Health Committee on Sept. 27th, 2022

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair. Thank you to all the witnesses for joining us today.

We heard from you, Dr. Roy, that depression, anxiety, obesity and some medical conditions also lead to bad health.

I want to bring your attention to celiac disease, which can develop at any time. After wheat or other gluten food are introduced into the diet, many kids are diagnosed when they are between six months and two years old. Celiac disease is treated by not eating gluten, but this can be hard because gluten is in many foods. It is the same thing for diabetes type 1.

How can teachers and the school play a role in assisting children with those kinds of chronic conditions?

[Dr. Marie-Claude Roy]

You've just pointed out how important teachers and the school system are for children's health. You mentioned two problematic conditions that occur frequently, but there are many others. Teachers are under a lot of pressure at the moment. They need to be capable of dealing with behavioural and social-emotional disorders, not to mention the usual teaching problems, and now, they're supposed to be able to learn how to deal with celiac disease and diabetes.

One of the secrets of success is the partnership between the health and educational systems, not only for behavioural and learning disorders, but also health. There are several pilot projects underway in Quebec on this. There are often nurses in the schools, but fewer and fewer of late because they too are in short supply.

Having medical staff and health professionals support the school systems is the key to success for these children. The families need to be equipped, but so do the schools.

[Sonia Sidhu, Liberal, Brampton South, ON]

To follow up on that, we also heard a bit about how the increased use of social media and screen time is having an impact on children's health.

Do you have any thoughts on how we can best promote health and development for our children in an increasingly digital world?

[Dr. Marie-Claude Roy]

The threat comes from people treating all this as normal and trivial. In my office when I'm dealing with parents, I have to challenge the 12 hours of screen time a day on a regular basis. Everyone looks at me as if I were crazy.

Just as we practise prevention by advocating physical activity and discouraging smoking, we need to make parents aware of their role and make society aware of the fact that it's not normal for a child to interact with the screen 12 hours a day, or even 18 hours a day. It needs to be seen as an opportunity for this generation, but also definitely as a threat to family life and to the development of these children.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Gruenwoldt, I have heard very positive feedback about virtual care, that for some older folks or due to a lack of time, virtual care is a good tool. Do you see any gap there, or do you think virtual care is good for Canadians?

[Emily Gruenwoldt]

I think we heard earlier that we've observed some very positive early outcomes in terms of accessibility to health care services, especially for families of children with complex medical conditions who are making frequent visits. It saves time. It saves dollars. It supports them in their family environment.

I think from a health systems perspective, there's lots to learn. There's lots to watch. But there's been lots of very early indications of success. We've seen lots of innovative programs and services pop up, including the virtual emergency department and other virtual clinics to serve specific patient populations.

I think it is a promising step in the right direction.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Feldman, we did a human health resources study. You were taking about the navigation project. Can you explore that project and what it is?

[Dr. Mark Feldman]

It's a pretty impressive project that comes out of Sunnybrook hospital in Toronto. What they do is they have some people at the other end of the phone who help find shorter wait-lists. When there is a mental health service that is private, they help negotiate lower rates. They help ensure that the referral is appropriate and that it's going to the right place. I've had patients referred to me who waited months, and it was clear that they should have been referred for a different type of specialty. I've had kids referred to me who really ought to have been managed by perhaps more of a generalist. With the resources provided by these navigation project offices, sometimes this can be circumvented. It's exactly what I think was talked about earlier in terms of not throwing money at things in making things more efficient.

Having said that, there's still a big human resource gap. There's a big two-tiered system with regard to mental health delivery that needs to be addressed. I think some funding will need to be applied.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Feldman.

We'll now go back to the Conservatives.

I would like to welcome Mr. Maguire to the committee.

Mr. Maguire, I would invite you to take the floor for the next five minutes.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

Thank you to the witnesses. I wasn't here for the first part of this, but it's been very interesting to hear your comments and the questions from my colleagues from all parties here on these issues.

Dr. Feldman, I think it was you, or maybe it was all witnesses, mentioning the priorities of youth and online training, which Ms. Sidhu was just asking about as well. The amount of time or the ease of being able to do that online is one thing for remote and other areas, which I believe Dr. Roy mentioned. Are there specific age groups, when we're talking about youth, that can be more helped in that area than not, using the example you used about autism, I believe?

Perhaps you would be able to expand on that.

[Dr. Mark Feldman]

Yes. It's a wonderful resource to now have this technology to save time, money, visits, etc., but it has its limitations. You would think that the sort of patients that I see in mental health would be ideally suited for distance learning, because you don't have to examine their abdomen or listen to their chest. But it turns out that you need to interact with them in person, frequently, to truly get a sense of their mood, their level of anxiety, their ability to pay attention and their social interactions. Sometimes just to connect at a greater level is so important when establishing relationships with your patients.

I think there will continue to be a need for both. What I've started doing with some of my patients is deliver every second visit virtually. Those kids who are on medications need to have their blood pressure checked and their height checked and their weight checked on accurate scales. So there is a need for both, but there is a great potential to reduce time and cost for both families and the system.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Dr. Roy, do you have any comment?

[Dr. Marie-Claude Roy]

We need to interact with children personally. While the diagnosis may be easy to establish, even virtually, we should not lose sight of the human aspect of medicine in our dealings with parents when explaining a diagnosis and the serious consequences thereof. That's my concern about all of this.

As for the frequency of follow‑ups, we need to take stock of the patients' circumstances, evaluate them at regular intervals, and schedule appointments between follow‑ups. Frequent follow‑ups are required for proper adjustments to be made. While it's easy to communicate a serious diagnosis virtually, it must not be forgotten that human contact, proximity and hearing from the parents in person are all extremely important and always will be.

[Larry Maguire, Conservative, Brandon—Souris, MB]

I'll make the comment as well that it may actually be easier to do those diagnoses for seniors, except they aren't the ones who are online as much in those areas.

There's a priority here. I was just at a hospital foundation dinner on Saturday night in my own constituency, so it's very pertinent for me to be able to ask these questions here. I come from a largely rural area. People have to travel distances, sometimes a couple of hours, to get to a major facility or a major hospital. There are rural hospitals. I'm wondering what your experience is with nurse practitioners. It came up in my experience in the Manitoba legislature. We were dealing with nurse practitioners and trying to promote them as doing quite a bit of the work that doctors do today.

Is there a greater need for people like nurse practitioners in some of those rural areas versus our major hospitals to be able to alleviate the shortage of physicians we have, which is directly proportional to the needs and care of youth? Can you comment on that? There are regulations and things that we've talked about for online, and yes, it's nice to be able to do that, but is there anything that a nurse practitioner couldn't do for youth development that doctors are presently doing in those areas? How would nurse practitioners be able to help alleviate the shortages we have across the country today?

[Dr. Marie-Claude Roy]

Medical practice has to be decompartmentalized. Services are provided by pharmacists, and nurse practitioners are already collaborating, at least in Quebec. What we're looking for is a clearly established line of attack that will give children rapid and effective access to a health professional. The nurse practitioners will definitely help us do that.

[Le président, Liberal, Sean Casey]

Thank you, Dr. Roy and Mr. Maguire.

The last round of questioning today will come from Mr. van Koeverden for the next five minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair. I appreciate the opportunity to ask a follow-up. My preamble unfortunately took a long time in the previous round.

Dr. Feldman, I would like to go to you and focus in a little bit on the preventative measures that I think are necessary and prudent. With regard to any further expenditure in terms of transfers, I think it would be prudent to meet those with efforts to ensure resiliency in child populations. I personally am very focused on physical activity and sport in my work, but there are many other ways to ensure that kids develop that resiliency.

Can I have comments from you on how we can ensure that fewer kids need to access mental health supports in the future?

[Dr. Mark Feldman]

It's a great question.

I'd love to see universal day care. I think that's going to be a wonderful thing. Exercise is key. In the patients I see, I'm heavily involved in managing kids with school and learning and development attention problems. With good evidence, I can confidently say, exercise has been shown to have a demonstrable benefit in terms of attention span and reduction in anxiety. A recent study showed that just 20 minutes a day of aerobic exercise for kids can have significant benefits. That's huge.

For many of these kids, we may be able to prevent some of the mental health challenges. Nature and nurture are both important, though. Some kids are born with a propensity for mental health issues that may not be preventable but can be treated. So both will be important—prevention and treatment.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much.

Very briefly, not considering those two things, prevention and treatment in two silos necessarily, but concerning exercise, exposure to arts and programming and lots of other social interventions, if you'd call them that, for people living with mental health challenges and illnesses, has there been proven—not talking about prevention so much—management? Is that also a preventative measure that could kind of—I hate to use such a crude term—slow down the tap a little bit on the number of people experiencing so many challenges or the severity of those challenges?

[Dr. Mark Feldman]

Yes, I think that there are so many different things that we can do that Dr. Roy talked about, in particular, looking at exposure to social media. The Canadian Paediatric Society has a statement that we could provide that makes recommendations—best opinion recommendations, because it's an area that needs to be researched—about the limitations and how we should participate with our children's online experiences to keep them safe. These are cutting down on time spent in the virtual world, getting out, doing more exercise and getting involved when possible in team and extracurricular activities that make kids social again. We are social animals.

[Adam van Koeverden, Liberal, Milton, ON]

I see that you agree on that, Dr. Roy. Do you have any comments?

[Dr. Marie-Claude Roy]

Only to say that would be a perfect ending. I fully agree with what my colleague just said.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you.

I cede my remaining time to the chair, then, in that case.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. van Koeverden.

That concludes the rounds of questions pretty much right at the top of the hour.

Please stand by, colleagues. I'm going to bid goodbye to our witnesses, then I have one small item of committee business to deal with.

To all of our witnesses, thank you so much for being with us today. We were fortunate to have one witness cancel, which allowed us to really get into the issues at some depth, and we very much appreciate the patient and professional way that you have handled all of the questions and the thoughtful presentations.

It will be of great value to us as we proceed along this route of the children's health study, which has a very broad range. We know that you're extremely busy, and we very much appreciate how generous you've been with your time today. Thank you, one and all.

Colleagues, I have one quick housekeeping matter to raise with you. When we embarked upon this study, we did not set a deadline for the receipt of briefs, and if it's the will of the committee to establish a date, I would suggest perhaps a month from today, which would give people lots of time, and it's also unlikely that we will be completely done hearing all of the witnesses by then.

The floor is open.

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

Mr. Chair, based on the trajectory of the committee's work and the expectation that we have some legislation coming our way, if you haven't had the opportunity already, could we check with the analysts if that's going to provide us sufficient time, even though we'd still be receiving briefs in advance of our conclusion of hearing witnesses?