Health Committee on Feb. 7th, 2023

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

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

I think the variety of different topics covered in today's meeting shows how broad and, perhaps, challenging this subject is. In this committee, we've learned, many times over, that children are not just tiny adults. They are their own entities, with different challenges. As the mom of a small kid, I see that on a very regular basis.

My first question is for Ms. Sarangi.

You touched on a piece very near and dear to my heart: northern and rural communities. After eight years of this government being in place, we're seeing record-high food inflation. In my own community of Fort McMurray Wood Buffalo, we've now seen that a third of the clients of the Wood Buffalo food bank are children, and the demand is rising month over month. We're seeing more and more kids going hungry, and we know that kiddos can't learn if they don't have adequate food.

My question to you is specific to northern, remote and isolated communities: What do you think part of the solution is to this?

[Leila Sarangi]

Again, I'll go back to the Canada child benefit: adding an additional supplement for families in northern and remote communities, one that takes into consideration the cost of living. Families in Nunavut have extraordinarily high rates of food insecurity and child poverty. Targeting those families through an additional income supplement is easy to do, because the administrative piece is already there. It just takes a bit more investment in the form of that additional supplement for those families.

That is one very quick and easy way to start to address this. Of course, there are more things that need to happen, but that is one quick and easy low-hanging fruit you can pick off quickly, I think.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I appreciate that.

I call Fort McMurray home, and Fort McMurray's groceries are substantially more expensive than what we see here in Ottawa. The further north I go, even in my own constituency, the more expensive groceries get and the more expensive gas gets. As the carbon tax has been added on and is ever increasing, what we're seeing is that it's being passed on to consumers. Milk is now more unaffordable than it was before, because the cost to transport the milk to some of these communities is that much more expensive.

Have you done any studies or is there any research that's been done on how much you would have to increase the CCB in order to combat this record-breaking food inflation?

[Leila Sarangi]

We have not done that study yet. I think that is a very interesting question, and it's a question I can take back to my colleagues.

We have done a study on the supplement for families in low income and how much it would cost to bring incomes up to the low income measure. In our submission, we have called for an investment of just over $6 billion for that “end child poverty” supplement that would cut rates of child poverty from an estimated 9%, according to the market basket measure, to about 3% in the first year.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Wow. That's very shocking. Thank you for that information.

To switch gears a bit, I'll go to Dr. Salami. As a University of Alberta alumna, I'm grateful to see you here. Thank you for the work you've been doing.

You talked a lot about the Black racialized.... Have you done any studies on indigenous people and how that impacts...?

[Dr. Bukola Salami]

My area of expertise is not.... I'm a strong ally and I know that there is a strong need out there—

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

No worries. I just wanted to see if you had.

It became very evident to me as you were doing your presentation that you are very supportive of community-based supports, like churches. Multiple times over, you talked about that. Again, to draw back on my experience in Fort McMurray, when we had to evacuate, it wasn't the big, bad government that came in and helped and made people feel good; it was churches and different community organizations that came from all over, opened up their doors and made my community feel so welcome in Edmonton and across the province.

One of the things we've been seeing from this government is tightening up on financing. That is preventing some of these church groups from being able to get summer students, and restrictions are being placed on them.

Do you think that's a wise move?

[Dr. Bukola Salami]

I will tell you, I did that study and analyzed the Canadian health measures survey to look at the mental health of immigrants in Canada. No matter how much we analyzed the data of 12,000 people on the Canadian health measures survey, the two strongest contributors to mental health were community belonging and income. When people feel they belong to a community, they are more likely to rate their mental health as being better.

I also, in the past, interviewed 300 families. When people feel like they belong.... The problem is oftentimes, we expect community agencies to support our racialized communities, but we do not give them the tools and the resources to be able to support or improve mental health.

I would support any activities that provide tools to community organizations to build the capacity of religious leaders and community organizations to address and improve mental health.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami.

We'll have Mr. van Koeverden, please, for five minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thanks very much for all the testimony from all the witnesses. It's been extraordinary. I've been really excited for this study. I'm glad we're focusing exclusively on children for a couple of weeks.

It's been very clear from all witnesses today that the inextricable link between income and health outcomes is critical, and we need to have a greater look at that.

When I look at those UNICEF numbers, I'm troubled as well when I see that Canada ranks so low. Weeks ago I did a little research on child poverty rates in Canada. In 1989 the House of Commons voted unanimously to end child poverty by the year 2000. Despite that, in 2013 it was higher than ever. By 2013 child poverty rates were worse than they were in the 1970s. Since then, thankfully, they've dropped by 71%, but they're still about 4.6% or 4.5%, which is too high for Canada.

I recognize that reducing child poverty doesn't instantly solve the problem, and that health outcomes aren't going to change immediately, even over a couple of years. There are lots of studies that show that if you're poor as a child and not as an adult, then health disparities persist throughout your life. That's something we need to address as well, but through measures like making the Canada child benefit not universal. Not sending $300 cheques to every single family in Canada but rather making it more of a means-tested program has been successful in reducing child poverty rates in Canada, but these numbers are still not satisfactory, particularly when ranked against those of our OECD counterparts.

Dr. Salami, my questions are for you. I loved your testimony. Thank you very much.

I'm particularly interested in subsidies for physical activity for youth. I think physical literacy is one of the best precursors for later health. How can we do a better job of bridging the gap in those OECD numbers, bringing our rank for child health closer to where we would like it to be—in the top 10 ideally, or maybe even better than that?

You have answered the question already, but from the perspective of recognizing that Canada has a low child poverty rate but still really disproportionately poor health outcomes, what can you point to in terms of the cause, and how we can do better?

[Dr. Bukola Salami]

I must say that poverty and income inequality do not exist in isolation. We also see, for example, race-based inequalities and how those contribute, for example, to income inequality.

Statistics Canada just released a report that found that, contrary to public opinion, African immigrants have one of the highest education rates in Canada. Also, consistent with popular opinion, African immigrants have one of the worst income rates in Canada. Access to professions and addressing those underlying inequalities will support and help in terms of addressing issues related to poverty and also the consequences of that: issues related to health.

Something that has also been talked about in some of the interviews they have done is access to professions for internationally educated health care professionals. We know, for example—and people have said this—that the health care workforce or the general workforce in Canada is like a cappuccino. It's white on top, and it's black underneath.

We need to stir it up, and that has consequences. In the case of the COVID-19 pandemic, it had consequences. We had a higher number of black people affected by COVID-19 because we had more black people on the front lines providing one-on-one care. We had more black people taking the bus. We had more black people with limited spaces, and that increased exposure to COVID-19, so the long-standing inequities that we experienced before COVID-19 had significant impact on the experiences during COVID-19. It is addressing those racialized health inequities that will help us to address some of the health inequities that we experience.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you. That's extremely clear. I appreciate that.

You mentioned sport, physical activity and recreation, in your testimony, so I thought maybe I'd provide you with an opportunity to elaborate a little, since that's my policy interest as well.

[Dr. Bukola Salami]

The youths I have met talked about.... For a lot of Black youth, a way for them to deal with the racism they experience, or the challenges, or just the general everyday stress was to engage in sports. People talked a lot about basketball and being able to engage in that.

Many of the youth discussed.... During the pandemic, in some provinces the bars were open but the sports activities were closed. They felt it was just such an inequity that what could help kids was closed, but the bars were open.

I think increasing access to sports and recreation, including subsidizing recreational facilities for low-income populations, will help in terms of addressing those inequities.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami.

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

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

Thank you, Mr. Chair.

I am going to continue with Ms. Haeck.

The provinces are facing much more serious financial constraints than the federal government is. That has been documented by the Parliamentary Budget Officer.

In the long term, we find ourselves in a situation in which healthcare is taking up more and more space in the provinces' public finances. As a result, other government missions suffer.

The second most important mission when it comes to the provinces' budgets is obviously education. Given that you work in both fields, I would like you to tell me whether, in your experience, it is easy for Quebec to come up with new money to work in both prevention and education for young children.

What could the federal government do to facilitate the provinces' funding in those fields?

[Catherine Haeck]

Thank you for your question.

In my first economics of education course, I show the extent to which healthcare eats up the budget. The fact that more and more is being invested in these causes funding for more or less everything to decline, particularly in education, but also in the community services that support the most vulnerable people. The result of this underfunding is that very little prevention work gets done.

I sit on the scientific committee on the prevention of obesity at Quebec's Institut national de santé publique, which is its public health expertise and reference centre. The committee has all sorts of lovely ideas about prevention for children and adults, but when it comes time to fund them, there is no money left to do it.

So all the money is often spent on caring for older people, and that is to be expected. However, the result of chronic underfunding of healthcare is that there are no prevention measures. Consequently, obesity among young people in Quebec and everywhere in Canada has risen enormously over the last 30 years. That problem would be fairly easy to solve with properly targeted prevention measures, because doctors and everyone working in the field have a lot of good ideas. However, they have no money to put them into action. So much for healthcare.

The education sector is also underfunded. So we find ourselves with a lot of children who have all sorts of problems and we don't have the resources to help them, because the money is being redirected to other needs that seem more urgent.

It has to be said, however, that children are our future. If we don't spend money on them, we are heading for a wall. We are eventually going to have to wake up. We can't keep investing money elsewhere than in our children, because that is going to catch up with us later on and we are going to find ourselves with a very messed up population when they reach adulthood.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Haeck.

Mr. Johns, welcome to the committee. It's so nice to see you.

You have the floor, sir.

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

It's good to see you, Mr. Casey. It's really good to be here.

Thanks so much to the witnesses for your important work. I was listening to you on my way over to replace Mr. Davies, and I really appreciate it.

What I really want to speak about is how, in Ontario, there are 28,000 children on wait-lists for community-based mental health. These waits can range from 67 days to more than two and a half years, depending on the service. That exceeds clinically appropriate wait times.

For children and youth, delays in accessing care—and I'm sure you can speak to it—can have lifelong impacts for them, their families and society. Tragically, it can be a matter of life and death. You talked a bit about UNICEF. According to StatsCan, suicide is the leading cause of death among youth and young adults aged 15 to 34. UNICEF has reported that Canada has one of the highest rates of youth suicide in the world.

We've been waiting for two years for the government's promised $4.5-billion mental health transfer, which clearly is not even enough.

Can you speak about the impact of the delay in that mental health transfer on youth?

Maybe I'll start with you, Ms. Bisaillon, if you want to speak a bit about that.

[Susan Bisaillon]

Certainly. The area I'm really focused on is children with medical complexities and more with disabilities, so I can't really comment with much evidence around the mental health.

However, I am in close contact and working with national groups like Children's Healthcare Canada, and with my colleagues in the acute and community systems. They are totally overwhelmed. What I hear is that they're not getting sufficient supports. They're not able to grow their programs to meet the demands.

We've seen the isolation and the mental health issues that have come from COVID rise, even in other focuses like eating disorders, depression and anxiety. The context I'm giving you is really from working with my colleagues.

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

I appreciate that.

[Susan Bisaillon]

I certainly can echo that I know it's a significant challenge in Ontario and across the country. Maybe my colleague, Dr. Salami, can also comment on that, as well. It definitely is a challenging area.

[Dr. Bukola Salami]

I totally agree with the need for community-based mental health service delivery. Right before the pandemic, we did a study in Alberta to look at the mental health of Black youth. We did one before the pandemic, and we did one after the pandemic.

We engaged about 129 Black youth in conversation cafés and also interviews on their mental health. On the last day of the conversation cafés, Black youth took us through what an ideal mental health service delivery would look like: culturally appropriate, delivered in spaces that are accessible to Black youth, and also provided by Black mental health practitioners.

Youth took that data, and they used it to create the mental health clinic—the first mental health clinic for the Black population in western Canada—during the pandemic.

One of the challenges, of course, is that a lot of the funding for mental health is put into acute care, which usually is a downstream approach to mental health service delivery. If we're able to address some of the upstream approaches.... Before, I talked about the need, for example, to look at community-based mental health service delivery, to build and capitalize on the strengths of community leaders, religious leaders, while also understanding that not everyone goes to a religious leader. We need community support and community to be able to address some of the mental health issues, and also community-based service delivery.

I've interviewed immigrant service providers before. They've talked about the backlog in terms of the long wait-list for people to be able to see mental health psychologists, counselling psychologists and practitioners. We just need much more investment in that in the community.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salami.

Next we have Mr. Jeneroux, please, for five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair, and thank you to all the witnesses for taking the time today. I think a lot of the testimony's been quite fascinating.

I want to pick up on a journal article that you wrote, Ms. Salami, in CMAJ. This is from the October 24, 2022, edition. One of the quotes in there says, “Racism was the most frequent factor identified as contributing to the mental health of Black youth,” in Alberta. As an Alberta MP, that jumped out at me and was of interest.

I'm hoping you can elaborate on some of those links between racism and discrimination and mental health and wellness in youth. Obviously, your expertise is in Alberta, but if there are other comments from across the country, too, I would certainly welcome them.