivers have had limited access to in‑person supports. There have also been disruptions in education and personal routines, which have made it challenging to maintain social relationships with family, extended family and friends.

To mitigate the effects of the COVID‑19 pandemic, the Public Health Agency of Canada is leveraging the autism spectrum disorder strategic fund to support the development of projects to address existing and emerging priority needs. The goal of the fund is to provide tangible opportunities for Canadians on the autism spectrum, as well as their families and caregivers, to gain knowledge, resources and skills.

There remains much that we still need to know about the impacts of the pandemic on all Canadians, including children and youth.

With Statistics Canada, the Canadian Institutes of Health Research and the Offord Centre for Child Studies, the Public Health Agency of Canada is cofunding a new cycle of the Canadian health survey on children and youth to assess these impacts and to compare pre- and postpandemic on a range of outcomes, such as healthy living, mental health and healthy child development.

In addition, the agency is supporting other research and data collection, such as CANCOVID-Preg, a study led by the University of British Columbia and cofunded by the Canadian Institutes of Health Research. This national project is assessing the impact of COVID-19 on pregnancy and infant outcomes.

Lastly, the agency is also working with the Canadian Paediatric Society through the Canadian paediatric surveillance program to field a two-year surveillance study on post-COVID-19 conditions, also known as “long COVID”, in children and youth in Canada.

I've touched on only some of the ways the pandemic has impacted children, youth and families, and provided just a few examples of how the agency is working to help protect and promote health among this cohort. There are a number of other ways that children and youth are impacted, and many other resources that the agency offers.

As we continue to navigate our way through this pandemic, we will continue to invest resources and support the health of our children and youth across the country.

Thank you, once again, Mr. Chair and members of the committee.

[The Chair, Liberal, Sean Casey]

Next, from the Canadian Institutes of Health Research, we have Tammy Clifford. You have the floor.

[Dr. Tammy Clifford, Vice-President Research, Learning Health Systems, Canadian Institutes of Health Research]

Thank you very much, Mr. Chair, and thanks to the committee for convening this important study.

On behalf of the Canadian Institutes of Health Research, it’s a privilege to be here today. As Canada’s investment agency for health research, CIHR understands the power of research to improve the health and well-being of Canadians. Our enabling legislation, the CIHR Act, is explicit that this includes all Canadians, beginning with our children.

It is, therefore, a core responsibility of CIHR to support and build capacity for research in children’s health. This commitment is reflected in our investments in child health research, which have increased steadily over the last decade, totalling around $195 million last year alone. It is also foundational to the work and scientific leadership of CIHR's dedicated Institute of Human Development, Child and Youth Health.

Of course, as mentioned by my colleagues, much of our focus in the past two years—as an agency, as a research community and, for many of us, as parents—has been defined by the onset of an unprecedented health crisis. The health and social impacts of the pandemic on our children have been substantial and complex, driven by the illness itself as well as by the ramifications of the pandemic, including school closures, social isolation and decreased economic stability, among many other factors. As mentioned previously, the pandemic also limited access to health services, both urgent and routine.

It's for these reasons, since the onset of the pandemic, that CIHR has mobilized emergency research to understand and mitigate these impacts on our children and to support the recovery and resilience of children and their families. As a result, we are funding a broad portfolio of COVID-19 research to address key questions, gaps and emerging areas of concern in children’s health, including the impact of the pandemic response itself.

One of our foremost concerns, of course, has been the impact on children’s mental health. That is why CIHR has supported proactive research in child and youth mental health in the pandemic context, and, importantly, the mobilization of this new evidence for the health partners and decision-makers who can use it.

While creating new challenges, the pandemic has also magnified the disparities that persist in children’s health in Canada, including among indigenous children and youth. CIHR has, therefore, dedicated funding for indigenous children’s health research in the pandemic context, which takes a strengths-based and community-led approach to address the priorities of indigenous communities.

I should note, Mr. Chair, that CIHR's pandemic response is ongoing. In December, we announced $10 million for 70 projects focusing on the impacts of the pandemic on children, youth and families. We expect to see the outcomes of this research over the course of the year. In March, we launched the Canadian pediatric COVID-19 research platform, a collaboration and coordination hub for 16 pediatric hospital-based research sites across the country. CIHR is also hard at work, preparing to advance new budget commitments on the long-term impacts of COVID-19, including on children.

In discussing the pandemic’s impacts on children’s health, it's also important to recognize that some children requiring special medical care have been disproportionately affected by pandemic precautions and medical backlogs. For these families, new waves and COVID-19 variants are accompanied by difficult questions about delays in treatment, increased risk of infection, and the repercussions for their already vulnerable children.

Indeed, this only illustrates the many urgent areas of children’s health research and why it was imperative for CIHR not to sideline these priorities during the pandemic. That is why, parallel to the COVID-19 response, CIHR has continued to advance research across the entire spectrum of children’s health. I am pleased to report, for instance, that CIHR is moving swiftly to implement a new pediatric cancer consortium, stemming from budget 2021 investments.

In collaboration with the Graham Boeckh Foundation and other partners, CIHR is working to establish a pan-Canadian network of provincial and territorial learning systems for integrated youth services. This approach is transforming youth mental health and substance-use services by ensuring that youth have equitable access to a range of community-tailored and evidence-informed services, including primary care and peer support.

Earlier this year, CIHR funded a new training platform to prepare the next generation of perinatal, child and youth health researchers for careers both within and beyond academia.

Mr. Chair, these are only examples of the many research priorities in children's health that CIHR is championing. As we move forward, CIHR remains closely engaged with this community.

CIHR's Institute of Human Development, Child and Youth Health recently launched a new strategic planning process to identify core priorities for child health research for the next five years. We know that this is of prime importance to Canadians, and we will continue to work closely with our partners to promote and protect children's health through research and beyond.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Clifford.

We're now going to begin with rounds of questions, starting with the Conservatives.

We have Dr. Ellis, please, for six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair, and thank you to the witnesses appearing here today. We certainly believe this is a very important study going forward for the health of Canadian children.

Ms. Voisin from the Department of Health, I have a couple of things to clarify. You talked about a $200-billion, one-time health transfer. I'm sure you meant $2 billion, but I just want to be clear on that.

Another thing you talked about very clearly included the 700,000 medical procedures in children that were lacking. Certainly, having just finished our study on human health resources in medicine and nursing, etc., we know there's a huge shortage of practitioners.

How are we ever going to make up these medical procedures that are missing with the number of practitioners who are able to graduate now? Is there a plan with the Department of Health to address that?

[Jocelyne Voisin]

Thank you for the correction there. Indeed, it is a $2-billion top-up for the CHT.

On the question related to surgical backlogs, that 700,000 surgical backlog number is all surgical backlogs in Canada, including those for children. We do not have a specific number related to children's surgical backlogs. CIHI doesn't report that number specifically, although different associations have published numbers they have from their own members or children's hospitals.

Yes, the health human resource issues and challenges are a big contributing factor to those surgical backlogs. We know that provinces and territories are working on different innovative measures to address backlogs, including looking at different spaces to address surgeries.

In terms of health human resources, we're working very closely with the provinces and territories through our existing committees on measures to address HHR issues and challenges, including innovative ways to increase and accelerate the credential recognition of internationally trained health providers. Some provinces have very innovative models in place that other provinces are looking at implementing. We are working very closely with them on getting those best practices out there and in the space so we can integrate those internationally trained professionals.

We're also working on other ways to support the health workforce, such as leveraging technology, for instance, and providing mental health supports for health workers, given that retention is a key measure to make sure that we continue to have the health workforce we need.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that.

Just as a bit of a follow-up, we've often heard the Prime Minister talk about 7,500 doctors, nurses and nurse practitioners. I'm not sure where they're going to come from.

Is there a plan around that from the Department of Health, or is that just kind of fantastical thinking?

[Jocelyne Voisin]

Again, we're working very closely with stakeholders, provinces and territories to really understand the issues and challenges, as well as innovative measures that can be taken. A lot of very good policy work and consultation is under way to really understand the problem and develop solutions collaboratively with our partners.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Just to reiterate, there is no specific plan to hire 7,500 or reason for it being 7,500, or anything like that.

[Jocelyne Voisin]

Budget 2022, as I mentioned in my opening remarks, announced funding to accelerate the integration of internationally educated professionals, so there's the foreign credential recognition program as well as enhancement to the student loan forgiveness for health professionals in rural and remote communities.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

That's lovely, but student loans are not more bodies. That's providing for the bodies that are there.

Thank you very much for that.

To Ms. St-Aubin, you mentioned a couple of programs there.

I've been a family doctor for 26 years. You mentioned the community action program for children and a prenatal plan. Quite honestly, I've never heard anybody talk about them before; I've never heard them mentioned before.

Is there a concern I should have about a two-way street with the Public Health Agency of Canada, that you're really not getting the message back to your department that these are not as effective as perhaps you would like them to be?

[Candice St-Aubin]

I will say that when it comes to the community action program for children, this is a 20-plus year program, as is the Canadian prenatal nutrition program. It's $80.6 million annually. Our CAPC, which is our community action program, is $54.1 million, and it promotes child health, safety and wellness. The prenatal nutrition program is $26.5 million. As I said, they have been around for 20-plus years, with ongoing evaluation every five years, providing outcomes and impacts for those communities and families most at risk.

I am happy to provide in writing some of those evaluation outcomes on which the communities and service providers have worked hard with our agency.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I'll reiterate that I find it shocking that I've never heard of them.

I have one quick question, as I know I have only about 30 seconds.

You talked about the difficulty with children not having in-person visits, and how it affects their sociability. How do you think that should affect public policy going forward with respect to lockdowns, school closures, etc.?

[Candice St-Aubin]

The Public Health Agency of Canada ensures that we follow and adhere and that we advise Canadians to follow and adhere to any of the guidelines that are being provided to all Canadians, as well as, of course, working with each province and territory to roll out and implement based on our public health guidelines.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. St-Aubin, and thank you, Dr. Ellis.

Next is Mr. Jowhari, please, for six minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to all the witnesses for your presence here and your testimony.

I'm going to start with Madame Voisin, the assistant deputy minister.

Madame Voisin, I'd like to get an understanding from your point of view and the department's point of view. What would you consider the key determinants of health as they relate to children?

The follow-up to that would be, what were the challenges before COVID, and how have those challenges changed during COVID?

[Jocelyne Voisin]

I am going to say a few words, but I will call on my colleagues from the Public Health Agency, on Candice, for example, to talk about the social determinants of health.

If we think about the health of children before and after the pandemic, mental health has certainly been a huge issue, but we know that the pandemic has also revealed inequities across the health system in access to services, and inequities that were revealed in terms of how healthy children are within their community, not just in access to services but also in how they live within their communities.

I'll turn to Candice to talk a bit about that.

[Candice St-Aubin]

The social determinants—and I think we refer to them often as communities or children at risk—have come very much to the front. A spotlight was placed upon it.

The Public Health Agency has worked with communities to try to address some of the issues around misinformation and disinformation for those communities that may be more at risk or more vulnerable, through programs such as the vaccine community innovation challenge, where communities themselves try to promote and create communication efforts in a language that represents or reflects the communities themselves, to try to increase uptake on some of those guidelines that the Public Health Agency has provided.

In addition, the Public Health Agency of Canada has currently put forward approximately $100 million over the next two or three years—and I'll have to come back with details in writing—to address mental health programming for those communities specifically.

Those are the projects tailored to racialized communities, indigenous communities, children with disabilities and those living with disabilities, etc., to try to have targeted investments within those communities that are more at risk.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

As I was listening to the testimony, I was trying to compartmentalize the different health-related factors when it comes to children. I figured out physical health, mental health, education, access, and socio-economic factors. Is there anything I'm missing if I want to compartmentalize so I can go down that road of accessing or further probing into areas?

[Candice St-Aubin]

Also, to clarify, education is also a component, a determinant of health, and therefore we work closely with provinces and territories to ensure they have the resources as well. We support them with whatever information we have through our guidelines. It's better for them to then roll out as they see is required within their jurisdictions.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Does anybody else want to make a comment?

No. Okay.

A couple of weeks ago I had the opportunity to visit one of the community organizations in my riding of Richmond Hill, the Children's Development Group. This is a small community-based organization that is focusing on children with autism. They shared their story of the challenges they had during COVID around access to care for those children and also the impact it had, not only on the staff but also on the children and family members, including the siblings, because the parents and the caregiver had to provide the same level of care to those children with the autism challenge while balancing their work at home, other children and their homework. An organization like that was acting as a relief valve for the families. Now, during that period, that relief valve was gone.

Is there anything planned as part of the government's agenda to address support for those with autism?

[Candice St-Aubin]

We certainly know that the COVID-19 pandemic has had a great impact on people with autism spectrum disorder, as well as on their families and caregivers, by limiting access to in-person supports, disrupting education and personal routines, and making it challenging to maintain social relationships with family and friends.

In order to address what we see as potentially a wider gap or wider data gap with respect to the health impacts of COVID-19, PHAC is investing $2 million specifically over three years to collect additional second-cycle data for the CHCSY, for data specific to that group—those living with autism.

As well, the Public Health Agency provided $75,000 to the Autism and Intellectual Disability Knowledge Exchange Network, or AIDE Canada, as it's called, to develop a COVID-19 resource hub to share up-to-date, trusted information related to COVID-19. It's specifically tailored to Canadians with autism spectrum disorder, as well as their families and caregivers.

In budget 2021, we provided $15.4 million, of which $7 million is new funding over two years, to start this year. We're working collaboratively with provinces and territories, families and stakeholders on the creation of a national autism strategy. We are looking forward to coming back and speaking more on this—