SCYR Committee Meeting

37th PARLIAMENT, 1st SESSION

Sub-Committee on Children and Youth at Risk of the Standing Committee on Human Resources Development and the Status of Persons with Disabilities

EVIDENCE

CONTENTS

Wednesday, April 17, 2002

¹

1540

The Chair (Mr. John Godfrey (Don Valley West, Lib.))

Dr. Jeff Reading (Scientific Director, Canadian Institute of Health Research Aboriginal Research Centre)

¹

1545

The Chair

Dr. Jeff Reading

The Chair

Dr. Jeff Reading

The Chair

Mr. Richard Jock (Executive Director, National Aboriginal Health Organization)

¹

1550

º

1600

The Chair

Mr. Spencer

Dr. Jeff Reading

º

1605

Mr. Larry Spencer

Mr. Richard Jock

Mr. Larry Spencer

Mr. Richard Jock

Mr. Larry Spencer

º

1610

The Chair

Dr. Jeff Reading

The Chair

Ms. Monique Guay (Laurentides, BQ)

º

1615

Mr. Richard Jock

The Chair

Ms. Valerie Galley (Special Projets Coordinator, National Aboriginal Health Organization)

Ms. Monique Guay

Ms. Valerie Galley

Ms. Monique Guay

Mr. Richard Jock

Ms. Monique Guay

The Chair

Mr. Richard Jock

º

1620

The Chair

Dr. Jeff Reading

The Chair

Ms. Monique Guay

Dr. Jeff Reading

Ms. Monique Guay

Dr. Jeff Reading

º

1625

The Chair

Ms. Monique Guay

Mr. Richard Jock

The Chair

Mr. Alan Tonks (York South--Weston, Lib.)

The Chair

Mr. Alan Tonks

The Chair

Mr. Alan Tonks

º

1630

Dr. Jeff Reading

Mr. Richard Jock

Mr. Alan Tonks

º

1635

Dr. Jeff Reading

The Chair

Mr. Richard Jock

Mr. Alan Tonks

The Chair

Dr. Jeff Reading

º

1640

Mr. Richard Jock

The Chair

º

1645

Dr. Jeff Reading

The Chair

Dr. Jeff Reading

Mr. Richard Jock

The Chair

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CANADA

Sub-Committee on Children and Youth at Risk of the Standing Committee on Human Resources Development and the Status of Persons with Disabilities

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NUMBER 022

l

1st SESSION

l

37th PARLIAMENT

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EVIDENCE

Wednesday, April 17, 2002

[Recorded by Electronic Apparatus]

¹  (1540)  

[English]

    The Chair (Mr. John Godfrey (Don Valley West, Lib.)): I apologize to the witnesses. We had this unusual event of honouring the 20th anniversary of the Charter of Rights and Freedoms, and that took up some speech and attendance time.

    So without much further introduction, let me welcome, from the Canadian Institute of Health Research Aboriginal Research Centre, Dr. Jeff Reading. From the National Aboriginal Health Organization, we have Richard Jock, who is the executive director.

    I think you've been briefed on what we are going to be doing. Our plan is to do four reports. The first one, which we're focusing on now, is on the status of aboriginal children on reserve from conception to age six. We clearly are trying to know more of the nature of the problem, and also focus on community-based solutions--on integrated services.

    So with that as an introduction, I hope you were briefed more or less that that's where we're going. That's where you're going too, so let's go.

    Shall we start with Dr. Reading, since you're the first on the agenda? Go for it.

    Dr. Jeff Reading (Scientific Director, Canadian Institute of Health Research Aboriginal Research Centre): I guess it's appropriate to be delayed because of the celebration of the Charter of Rights and Freedoms. It's enough reason to spend a little time in the House of Parliament.

    Thank you very much for the opportunity to present today.

     I'm not really going to talk about the litany of problems associated with health status. I think my colleague will present some of that information. Certainly it's well documented that on every health status indicator we can measure as scientists, there's a profound disparity between the health and well-being of aboriginal children, compared to their mainstream counterparts in Canadian society.

    It's really a tragedy because the population is rapidly growing. About 50% of the population is under the age of 25, so there's a baby boom occurring in aboriginal communities, whether it be in inner cities, rural environments, or isolated or semi-isolated communities all across Canada. The bottom line is that if children inherit the risk of their parents, it will be a tragedy we can actually prevent.

    We know a lot about the levers for prevention. We know there are certain things we can do in terms of health services that will improve the health and circumstances of children. There are also what we call the upstream determinants of health. We're all familiar with these too. It's nothing new that factors outside the provision of health services, like adequate education, nutrition, income, employment opportunities, housing, and potable water all have a major influence on health, and in lots of communities those aren't forthcoming. So those are fairly simple ideas.

    In my position as a scientific director of an institute that focuses on aboriginal people's health, it's really the only institute in the world that actually targets aboriginal people as a focus at the national level for a research priority. The reasons are that these problems are complex, they've been around for a long time, and they're overlaid by political, social, historic, and economic circumstances that don't seem to be changing that rapidly.

    But the idea here is that if advanced research can lead to solutions to complex problems, then we should invest in the advanced research agenda. That's what's happening with CIHR and the Institute of Aboriginal Peoples' Health.

    On some of the things we've done early in our mandate--we've only been up and running for about a year--we've put out requests for applications to the research community that put significant resources into developing the next generation of research scientists, who focus their efforts on aboriginal health. This is across the four domains of research, including biomedical, clinical, social science, and health services research at the advanced level. That's a major program that involves up to $3 million of funding over a six-year period, so it's a capacity-building environment.

    In terms of specific programs around research that aim to improve the health status of native children, we have one program looking at child and youth health, specifically focusing on children at risk. This includes children who are beginning to experiment at a very young age with substances such as tobacco, solvents, or other factors. We believe a multidisciplinary approach to health promotion and disease prevention that includes physical activity, recreation and leisure, developed by the community at the community level, is very important in terms of normal human development of children.

    We've observed obesity in very young children, which leads to type II diabetes. In fact, there have been cases of children with type II diabetes as early as age 7. You don't get diabetes at age 7 unless you're under very exceptional circumstances, where you have an extremely poor diet, extreme lack of exercise, and lack of opportunity.

    So targeting obesity through primary prevention, intervention, physical activity, and nutrition is a primary focus of addressing the problem of diabetes.

    Fetal alcohol syndrome and fetal alcohol effect are clearly totally preventable problems. Because of the circumstances of aboriginal communities, it's not that difficult to understand why we have this problem. What's difficult to understand is why the problem persists.

    When I was a student and we wanted to talk about researching fetal alcohol syndrome, it was kind of like a Pandora's box. Nobody wanted to touch it because they were afraid of what they might find inside the box.

    I think Canada has begun to look at research. In fact, we had a meeting in Saskatchewan where we brought together researchers to talk about the problem of fetal alcohol syndrome and how to prevent it in aboriginal communities. Biomedical researchers, clinical researchers, social scientists, and health services people were brought together with the community, and we came out with a number of priorities. CIHR will focus its efforts on researching the problem of fetal alcohol syndrome.

    Improving access to appropriate health services for marginalized groups is another area where we focused our activity. We know the kinds of services that native people receive, particularly in remote communities, is really substandard compared to the kinds of services received in urban centres and even rural centres. The high cost of transporting patients to tertiary care centres in cities is a significant barrier to improving services. We need to focus more resources on innovative ways to deliver services in the community that would include more investment in telemedicine and opportunities to connect tertiary care centres to nursing stations in the north and other parts of Canada.

    Finally, there are different kinds of injuries and accidents. There are the intentional kinds, which have to do with physical violence and addictions and abuse. Then there are the unintentional ones, which have to do with risk: basic use of helmets when riding snowmobiles or life preservers in boats, or using seatbelts in cars. We think that in native communities that has the potential to rapidly transform health by just focusing on preventable injuries as a result of the physical environment. We have to make machines like snowmobiles, cars, and boats, and also housing circumstances, more safe, particularly for children. Materials in clothing and bedding that's non-flammable would save lives--that kind of thing. So those are just a few areas.

    I just want to end with tobacco as being an enormous area. If a mother smokes and is pregnant, it is transferred to the placenta. The unborn child is completely dependent upon the mother's circulation, so anything that is put into the system is transported by the blood to the developing fetus. All the research shows that smoking while pregnant is not a good thing. It has negative effects on the child, and after birth it's associated with higher levels of sudden infant death syndrome and other problems of a respiratory nature.

    Of course, as the child develops, they develop upper respiratory tract infections and then they're predisposed to becoming smokers later in life. I would say tobacco is probably the number one preventable problem we could address in native communities. We know the levels among aboriginal people living on reserve in Canada are among the highest in the world. We need to begin our interventions as early as age six to begin to overcome this kind of problem. I say it's the number one problem because it's totally preventable, and it's affecting the greatest number of people.

    Those are a few areas where we could begin some discussion.

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    The Chair: Thank you, Dr. Reading. Just to be certain, as I understand it, your institute has virtually just started, hasn't it? Was it in March that...

    Dr. Jeff Reading: Yes, we started last year. Richard Jock is also on my advisory board.

    The Chair: Where are you physically located? How does this work?

    Dr. Jeff Reading: Well, these are virtual institutes. I'm physically located at the University of Toronto, along with three other institutes. I'm in the Department of Public Health Sciences there. There are 13 institutes and they're scattered around the country at various centres. We meet two days a months with the president of the CIHR and we develop national health research priorities.

    The Chair: Thank you.

    Mr. Jock, welcome. Where are you located?

    Mr. Richard Jock (Executive Director, National Aboriginal Health Organization): Physically, we are at 56 Sparks Street, just a couple of blocks away.

    Thank you. I would like to begin by reinforcing some of the points that have been made by Dr. Reading.

    In the statistics I am citing, essentially what I've done is provide the background material that provides the source for the statistics. That will be potentially of interest to you as you pursue your report.

    One of the things I want to begin with is just to reinforce the notion that aboriginal children sustain a disproportionate burden of illness. That's clearly reflected in the percentage of population that is considered to be children and youth, birth to 19 years of age, which represents 44% of the aboriginal population. Of those, 52.1% of those children, aged zero to 14 years, live in poverty. Simply stated, those two elements are really important factors as we look at the issue of dealing with aboriginal children.

    In some of the studies done by Kue Young, now a colleague of Jeff's, he has traced high levels, between 30% and 60%, whose weight is over the 85th percentile rate. This has tremendous impacts in terms of the potential for both early onset and adult diabetes, and also is directly related to the issue of food security and good nutrition.

    In terms of looking at the age group that you've identified, we see that there are really three distinct areas of concern: prenatal, postnatal, and ages one to six.

    In terms of prenatal issues, the issue of teenage pregnancy and the over-prevalence of that among aboriginal populations is certainly an issue, and related to that as well is the notion of nutrition or food shortage as being key to the development of the unborn fetus.

    Fetal alcohol syndrome and fetal alcohol effects, as have been previously cited, really are important. It is also difficult to really nail down the incidence or prevalence of this. The most reliable information we've found is that in high-risk populations in B.C., it may be as high as one in five. Nevertheless, whether or not the children experience the full fetal alcohol syndrome or whether there are other physical or behavioural manifestations that result from abuse of substances, those still have a massive impact on the capacity of children to have a potential and on the system in terms of meeting their needs, both immediate and long term.

    Gestational diabetes is also an issue. High birth weights are as equally of concern as low birth weights and create potential future problems for the developing individual.

    As well, there is the issue of the impact of family violence.

    In terms of postnatal to age one, the issues are a bit different. However, concerning infant death, for both neonatal death and death in the first month, the rate is, as you know, two times higher for aboriginal children than for non-aboriginal children and three times higher for Inuit infants. The post-neonatal to one year death rate is three times higher for aboriginal children than for non-aboriginal children and four times higher for Inuit children.

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    So again, although there's not a lot of investigation on the direct causes of these, I'm sure the determinants-of-health issue raised by Jeff...other factors such as smoking and substance abuse are certainly factors.

    From postnatal to age one, the death rate due to injuries is four times higher than Canadian infants overall. Also, from age one to age six, the preschool death from injuries for aboriginal children is more than five times higher than that of Canadian infants overall.

    I'd like to also spend a bit of time on what works, and I would like to reinforce what we see as the early evidence that Aboriginal Head Start is an effective approach. Even though this is still a new program, at this point it has a relatively modest level of coverage. The Aboriginal Head Start urban and northern initiative, which represents aboriginal three- and four-year-olds off reserve, makes services available to 3,236 children, which is about 12% of the total population. This is in contrast to on reserve, where 7,700 children are provided coverage on 305 sites, which also represents 12% coverage.

    There are some early successes from that. In the first review of the northern and off-reserve portion of that program, there do seem to be some indications of areas that potentially would be of interest. For example, almost one-fifth of children require greater than normal staff time due to special needs such as speech delays, FAS, FAE, emotional or behavioural problems, and hearing and visual impairments. Also, 38% of children report poor economic conditions, 32% report substance abuse--alcohol, drugs, and solvents--and 32% report other forms of abuse such as family violence.

    We've done a little bit of looking at other examples that you may or may not be aware of. In particular, there's a program in the United States called the Perry Preschool Program, which is an American early intervention program begun in the 1960s. Essentially there was a longitudinal study done for this that followed those participants into adulthood. It had demonstrable results in areas of higher achievement--a higher percentage of individuals graduating from high school, lower percentages receiving welfare as adults. There were demonstrable savings to the justice system--less arrests as adults--and also savings in terms of special education requirements as well as the lessened requirements for mental health interventions. In terms of success, that would seem to be a template of further work here in Canada for aboriginal children.

    I was quite pleased to hear your reference to the desire for an integrated approach. I think that would be a point that we would make. In fact, there should be an integrated children's strategy that addresses some of the more pressing needs. One element of that should be increased funding for existing and new Aboriginal Head Start programs to have much greater penetration and availability as opposed to the current level of 12%. The indigenous language portion and the cultural portions should be supported by curriculum development funds. Currently those programs are provided, but nevertheless the supports to providing effective programs for languages really demands some of the pedagogical supports in order to make that most effective, particularly in an immersion approach.

    We also intuitively feel that day care should be an element within that. Expanding day care and having such day care available to aboriginal children whose parents are on social assistance may also be a way of breaking the cycle of poverty and lack of exposure to intellectual and social stimulation. Lunch and breakfast programs targeted to aboriginal children would be a way to deal with some of the food security issues and would be a way of ensuring that in effect all of the nutritional requirements of those children could be met essentially within the auspices of those two elements.

    I would also add that a look be taken on activity-oriented programs to stimulate increased levels of physical activity. These activities would not necessarily be in the competitive sports arena but rather in pure, focused, physical activities in order to begin dealing with the issues of rising obesity.

    I want to conclude by saying that such an integrated strategy I think would help deal with some of the short-term and identifiable needs that we can clearly see are there for aboriginal children, but that really the long-term approaches must be addressed, such as the multiple determinants of health, poverty, housing, water quality--the issues that Dr. Reading had cited previously. It's also the position of the National Aboriginal Health Organization that self-governance and self-management by itself is also a determinant of health and that moving to self-government is really an essential ingredient in terms of the health of its people.

    Thank you.

º  (1600)  

    The Chair: Thank you very much. Thank you both. Let's move straight to questions. Larry Spencer.

    Mr. Larry Spencer (Regina--Lumsden--Lake Centre, Canadian Alliance): Thank you. I'm sorry to be late; we got detained watching guard over the House. We were afraid the Liberals might do something. Anyway, we're here.

    I was jotting down the issues you mentioned, especially the teenage pregnancy issues. I've just mentioned one segment here, but this is such a broad issue. You've spoken of everything from lifestyle choice--that is, use of alcohol, tobacco--to food availability. How do you suppose a government can get its hands around that massive kind of problem? It seems you're almost asking that these people be provided for in every way. It seems overwhelming. It seems like a problem that's bigger than government even. And if we looked at it that way, what could be done? What else is there other than government money that's being done?

    Dr. Jeff Reading: Well, this is not a problem that was created by aboriginal people. That's fairly clear. It's an historic problem and a political problem and it's embedded in the political economy of how Canada became a nation state. There was a very messy situation with residential schools, which was really failed forced assimilation of people, and we have a very messy cleanup job to do as a result of that failure.

    It's in the context of circumstances that have placed aboriginal people and their communities at a disadvantage from the get-go. Turning around and blaming aboriginal communities for a problem and being a burden on the Canadian taxpayer is simply inappropriate.

    The bottom line is there will need to be more resources spent in the short term to have positive outcomes in the long term. We can keep throwing money down the black hole until we figure that one out. But we are locked into a circumstance where we have to address these issues. There was just a celebration of the Charter of Rights. It means we can't discriminate on the basis of race, or geographic or gender characteristics, or on any of those issues. If people are suffering, and we've documented the fact that people are suffering, and particularly children--you know, they didn't choose to be born into those families--what does a country like Canada do?

    Canada could eliminate this problem rather rapidly, but we choose to tolerate the suffering, to turn a blind eye to it; that's the bottom line. That's the native perspective on it.

º  (1605)  

    Mr. Larry Spencer: Yes, I understand that, and I don't disagree with anything you're saying. When I think of these kinds of problems, though, I'm reminded of some of the problems that happened in the United States with the transition the black folk went through. The states felt they had the obligation to assist heavily in welfare, and they established all these ghettos--they ended up being ghettos--for these people to live. Now there's a real revolution going on down there--people deciding and understanding they've been caught in a trap that hasn't been healthy for them in the long run.

    I think at the same time we have to recognize somehow a need to develop--you called it self-government--a greater self-input and self-reliance.

    The other question I wanted to ask comes from Mr. Jock's mentioning that there needed to be an expansion of day care to those on social assistance. What would you see that accomplishing?

    Mr. Richard Jock: I think one of the models that really should be looked at in-depth by this committee is the day care model. It involves children from age one to three. It's actually a wonderful program where there's structured teaching, educational exposure, and intellectual enrichment. As well, they work with the parents in terms of parenting skills. In short, if you look at some of the objectives of this program it's like Head Start except it's starting much earlier.

    The advantage of this is that persons who may be on social assistance may have limited opportunities to expose their kids to those kinds of educational opportunities, that kind of social exposure, the food, and also the socialization with other kids. To me, this would be a very real way to enrich the lives of those children and make possible their escape from that cycle.

    Mr. Larry Spencer: But you do include, as you mentioned, some work with the parents.

    Mr. Richard Jock: Yes.

    Mr. Larry Spencer: Because it seems to be an unhealthy situation if we simply enable a parent who's unemployed to have no responsibility while someone else is caring for their children. Is there any integration of parents in the day care program in terms of bringing them in and actually teaching them how to deal with children on-site as a part of the care for that child?

    Mr. Richard Jock: Yes, at least for the Ontario versions that I'm familiar with. I feel fairly secure in saying that the same also exists in the Quebec model. So in a sense what I'm suggesting is that when you're looking at the issue of integration, you look really at health and social services, Head Start, day care, some of these efforts, and really just broaden its reach, because there are some good approaches out there.

    Mr. Larry Spencer: That's encouraging, because it seems to me that when we talk about abuse, when we talk about the injuries--my kids would have had their share of injuries if somebody hadn't been watching to say “Get down off the fence”--a very important part of this, a strong ingredient in this, is to involve the parents in parental training in this scene of taking care of their and their friends' children on some sort of a rotational basis.

º  (1610)  

    The Chair: Dr. Reading.

    Dr. Jeff Reading: One of the key ingredients, and one of the six themes identified, in Aboriginal Head Start is parenting as a core value. The parents need to be participating in the program for their children to remain in the program. The evidence from the United States since the 1960s has shown that the parental effect is one of the main determinants of the success of programs such as the Perry Preschool Project, which Richard was speaking about.

    The Chair: Madame Guay.

[Translation]

    Ms. Monique Guay (Laurentides, BQ): Thank you, Mr. Chairman. Thank you, Mr. Jock and Mr. Redding, for coming today.

     I am happy that you have come today to give us your vision of what is happening with regard to our Aboriginal children throughout the country.

    You mentioned earlier that we are celebrating the 20th anniversary of the Canadian Charter of Rights and Freedoms. There are also other events that are not as joyous, namely the 20th anniversary of the patriation of the Constitution. For Quebec, it's an entirely different event.

    Having said that, we have spoken about children at length. We have heard evidence that has been very touching. We must draft a report in order to make suggestions for the short, medium, and let's hope, as few as possible for the long term, because we want to come up with solutions as quickly as possible to help these children grow up like all other children in the world, safely and above all healthily.

    Mr. Jock, you talked about a pre-school aid program for Aboriginals. I would like to know for how long this program has existed and where it is used, and I would also like you to give us a more specific description of the program as such. I would like to know who administers these programs. I will ask some other questions after that.

º  (1615)  

[English]

    Mr. Richard Jock: This Health Canada program is funded through two branches, the population health branch, which has responsibility for the populations in the northern territories and in the off-reserve populations, and first nations and inuit health branch, which provides services for the on-reserve population. They did an interim assessment of the off-reserve piece, which I believe has been in place since about 1995. One of the individuals involved with that implementation is with me here today.

    The Chair: Perhaps you could introduce yourself and just add a word on that.

    Ms. Valerie Galley (Special Projets Coordinator, National Aboriginal Health Organization): My name is Valerie Galley, and I currently work for the National Aboriginal Health Organization.

    I was involved in the development of the Aboriginal Head Start urban and northern initiative, which was announced in 1995. I believe projects became operational in 1996 and 1997. In 1999 the funding was announced for the first nations and Inuit health branch, which is the on-reserve program.

    What was the other part of the question?

[Translation]

    Ms. Monique Guay: Who administers the programs? Are they administered by networks on reserves, Aboriginal community centres, or by the government?

[English]

    Ms. Valerie Galley: The program is administered by what are called program sponsors. That could be a friendship centre or a Métis organization. The oversight is done by the national office of Health Canada and the program consultants within their regional offices. The on-reserve program would be administered by the first nations themselves.

[Translation]

    Ms. Monique Guay: We have, of course, heard about other programs, Mr. Chairman. We will have to look at them all and determine which ones... You said that this was a good program. So it must be maintained, if I have understood you correctly. Does this program extend to all reserves, or is additional assistance required so that this program can continue to operate? Now is the time to tell us, because we are going to make recommendations.

[English]

    Mr. Richard Jock: No, I think that is actually the point. Both of those programs only cover 12% of the total population.

[Translation]

    Ms. Monique Guay: So the needs are there and the resources need to be increased so that this program can do a better job for... So, we need to bear this in mind in our research, because if we have something that works well, we must try to improve it.

    The Chair: May I add a clarification?

[English]

    Maybe I'll ask it in English. Are you arguing that in fact the ideal situation would be 100% coverage of all children, or are you saying that although we're covering 12% of all children, we might be covering, by definition, a larger percentage of children at risk, so this is not a...? You could if you want. That's all right. Are you asking for a universal program? What would success look like? What percentage of aboriginal kids ideally should be covered to get the job done?

    Mr. Richard Jock: I don't necessarily have an opinion on that. I think a higher percentage coverage would be much better. I think the cost to implement it 100% may be quite a bit different from doing it at 75%, for example.

º  (1620)  

    The Chair: Dr. Reading, do you have a view of that?

    Dr. Jeff Reading: One of the things that distinguishes Head Start in Canada from Head Start in the United States is that there's no means test involved. In the U.S. you have to be deep into poverty before you qualify for this kind of program. The assumption in Canada is that's the case but it's not always the case.

    The other thing I'd like to mention is that Head Start prepares children to enter kindergarten with the kinds of skills and abilities that other children have. Evaluation of the readiness to learn at this stage of entry into kindergarten would be a good instrument to gauge what the scope and magnitude of the program should be.

    The Chair: Madame Guay.

[Translation]

    Ms. Monique Guay: One of you mentioned child care programs. Of course I respect these programs and would hope that each province would have them. In Quebec, you work with the CLSCs and there is success with Aboriginal people. Different methods are used, which are culturally sensitive. There are specific programs for Aboriginal people. That is done to some extent in Quebec and it works well. We must not change something that is already being done and that is working well.

    In Ontario, you have other kinds of programs, and in the other provinces, they have their own way of doing things, which also depends on the percentage of Aboriginal people in each province. It varies widely, so programs are very different, because the approaches used cannot be the same everywhere. It also depends on different cultures.

    You talked about child care earlier. You mentioned models for children from birth to age three. In Quebec, we have a model for children from birth to age five, and parent involvement is of the utmost importance, because without parents the model cannot work.

    So I do not know what your opinion is on child care models. What is your opinion of them? What is your experience with them? You talked about Ontario earlier, but how does it work in the other provinces?

[English]

    Dr. Jeff Reading: This is all under the same program name in different forms. It's called early childhood education. Day care doesn't necessarily have objectives in learning or a curriculum associated with it, so the various programs identified as early childhood education aim to stimulate cognitive development in the child's brain, which is different from some of the other private programs that may not target those factors.

    There's evidence in biological research that shows this does occur, that there is actual brain stem activity as a result of a stimulating environment, with the proper nutrition and the proper precursors for normal development.

    I'm not familiar with all the programs, but I think they're all under the same rubric of early childhood education, and they have measurable outcomes and measurable targets of human development.

[Translation]

    Ms. Monique Guay: There are also other programs that we must maintain for women who are expecting. Have I used up my time, Mr. Chairman? I have one last question.

    The Chair:One last question, that is perfect.

    Ms. Monique Guary:Talking about women who are expecting, you said that there are many young women, and young girls who get pregnant at a very young age. So there must be prevention and education for them. What is done at present? Do those programs need to be improved as well?

    This is a two-part question. There are children who are suffering from obesity. I have been told that this is becoming a serious problem among Aboriginal children. Is that true? Is anything being done to improve the situation?

[English]

    Dr. Jeff Reading: The problem of obesity is not owned by the native community. It's a prevalent problem, but certainly, if you track the increase of obesity in North America over the last ten years, it's astounding to see how quickly it's affecting children. It's a result of the kind of lifestyle--television, cars, fast food. We all know this, right?

    But at the CIHR there's an institute for nutrition, metabolism, and diabetes, and of all the areas they could be focusing on for their research, they've targeted obesity as their single, most important area of interest. That's a bold step, but obesity is related to so many other negative outcomes in the area of health, and it begins in early life. There's a lot of basic science that is poorly understood.

    So we're interested in participating in that research agenda around obesity, especially as it relates to child health and diabetes.

º  (1625)  

    The Chair: Thank you.

    Go ahead.

[Translation]

    Ms. Monique Guay: For young women...

[English]

    Mr. Richard Jock: I just have a couple of comments.

    I do think that some of your points are apt and would be really apropos once we start discussing the older group, say aged 14 to 19, where in fact some of those parenting skills should really occur at a much earlier age. It's almost too late if you wait until somebody is pregnant to start talking about parenthood. That's really more an intervention than prevention. I would think that this would probably be a topic for later age groups.

    Similarly, as to the assistance and aids required for children who have learning disabilities, these tend to have some manifestations at the preschool stage. Obviously, as the children actually get into the academics, then it becomes much more obvious and the needs are much more acute. Again, I would think that's something we would want to pay attention to at a later phase of the committee's deliberations. Jeff has really covered the points on obesity, and that is probably one of the biggest health issues in North America at this point.

    The Chair: Thank you very much.

    Here's just a word of a procedural nature to committee members. I've talked about this to the witnesses. I was hoping we might be done perhaps by 4:45 or 4:50, if it's going to work out for us, if we have enough time, in order that we might spend about ten minutes talking a bit about where we go from here. I think we need a little chance to regroup. If the two of you wouldn't mind staying, I need some kind of constitutional legitimacy here. Now that Spencer is gone, I really am down to the short....

    Mr. Alan Tonks (York South--Weston, Lib.): If we don't stay, you're going to be doing it yourself.

    The Chair: I will tend to agree with myself.

    Mr. Alan Tonks: And you'll probably be right.

    The Chair: I won't need a second opinion.

    Mr. Tonks.

    Mr. Alan Tonks: Thank you for your deputations.

    A recurrent theme that we've had is that there are communities, first nations people, that are being more successful than others with respect to a more holistic and more integrated approach. We haven't referred to it in the sense that they've achieved any level of self-government greater than that of any other group. They have bumped and nudged to achieve a better model, and they're getting more support. They're using the approach that's taken in Quebec with the CLSCs, a clinic approach that makes health services more available on reserve and that is more tailored to specific, local needs.

    We've talked about programs that integrate language and skills development and employment searching with the support required for day care, and these are more locally administered.

    Do your statistics...? In all these various approaches, the absolute first principle that is typically related to success is that it's the family that becomes the focal point of the strategy, and they don't try to treat just a particular member of the family. It's a case of involving the parents, and it's using the various programs to support the efforts.

    My first question is, using your statistics, do you look at these strategies across the country, and do you try to quantify or qualify the success? Then would that help us to back-load on that in terms of what a better model for us to pursue would be?

º  (1630)  

    Dr. Jeff Reading: I can begin that. That's a very interesting question. It's been applied to the mainstream Canadian population by Bob Evans, from UBC, an economist. He wrote a book called Why Are Some People Healthy and Others Not? The question you're asking is why are some first nations or aboriginal communities healthy and others not, and that's a very complex question. Part of it has to do with socio-economic and upstream determinants of health, but that doesn't answer the whole question. So that is a very complex research question in itself, and there are a couple of people in Canada who are studying this, one being John O'Neil at the University of Manitoba, in partnership with the Assembly of Manitoba Chiefs. Some people on the west coast have looked at self-determination and showed some early positive signs that having self-determination through local governance is a significant contributor to improved health in the community.

    So those are early signals, but I think we have to do more research. It makes intuitive sense that if people have a control in the way and say in how their lives are run, that would contribute to a sense of well-being. If they had the economic opportunity that flows from a sense of control, that would also influence a sense of well-being. It's sort of like turning the corner. The context, in my view, of aboriginal communities is that it's been this paternal relationship from a government making decisions for a very long time, and as communities trend toward more autonomy, then there should be spinoffs of improved health.

    Mr. Richard Jock: Some of the data that's been done in terms of regional health surveys, where there are communities that have been studied in a fair amount of detail, show that those communities that are essentially running their own affairs, even though it may not be the total model of self-government, are healthier. So that is supported by the stats that are available, but obviously it requires further depth.

    Mr. Alan Tonks: I appreciate those answers. I'm not suggesting that I know it as fact that there are communities that are healthier than others. I don't know that. My slant is a little bit different. I suppose you do have to have a base level in terms of looking at program effectiveness, as opposed to... You have to have an idea of where that baseline is where you're starting. My question is a little bit different in terms of the slant.

    If we made some basic assumptions in terms of the self-evident relationship between second-hand smoke and the relationship of lifestyle to diabetes and the propensities and probabilities that occur and the statistical indicators that bring you to the conclusion that indigenous peoples, no matter where they live, are more at risk and vulnerable because of these lifestyle circumstances beyond their control--or a corollary to that, that are within their control--my slant is to ask where are the programs, and how are we measuring the effectiveness of them? Should we then be universalizing those programs and then put them within a format that is more community-based and that has a community-based board, a democratic board?

    I'm not leaning terribly on self-rule or the notions of it. Those are political. To me, they're political at this moment, and I don't want to get bogged down by politics. I want to know what the effective programs are, how we measure them, and if we have limited resources, how can we emphasize that those are the programs that are working? Let's provide those instruments as quickly as we can.

    I would take the Quebec model, of which I know not that much, but there has been a huge amount in the health care area on which they have been successful. Would that be a model? I guess that's the slant I'm taking on it.

º  (1635)  

    Dr. Jeff Reading: You're obviously very knowledgeable about dynamics in aboriginal communities, because this is really what the community is asking for. I'll give you an example of how we evolved the institute, which is only about a year and a half old.

    We have two values that are guiding principles. One is the pursuit of scientific excellence based on international standards of research excellence. The other one is meaningful community relevance, or community participation from the beginning of the study. On my advisory board I have a majority of aboriginal people from all across the country who advise on the national research priorities. In each of the training things we put out and in each of the research applications we put out, we ask for those two principles of scientific excellence and community relevance to be integrated.

    When we rank the proposals on the basis of their merit, they're ranked on those two criteria. If they're missing on one or the other, they don't get ranked as high, and consequently won't be as funded, because it's a very competitive environment.

    This is in a context of research. When you go to native communities and you're from a university and want to push a research agenda, people will tell you they've been researched to death, that they want nothing to do with it, because they've been stigmatized, often don't get any of the results shared with them, and don't see the research leading to improvements in the health status of the community.

    Taking an active role in the research itself at the beginning and being partners in that initiative is seen to ensure the results of research will be applied immediately to change the circumstances within the community, either through the political process or at the local level.

    That's a trend. I think Head Start is another example, where you have meaningful involvement from the beginning.

    The Chair: Mr. Jock.

    Mr. Richard Jock: The other thing, which we're involved with, is developing a best practices framework. Part of it is to respond to the kinds of interest you've described. Part of what is important with it is identifying the success factors within some of these best practice sites. There are communities that have approached these and other issues very successfully. Documenting what are the elements that help them deal with the issue or deal with it effectively, and addressing the unique issues as well as the transferable skills really is a way to make sure people understand more about those approaches and how they may work elsewhere.

    That's what I would call an everyday or common sense approach to getting more information out about some of those communities that can and should be considered as good sites for various elements, including the one we're discussing today.

    Mr. Alan Tonks: Thank you very much. Thank you, Mr. Chairman.

    The Chair: I'll put a few questions, if I may. Actually, I may even segue into the next part of our meeting, because I found your presentations extremely useful. I have a feeling we may want to continue our discussion--not this afternoon, but as we move forward in our work.

    I want to begin with a couple of questions that relate to what we know or what we hope to know, although I take the point about being researched to death.

    The first question is, are you measuring the differences in health status for aboriginal kids--you do between the Inuit and the aboriginal community--but let's say between status Indians on reserve and off reserve? Are you making those sorts of distinctions? Is that work being undertaken?

    Dr. Jeff Reading: It's really kind of sad, because back in 1994 Canada initiated a series of longitudinal cohort studies to measure the health status of Canadians. One of them was a longitudinal study of children and youth. First nations and Inuit people were the only group in Canada that were specifically excluded from that study. It's really astounding to me to understand why. Why would you exclude the population well known to have the poorest health status? It doesn't seem to...

    I know the aboriginal groups, through the National Aboriginal Health Organization, have tried very hard to bring this back to the agenda, to bring back a real, longitudinal cohort study of aboriginal children. The advantage of doing it would be that you would have data that would be longitudinal. It would be like a video; you could watch the movie instead of just watching a photograph. You could see how things change, positive and negative. You could look at interventions like Head Start. Or you could look at interventions such as a community turning itself into a non-smoking community. What would be the impact on child health as a result of that policy initiative at the local level?

    You could tag that in a number of communities and look at the health outcomes over a period of time. There's tremendous value added. Canadians recognize that, but it hasn't been extended.

    So the answer is, we don't have good data that compares, on a longitudinal basis, between urban and rural aboriginal people in Canada. We need to develop it, but we need to do it in partnership with the community by being researchers at the beginning of it and playing a role. The community is ready to do it.

º  (1640)  

    Mr. Richard Jock: I have a couple of comments. For status Indian people on reserve, there is a survey, first done in 1997, the regional health survey, which did have a fair breadth of questions. Actually, Jeff was involved with that with AFN. There is funding for a second survey, which is intended to be carried out this summer, albeit at a bit of a reduced scope. Nevertheless, I would say we would have about 20% of all the communities for which a detailed survey would be carried out and should yield useful information.

    The same cannot be said for the Métis and off-reserve populations. I just came from a Métis policy forum in Saskatchewan, and they do not necessarily feel they've been researched to death. In fact, there's quite an absence of data for that particular group. What Jeff has said certainly applies to first nations and Inuit people, but the Métis and urban groups are really a void that I think should be filled if we're going to be able to answer the kinds of questions you raised earlier.

    The Chair: Thank you. I have two more questions.

    My second question is an attempt to bring together the remarks you made about the determinants of health--I think both of you--with something Mr. Spencer said. I very much liked your original answer to Mr. Spencer, but to be fair to him, I don't think he was trying to avoid the blame. I think he was saying this is so overwhelming when you hear the list, how do we prioritize?

    When I think about the determinants of health... and God knows, I've spent enough time working with Fraser Mustard that I think about the determinants of health. By the way, when he was here, although I wasn't here that particular day, I think he brought along that British Columbia paper about the correlation between suicide rates of youth and the self-governance issues, which is quite suggestive and compelling. I guess that's the one you were referring to.

    But what strikes me is, in the notion of prioritizing, or leveraging, if you like, if you think about the Perry Preschool Project, they changed only one variable. They didn't change the housing status of the parents; they didn't alter the poverty rates; they didn't improve anything there. They just worked on the kids.

    Of course, the evidence is, because those kids were at such risk, you get these famous seven-to-one paybacks and all the rest of it. Yet it would seem that even by changing that one variable, they really did have a huge impact on changing the life course of those children.

    I've seen some of the data on the Moncton Head Start program, where it's a little less conclusive, and I don't know for what set of reasons. In a world of limited resources, even though one completely agrees with the fact that we have a moral obligation to attend to all these matters, and recognizing that we have to make life pleasant or improve the qualify of life for people who are with us and older... Nonetheless, if one were to focus--and this is a question for our report as much as anything else--on what I think is emerging as a kind of integrated set of early childhood development services at the community level, which would be respectful but which would, from the federal point of view, pull together all these silos of child care that are administered by HRDC, and it is related to the fact that if you're not in training, you don't have a job, you can't do it, and welfare doesn't count...to Aboriginal Head Start, to the Canada prenatal nutrition program, to the community action program for children, you name it... If we were to create a kind of one-stop shop, perhaps based on the Quebec model, as we understand it, so that it essentially leverages off the health care, which deals with all sorts of governance issues with first nations and all the rest of it, can you see that even if we weren't able to attend immediately to the housing issues, the water issues, the job issues, and all those other dreadful poverty issues, this, in and of itself, would have a community-building effect?

    One of the things that seems to come through from the Head Start evaluations is that you're getting all sorts of collateral benefits. You're getting empowered women who have been working at the community level suddenly feeling good about themselves, and they're part of the parenting world. It goes beyond the kids.

    So in our determinants of health, if we have to pick priorities, should we start here?

º  (1645)  

    Dr. Jeff Reading: If you're looking for a panacea, I don't think it's going to be that.

    The Chair: No, I know.

    Dr. Jeff Reading: Certainly, it's going to improve things, but it's not going to eliminate the problem.

    I'll give an example. Say you focus on dental health, which we haven't discussed. Dental health is extremely poor among children in first nations communities--some first nations communities. When dental health is extremely poor, that affects food choices. So people tend to eat foods that are less nutritious, and that in turn affects obesity, which in turn affects diabetes, which in turn affects a range of issues like becoming blind in later life, losing your limb, getting renal failure, becoming predisposed to aschemic heart disease.

    So it's a vicious cycle, and I think to try to focus on one sort of intervention in early childhood education as some kind of panacea that's going--

    The Chair: I'm not using it as a panacea, but I am saying, me to you, would you say, get the housing straight first and then worry about the kids? No, you wouldn't say that either.

    Dr. Jeff Reading: No, but I think really there needs to be something like an omnibus type of approach where a number of issues are done in parallel. And certainly whatever you do, early childhood education should be done, but I think it has a synergistic effect when it's combined with other things that are equally known to improve the health conditions on reserve or in urban communities.

    The Chair: Of course.

    Jock.

    Mr. Richard Jock: I think if you were to broaden your interests and include young adults, those who are also at the post-secondary education level, and you examine policies and opportunities in terms of assuring that people have the opportunity, when and if they have the innate ability, to aspire to post-secondary education.... It's been shown that this lessens demands on the health system as well. So I think this would help meet our needs in terms of the future job market, labour market; I think it would meet needs from a lot of perspectives.

    My question back is, really, how do you engage the community? I'm not sure how successful an external mandate, an external process that's just imposed, would be, no matter how well-intentioned it is.

    A good process that really appropriately engages the community, an effective process, to me would be a key to that success.

    The Chair: On that note, I'm going to thank both of you because I know Dr. Reading has wild ambitions to catch a 5:30 p.m. plane and we don't want to risk the life of the taxi driver intervening.

    We will be back to both of you I think as we proceed with our work. I want to thank you very much for your interventions, your warnings, and your encouragement. Thank you for coming. We appreciate it. The meeting is adjourned.