Human Resources Committee on March 31st, 2022

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Martinez Ferrada.

Ms. Chabot, you have the floor for six minutes.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

Thank you very much, Mr. Chair.

I would like to welcome the witnesses and thank them for taking part in this study and contributing to it.

My first question is for Ms. Yalnizyan.

You have a background in economics and you are a columnist. You have given examples relating to the care economy. However, the repercussions of the labour shortage on the Canadian economy are being felt in several sectors of activity, including manufacturing and small and medium-sized businesses. I could also talk about food processing in the agricultural sector.

I read what the Ontario Chamber of Commerce wrote about the labour shortage. In summary, the two factors that businesses are concerned about are labour shortages and inflation.

From a broader perspective, do you have any observations about the impact of labour shortages on the Canadian economy? What solutions could be considered?

[Armine Yalnizyan]

Thank you for the question, Madame Chabot.

If I understood the question correctly, you were asking how the economic pressures of labour shortages might coincide with inflationary pressures facing all businesses.

I know the transitory phase has been going on a lot longer than anybody would have liked, but we did have a war in addition to a pandemic that won't go away because we won't treat it seriously. The inflationary pressures are unlikely to last over the long term, whereas the labour shortage issues are likely to accelerate over the next couple of decades. We need a strategy to deal with that. Simply saying that rising wages are going to do it will actually lead to more inflation, if that's our only strategy.

We can absolutely maximize the potential of people we underutilize in our own economy—indigenous populations, youth at risk, people who are disabled, recent immigrants and women. We could be using all sorts of people more fully, using their potential more fully. We could be using people who already have training.

I was interested to hear what Richard Holden said about the dental technicians. Certainly one of the ways we met the primary and preventive care needs of children for dental care in the late 1970s and early 1980s in Saskatchewan and Manitoba was by setting up schools for dental technicians so that dentists became not the number one way that we provided primary and preventive care but rather the backup, and dental technicians did most of the heavy lifting by going to the schools for children under the age of 13, to pre-high school kids, to provide initial primary and preventive care. That's an indication that we are underutilizing the capacity we have right under our nose.

As I said in my presentation, I think there are other ways we can prevent wages from being the primary inflationary thing. Some of the key examples of the last year were the early learning and child care agreements, which will support better wages in the sector providing the care but also reduce costs to parents.

In an era when one in four Canadians is going to be a senior and living on a lower income or a fixed income, and will be very resistant to seeing any protracted period of inflation—

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

I had another quick question for you, and I don't have much time left.

Do you believe that the participation of temporary foreign workers can be a solution to the labour shortage?

There is also the demographic context in certain provinces in Canada, where the demographic curves indicate that the labour shortage situation will persist. Quebec is one of them, and I think Ontario is as well. The participation of temporary foreign workers may not become the long-term solution, but at least it is a solution that should be considered.

Is immigration part of a solution to the labour shortage?

[Armine Yalnizyan]

It does one hundred per cent. We will not be able to deal with all of our labour shortages just with people born in Canada.

The question of the relationship between those who are invited to come here as permanent residents and to build their lives and those who are invited to come here only to do the work and are not permitted to stay is actually an ethical one as well as a social and economic issue. Yes, we will probably turn to more temporary foreign workers in the short term because immigration is backed up, but we need more paths to permanence. It can't be that they are good enough to come here to work but not good enough to stay. That doesn't sit well with me as a Canadian, and I'm sure it doesn't sit well with you as a Québécoise.

[Louise Chabot, Bloc, Thérèse-De Blainville, QC]

That is an important link you are making.

Ms. Shields, unfortunately, I do not have much time left.

As far as mental health is concerned, I have a better understanding of what is happening in Quebec. All community mental health groups report to the Quebec Ministry of Health and Social Services for funding. These community groups in Quebec provide a complementary service to the public service offer. So they play an important role.

You know that Quebec and the provinces are asking the federal government for increased health funding. Do you agree that our health care systems should be better funded?

[The Chair, Liberal, Bobby Morrissey]

Give a short answer, please.

[Rebecca Shields]

Oh, absolutely. We need a huge investment. We need investment in core publicly funded community-based counselling and psychology. Programs that have recently launched across Canada, such as the BounceBack program, need to be available for all Canadians. We need to prioritize more investment in housing, income supports and food security, because you are never going to fix somebody's mental health if they are afraid that they have nowhere to live and nothing to eat. We need to increase funding and strengthen the capacity of core mental health addiction services and supports.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Shields. You could continue during another question, as Madame Chabot's time has gone by.

Now we go to Madame Zarrillo for six minutes.

Madame Zarrillo, you have the floor.

[Bonita Zarrillo, NDP, Port Moody—Coquitlam, BC]

Thank you, Mr. Chair.

All of my time will go to questions for Ms. Yalnizyan. We definitely heard in earlier testimony today why this sector of the economy is growing.

My questions, Ms. Yalnizyan, are just to pivot to our shining a light on why the care economy has not been given the respect it deserves over time, and why filling these labour gaps in the care economy is more important now than ever, and to share why this sector as an economy can lead to a bigger economy and a better life for Canadians. Hopefully I'll have some other time later, but we'll start with those ones.

[Armine Yalnizyan]

Thank you, Madame Zarrillo, and again thank you for setting up this conversation and study on this topic at committee. I appreciate that you are asking me these questions, albeit some of them I can't answer, of why we haven't invested in them before.

We do know that health care is the most publicly supported program. What the pandemic has shown is that child care is now every bit as critical to the functioning of the economy as education is, except child care was primarily provided through the market across the country. A bunch of it will have collapsed because of pandemic economics. These are the same things that Richard Holden was mentioning: higher costs, lower revenue, fewer people coming in, and more expenses to be able to provide it. That also affects businesses that provide child care that have much lower margins and are very high touch, very labour intensive.

Why haven't we invested more in child care? I've been asked so many times in the last few months, how are you going to pay for it? Yet all of the evidence over the last 25 years shows that if you buy it, it pays for itself in higher labour force participation rates. That's in the short term. In the longer term, depending on the type of program you have, because just spending more won't necessarily give you maximum returns, the maximum returns come when you provide high-quality care for kids who are at risk of not being learning-ready when they enter school, and not learning-supported as they go through school.

If you do that and provide high-quality care for these kids who are at risk and for some of the people Rebecca Shields was talking about—newcomers, immigrants and refugees, people who have been through trauma—you support people, or kids who have disabilities, and you give everybody a fighting chance as they enter school in their early school years and you maximize their potential for the rest of their lives. You reduce their reliance on unemployment insurance. You reduce their reliance on health care. You reduce their reliance on the policing and incarceration system. It pays dividends to the public purse in so many ways and it increases their individual incomes and earning potential. You improve their learning potential and you improve their earning potential, how much they pay into the public purse instead of taking out of the public purse.

We should have done this 50 years ago when the Royal Commission on the Status of Women asked for it. It took us 50 years. We're here now. It's not enough to simply to sign the deal: We have to deliver great care.

Now I'm going to turn long-term care. The pandemic showed that it matters how you deliver long-term care. Private, for-profit care, which is the majority of care across the country, was the coffin for so many people because profit preceded care as the number one principle. There were too many people in overcrowded rooms, too many low-paid workers who were not permitted to add enough hours for benefits to kick in, so they had to go from one home to another bringing the disease with them everywhere they went. This is craziness. We need to learn from the pandemic, especially with an aging population, the importance of having services at home, services in long-term care facilities, services in child care centres and services in hospitals that are there for people when they need them so they can go about the job of growing prosperity, doing other things that grow GDP. Too often we think about the care economy as the derivative, as I said. It's the thing that happens after the economy grows.

In fact, we need to understand that it is the foundation for an economy growing to its maximum potential. The reality of population aging is not unique to Canada; it is happening throughout the global north. There are going to be labour shortages in every country. We are going to be competing with other rich countries everywhere to attract newcomers, whether they're temporary or permanent because there simply aren't enough workers anywhere.

What we are going to discover is what the pandemic already revealed if we are willing to pay attention to it, which is that once you give people the chance to go about their work, because they're not spending all of their time providing unpaid care, you will maximize their potential. You make people healthier, as Rebecca Shields was saying. Like the people who both Dr. Burry and Richard Holden were talking about, when you have a healthy mouth you can get a better job, right? Cavities are mostly preventable if you get at them early with fluoridization programs and you do regular check-ups. These are costs that we could be saving. Why aren't we investing more? It's because if it bleeds it leads. That is, whatever is the noisiest is what's gets funded. There's the preventative health care approach, which the pandemic is forcing us to take a look at and, in fact, the war with Ukraine is forcing us to look at.

What are we doing to prevent these things in the first place? It's deeply unsexy. They pay “dividends”, and we won't have a lot of money to burn as a quarter of the population becomes older, pays less in taxes and draws more in services, so we'd better figure out a way of maximizing what we get for our tax dollar pretty darned fast.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Madame Zarrillo. Your time has gone by.

Now we go to Mr. Liepert for five minutes.

You have the floor.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Thank you, Chair.

Thank you to the guests for being with us today.

Ms. Shields, I can attest to one thing that you stated, that alcohol consumption has gone up. I can assure you that in the last two years I've been drinking more than I've ever drunk.

Seriously, I want to make a couple of comments and get your feel on whether or not I'm on the right track or the wrong track.

I'll start by saying that I had the privilege of being health minister in the province of Alberta for two years, in 2009 and 2010. I've always felt, after having that privilege, that health care in this country has a real structural problem. We spend all of our effort and all of our money on treating sickness, and not nearly enough on preventative care. I've always felt that mental health was the poor cousin of health care spending because it's almost a hidden disease. If you see someone who has a broken leg, you'd better fix it, or if someone has cancer, you need to treat cancer, but mental health is a very silent issue.

Despite the fact that we've spent all of that money on health care and continue to spend a tremendous amount of money on it, Dr. Smart from the Canadian Medical Association, who was one of the witnesses at our last meeting, described Canada's health care system as being on life support and in a crisis.

Would you agree that we need to fix the structural problem of health care and not just throw more money at it, which is so often the call of everyone we talk to about how to fix health care?

[Rebecca Shields]

I really do agree with that statement. I think there are efforts made to better integrate health care so that we can provide holistic care, whether they are digital strategies, where we can all share electronic medical records, or just how we fund, as you said, better prevention.

I want to just take two seconds to talk about that because it came out of Alberta from Alberta Health Services, namely the impact of chronic loneliness on overall health care costs. Chronic loneliness was shown to be the biggest driver of keeping people in hospital who could have been removed from hospital or ALC—alternate level of care. It also showed that the most likely reason that a senior would end up in hospital is if they were lonely. It is also a driver of chronic illness, and it is equivalent to smoking 15 cigarettes a day.

Dealing with chronic loneliness is a huge issue that could, like other things, have transformative cost. It drives anxiety, it drives depression, it drives suicide rates and it drives a whole lot of issues that, if we tackled with early intervention and mental health promotion and belonging, we would have much more health and well-being in society.

Thank you.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

The second thing I would like to discuss a little bit is the real challenge that we have. As a country, we are fortunate enough that we have to be a leader in humanitarian aid. I think we don't recognize some of the trauma that many of these new Canadians face.

When we finally got some 200 Yazidi women relocated to Calgary, I had the privilege of their ending up primarily in my riding. Some of their stories were just unbelievable, and it was all around the trauma that clearly goes back to their mental health status.

How do we treat situations like that when it's not necessarily a physical issue? My God, it must be a difficult job.

[Rebecca Shields]

I want to share what my branch of the CMHA started. It's the first of its kind in Canada, funded by the federal government through Immigration, Refugees and Citizenship Canada. We've embedded holistic, trauma-informed mental health care in settlement agencies. It is specific to our region. We called them “welcome centres”. Our team was embedded in the welcome centres to provide care, so that these people didn't have to get referred out of the settlement services.

We had a nurse practitioner to deal with the health care issues, as well as specialized, culturally competent mental health workers. We also partnered with trauma specialists, so that we could deal with people who had family issues, settlement issues and physical health issues. This is because newcomers and refugees may not want to talk about their mental health. It may present as health care issues, but then when we dig deeper, there are underlying health costs.

The answer is that you have a holistic team that has embedded primary care along with specialized treatment that is culturally competent for newcomers and refugees and that has a trauma-informed approach. It cannot be siloed. You have to work with the community to embed services together, so that they're seamless and integrated, and they build the capacity of settlement workers to also recognize and refer appropriately.

Thank you.

[Ron Liepert, Conservative, Calgary Signal Hill, AB]

Thank you.

[The Chair, Liberal, Bobby Morrissey]

Thank you, Ms. Shields and Mr. Liepert.

Now it's over to Mr. Long for the last round. Before we go to him, I want to advise Madame Chabot and Madame Zarrillo that we will have time for a short question from each of them before we conclude this round.

Go ahead, Mr. Long.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you, Mr. Chair.

Good afternoon to my colleagues.

Welcome, MP Muys, to HUMA.

My first quick question is for Ms. Yalnizyan. I'm impressed with your record collection. We're just wondering if you have any April Wine, BTO or Stampeders in that collection.

[Armine Yalnizyan]

Are you kidding? Of course I have.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

I'm glad to hear that.

My questions will actually be for Ms. Shields. Thank you for your testimony.

Thank you to all the witnesses for your testimony. It's very beneficial to us.

Ms. Shields, I want to talk to you more and give you an opportunity to elaborate more on the crisis we're facing in our health care system with respect to mental health.

I'm going to quickly quote. I read an article this afternoon on CBC, which reads:

Rose Mary Buote says she spends her shifts saying sorry—sorry a patient is so sick because a surgery was pushed back, sorry she left a patient's next of kin on hold, sorry she is stretched too thin to provide the care she wants to give.

She feels "so guilty”.

We're all aware that so many health care workers are cracking under the strain of the system. We, as a society and a community, are trying to move past the pandemic, but we have a health care and caregiving force that is exhausted and depleted. We've heard from multiple witnesses that health care workers are depleted and distressed. We are told that rates of severe burnout among health care workers have almost doubled. Recent figures show that 20% of frontline health care workers have thought about suicide and, sadly, 6% had planned an attempt.

Ms. Shields, can you speak and elaborate more and in more detail about what your organization has heard from health care workers?

Thank you.

[Rebecca Shields]

I've heard the same thing you've heard. In fact, we witness it. We partner with and we work inside our hospitals, so our staff are working in an integrated manner.

It is the moral distress of not being able to provide the care, the burnout, having to deal with the number of deaths you've witnessed from the pandemic, and transferring patients. One of the nurses I know said that she had to hold her nose because she had to transfer patients to another hospital far away from their family. That was the only thing she could do, even though she knew it wasn't best for them or their family. There was just no space.

The reality is that our ICUs are still filling up with people with COVID. COVID isn't over for the health care system. It isn't over for long-term care. I mentioned the impact of health care workers feeling that they were being threatened and protested against by people who were protesting against public health guidelines. It wasn't the ringing of the pots and pans any more. It was how they felt when they were told they couldn't wear their nursing uniforms or their medical uniforms to care.

We need to stand in solidarity with our health care workers. We need to remind Canadians that they deserve the compassion and empathy that you want them to have. I know, and I think all Canadians know, that when you show up to the emergency room for yourself, your loved one or your child, you want your doctor or nurse to be at the best of their game. When they're burnt out and tired, they may not be, and that puts everybody at risk.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you for that.

Ms. Shields, I want to continue. Our Minister of Mental Health and Addictions, and associate minister of health, Minister Bennett, has been tasked in her mandate with strengthening our mental health systems. Last week, our government introduced a $2-billion transfer to provinces and territories that would assist in improving mental health services. Do you think treating our mental health as we do our physical health will encourage people to enter the health care field? How can it help with the labour shortages we are currently facing?

Thank you.

[Rebecca Shields]

I think it's the fact that there's an investment and that people can see careers in mental health whereby they can support the well-being of their community, and the integration of health and mental health. Mental health is health, and we know that, so as we integrate care, I think it's going to be an exciting profession in which people can really make change and improve well-being. That's why we do this. That's why I'm in my role, because I want to make a difference.

I applaud the investment, but I do want to make a recommendation. One of the investments or directions they spoke about was to support more funding for colleges and universities to fund counselling and services for youth, but I really worry that they're going to fund the colleges and universities to provide that care, rather than funding community or health care providers, creating yet another silo whereby you have the health care funded through universities and the health care funded through provinces. What I urge is that all of the services be integrated. It's like the refugee and settlement program I spoke about, which is integrated so those people can have holistic care that is not just siloed thus creating more navigation problems.

[Wayne Long, Liberal, Saint John—Rothesay, NB]

Thank you very much.