Health Committee on Sept. 22nd, 2022

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Davies, go ahead, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to all of the witnesses for being here.

Ms. Wilson, I'd like to begin with you. You painted an extremely clear picture of the extensive needs of children and the critical importance of early intervention in terms of speech and communication development for kids, particularly under the age of three.

Can you give us a sense of the scope of the lack of access to effective therapy? Is this a small problem? Is this a medium problem, or is this a problem across the country in terms of kids getting the access to therapy that they need?

[Dawn Wilson]

I can definitely speak to that.

I think the scope of this is nationwide. This is something that is in all elements of our society. In schools, there's a lack of awareness. There's a lack of services in primary care. The scope is large. There is a lack of practitioners. There is a lack of training. There is a lack of data, in order to understand the scope of the problem for our professions. We know there isn't reliable health workforce data. As well, the capacity of our current practitioners is stretched. They have high caseloads, and that impacts their ability to deliver service, as does the nature of Canada and the fact that there are rural populations that are even harder to reach. I would say the scope is far-reaching.

My colleague Anne may have something to add.

[Don Davies, NDP, Vancouver Kingsway, BC]

You are a speech pathologist.

[Anne Carey, Director, Speech-Language Pathology and Communication Health Assistants, Speech-Language and Audiology Canada]

Yes, I am a speech-language pathologist.

One of the big challenges, especially when we're talking about that zero-to-three age, is that we currently don't have speech-language pathologists embedded in day cares. They're not there. A lot of times, the primary point of care—family physicians or early childhood educators—don't necessarily feel comfortable in recognizing and identifying speech, language or communication delays.

We can think about it like an invisible crisis. If it's physical, you might see it, but for speech-language delays, it's something that is harder and nuanced. It's not invisible to us as speech-language pathologists. We see it, but we're not in the places where we can get the child to access the services that they need.

[Don Davies, NDP, Vancouver Kingsway, BC]

Even if a child were attached to a speech-language pathologist and you could identify, say, a child at two who is not just quiet but is actually exhibiting a speech or communication delay, is our system responsive enough that the child would get the therapy they need, to actually make a difference?

[Dawn Wilson]

I would say that even if the child is identified, there is still a lack of access to care because there are not enough speech-language pathologists, and they're not working in the areas where they're needed the most. Even if we do progress in the early identification, we still don't have enough. We still need a better approach, and we still need a broader integration into primary health care teams as well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Are children from disadvantaged backgrounds at higher risk of developing speech and language disorders than their peers?

Second, we pride ourselves in this country on having universal access to care. Do kids from poor backgrounds get the same kind of access to treatment as kids from families, for instance, that are able to pay out of pocket for SLP services?

[Dawn Wilson]

I think there's a lack of public awareness and education around the identification of speech and language disorders. Maybe we could be working with the Public Health Agency of Canada to educate the public around the factors that place infants and toddlers at risk for speech and language disorders. I think what we need is to understand the conditions that ensure the optimum development of speech and language abilities, and we desperately need the appropriate referral pathways to our practitioners to support the care.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to turn to hearing, because it's Speech-Language and Audiology Canada. Are hearing services consistently covered under provincial and territorial public health care programs across Canada today?

[Dawn Wilson]

No, there's an inconsistent approach across provinces. I think five provinces are doing relatively well on their early hearing detection and intervention programs. There's also not a universal approach to hearing screening, and we need to do better.

[Don Davies, NDP, Vancouver Kingsway, BC]

We've just been through COVID. A lot of health care professionals have tried to shift care to virtual models, with some success.

To what degree have speech-language pathologists and audiologists been able to replace in-person visits with virtual care over the course of the COVID-19 pandemic? Do you see any prospect for improved access to care using technology in the future?

[Dawn Wilson]

Speech-language pathologists and audiologists have by and large transitioned to virtual care as a means of supporting access to speech-language pathology and audiology services. The federal government's funding of $240 million in 2020 certainly helped. However, we still need to expand and launch virtual care and mental health tools just to Canadians in general.

Access to additional funding for our practitioners will help them expand the technology that they need in order to properly deliver the care. That includes digital platforms. A lot of our members have moved away from the public system into private practice because of funding cuts, and those practitioners need additional technology to support the delivery of virtual care.

While we have adapted and support the use of virtual care, more can be done to support the practitioners who need to deliver it and who also have to align with the requirements of the Accessible Canada Act.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Wilson.

Thank you, Mr. Davies.

Next, we'll have Dr. Ellis, please, for five minutes.

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

Thank you, Chair.

Thank you, everyone, for coming.

I will underscore, if I might, the childhood crisis that we have at the current time, despite having a government that's added more to the federal debt than all the other governments combined. I think it germane to really underscore this issue. This is from September 2020:

Canadian childhoods are in crisis according to a new report released today by UNICEF Canada. UNICEF Report Card 16, which measures the state of children and youth under age 18 in wealthy countries, ranks Canada 30th out of 38 nations on the most recently available data from just before the pandemic.

My understanding is that previously we were 10th out of these 38 countries. Clearly, our children are being left, and they're falling behind. This is obviously a significant and weighty issue.

For my colleagues, I think it behooves all of us here to understand that perhaps these six meetings we're having with respect to child health are really going to be a door-opener for all of us to understand that creating a childhood health strategy for Canada, which I think we're all interested in, is going to take much longer than six meetings, but perhaps this will help us focus better on what we really need to be doing here.

Thank you to the witness for hearing that.

Dr. Ungar, I understand that your expertise is in resilience. That being said, obviously this is a huge topic as it perhaps relates to COVID and the ongoing pandemic and the uncertainty that exists. I guess my question for you, Dr. Ungar, is to understand better what you think about how this is affecting children with the ongoing threat of lockdown and the return of those mandates and sanctions, without any realization of the science that goes along with it, and to understand better what might be helpful from the perspective of the government if they were to release this elusive science that they refuse to share.

[Dr. Michael Ungar]

Thank you very much for the question.

I won't necessarily get into the politics of what's being released or not, but what I can say is that we do know that children have taken on a disproportionate negative effect. If we look at depression scores or anxiety from Statistics Canada or Public Health Agency of Canada statistics, we know that children disproportionally showed increased or elevated levels of these particular mental health disorders throughout the pandemic. Basically, the older you were, the less you were affected, at least from a mental health point of view. We very much downloaded the crisis. While the physical health crisis was on the elderly, the mental health crisis was largely visited upon our children, because their lives were the ones that were so disrupted. Anyone who has a teenager would know that. All those sporting activities and the rights of passage into adulthood were disrupted, and that has taken a toll.

I am very cautious. When I look at any imposition of new regulations, I am very cautious that most of those regulations are being imposed in zones like children's activities. The consequences are being felt most by kids, even though the impact or the benefit is being accrued in terms of health consequences for the adults: the care providers, the teachers and that type of thing.

There's a fine line to walk here between disadvantaging our children and trying to keep adults healthy. If you look at, say, the work of Sara Austin at Children First Canada, you would certainly see that what we're trying to do is advocate more, so that we can actually think about the needs of children before we put these policies in place. Indeed, let's be really clear that there are long-term consequences as we disrupt children's lives: depression, suicidality, long-term developmental challenges and, as my colleagues here on all the medical sides of this are showing, that whole sort of delayed diagnosis of pathology that is occurring in children's lives and that has lifetime consequences in delayed educational gains, delays entering post-secondary and delayed productivity.

I am definitely on the cautious side in terms of imposing new regulations. I was very much for them, previously, of course—we were in a pandemic—but I am very cautious about carrying these on too long-term in terms of children's mental health.

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

That underscores very urgently the need to make sure that the Canada mental health transfer so promised by this government is delivered upon. I also think that it behooves this government to ensure that the science and the mandates are well supported and well broadcast out there among those who perhaps care for children and who have children, like many of us here do.

Thank you, Mr. Chair. I appreciate that.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Next, we have Mr. van Koeverden, please, for five minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Thanks to all of the witnesses for being here today and for all of their testimony.

I have three questions for three witnesses. I just ask that your answers be as brief as possible.

First, Dr. Tomkins, you stressed the importance of oral health for children, and its being the most preventable and most prevalent health concern for children in Canada, as well as the leading cause for missing school. In your work and experience, do kids in lower-income Canadian households typically have access to the same oral health care as their middle-class and wealthier neighbours do?

[Dr. Lynn Tomkins]

No, and it's for all the reasons we've just talked about. Cost is a barrier. Sometimes language is a barrier, and sometimes the education and awareness of the parents is a barrier. With this new program that's coming out right now, that would be one of the things we would like to see—that people who are eligible would be made aware of this Canada dental benefit so that they could bring their kids to the dentist.

[Adam van Koeverden, Liberal, Milton, ON]

Do you have any recommendations for spreading awareness and ensuring that Canadians are as cognizant as they can be of the need to visit the dentist?

[Dr. Lynn Tomkins]

Certainly as the Canadian Dental Association that represents 20,000 dentists from coast to coast to coast, we would be happy to partner with the government to make everybody aware of it.

[Adam van Koeverden, Liberal, Milton, ON]

That would be great. Thank you very much.

You also highlighted the need for better dental services for people living in indigenous and remote communities across Canada. This summer I was lucky enough to visit the beautiful Cape Breton University to discuss recruiting to those schools people who are actually from and who live in some of these remote and indigenous communities across the country, in order to ensure a longer-term solution rather than recruiting people to go for just six months or a year.

Does the Canadian Dental Association have a position on being able to use some of the newly minted virtual technology that we all avail ourselves of to train potential dentists in rural areas so that they can practise at home for the duration of their career?

[Dr. Lynn Tomkins]

We don't have a formal position on that, but it raises a very interesting idea. Dalhousie would be the closest dental school. There are 10 dental schools across the country: three in Quebec—two French-language—and one in almost every province, and then one in the Atlantic region.

I do know that the University of Toronto, where I am on staff, is looking at satellite clinics and actually going out into communities where there are going to be students who are interested. A dental school in and of itself is an extremely expensive proposition to build. It's like building a hospital that is almost entirely privately funded, so I think utilizing any kind of....

Dentistry, to a large extent, is still very hands-on. There's not a lot of dentistry we can do virtually, so I think to the extent that we can use technology to recruit prospective students and students from all income levels and from all groups of Canadians, that is something that all the universities are interested in doing.

[Adam van Koeverden, Liberal, Milton, ON]

I've visited a foreign credentials qualification school in Mississauga, specifically for dentistry, so that we can maximize the number of dentists in Canada. Very briefly, if you can, do you see a practical application for more schools like that to ensure that people who are qualified get to work in Canada?