Health Committee on Feb. 7th, 2023

[Dr. Bukola Salami]

Thank you.

That project that I did was only in Alberta. Now, the survey that we're doing currently—with 2,000 Black youth and 50 interviews—is across Canada. In that project, we interviewed 129 Black youth in that focus group. The most frequently talked about contributor to their mental health was racism.

For example, let's take the case of Black boys. Many of them discussed the perception that toxic masculinity was a Black male thing, which, of course, it's not. They also discussed, for example, having always to prove themselves innocent because the first perception is that you're guilty. For everyone else, you're innocent until proven guilty. For Black people, especially Black males, you're guilty before you're proven innocent.

With regard to racism, I remember a quote that one of the youths said. She said, “God, I grew up with so much internalized anti-Blackness. I hated myself. I wanted to be white so bad. I wanted to have lighter lips.” Then she discussed an experience in which she was crossing the street when someone threw a Slurpee at her and calling her a racist bad word. That continues to shape her perception. She's internalized that racism, and it continues to shape her mental health.

Those are some of the things that Black youth deal with in the province of Alberta and, as we've seen in interviews that we've conducted across Canada, across Canada, too.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

What are some of the best practices, then, that you can suggest? We're at the federal level, but I would certainly welcome you to take the opportunity to dive into provincial and municipal levels as well. What are some of those best practices, then, that we can put in place?

You said your study is ongoing. Perhaps you'll have some outcomes at the end of that, but initially are there some steps we can look at today?

[Dr. Bukola Salami]

The consultative part of the study is ongoing, but we've completed the qualitative phase, and there are a few things. Oftentimes we are focused on train, train, train and fundraising initiatives. People get training; they get out of the room; they leave everything in the room, and it's all done.

We need to infuse accountability measures into our training. When people are racist, we can say they are incompetent. Infusing anti-racism, for example, in people's evaluations, in granting programs to ensure.... I am always interested.... A lot of the funding programs will say, for example, “You have to identify gender-based analysis plus.” The only thing is that people hear gender-based analysis and sometimes the plus is thrown away. Sometimes we don't know what the plus means, right?

We need to spell out what the plus means. People need to understand that. We need to make sure we collect data on that. I think race-based data collection is also very important and will help in terms of addressing some of these inequities.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

You mentioned some of that in your earlier testimony, but thanks for highlighting it again. You also mentioned earlier some of the distrust in the Black community.

What factors influence that level of distrust?

[Dr. Bukola Salami]

I am a member of the Black Opportunity Fund, which serves to address anti-Black racism in Canada through raising a pool of funds.

In the early days of the COVID-19 pandemic, we organized town halls to address COVID-19 vaccine hesitancy. I remember doing one of those town halls. One of the parents said, “Is this another experiment that the government is doing on us?” We had to debunk that. There are long-standing issues of mistrust. For example, unethical studies have been done within Black communities that Black people still know about, or are acutely aware of. There is also racism that Black people confront within the health care setting.

That's why I say that competency related to anti-racism is important. When you go to many standards of practice for health care professionals, for example—and I know this is largely not in the federal jurisdiction, but I must mention it—many standards of practice do not even mention the word racism in them, right? That means you can be practising as a health care professional, and be racist. You can still be considered competent, because it's not seen as incompetency based on the standards of practice. We need to change that. We need to ensure that anti-racism is infused in all evaluations, and also in all standards of practice for health care professionals.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami.

Next, we're going to Dr. Powlowski, please, for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you. I have a question for Leila Sarangi from Campaign 2000.

You mentioned in your testimony that there were some immigrants with children who paid tax but didn't get the Canada child benefit. Can you try to narrow this down? Which group of people are you talking about here that are in this category?

I got my overpaid assistant Tyler over there to look this up for me. He came up with this list. He said the people who get the Canada child benefit are the spouse or common law partner who are either citizens, permanent residents, protected persons, i.e. refugees, and temporary residents who have lived in Canada for the previous 18 months, and who are validly in the country.

Can you narrow down the category of people you're talking about who are immigrants and pay taxes but don't get the CCB?

[Leila Sarangi]

There are people with precarious immigration status who have filed and are waiting for a claim to come through. Their immigration claim has been denied, but they cannot be deported, because the Government of Canada has deemed their home country too dangerous, so they don't have anywhere to go. There are people who are in limbo because of their precarious status. It is not a large number of people, so it doesn't cost a lot of money. In that category, they are considered residents under the Income Tax Act, so while they are waiting, they are here, they are working, and they may be having more children born in the country, but they are still denied the Canada child benefit.

Repealing that section in the Income Tax Act, which is arbitrarily making that eligibility requirement, would not have a very big cost in the federal budget, but it would have a very deep impact for these families who are dealing with many health-related and other issues.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

You talked about food insecurity in Nunavut. I would have thought part of the answer to that was the nutrition north subsidy. Does your group have any position on those subsidies and whether those ought to be increased?

[Leila Sarangi]

Our partners in Nunavut and the Northwest Territories have talked about how the subsidies go to retailers and are not necessarily passed on to residents. I get photographs of the cost of food in the grocery stores on a regular basis, where it's about $75 for a piece of steak or $60 for diapers. It's outrageous that the nutrition north program funding is going to the retailers and not necessarily being passed on to the local residents there, which is why we're calling for income transfers directly to families and individuals.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Do you see that as a better way of addressing food insecurity than improving the nutrition north program?

[Leila Sarangi]

From our assessments, yes, that is one of the ways we would prefer to see food insecurity in the north addressed.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Now I'll turn my attention to Dr. Salami.

You mentioned the fact—and I agree with you—that obviously the biggest social determinant of health is poverty, but you just fleetingly mentioned that under COVID perhaps that wasn't the case. Do you want to just elaborate on that? What was a greater social determinant of health under COVID?

[Dr. Bukola Salami]

In 2020, an analysis was done in Montreal, Toronto and Ottawa on neighbourhoods, and when you look at neighbourhoods and COVID-19 distribution, it found that the strongest determinant of whether or not you'd get COVID in the early days of COVID was whether or not you were Black—the concentration of Black people in the neighbourhood.

Before the COVID-19 pandemic, I always told my students that income was the strongest determinant of health. During COVID-19, I started taking caution, but of course there is income.... I mean, racism does not exist in isolation; it intersects, and it reproduces income inequality. It also then intersects with income inequality. Those are some of the lessons we've learned.

I think what would be very important going forward is for us to start collecting race-based disaggregated data, which we did not have before COVID, to really shed light on how to ensure that we can have targeted interventions to address disparities.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami and Dr. Powlowski.

Next we're going to Dr. Kitchen, please, for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair, and thank you all for being here today. It's greatly appreciated.

I appreciate, particularly Dr. Haeck and Dr. Salami, your comments on dealing with mental health, in particular on the aspects of dealing with how it impacts sports and education and how important that is. It's something very important to me, recognizing that it was a great benefit to me many years ago when I was dealing with aspects along those lines. With that said, I hope I'll be able to ask questions on that.

My main first question, though, is.... Thanks to our analysts, we received some interesting information from CIHI, the Canadian Institute for Health Information. They point out that medical complexities make up about 1% of the pediatric population, and they're heavy users of the health care system at around basically 50% of our total hospital costs, which are quite significant numbers.

With COVID, it unfortunately appears that we're seeing a lack of education in public usage of emergency situations in bringing children to hospitals, which is tying up a lot of hospital areas such as emergency rooms with situations that might be able to be dealt with at home with better education systems and better understanding of the health care system. These are important things, so I guess my question is, how do we get that education to Canadians such that they understand it?

What we saw with COVID and we've seen over the last couple of years is basically uncertainty and misinformation that the public believes is coming from government. We as a federal government are trying to deal with something that is provincial in nature, but how do we as a federal government advance that education so that we can educate parents to understand how to deal with health issues for their children?

Ms. Bisaillon?

[Susan Bisaillon]

You're absolutely right. The CIHI study was a really important study. It was done in the last few years, I would say. We're hoping to get the information updated.

On the complexities, that top 1% of them—you're absolutely right—takes up a huge component of the dollars. In terms of thinking about how we work with families, there are not well-established programs. There's not a lot of data. As I listen to my colleagues, I see that there's a huge issue with regard to data with our population.

Certainly, those families may be supported in the acute care sector. That's why they go back to a lot of the hospitals: We don't have well-established continuum-of-care supports. Families need to have stronger supports in the community. They need help to understand how to cope in the community so that we're using our health care system—acute care for acute care—and have well-established home- and community-based care, where families then can cope.

Right now, with the way the system is, we don't have that cross-continuum support. That's what I've been advocating for so that we have an established system of care across, outside of hospitals, and so families don't have to go to the hospital and, to your point, so parents can access services in the community as opposed to going to an emergency department.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you very much. I appreciate that.

Perhaps if any of the other witnesses have anything they'd like to add on that, they can provide it to the chair or the clerk and analysts and we can get that out. I'd appreciate that.

On the issue of sports, which we're looking at and dealing with, Dr. Salami, you talked about that and how one of the recommendations is a possible reinvestment in sports targeting youth, especially for indigenous and Black populations. I agree with you a hundred per cent on that. I see such a benefit from sport. Unfortunately, because of COVID, we lost that ability to get people out.

I'm just wondering if you have any further comments along those lines, because for a lot of it, we start to look into an issue.... You sort of touched on suicidal ideation and that aspect. Participating with groups and being together sort of helps us to communicate among each other.

Dr. Salami, do you have any comments along those lines?

[Dr. Bukola Salami]

I think one of the things about sports is that it goes through several pathways to influence health, whether it's mental health or physical health. We know that sports also contribute.... As I said, community belonging is one of the strong determinants of mental health, at least based on my analysis. Sports can also help in terms of fostering that belonging and social inclusion of Black and racialized kids.

Especially in light of the recovery from COVID-19 and the separation and social isolation that people have experienced, it's of vital importance to invest in sports activities for all kids, but also to ensure that it's subsidized for those who are much more marginalized within society.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami.

Next we have Ms. Sidhu, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair, and thank you to the witnesses for your valuable testimony.

My first question is for Dr. Salami.

You talked about racism, but what role do culture and language barriers play in affecting the health outcomes of immigrant children and youth when they don't have any awareness of vaccination or disease prevention? How does that come in?

[Dr. Bukola Salami]

Someone asked about improving access to emergency services. I think that one of those things is addressing issues related to language barriers and also those related to culture as a social determinant of health.

Years ago, the Public Health Agency of Canada used to have racism subsumed under “culture” as a determinant of health. Now we realize that there are many more differences in terms of racism and culture as the determinants of health, so yes, it's very important in terms of being able to address culture. It's also important to address issues of racism, and also, for a lot of immigrants, to address system navigation: just knowing where to go and how to navigate the system.

Oftentimes, we think of language barriers in terms of, “You speak Arabic and you speak Arabic; just come together and you can interpret for each other, and voila, everything is all done.” Some of the research I have done tells us that there are complexities in terms of interpretation services. You know, one of the participants I interviewed, an immigrant service provider, talked about that. For example, if you have two interpreters, one from the Taliban tribe and one from the Pashtun tribe, and you bring them together and tell them to interpret for each other, there may be clashes in that, because you are bringing together the oppressor and the oppressed.

There also are delicate aspects in terms of gender-based violence. Sometimes you may want to match based on gender.

There are so many complexities in terms of culture and interpretation services, yet, without interpretation, it makes it so much more challenging to address the needs of immigrant populations in Canada.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

How can health care providers better serve the needs of immigrant populations, particularly in terms of language and culture? You already talked about that.

However, can you also discuss the importance of research and data collection—which are very, very important—and how we can bridge that gap? What data and research are needed to better understand the health needs of children in Canada, and how can the federal government support the collection and analysis of this data?

[Dr. Bukola Salami]

I think we need to subjugate our data. One of the challenges, and one of my colleagues said this.... For example, I did a study where I looked at the mental health of immigrant and non-immigrant kids in Canada. When you look at all of the data together, everything gets clouded, but then when you start to disaggregate it.... The problem is that when you go, for example, to the Canadian health measures survey, which I try to use, you cannot disaggregate the data. The analysis is just not possible.

When you go to the Canadian community health survey, which has the largest sample size, and in which you may be able to disaggregate the data, they do not collect data on children who are less than 12 years old. Maybe that's one of the places that we need to begin to start collecting data.

My colleague talked about the longitudinal survey of immigrant children and youth, which also provided disaggregated data related to immigrants in Canada, and there was another national study. However, many of those longitudinal studies have been discontinued.

For example, when you look at much of the small-reach longitudinal data across Canada, some of the challenges are that the sample size for the racialized population is so small.

I'm currently doing a study for the Public Health Agency of Canada, looking at how race-based data is collected for black populations in Canada. There are culturally appropriate ways that we must infuse into our race-based data collection to ensure that we have appropriate sample sizes. Right now, at least with the Canadian health measures survey and the Canadian community health survey, the percentage of black, racialized immigrant population interviewed in those surveys is less than the percentage they represent of the Canadian population. That has to change and we need to be able to disaggregate that data.

[Sonia Sidhu, Liberal, Brampton South, ON]

Okay, thank you.

Ms. Bisaillon, are there any final comments you want to express on that?