Health Committee on Nov. 27th, 2023

[Cindy Moriarty]

I am not an expert in the Canada Health Act, but I hear you. There have been deductions to New Brunswick. I guess it depends on your point of view whether they are significant or not. In 2020, there was $334,000. That may not be having the impact you desire.

There are limits to the Canada Health Act. I would point to other efforts that the government is making through the sexual and reproductive health services program. We are funding community-based organizations. We have some funding that's specifically targeted to improving and increasing access to abortion.

We can't pay for the abortion service itself. That's within the provincial jurisdiction. Certainly, everything that helps the women get there and get back is covered—for example, travel, child care and hotels. This is a particular issue with geographic boundaries, women of low income and all sorts of other circumstances. We're putting our efforts into improving and increasing the access overall.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you.

Clinic 554 is here in Fredericton. It's often at the centre of that conversation. What it also really served as was this centre of excellence for trans care and gender-affirming care. The latest census data has us as the fourth most gender-diverse city per capita, of which we are very proud. Again, we know there are issues with access.

Again, I am just seeking your advice on how we can ensure better health outcomes for the 2SLGBTQ+ community, regardless of jurisdiction, even in small provinces like New Brunswick.

[Cindy Moriarty]

That's a big question.

You know, we're very well aware of the misinformation and disinformation campaigns and the public discourse that's anti-trans and anti-2SLGBTQ2. A lot of the context is really around the social context and where people are at. It's a challenge that I think every jurisdiction and every community is going to have to meet with different things.

We are providing funding through the sexual and reproductive health services program to support access, training for health care providers and support that's going to patient-centred organizations in terms of knowing their rights and knowing where to go. I'm very concerned about ensuring that people know where to get good and reliable information, and that they are taken care of safely.

There are large challenges ahead of us. I don't want to deny that on this front. It's something that we're looking at with great concern.

[Jenica Atwin, Liberal, Fredericton, NB]

Thank you. I hope you feel better soon.

I've have another big question for Dr. Kaida. I know my time will be wrapping up.

This will be a recurring theme for me. I ask it just about every time we have witnesses on this panel.

It's in regard to Joyce's principle. I'm thinking about the horrific story and experience of Joyce Echaquan in Quebec around systemic discrimination and racism in our health system. I'm really looking for ways that we can formulate measurables.

What can we do in a health care setting to ensure that everyone has access, regardless of where they come from, and to ensure that they are being culturally respected at the same time?

[Dr. Angela Kaida]

Thank you so much for that excellent question.

I will share with you that I hope to be asked that question over and over, as it's similarly a priority for me.

From a research perspective, certainly CIHR recognizes racism and discrimination as structural forms of discrimination that negatively influence our health. We also recognize that racism and other forms of discrimination disproportionately affect key members of our Canadian communities, including indigenous women, Black women and other racialized communities.

In terms of our priorities, we have been funding research teams that are looking specifically at the impacts of racism on health outcomes. They are trying to identify community-led solutions to address racism in the health care system, as well as generally in our society, as Canadians. That focus on the specific question of racism—not just generally about structural violence—is such an important part of what we are committed to in terms of the research we fund on health outcomes.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Atwin. That's your time.

Ms. Larouche, you have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Chair.

Thank you to all the witnesses for being with us today for this study, which is important for understanding why there is so much work to do for women. As you said in your opening remarks, we haven’t yet given enough thought to the right way to treat certain types of cancer that are specific to women.

Dr. Kaida, on this subject and before I go any further with my questions, you touched on the issue of cervical cancer in your opening comments or in one of your answers. What’s worrying in the data that’s recently emerged is that the number of cases of this type of cancer is on the rise. To what do you attribute this and what are your potential solutions?

[Dr. Angela Kaida]

Thank you for the question.

Absolutely. Cervical cancer is a priority for us as Canadians, and it's a priority for us at CIHR, in terms of innovative research to address rising incidents of cervical cancer. As I mentioned earlier, we are very proud and fortunate to be able to fund Dr. Gina Ogilvie at the Women's Health Research Institute here in British Columbia. Her work has focused for decades on looking at HPV vaccination, uptake of HPV vaccine and moving us from cervical cancer screening towards HPV screening as a strategy for eliminating cervical cancer in Canada.

The Canadian Partnership Against Cancer, or CPAC, which is funded by the Government of Canada and its partners, has developed an action plan to eliminate cervical cancer in Canada. Importantly, this action plan engages with partners across the country. These partners include women and gender-diverse people with lived and living experience of cervical cancer within the action plan's priorities. To reinforce this, these priorities include improving HPV vaccination rates among young girls and young boys, as well as young women; implementing HPV primary screening; and enhancing efforts to follow up abnormal results of testing procedures.

CPAC also hosts the pan-Canadian cervical cancer screening network, which undertakes system performance for reporting on cervical cancer and support for the development of sharing best practices for screening and treatment.

I'll reinforce that this is a priority area for research, programming and practice to transform cervical cancer incidents among, and their impact on, women and gender-diverse people in Canada. Thank you.

[Andréanne Larouche, Bloc, Shefford, QC]

Very well. I understand that one possible measure to tackle cervical cancer is to combine vaccination and screening. Let’s keep in mind that this is one of the few cancers for which we have a vaccine and on which we can really take action. In a few years, it will be interesting to see the impact of this vaccination on that type of cancer.

Ms. Moriarty, you mentioned in your opening remarks that, according to some health research institutes in Canada, sex and gender influence the risk of developing certain diseases, reactions to medical treatment, and the frequency with which a person seeks health care. In addition, gender is one of 12 health determinants identified by the Public Health Agency of Canada.

As you said, there’s a bit of a narrower approach, certain things that are exclusively for men, and others that are specific to women. Please give us a few more examples of how sex and gender factors can have different effects on women’s health compared to men’s.

[Cindy Moriarty]

Thank you for the question.

I’d like to be sure I understood you. Are you asking for examples of general differences, rather than on a particular health topic?

[Andréanne Larouche, Bloc, Shefford, QC]

You mentioned different diagnoses. Among the differences, there are not only diagnoses, but also treatments and symptoms that would not be the same. Please expand on that issue.

[Cindy Moriarty]

That’s a broad statement that covers a number of situations and conditions. For example, in cases of heart attack, women’s symptoms are different from men’s. Sometimes they go unrecognized. Women themselves may not recognize the symptoms. A misdiagnosis can therefore ensue.

I’ll let my colleague Ed Morgan talk about medical devices. I can tell you, however, that historically, many of these devices were designed for a man’s body from a size perspective and did not necessarily meet women’s needs.

When it comes to differences in diagnoses, treatment and symptom identification, it’s hard to find a disease or condition that wouldn’t be affected by these circumstances. That’s why we conduct sex and gender analyses in all our work, because we don’t know what we don’t know. It’s really about making sure that we take the different circumstances and needs of all populations into consideration.

Ed, I don't know if you want to add anything in terms of diagnostics and medical devices for men and women, just in terms of differences.

[Ed Morgan, Director General, Policy, Planning and International Affairs Directorate, Department of Health]

I think you did it wonderfully. I'd only add that we do have an expert scientific committee helping to provide the department with advice on these issues as well. However, other than that, I think you covered it well.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Morgan.

Thank you, Madame Larouche.

Next we have Mr. Garrison, please, for six minutes.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much, Mr. Chair.

I know you all note my late arrival here this morning. The vagaries of House scheduling meant that Ms. Idlout had to step into the House to give a speech on the very important Truth and Reconciliation Commission call to action number six on the physical punishment of children. Therefore, I get the privilege of being here for a few moments on this very important topic.

I know that other members of the committee have already noted that this is a long overdue study in this committee. One of the things I hope the committee will consider as it works its way through is including in its mandate for its study here of women's health the study of gender-affirming health care for transgender and gender-diverse women in this country who do not have equal access to services.

However, I want to focus my questions this morning on something that most frequently comes up in my riding when it comes to women's health, and that's access to mental health services—especially for young women and girls in Canada and also, because my riding stretches from urban to rural, in rural areas—and this lack of availability.

Earlier this year, in March, the House of Commons' status of women committee completed a study on the mental health of young women and girls. I guess my question for you, Ms. Wong, is this: How is the government making progress in responding to those recommendations, making sure that equitable services are available in mental health for women and girls?

[Suki Wong, Director General, Mental Health Directorate, Department of Health]

I think that, as members of this committee know, the delivery of health services access is the responsibility of provinces and territories. With that view, we work very closely with our colleagues in the provinces and territories to ensure that access to vital mental health services is provided in a timely way.

As you know, and it's represented by the sheer number of colleagues around this table, the delivery of mental health services is shared across the federal jurisdictions, whether it's the Public Health Agency from a prevention and promotion perspective, my colleagues at the CIHR from a research perspective, or our colleagues at WAGE, the Department for Women and Gender Equality, as well. We're working very closely with our partners in other federal government departments.

As you also know, in the recent budget, the amount of $25 billion over five years was transferred to provinces and territories to ensure that they do address mental health as part of the shared priorities. We're working very closely with colleagues to ensure that the really important recommendations from the committee continue to be addressed.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you very much.

I appreciate, of course, that health and mental health are a shared jurisdiction, but there are some areas for which the federal government has primary jurisdiction, particularly in dealing with mental health for indigenous people. I have a large indigenous population in my riding. There are both on-reserve and urban aboriginal populations.

Can you speak a bit about what's happening with the provision of mental health services for indigenous communities and making sure that culturally appropriate services are available?

[Suki Wong]

Absolutely. I just want to say that the best people to answer this question would be our colleagues at Indigenous Services Canada.

However, with respect to how we are working to increase access to mental health services in indigenous communities, we are working very closely with our colleagues. There are specific hubs especially for access for youth and children as part of our integrated youth services program at the federal level. We're working very closely to advance and roll out those services in the communities as well.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I know delivery is primarily a provincial responsibility, but we see very large gaps in the availability of mental health services in rural areas throughout British Columbia, where I'm from. Quite often, people in crisis are told to come back later because of a long wait-list for services.

Are there any ways in which the federal government can provide pilot projects in rural areas or leadership in rural areas to improve the access to services, perhaps through technology?

[Suki Wong]

One of the programs I think are important to address in terms of access and special rural access is the Wellness Together Canada program. It was first implemented during the pandemic to assist Canadians from all jurisdictions to have access to 24-7 counselling, as well as to access their own mental health services.

Right now, for the delivery of mental health services virtually, we would like to point to the Wellness Together Canada portal, where all Canadians can have access not only to 24-7 self-assessment peer counselling, but also to 24-7 mild to moderate mental health services.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

You have 30 seconds, Mr. Garrison.

[Randall Garrison, NDP, Esquimalt—Saanich—Sooke, BC]

I'll ask a quick question about access to reproductive health. I'm not sure who this actually goes to around the table.

British Columbia recently made reproductive health and birth control free. Are there any initiatives by the federal government to encourage other provinces to make contraception widely available, especially to young women who don't have financial resources?

[Cindy Moriarty]

Thank you for that question. That would be for me.

I'm not specifically aware of discussions between the federal government and provincial jurisdictions on that matter. I would expect that other jurisdictions are looking at it closely. I was certainly very happy to see that initiative from B.C.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Garrison.

Thank you, Ms. Moriarty.

Next is Mrs. Roberts for five minutes.