HESA#113: On Women's Health

Jenny Kwan Vancouver East, BC
NDP

Thank you very much, Mr. Chair.

Thank you to all of the witnesses for sharing your expertise with this committee.

I'm particularly interested in what work you think can be done and what the government should do, particularly in looking at the issues through the lens of under-represented communities, for example, in the racialized community, the LGBTQ2+ community and, I would even venture as far as to say, for seniors, who are often put on the back burner, especially as they age. What are some of the health concerns, both on the research side, as well as on the side of actually providing real supports?

That is to all of the presenters, please.

Dr. Pamela Valentine
President and CEO, MS Canada

I'll jump in. I don't know if anybody else will make the same comment.

We have a real problem with information and data in this country. I sit as the CEO for MS Canada, and I cannot answer what the diversity of our population living with MS in this country looks like. I can give gender—it's fantastic to know that there are three times as many women as there are men—but after that, it's really difficult to answer those questions.

To get data in this country that crosses provincial borders is exceptionally difficult. That will not be a surprise to you. That definitely costs us more time, money and energy to get the solutions that we have today, as Ruth Ann has suggested, into the hands of the people who are going to put that information to work.

It's a very real barrier for us.

Health Committee on May 2nd, 2024
Evidence of meeting #113 for Health in the 44th Parliament, 1st Session

1:20 p.m.

The Chair Sean Casey
Liberal

Thank you, Dr. Valentine.

Next we have Ms. Kwan, please, for six minutes.

Jenny Kwan Vancouver East, BC
NDP

Thank you very much, Mr. Chair.

Thank you to all of the witnesses for sharing your expertise with this committee.

That is to all of the presenters, please.

Dr. Pamela Valentine
President and CEO, MS Canada

I'll jump in. I don't know if anybody else will make the same comment.

It's a very real barrier for us.

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology,
University of British Columbia, As an Individual

I'd like to pick up on that theme.

What we know is that with many diseases, particularly as they affect women, they're definitely overrepresented in racialized communities and in rural and remote communities. However, we have a terrible problem with getting accurate data, really, on any health condition in this country that covers the whole country and that tells us where people live, what their cultural or racial background is, what their first language is and so on.

The lack of ability to link data within health authorities across the province and across provinces and territories is an enormous barrier to moving the dial in this area.

Jenny Kwan Vancouver East, BC
NDP

Thank you for that.

What do you suggest to address this issue? Should there be dedicated funding targeted toward this data collection and research in this area?

What would you say needs to be done? What is the number one priority that the government should undertake to address this?

Dr. Money.

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology,
University of British Columbia, As an Individual

Funding is always helpful, but to be perfectly honest, the barrier is legislation. We are not permitted to share data without enormously complicated agreements. Every single time we try to look at another thing—be it COVID, syphilis, congenital syphilis or whatever—we have to go through new individual-level agreements to get permission to share what is actually de-identified data, but has some information on it around, say, rurality.

That's our biggest barrier.

Jenny Kwan Vancouver East, BC
NDP

To that end, the federal government should take a national approach and coordinate this effort between provinces and territories through legislation or whatever is needed so that it doesn't become a barrier to addressing women's health.

I'm seeing nodding heads. We will make sure that....

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology,
University of British Columbia, As an Individual

Absolutely.

Jenny Kwan Vancouver East, BC
NDP

That's your recommendation for a priority item that the government should undertake.

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology, University of British Columbia, As an Individual

It's a big priority for me. That's for sure.

Jenny Kwan Vancouver East, BC
NDP

Dr. Valentine, do you have anything to add?

Dr. Pamela Valentine
President and CEO, MS Canada

I was just going to ask Dr. Marrie if she wanted to comment, as a researcher who very regularly tries to get data across provinces.

Dr. Ruth Ann Marrie
Professor, Department of Medicine, Max Rady College of Medicine,
University of Manitoba, As an Individual

Thank you for that.

Yes, I agree with the regulatory barriers issue. We know why they're there. It's important to protect the privacy of health information.

Unlike countries in Scandinavia, where you can have all the national data all at once through a single process, we have multiple processes, as Dr. Money said. Even within provinces, I had one study that needed 13 regulatory approvals to do one study in one province. This adds to costs, it reduces the productivity that we have for the amount of research dollars invested and it limits our ability to do things that are relevant on a national scale.

In addition, we have a fundamental data harmonization problem. We collect information differently in different regions about these key socio-demographic and diversity characteristics.

Jenny Kwan Vancouver East, BC
NDP

Thank you very much that. I really appreciate it. I hope we'll make sure that we can advance that as a recommendation from this committee.

One of the issues that women often tell me is forgotten or is even hard to diagnose is endometriosis in women, and particularly young women. They're in such pain. Do you have any advice or action that needs to be taken to address that?

Dr. Money.

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology, University of British Columbia, As an Individual

We do have research in this space looking at biomarkers—so markers in the blood—to pick up endometriosis in its early stages. It can be diagnosed surgically, and that requires a specialized centre and individuals with expertise. Again, focused research in areas like this are making a difference, and I think if we can get to the point of non-invasive markers that make it simpler in-community to make these diagnoses, it will help these young women.

The Chair Sean Casey
Liberal

Thank you, Ms. Kwan.

Colleagues, we have resources and sufficient time for one more round of questions from each party if the witnesses are prepared to stay for another 15 or 20 minutes. Does that suit you? Great. Thank you.

Ms. Roberts, please go ahead for five minutes.

--------

1:40 p.m.

The Chair Sean Casey
Liberal

Thank you, Dr. Money.

Thank you, Ms. Larouche.

The last word goes to Ms. Kwan, please, for two and a half minutes.

Jenny Kwan Vancouver East, BC
NDP

Thank you very much, Mr. Chair.

I just want to follow up quickly on my last question.

It's good to hear that there is perhaps more research and potentially emerging research coming forward. In the meantime, what should women do? Often it's just sort of overlooked, and it's hard for women to tell their physician to look into the issue, so what can they do? What can they do practically at this point?

Dr. Deborah Money
Professor and Head, Department of Obstetrics and Gynaecology,
University of British Columbia, As an Individual

I think there are two sides to it. One is that women need to be empowered with the understanding of what this condition is and how it can manifest, and then they can self-advocate.

The side I sit on is as an educator for women's health for obstetricians and gynecologists, primary care providers and so on. We have spoken about this a great deal. We need to increase the general understanding by practitioners of how this manifests and ensure that these women are taken seriously when they present with symptoms that may be a little bit non-specific but can sometimes be very devastating.

We need to increase the number of practitioners in OB/GYN who can do the current surgical diagnostic procedures that are needed until we get research into non-invasive options.

Jenny Kwan Vancouver East, BC
NDP

I note in the MS Canada presentation the need for research and the call for a $15-million investment in research. Of the different recommendations that you want to make to the Canadian government, would this be your number one request by way of research investment?

Dr. Pamela Valentine
President and CEO, MS Canada

What we do know is that less than 6% from the major MS research organizations around the globe—both governmental and not-for-profit organizations like mine—is spent on prevention. I think this is an unprecedented opportunity to prevent a debilitating neurological disease, which largely affects women, in the next generation, and probably in 10 years.

I think about where we've gone in the last 15 years; we have gone from three to 20 disease-modifying therapies that have produced the kinds of health outcomes that have reduced mortality by 30% and offset disability by 10-plus years. To be able to make those investments today is going to change the face of MS 10 years from now. There isn't another neurological disease, I don't think, in which you could make that claim with the evidence that's available to us today.

We're certainly asking the federal government to come in on that as a partner with a lot of concerned citizens who are going to give us money to partner on that. That's one of the specific requests that we've been making.

The Chair Sean Casey
Liberal

Thank you, Ms. Kwan.

Thank you, Dr. Valentine, for allowing us to finish on such an optimistic note.

This concludes the time that we have, and it also concludes the testimony that we intend to receive on this particular study. Next week, we'll be giving drafting instructions to the analysts.

Thank you for sticking with us and putting in the extra time. It will be of significant value to us. We appreciate your patience and professionalism.

Is it the will of the committee to adjourn the meeting?

Some hon. members

Agreed.

The Chair Sean Casey
Liberal

I see consensus. The meeting is adjourned.

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James McNamee, Director General, Family and Social Immigration Branch, Department of Citizenship and Immigration
I would say that's generally the case. If the work permit they obtained was originally connected to the public policy, that's correct. I don't know if that's the situation in all cases. In some cases, applicants may have had an LMIA-based work permit to begin with.

Jenny Kwan Vancouver East, BC, NDP
That's right. However, under the special immigration measure, the LMIA is not required. I have a list of applicants in those circumstances. Their work permit renewal application was rejected. They were asked to submit an LMIA, which makes no sense. I want to flag that as a deep concern now emerging for people whose open work permits are being rejected as they wait for their permanent resident status. At this rate, given the immigration levels plan numbers and the processing delays happening, and with the number of applicants in place, you can imagine that it's going to take something like eight years to get through the backlog of people getting their PR status. This means that if they are trying to get their pension, they will not be able to do so for eight years, because they are required to provide proof of permanent residence.
I want to flag this as a major concern. I hope the department will take action to fix the error being applied to applicants whose open work permits are being rejected under this stream. Can I get a confirmation from officials that this will be undertaken?

James McNamee, Director General, Family and Social Immigration Branch, Department of Citizenship and Immigration
Yes, that issue has been raised with the department already, and we're looking into it to see what exactly happened in those situations.

Jenny Kwan Vancouver East, BC, NDP
Okay. Officials are aware of it, and yet it's still happening. I have cases coming to me that are happening. I'm about to prepare a giant pile of this stuff for the minister, so I hope the officials will fix that. The other thing related to the pension, of course, is lengthy delays for people to get their permanent status. Based on the immigration levels plan and the number of applicants in place, is it the officials' anticipation that it will take about eight years to get those applications processed?

James McNamee, Director General, Family and Social Immigration Branch, Department of Citizenship and Immigration
We have looked at that possibility. Certainly, it will take longer than we had previously indicated to the committee. I would note that the first year of the levels plan is the fixed year. The years that follow, in this case, 2026 and 2027, are flexible. There are opportunities to adjust those numbers in the future, and that could affect that timeline. It's hard to say whether eight years will be the timeline, but it will be longer than had been originally predicted because the numbers have gone down.

CIMM#114: Recent Reforms to the International Student Program

Jenny Kwan Vancouver East, BC
Aside from looking at patterns of potential violators—the groups and organizations taking advantage of students with these fraudulent letters of acceptance—will you be including in the analysis what types of institutions are being utilized for these fraudulent letters? In other words, is it private institutions versus public institutions, colleges versus universities and so on? Will that be part of the analysis?

Bronwyn May, Director General, International Students Branch, Department of Citizenship and Immigration
It's not always the case that a letter originates from an institution. We would need to look at various possible sources.

Jenny Kwan Vancouver East, BC
Maybe I can reframe that.
Obviously, as these are fraudulent letters of acceptance, they wouldn't be issued by the institutions. However, regarding the list of institutions being used for the purpose of these fraudulent letters, I would be interested in obtaining information to determine what percentage are private institutions and public institutions, how many of them are colleges, how many of them are universities and so on. That will tell us very specific information that I think is important when trying to tackle fraudulent activities.

Bronwyn May, Director General, International Students Branch, Department of Citizenship and Immigration
I completely agree. That's a very important line of analysis.

Jenny Kwan Vancouver East, BC
I will make the further request to make sure you share this information with the committee. I'll argue that this information should not be kept secret. It should be public and transparent—shared with all Canadians—so that we're aware of what the landscape is and of how international students are being taken advantage of. With respect to that analysis, will there be information and data on what countries are being targeted?

Click to read the full discussion from the Committee meeting

CIMM#113: Pension Transferability and Access to Mandatory Provident Fund (MPF), and Delays in Permanent Residence and Visas for Hong Kongers

Jenny Kwan Vancouver East, BC
All right. Thank you.
Hence, we have this problem. You have the Canadian government, which created this lifeboat scheme for Hong Kongers who are fleeing persecution in Hong Kong as a result of the national security law. The government, in its wisdom or lack thereof, created this lifeboat scheme that only provides for temporary residence by way of a work permit or a study permit. Then these people have to go to the queue to make an application for permanent residence, and we know that there is a huge backlog and delay in processing.
In the beginning, there was swift action, but as time has passed, it's been lengthened by way of the delay, to the point where the former minister even made an announcement to further extend people's work permits and study permits for another three years. That is to say, a person could be here for six years—as long as six years—under this current scheme without getting permanent residence. This is because the minister anticipated that people would not be able to swiftly get their permanent resident status. That is the reality.
As a result of that, people are not able to provide proof of permanent residence, because the application is in process. To make it even worse, the government—the minister—just made an announcement about the levels plan, cutting levels to the tune of 105,000 permanent resident status applications.
You can imagine how long the wait-list is for Hong Kongers as they continue to wait. Now, these Hong Kongers have zero intention of returning to Hong Kong, because they know that they would be persecuted if they did. People know that. I think the Canadian government knows that.
This is my question, then, to you as the manager of their pension, which, because of this rule, they're unable to access: Would your organization be willing to write to the regulator to ask for consideration for these applicants who are in a prolonged period of waiting for permanent resident status, to ask that their declaration indicating that they do not intend to return to Hong Kong be accepted as proof that they intend to leave Hong Kong permanently so that they can access their pensions? Is that something that your organization would consider doing?

Maryscott Greenwood, Global Head, Government Relations, The Manufacturers Life Insurance Company
I think I understand the question.
The basic premise of your question has to do with the period of time it takes for the Government of Canada to determine and provide permanent residency or citizenship. It seems to me that this is a function of the Government of Canada, as opposed to a regulated entity. That's how I would answer that.

Laura Hewitt, Senior Vice-President and Head, Global Government Affairs and Public Policy, Sun Life Financial Services of Canada Inc.
Yes. I would say that it's not within our authority to change the criteria.
However, our numbers show that once that permanent residency does come through, we're able to process the applications and approve Canadian permanent residents.

HESA#113: On Women's Health

Latest posts

CIMM#115: Pension Transferability and Access to Mandatory Provident Fund (MPF), and Delays in Permanent Residence and Visas for Hong Kongers Recent Reforms to the International Student Program

CIMM#114: Recent Reforms to the International Student Program

Click to read the full discussion from the Committee meeting

CIMM#113: Pension Transferability and Access to Mandatory Provident Fund (MPF), and Delays in Permanent Residence and Visas for Hong Kongers

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