Health Committee on Feb. 7th, 2023

[Susan Bisaillon]

Just listening to the conversation is so interesting. I also think of it from the perspective of vulnerability. I deal with a lot of clients and families who are new immigrants or refugees coming into the country. They are labouring over the fact that they're new to the country and there are issues because of access.

Some of the comments I want to emphasize are about trust in the system. During COVID, I had a lot of experience on the ground with indigenous and other marginalized communities.

There is a lot of work to be done in terms of educating our health care colleagues and frontline staff about culturally sensitive care and working with people of different races. There are a lot of biases there. That goes to your point about the standard of care. If you're working in the health care system, there should be standards around how we interact and work with people of different cultures and backgrounds.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Bisaillon.

Mr. Garon, the floor is yours for two and a half minutes.

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

Thank you, Mr. Chair.

I find it very interesting that you are talking to us about data, particularly data that enables us to implement good social policies and compare ourselves to others, for example. It's the flavour of the month.

My question is for you again, Ms. Haeck.

I get the impression that each group of researchers wants its own data and there are a lot of very specific little data collection initiatives.

What would the ideal model be, in Quebec and in Canada, that would enable researchers to get data that is comparable and accessible to everyone, and would put Canada on the world stage?

Do we have that model today?

[Catherine Haeck]

No, we don't have it today.

In fact, there are a number of initiatives funded by the federal government. It funds all sorts of projects all over Canada, where people create their own databases. When researchers do that, the data they collect belongs to them and is not disclosed to others. So the researchers are funded out of public money, their data belongs to them, and the data is not accessible to other researchers.

So the best way to work it is to go through Statistics Canada so the study is conducted using recognized methods, so we know how it was done, so the sample is representative of the population and important minority subgroups...

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

Forgive me for interrupting you.

How is it that this is still not the case? How is it that we are still working in a decentralized manner and we don't have this model? How do you explain that?

I'm surprised at your answer.

[Catherine Haeck]

I have no idea.

For example, the data used for doing the UNICEF report that some people have talked about is the HBSC data funded by Health Canada, but it is not accessible to researchers. I have tried to obtain it, I promise. It is impossible to access that data, even though it is collected using public funds and is used to position Canada on the world stage.

This isn't data that comes from Statistics Canada. We can't validate or verify the data. The methodology used is not easy to understand, to make sure the research has been done properly, and we can't be certain that the samples used are representative of Canada.

In my opinion, assigning the data collection to an organization of researchers rather than to Statistics Canada, for ranking Canada in the world, makes no sense. I don't know what logic is behind this arrangement, but this kind of funding, which is allocated here and there around the country, is very common.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Haeck.

Next, we have Mr. Johns, please, for two and a half minutes.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Thank you.

Ms. Sarangi, in May 2022, Auditor General Karen Hogan did a report. She stated that with the CCB, the government has not done enough to help hard-to-reach Canadians access the benefits they're eligible for, and it failed to improve the lives of individuals who need the help the most. She cited indigenous peoples, housing-insecure individuals, new immigrants, newcomers to Canada, refugees and people with disabilities as being disproportionately impacted. I can see that in my own riding, certainly with indigenous people who might be behind on their taxes and whatnot. They said it lacks insight.

What changes need to be made? In your recommendations, you talked about the cost of families not getting the CCB as a result of these failures.

[Leila Sarangi]

Of the changes that need to be made, automatic tax filing will go a long way. It will help people who have filed taxes in previous years, for whom the CRA has information. They can automatically file taxes, and then individuals can go back in later and make any adjustments. That's something that was in the mandate letter to the minister. We feel that should be moved on.

We need to broaden that income tax system using those kinds of initiatives that are more community-based.

[Gord Johns, NDP, Courtenay—Alberni, BC]

There's still no comprehensive action plan.

Can you speak about the cost of that to the children who are impacted?

[Leila Sarangi]

There's a deep connection between material deprivation that comes along with not having access to those benefits.... There's a lot of money that is left on the table from families who are not filing taxes and don't have access to that money. That means children are going to school without the right kinds of clothing and without food in their stomachs. Families are missing out on medication. Rents are not being paid.

I think, as we're talking about some of those social determinants of health, we need to look holistically, including at how to keep people housed adequately and how to make sure people have access to medications. Those basic needs are things families have trouble with. They cannot access them if they're not receiving their income benefits. That leads to a lot of stress in families, and it leads to worse mental health and all the outcomes we've been hearing about from all the panellists today.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Sarangi.

Next we're going to go back to the Conservatives and Dr. Ellis, please, for five minutes.

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

Thank you very much, Chair.

As I said at the outset, it's been a very interesting panel to help us understand the plight of children in Canada and, perhaps, some of the way forward.

I have a question for Dr. Salami, if I may, and then I'd like to turn to the other witnesses in a different vein.

Dr. Salami, you specifically referenced the credentialing of internationally trained health care workers. I can well imagine that it sets a great example for children and families. Of course, generally speaking, jobs in the health care sector are better paying than others, which again helps kids.

Can you talk a bit about any ideas you may have about credentialing international health care providers?

[Dr. Bukola Salami]

I should preface by saying that my doctoral work was actually on the migration of Philippine-educated nurses to Canada to work as domestic workers. That was about nine years ago, but some of the issues still exist now.

I am also on some WhatsApp groups for some internationally educated professionals. In the past I have helped organize information sessions to bring together the National Nursing Assessment Service with internationally educated professionals. There are small things we can do and there are big things we can do. In some of those sessions, internationally educated nurses have talked even about the length of time it takes in terms of credential assessment, or about being able to have a checklist on the website, so that when they're sending their documents back home, those back home know that these are the things they need to provide to be internationally educated.

In terms of provinces, there are so many differences in requirements, in both English language requirements and other requirements. Then there's the three-year entry into practice competence. The requirement is that you must have practised in Ontario within the last three years to become an internationally educated nurse. When you go to Alberta, it's five years. Why are there so many differences across Canada in terms of that?

Opportunities that allow professionals to be able to practise across different provinces may also be beneficial for internationally educated professionals. For example, at the federal level.... A lot of the policies related to internationally educated professionals fall under the provincial level. At the federal level we can do more by supporting the National Nursing Assessment Service to be able to facilitate.

For example, right now a lot of the processes related to credential assessments for internationally educated nurses are actually done in the U.S. That slows down the process. If we want to really hasten it, make it so that it's done in Canada. It will cost us more, but then how many gains will we have in terms of patient outcomes and the supply of human resources? I think in Canada that's one thing we need to explore. Is it possible to actually have things done in Canada so that we are able to move internationally educated nurses faster through the system?

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

Thank you very much.

Doing more things and making more things and having Canadians prosper really makes sense to our side of the House, anyway.

That being said, I have a couple of other questions, so I'll change gears a bit.

Professor Haeck, you talked about school closures and certainly a difference in Belgium. Did any Canadian jurisdictions that you know of do a better job than others? That's not to create disparity but to look at lessons learned as we go forward.

[Catherine Haeck]

In terms of school closures, it was pretty uniform across Canada, but some provinces reopened schools a bit faster. In Quebec we reopened schools a bit faster than elsewhere. Then again, it wasn't that much faster, so it didn't make a big difference. I know schools in Ontario were closed a bit longer than elsewhere, especially in southern Ontario, where in January 2021 they were closed for a while.

Thinking about it, I love this about Canada. We're able to do different things and learn from each other, and I think we really should try to learn from what we did. The problem is that we don't have data to learn from all of this, because we didn't collect data on kids over the last three years.

Yes, there were some provinces that were marginally better, but there was nothing fantastic.

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

Thank you very much.

I think I'm almost out of time, Chair, so I will cede the rest. Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Mr. Jowhari, you have five minutes, please.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thank you to all the witnesses. This has been very great testimony focusing on many things, whether it be the social determinants of health, the impact of COVID on the most vulnerable, or the data and some of the research done around the intersection of gender, race, class and nationality.

A lot of the questions I had were answered, but I'd like to take a little bit of time and look forward. Specifically, I'd like to look at the policies that exist, the practices that exist, the opportunities there and what we should really focus on to address some of those challenges.

With four minutes remaining, I'm going to go to each one of the panellists here and ask for a one-minute intervention. I want to acknowledge that health is a shared jurisdiction between provinces, territories and the federal government, but if there was one area of policy that we could focus on to help improve or eliminate some of the challenges you highlighted, what would that area be? That would be really helpful for our study.

I'll start with Professor Haeck and continue in the order in which you presented. Could you please give us that one policy that you think we should be advocating for?

[Catherine Haeck]

I think that when it comes to policies, we are investing massively in childcare all across Canada. I think that is a good initiative; it's a way of providing high quality services for the most vulnerable. For children, everything happens primarily before the age of five.

I think that is where we have to put our efforts in order to do a good job everywhere in Canada. That being said, it is necessary to collect data so we know whether our work is effective. Just throwing money around without knowing what is being done will not help us.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

I'm proud to announce that our government has made sure that the $10 day care is a reality now, so thanks to all the provinces who participated in this.

Next we go to Dr. Salami.

[Dr. Bukola Salami]

I would say addressing racism as a social determinant of health. As I said, there is segregation in the health care workforce. How do we have interventions that ensure that there is diversity across all levels of the health care workforce, from leadership positions to frontline service delivery?

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

That's very informative. The timing is perfect, as we are about to release our findings related to the health care workforce.

Next we go to Madam Sarangi.

[Leila Sarangi]

Thank you.

I have talked a lot about the Canada child benefit and what can be done to broaden and enhance that. I think our bottom line is raising incomes for families. That goes a long way. Studies have shown how raising incomes in low-income families leads to better overall health and wellness and better outcomes for children.

Just because the day care model has been mentioned, ensuring that the expansion of that model goes into the public not-for-profit day care systems and that it's accessible to families who are on low incomes.... Campaign 2000 has worked with advocates and researchers to put forward a “zero to $10 a day maximum” sliding scale model to make sure it is accessible to the families we are concerned about who are on very low incomes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Madam Sarangi.

Last we have Madam Bisaillon.