Health Committee on Sept. 22nd, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 30 of the House of Commons Standing Committee on Health. Today we're going to meet for two hours with witnesses on our study of children's health.

Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022.

I'd like to make a few comments for the benefit of witnesses and members.

Please wait until I recognize you before speaking. For those participating by video conference, click on the microphone icon to activate your mike, and please mute yourself when you're not speaking. For interpretation for those on Zoom, you have the choice, at the bottom of your screen, of floor, English or French. For those of you in the room, you can use the earpiece and select the desired channel.

Screenshots or taking photos of your screen is not permitted. The proceedings will be made available via the House of Commons website.

In accordance with our routine motion, I am informing the committee that all witnesses have completed their required connection tests in advance of the meeting.

We are welcoming a new committee member, Mr. Perron, whom I welcome.

I see Ms. Vien is filling in. Welcome. It's nice to have you here.

I would like to welcome the witnesses who are with us this afternoon. It's an absolute pleasure, after so long, to see witnesses physically present, so a warm welcome to you.

Appearing as an individual is Dr. Michael Ungar, Canada research chair in child, family and community resilience, resilience research centre, Dalhousie University—my alma mater. We have the Canadian Cancer Society, represented by Kelly Masotti, vice-president of advocacy, and Helena Sonea, director of advocacy. From the Canadian Dental Association, we have Dr. Lynn Tomkins, president, and Dr. Aaron Burry, chief executive officer. From Pharmascience, we have Sarah Douglas, senior manager of government affairs. From Speech-Language & Audiology Canada, we have Dawn Wilson, chief executive officer, and Anne Carey, director of speech-language pathology and communication health assistants.

Thank you all for taking the time to appear today. As I believe you were informed, each organization has up to five minutes for an opening statement. I'm going to invite Dr. Ungar to begin.

Dr. Ungar, welcome to the committee. You now have the floor.

[Dr. Michael Ungar, Canada Research Chair in Child, Family and Community Resilience, Resilience Research Centre, Dalhousie University, As an Individual]

I'd like to say a huge thank you, Mr. Chair, for this opportunity.

I would like to bring you a little bit into my world, which is the study of the resilience of children. I know that we're going to be experiencing a huge amount of delayed pathology because of COVID. I also want to bring you the message that there are potentially a lot of resources in our communities.

When I think about the work that I do, I'm also thinking about a young fellow, 11 years old, who is in elementary school and is exposed to a great deal of stigma. He lives in poverty in social housing, and his parents have incredibly few resources to cope with him. However, this fellow, who has bad teeth and is teased in his community, found inside his school community a custodian, a janitor of the school, who took him under his wing and who provides an element of protection and a sense of belonging.

We don't normally think of custodians at our children's schools as part of a mental health strategy. My research on resilience globally is showing that we need to begin to think about resilience and the health of our children in a more multi-systemic way. We need to get beyond simplistic solutions like offering a child a self-esteem workshop or a mindfulness-based stress-reduction workshop or simply a better educational experience. From the research that is emerging, we understand that when children's lives are thought about in their complexity—and this is what I so appreciate about a panel like today's, where you're seeing many aspects of a child's life represented—we tend to get better social policies. That means how the courts sentence children or indeed how schools respond to children.

My work is about looking at this cascade of positive effects. If we can jump-start one system, whether it's an educational system or better support for families.... The real trick with policy that seems to have an impact on long-term resilience for children is understanding that it is almost like dominoes hitting one another to create the kinds of changes that we're looking for.

In my research and my work, I'm now involved in looking at the impact of boom-and-bust economies on children and families in those communities that, as we green our economy, we're going to be displacing. Literally hundreds of families and communities are dependent on the oil and gas industries in places like Alberta, here on the east coast in Saint John, and indeed Newfoundland.

When we begin to think about resilience, and when we think about children's well-being and mental health, which is my concern, I'm thinking about the impact of even macroeconomic factors as they change family patterns, recreational services and opportunities for children to do the kinds of things they need to do.

A concept I might introduce to policy-makers is the idea of differential impact. What you offer as a policy might have a different impact on the child, depending on three things. First, what are the actual risks they experience? Second, what are the protective factors that are most likely to impact that risk and be helpful? And of course, what is the outcome you are trying to achieve?

All of that leads me to think about St. Mary's, a school outside Saskatoon. When they renovated the school—even though they serve a large population of indigenous children, refugee children and children who are visible minorities—they were having trouble getting those children to the local children's hospital for the appointments they needed. What the school board did, when they renovated St. Mary's, a K-to-9 school, was to build a purpose-built pediatric clinic in the school, so then it was easier for families to get access to those services close to their homes.

That is the kind of multi-systemic thinking, reaching beyond single, simplistic solutions to very complex problems, where systems are working together, that is likely create a cascade of positive impacts that will make our children more resilient, especially as we come out of this period of COVID, when there have been so many delays in their psychological and social development.

I'll leave it at that.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Ungar.

Next we're going to hear from Dr. Tomkins of the Canadian Dental Association.

You have the floor for the next five minutes. Welcome.

[Dr. Lynn Tomkins, President, Canadian Dental Association]

Thank you, Mr. Chair.

Good morning, committee members.

Before I begin my remarks, I would like to take a moment to recognize that I am joining you here today on the unceded territory of the Algonquin Anishinabe people.

I'd also like to thank you for taking the time to study this important topic of children's health, and I sincerely appreciate your inviting the Canadian Dental Association to participate in this morning's meeting.

At the Canadian Dental Association, we know that oral health is an essential component of overall health, and we believe that Canadians have a right to good oral health. That is why we fully support efforts by all levels of government to improve Canadians' oral health and enhance their access to dental care.

Poor oral health strains other parts of the health care system, whether through hospital visits for emergencies or through managing the long-term impacts of poor oral health on systemic disease. This is particularly the case with children, as good oral health in childhood serves as a foundation for the rest of a person's life.

Unfortunately, in spite of significant progress over past decades, tooth decay remains the most common yet preventible chronic childhood disease in Canada. It is the most common reason for Canadian children to undergo day surgery, and it is the leading cause of children missing school. Beyond the risk of pain and infection, tooth decay, particularly in young children, can impact eating, sleep, proper growth, speech, tooth loss and malocclusion, and it increases the need for dental treatment later in life.

On a personal level, having been in practice for over 35 years, I can tell you that it is heart-wrenching to see a young child with severe dental decay. This often requires treatment under general anaesthesia in a surgical facility, which can also involve lengthy wait times. In addition to the impact on a child's health, the experience can lead to long-term dental fear and anxiety. Therefore, it is important to ensure that Canadian parents can access dental care for their children within months of the eruption of the first tooth.

Early exposure to good oral hygiene habits and preventive care can make a lifetime of difference for a person's mouth, and while Canada compares favourably to many other countries, too many people, including children, still do not receive the dental care they need. More than six million Canadians each year avoid visiting the dentist, primarily because of cost. This is especially true for low-income families.

While every province and territory in this country has publicly funded dental programs for children, these vary from jurisdiction to jurisdiction, leaving significant gaps. This is why the CDA welcomed the federal government's commitment earlier this year to a multi-billion dollar ongoing investment in enhancing access to dental care for Canadians. It comes after years of encouraging federal investments in dental care by the CDA, and all those who have advocated on this issue, whether on behalf of CDA, provincial and territorial dental associations or on behalf of other health organizations, should be proud that their hard work has led to this once-in-a-generation opportunity.

In particular, CDA appreciates the phased approach being taken by the federal government, illustrated by last week's announcement of a proposed Canada dental benefit and this week's introduction of legislation to implement that proposal. This will allow time to consult and collaborate with all relevant stakeholders on a long-term solution that is well informed, targeted, comprehensive and effective. We appreciate that this interim measure balances supporting the oral health needs of Canadians with several key priorities for Canada's dentists.

We've also appreciated the close collaboration demonstrated so far by Minister Duclos and his team at Health Canada, and we look forward to working with him in the months ahead. We would also like to thank Mr. Don Davies for his advocacy on oral health over the past number of years, which has culminated in this historic federal investment in enhancing dental care for Canadians.

Finally, beyond reducing financial barriers to accessing dental care, there are several other items that CDA has focused on in its written brief to the committee. These include recommendations that the federal government implement the remaining measures of Canada's healthy eating strategy, with a focus on food and beverage marketing to children under age 13; review its programs providing funding for drinking water systems and look for ways to support enhanced access to community water fluoridation; and examine the administration of the NIHB program for first nations and Inuit to ensure timely access to surgical facilities for children requiring dental treatment under general anaesthesia.

As well, we believe it is essential for the federal government to include oral health as a component in any studies on the long-term impact of the COVID-19 pandemic on children.

Thank you once again for the opportunity to participate in today's meeting. I would be happy, along with the CDA CEO, Dr. Aaron Burry, to answer any questions that you might have.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Tomkins.

Next, from Pharmascience, we have Sarah Douglas.

Ms. Douglas, you have the floor.

[Sarah Douglas, Senior Manager, Government Affairs, Pharmascience]

Thank you.

Good morning, Mr. Chair and members of the committee.

Thank you for inviting Pharmascience to appear before the House of Commons Standing Committee on Health. I'm here today to share our perspective as a manufacturer of medicines on the crucial issue of access to pediatric drug formulations and the challenges we face in bringing these child-friendly formulations to market in Canada.

For some context about who we are, Pharmascience is the second-largest Canadian-owned pharmaceutical company, founded nearly 40 years ago by pharmacists Morris Goodman and Ted Wise. We're a proudly Canadian company, with our global headquarters, manufacturing facilities and R and D labs all located across the greater Montreal area, where we employ almost 1,500 people. Importantly, we invest about $40 million to $50 million annually in R and D in Canada, consistently appearing among the top 100 companies investing in R and D.

In 2019, Pharmascience representatives appeared before the House of Commons Standing Committee on Industry, Science and Technology to express their concerns regarding the issue being studied.

Compared to other similar countries, Canada lags behind in the availability of drug formulations specifically for the pediatric population. This is not a matter of demand; pediatricians, nurses, pharmacists, and parents of sick children have always asked for specific pediatric formulations.

Pediatric formulations are drugs that have a dosing regimen tailored to children and have certain characteristics that differ from those of adult products, such as specific formulation ingredients, formulation form—liquid or solid—concentration of active ingredients, indications for product approval, or packaging.

Pediatric formulations are not necessarily simple to develop, but they are essential to have. There are numerous new approaches that allow us to tackle the challenges, but market conditions have made it difficult for manufacturers to launch these formulations in a commercially viable manner.

That being said, I do want to recognize that there has been progress since 2019, including Health Canada's pediatric drug action plan in development and a recent decision from the pan-Canadian Pharmaceutical Alliance that will allow Pharmascience to market levetiracetam, one of the most needed pediatric formulations for epileptic children. This decision marks a possible breakthrough in the reimbursement of pediatric drugs, but it's still early and there's much more work to do.

As a manufacturer, I'd like to highlight our main general concerns that make it difficult to manufacture pediatric formulations in Canada. First, the pediatric market is completely different from the adult one; it is much smaller. The market size difference alone challenges the viability to market these formulations. On top of this, pediatric drugs have been treated the same way as their adult equivalents in pricing. Given the extra effort it takes to market pediatric formulations, this makes prices so low that no one can successfully market the drug. A different pricing grid for public reimbursement of pediatric drugs is needed. Third, nearly all of the drugs identified by pediatricians needing a pediatric formulation are off-patent. This makes the R and D investments by manufacturers extremely risky for pediatric formulations as we may not be able to recoup the investment.

Thankfully, Health Canada has heard the call and is developing a pediatric drug action plan with the goal of improving the availability of pediatric formulations in Canada. We are working closely with Health Canada to develop this plan.

As part of the pediatric drug action plan, measures that would help us get more pediatric formulations to market include the waiving of submission fees, as well as a period of market exclusivity for non-patented or generic pediatric formulations. These are measures that exist in the European Union and the United States. Those regions have recognized the need to encourage the creation and availability of these drugs.

It will be absolutely crucial for Health Canada to implement regulatory changes to support the development of new pediatric formulations. This isn't just a call from us. Many other stakeholders in the pediatric space put out a call for change earlier this year. It will also be critical to change the public reimbursement environment and to recognize that pediatric drug prices need a different pricing standard from adult dosage forms. We need to keep up the momentum to get this done, and the steps that are made today will create a better future for children.

Pharmascience is one of the few Canadian manufacturers that have taken the risk to invest in pediatric drug formulations to meet this important unmet need in spite of the unfavourable market conditions. At stake is the health and safety of children. If the policy changes that we are endeavouring are implemented, simple, affordable and significant innovation can be brought to the practice of pediatrics.

Once again, thank you for the invitation to appear, and I'd be pleased to answer any questions that you may have.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Douglas.

Next, from Speech-Language and Audiology Canada, I believe Dawn Wilson will be speaking for the group.

You have the floor for the next five minutes. Welcome to the committee.

[Dawn Wilson, Chief Executive Officer, Speech-Language and Audiology Canada]

Thank you, Mr. Chair and members of the health committee.

I would like to thank you on behalf of Speech-Language and Audiology Canada and our 7,500 members. I appreciate the opportunity to speak to you today about timely diagnosis and access to speech-language pathology and audiology services for children.

We know that effective communication is foundational to a child’s social, emotional and educational development. Research has shown that the first three years are a critical period for normal speech, language and hearing development. Early identification of difficulties is therefore key to ensuring timely access to appropriate interventions for long-term success. Learning is cumulative. Difficulties not addressed early are compounded in later years. Thus, addressing communication health needs early has a decisive influence on later academic accomplishments, health, well-being and quality of life. Our members are vital in terms of being part of a primary health care team to support this process.

Across Canada, our services are offered through a combination of public, private and school-based providers. However, insufficient positions and inconsistencies in service delivery result in inadequate access to care. The situation is worse in many rural and remote areas. Parents report lengthy wait-lists in both public and private settings during this critical developmental window, which can be exacerbated for specialized groups such as children with autism. The demand for our services exceeds the capacity of available professionals.

Detection of hearing health issues is critical in the very early stages of life. Access across Canada is inconsistent. Almost half of the provinces and territories received a failing grade on a 2019 early hearing detection and intervention report card. Related, most provinces and territories do not offer universal newborn screening for congenital cytomegalovirus, despite its being the most common infection transmitted from mother to baby during pregnancy. The prevalence rate of CMV is approximately one in 200 newborns and is the leading non-genetic cause of neurologic disabilities and permanent hearing loss worldwide.

In the preschool population, acute otitis media—or middle ear—infections are extremely common, affecting approximately 75% of children at least once before starting school. Chronic suppurative otitis media in early childhood can lead to increased risk of auditory processing disorders later in life.

When speaking to their child’s health care providers, parents often report speech and language delays as a primary concern. Prevalence data suggest these difficulties are common. Speech sound disorders in preschool children range from 2% to 19%. Developmental language disorder is one of the most common childhood disorders, affecting 7% of children. Speech sound disorders range from 2.3% to 24%.

Communication difficulties follow a child later into their school years. A recent report indicated that there are insufficient speech-language pathologists working in Canadian schools to meet the needs of students who require their services. These staffing shortages are long-standing. However, closure of day cares and schools during COVID-19 further exacerbated the issue with increased levels of burnout and heavier caseloads. Prior to the pandemic, many indigenous children were already missing literacy benchmarks for their age groups.

Long-standing communication difficulties and their far-reaching effects cannot be easily remediated, though an early investment can have a multiplier effect. A dollar invested in addressing problems today will mean many more saved in the long term. In other words, inaction now carries very high long-term costs. Delayed intervention costs 10 times more than if intervention were accessed early. Children who do not achieve optimal early language learning are not prepared or equipped for compulsory formal education by age five.

We recommend that the federal government work with provinces and territories through recent day care deals to train early childhood educators on speech and hearing delays; that we integrate speech language pathology and audiology services into licensed day care settings, in collaboration with provinces and territories; and that the federal government establish a primary health care transition fund to assist provinces and territories in their work to expand access to speech-language pathologists and audiologists through primary health care teams. Of course, we desperately need initiatives to recruit and retain speech-language pathologists and audiologists in any federal efforts to improve health human resources.

Again, thank you for the opportunity to be here today. We are happy to answer questions.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Wilson.

Next, we're going to hear from the Canadian Cancer Society.

Ms. Masotti, I know you had some trouble getting online, but I see you there now. I know you're no stranger to parliamentary committees. You know the drill. You have the floor for the next five minutes. Thanks for your patience, and welcome.

[Kelly Masotti, Vice-President, Advocacy, Canadian Cancer Society]

Thank you, Chair. Thank you for your patience. I also really appreciate the support from House of Commons IT staff.

Good morning. Thank you, Chair and committee members, for having me here today. My name is Kelly Masotti. I'm vice-president of advocacy. Here with me today is Helena Sonea, director of advocacy.

Before I begin my remarks, first I'd like to acknowledge that we are both speaking to you today from the traditional unceded territory of the Anishinabe Algonquin people.

I'm pleased, on behalf of the Canadian Cancer Society, to participate in today's committee discussion regarding children's health. Cancer is the leading cause of disease-related death in children under the age of 15 years. This is why the Canadian Cancer Society has invested $16.4 million in childhood cancer research projects across the country in the past five years alone.

In trusted partnership with donors and volunteers, we work relentlessly to improve the lives of those affected by cancer, through world-class research, transformative advocacy and compassionate support. We also work to provide real-time support to people with cancer and caregivers. Last year alone, we provided trusted information to over 125,000 users of cancer.ca looking for information specific to childhood cancer.

It's auspicious that we're gathered here today to discuss this topic, given that September is both nationally and internationally recognized as childhood cancer awareness month. We know that an estimated 1,100 children under the age of 14 were expected to have faced a cancer diagnosis in 2021. However, it's suspected that diagnosis for many cancers has fallen since the onset of the COVID-19 pandemic in Canada.

We have had success diagnosing and treating cancer impacting children over the past number of decades thanks to world-class research and innovative treatments. The five-year survival rate for childhood cancer is about 84%. This means that about 84% of children with cancer survive at least five years past their diagnosis.

Although childhood cancers account for less than 1% of all cancer cases diagnosed in Canada, they have a significant and lasting impact on both the individuals and their caregivers. An estimated two-thirds of childhood cancer survivors have at least one chronic or late side effect from their cancer therapy, including a high risk of physical and mental health problems or secondary cancers.

I'll now turn my remarks over to Helena.

[Helena Sonea, Director, Advocacy, Canadian Cancer Society]

Good morning.

I will use our remaining time to highlight several areas that require further investigation and resolution to support children's health. It's important to note that the causes of most childhood cancers are largely unknown, and modifiable risk factors usually have little to no effect on most of them, but it is important to recognize that teaching healthy lifestyle choices and preventing certain environmental exposures in childhood may reduce cancer risk much later in life.

We would be pleased to discuss each of these recommendations further during our question and answer period or provide further information in writing should committee members wish.

First, the overwhelming majority of people who smoke begin as underage youth. Far more needs to be done to reduce youth tobacco use to help achieve the goal of under 5% prevalence of tobacco use by 2035. Canada is currently faced with a dramatic increase in youth vaping, leading to overall increase in youth nicotine addiction. Among high school students in Canada in grades 10 to 12, youth vaping increased from 9% in the 2014-15 school year to 16% in 2016-17, to 29% in 2018-19, tripling over a four-year period. It is essential that the government take further action to reduce youth vaping, in particular to finalize regulations restricting flavours on e-cigarettes.

Research shows that as much as 90% of food and beverages marketed to children for processed foods are high in sugar, salt and/or saturated fats. Food and beverage marketing has an impact on the foods that children eat, from their food preferences and beliefs and the food they beg their caregivers to buy, to rising rates of childhood obesity and increased risk factors for chronic disease such as diabetes, heart disease, stroke and cancer. There's a clear need for the government to fulfill its commitment to restrict the commercial marketing of all food and beverages to children and youth.

Everyone in Canada needs better palliative care options, regardless of age, gender, income, race or sexuality. Significant work is required to give families who need palliative care, particularly for a child, the support they deserve, including improving education and training for health care workers, addressing equity, supporting children struggling with grief, establishing standards, and improving the quality of care through better research and data collection. There's considerable space for the federal government to lead here, in addition to the necessary improvements to care delivery by the provinces and territories.

Canadians, and especially our children, should also have equitable access to life-saving drugs that play an essential role in treatment and can greatly improve health outcomes and quality of life for people living with cancer. As the government provides further detail on its pharmacare commitment, we would encourage the government to improve access to drugs, accommodate and accelerate approval and funding for innovative cancer treatments and clinical trials, and remove unnecessary administrative barriers to ensure children with cancer have equitable access to the cancer drugs they require without financial hardship on their caregivers, regardless of where they live and where the drugs are taken.

Finally, we know that federal, provincial and territorial governments are due to discuss the state of health funding transfers. From our perspective, ensuring that governments are properly funded to address the critical issues facing Canadians is paramount. While governments may debate the funding amount needed and the funding conditions, what we want to see is taxpayer dollars focused on improving health outcomes, measuring those outcomes, and supporting vital inputs like health research that give children a better chance to live and have a healthier and higher-quality life. Because of investments in world-leading research and clinical trials, we now have a better understanding of childhood disease and treatments that are helping children live longer. We will continue to invest our focus and our dollars to support this work, and we encourage the government to do so as well.

I want to thank the committee again for having us here today. We look forward to your questions.

Thank you.

[The Chair, Liberal, Sean Casey]

Thanks to you both.

We're now going to proceed directly to questions, beginning with Mr. Barrett for six minutes.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks very much, Chair.

Thanks to all the witnesses for joining us in person and virtually today. It's great that we're all gathered to talk about children's health.

My question is for our witnesses from the Canadian Cancer Society. It deals specifically with an issue that's been flagged for us as a result of the restrictions and measures that were put in place because of COVID-19 and that have caused delays in the care and screening appointments for cancers. What I'm looking to find out is whether the backlog of care and screening appointments for children is at the same rate, less than, or worse than it is for adults.

[Helena Sonea]

Thank you very much for the question. It's nice to see you.

We absolutely know that there is an overall delay for Canadians living anywhere in the country, whether it's access to diagnostics or the treatment and the surgery. Unfortunately, the information is not available at this time, but we can certainly have an additional poke-around for you following this committee appearance here today to ascertain whether or not the delay is more significant for the childhood population.

I think we certainly know that, generally speaking, there is a delay to all different types of cancer diagnoses throughout all age groups, so we will get back to you with the specific number. I would certainly say that my hunch is that it is applicable to this age group as well.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thanks very much, and I look forward to the information you're able to track down.

In practical terms, can you share with us what the effect is of those delayed diagnostics, care and screening for children who would have had a cancer diagnosis potentially earlier, but it ends up being missed or significantly delayed? What's the impact on them and their families and on the ability for them to be treated?

[Helena Sonea]

That's a fantastic question. Since the start of the pandemic, the Canadian Cancer Society has done our very best to conduct patient and caregiver surveys and share these results with government to really demonstrate the increased levels of anxiety and stress that we see with people living with cancer, especially those little ones.

For example, at the start of the pandemic—and I would say that the shift has happened over the past couple of years—caregivers were not able to attend appointments with their children, so that would absolutely cause increased levels of anxiety and stress for all different family members.

Something that I would also add is around grief and bereavement and not necessarily having the access to those types of supports in a comprehensive manner, just because the system was rather inundated with additional mental health requests at that time.

We also know that the psychosocial impacts and requests that come from the cancer community have always been a concern. For example, the Canadian Partnership Against Cancer released a report a couple of years ago, and one of the top recommendations that came from this report was the need for long-term psychosocial support for the cancer community. As Kelly mentioned as part of our witness testimony, the Canadian Cancer Society is proud to provide information and support services to people living with cancer, and their loved ones, in over 200 different types of languages.

Kelly, is there anything you want to add?

[Kelly Masotti]

Thanks, Helena, that was great.

Yes, I just have two points as it relates to later-stage diagnoses. If we miss that, then that can be harder to treat, as well as costing the system more.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thank you very much.

I have a series of additional questions, and I'm probably not going to get through them all.

Perhaps this is something you could provide to the committee later, additional information if you have it, but what would you say are the immediate steps that could be taken to rectify these backlogs, specifically as this deals with children? Would it be addressing the number of pediatric oncologists? Would it be other specialties, haematology? Is it equipment, better research? Where is the most acute pain point right now? How do you think we can address that?

[Helena Sonea]

That's a great question that I think requires a multipronged response.

We were thrilled to see in the most recent budget the commitment of $2 billion to help unclog the backlogs. I would say that this type of investment, and then the continued discussions that are ongoing between provinces and territories and the federal government, need to prioritize cancer. We know that approximately two in five Canadians will be diagnosed with cancer, and this absolutely applies across all different age groups.

You're actually going to enjoy this fact. I am nine months pregnant, so pregnancy brings us back to—

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Congratulations. That's incredible.

[Helena Sonea]

So I have an extra reason to provide you with strong testimony today.

We know that health care providers, both at the front line of service delivery and in supportive roles, play a key role in providing accessible, quality cancer care to Canadians. The Canadian Cancer Society supports recommendations from other health care provider stakeholders to implement a comprehensive and integrated pan-Canadian health human resources strategy, as well as continued investments in health research and, as I mentioned before in my testimony as well, increased access to palliative care, as well as those live-saving treatments.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sonea.

Thank you, Mr. Barrett.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

If I can, Mr. Chair, I'd like to say thanks very much to Ms. Sonea for joining us at nine months. I wish very good health to her, her child and her family.

[Helena Sonea]

That's very kind.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Barrett.

Next we have Ms. Sidhu, please, for six minutes.