Health Committee on Sept. 27th, 2022

[Dr. Marie-Claude Roy]

The population of each province has its own characteristics. It's false to say that Ontario, New Brunswick and Quebec have the same parameters and the same problems, even though they're similar.

The provinces are often in a better position to set their priorities because health is historically a provincial jurisdiction. Restructuring must be done and investments made in the right areas and the right ways. Earlier I mentioned the Agir tôt program, which was set up in Quebec for the early detection and stimulation of children with developmental issues. The program addressed a problem in Quebec that may not have emerged in another province. Since that problem has been addressed in Quebec, we may be able to focus more on mental health prevention and care for adolescents. Mental health services for the adolescent clientele are abysmal. We're very concerned about suicide, depression and school drop-out rates.

These variables suggest that the provinces are in the best position to take action. This isn't a matter of mismanagement. A trivial example here would be the issuing of passports. We haven't experienced all these problems just because this is a federal jurisdiction. Other factors have made it difficult to find a solution.

Similarly, the current restructuring of health care is a difficult issue for many reasons. They may include, for example, the aging population, labour shortages and obsolete structures. It's not a management issue; it's a matter of sociodemographic parameters as a result of which our health system must be reorganized. In my view, setting conditions on this funding merely raises another barrier between children and the resources they deserve.

[René Villemure, Bloc, Trois-Rivières, QC]

So you disagree with the federal government's setting conditions on the transfer of amounts owed to the provinces.

Is that correct?

[Dr. Marie-Claude Roy]

I think the federal government's concerns will definitely be the same as those of the provinces. Introducing restrictions limits the freedom and fluidity with which services are organized, and that, once again, puts another barrier between the resources and the child.

My concern is to ensure that children get the right resource at the right time, whether they're in British Columbia, Ontario or New Brunswick, for example.

[René Villemure, Bloc, Trois-Rivières, QC]

Earlier you mentioned literacy. Please tell us more about that.

[Dr. Marie-Claude Roy]

A study was done in the United States, and I think we can draw on it since it may apply to the problems we have in the same area here.

The pandemic set our young children's reading and writing skills back 20 years. Good reading skills from the start of primary school are the most significant factor enabling children to do well in school and earn their diplomas.

That's an aspect that must be addressed. That's why I discussed “educational” health in addition to physical and psychological health. We now have children in grade two or three who didn't go to school during the pandemic. They've experienced interruptions since their education started.

That's an example of the unique nature of a province. I'm extremely concerned that, as a result of the COVID‑19 pandemic measures, children in Ontario can still choose not to go to school. We feel that attendance at school, without negotiation or compromise, is extremely important because it's their reading, writing and numeracy skills that will enable them to improve their educational trajectory. This is what was done in Quebec when students went back to school for the first time in the spring of 2020. It wasn't a choice. The children had to go to school unless there was some major health problem.

We know that school attendance is an extremely important health parameter for educational skills and the social safety net that the school system represents. It's an environment for growth that can't always be offered at home for certain children.

[René Villemure, Bloc, Trois-Rivières, QC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Roy.

Thank you, Mr. Villemure.

Next, we have Mr. Davies for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to all the witnesses for being here.

We're only on our third meeting regarding this important study and I already detect a theme coming through, which is the importance of early identification, intervention and treatment for children. We had speech pathologists and audiologists here last week, who talked about that crucial period between zero and four, when language and communication skills are being developed. Dr. Feldman mentioned the concept of brain plasticity.

Ms. Gruenwoldt, I want to put my first question to you.

You brought up, as one of your three suggestions, better beginnings for maternal and newborn health. Can you expand a bit on what you would like to see as elements of a maternal and newborn health strategy?

[Emily Gruenwoldt]

To your point about those early days, weeks and months of a child's life, we know how critical maternal health is pre-pregnancy, as well as health and well-being throughout pregnancy and in those early days, weeks and months after birth. We know it's a critical time period, where early intervention matters in terms of the mental health of the family—mother, father and others who might be part of that family—as well as the critical care delivered within the hospital institutions.

Across this country, right now, we're seeing increased pressures and demands on neonatal intensive care units unlike anything we've ever seen before. Hospitals are now preparing different strategies to cope with that demand and to get a sense, from a health human resource perspective, of how we are training those pediatricians, specialists, nurses, etc. caring for children.

What I'm trying to say is that we need to think about the full continuum of the child's life, which begins before conception. We need to think about the research strategies and the gaps in our knowledge. We need to think about the data strategies, in terms of what we understand about the health and well-being of those children at that age, set clear targets and parameters for what that ought to look like, and look at international comparisons, as well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I will turn to you, Dr. Feldman.

Are kids in Canada, from birth to the age of five, getting the kind of access to therapy and treatment they need, resulting in the kind of great story you relayed to us about that young man who graduated?

[Dr. Mark Feldman]

Unfortunately, the simple answer is no. They're not getting the access. We think about 20% of people are getting access to the care they need. This is a grave problem right now. There's a huge gap in the delivery.

[Don Davies, NDP, Vancouver Kingsway, BC]

Could you perhaps give us some of the key areas where they're not getting it? I guess this would be a relatively comprehensive problem, but where do you see the most acute needs in those gaps?

[Dr. Mark Feldman]

There are a number of things.

Assessments for kids with learning problems, psycho-educational assessments, cost about four to five thousand dollars. They're done privately, so most people can't afford them.

Now, there was a “right to read” inquiry in Ontario, and those psychological assessments have now been identified as a barrier to learning to read, because often an individual education plan in school is not enacted until they have that assessment, which for a publicly funded assessment in a school may mean being on a two-year wait list. Assessments are one thing.

Another thing is the learning and educational issues that Dr. Roy spoke so articulately about.

Another thing is therapy. For kids with anxiety or depression, the first line of therapy is a type of talk therapy called cognitive behavioural therapy. Cognitive behavioural therapy is an evidence-based, proven, effective strategy. Psychological services that deliver CBT, again, cost big money and they are private. They're not publicly funded or available, and so often kids are put on medication—which is a second line of therapy—first for their anxiety or depression.

I'm sorry. Go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

I hate interrupting you, but I have only six minutes.

You brought up medication, which made me think of another question I wanted to direct to you. The Canadian Paediatric Society has been leading the call for child-friendly pharmacare in Canada. A few years ago, the CPS issued a statement with respect to the NDP's Canada pharmacare act that said the following:

The establishment of paediatric-sensitive national pharmacare is an opportunity to correct the long-standing regulatory neglect that has led to a poor availability of paediatric drugs and child-friendly formulations. We...strongly support a pharmacare system that prioritizes the needs of children and youth and upholds the core principles reaffirmed in Bill C-213 of public administration, comprehensiveness, universality, portability and accessibility.

Those are the Canada Health Act principles.

Could you outline the barriers that Canadian children are currently facing in accessing affordable and effective medication?

[Dr. Mark Feldman]

I'm going to defer to Ms. Gruenwoldt, who has been much more involved on that.

Very quickly, there aren't a lot of pediatric-friendly formulations. A lot of what we learn and apply to children's care comes from research in adults. There are a lot of medications that are simply not on public formularies. There are a number of strategies for which a pharmacare strategy will be important.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Gruenwoldt, before you answer that—I want you to—I'm also going to throw in another question.

You mentioned that Canada is 35th of 38 in adolescent suicides. Is there any data or theories as to why that's the case, as well as the other question?

[The Chair, Liberal, Sean Casey]

I don't know that you're going to be able to get both questions in given that we're out of time, but we'll allow you time for a brief response if possible and you can supplement it in writing afterwards if you wish.

You can give a brief response, please, Ms. Gruenwoldt.

[Emily Gruenwoldt]

Sure.

With respect to the pharmacare program, I think any opportunity we have to increase access to safe and effective medications for children is a step in the right direction. We know that one in six families has struggled to fill prescriptions that have been directed for their children because of cost.

In terms of the safety and efficacy of the formulations themselves, 80% are prescribed off label, which means that it is not an approved, regulated dosage for a child or a youth. Safety and efficacy matter. Children have very specific sizes and develop at very specific stages and so it's not appropriate to look at an adult dosage and scale back. There are lots of challenges in terms of regulatory barriers for pharmaceutical companies to invest in the clinical trials for children, so that's an opportunity that the CPS has been leading in terms of regulatory reform for pharma.

[The Chair, Liberal, Sean Casey]

Well done. Thank you.

Mr. Lake, go ahead, please, for five minutes.

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

Thank you, Mr. Chair.

Dr. Powlowski brought up disinformation, and I share his concerns. In fact, in 2018 as a parent of a child with autism, I wrote an op-ed to talk about Andrew Wakefield's disinformation and the impact that it had on parents' decisions to vaccinate their kids.

I'm also concerned about another form of disinformation that comes in the form of a political party—when it comes time to run in an election—putting out promises and then clearly not delivering on those promises—like the promise by the Liberal Party to spend $4.5 billion on a Canada mental health transfer and page 75 of their platform document, which clearly indicates that $875 million would have been allocated by now.

Ms. Gruenwoldt, I think your suggestion was for 25% of that Canadian mental health transfer. Unfortunately, 25% of nothing is still nothing, so it wouldn't result in a change, but if the government had delivered on that promise by now and put $875 million towards a Canada mental health transfer, your proposal would have meant over $200 million delivered to benefit children.

What kind of impact would that have had? What would that money have been spent on had that promise been delivered?

[Emily Gruenwoldt]

Absolutely.

In Ontario, we know that prepandemic there were 28,000 children on a wait list for mental health services delivered in the community or acute care centres. We anticipate that number has grown over the course of the pandemic. Across Canada, that number is closer to 100,000 children on a wait list.

We know the impact that early intervention can make on children's mental health. It pays lifelong dividends in terms of their overall health and well-being. Proportionately, 25% reflects roughly the number of children and youth under the age of 18 in Canada. What we don't want to see is children left behind in any sort of funding envelope to address mental health, children being an afterthought. We really want to make sure they are prioritized in the rollout of any programs and services to improve their access to care.

Whether that is increasing the number of providers who are trained in the pipeline to provide services in the community, or whether that includes space in our acute care facilities to care for the most complex acute mental illnesses amongst our children and youth, those are all opportunities that immediately require investment that those dollars would support.

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

Thank you.

Dr. Feldman, I'm wondering if you could weigh in.

Say over $200 million that was promised had been delivered, and $800 million for Canadians across the board. Let's say that about $200 million was spent already by now, invested into the system.

Where would you suggest allocating that money?

[Dr. Mark Feldman]

I would perhaps look at advanced training programs, more doctors, more training for doctors out in practice, and continued professional development. I would also look for more publicly funded therapy and regulated evidence-based therapies.

I can spend it pretty quickly.

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

Just doing a quick calculation, if you calculate the $875 million that was promised to have been spent by now, about $200 million would have gone to Quebec.

How do you think that money would have been best spent in Quebec, the $200 million toward mental health?

[Dr. Marie-Claude Roy]

Is that question for me or for Dr. Feldman?