Health Committee on Nov. 27th, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 91 of the House of Commons Standing Committee on Health. Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders.

I have a few reminders for the folks participating on Zoom. Click your microphone icon to activate your mike, and mute yourself when you're not speaking. For interpretation, you have the choice, at the bottom of your screen, of floor, English or French. Screenshots or photos taken of your screen are not permitted.

In accordance with our routine motion, I am informing the committee that all remote participants have completed the required connection tests in advance of the meeting.

Pursuant to Standing Order 108(2) and the motion adopted on May 16, 2022, the committee is beginning its study of women's health, at long last.

Before we begin, I would like to welcome the officials who are with us today. We have quite a number of them.

From the Canadian Institutes of Health Research, we have Dr. Tammy Clifford, acting president, and Dr. Angela Kaida, scientific director, institute of gender and health, participating via video conference. From the Department of Health, we have Ed Morgan, director general, policy, planning and international affairs directorate; Cindy Moriarty, director general, health programs and strategic initiatives; and Suki Wong, director general, mental health directorate.

From the Public Health Agency of Canada, we welcome Annie Comtois, Executive Director of the Centre for Chronic Disease Prevention and Health Equity, Shannon Hurley, Associate Director General of the Centre for Mental Health and Well-Being, and Mark Nafekh, Director General of the Centre for Health Promotion.

Thank you all for taking the time to appear.

We're ready for opening statements of five minutes or less. We're going to begin with the Department of Health.

Who's doing the speaking for the Department of Health?

Ms. Moriarty, thank you for being with us. I understand you're a little under the weather and that there were some near-heroic measures taken to accommodate that. We're glad to see you here.

You have the floor for the next five minutes.

[Cindy Moriarty, Director General, Health Programs and Strategic Initiatives, Department of Health]

Thank you very much, Mr. Chair and honourable members.

Thank you for the last-minute accommodations.

You've already introduced me, so I won't say again who I am, but I'm with the health programs and strategic initiatives directorate at the strategic policy branch of Health Canada.

We’re here to discuss women’s health. Before we begin, I want to make it clear that many trans and non-binary people are affected by women’s health issues.

Today I'm accompanied, as you know, by officials who can speak to diverse topics, including sexual and reproductive health, intimate partner violence, women's mental health and well-being, women and aging, women-focused health research, and issues pertaining to gender-diverse individuals and trans women.

In Canada, women's health as a field of care, research and program implementation has made great strides. For example, the national women's health research initiative is advancing a coordinated research program to address high-priority areas of women's health. Funding is also flowing on other fronts. Budget 2021 committed $7.6 million over five years to Stats Canada to develop and implement a national data initiative on sexual and reproductive health.

Despite these efforts, gaps remain in our understanding of women’s health issues. Compared to men, women and trans or non-binary people have poorer health outcomes, and this is due to misdiagnoses, minimized symptoms, a heavier burden of specific diseases and poorly targeted treatments. This problem particularly affects racialized and Indigenous women, as well as women with disabilities.

Traditionally, the medical system has taken a narrow approach, with health data and research results stemming from male-only studies and clinical trials. However, this is changing. Today, much more attention is paid to women's health, and a greater general understanding of women's health issues exists than was the case even a decade ago.

For example, since 2007, Health Canada has provided approximately $50 million per year to the Canadian Partnership Against Cancer. The partnership convenes and supports the Canadian breast cancer screening network. It has also worked with the radiology and breast cancer screening communities to develop the “Pan-Canadian Framework for Action to Address Abnormal Cell Rates in Breast Cancer Screening”.

The Public Health Agency also provides funding and support to the Canadian Task Force on Preventive Health Care, an independent panel of experts that develops robust and evidence-based guidelines on preventive medicine topics such as high blood pressure and certain cancers. The task force is currently undertaking an expedited update of its 2018 breast cancer screening guideline. The recommendations will be based on assessments of available scientific evidence and involve stakeholder input from multiple experts and patients.

However, closing the gender gap in health requires more research focused on health priorities that affect solely women either disproportionately or differently. This includes research with trans and non-binary people, as well as better data.

We're fortunate to have a strong public health care system in Canada that is supported by so many dedicated nurses, doctors and other health professionals. However, we also recognize the challenges the health system is facing, as noted in this committee's recent report on Canada's health workforce.

We are aware, however, that there is still a great need to address the issue of women’s health, to take initiatives and to play a leading role in this field.

I am pleased to say that the government has already begun this work on a number of fronts. Budget 2016 committed $5 million over five years to the Heart and Stroke Foundation to support targeted research on women's heart and brain health, and to promote collaboration between research institutions across the country.

Budget 2019 committed $10 million over five years to help address gaps in knowledge about effective prevention, screening and treatment options for ovarian cancer. At the same time, the government is also supporting a broad range of initiatives and organizations to promote and enhance women's health.

That’s why Budget 2021 allocated $45 million over three years to improve access to a full range of sexual and reproductive health support, information and services for Canadian women facing the greatest barriers to access. The 2023 budget renewed this investment to the tune of $36 million over a further three years.

Through this funding, partner organizations are empowered to design and deliver programs to address the diverse health needs of women.

Many advances have been achieved in women’s health in recent years. Behaviours are evolving, and our approach to research and program delivery and policy analysis is changing and continues to change.

For example, the government now broadly applies sex- and gender-based analysis to all of its activities to ensure that the issues experienced by women and gender-diverse individuals are considered when we're developing new policies and programs. This enables us to formulate responsive and inclusive health initiatives to promote greater equity.

More broadly, awareness of the importance of women’s health issues continues to grow, affording us a number of opportunities to address the aforementioned gaps and gender inequalities in health care.

This study you're launching now is one more contribution to this important conversation, and we look forward to today's discussions and to answering your questions.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Moriarty.

Next, from the Canadian Institutes of Health Research, I believe we're going to hear from Dr. Clifford and Dr. Kaida.

You have the floor. Thank you. Welcome.

[Dr. Tammy Clifford, Acting President, Canadian Institutes of Health Research]

Thank you so much.

As Acting President of the Canadian Institutes of Health Research, or CIHR, I am pleased to appear before your committee to discuss women’s health research, alongside my esteemed colleague Dr. Angela Kaida, Scientific Director of CIHR’s Institute of Gender and Health, who will also be speaking today.

As Canada's health research funding agency, we at CIHR understand the power of research to improve the health and well-being of all Canadians, including women and girls. We know that sex and gender influence our risk of developing certain diseases, how well we respond to medical treatments and how often we seek out medical care, yet, as recently as 2010, fewer than 20% of basic scientists, 25% of health systems researchers and only a third of clinical and population health researchers in Canada accounted for sex in their studies. This meant that research results often stemmed from male-only studies and clinical trials, limiting our understanding of women's and gender-diverse people's health, which obviously impacted the quality of the care they received at that time.

It's in this context that, over the last decade, CIHR has taken action to promote the integration of sex and gender in research, including offering training modules for CIHR funding applicants and peer reviewers, and requiring researchers to integrate sex and gender into their research design when possible.

Thanks to leadership from CIHR, along with federal funding investments in sex and gender science, today, the integration of sex in health research proposals in Canada exceeds 90%, and gender is addressed in the majority of human research studies. Canada is now recognized as a world leader in sex and gender science, and a review that was published in the journal Science ranks CIHR as the number one agency in the world for the appropriate integration of sex, gender and intersectionality in funding policies.

In addition, CIHR is driving research in key priority areas of women's health.

I’ll now turn to my colleague Dr. Kaida, who will tell us more about these fascinating initiatives.

Go ahead, Dr. Kaida.

[Dr. Angela Kaida, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research]

Thank you, Dr. Clifford.

As my colleague indicated, the Canadian Institutes of Health Research’s policy changes have significantly increased the integration of sex and gender into health research.

These policy changes are helping to make CIHR-funded science more rigorous and more inclusive to increase research impact.

As the scientific director of CIHR's institute of gender and health, I am committed to advancing research that will further help to close the gender health gap. This is why I am thrilled to help deliver on a budget 2021 investment of $20 million for women's health research.

With this important investment, CIHR, in partnership with Women and Gender Equality Canada, and in consultation with researchers, clinicians, communities and trainees across Canada, is leading the national women's health research initiative. This initiative is advancing a coordinated research program to address high-priority and under-researched areas of women and gender-diverse people's health. By embracing a community-engaged approach and committing to the principles of equity, diversity, inclusion and indigenous rights, this initiative will support the creation of research evidence to improve women's health care and women's health policies and practice in Canada.

As the first phase of this initiative, in August 2023 the Minister of Health announced an $8.3-million investment to support the creation of 10 women's health hubs. These hubs will focus on mobilizing research evidence in key priority areas of women's health, including sexual and reproductive health, HIV care, the prevention of violence and equity in health services access, to name a few. For example, the women's cardiovascular health hub, led by Dr. Kerri-Anne Mullen and Dr. Thais Coutinho and their team at the Ottawa Heart Institute Research Corporation, will leverage Canada-wide networks to address cardiovascular disease, which is the leading cause of death and hospitalization among women in Canada.

For the next phase of the initiative, CIHR will invest in a hubs coordinating centre; biomedical discovery research; translational research in health care diagnostics, therapeutics and devices; as well as implementation research to remove barriers to accessing health care. This initiative aligns with additional investigator-driven CIHR investments in women's health research, which totalled over $60 million in 2021-22 alone.

As a short example, I'd like to highlight the work of Dr. Gina Ogilvie and her team at the Women's Health Research Institute in British Columbia, who are advancing research on HPV vaccination and cervical cancer screening methods. Dr. Ogilvie's world-class research program is accelerating Canada's efforts to become the first country globally to eliminate cervical cancer.

As you can see, CIHR is committed to advancing research that stands to improve women's health and health care. I deeply look forward to the outcomes of your study and would be pleased to assist your efforts in any way.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Kaida.

We're going to begin rounds of questions now, starting with the Conservatives for six minutes.

We have Ms. Vecchio, please.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Thank you very much. I really appreciate it.

Thank you to all of the people who have come here to provide us testimony today.

I want to start with Cindy.

Cindy, I have your first name here, but I didn't get your last name down.

You noted the priorities. I wanted to find out from you, in terms of this list of priorities, whether the priorities are chosen by the health officials. Is there some sort of consultation done with the people on the ground, such as the physicians, nurse practitioners and the people who are working hand in hand with the patients themselves?

[Cindy Moriarty]

Thank you for the question.

If I'm understanding your question properly, it's really about priority setting generally. It's very much an iterative process. Very often, priorities are determined through long-standing work, trends that are emerging or issues that are being presented to government or to the department. They could come through a crisis or something that happens in the media that draws attention to something. It's not a one-size-fits-all. If there's a particular issue you're interested in, I could maybe drill down a little bit more.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

No. That's perfect. I just wanted some information on that specifically.

I have a specific question, though. You can answer this one, or perhaps somebody from one of the departments may be able to answer. When we were looking at the gender-based analysis and at things that had come out from the Auditor General, she was indicating that only 40% of budgets and policies had actually gone through the GBA. I was wondering if you could advise me of whether or not your department went through a thorough GBA for all of your programs, policies and budget advancements.

[Cindy Moriarty]

I can speak for Health Canada. I'll let my colleagues from the Public Health Agency and CIHR speak for themselves.

Generally speaking, the health portfolio is seen as a lead in sex- and gender-based analysis. I just want to clarify that, in the rest of the department, it's GBA. In health, we talk about sex and gender, because sex is about the biology and the science as well as the gender.

We have consistently been ahead of the pack. I can assure you that all of our budget proposals, MCs and Treasury Board submissions are 100% vetted and go through a process with sex- and gender-based analysis.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Thank you very much. I really appreciate that.

Shannon, I want to turn over to you. I'm not sure specifically what department you are with. You are with the centre for mental health and well-being. Is that correct?

[Shannon Hurley, Associate Director General, Centre for Mental Health and Wellbeing, Public Health Agency of Canada]

Yes. That's right.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Excellent.

With regard to women, we're hearing from the numbers that violence against women has just boomed. We know that. Working on the status of women committee, we also know that the money has also increased, but it is not keeping up with the numbers with regard to violence. I think 79% is what I heard most recently.

What's something that you see we'd able to do through Health Canada that would help start alleviating these issues when we have violence against women?

[Shannon Hurley]

Thank you.

Just to clarify, I work with the Public Health Agency of Canada at the centre for mental health and well-being. I can say that, at the Public Health Agency of Canada, we really try to contribute to addressing the problem of violence against women and gender-based violence in all its forms through programs that deliver interventions and that also test and learn about effective approaches, so that they're building the evidence base of what works.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

I really appreciate that. I think one of the greatest challenges in Canada, though, is the geography. If you live where I live, you're 20 minutes away from the London Health Sciences Centre, but for the people that I'm speaking to, especially women who are trying to flee violence, sometimes it's an airplane away. Sometimes there's not a registered nurse on a reserve.

How do we make sure that GBA+ and accessibility are there for those people who are living remotely?

[Shannon Hurley]

That's a really great consideration. I'll say that the kinds of programs we support are about promoting the health of people who have experienced violence and also about preventing violence through health promotion, healthy relationships, building skills and building ability.

We're not the order of government that's delivering the services, but we certainly work with partners. It really requires a multisectoral approach to address this issue.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Finally, do you have any programs specifically directed at men? When we talk about violence against women, we know that it's not just about women. It's about men and women working together to change that type of relationship so that it is much more respectful.

What programs do you have that are directed at men and abuse?

[Shannon Hurley]

Absolutely—it's not up to women to end violence against women. We have streams of funding addressing family violence and gender-based violence. Of course, these are intersecting issues. Some of the projects funded through those programs are indeed reaching men and boys. For example, there's one working with police services to look at gender norms. There's one that's working with adolescent boys to teach them more healthy ways of being a guy, expressing their emotions and being able to use language about their emotions.

Indeed, we absolutely recognize the need to work with men and boys too.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Awesome.

Since I still have the floor, I'm going to pass it to you, Mark, because I see that you deal with the correctional system.

When we're looking at women in the correctional system, what's the percentage of indigenous women who are in the federal correctional system? Can you give me a percentage there?

[Mark Nafekh, Director General, Centre for Health Promotion, Public Health Agency of Canada]

I do work for the Public Health Agency. I have worked for Correctional Service Canada in the past.

I don't have a response to that in my current role. You have my apologies. I can look at that and bring it back.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

That would be wonderful. I think knowing that correlation is really important there as well.

You do bring lots of experience from that, of course. Would you be able to put on that hat from before and tell me whether, when we're looking into these penitentiaries, they're actually talking about violence against women and how to change their beings or anything like that? Do you see any of that, where we're doing things to contribute to the person's outcomes?

[Mark Nafekh]

I'll preface my response by saying that it's been three and a half years since I've worked for Correctional Service Canada. I can tell you that you're absolutely right that indigenous women are very much overrepresented in the federal correctional system. They do offer violence prevention programs there. I just can't give you the details at this point in time.

[Karen Vecchio, Conservative, Elgin—Middlesex—London, ON]

Perfect. Thank you so much.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Vecchio.

Next we have Mrs. Atwin online for six minutes.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you very much, Mr. Chair.

Thank you to our witnesses for being with us today for this really important study. I'm really excited about this. I think it's a long time coming.

I'm speaking to all of you from Fredericton, New Brunswick, the unceded Wolastoqiyik territory here.

I'll start with Ms. Moriarty.

Specifically, you mentioned sexual and reproductive health. I have a particular preoccupation with that. I'm from New Brunswick, and we are perhaps infamously known for not upholding the Canada Health Act as far as having access, regardless of where you live in the province, to reproductive access and care is concerned.

We actually have a research study that's being undertaken here. It should be close to completion, quantifying what that experience looks like here in New Brunswick and some of the impacts from not having that ease of access. The province was concerned we weren't moving beyond anecdotal evidence. It's really important to have this research project capture that.

As a result of some of this, we've actually had health transfer dollars held back throughout the province of New Brunswick. It seems to be the only kind of stick we have. It's not necessarily working, especially in a province that has surplus budgets.

Can you provide us with any direction as far as the Government of Canada is concerned? What other mechanisms do we have, or should we have, to enforce the Canada Health Act when it comes to reproductive care and access?