Evidence of meeting #56 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pediatric.
A recording is available from Parliament.
Chair and Chief, Department of Pediatrics, Faculty of Medicine, Université de Montréal and Centre hospitalier universitaire Sainte-Justine, As an Individual
It represents approximately 100,000 preterm births.
Bloc
Chair and Chief, Department of Pediatrics, Faculty of Medicine, Université de Montréal and Centre hospitalier universitaire Sainte-Justine, As an Individual
Well, in Quebec, birth weight data are reliable since around 1976. As a result of the phase during the transition to the metric system, we are not always entirely sure whether weight data entries are in pounds or kilograms, hence the importance of having quality data. Sometimes, for example, we don't know whether the weight indicated was three pounds or three kilograms.
From 1976 onward, the data are reliable. This enables us to track people up to the present day. Since 1987 in Quebec, we have reliable data from MED‑ECHO on the history and diagnoses made during hospitalization. However, we don't have reliable data on visits to the doctor. If someone went to the doctor's office because of diabetes, an ear infection or for any other reason, we have only a single diagnosis, the one drawn from the database.
There are areas that need improvement; hence the importance of data.
Bloc
Luc Thériault Bloc Montcalm, QC
Given the advances in neonatology research, how many weeks is a fetus considered viable without any disastrous consequences?
Chair and Chief, Department of Pediatrics, Faculty of Medicine, Université de Montréal and Centre hospitalier universitaire Sainte-Justine, As an Individual
We could have a separate discussion about the definition of “disastrous consequences” for three hours, but in most western countries, or the richest countries, children are generally resuscitated at 22 to 24 weeks.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Nuyt and Mr. Thériault.
Next is Mr. Davies, please, for two and a half minutes.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thanks.
Dr. Blackstock, I wasn't sure if you were referring to a historical figure, but is there a relatively accurate number about what Canada spends today per capita on indigenous children's health versus non-indigenous children's health?
Executive Director, First Nations Child and Family Caring Society of Canada
I don't have that information.
NDP
Don Davies NDP Vancouver Kingsway, BC
When you referred to “three times” more, was that a historical figure?
Executive Director, First Nations Child and Family Caring Society of Canada
Yes, that was a historical figure.
The Auditor General has done some reviews of health care delivery in northern communities, etc. This is why we want the Spirit Bear plan. It's to cost out those inequalities and propose remedies for them.
NDP
Don Davies NDP Vancouver Kingsway, BC
You anticipated my next question. I know that the Spirit Bear plan was adopted by the Assembly of First Nations chiefs and assembly in 2017.
Executive Director, First Nations Child and Family Caring Society of Canada
That's correct.
NDP
Don Davies NDP Vancouver Kingsway, BC
Could you outline the federal government's response to the Spirit Bear plan to date? Have they committed to timely and full implementation of that plan?
Executive Director, First Nations Child and Family Caring Society of Canada
No, they have not, and they have not proposed an alternative that would remedy those inequalities.
NDP
Don Davies NDP Vancouver Kingsway, BC
I want to turn a bit to food insecurity.
We've been hearing a lot about it at this committee. When we think of health and our health system, we often think of the treatment of illness once people are ill, but the determinants of health and preventive measures such as making sure children have access to good nutrition are also on our minds. Can you tell us what you think we should know about food insecurity and the impact it has on indigenous children in Canada?
Executive Director, First Nations Child and Family Caring Society of Canada
I'm alive to the testimony yesterday of the large grocers and the impact that food insecurity has on Canadians.
I've been to many northern communities where a small jar of peanut butter is $16, and that was before the inflation element. Being able to make choices about feeding your family a healthy diet is almost impossible in northern communities, yet things such as cigarettes and booze are often subsidized.
I think we need better subsidies to make sure people in northern Canada who are living in these other areas are not paying prices for groceries that we are not even glimpsing at here in southern Canada, even with inflation.
NDP
Don Davies NDP Vancouver Kingsway, BC
We talked about data. Do you agree that Canada should have a national data strategy related to child and youth health, including, of course, an important focus on indigenous children? What is the state of data in this country on indigenous children's health?
Executive Director, First Nations Child and Family Caring Society of Canada
It's not good.
The Truth and Reconciliation Commission pointed to that recommendation as one of the top calls to action. For example, in child welfare, countries like the United States, which has 50 different U.S. states, have national child welfare data collection systems so they know about the kids who are in care, what their needs are and how they're doing over time. Australia also has it. Canada does not.
What is the rationale? The rationale is that we have 13 different districts, but surely if the United States can overcome 50, we have the competency to overcome 13.
This type of data is going to be very important for making sure we are able to track whether the different interventions we're making, be they at the policy or the treatment level, actually are working for kids.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Blackstock.
We have Dr. Kitchen, please, for five minutes.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
I'm so impressed. The panel we have here today is just amazing. Their answers are so succinct, so clear, and they're much appreciated by the committee.
In doing a study on children's health, where do we begin? There are so many avenues to touch on. How do we do that?
Hopefully, I can get a couple of questions in here.
Dr. Quach, thank you for your work with NACI and for your presentation to the committee in the past. We really do appreciate that.
Over the years since COVID-19 started, there have been lots of things. Today you touched on one thing that's of interest to me.
You mentioned polio being back in the U.S. for the first time. I've been to the polio centre in Islamabad, Pakistan, and I've seen the great work that they're doing and the great work that all Rotarians do in Canada in helping to fund some of that programming to deal with the polio vaccinations. We have measles. We're seeing parents who are not having their children vaccinated for measles. We're seeing tuberculosis back in Canada, and that's something that lots of Canadians don't even understand. In my hometown of Estevan, we had tuberculosis in the southeast corner of Saskatchewan. Most people think it's just in the north, and therefore they don't have to think about it; it's there, and we need to be touching on these things.
The concern we have is that when COVID-19 came, unfortunately, it was such a scramble. We got so much misinformation at the time, and there were so many decisions made in haste that were then retracted, etc. For example, the Public Health Agency of Canada was coming up with certain points and then changing those points.
My question to you, Dr. Quach, is this: What can we do to rebuild that trust? What would be one of the first steps we need to take to rebuild that trust with Canadians? They need to see that trust so that they can start recognizing the great value of vaccinations.
Pediatrician, Infectious Diseases and Medical Microbiologist and Physician Lead, Infection Prevention and Control, Centre hospitalier universitaire Sainte-Justine, As an Individual
That's the million-dollar question. If I had the answer, I would give it to you.
The first thing is for people to understand what decisions were made based on science and what decisions were made for political reasons. I don't know how easy that is. I don't know how to rebuild, except to start discussing and talking and be able to say that there are some things that we don't know but there are other things we have good evidence for.
One thing that is not about trust is the storytelling. As you said, you've seen polio cases, but most of us have not. Grandparents who used to go to the pool in the summer and not come back in the fall to school are not there anymore. How do we ensure that parents understand that we have the data to prove that vaccines are safe, but that on top of that they are a great help to our health and that in fact they save our health?
I think with the pandemic we were seeing more and more meningitis and other bacterial cases. Some of them are vaccine-preventable and some are not. It's just understanding that we still face infectious diseases. You're saying measles is back and syphilis is back. We're seeing congenital syphilis cases that we weren't seeing before. That's not a vaccine-preventable disease, but it's just a matter of understanding that these diseases are back and if you don't maintain a good vaccination coverage, they will be back and will have deadly consequences.
I don't know where to start to rebuild trust except to discuss and have frontline doctors and nurses discuss with their patients and make sure that those who are in contact with parents are able to have all of the knowledge they need to have that conversation and to ensure that in medical and nursing schools we do have those conversations and those classes to make sure that people feel well tooled—or outillés, I'd say in French—to be able to answer those questions parents will have, because in the end those people who we listen to mostly—“we”, as in parents—are the people who take care of our children.
I trust my physician. When my doctor asks if I've read about this and that for my child, I say, “No, I trust you. If you tell me that my child needs whatever medication, I will trust you.” Trust starts there with our health care workers.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, and I appreciate that. I appreciate your comments on recognizing that there is a difference and that certain vaccines are of value with certain diseases and certain ones are not. Basically we're dealing with antibiotics that we need in order to deal with certain things, and you touched on that a little bit earlier.
Dr. Blackstock, I appreciate your comments. My colleagues touched a little bit on what I'm concerned about in basically competent care. I have a number of first nations in my riding, and in particular one great first nation, the Cowessess First Nation. The chief has done tremendous work there. They started up a home for young girls. The home has 10 young girls from 14 to 17. They have big challenges as they try to bring them back and get them to where they were taken away and now coming back to get that support. If you want to just touch on that, I would appreciate it.
As well, do you want to throw in a comment on how we can get that trust back? I would be happy to hear that as well.
Executive Director, First Nations Child and Family Caring Society of Canada
For the member's information, according to 2019 data, first nations children are 17.2 times more likely to be in child welfare care owing to poverty, poor housing and caregiver substance misuse related to multi-generational trauma from residential schools. The work Cowessess is doing is about trying to address those drivers, which brings us back to the Spirit Bear plan, because that will be a good success under a self-government model.
It's very important for the long-term success of these initiatives that equity and self-government go together. Substantive equality and equity and self-government go together so that you can continue these culturally based programs. Really what we're doing is trying to address the trauma that has piled up since Confederation on these children and families and bring them back safely at home, but as you can imagine, Member, if you are in a community where there is a housing shortage, how do you bring these children in care back home? If you're in a community where there is no water, how do you bring these children back home? That's a part of it.
In terms of the trust aspect, it's always interesting when I hear people say that first nations don't trust them. I always say, “The beginning is acting in trustworthy ways.” I think that begins with carrying out your promises and acting with integrity as government. I think that goes a long way in being able to address this, and when solutions are put forward to government, it's to have them really engage and critique them and really implement them if they seem to be in the best interest of public policy, which they often are.