Health Committee on Sept. 22nd, 2022

[The Chair, Liberal, Sean Casey]

The question was posed after your time was up. You will get another turn, Mr. Davies.

Mrs. Goodridge, go ahead for five minutes, please.

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

Thank you, Mr. Chair.

Thank you to all the witnesses for being present.

Dr. Ungar, you really tweaked a piece in me with some of what you were talking about, and I really felt as though you were talking about my hometown of Fort McMurray, where there have been multiple traumas placed on many of these kids, from the fire to the flood and then the pandemic.

I'm wondering if you can elaborate a little bit on what communities can do and what individuals can do to help build resilience in kids who have experienced multiple traumas.

[Dr. Michael Ungar]

That's a great question. Thank you very much for the question.

What we're seeing in other communities is the need for a more coordinated approach. My own work is largely in Drayton Valley, an Albertan community, one of the Canadian communities heavily reliant on oil and gas. What we're learning from those communities, as well as from indigenous communities, is that we need to be thinking about children's lives in a more total way, including recreational spaces, access to green spaces, access to safe water, access to the health care professionals we're hearing about on this particular panel, better coordination and access to child care for families, etc.

I think sometimes what happens is that when we have a mass dislocation or problem, we tend to focus in very quickly on a particular solution, like education, speech-language, teeth or whatever. What we're actually seeing in our research is that the more we are able to co-locate and think about a child's life in its totality....

For instance, I'll give you a very small example. It's not really a child example, but in Fort McMurray there was a big effort to get insurance adjusters to respond to the families who were dislocated after the large fire that occurred. The insurance adjuster became part of a mental health team, in a sense, because when you get people's insurance claims settled very quickly, families can relocate back to the community and people can get back to work. Indeed, family cohesion and children's mental health are better protected when their parents are back at work, houses are re-established, homes are re-established and communities are re-established. Sometimes we tend to partialize this. We tend to think, “Oh, let's just get a psychologist to visit the family.”

I'm a mental health professional, but we miss the fact that without these other coordinated services, trauma tends to persist. Sometimes it's these other allied services. For instance, we know that a child who is better diagnosed as having speech language issues is better ready earlier, is better ready for school, and will have a higher school achievement throughout their life.

We need to get out of this idea that we keep funding single solutions in isolation from others. I think what happened in Fort McMurray is simply another example of how we will get better long-term outcomes when we think more holistically.

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

That's wonderful. Thank you for that answer.

I'm going to switch gears a little bit and go to the Canadian Cancer Society.

You guys raised some really interesting points regarding some of the challenges and issues faced when it came to COVID and getting delayed diagnoses and not being able to have the same level of support when patients were going through cancer diagnoses.

I'm wondering if you can give us any potential solutions you have so we can not just catch up but prevent something like this from ever happening again.

[Kelly Masotti]

I'll start this, Helena, and then you can add.

I think what's most important is to continue to place an emphasis on the importance of screening and diagnoses. We have seen a shift to virtual care in some instances, so it would be to continue to encourage parents to take their children to see their family doctor if something arises at a time when they feel they're comfortable to go into a hospital or into the physician's office.

Continue to ask your doctor questions when you have concerns about your child. As well, encourage the government at all levels to make sure there is a continuation of those screening programs. We don't want to see an end to screening programs—provided it is safe to do so—but to continue those school-based screening programs when it's safe to do so and when we can.

That's a short answer. Helena, I'll turn to you.

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

I appreciate that. I have about 30 seconds left and there's just one piece I'd like to say.

There was a little boy in Lac La Biche, Ezra Marfo, who had a very rare form of blood cancer and who passed away, unfortunately, on September 16, just last week. One really amazing thing that his parents were spearheading in trying to save his life was getting more people to swab and get on a stem cell registry. While it's already too late to save Ezra's life, I would encourage everyone to visit blood.ca so they can swab and get on the stem cell registry. They could potentially save the life of a little boy or a little girl.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mrs. Goodridge.

Next is Dr. Hanley, please, for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you to all of the witnesses for the varied and interesting testimony.

I think I'm going to start with you, Dr. Tomkins. Coming from Yukon territory, I'm certainly concerned about dental care, as you are, in rural and underserved areas.

One area I'm quite interested in is the role of dental therapists. I know that you've addressed getting dentists more connected to remote areas and some of the barriers there—surgical centres—but what about dental therapists? We know that Saskatchewan has been a leader in that area. I'm just wondering what your thoughts are on this particular cadre and how we might scale them up as practitioners as well.

[Dr. Lynn Tomkins]

You may recall that I said earlier that there really isn't a shortage in terms of number of dentists in the country. We see lots of new entrants into dentistry every year, both from our dental schools and from graduates coming from countries outside of Canada.

I think the emphasis has to be on encouraging young people. I teach in a dental clinic. I talk to dental students about going to places like Whitehorse, Atlin, Hay River and so on, and also further north—I mean, that's the southern Arctic—and the wonderful opportunities that are available and the great need there. First, I think, we need to focus on getting new graduates to come to practise in those areas, because the infrastructure, whether it's a dentist or a dental therapist, is going to be the same.

In terms of dental therapists, there have been successes in provinces like Saskatchewan. In my understanding, many of them don't actually end up going out to remote and rural areas. They end up in the larger cities and working in dental offices alongside dentists, because they can provide quite a variety of services. Not to dodge the question, but I'm going to ask Dr. Burry to talk specifically about what's happening right now with dental therapy in Canada.

[Brendan Hanley, Liberal, Yukon, YT]

If you wouldn't mind, answer very quickly, please, because I have a few more questions.

[Dr. Aaron Burry, Chief Executive Officer, Canadian Dental Association]

The government has started a new program, which is largely looking for therapists or to educate therapists for the north. It's certainly a step in terms of replenishing what is a very significant number of retirements in that particular discipline, particularly those who are focused on school-based programs, which is something we would certainly support, and in indigenous communities.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Ms. Wilson, I think you mentioned in your remarks the idea of training early child educators to detect and be familiar with speech-language pathology. I'm wondering if you could briefly elaborate on that particular area. Given the real shortage of practitioners, I think we need to expand the knowledge and the ability to screen and detect.

[Dawn Wilson]

Yes, I think it's paramount that we work in the early learning and child care centres to improve outcomes for early diagnosis. Working with those ECEs directly in their centres is really important, as well as potentially working through the provinces to incorporate our services through the deals that have been provided to day cares.

I think it's also really important to stress what happens later on and what the impact is if the disorders are not treated. The ability for us to work in those day care centres is critical.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you. If time permits, I may come back to you.

I want to ask Ms. Masotti or Ms. Sonea this: The vaping stats you related are certainly alarming, in terms of the increasing trends, although I think the data you quoted stopped in 2019. I wonder if you have information on more recent effects—particularly pandemic-related effects—and also evidence about vaping and tobacco use, not just nicotine addiction, and therefore the link to cancer and what legislative aspects may be needed—all in the remaining 30 seconds I have.

Thanks.

[Kelly Masotti]

I will do my best to answer quickly.

We're very concerned by the dramatic increase in youth vaping, and there needs to be comprehensive government response.

For example, the draft regulation on flavours and e-cigarettes should be adopted as soon as possible and, indeed, the proposed regulation can be strengthened by removing the exemption of mint and menthol. Among provinces and territories, New Brunswick, Nova Scotia, P.E.I. and the Northwest Territories have implemented legislation banning flavours. It is the same with various states in the U.S. as well as in Europe, where a growing number of countries are doing likewise, including Finland, Lithuania and the Netherlands. If they can do this in all of these places, so can we in Canada.

We have made such great progress in reducing youth smoking. We do not need a new generation addicted to nicotine, but that's what's happening. We do support a tax on e-cigarettes, and it's essential that flavours in e-cigarettes be restricted.

We are concerned. Health Canada has said that e-cigarettes are less harmful than conventional cigarettes. However, the problem is that a large proportion of vapers are still smoking, and we're seeing a rise in dual use. This is also evidence that dual use can inhibit cessation, so we are concerned, and we are seeing a rise.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Masotti and Dr. Hanley.

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

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

Thank you, Mr. Chair.

It's a great pleasure to continue on with this.

Just before I get started, I want to editorialize a bit, perhaps, in terms of admonishing my colleague for his factional line of accusations with respect to vaccines. Once again, we need to understand that those who are vaccine-hesitant need not be divided and conquered and admonished for their choices. They need to be encouraged. They also need to be educated. To continue with this, as I said, factional line of accusation is not helpful.

That being said, Ms. Wilson, I think that when we originally designed this study, we really knew it was important to begin to understand the effects on speech language acquisition with respect to masking and COVID. That's where we started with this study. I realize that it has morphed into something else. However, I think it's germane that we undertake that line of questioning, especially with something we have never faced before.

Often people want to place a tinfoil hat on my head and say, “Why are you talking about this? This is not an issue,” etc. However, if we do not delve into this deeply, my fear, of course—and hopefully it's shared by a multitude of my colleagues—is to understand.... Are they bad for kids in their language acquisition? We don't know the answer to that. Perhaps you and Ms. Carey could help shed some light on that, or perhaps on what direction we need to take in the future.

Thank you.

[Dawn Wilson]

I don't think we have enough research at this point in time to show that there's a long-term impact on the speech and language development in children as a result of masking. We know there's an impact.

Actually, as I was waiting to come into this room, my colleague, Ms. Tomkins, and I were speaking. She was masked, and I couldn't understand what she was saying.

For sure, there's an impact. We don't have enough research at this point in time that I could say with certainty what the long-term impacts are, other than to say that there is most certainly an impact on the ability to understand speech with a mask on and for children to develop those critical skills when masks are being used in schools in particular.

I don't know if you have anything to add because we don't have any research at this point.

[Anne Carey]

We don't have the research to give specific data. There are specific at-risk groups. Hard-of-hearing children might be more at risk and things like that.

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

Ms. Carey, do I understand correctly that you're a practising speech-language pathologist at the current time?

[Anne Carey]

I am a registered speech therapist.

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

Have you seen issues related to this, or do you think it's still too early? Do we still not have enough trained professionals like you getting the referrals so that we really don't know where we are?

[Anne Carey]

We don't have the data. I think that is the cleanest answer for that one.

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

Perhaps between the two of you, do you have any suggestions for how we might proceed with understanding this complicated problem more fully?

[Dawn Wilson]

I think we have heard other people here today talk about the need for a reliable source of health human resources data so we can understand the scope of what we're dealing with, because we really don't know. I think we definitely would support any initiatives that the federal government would have to recruit and retain speech-language pathologists and other allied health care professionals to improve the situation in health human resources.