Health Committee on Sept. 27th, 2022

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

As a mom of a little boy who is getting his first molar, the shortages have really amplified the stress, and it's made me really curious as to why something that is so required and can prevent children from filling up your ERs is so hard to come by.

I was wondering if Ms. Gruenwoldt has anything to add on this subject.

[Emily Gruenwoldt]

What we have been encouraging parents to do is lean into trusted resources, their pediatrician or their children's hospitals, for other sources of information or advice to manage pain. There is also a federally funded NCE program called Solutions for Kids in Pain that offers a number of different pain management strategies that parents might find of use.

To the general problem and the role of the federal government, I have nothing to add to Dr. Roy's testimony.

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

Thank you for that.

I'll go back to one of the pieces that was touched on by Dr. Feldman about eating disorders in kids. I think that's incredibly troubling.

How young are the children we're seeing eating disorders in, and are there any causes that are being identified that perhaps we could address as a government to make sure that we are taking care of these children?

[Dr. Mark Feldman]

Unfortunately, in young, prepubertal kids, we're seeing eating disorders. The cause of it is unknown. There is conjecture again, in part. Speaking with some adolescent medicine colleagues and asking them the very same question, one of the theories is that during a period of time in this pandemic, with no sense of control, it was the one thing that they could control.

Other theories include online learning, dissatisfaction with their image and social media.

There are a number of theories, but we don't know 100% for sure.

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

Thank you for that information. This is clearly a space in which mental health is driving some of this, and it has long-term impacts. It can impact fertility later on in life. It can impact overall health.

Do you have anything to tell parents who might be listening about what they could do to help kids who are struggling with eating disorders?

[Dr. Mark Feldman]

I'll defer that one to Dr. Roy, if she sees a lot of kids with eating disorders.

It's not a part of my practice, but, in general, we know that being very positive, not telling kids that they're worried about their appearance, talking about healthy lifestyles and not appearance.... These are some very general recommendations.

Largely why some kids are affected by anorexia nervosa and others aren't is still a bit of an unknown.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Feldman and Ms. Goodridge.

Next is Dr. Hanley for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you to all three of you for the testimony today.

When we're thinking of recommendations and outcomes from this study.... I think part of the context of the child health study was the pandemic and the effect of the pandemic on children's health. There are various questions around what the pandemic has revealed or laid bare in trends that were already happening. What has it perhaps exaggerated? What are the direct effects of the pandemic?

If you had $4.5 billion, what is going to heal, as we heal as a society? What can we perhaps leave to heal as more of the transient, stress-affected results of the pandemic? Where do we need to focus on targeted interventions?

Dr. Roy and Dr. Feldman, you have both talked about that to some degree, but I'm thinking with this amount of funding, we need to be very efficient in how we use it, because it will disappear, especially if it is not well used. Perhaps each of you could comment—Dr. Roy first and Dr. Feldman in a minute.

Where you would put that money and get the best bang for your buck?

[Dr. Marie-Claude Roy]

I really liked the way you put it, meaning that the pandemic exacerbated an existing problem.

Let's go back to adolescents. There are many hypotheses about this, but what mainly allows adolescents to develop and grow towards adulthood is the ability to leave home. That's because they've assimilated their family's values, turned outwards, and made other connections. Parents become secondary and friends become a priority. After that, they fashion their own personality. That's precisely what the pandemic prevented them from doing. It forced adolescents to turn inward and to depend on screen time and social networks, immersing them in a flow of images of perfection and the feeling that they have completely lost control, which is toxic for them.

It's essential to consolidate what adolescents and young people learn, and to strengthen their feelings of accomplishment and self-esteem. Mental health support is, of course, the starting point, as was mentioned. Young people consolidate what they have learned and blossom as they succeed at school, as they get coaching, tutoring and encouragement for their educational performance at school. They can apply their talents to sports and physical activity, as well as in positive interactions with coaches or other adult models they can emulate.

A massive investment is needed in all the social safety nets for children. As was mentioned earlier, the family setting is not always solid enough to consolidate children's achievements.

But as I was saying, the provinces need latitude so that they can invest in other sectors that can have an impact on children's health, like education, sports and other forms of support. Of course, prevention programs also required to help them develop properly.

The health sector needs to be decompartmentalized and health needs to be viewed as a set of parameters that gravitate around children, precisely to help them consolidate their personality. I believe it's a potential solution that ought not to be ignored.

[Brendan Hanley, Liberal, Yukon, YT]

Dr. Feldman, perhaps you can add to that.

[Dr. Mark Feldman]

Thank you.

I think of it as both quality and quantity of health care delivery. For quality, I break it down into efficiency and effectiveness. How are we more effective? We need to make sure that therapies are evidence-based. We shouldn't be giving any money to unproven therapies. Effectiveness is through evidence-based practice.

Through efficiency, there are a few strategies. One is to have, perhaps, the mental health care team model in which only one of them, perhaps, is a physician, pediatrician or a psychiatrist, and there are a number of more cost-effective solutions and team members that can provide care.

In Toronto, there is something called the family navigation project, which helps with more efficient navigation of referrals, getting the people to the right place at the right time to navigate wait-lists. So, it's efficiency through navigation, efficiency through involving our non-physician colleagues, and effectiveness by demanding that they be evidence-based practices. In terms of quantity, we need more health care providers.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Feldman and Dr. Hanley.

Next we have Mr. Lake, please, for five minutes.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you.

Ms. Gruenwoldt, I was really struck hearing.... We've talked a lot about it, but those numbers from the 2020 UNICEF report are very problematic and troubling: We're number 30 out of 38 countries on physical health and number 31 out of 38 countries on mental health.

What is the connection between mental health and physical health? Maybe speak to that because I think those numbers.... It's not coincidence, necessarily, that we're around the same ranking in both.

When we think about mental health—and I'll go to the two doctors after this on the same question—as mental health deteriorates, what's the impact on physical health for kids?

[Emily Gruenwoldt]

That's probably a great question for your two pediatricians, but my observation would be that a piecemeal approach to addressing children's health and well-being—physical health and mental health—has not served us well to date and, I think, is not what is required to get us...or to measurably improve children's health. We really need to think more systemically.

What we heard through the “Inspiring Healthy Futures” report was that there are five interlinked areas that require simultaneous investment and consideration. That's around children's physical and mental health. It's around the schools and communities in which children live. It's around a robust health research agenda. It's around strong policies to support children's physical and mental health and well-being and social development. It also involves that idea about empowering youth. Looking forward, we have piecemeal investments. Where do we start? We really need to think about this more systemically. This isn't “throw money at one particular problem and we're going to solve children's health.”

As for your point about mental health impacting physical health, I'll defer to the two physicians on the line.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

I just asked you first because you were the one who raised the statistics.

[Emily Gruenwoldt]

No problem.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Dr. Feldman.

[Dr. Mark Feldman]

Thank you.

It's a great question. Kids with depression, anxiety, learning and attention issues are more at risk for drug addiction and alcoholism, and that's going to affect their health. Kids with ADHD are two to three times more likely to be obese because of impulse eating, and that's going to affect their health. Kids with eating disorders have consequences from their food restrictions. Kids with mental health disease in general make poor nutritional choices and lifestyle choices, and then there are some—not to go into too much detail—conditions that lead to both health and mental health issues. There are kids with medical complexities who have mental health issues as a result of their medical issues. So, they are intertwined and additive to each other.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Dr. Roy.

[Dr. Marie-Claude Roy]

I would add that mental health definitely has an impact on physical health, but that the reverse is also true: physical health has an influence on mental health. Another point worth making is that the mental health of parents also has an impact on the mental health of their children.

As for psychological health, children and adolescents who are not doing as well, or who are less active, will suffer more from problems of obesity and too much screen time. Behavioural and emotional problems in children inevitably lead to distress for parents. Exhausted parents are also less likely to be proactive about doing something to adopt healthy sleep and diet habits for themselves and their children. It's all highly interrelated.

Nor should chronically ill patients be underestimated. It's often been said that mental health has an impact on physical health. Chronically ill patients experience distress and their children don't have a normal adolescence. This can generate considerable psychological distress.

And the social and emotional aspect mustn't be forgotten. It's been shown that having a less caring family network, in which emotional ties are limited, with signs of attachment disorder, automatically has a harmful effect on children's height and weight.

All these parameters are interrelated. Earlier, we were talking about brain plasticity and development. That's why the psychological health of parents ought not to be underestimated. From very early on, in the first few weeks of life, the parents' psychological health has an impact on their child's physical and emotional development.

[The Chair, Liberal, Sean Casey]

Next is Mr. van Koeverden for five minutes.

Go ahead, please.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Thanks so much to all the witnesses today for their extraordinary testimony.

I have two main questions, both a little vague.

As we've been talking and poring over data tables and things like that, I've been a bit distracted by the numbers.

I'm curious about folks and their opinions on the dichotomy between the fact that Canada tends to rank fairly high on health care expenditures and quite low on good outcomes. It strikes me that either our challenge is greater or the delivery is flawed, or there are other factors at play. I tend to want to resist the temptation to recommend that we throw more money at the problem. If it's not currently being spent as efficiently as other countries, then I want to investigate how we could be doing more and better with the money that's currently being spent before we react with more health care transfers to provinces.

I really appreciate the intervention from Madame Roy with respect to the upstream challenge of health care, primarily from a mental health perspective, but a physical perspective as well in preventative medicine and trying to provide better conditions rather than only just mental health services.

Certainly, I take your comments very well, Dr. Feldman, with a need to provide more remedial services but at the same time ensuring that we're building resilience and ensuring that kids have access to all of the things that keep them resilient, happy and healthy—from good food, good living conditions, access to sports and the arts. I think that very good living and education environments are key.

Could we have a brief comment from each witness, perhaps, on the necessity to focus in on some key areas with respect to efficiency and spending, and areas in which they believe we could be more efficient with that delivery, and on that upstream challenge with respect to how Canada differs?

I think I'm less concerned with the rank and more concerned with outcomes. It's obvious that we need to improve outcomes for Canadians.

Perhaps I could start with you, Dr. Roy, since you're nodding.

Thank you.

[Dr. Marie-Claude Roy]

There are several aspects to your question. I agree with you. The numbers and the rankings are not what I am most concerned about. We discussed deaths, for example among highly premature infants. I think we need to get away from the numbers and begin with the outcomes. We need to see what we want for our children and how we can have a real impact. We need to ask why there are still gaps and how they can be addressed.

Unfortunately, whether what's involved is mental health or child protection services, the system has perhaps always been accustomed to taking action when the problems had become clear and obvious, and when it was too late to do anything about them. We need to return children to the top of our priority list and focus on prevention. It's easy to say that we're going to work on preventing anxiety in the schools. While there's nothing the matter with that, I believe prevention has to be at the societal level.

I'm thinking of some parents who, morning, noon and night, don't have meals with their children. This might seem to be a minor point, but prevention is also to be found in sound family values that help children develop properly. We're talking here about teaching people to adopt healthy eating practices, to sit down to eat properly, and to have a healthy lifestyle. It may sound trivial, but it's what has the greatest impact in the everyday lives of parents.

Children with ADHD do better when there's a family structure, some form of regularity in everyday life. When children engage in outdoor activities, and get moving, the use of medications drops. The same is the case for ADHD and developmental problems. That's where prevention lies.

Prevention can also take the form of raising awareness in society. What I'm talking about here is social networks. Children have a cell phone when they're 10 years old. They learn to use it when they are very young. A child's right to have a smart phone of their own has become a societal norm. Why? It has to do with parental anxiety. As a result, children are exposed to cyber predators. They also are constantly exposed to images of perfection. The result is a form of dependence that becomes central to their life. Life has become virtual and faster.

Prevention therefore requires a much broader approach. Adjusting these parameters is what might eventually lead to results. Problems need to be dealt with when they appear, but it's also important to try and prevent them by exploring new avenues.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Dr. Roy.

[The Chair, Liberal, Sean Casey]

I'm sorry, but there's no time left for the other witnesses.

I will now give the floor to Mr. Villemure for two and a half minutes.