Health Committee on Sept. 22nd, 2022

[Dr. Lynn Tomkins]

I think the system we have right now, which is the National Dental Examining Board system, is very equitable. It's very skills-based. It evaluates people on their actual ability to do dentistry.

We have one of the highest standards of dental care in the world, and our dental schools are among the top in the world, so I think we want to make sure that we maintain a balance of providing enough dentists—and currently there are enough dentists in the country, although we have a bit of a maldistribution issue—while we maintain the high standard and have an equitable process for bringing foreign-trained dentists into the country.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. Tomkins.

My next question is for Ms. Wilson.

Ms. Wilson, the former Secretary-General of the UN, Kofi Annan, famously stated, “Literacy is a bridge from misery to hope.” He talked a lot about its ability to fight poverty and to be “a building block for development”. I'll make a full disclosure: My partner is a researcher and a speech-language pathologist who is studying literacy.

I'll ask the same question of you: Do kids in lower-income families have the same outcomes as their middle-class and wealthier neighbours when it comes to literacy and the determinants of health related to reading and hearing?

[Dawn Wilson]

I would have to say no.

[Adam van Koeverden, Liberal, Milton, ON]

That's what I was looking to hear. It's important to recognize where the system leaves people out.

My third and final question is for you, Dr. Ungar. You mentioned a really troubling statistic, that the world is seeing a rise in preventable diseases like polio—something that was all but eliminated by vaccination, yet we have politicians questioning the usefulness and practicality of compulsory vaccination programs in Canada to fight diseases like mumps, rubella, polio and many others.

Do you find it troubling when politicians question these types of programs in Canada?

[Dr. Michael Ungar]

I find it extremely troubling when politicians step beyond their expertise and enter what is the domain of simple science. Where we could actually get really good decisions on scientific merit, I would also encourage those same politicians to take a trip to other countries and other parts of the globe where these diseases are still debilitating the lives of millions of children and then see if they'd be so flip about what we decide here.

I travel the globe on a routine basis, and that is a completely naive position. It's just mind-boggling that anybody would take these positions. We have seen the impact of that, of course, when it comes to COVID as well. There was vaccine hesitancy. In a sense, we had the drugs but we didn't have the sociology to help us understand what was about to happen, and the hesitancy resulted in deaths—and continues to result in deaths.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ungar and Mr. van Koeverden.

Mr. Perron, you have two and a half minutes.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

Thank you, Mr. Chair.

I'm going back to you, Mrs. Wilson.

In response to an earlier question, you said that due to the lack of funding, many professionals who belong to your organization have left the public system to go work in the private sector.

How would you explain that? Why isn't there enough funding?

In your opinion, are government budgets too low for front‑line services? I'll repeat what I said earlier, but do you feel that first and foremost it would be a good idea to increase federal health transfers?

[Dawn Wilson]

I think it is a good idea to increase federal transfers for health, but the concept of strings attached to those transfers needs to be embedded in whatever transfers are there. How provinces and territories spend their money is not always where we would want it to be. I do support the concept of the health transfer, but there need to be strings attached.

[Yves Perron, Bloc, Berthier—Maskinongé, QC]

We're talking about money intended specifically for health care. Thank you.

Dr. Ungar, in response to an earlier question, you just stated that you're always cautious about any imposition of new regulations. I'd like you to elaborate on that.

I'd also like you to tell me if you feel local government should receive more funding. This ties into our first series of questions earlier, when you said it was extremely important that decision‑making be decentralized.

Lastly, you'll have about 30 seconds to answer my final question: Are you concerned that the $650 benefit might not be spent entirely on health care? An individual who submits a split receipt would automatically receive $650, and there would be no follow-up.

I'd like to know what you have to say about this.

[Dr. Michael Ungar]

I actually don't have a lot of familiarity with the last piece of that. I think that's really a political decision. Hopefully, families are encouraged and the funds do go to what they do, but I will say that in terms of the actual money flowing, what I'm perceiving from my perspective is that this is not always a case of more funding. I know this is not politically astute to say—I'm not a politician.

What I will say is that often it's about the service delivery models being dislocated. So much of what my colleagues here have said today is about whether we could be better at co-locating services, as some initiatives nationally have done. I can certainly give you some details on those later.

The largest problem is that we have lots of money floating around, but it is incredibly wasted in many cases. It is not coordinated, and children and parents have to get to multiple domains to get services—rather than us thinking from the point of view of the families and putting those services together so that indeed this would be more cost-effective and we'd be catching more of these pathologies earlier.

It's a systems problem, in part, and not just basically throwing more and more money at these problems.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ungar.

Thank you, Mr. Perron.

Next we have Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Tomkins, I wanted to first of all express our thanks to the Canadian Dental Association and, frankly, to all of your members for their contributions to public health in this country. I know that dentists across this country have long been bothered by their inability to provide necessary dental care. As you've pointed out, oral health is primary health care. I'm really looking forward to allowing dentists to be able to treat more people for this essential health need.

Can you give us an idea, Dr. Tomkins, of approximately how many children across Canada currently lack sufficient coverage to access the full suite of recommended oral health services?

[Dr. Lynn Tomkins]

Well, one of the numbers is actually in the government's backgrounder for this program: an estimate that approximately half a million children could be eligible to access this program. I think that's probably a good starting point.

[Don Davies, NDP, Vancouver Kingsway, BC]

The CDA's written submission to this committee noted that remuneration rates for dentists vary significantly under existing provincial and territorial dental care programs for children. I'll say it bluntly: Dentists have been underpaid generally by the provinces' programs, to the point where often they're subsidizing the care that they have to give.

Can you outline the impact that this variation has on dentists' participation in these programs?

[Dr. Lynn Tomkins]

Thank you for that question.

There is considerable variation across the country. If you go to provinces like Newfoundland or P.E.I., which do have programs, they are funded well enough so that dentists are reimbursed for the cost of providing care and the ability to make a living while they're doing that. In other provinces, programs have been chronically underfunded. Ontario is probably the worst example of that. You are right that dentists who do participate in these programs are actually paying out of pocket to provide the care.

Every dentist will do what they can to provide care. Frequently these kids are part of larger families we treat in our practices, but it's not a sustainable situation. We hope to gain a remedy for that.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to say on the record right now that in any dental plan we create, in my view, dentists have to be paid 100% of the fee schedules in the provinces. They deserve to be treated as the professionals they are. This should not be a program for poor people. It should be a normative program so that people get access to the care they need.

I want to conclude—

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

—by asking about fluoridation. You noted that only 39% of Canadians have access to water fluoridation. Americans have double that.

[The Chair, Liberal, Sean Casey]

Mr. Davies, that's your time.

[Don Davies, NDP, Vancouver Kingsway, BC]

Oh, I'm sorry.

[The Chair, Liberal, Sean Casey]

Thank you.

You're more than welcome to follow up with a written brief. We're going to move on.

Mrs. Goodridge, please go ahead for five minutes.

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

Thank you, Mr. Chair—

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, on a point of order, with Mr. Perron the answer to the question went significantly past the two and a half minutes. I wonder if we could just have a 20-second answer from Dr. Tomkins.

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

Your question started after he told you to stop.

[Don Davies, NDP, Vancouver Kingsway, BC]

Oh, I'm sorry. I didn't hear.