Human Resources Committee on Nov. 22nd, 2018

[The Chair, Liberal, Bryan May]

I call the meeting to order.

Good morning, everyone. Pursuant to Standing Order 108(2) and the motion adopted by the committee on Tuesday, September 18, 2018, the committee is resuming its study of supporting families after the loss of a child. Today the committee will hear from department officials.

With us from the Department of Employment and Social Development are Michael MacPhee, director general, employment insurance program and services oversight, transformation and integrated service management branch, and Rutha Astravas, director, special benefits, employment insurance policy, skills and employment branch.

As well, from Statistics Canada, we have Ron Gravel, acting director of the health statistics division, and Valérie Gaston, the chief of vital statistics, health statistics division.

Welcome, and thank you to all for being here this morning on this wonderful fall weather day.

We'll begin with opening remarks.

Michael or Rutha, the next seven minutes are all yours.

[Rutha Astravas, Director, Special Benefits, Employment Insurance Policy, Skills and Employment, Department of Employment and Social Development]

Mr. Chair and members of the committee, thank you and good morning.

My name is Rutha Astravas.

I'm the director of special benefits for employment insurance policy at the Department of Employment and Social Development. As you said, joining me is Mike MacPhee, my colleague from Service Canada.

I am thankful for the opportunity to appear again before the committee to address this very important issue and build on previous discussions.

I sympathize with Canadians who lose an infant child to sudden or unexpected causes, including in the case of sudden infant death syndrome, or SIDS. It is hard to imagine the suffering families experience when they lose a child suddenly or unexpectedly, yet some share their deeply personal experiences at this committee.

We've paid close attention to these hearings focusing on supporting families after the loss of a child and we're thankful for the evidence shared by families; non-governmental organizations, including support networks across Canada; and Canadian and international researchers. We've shared the concerns and suggestions with our service delivery counterparts.

In particular, we acknowledge the challenges that parents must face in grieving the loss of their child and maintaining their emotional and physical well-being while trying to return to work. It's tragic to consider that in 2014 alone, there were approximately 1,800 total infant deaths and 3,200 stillbirths, according to Statistics Canada.

During a previous committee appearance, we presented an overview of employment insurance benefits that could support parents who lost their child, as well as recent changes to make the El program more flexible and inclusive for maternity, parental and caregiving benefits.

We explained that EI maternity benefits continue to be payable in the tragic event that a child passes away, because they're paid in relation to the mother's recovery from pregnancy and childbirth. We also explained that parental benefits payments end in the week of the death of the child, as care for the child is no longer required. We heard concerns about that policy, which is reflected in the Employment Insurance Act.

We also highlighted that the sickness benefit provides income support to claimants who are unable to work due to illness or injury, including incapacity due to emotional or psychological distress that a parent may suffer following the death of a child.

While there are no EI benefits specifically to cover a period of bereavement, grieving parents are eligible to receive up to 15 weeks of EI sickness benefits provided they obtain a medical note. The note must be signed by a medical practitioner and indicate the period during which the claimant is unable to work. This is separate from existing unpaid bereavement leave under federal, provincial or territorial labour codes or employer-paid leaves.

Other supports are available to parents and families through federal initiatives promoting public health of Canadian workers, parents and children; information campaigns and research regarding SIDS, infant health and safety; occupational health and safety programs for workers overall; and during pregnancy and nursing.

We heard from witnesses about the importance of easy-to-find information of what to do when a family member dies and making the reporting process simpler and less intrusive.

Service Canada is the main point of contact to report a death to the federal government, or that a death occurred in the territories or outside of Canada. On its website, you can find information on what to do in the event of the loss of a family member. Families residing in one of the provinces also need to notify the province where they reside.

We've heard how traumatic the loss of a child may be for families. We also know that it takes a variety of supports to respond to their needs. That may include community supports and grief counselling, as well as government programs. As we've described, the EI program provides a range of supports to qualifying workers, and changes have been made to make them more flexible.

With that, I look forward to your questions on the program and its delivery, as well as any suggestions for improvement.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much.

Now, from Statistics Canada, we will hear Ron Gravel, acting director, health statistics division, and Valérie Gaston, chief of vital statistics, health statistics division.

You have seven minutes, please.

[Ron Gravel, Acting Director, Health Statistics Division, Statistics Canada]

Thank you, Mr. Chair.

Good morning, my name is Ron Gravel, I am the director of the health statistics division at Statistics Canada, and I am here with my colleague, Valérie Gaston, chief of vital statistics.

I would like to thank the committee for inviting us to appear today in the context of your study of support to families after the loss of a child.

The following presentation will provide information on youth mortality in Canada and will focus on infant deaths.

We'll start by providing some context to explain how the presentation evolved.

Statistics Canada currently holds information on home care, caregiving and care receiving for long-term health conditions. Unfortunately, after careful review, we can confirm that these data holdings do not contain information in response to the committee's request for information on support to parents after the loss of a child. These holdings also do not contain enough information on the profile of the children, in regard to the conditions, to support this request.

However, Statistics Canada does have data on stillbirths and deaths of children in Canada. We will highlight some of the information available on these deaths.

The key messages for the presentation today are these: Deaths of infants less than one year old represent more than half of all youth deaths—that is, of all people 19 years old and under. Neonates less than one day old represent more than half of all infant deaths. The total number of stillbirths—that is, fetal deaths—has increased over the last 25 years.

On slide 3, I'm showcasing a decentralized system of civil registration and vital statistics, just to give you the context. Canada's national vital statistics system is based on co-operation and collaboration among the 13 provincial and territorial vital statistics registries and the federal government, represented by Statistics Canada.

Civil registration of births, deaths, still births and marriages are the responsibility of the provinces and territories. Each provincial and territorial registrar operates under its own provincial or territorial vital statistics act. The collection and dissemination of national vital statistics are the responsibility of Canada's central statistical agency. Statistics Canada is legislated under the federal Statistics Act.

[Valérie Gaston, Chief Vital Statistics, Health Statistics Division, Statistics Canada]

I will take over from here.

The next slide we'll be looking at is a chart that identifies the breakdown of youth deaths in Canada by age group in 2016.

There were 267,000 deaths in 2016. Of these, 3,120 were youths aged between zero and 19 years. This represents 1% of all deaths.

As you can see by the larger section in light blue, 56% of all youth deaths occurred in infants. Children aged five to nine years, in grey, represent the smallest proportion of youth deaths, at 5%. The proportion of deaths occurring in each age group to overall youth deaths has remained consistent over the past 25 years.

This next slide describes the trend in youth deaths in Canada, since 1991 across the different age groups. Over the last 25 years, youth deaths have decreased across all age groups. Infant deaths contributed most to this overall decline with a reduction of 832 deaths.

I will now describe the differences in the youth mortality rate across the provinces and territories, and this is on slide 6.

In the table, red cells indicate rates above the Canadian average, yellow cells rate equal to the Canadian average, and green cells indicate rates below the Canadian average.

The variability in mortality rates is greatest in infants, with rates ranging between 3.5 in British Columbia and 17.7 in Nunavut. In the table, two provinces stand out due to trends in their youth mortality rates: Saskatchewan rates are above the Canadian average for each age group, while Quebec is the only jurisdiction where rates are equal to or below the Canadian average for each age group.

The next slide shows the trend in infant deaths, by age group, from 1991 to 2016.

Infant deaths—under one year—have decreased in all age groups with the exception of the under one day age group. The greatest drop in number of deaths occurred in infants one to 11 months old, from 935 in 1991 to 450 in 2016. Both the one to 11-month and one to six-day age groups experienced the greatest relative decreases of 51%.

The following chart shows the breakdown of infant deaths by age group, and here we are on slide number 8.

Overall, 1,741 infants died in 2016. Almost three-quarters of these deaths occurred in infants under one month and over half of all infant deaths occurred to neonates less than one day old.

Finally, the number of infant deaths tends to decrease with age, with the lowest number of deaths occurring in the six- to 11-month age group.

We'll now shift our focus to the leading causes of deaths in Canada. This is slide number 9. The following bar graph identifies the five leading causes of infant deaths in 2016. Most infant deaths are the result of congenital malformations—chromosomal abnormalities—followed by deaths due to short gestation and low birth weight.

Although sudden infant death syndrome is not part of the list of leading causes in 2016, it was part of the top five leading causes of death historically. As of 2012, this concept is no longer used by most certifiers in Canada. As a result, it is no longer possible to compile the number of SIDS deaths occurring in Canada. The deaths once confirmed as SIDS can now be found in the unknown category.

There were 3,159 stillbirths in Canada in 2017, and less than one-third of those deaths occurred at a gestation of 28 weeks or more. Although the total number of stillbirths has been on the rise since 1991, the number of late fetal deaths at 28 weeks or more has actually decreased by 23%.

The last slide shows the stillbirth and perinatal death rates, which is the period of 28 weeks of gestation up to six days after birth.

The mortality is variable across the provinces and territories.

The Atlantic provinces have rates equal to or below the Canadian average, with the exception of Prince Edward Island where the perinatal mortality rate is above Canadian average.

Quebec and Alberta have rates below the Canadian average, while Ontario, Manitoba and the territories have rates above the Canadian average.

Though British Columbia has a perinatal mortality rate below the Canadian average, the stillbirth rate is the highest amongst the provinces.

Saskatchewan has a stillbirth rate below the Canadian average but its perinatal death rate is above the Canadian average.

This concludes the information we have to present to you today. We'd be happy to answer any questions you might have.

[The Chair, Liberal, Bryan May]

Thank you very much.

First for questions is MP Barlow, please.

[John Barlow, Foothills, CPC]

Thank you very much, Mr. Chair.

Thank you to the department officials for being here with us today. Ms. Astravas, I believe you were here earlier, and I appreciate your taking the time.

First, I have a couple of questions on the Statistics Canada information. This is more because of my not knowing some of these things, but, Ms. Gaston, what was the reason for the SIDS definition to be changed to “unknown”? Was there a clinical change, or did the health sector cause that change? If there is no designation for SIDS, I'm wondering what the reason is to put it as unknown.

[Valérie Gaston]

SIDS, or sudden infant deaths, or sudden and unexpected deaths, would be investigated by the coroners and medical examiners. The definition of SIDS is essentially that after all the investigations—they've done an autopsy and looked at everything—they cannot conclude what the infant died of. Because it was a diagnostic of exclusion, it became a nomenclature. Giving it a title, a cause of death, as “SIDS” means it's unknown.

Those cases are still in the statistics. We can get them under the “unknown” category; they're just no longer headed as “SIDS”.

[John Barlow]

Right. They didn't want to give a title to a death for which they really didn't know the cause, so it was becoming, maybe, a bit easy just to say...I don't want to say “easy”, but SIDS was a misnomer because there really was no definitive cause of death that they could figure out, so “unknown” was a better term, I guess.

[Valérie Gaston]

That's how they felt. I can't really speak for them, but yes.

[John Barlow]

I'm sorry. I don't mean to be putting you on the spot. I was just curious. I hadn't heard that before. That does make some sense. I can see that.

I want to ask another question of Mr. Gravel or Ms. Gaston—I can't remember who was talking about it. You were talking about the decrease in the number of infant deaths over the years, from 1991 to 2016. I'm going to make the assumption that improvements in health care and technology have been a part of that, but is there any definitive data about why we've seen that steady decline, except in that one area where it's been more fluctuating, one year old or less?

[Valérie Gaston]

We didn't focus much on the older age groups, but there are a lot of decreases in accidents. As you were saying, some improvements in safety could account for some of the decreases we've seen.

[John Barlow]

On the definition of stillborn, does that include a late-term miscarriage? I think that the wording you had was “under one day”. Does under one day include pre-birth? Would a late-term miscarriage be included in that, or would that be something entirely different?

[Valérie Gaston]

It becomes very complex, because there are all these different terms for different periods. On the last slide, we talked about the perinatal mortality rate, and perinatal would include late-term stillborns after 28 weeks and also live births up to six days.

[John Barlow]

Okay.

On that last slide we see that there has been a trend downward, except for those that were one day or less. Is there a reason we're seeing that increase? That was on page 10.

[Valérie Gaston]

The increase is on slide 10?

[John Barlow]

Yes. It says, “The total number of stillbirths has increased since 1991”. Do we have a direction on why that would be?

[Valérie Gaston]

I would prefer suggesting that colleagues at the Public Health Agency answer those questions. We don't have the background or expertise in that field to really offer an answer.

[John Barlow]

Sure. I appreciate that. If you're not sure, I don't expect you to take a wild guess. That's okay. We're here to try to get some information, and that's totally fine.

For Service Canada, Mr. MacPhee and Ms. Astravas, I know you may have heard some of these questions when you were here before, but I'm not sure we got to all of them.

One of the things that we've certainly heard over and over again from the stakeholders is the need for a one-door-in resource, either a website or a dedicated phone line. Is this something that Service Canada has discussed before? Is this a possibility?

It seems to be that one real common denominator that we've heard from stakeholders: when they are dealing with this is that there's a lot of confusion about where to go to access programs. We've certainly heard the stories of people having to go to the bank and repay EI and things like that. Is there a possibility to have a one-stop shop, for lack of a better description, or a dedicated phone line or website for infant death and bereavement?

[The Chair, Liberal, Bryan May]

Give a brief answer, please.

[John Barlow]

Thanks, Mr. Chair.

[Michael MacPhee, Director General, Employment Insurance Program and Services Oversight, Transformation and Integrated Service Management Branch, Department of Employment and Social Development]

It certainly does form part of the larger work that we are undertaking at Service Canada as it relates to modernizing the way we deliver services and moving away from a siloed service delivery model, program by program, to a more coordinated or one-stop-shop approach, as you have suggested.

To this point, it's certainly within the medium-term plans around how we more effectively reduce the burden on clients—all clients, for that matter—and facilitate their access to the programs and engagement with the department.

[John Barlow]

Thank you.

[The Chair, Liberal, Bryan May]

Mr. Morrissey is next.

[Bobby Morrissey, Liberal, Egmont, PE]

Thank you, Chair.

I want to pursue the question raised by my colleague Mr. Barlow. In all the hearings to date and with the witnesses who appeared, there were what I term three themes that came out.

There was financial distress at a difficult time in a person's life. The big thing that government should be concerned about was the insensitive structure that people had to navigate, with no one particular door to go to. EI was part of it, and Service Canada, and there were a number of the child benefits in those, and each case is slightly different. They are not the same.

I have experienced this in my constituency. Even if I focus on employment insurance, it is not simple. It's cumbersome at a very difficult time.

How is Service Canada going to deal with this? It's been identified that there should be one dedicated line, for instance, with people who are trained on dealing with individuals who are suffering in this case, and it can be different from region to region. That's been a big issue that's been brought to this committee, and it's an issue that, quite frankly, should be resolved by government, and it should have been resolved by now.

Could you comment on that briefly? There is a patchwork of delivery. It's not simple to navigate. I've seen, in looking at your comments, wonderful statistics that it takes this much time, on average, to get here or to get there and everywhere, but that's not the real world. It is a cumbersome, insensitive system to navigate.

If I look at the testimony that was given here this morning, it is that bereavement is not allowed, but if you get the doctor to say you may not be feeling good or something, we will put you on that. Bereavement should be part of the system that triggers EI benefits for sickness, and this does occur in a way: People are told that if they say this or that, they're not eligible, so they should simply get the doctor to say that they're not feeling well or that they're under stress.

We shouldn't be forcing people to provide information that is totally inaccurate.