Health Committee on Feb. 7th, 2023

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garon.

I am informed that there has been an attempt to contact the workers to ask them to stop working.

We can suspend the meeting while we wait for the problem to be fixed.

It seems that someone is there to try to fix the situation.

Dr. Hanley, you have about another 90 seconds.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Maybe I'll take this opportunity to move to another question. I think you pointed out a useful reference there.

I want to move to Dr. Salami and then save a few seconds at the end.

Dr. Salami, we heard a story in the media today about the lack of research on Black Canadians and cancer outcomes. It led to that theme of the research environment enabling adequate research on racialized or marginalized Canadians.

Can you comment generally on how you see the adequacy of funding and whether there are ways we should be improving that?

[Dr. Bukola Salami]

As I said earlier, we have a lack of data—disaggregated race-based data. There is a strong need for disaggregated race-based data.

When you talk about cancer, I just did an analysis of the Canadian community health survey and found that 18% of the Black population have never had a pap smear in their lifetimes. For white Canadians, it was 7%. That has consequences for health outcomes.

As you said, there are disparities in terms of data in cancer outcomes, so I think we need to do more, even in terms of children, to be able to address some of the disparities children face. We need the data out there. We need investment in research to be able to uncover what those disparities are and what the best approaches are to addressing some of those disparities.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Do I have any remaining time?

[The Chair, Liberal, Sean Casey]

You do not.

Thank you. I'm sorry for the interruption, Dr. Hanley.

Mr. Garon, you have six minutes.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you, Mr. Chair.

First, I would like to confirm that there is no torture in Canada. I therefore retract what I said earlier.

I would also like to take the opportunity to thank all of the witnesses for being with us today.

Ms. Haeck, last fall, an official appeared before the committee and said, in answer to one of my questions, that there were no studies about the effects of the lockdowns and school closings on children's health, socialization or mental health. I am a bit confused, because in your opening remarks, you suggested that those studies existed.

Can you confirm that that is actually the case?

[Catherine Haeck]

Yes.

Those studies exist and date from before last fall.

A lot of things were done during the pandemic. As I said, in the summer of 2020, we were already publishing things that gave an idea, based on what we knew from the earlier literature, about the consequences of the impact of school closings. We now have real studies, that were published before last fall.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you.

We are talking about children's health, but it is important to talk about healthcare funding. In fact, an important meeting is taking place today between the provincial premiers and the federal government.

I have the feeling that our healthcare systems have been underfunded for a long time, that the provinces had been experiencing shortfalls in federal transfers for a long time, and that, to a certain extent, children paid for adults during the pandemic. That is, to protect adults, who had more serious symptoms of COVID‑19, we closed the schools because the hospitals did not have sufficient capacity.

I wonder whether the chronic underfunding of our healthcare system ultimately caused indirect harm to children's health. This is important, because it is a federal responsibility. Children's health itself is not, but healthcare funding is.

Do you agree with my interpretation?

[Catherine Haeck]

I agree entirely.

The Belgian schools were closed for much less time. I did my doctorate in Belgium, so I can tell you that the healthcare system in that country has much greater capacity. The system is able to absorb the cost. The schools reopened before the end of 2020, and they were able to measure the impact of the seven-week closing on their children. There were super data, which we do not have.

So it is certain that our system's weak capacity harmed our children. They paid the price, and they are still paying it today. I would really like people to bear this in mind: it is far from over. Adults have moved on to other things, but children are still suffering.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Thank you.

Here in Ottawa, people want there to be conditions attached to health transfers, but what's funny is that there are so many needs all over, that the groups all come, one after another, asking for health transfers that are unique to their own fields. My conclusion is that there is a funding shortfall in general.

Because distinctive features would be needed everywhere, they would not be needed anywhere, in fact. This is particularly true for mental health, which is obviously not under federal jurisdiction, but nonetheless there is a Minister of Health in Ottawa.

If there were better funding for healthcare, stable, predictable, unconditional funding, would we have been able to do more mental health prevention with children in the last few years? What effect would that prevention have today, or what effect would it have had during the pandemic?

[Catherine Haeck]

I will give you an example.

I did a study of more than 800,000 children in Quebec using administrative healthcare data from Quebec. I found that we are unable to diagnose attention deficit and hyperactivity disorders properly in Quebec. In fact, that isn't just in Quebec; it's everywhere in Canada.

Because we do not invest enough in healthcare and healthcare services for children, we are unable to diagnose properly. So we find ourselves medicating children for nothing, without knowing the long-term effects of the drugs.

That is one of many examples showing that we are not focusing on prevention. Given that we are under-investing in healthcare, we do things in haste, and that has an impact on the education system. Teachers inherit these children who have not received proper care from the healthcare system.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Obviously, I want to pick your brain about this. Do you feel that the federal government is in a good position to design services, to plan mental health services, to tell the provinces how to orchestrate them, and to assess the needs?

Do you believe that the brains of the thing should be in Ottawa, if we want to provide children with good services and be able to do prevention, particularly in mental health?

[Catherine Haeck]

No. Knowing what needs to be done and how to provide the services calls for on the ground expertise. You have to be very close to the ground, and while the federal government does its best, Ottawa is far from the ground. So it is not in a position to make this type of choice.

This really has to be left under the provinces' jurisdiction, particularly knowing that each province's situation is different, in terms of both its cultural community and its health problems, which may vary from one place to another. The provinces really have to be allowed to choose what makes most sense for them.

Services are organized very differently from one province to another already. If the federal government tries to get involved, that risks causing mayhem.

[Jean-Denis Garon, Bloc, Mirabel, QC]

I have 30 seconds left.

I'm going to follow up on what you said earlier. COVID‑19, lockdowns, and the fact that the schools had to be closed because the hospitals were overflowing, had consequences for children's socialization, learning, and physical and mental health.

How long are these consequences going to be felt, do you think?

[Catherine Haeck]

It's hard to estimate, but certainly they are going to be felt for some time. That will be longer or shorter, depending on the age group. I think some age groups will have been affected much more than others, and I am not expecting that we will see the end of it for at least another five years.

I have no scientific basis to rely on in saying that, but some studies have been done. For example, a study was done in Chile on large-scale school closings, and the effects have been felt even into adulthood among some people who were affected when they were very young.

So it can last a very long time. It depends on the measures put in place: how long it lasts will depend on what we do. Personally, what worries me is that I feel that we are forgetting our children. I feel that we have moved on to other things, we are no longer investing in them, and we are no longer talking about the effects of the pandemic on children.

[The Chair, Liberal, Sean Casey]

Thank you, Monsieur Garon.

Next we have Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

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

Dr. Haeck, I'd like to start with you, please. A peer-reviewed journal article co-authored by you discussed the need for a “unified monitoring strategy” to address data gaps on childhood development indicators in the context of the COVID-19 pandemic. You and your co-authors noted a lack of both intersectoral and longitudinal data.

There's going to be a lot of focus on data today, as the provinces gather with the federal government. I think we all acknowledge that the lack of unified longitudinal monitoring systems in most provinces and territories is cited as a barrier to the early implementation of preventative and therapeutic services.

The Manitoba population research data repository is provided as a positive model. Can you outline for us what the elements of Manitoba's data repository are that might make it successful?

[Catherine Haeck]

In fact, what would have the most success and be the best for us would be for the federal government to put systems in place to collect data about children, and for that data, which would be protected and high quality, to be hosted in data centres dispersed throughout Canada and be made available to all researchers.

Historically, we had access to very good data about children. It wasn't perfect, but it was very good quality. It came from the National Longitudinal Survey of Children and Youth, which was abandoned in 2008, at the time it was last published.

This type of data is extremely important for understanding children's development. We can't just rely on administrative data because, as other witnesses have said, administrative data does not show the child's cultural community or religious affiliation, for example. All sorts of dimensions are missing from administrative data, but they are very important for understanding children's development and welfare.

We need a central initiative that collects data from all over Canada so we can compare results from one province to another; that data set must be large enough to be able to study small groups. I heard other witnesses talk about the fact that we can't study small groups, but it's not because researchers don't want to. I assure you that we want to. However, when we are working with small samples, the data are not valid. When there are not enough people in the sample, we can't say anything about it and Statistics Canada doesn't even let us output the data.

I was a laboratory director at Statistics Canada for several years and I am very familiar with the machine. We need major funding from Statistics Canada in the area of children's health. Children represent almost 20% of our population, but I can assure you that Statistics Canada does not devote 20% of its budget to collecting data on children. The agency can put out the Labour Force Survey every month; it can...

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm sorry. I'm going to stop you there, if I may, because I have other questions. Thank you for that.

I will move to Campaign 3000. I'm sorry—2000. It's inflation.

[Voices]

Oh, oh!

[Don Davies, NDP, Vancouver Kingsway, BC]

According to Stats Canada, one-parent families with young children are almost five times more likely to experience poverty than couples with children of the same age. You've clearly made a link between poverty and poor health in children.

In your view, what steps should the federal government take to address that disparity?

[Leila Sarangi]

I would point out that the majority of those families are led by single mothers, so intersectional, disaggregated data is needed to help us better understand who these families are. The supplement targeted to low-income families that I mentioned would drastically reduce the rate of poverty among lone-mother-led families from an estimated one-third to about 8%, and it would do that very quickly.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Salami, I'm a proud graduate of the University of Alberta, so I have to ask you a question.

You clearly linked the intersections of racism, poverty and health among Black youth in Alberta. I know you talked about the need for more research. From the research that has been done, have any solutions emerged that you would recommend we adopt?

[Dr. Bukola Salami]

One thing that has been repeatedly talked about on this panel is the need for us to focus on the causes of the causes. We've already mentioned some of those causes: income and racial and gender inequality. You talked about single-parent families. For example, I've done research, in the past, on single-parent moms. Black boys living in single-mother households face one of the starkest disparities in Canada, including in outcomes. Providing much more support is important.

When I've done interviews in the past, people also talked about parenting programs. Oftentimes, we think parenting programs are just for kids, but they're also for family health. Kids are situated within the context of families. When families have better health outcomes, it's better.

There's also the talked-about need for community-based mental health service delivery that is focused on not just institutions and acute care but also community. In terms of resilience, there's a need to create community belonging and strengthen positive cultural identity for Black and racialized communities. Spirituality is important, and building the capacity of religious and spiritual leaders. There's also access to sport and subsidizing sport participation, so people are able to capitalize and build on their resilience.

I would say that addressing racism is also of vital importance.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Davies.

Next, we have Mrs. Goodridge for five minutes.