Indigenous and Northern Affairs Committee on Sept. 26th, 2024

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Thank you to all of the witnesses today.

Dr. Reimer, I'm going to focus my questions on you.

Thanks for your testimony. You and I are both public health physicians and have had experience issuing boil water advisories. I wonder if you could talk about your experience issuing boil water advisories, particularly the effect on the community and the social effect.

Can you describe some of your experiences there?

[Dr. Joss Reimer]

Issuing a boil water advisory is not a minor decision. It causes incredible stress on a community, and on businesses as well, because it requires them to change everything about how they go about their daily lives, whether that's washing the dishes in a restaurant or preparing food at home or doing laundry. It's quite striking, when you see how a temporary boil water advisory can be so disruptive, to think that this is the daily reality for so many people.

In fact, in many cases, when the contaminants are not microbial and are not infectious, a boil water advisory won't even address the concerns. It may in fact make it worse, because you make the water more concentrated with whatever substance may be in it. This is something that we do in partnership with drinking water officers and indeed with operators. We very much value the expertise of the operators who are on the ground.

Advisories can cause dramatic effects in that community and for people trying to run their businesses in the community. It's for that reason that we support the passage of this bill, but we certainly do emphasize that within regulations, it would be important to ensure that the real costs of not just implementing water treatment and wastewater treatment but also the ongoing running of the infrastructure be included in discussions with first nations.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

Can you also describe community readiness? When it comes to lifting boil water advisories, you would usually offer guidance in that area. Apart from, obviously, the quality testing, can you comment on how else you assess or are involved in community readiness to lift boil water advisories?

[Dr. Joss Reimer]

One of the very challenging and less measurable effects is the fear that comes along with a boil water advisory. While there need to be multiple testings showing the water is safe in order to lift a boil water advisory, it's very challenging for a community to trust that this water they were just told was dangerous is now safe for consumption.

We're very thankful to the operators, the drinking water officers and all the folks who developed materials we can share with community members about how to function safely during and after a boil water advisory, but certainly that fear is not something that disappears immediately. It can have lasting effects, because those communities wonder whether this same problem may occur again and whether it's safe for their children to drink the water on a day-to-day basis.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you. That's very helpful.

As a public health physician, you clearly have familiarity in provincial legislation and working with regulations, both in interpreting and in helping to enforce regulations. How do you see the benefit of having this overarching federal legislation, Bill C-61? You urged us to pass this quickly. How do you see federal legislation as being helpful in ultimately enabling clean water in first nations communities?

[Dr. Joss Reimer]

We must put an end to the environmental racism that we've seen for far too long in this country, and the experiences of many indigenous peoples across the country are deeply unacceptable. While there is no bill that is perfect, this is an important first step in acknowledging the rights of indigenous peoples and the rights of first nations peoples, particularly in concordance with the UN Declaration on the Rights of the Indigenous Peoples, to ensure that they have self-determination over the resources that affect them on a day-to-day basis.

Therefore, while there will undoubtedly need to be a lot of discussion and partnership with many different jurisdictions, we still believe in the CMA that this is a critical first step in recognizing those rights and helping move things forward in a positive way.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you.

I have a little bit of time left. I was very interested that you brought up climate change and its relationship to health. I know that as an organization, CMA has done a lot of recent work on the relationship between climate change and health. Again, with your public health hat on, can you comment on the importance of recognizing and responding to climate change as it relates to protecting source water and supporting maintenance of clean water?

[Dr. Joss Reimer]

Water truly is life. It's needed for everything on a day-to-day basis. When we see the many effects of climate change—whether it's changing weather patterns that are leading to more heat-related illness and death, or wildfires that have caused both injury and respiratory conditions and the stress that comes along with it—protecting water is another element of that. With the changes in what infectious diseases can survive in different parts of the world, we see some of the shifts in what might be in the water. We see some invasive species that are taking hold in some parts.

I live in Manitoba, where Lake Manitoba has invasive species that are living in the lake, causing harm to that water and making it unsafe to use for many things. This is something that is interlinked and affects the health of all of us.

[The Chair, Liberal, Patrick Weiler]

Thank you very much, Mr. Hanley.

Next up is Mr. Lemire for six minutes.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Thank you, Mr. Chair.

I thank all the witnesses for their contribution and their sensitivity to indigenous realities. Their testimony greatly advances our discussions. They also remind us that we are going to have to show sensitivity when we begin the clause-by-clause consideration of the bill.

Dr. Reimer, the Canadian Medical Association said last week that they had done a multi-year review of their archives and other documented interactions with indigenous communities. It uncovered a long history of harm caused by Canadian physicians.

How did you access data from federal hospitals? Has it been hard to get co‑operation from health care institutions? Do you have information on all the provinces?

[Dr. Joss Reimer]

Thank you for your question.

For our review we accessed the data specific to the Canadian Medical Association, so we did a multi-year review of our specific records.

The Canadian Medical Association does not run any health systems or services directly. However, despite not doing that, we still found many incidents of prejudice and discrimination within our own records. Whether that was how we promoted physician income over the wellness of indigenous peoples, for example, there were things that were clear in our records.

We are also currently going through the Canadian Medical Association Journal to look at the research that has been published over the entirety of that journal's existence, and we expect those results to be ready in 2025.

In addition, we met with many indigenous community members and had a guiding circle made up of elders, knowledge keepers and indigenous physicians, who gave us a lot more information than what we could find in our records. For example, they expressed to us, despite its not being in our records, the role that physicians played in the sixties scoop, as well as in the ongoing overrepresentation of child apprehension that occurs with indigenous families, so that was included in our apology, as well as what we found directly in our records.

We don't have access to the hospital records directly, but we do have the records of how the association representing physicians communicated about and advocated—or rather, in many cases, didn't advocate—on behalf of people who were experiencing harms in those hospitals.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

That is very useful.

I also feel that it is very hard for first nations to get access to the data on them. We saw proof of that at the inquiry into missing and murdered women, for one. It's very hard to get access to the data, particularly the health data. The process is still very useful, and I thank you for enlightening us on that matter.

How do you manage the ethical concerns raised by certain practices indicated in the specific report you just mentioned as well as in other reports?

[Dr. Joss Reimer]

During our assessment we used our code of ethics to guide some of the work we did. However, we also found that our code of ethics is insufficient when it comes to addressing racism and discrimination within the health care system. That's one of the commitments in our action plan. We're going to open up our code of ethics and do a review of how we need to improve that code, because it applies to all physicians in Canada: They must abide by this code of ethics. Therefore, one action item coming out of the apology is to strengthen the wording in that code of ethics so that all physicians are aware and are held to the standard that we should have been held to all along: protecting the health of indigenous peoples.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

What work has been done or is being done to explore the epigenetic impact on the health of indigenous communities?

[Dr. Joss Reimer]

The epigenetic effects were not specifically looked at in our review. That didn't appear in the documentation from the CMA. However, there is good research that these epigenetic effects do indeed occur and have long-lasting impacts on generations.

I don't know the answer to this at this point, but I wonder whether we may see some of that come up in the review of the Canadian Medical Association Journal, because there will certainly be evidence. I can hope that maybe it won't come up because it's not an example of racism but instead is a positive example of working in reconciliation; however, we don't yet know what we're going to find in that review.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

You touched on the issue, but I would like to take it a little further.

How could we make a concrete recommendation to integrate epigenetic impact analysis into public health policies, while ensuring that research funding prioritizes the specific needs of indigenous populations and at-risk groups?

[Dr. Joss Reimer]

Epigenetic effects refer, really, to the impact that certain traumas can have on generations going forward, even if the specific harm is not ongoing. When it comes to first nations communities, not only was there historical trauma, but there are ongoing harms as well, and so both of those circumstances apply in this situation.

I think it will be critical to have first nations' voices front and centre in the consultation around the regulations, making sure that their self-determination is consistent with the UNDRIP requirement that those voices are heard and valued in the regulations and in the decision-making about how costs should be assigned.

[The Chair, Liberal, Patrick Weiler]

Thank you, Mr. Lemire.

Next up, we have Ms. Blaney joining the committee today. You have six minutes.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Well, thank you, Chair. It's good to visit.

I used to sit on this committee, so I always enjoy a little bit of time back to talk about these really important realities.

I'm going to start with you first, Dr. Reimer, through the chair, of course.

You mentioned in your testimony that you have issued boil water advisories in first nations communities, and we know that prior to colonization—it's very clear from the history—first nations managed their water and had clean water, and it was a pretty good system they had in place.

I'm wondering if you could tell us a little bit about the difference between what it is like to call a boil water advisory in a first nations community compared, perhaps, to a community like mine. I think of Courtenay, which had a few boil water advisories.

[Dr. Joss Reimer]

Thank you so much for the question.

The jurisdictional divide does make it complicated when we're issuing temporary boil water advisories, and it may differ from province to province or territory as well.

In Manitoba, we have a public health physician who is on call 24-7 for the entire province, so if a boil water advisory needs to be issued, say, on the weekend, regardless of where it occurs, it would be that individual who issues it. However, come Monday morning, if it's a first nations community, we would need to work with the first nations and Inuit health branch, or whatever it is titled at that time, to ensure that the ongoing work, the official issuance, occurs with them.

Consistent with some of the challenges we've seen with Jordan's principle, it can add complexities when it's a provincial medical officer of health who's done the initial advisory, but it's on a first nations community that is under federal jurisdiction.

[Rachel Blaney, NDP, North Island—Powell River, BC]

I hear you when you say that it adds to the complexity, and that can make it a little more stressful. I'm just wondering, in terms of making those announcements and in terms of the community's response, if there's a uniqueness or something that we should better understand about what that feels like for the community.

I know in my riding—I'm in B.C.—I have a few very remote communities, and they have water systems that sometimes have huge challenges to them. It can be very stressful for them because, as another person testified today, you don't necessarily have the remedies to fix it because you are so very remote, and that just brings up such fear.

Could you talk about that impact on the community, not only on the health and well-being of their bodies, but maybe of their minds?

[Dr. Joss Reimer]

The more remote a community, the more stressful something like a boil water advisory can be, precisely because of what the other witness mentioned—there's a lack of resources, and it takes a longer time to find solutions and resources. In particular, on average, first nations communities have less access to resources, have lower income and so may face additional challenges in those solutions, regardless of where they're located.

Never having lived in a first nations community, I would defer to the chiefs and other first nations members who have spoken to this committee about their experiences. To me, as a non-indigenous physician, the challenges seem much higher when you have that lack of resources, as well as the jurisdictional challenges they may face.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you.

I'm going to go to Mr. Mitchell. I believe that's the name.

I'm just curious. You talked about the remoteness and the challenge of building capacity in some of these small remote communities. I guess my question is around resources, because what I've heard from some of the communities I represent is that often the government will give some money to fix those pipes, but if you want to train people to make sure that those pipes stay good, that's going to be another source of funding, and there might be some information, but the timing doesn't work, so that ongoing work of building capacity and spreading the knowledge around the community a little bit more tends to be a challenge.

I'm wondering if you could speak to that and whether that's something you've heard or experienced yourself.

[Desmond Mitchell]

That's a great question. Respectfully, I would like to defer this to Deon. I believe he may be in a better position to answer it.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Perfect.