Status of Women Committee on Dec. 2nd, 2024

[The Chair, Conservative, Shelby Kramp-Neuman]

Meegwetch.

Next I would like to welcome MP Idlout.

You have the floor for for six minutes.

[Lori Idlout, NDP, Nunavut, NU]

Qujannamiik, Iksivautaq. Thank you, Chair.

Thank you to the witnesses for appearing today for a second time for this very important study.

My first question will be for Alethea Kewayosh.

I understand, based on the previous meeting, that there were some discussions with regard to racism in the health care system and how a lack of access to health care is placing indigenous women more at risk of not being diagnosed at earlier stages of cancer.

I wonder if you could briefly expand on that.

[Alethea Kewayosh]

You only have to pick up a paper to see different incidents happening in hospitals across Canada, but in Ontario we have had recent incidents of racism happen in hospitals across the province, with some incidents leading to people not surviving.

We feel that if a bigger penalty was applied for a racist incident, those incidents would probably stop, but people get a little slap on the wrist or they're told not to come back to work for a few days and nothing happens. The community knows this. They know that if a situation occurs, they're not going to be the ones who are hurt.

We have the Patient Ombudsman's office, which we've been working closely with to put in an indigenous early resolution specialist position, and that's helping. We've also been working more closely with the Ontario Human Rights Commission, but the other part of this is education and creating understanding across hospitals when it comes to cultural safety. We work closely with partners like the Indigenous Primary Health Care Council, which has done cultural safety training that helps to show people what's appropriate and what's not appropriate.

I think a lot of it is based on ignorance and people just not understanding how offensive they are when they say certain things to indigenous people. I don't think it comes from a place of malice necessarily, but one of ignorance. We need to do more to educate health care providers and the health care system about cultural awareness and cultural safety. We are working to do that, but there's an onus on them to step forward as well.

The other part of that is the need for resources so that workers in our health care system can afford to take time away from their incredibly busy schedules to take this type of training. I think it's really important that people understand the true history of this country and the role that first nations have played, and the other nations as well, but most people don't. A lot of folks in the health care system are newcomers to Canada and they don't have any concept of the history.

More needs to be done to improve understanding of the history of Canada, the role that indigenous people have played and the historical traumas that have been perpetuated on them, which have led to what we see in communities today. People are still struggling to break free of that and come out from under the shackles of residential schools and the discriminatory policies in the Indian Act. So many things are still in place today, and it's hard to come out of that when they're still there.

Indigenous people are incredibly resilient. Where 20 or 30 years ago they would have just accepted what somebody told them, they're now standing their ground and saying, “Wait a minute; I'm not going to take that from you.” We are doing our bit to make sure we're pushing back on those types of behaviours, and I see communities stepping up more and more on that.

[Lori Idlout, NDP, Nunavut, NU]

Thank you so much. You naturally responded to the follow-up questions I was going to ask on ensuring that the health care system is more trauma-informed about Canada's treatment of indigenous peoples.

Of course, you mentioned residential schools. In the High Arctic, we had the dog slaughters and things like TB. I wonder if you could speak to how the current system is having a negative impact on indigenous women's health with its lack of investments in housing and its lack of investments in infrastructure, and how that impacts the ability of indigenous women to seek breast cancer screening.

[Alethea Kewayosh]

One of my colleagues mentioned that most screen-eligible women—50 and up and 40 in Ontario if you talk to a primary care provider—can't get screened. We have women who are not only looking after their grandchildren, but looking after their great-grandchildren. They're trying to put food on the table. They're trying to keep a roof over their heads. Getting screened is the last thing they're thinking about because these are the issues they contend with every day.

We have communities that are struggling to make ends meet. Where does any kind of screening or any type of self-care come into place? We have high rates of diabetes, as one of my colleagues mentioned. We have heart disease. When it comes to health issues, we have them all. It would probably be easier to identify the ones we don't have than the ones we have.

How do you prioritize health care and self-care when you are dealing with these day-to-day struggles of trying to feed your family, look after the grandkids, look after the great-grandkids or deal with a family member who may have taken a path that leads to unhealthy coping mechanisms, such as drug abuse or alcohol abuse? These are the realities in communities.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

Mrs. Vien, you have the floor for five minutes.

[Dominique Vien, Conservative, Bellechasse—Les Etchemins—Lévis, QC]

Thank you, Madam Chair.

We are learning today—actually, we already knew—that women’s mental load knows no borders. It extends everywhere, all the way into the far north.

Ms. Kewayosh, you talked about the enormous mental burden carried by our grandmothers and our great-grandmothers, and the burden women may carry today.

I thank this wonderful panel of witnesses for being with us today. You are very busy women. You save lives every day, which we don’t do. Thank you for taking the time to come and meet with us today.

I am a little upset about the guidelines the Canadian Task Force on Preventive Health Care wants to maintain. In any case, those are the signals we’ve been getting. Clearly, this working group unanimously rejected the recommendation to allow systematic screening, if women so wish, from the age of 40. What I want to say to them today, and I am certain my colleagues all agree, is that the service should instead be made available to women, and they should be left to make their own decisions. Stop infantilizing women. When women see their doctor and they have a urinary tract infection or severe menopause symptoms, everyone contradicts them. They know their body and, most of the time, they know what is happening to them. It seems to me we should put this service in place and tell women that, because it is their body, it is up to them to decide whether or not they want a mammogram or a screening test.

I cannot believe that today, they’re still saying that if women don’t get diagnosed and don’t access the system for early screening, it is because they are afraid of what they might see or hear, or because they may experience stress or anxiety.

I do not believe that. It is impossible. Some of the women I know, both young and less young, went through that experience. Not a single one of them fails to thank the heavens above for being able to get screened and get a much earlier diagnosis. Furthermore, we know that when breast cancer is detected early, it is easier to treat.

Ms. Daniel, you told us today you think the chair of the working group believes that women don’t want to know. I am sorry, but I do not agree. All throughout this study, not a single person said that to us. Not a single member of the committee said it either. I am sure it is not true.

Ms. Kewayosh and Ms. Daniel, if I correctly understood what you are telling us today, breast cancer is a taboo subject among Indigenous people. That is why some women may not want to get a diagnosis. In fact, you said that during our first meeting.

For your part, Ms. Daniel, you told us a kind of curse is associated with this knowledge, as well as a stigma. This is a barrier that could certainly be removed, specifically by using awareness and communication campaigns. Do you not agree?

Also, have you approached the government or other authorities so that we can solve this problem?

Ms. Kewayosh, I invite you to answer first.

[Alethea Kewayosh]

Yes, I believe we can improve upon the understanding of what people think of cancer today. We have done that in Ontario for the last 15 years. We launched a massive communication and education campaign to help communities better understand what cancer is and what they can do about it. Fifteen years ago, people wouldn't even talk about cancer, and if they did talk about, all they knew about it was that it was a death sentence. However, to fast-forward to today, we have communities asking us to develop survivorship programs because they are now seeing people surviving cancer in their communities. To me, that is so heartwarming because we are working so hard to get them to that understanding.

Is it across the board? No. We still have a lot of work to do, but for communities to now see themselves surviving cancer is a major development and is the result of a lot of work to help increase the understanding of cancer in communities and take away the fear from that word. We are moving in that direction, so yes, I believe that we can take out the stigma.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

Thank you, Mrs. Vien.

Sonia, you have the floor for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you to all the witnesses.

We heard in this committee about reliable data and education for cultural safety.

Dr. Caron, last week, the Minister of Health announced funding for research into breast cancer screening, including treatment and outcomes by race and ethnicity. You mentioned the lack of data, specifically on triple-negative breast cancer in indigenous women. How can we bridge this data gap and ensure that women are getting the care and access to breast cancer screening they deserve?

[Dr. Nadine Caron]

That is a great question, and it's great to hear.

One answer to that is that you can't do something about indigenous women and indigenous people without indigenous people. It can't be done. It will never be done successfully. That's yesteryear. That's a historical response. That's number one.

Second, you're tapping into indigenous scholars, physicians, health care providers and researchers. Given the historical approach to education and the marginalization of indigenous peoples in this country, that is a relatively small pot. We have to acknowledge that and support those who are willing to go into that space.

Third, we have to recognize and not lose sight of the fact that data has been absent—we have a bit of data—and then be patient and wait for it. In saying to be patient and wait for it, I really cannot stress enough that we should not have to prove we need it. The governments and funding bodies of the health systems that would pay, fund and resource the screening mammogram, for example, should have the burden finally fall on them, as the health care system, to prove that indigenous people will not benefit from this.

It's always like the data needs to be there to prove that the resources are warranted. As a first nations physician, a breast cancer surgeon and a breast cancer researcher, I hear it ad nauseam. Why? We don't have the data because we haven't had the resources and don't have the educational background based on residential schools and all that. Patience needs to mean that until we know otherwise, we're going to be very cautious and value indigenous lives in this country.

Finally, what's really emerging now is indigenous data sovereignty. When we generate data, start to get this knowledge and move together as a country in our health care systems and public health systems, we need to recognize that we need to protect the sovereignty of this data, which is owned by indigenous people and should be guarded by indigenous people. Knowing how that data will be used is very important. How do you do that? I'll go back to my original answer: not without indigenous people to help direct it.

I think we're at a place where I can trust, as an indigenous researcher and health care provider, that with the right people in the room, the whole room doesn't need to be indigenous people. I'm hearing all these questions and brilliant responses from elected officials—and you guys sound like you're listening, you sound like you care and you sound like you're hearing us—so you don't need to be indigenous to care or understand, but I think we need to move forward as a country, as a community.

The fact that you asked this question is in itself a step forward.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

We heard one of the witnesses last time, Jennie Dale, note that women often face a power imbalance with doctors. This makes it difficult to push back when a doctor refuses to refer them for screening. What has the impact of this power imbalance been, particularly on women of colour, indigenous women or racialized women?

[Dr. Nadine Caron]

Actually, we can take the adjectives off. Women in general tend to have a power imbalance. I feel this as a surgeon when I walk into the room and I'm surrounded by male colleagues. I think it's improving, but it hasn't gone away.

In the power imbalance between a patient and a health care provider, when you add the beliefs of the health care provider, having spent years studying and learning, and those of the patient, who is not really thinking about breast cancer day in and day out if that's not their field, there's a power imbalance of knowledge, and it can magnified by stereotypes, bias, racism, and gender or sex inequity—power imbalances that way. As Alethea said, I don't think that should be tolerated. There should be significant ramifications for it.

If you're looking at this concept of racism and whether there is data, during the pandemic, the provincial government launched an inquiry into indigenous-specific racism in the health care system. This was not related to COVID. It wasn't related to vaccines. It wasn't related to PPE. It was literally related to everything in our health care system, and in the middle of a pandemic, it became an urgent inquiry into what was going on in our health care system. It's not one story, one patient; it's an entire population in an entire health care system that no doubt mirrors the rest of Canada.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you very much, Dr. Caron.

Andréanne Larouche, you have the floor for two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

Once again, I thank all five witnesses for being here this morning.

For my second turn—and likely my last—I will address you, Ms. Daniel.

You talked about biomarkers. We obviously heard about it before, but I am struck by it every time. Correct me if I’m wrong, but you said 40% to 70% of them were present in Western Africa.

Are these, in fact, breast cancer biomarkers? I am not sure, because opening statements sometimes go by quickly. You also said the percentage was 20% to 22% in the United States and 10% in Canada.

Are those the right numbers? Did I understand correctly?

[Prof. Juliet Daniel]

The statistics I mentioned are basically on the incidence of triple-negative breast cancer, not the biomarkers. The incidence of triple-negative breast cancer ranges from 40% to 70% in West Africa; 20% to 25% in the Caribbean, which is relatively homogeneously Black; and then, similarly, 20% to 22% in the U.S. However, in white women the incidence of triple-negative breast cancer is only 10%.

Based on the research I'm doing in my lab, we think there are unique genetic mutations or epigenetic marks on our genomes that are predisposing Black women to this aggressive breast cancer subtype compared to white women and other women. However, what I also want to point out, which we didn't get to talk about much today, is that studies in the U.S. have found that racism is a social determinant of health. There are studies and researchers in the U.S. examining this at the molecular and genetic level, and what they have found is that continued perpetual racism can lead to epigenetic changes on our genomes. They are not mutating the genes; you can think of these epigenetic marks as a tag or tattoo that goes on the genome. That slight modification is not changing the DNA sequence, but it's changing the way our genes are then expressed. Some genes could be turned off when they should be on, or they are turned on when they should be off.

That's a booming field of research that's growing, but we do need to identify those biomarkers and epigenetic marks in populations that have been historically traumatized and oppressed by racism, because that would shed significant light on why we, including me as a Black woman, have or may be predisposed to these very aggressive types of cancer.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

MP Idlout, you have the floor for two and a half minutes.

[Lori Idlout, NDP, Nunavut, NU]

Qujannamiik, Iksivautaq.

I'll be asking my questions of Dr. Letendre.

I want to divert my question a bit away from the importance of distinctions-based research or care. I understand how different that is and I completely agree that we need to make sure that first nations, Inuit and Métis are included in all of this work. However, I want to take the opportunity to ensure that remote communities are being amplified.

I want to ask you very quickly if you have read a study called “Perspectives of Nunavut patients and families on their cancer and end of life care experiences”. This study was conducted by Tracey Galloway, Sidney Horlick, Maria Cherba, Dr. Madeleine Cole, Roberta L. Woodgate and Gwen Healey Akearok.

[Dr. Angeline Letendre]

Yes, I have read that study. I'm the vice-president and research chair for the Canadian Indigenous Nurses Association, and we work with all three distinct groups in the country. We are actually celebrating our 50th year anniversary this year. We are the oldest health care provider organization, both indigenous and non-indigenous, in the country.

We've done some really groundbreaking work with primary health care providers. We worked with the Pauktuutit Inuit Women of Canada committee quite closely on this, and we were able to support them to do some information and data gathering not only with the Inuit communities they work with, but also with health care providers.

Much of our work—and we're going into phase two of it—is about working with primary health care and national indigenous primary health care organizations. We started out with friendship centres, social workers, physicians and, of course, nurses, and now we're going to expand to try to work with pharmacy, occupational therapy and indigenous dental associations. What we have found from our work is that primary indigenous health care providers are facing multiple challenges in trying to address the cancer and cancer prevention needs of indigenous communities, and certainly Inuit and northern ones.

Thank you for the good question.

[The Chair, Conservative, Shelby Kramp-Neuman]

Thank you.

For the last two members, instead of five and five, we're going to do four and four, just to shave off a few minutes so we have room for the second part of the meeting.

Michelle, you have the floor for four minutes.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Thanks, Madam Chair.

Again, thank you to the witnesses. It's valuable expert testimony coming from the years and decades of experience we have from those sitting on this panel.

I have a fairly pointed question, because as I've sat here and thought about how this is playing out, I've felt that a lot of it doesn't make any sense to me. My colleague Ms. Vien was so articulate in what she said about women being able to advocate for themselves and ask for what they need, but unfortunately the problem is that a lot of people don't even have access to doctors in this country. That is one of the big issues, for sure.

I'm curious about what you guys would suggest for this task force and its chair. We have to put together recommendations from this study. Would you ask for the resignation of the chair?

Who wants to start? I'll go with Professor Daniel.

[Prof. Juliet Daniel]

My recommendation would be to dismantle the task force and have a completely different task force with membership that's representative of the Canadian population they're serving so that there is a diverse membership on the committee. We could have, for example, indigenous and Black breast cancer oncologists and physicians; Black and indigenous cancer researchers and biologists; cancer survivors; and cancer caregivers. I think we don't get the perspective of the caregivers of cancer patients often enough, and that's a valuable perspective to have in these decisions.

I would not necessarily recommend the resignation of the chair, but I think the entire committee should probably be dismantled and a new task force struck that will approach this from the lens we've been discussing for the past hour, plus the hour a couple of weeks ago.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

Just to push back on that—and I'd like to hear anybody else's answer to this question if we have time—do you think the task force is even efficient? If you have provinces doing this job and overseeing it—provinces already doing their own thing—do you think a task force is just another arm of bureaucracy?

[Prof. Juliet Daniel]

It definitely is, and I think for many of us, that's probably one of the questions we had. Why do we have a task force when every province seems to be doing its own thing? As a settler immigrant in Canada, that's been one of my challenges. I see how our provinces tend to be responsible for health and education, but the federal government also plays a role in that, and they don't get along. That's a whole different story, but it is a challenge.

For example, when I was diagnosed, I couldn't get my mastectomy and reconstruction at the same time. The only province that was doing that in 2009 was British Columbia. That was when I realized that there were discrepancies in our health care system and that, as a Canadian, I wasn't privileged to be in the right province at the right time when I was diagnosed. To me, as a Canadian, it shouldn't matter where one lives in Canada. We should all have access to the same health care. It should be equitable, regardless of the province we reside in.

[Michelle Ferreri, Conservative, Peterborough—Kawartha, ON]

I only have 20 seconds left. Just quickly, would any of the experts want to see the resignation of the task force chair?