Health Committee on Nov. 27th, 2023

[Annie Comtois]

My understanding is that there were always experts brought into the development of guidelines, but, in this one instance, I know that there are specifically four experts who are engaged in the working group, including three patients with life experience.

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

It wasn't my understanding that there were experts brought in, because that was part of the complaint.

Okay. Who selects the members of the task force? I assume it's someone in government. Who is that?

[Annie Comtois]

The selection of task force members is done through a selection committee. The chairs of the task force are part of that selection committee. There's also a representative from the Public Health Agency of Canada and one from the College of Family Physicians of Canada.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski and Ms. Comtois.

Next is Dr. Kitchen, please, for five minutes.

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

Thank you, Mr. Chair.

Thank you, all, for being here. It's greatly appreciated. I know we have the Department of Health and PHAC and researchers here as well, who are great to have.

We're looking at women's health and ultimately how we address this issue. There's a lot of concern, and I'm going to go right to what I hear from patients. Ultimately, one of the concerns you hear from patients is that female patients, first, can't find female practitioners. When I went to school 39 years ago, there were more men than women in the practice. Now, when you look at it today, you're looking at over 50%.

In my latest research I saw that, overall in Canada in 2022, 49.7% of physicians were female. When we look at gynecologists, we see that just under 60% are female gynecologists, which is great to see, and because that knowledge is there there's that ability to interrelate.

However, the concern a lot of female patients have is that they can't get access to a practitioner who will talk to them or a female practitioner they can relate to. This question is for all of you, and maybe I'll start with Dr. Clifford. What do we need to be able to do here in Canada to, first, have more female practitioners and, second, make certain we have them out there such that patients have a chance to see them?

[Dr. Tammy Clifford]

Thank you so much for the question.

I really wish I had an answer to it as well. I'm hoping that the other study that occurred on health human resources might shed some light on that. In fact, if it was taking a GBA+ approach, that should be picked up in that conversation as well.

From CIHR's perspective, I can tell you what we do in terms of researchers who identify as female, because we've certainly recognized the importance of this in terms of not only the research community but the types of questions that researchers study. There is a link there in terms of what actually gets taught to physicians and, of course, what gets practised.

For a few years now at CIHR, what we have decided to do is to equalize success rates, if you will, in our largest grant program, which is called the project grant program, because we recognized that, despite the fact that there are increasing numbers of female principal investigators who are applying, they were not, for a variety of reasons, achieving the same success rates. Therefore, for a few years now, we have said, for example, that if 40% of the grants come in from female researchers, 40% of the grants we award will also go to female researchers.

That is one step. I know it's not specifically answering your question, but in terms of research contributing to clinical care, we felt that this was important to do based on the levers we have.

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

Thank you. I appreciate that. You've opened a whole new kettle of thought in my mind.

As we indicated, CIHR gets a lot.... There's money that's given by the federal government for a lot of research. It's great to see that you're looking at delegating that for female researchers.

Ultimately, though, the patient wants to know the outcome, and they want to know the research is actually going to provide an outcome to something that's going to improve female health. I'm just wondering how many studies are being done where you actually have an outcome that can be put forward to improve female health care.

[Dr. Tammy Clifford]

That's a wonderful question. I might also tee up my colleague to be ready to get in here with specifics.

Again, it's relatively recently, but what I can tell you is that CIHR now requires that those who are funded through federal tax dollars ensure that the results of their research end up in the public domain. This is a fairly new phenomenon. This is particularly true for clinical trials. Those data need to appear in the public domain within one year of the completion of the study.

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

Thank you.

I know my time is basically up. I suspect we will probably address it when we get to the endometriosis study, but the reality where we have so many issues dealing with.... I know when I went, I took an interest and followed my stream into what I wanted to go to. I see that so much out there. The concern we have for so many patients who are dealing with endometriosis is that they're not able to find a practitioner who even has it as an interest or can even answer their questions.

Perhaps you might be able to provide suggestions on how we get that interest into practitioners such that they're aware of this topic and are continually on top of it such that, when women come to them, they're able to deal with that aspect. I realize there's no time to answer that, but I appreciate that. Thank you.

[The Chair, Liberal, Sean Casey]

Can you respond very briefly to that?

I would be interested to hear the response, although we are out of time.

[Dr. Tammy Clifford]

Go ahead, Cindy.

[Cindy Moriarty]

Thanks.

We are funding a couple of projects through the sexual reproductive health fund that are focused on endometriosis. One is going to the Endometriosis Network Canada. They are doing patient-centred public education. We're also providing funding to the Society of Obstetricians and Gynaecologists to look at capacity building and training for health care providers to have a better understanding of endometriosis.

I'm happy to provide more information on either of those, if that would be helpful.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Moriarty.

We'll go to Dr. Hanley for five minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Hello to everyone. Thank you so much for coming out. I also want to thank you for all the work you do.

First of all, I wanted to clarify something. I believe there was a comment earlier from my colleague, Madame Larouche, about an increase in the incidence of cervical cancer. To my knowledge there is no increase. There may be a recent attenuation of the decrease.

I wonder if Dr. Kaida or someone else could please clarify that quickly for us.

[Dr. Angela Kaida]

Thank you so much for the question and opportunity to clarify.

I don't have the specific numbers for the incidence of cervical cancer in Canada right now. I do know that, because of improving detection and earlier screening, we may see an increase in the number of cases that are detected, but that's possibly a good sign. It just means that we are identifying those cases earlier.

Unfortunately, I don't have the numbers right in front of me about whether we have seen an increase in cervical cancer in Canada or whether it is, as you say, an attenuation.

I'm happy to provide that.

[Brendan Hanley, Liberal, Yukon, YT]

I think that would be very useful to get some clear data and clarification on that because, despite what you're saying about increased detection, I don't believe that's a factor. I could be wrong if there's a recent change. That would be very important for us to know.

I wanted to switch to a point that was referred to earlier. I just want to get a bit more information. This is about perinatal mental illness.

Recently I had a conversation with someone in my riding who described her own experience and was also advocating and researching how we can improve access to perinatal mental health services for those mothers who are struggling, whether that's expectant mothers, after birth or through the process. We know that getting help has not always been easy.

Ms. Wong did mention the project, which I appreciate, that is currently under way through Women's College. I wonder if Dr. Kaida could briefly comment on what efforts and initiatives there are for improving access to perinatal mental health services from a research point of view. Then I would ask Ms. Hurley to comment on other projects within the scope of the Public Health Agency.

[Dr. Angela Kaida]

Thank you so much for the opportunity to follow up on that question.

From a research point of view, this is definitely a priority for us. One of the knowledge mobilization hubs that we funded in August 2023 is from a group at the University of Calgary that is focused on the Inuit perinatal health hub. It is really about developing and building Inuit-specific resources and support for Inuit women in Nunavut. I think that's an example of a very particular community and of mobilizing research evidence that is focused on perinatal health.

I'll add that on March 9, 2022, a ministerial round table was held with some key stakeholder groups in perinatal mental health, which included experts, practitioners and people with lived and living experience. It focused on examining access to perinatal mental health. We're looking forward to seeing the results of that study.

I think my colleague Cindy also mentioned the work that's focused on creating a national clinical practice guideline for perinatal mental health. I'll be happy to follow up with you with additional details from that research and what we're learning.

Thank you.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Ms. Wong or Ms. Hurley, would you have anything else to add in terms of more on-the-ground support for access to care?

[Shannon Hurley]

I'll close the loop.

In terms of mental health promotion, our programs at the Public Health Agency of Canada are not specifically aimed at perinatal mental health but more at addressing risk factors and boosting protective factors. We do have one project that's funded right now that's looking at maternal mental health through a wraparound model, and that's just an example among more general programming.

I'll turn to my colleague Mark, who works more with the children and youth division.

[Mark Nafekh]

We do offer the Canada prenatal nutrition program, which is a $26-million annual program to community-based groups. Through those community-based groups, we look to develop and deliver comprehensive culturally appropriate programs that promote health, including mental health.

An example would be a program called “Nobody's Perfect,” where trained facilitators work with participants to increase their understanding of health behaviours and also to bring them in contact with community resources and services, including for mental health.

[The Chair, Liberal, Sean Casey]

Thank you.

Ms. Larouche, you have two and half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Chair.

Mr. Morgan, you may have had the opportunity to look at national women’s health strategies in other countries. During my last turn, I listed examples of countries that recently published such national strategies, including Australia. Do you have anything to add in relation to the question I asked earlier?

[Ed Morgan]

Internationally, we work very closely with our counterparts on these issues. For example, we work with ICH, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, which is responsible for harmonizing and updating our rules and guidelines for clinical trials.

That's one example.

We’re also part of other international working groups. We’re working with ICMRA, which is the International Coalition of Medicines Regulatory Authorities, an international coalition made up of regulatory bodies, on the issue of data and how we can improve the way we ask big companies to provide us with their data. So we’re working very closely with our partners on the international stage.

[Andréanne Larouche, Bloc, Shefford, QC]

As previously stated, in Canada, health care is the responsibility of Quebec and the provinces. They have the expertise and manage the health care system. This is a uniquely Canadian feature. However, when it comes to health care, it’s true that statistics, data collection and research are the responsibility of the federal government. How do you take this division of powers into account when you compare Canada’s strategy with those of other countries?

[Ed Morgan]

I can tell you that clinical trial data, for example, is not protected and therefore does not raise any major concerns. When it comes to data in general, however, my colleague Cindy Moriarty can provide you with a better answer.