Evidence of meeting #57 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A recording is available from Parliament.
Noon
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Skarsgard and Mr. Jeneroux.
Next is Dr. Hanley, please, for five minutes.
Noon
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
I also appreciate the excellent testimony we've heard from all of you today. Thank you for that.
I'm going to try to pick up a few themes that haven't been discussed as much.
Dr. Grandvaux, first of all you talked about the need to improve air quality and how we can move towards matching what we have achieved in public health in water quality. I think one difficulty is arriving at standards. I wonder if you could reflect on that a little bit.
We know that there's already a tremendous variety in air quality, depending on the size and age of the building. How do we develop standards so we actually know what we're aiming for, rather than a more general improving air quality kind of question?
Noon
Professor, As an Individual
Thank you for the question.
It is true. There have been a lot of committees in place—for example, in the U.S., Europe, Belgium and France—to discuss what the standard should be. We already have standards that exist from different organizations.
Experts in ventilation could definitely explain it better than me, but from what I have read and what I see worldwide in countries that have taken on the task of improving indoor air quality is that they rely on CO2 measurements to give an idea of how efficient the ventilation and air exchange is inside. I think, from what they have done so far, it's a good and easy measurement with the apparatus that is available right now. They can measure how the air is changed in an environment.
I think it's really powerful because it will indicate, in terms of infectious diseases.... It's what we need. We need the air to be exchanged to decrease the number of aerosols inside. There are different associations in the world committed to defining the standard. They are already out there. For example, Belgium or France have decided to go with 800 parts per million as a definition. In Quebec, we are still at 1,500, which is far above the international standards that have been decided.
I think we need to discuss with the international commissions to adopt the same standard.
Noon
Liberal
Brendan Hanley Liberal Yukon, YT
Thank you.
That's very helpful. Hopefully we can work on developing some national agreement.
I'm going to jump to Ms. McKinney and change the subject a bit.
You mentioned moving upstream. I'm going to take you a little further upstream.
When we look at some urgency of our children's health, particularly indigenous children's health, given the many challenges both prepandemic and postpandemic, there's been a lot of work in the Yukon territory amongst the self-governing first nations in particular on developing language nests and increasing that connection with culture, mainly through language development.
I wonder if you could comment on the importance of supporting indigenous language knowledge development and, through that, a greater connection to one's culture.
12:05 p.m.
Executive Director, Under One Sky Friendship Centre
Absolutely. We know it's part of wellness, especially for indigenous people. The loss of our language has impacted our entire family for generations, so we know this. There's a whole body of research out there on mother tongue languages and how important those are for children developmentally. Many of the friendship centres across the country are trying to focus on restoring and resurrecting our indigenous languages. We have two languages in New Brunswick: Wolastoqiyik and Mi'kmaq. We are working diligently on that, but we have to understand it's a challenge, because many of our speakers are aging. We're losing them, so we have a sense of urgency around that.
For indigenous people, it's all connected. We take a holistic approach toward health and wellness. It's not just about how much you weigh or what your blood pressure is. It's about how well you are within your community, culture and language, and how families are being supported. It's very important, especially for children, to realize that our language is as important as other languages.
New Brunswick is the only officially bilingual province in the country. Our French brothers and sisters have done an amazing job of making sure that happens for their children, because they know it's important. It's not as if we have to look outside the country for that. We have amazing examples in our own country and province. French-speaking children can go to French kindergarten, day care, middle school, high school and all the way up to university, but we don't have that. At a minimum, that's what we're hoping for someday.
I don't know whether I answered your question.
12:05 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. McKinney.
Mr. Thériault has the floor now for two and a half minutes.
12:05 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
My questions are for Ms. Grandvaux and Mr. Lamarre.
At the last committee meeting, Dr. Quach‑Thahn said the next pandemic might involve resistance to antibiotics. Do you share that concern?
In this regard, she noted that the increase in viruses at CHU Sainte-Justine was also accompanied by an increase in serious bacterial infections. In that case, shouldn't it be mandatory to maintain or increase immunization?
Could you both comment on that please?
12:05 p.m.
Professor, As an Individual
I can begin.
I completely agree with Dr. Quach‑Thahn. There was concern about resistance to antibiotics long before the COVID‑19 pandemic. This should be a research priority in order to find alternatives to antibiotics.
I believe Canada has already invested in this in the past. We must continue this type of research in order to find alternatives to antibiotics.
Viral infections have a significant impact on bacterial infections. We have seen this and we must address it.
As I said before, a certain number of bacterial infections are also picked up from the air and from contacts. If we work proactively to prevent infections, that will also limit their impact.
I will let my colleague continue.
12:05 p.m.
Full Professor, Institut national de la recherche scientifique, As an Individual
I would have said the same thing.
I would add that, unfortunately, the big pharmaceutical companies have little incentive to develop new antibiotics. It is a very complex and very competitive market.
So we have to rely on the research done by universities which, however, depends on government and federal funding. That funding must therefore be sufficient, especially for research and development of new antibiotics.
12:10 p.m.
Bloc
Luc Thériault Bloc Montcalm, QC
Could immunization be one proactive approach to fight that potential pandemic?
12:10 p.m.
Full Professor, Institut national de la recherche scientifique, As an Individual
Definitely.
People working on fighting infectious diseases all agree that we need the highest immunization rates possible. Unfortunately, there are no vaccines that combat all infectious agents. So there are still many more vaccines to be developed.
I mentioned the respiratory syncytial virus, but there is a whole range of illnesses for which there is still no vaccine. Those include HIV, the hepatitis C virus, and malaria. There is still much work to be done in this regard.
12:10 p.m.
Liberal
12:10 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
Dr. Skarsgard, help me get a better, clearer picture of the state of operating room capacity. Obviously, you can speak about the capacity at B.C. Children's. I wonder if you know a bit more broadly if our operating rooms are being utilized at full capacity right now.
12:10 p.m.
Member, Pediatric Surgical Chiefs of Canada
We have operating rooms at B.C. Children's Hospital, and, for example, at Sick Kids and other larger children's hospitals in Ontario. I know less about Alberta, but we have children's operating rooms that are fallow. They are empty. It relates to the fact that we aren't able to staff them. The point was made that you need a full team. You need a surgeon, an anaesthetist, nursing and RTs. There are lots of human resources that go into being able to run an operating room, and you need every critical piece to ensure a safe operative encounter for a child. I would say that we don't really lack in many of our hospitals in physical capacity, but, again, we lack the staffing that's required to safely and efficiently run an operating room.
In terms of our operating room efficiency, what we do notice is that, when we shift the focus from elective care to urgent emergent care.... It's important to realize that throughout this period we have never neglected our obligation to look after children who are in need of urgent surgical care, but if you shift a resource that is intended to be used efficiently electively to support emergency care, instead of running eight elective rooms, you run four, and then you run four urgent rooms. That's where your efficiency really goes down, because you're changing.
In a single day, you may have a heart operation, an orthopaedic operation and an appendectomy, and when you do that, when you're shifting teams in and out of rooms, that's where efficiency really takes a hit. It's a capacity that needs both the guarantee of an elective schedule to run efficiently, but also sufficient capacity so you can get at the patients who are on the wait-list and really dig into those to make reductions in those long wait-lists.
12:10 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Skarsgard.
Next we have Dr. Kitchen for five minutes, please.
12:10 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you to our witnesses for being here. It's greatly appreciated.
Some of my questions have already been sort of touched on, so I'll try to touch a little bit differently on them.
Dr. Skarsgard, thank you for your presentation. You talked a bit in your point number one about dealing with the lack of skilled, specialized nurses.
One of the smartest, hardest-working and most compassionate people I know is my wife, Donna. She started her career as a neonatal intensive care nurse in the ICU at University of Alberta Hospital. Then she went to the ICU at the Hospital for Sick Children. She was there for a number of years, and we got married. She moved from there to Sunnybrook trauma centre. She did all this progressing as she went along.
Your comments about how we improve these nurses' skills and get them to be involved is very commendable, and it is something we need. Has the Pediatric Surgical Chiefs of Canada talked to the regulatory bodies or to the universities to look at providing these programs and how they can move forward on that?
12:15 p.m.
Member, Pediatric Surgical Chiefs of Canada
I can't say that the surgical chiefs have directly, but through our strong collaboration around advocacy with Children's Healthcare Canada, I know that there have been some conversations at the level of provincial nursing colleges trying to create more seats for nursing and then specifically trying to incentivize a diverting pipeline of nurses who then go on to dedicate their careers, as your wife did, to that of child health.
What we do see is the phenomenon of nurses who drive by many community hospitals to commute to work at a children's hospital at personal expense. It's because of that dedication they do that. We need to create more of those nurses who are dedicated to a professional career in looking after children and families. We do that through advocacy in the provinces, and we do that, as was mentioned, in collaboration with these groups that are across Canada so that we can also bring this voice to you and drive the message that we need to target resources of all kinds, but particularly for recruitment and retention, to the pediatric health workforce.
12:15 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you.
One of the challenges we see across Canada now is travelling nurses. They're travelling all over the country and all over the world, and taking their skills to various levels, which is a huge challenge. My wife and I moved to rural Saskatchewan, so, as many of my colleagues do, we deal with rural areas. We're challenged in those areas to ensure that we have appropriate staffing. You mentioned quite clearly about community hospital centres having the ability to try to keep people in those local communities before the parents send them or the doctors end up sending them up to the specialty hospitals, in particular the children's hospitals—for example, Pattison Children's Hospital in Saskatoon, or in Calgary, etc.
Ultimately, these are challenges. The concern that is out there is that today the public tends to turn around and look at Dr. Internet and Dr. Social Media to choose the answers and determine what their problems are. Through that, they then jump on it and say they have to go to these...and clog up a lot of the children's hospitals or even our mainstream hospitals.
How do we go about solving that? What steps can we take to try to get Canadians to understand that their practitioners are where they need to be getting their advice from?
12:15 p.m.
Member, Pediatric Surgical Chiefs of Canada
It's a really good point. I think it speaks to the need for an increased capacity and strengthened relationship of the public with primary care and family doctors. That really should be the source of advice for families, particularly if they're seeking or need specialty care.
In terms of trying to create capacity and create confidence in communities in community health capacity for children's services, I think part of that is a partnership of children's hospitals with those communities and with the providers in those communities where there is a sense, whether from branding or even just presence.... Many of our specialists go to many parts of the remote areas in B.C. to do outreach. They have cardiology clinics in remote areas. Digital health allows that opportunity as well. We can use telemedicine to meet families in their communities and give them the sense that they are really closely linked to specialty care.
I really think it's that strength of partnership with community, where we create child-specific and child-safe capacity to deliver care in those communities, where families will get confidence that it's safe for their 10-year-old child to have their hernia fixed by a general surgeon in Prince George rather than travel all the way to Vancouver.
12:15 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Skarsgard.
We'll go to Mr. van Koeverden, please, for five minutes.
March 21st, 2023 / 12:15 p.m.
Liberal
Adam van Koeverden Liberal Milton, ON
Thanks very much, Mr. Chair.
Thank you to all the witnesses today. It's been a fascinating meeting so far, and I look forward to hearing more.
One thing I've been preoccupied by, in listening to some of the testimony today, is how much more valuable a health intervention is at some point early in a person's life, as early as possible, actually, particularly if they're dealing with adverse health conditions early on, like a rare disease or something like that. My questions are around that, about early intervention for people and how that can have a positive impact on the trajectory of their lives.
Last week, on our break week, I was fortunate enough to go to Canmore, Alberta, to take part in an organized activity with Spirit North, a sport organization. It's a charity that provides sport, physical activity and recreational opportunities to indigenous youth, first nations youth primarily, throughout Alberta, Manitoba and Ontario. It was awesome to see so many smiling faces and to see so many young people loving and enjoying moving and physical activity.
My first question is for you, Ms. McKinney. I'm curious about specific interventions that would address and improve children's health issues from an indigenous perspective and how our government can more thoroughly address and support these types of interventions. Are there any studies, programs or policies that you see that have been making a difference and are things that we should do more of?
12:20 p.m.
Executive Director, Under One Sky Friendship Centre
That's a great question.
One of the things we're doing here is land-based learning. We developed a nationally renowned program called “Take It Outside”. It's a way of getting our children back out onto the land. It's not just a matter of taking them out on the playground. We take them to an old-growth forest with very natural environments, and it's also a great way for us to teach them their language in that environment.
One of the challenges we face is that families are living in substandard housing. We have really poor air quality and overcrowding, so all of those things lead to really poor health, especially for our children.
Those are some of the things we're trying to do. We actually had a bit of a kickback from the province here around our “Take It Outside” program during COVID. They called it a field trip. It's not a field trip. It's a part of our curriculum to get our kids back outside on the land. What's more healthy—being stuck in a classroom or being out on the land?
Those are some of the challenges we face, which is why it's really important for us to be delivering some of these programs as opposed to the mainstream programming. I know the mainstream has wonderful intentions, but it doesn't always work out well for indigenous families, so these kinds of programs become really valuable to the community.
One of the things we're doing is this land-based learning, but we're also now bringing it to adults. We have land-based learning for university students. All of that we think is really important. It also connects non-indigenous students with indigenous students, which speaks as well to wellness and some of the issues we have to deal with here. We have families living in poverty and substandard housing, and they're being faced with a multitude of really poor health issues. We care about healthy food, but how do you afford to buy healthy food when you're living on a fixed income?
Those are some of the things we're trying to get a little further upstream on before folks end up in the health care system.
12:20 p.m.
Liberal
Adam van Koeverden Liberal Milton, ON
Thanks, Ms. McKinney. You kind of took the words out of my mouth for my segue to the second half of my question.
With respect to being able to prevent people from having to access the health care system, it's a little bit of a guess that I'm making and I was hoping that one of the doctors might be able to provide some insight as to whether or not this assumption is at all correct.
When we're talking about lifestyle interventions to prevent people from having to access the health care system, I imagine a lot of those are far more effective for adults because they've lived longer and they probably suffer disproportionately from more lifestyle-related illnesses, like type 2 diabetes and others, but I imagine that those are becoming more and more a priority for children's health as well.
Would any of the pediatric experts or the doctors on the call like to comment on the value or the necessity of preventing children from having to access the health care system?
Ms. Grandvaux, go ahead.
12:20 p.m.
Professor, As an Individual
It's a bit far from my expertise, but what I would say as a citizen maybe and from my reading of the literature on the benefits, not my direct expertise, is that I agree with you that lifestyle impacts the diseases that we see in others, but it's a lifelong story and everything we do when we're young also has an impact on our health when we become adults. I think the sooner we teach our children how to get good food, with all the limitations that Ms. McKinney just described, the better. You need to make that as well as physical activity available.
All of this is something that children, when they become adults, will have. It's baggage that they will have with them and that will help them in the long run. Just because we only see the diseases when we are adults does not mean that the behaviour when we are kids is not having an impact over the long term. I think we need to act as early as possible. I think there is a benefit to introducing that and to keeping children from having to go into the health care system when they are kids or they become adults.
12:25 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Grandvaux.
Next is Ms. Goodridge.
Go ahead, please, for five minutes.