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 24, 2002

¹

1525

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

Ms. Monique Guay (Laurentides, BQ)

The Clerk

The Chair

Ms. Monique Guay

The Chair

¹

1530

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations)

¹

1535

¹

1540

The Chair

Ms. Marilyn Carpentier (Coordinator, Canadian Prenatal Nutrition Program, Health Secretariat, Assembly of First Nations)

The Chair

Mr. Larry Spencer (Regina--Lumsden--Lake Centre, Canadian Alliance)

The Chair

Mr. Larry Spencer

Ms. Elaine Johnston

Mr. Larry Spencer

Ms. Elaine Johnston

Mr. Larry Spencer

¹

1545

Ms. Elaine Johnston

Ms. Marilyn Carpentier

The Chair

Mr. Larry Spencer

Ms. Elaine Johnston

¹

1550

The Chair

Ms. Elaine Johnston

The Chair

Ms. Monique Guay

Ms. Elaine Johnston

The Chair

Ms. Elaine Johnston

¹

1555

Ms. Monique Guay

Ms. Elaine Johnston

Ms. Monique Guay

º

1600

Ms. Elaine Johnston

Ms. Monique Guay

Ms. Elaine Johnston

Ms. Marilyn Carpentier

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1605

The Chair

Ms. Marilyn Carpentier

The Chair

Ms. Elaine Johnston

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1610

The Chair

Ms. Monique Guay

The Chair

Mr. Tony Tirabassi (Niagara Centre, Lib.)

Ms. Elaine Johnston

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1615

Mr. Tony Tirabassi

The Chair

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

Ms. Elaine Johnston

Mr. Alan Tonks

Ms. Elaine Johnston

Mr. Alan Tonks

Ms. Elaine Johnston

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1620

Mr. Alan Tonks

Ms. Elaine Johnston

Mr. Alan Tonks

The Chair

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1625

Ms. Elaine Johnston

The Chair

Ms. Elaine Johnston

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1630

The Chair

Ms. Elaine Johnston

The Chair

Ms. Monique Guay

Ms. Elaine Johnston

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1635

Ms. Monique Guay

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 023

l

1st SESSION

l

37th PARLIAMENT

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EVIDENCE

Wednesday, April 24, 2002

[Recorded by Electronic Apparatus]

¹  (1525)  

[English]

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

     If you wouldn't mind, we just have a little business to take care of. We're delighted to have witnesses today, particularly these witnesses. But as your witness list suggested, we were also expecting “L'Association des femmes autochtones du Québec”. The short version seems to be that the people we had originally contacted felt there was a more appropriate witness to come before us, and they proposed this other person. However, the other person could not make it for today. We do need to make good on that witness because we want very much to hear from folks in Quebec. I don't know what the state of the conversation is.

[Translation]

    Where were you at in the conversation?

    The Clerk of the Sub-Committee: In the other committee.

    The Chair: Oh, you were in the other committee. I do not know if we can settle this immediately.

    Ms. Monique Guay (Laurentides, BQ): I believe so, Mr. Chairman. I myself have contacted Quebec's “Ministère de la Santé, Secrétariat aux affaires autochtones” and “Ministère de la Famille et de l'Enfance”. I sent out an appeal but you see the timelines are very tight and the National Assembly is sitting intensively until June. I got no responses and am awaiting word. There did not seem to be an marked interest in the possibility of a meeting with our committee because of their need to deal with some urgent situations and other issues.

    There was also mention of “l'Association des femmes autochtones du Québec”. I did not, therefore, make any other overtures. I believed that these women were coming today and have just learned that they will not be. I do not know whether Ms. Bélisle can tell us whether they will be coming or not.

    The Clerk: I am told they were prepared to come another time, and could be part of another bundle. I thinking it might be May 8.

    The Chair: At any rate, if I have understood correctly, we have a vacancy next week. Is that it?

    The Clerk: Yes.

[English]

    We are blessed with the witnesses we have, and we're thrilled you're here. You can imagine what would happen if you weren't here.

    As we have two witnesses instead of four, I'm going to propose that we perhaps take a little time at the end to help Lyne figure out what to do for next week. We have lots of ideas, but we need to get a move on in order that we don't have a hole in next week's schedule and have to keep moving things around.

[Translation]

    Ms. Monique Guay: Mr. Chairman, I need to leave by 4:45. I have a meeting on Israel, since I have to leave for Israel on Friday. A meeting has been organized by the government for 4:45.

    The Chair: We understand and will to our best to get the scheduled witness or another in. We need your assistance regardless.

[English]

     That bring us to today's proceedings. We have a quorum.

    We are delighted that we have, from the Assembly of First Nations, a friend--I won't say an old friend, Elaine, I can't put it that way--of some standing, Elaine Johnston, who's the director of the health secretariat. We are delighted as well to welcome Marilyn Carpentier, the Canadian prenatal nutrition program coordinator, a program for which we all have a great deal of regard. We welcome you to the committee.

    You understand that our focus right now is on children from conception to six initially on reserve. We're absolutely delighted you're here, because a crucial part of our work is to consult widely with first nations on what seems to be working and to work with them to come up with a better system for early childhood development using their guidance and experience. So it's in that context of consultation that we welcome you.

    I don't know if you have a preferred batting order. I know you have things to tell us. Who wants to go first? There's no right answer to that. It's whichever order you'd like to go in.

    Elaine, are you going to go first? Welcome.

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    Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations): Thank you very much for inviting us to present from the Assembly of First Nations.

    As was mentioned, my name is Elaine Johnston and I'm the director of health at the Assembly of First Nations. I am Ojibway Potawatomi from Ontario. I have a background actually of 25 years in the health field, with a Bachelor of Science in Nursing. I've worked in a number of environments, both off-reserve and on-reserve.

    We want to share with you some of the issues. I thank you for clarifying the zero to six, because we just received that clarification. Our presentation is basically on children--on first nations children--and if there are other presentations that are being done, we can focus it more on zero to six.

    What we want to tell you is that healthy children are necessary for healthy first nations. First nations children population is characterized as the youngest and fastest-growing segment of the overall Canadian population. The growth rate is almost twice that of the Canadian population. According to the recent stats found in the Indian Register of the Department of Indian Affairs and Northern Development, the total first nations population as of December 31, 1999, was 660,000 people.

    First nations under the age of 15 make up approximately 30.6% of the first nations population. The five to nine age group represented the largest segment, with 76,000 of the first nations population, and the 10 to 14 age group was the second-largest segment, with 69,000. We don't have a total breakdown, though, as you say, about the zero to six group.

    What are the issues? Poverty and the determinants of health. Dramatic improvements have taken place over the past 200 years in the health of Canadians because of economic growth, better food, safer housing, clean water, adequate waste disposal, and planned parenthood. On the other hand, first nations communities have high rates of poverty, bad housing conditions, unsafe water supplies, and inadequate waste disposal. Fifty percent of all first nations children living on or off reserve live in poverty. Canada's census figures indicate that the income of nine out of every 10 first nations persons living on the reserve with a disability are below the poverty line. First nations houses on reserve are 10 times more likely to be overcrowded than the houses in the general population. Overcrowding leads to a reduced lifespan as well as increased social and health problems such as family tension and family violence. Up to 32% of aboriginal children live in households with a lone parent, and 39% of aboriginal adults report family violence as a problem in their community.

    Housing, where children spend most of their time, constitutes a powerful health determinant. Canadian children spend 90% of their life indoors, mainly their homes. The study entitled Healthy Homes, Healthy Families, done in Kanesatake, which is in Quebec, concluded that 37% of Canadian homes are damp or mould-contaminated. However, in Kanesatake, 83.5% of homes were found to be damp or mould-contaminated. Respiratory illness is the single greatest cause of hospital visits for young first nations children. In 1997, 15% of children under six, 11% of children aged six to 11 years, and 9% of children aged 12 years and older had asthma. Bronchitis affected almost one in 10 children under six. Respiratory illness is the single cause of hospitalization for young aboriginal children as it is for non-aboriginal children.

    Poor nutrition makes first nations susceptible to infectious diseases and slows the healing process. Preschool death rate for first nations children is five times greater than the Canadian average, and for first nations teenagers death by injury rate is more than three times the Canadian average.

    The first nations children in Canada are at risk. Poverty and poor living conditions contribute to alcohol and drug abuse, family violence, and sexual violence. The rate of suicide amongst first nations adolescents is up to seven times the national average. First nations youth aged 10 to 19 are five times more likely to commit suicide than other Canadians their age. According to the First Nations Inuit Regional Health Survey, 62% of the respondents said they smoked cigarettes. Children as young as six smoked, with rapid increases of reported smokers at ages 11 to 12.

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    According to a Manitoba case study, the proportion of first nations children in some first nations communities affected by fetal alcohol syndrome was between 28 and 72 per 1,000, compared to a worldwide incidence of 1.9 per 1,000 live births.

    The cost of the lack of preventative support--evident in the rate of incarceration and recidivism--is currently in the order of $306 million annually. The choice remains whether to intervene earlier or pay for repeated attempts at reform in later years. Aboriginal youth are at an elevated risk of becoming pregnant at an early age, and at greater risk of contracting a sexually transmitted disease.

    So the question is, what do children need? New evidence indicates, as parents have always known, that children's experiences and environment during early childhood development, including the active engagement of parents, are critical to brain development for children in their early years. Babies, young children, and youth need to be valued, respected, nurtured, and loved. All children in general need the basics of food, shelter, security, clothing, health care, and educational and recreational opportunities, to create the stable and nurturing environment they need to fulfil their potential.

    It is critical that the needs of aboriginal children be a priority, in order to build the strength of first nations communities over the longer term. It is estimated that children and youth represent 57% of the on-reserve population.

    Poverty is an important determinant of health and child development. In a British report, Inequalities of Health, British researchers reported:

While remediable risk factors affecting health occur throughout the life course, childhood is a critical and vulnerable stage where poor socioeconomic circumstances have lasting effects.

If economic and community conditions can be improved, children's health and development can be positively affected.

    A comprehensive first nations children's health policy framework is required. Early intervention is the key to giving children a chance to lead healthy, productive lives. These elements include nutritional health promotion and related disease prevention; safety and welfare initiatives aimed at 7- to 12-year-olds; mental health initiatives; and support for children with disabilities.

    First nations require resources that are stable and equitably distributed for long-term sustainability. Resources are required for the development of proper facilities that include operation and maintenance costs for sustainability purposes. There is a severe lack of capital facilities.

    First nations require resources for smoking prevention, cessation and treatment programs at the first nations community level. Funding--for treatment, prevention, and promotion in mental health, and health and social programs--is also needed.

    The human resource needs of first nations to deliver services at the community level are great, and urgently needed. A strategy to address this human resource deficit is required. This priority area is linked directly to the issue of building and sustaining first nations control of health and health care systems. First nation-specific training must be developed and delivered to ensure there are sufficient human resources to meet the needs of first nations children and parents. Culturally specific curriculum is also required.

    Participants in a recent national youth conference on empowerment and healing, sponsored by the AFN, made these recommendations: develop traditional parenting classes to be taught in schools; provide day care services for parents who wish to continue their education; offer workshops on personal wellness to parents, as healthy parents produce healthy children; provide training on anger management for children; instruct parents on the importance of teaching children respect; advise new parents about the steps of child development; and teach what being a good parent is to the whole community.

    In conclusion, Canada must find the resources to launch a concerted campaign for a child health policy framework, to drastically reduce all forms of risky behaviour among first nations youth. Programs must be designed and delivered with the input of first nations. The most effective health programs are the ones designed and delivered by first nations practitioners for first nations peoples.

    Jurisdictional issues continue to be a factor for first nations children, and must be considered in a first nations child health policy, in order to ensure first nations children do not fall between the cracks of federal and provincial jurisdiction.

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    We have talked about this in other forums. When we develop the policy on children, we need to look at putting the child at the centre, where community, the individual, the family, and the nation all have a responsibility to that child. The bottom line here is that if we look at the children and the future, we have to put emphasis on those children if we want to have healthy families and communities.

    Those are my comments. I thank you again for inviting us to present to you.

    The Chair: Thank you very much, Elaine Johnston.

    Marilyn, do you want to add anything? Do you want to be a resource person when we ask about prenatal nutrition, or do you have a presentation you wish to make?

    Ms. Marilyn Carpentier (Coordinator, Canadian Prenatal Nutrition Program, Health Secretariat, Assembly of First Nations): No, we worked together on this presentation.

    The Chair: Perfect.

    We thank you for that very useful introduction. I don't want to read too much into it, but I would say you have touched on many of the themes we've been hearing before. It encourages us that our thoughts are moving in the right direction, and we're glad to see that we're not dissonant with what you're saying.

    I'm going to move right now to questions. Mr. Spencer, did you have some thoughts?

    Mr. Larry Spencer (Regina--Lumsden--Lake Centre, Canadian Alliance): Actually, I do today. I have a couple of thoughts. That's new to the committee.

    An hon. member: He always does.

    The Chair: You had a particularly large number of thoughts yesterday, I noticed.

    Mr. Larry Spencer: That was a different issue.

    Thank you again for sharing with us. I'm just looking down the fact sheet. We always recognize and know that there's such an overwhelming and tremendous problem out there with our aboriginal children and youth. If anything has been driven home to us, it has been that.

    I want to ask some questions here, and I'm leading to something that has to do with the government. I'm not in any way trying to put this down. We've heard this from other witnesses, but I like to hear it over and over. With repetition, I eventually learn.

    You mentioned that one of the needs for educating your children, of course, is culturally specific material. I'd like to hear your description of that and then what you see that doing for your children, just your version of it.

    Ms. Elaine Johnston: Certainly. I can speak as a registered nurse who has worked in the communities. When I talk about culturally specific materials or even education training.... For example, we had a prenatal program that targeted zero to six and even before birth. The issue is to make it relevant, but also to make it so that the individual or families would understand their role.

    In our practice as community health nurses, we used the medicine wheel to do prenatal teachings. It was very important because the medicine wheel talks about the concept of putting the child in the middle so that all services, all roles and responsibilities, were identified. So it was not just government; it was also our responsibility as first nations, as parents, as siblings.

    It was important from that point of view to talk about our roles and responsibilities and what each of us contributes to raising that healthy child. That's what I mean by culturally specific. You can use those kinds of tools to get the message across, so that people can take it and say, yes, this makes sense to me, yes, I can apply it to my family.

    Mr. Larry Spencer: The next question is in two parts. Where do you get this material, or is it available? Is it part of any government-sponsored programs that are involved with that, such as Head Start or early childhood education?

    Ms. Elaine Johnston: Yes, they are part of various programs, whether they're provincially funded or federally funded. What has happened is that the first nations may have developed these tools in partnership with government, they may have done them on their own, or they may have done them in partnership with other organizations. I know that in developing and using the tool I talked about, we had actually done it with non-aboriginal communities, and they liked this model. They felt they could use it in their own community as well.

    So they do exist, and I think there are best practices out there that can be shared with first nations communities as well as with the non-aboriginal community.

    Mr. Larry Spencer: I have one last question. What programs, if any, that address the malnutrition problem are being carried out through government assistance?

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    Ms. Elaine Johnston: This is where we have been involved with the Canadian prenatal nutrition program. Maybe I'll hand it over to Marilyn to give you more specifics on that.

    Ms. Marilyn Carpentier: I'm an Algonquin from Kitigan Zibi, and I have a nursing background as well. I just started in January with the health secretariat, with the CPNP evaluation program. Before that I was in the housing area. And, yes, I'd like to talk to you about the CPNP program.

    This program is targeted to pregnant women to teach them. The component for nutrition is to speak to them about good nutrition--what the healthy foods are and what things to avoid to ensure their unborn baby is getting the nutrition requirements it needs to develop.

    The CPNP program started in 1994. The Canadian government started this. What we found was that it wasn't reaching all first nations women. The chiefs and our chiefs committee decided to make an evaluation of this program to find out why it wasn't reaching all the women and to find out from the ones who are receiving this, who are actually getting the program, what works for them and what doesn't. So we are undergoing an evaluation. This has started. It's in the last year of four years now. We have a sample of 100 communities that we're working with. The sample accommodates the remote areas and tries to get a good sample across Canada.

    This is going very well so far. We're not only going out there to get data, but we're also giving information to them on nutrition, on the dangers of fetal alcohol syndrome, and getting information, data collection, on the women. It's quite extensive. We're targeting not just the young mothers but the youth as well, talking to the service providers, getting information from them, and giving them information also on nutrition and everything like that.

    We're also training the community-based researcher, a person chosen from the first nations who we train. They're out there taking this collection of data, but they're also gaining a capacity and knowledge of evidence-based planning. These are some of the things that we're doing right now.

    The Chair: Thank you very much.

    Did you have a question?

    Mr. Larry Spencer: Yes. She dealt with the prenatal, and did a great job of that. But once the child is born, from zero to six, what inputs do government programs have to the children's nutrition?

    Ms. Elaine Johnston: I can respond to that. Government has come forward with the Aboriginal Head Start program. It came to the off-reserve groups first. The first nations came later. This program has been highly successful, but it has not reached all the first nations communities. It has also looked at cultural types of programs within that. Some first nations too have had access to day care services, but not all first nations have been able to access that, as well. There are a number of parenting programs out there. Some of them are funded by the federal government. Some have also been funded by the provinces, depending on the province, but they are sporadic, and I can't even tell you from all the first nations communities what percentage of those programs are being funded for those programs.

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    The Chair: For the record, as I understand it, the prenatal nutrition program does not, despite its name, end at birth. I believe there is some carry-through for the first months.

    Am I right?

    Ms. Elaine Johnston: That's correct, it's pre-conception. The reason for working with mothers is to ensure that we look at pre-conception but also once they've had the baby, so it's past birth.

    The Chair: Madam Guay.

[Translation]

    Ms. Monique Guay: Ladies, thank you very much for being with us today. It is greatly appreciated and your comments and recommendations will enable us to make a far more detailed report.

    We have been receiving witnesses for a number of months now, and we have been discussing the situation of this country's children. I would very much like to hear your views on the programs. There are some programs for all of Canada, but they are working better on some reserves than on others. Is this because some community health centres are more structured and able to take a more strategic approach to applying the programs? In your opinion, should the reserves have more community centres in order to apply these programs? I know there are a number of programs, but I would like you to tell me about one that, in your opinion, is operating very well and should absolutely be retained. That recommendation could be included in our report.

[English]

    Ms. Elaine Johnston: I can speak from having worked in isolated northern communities and also from working in southern communities, and there is a difference.

    The first community I went to was actually Pikangikum. It was quite often in the media for its suicides and--

    The Chair: As you speak of these communities, would you mind telling us exactly where they are?

    Ms. Elaine Johnston: Pikangikum is a community in northwestern Ontario, north of Red Lake, and it is a large community of close to 3,000 people. At the time I went I was one of two nurses, and they now have the capacity to have 11 nurses in that community. They've had a rash of suicides. I've had the opportunity to work in that community and live in that community, and I've also had the opportunity to return to that community in the past year, to note the difference, if there was any difference.

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     But I can tell you, as a first nations member myself, having lived and grown up on a reserve.... As I mentioned, I grew up in the Serpent River First Nation here in Ontario.

    The Chair: Whereabouts in Ontario?

    Ms. Elaine Johnston: It's considered north-central. In Ontario anything north of Barrie is considered north.

    When I was growing up, my community did not have running water and sewage. However, as time went on, we did get better housing conditions, we did have running water and sewage, and the opportunities started to open up for education. As a result of my going on to school, I was able to go into nursing.

    When I went into the community of Pikangikum, it was an eye-opener for me as a nurse and as a first nations member to see the living conditions of that community. When you're dealing with basic human needs like shelter and whether you have a proper stove to cook on.... When I was a nurse in that community and when we did home visits to community members, I would find circumstances where families did not have a proper stove to cook on. They would have a barrel in the middle of their home, they would be putting wood into this barrel, and that's how they would be heating their home and in some cases cooking their food.

    When you're dealing with basic human conditions, with regard to looking at programs, the problem is that they're dealing with basic human needs. The programs are, I think, problematic; do they have the capacity? When I ask about the capacity, what I mean is, do they have people who are trained in the community to be able to provide those programs? Now that I've had the opportunity to go back into Pikangikum--this was about 10 years later--I would say that the capacity is slowly getting there, but it's taking time.

    For example, Aboriginal Head Start is, I think, an excellent program. It needs to be funded, and every community should have the opportunity. The problem with the Head Start program and how it came out was that there weren't enough dollars for it. It was sent out to the various regions in Canada, and it was based on need but also proposal-driven, based on whether there were day care centres or what kind of linkages they could... If you do not have the capacity in the community to develop and then implement those proposals, it is problematic. From what we've been able to tell, the Head Start program is a very important program and needs to be expanded. It's very critical when we talk about what is culturally appropriate, and that program is that.

[Translation]

    Ms. Monique Guay: That is what I would call a clear reply, Mr. Chairman. Thank you very much.

    In Quebec, the Canadian Prenatal Nutrition Program is implemented through the CLSCs. Health Canada representatives who have come before the committee have told us that this is a very effective and efficient service delivery model.

    What do you think of it?

[English]

    Ms. Elaine Johnston: I'm sorry, what is it called?

[Translation]

    Ms. Monique Guay: The Canadian Prenatal Nutrition Program, In Quebec this program is delivered through the CLSCs. You know what a CLSC is. They work very well with the first nations, because they dispense the services under federal programs directly to them. The agreement is a very good one. It is not the same situation everywhere, but in Quebec it works very well.

    Then there are such things as the $5 daycare program. These are essential services for enabling some women to escape poverty. The Canadian Prenatal Nutrition Program is, therefore, working very well through the CLSCs.

    On the reserves, is it delivered through the community health centres? Would it be desirable to make it available elsewhere, in other regions of Canada?That is my question. We have been told that it was working very well in Quebec, but not necessarily in place elsewhere.

º  (1600)  

[English]

    Ms. Elaine Johnston: Yes, the Canadian prenatal nutrition program has been developed in first nations communities, through the health centre. Again, the problem has been the lack of dollars identified for it.

    When the number of dollars are divided among all of the first nations communities across Canada, there aren't many with which to run this program. We have found that in order to be able to deliver a good program, first nations communities combine money they get for other programs with the funds for the prenatal nutrition program. If they don't do this, then they may have project-specific activities.

    I worked for a tribal council in Ontario with representation from eight first nations communities. We linked the Canadian prenatal nutrition program dollars with other program dollars we had received. We did “breakfast for learning” types of programs, working with our mothers in educational programs on proper nutrition. In some cases, communities are doing that, but it varies across the country.

[Translation]

    Ms. Monique Guay: We also have a school breakfast program. Very often, in the general population, there are children from disadvantaged families living in certain areas who do not eat breakfast. In Quebec we have therefore created the “breakfast club“, where all children eat together. There is therefore no discrimination against certain children and it is working very well. It is our hope that some day these services will no longer be needed, and all children will be able to eat breakfast in their own homes.

    I would like to ask a question about housing. You had a lot to say about housing. There is a crying need for housing in the first nations communities. Are there specific federal programs for this, or provincial ones, or are there any shared programs? Perhaps you could give us some more details on this. Housing is essential to survival, after all. It should be included in our recommendations.

[English]

    Ms. Elaine Johnston: I'll give you my thoughts on this and then I'll hand it over to Marilyn, because she used to handle the housing portfolio for AFN.

    Housing is a big problem across the country for first nations. There are big housing waiting lists in the first nations communities. The other thing we're noticing is that while we do have a big off-reserve population, a lot of our members are coming back home to their communities. One challenge is to find a house for them to live in. And for those who go on to school, whether college or university, another challenge is finding economic development opportunities that they can come back home to once they've completed their education. This is another problem.

    As for housing issues, there are many. The money that does come forward is from Indian Affairs, and CMHC provides part of that. There are problems with the shipping of materials, especially in the north. It's very expensive. There are many, many issues and we can't seem to meet the housing needs.

    I'll ask Marilyn to contribute, since she did have that portfolio.

    Ms. Marilyn Carpentier: Thank you, Elaine.

    About housing, of course INAC does have a program for housing. Under the new housing policy, an average reserve that normally got five houses, say, would make this proposal, which is a five-year plan, and they would get five extra houses for that five-year plan.

    The subsides that Indian Affairs provides don't cover the total cost of the house. A reserve that's on the southern side in Canada, closer to a major city, would get maybe $25,000. Well, that's not enough, so they would put in sweat equity, or sometimes they have revolving loans. But what happens up north is that the transportation costs are so high that if they were allocated, say, five houses, they'd lose one house just in transportation costs.

    We were talking about nutrition. When it costs $6 for a pint and their basic food needs are so expensive, they hardly have any money to put into things like improved housing.

    There are CMHC programs; these are loans. A portion of it is a grant or a subsidy, but the majority of it is a loan. They follow 25-year amortization periods.

    Not only that, but with regard to the section 95 program, it doesn't allow for any long-term planning. Under the new housing policy, it's a five-year plan, so they are able to do some long-term planning. But with the allocation they get from CMHC, it's yearly. I think they've finally increased it to two years, but they're not able to do any long-term planning, and it's something they have to pay back. They charge rent to the clients, and the clients have to pay it back. It's the same thing up in the remote communities or where they have high poverty; they're having trouble paying their rent. So the band has to try to find some moneys, because they have their operational expenses.

    Another problem we're having with housing is mould. Mould is a big issue in the Atlantic, Manitoba, and B.C., and the cost for clean-up or remediation. We don't have a program for that.

    I know they did send out some moneys this past year, but just enough to make a little dent in it. It's still a big problem, and the mould is causing ill health for the people who live in these homes.

º  (1605)  

    The Chair: Thank you.

    I'd like to ask a follow-up before we go to Mr. Tirabassi and Mr. Tonks. It's on Quebec, and it's really directed to Ms. Carpentier.

    I'm just trying to make sure I understand this. Our understanding is that in Quebec, the CPNP, the Canada prenatal nutrition program, is done through the local community health centres, the CLSCs, and we've heard from Health Canada that this works. So we're anxious to know from you, Ms. Carpentier, and indeed from Ms. Johnston, first, whether this is true, and secondly, whether it's a model, something that is essentially based around a community health centre with all sorts of things like child care attached to it. Is this something we can learn from?

    Ms. Marilyn Carpentier: Yes, the programs are delivered through the health centres on the reserve, like the CLSC. The program is very well received. What I was saying earlier is just that it's not getting to all the people we need to get to. Especially as Elaine was saying earlier, the amount of money to deliver the program is not adequate in a lot of cases. Sometimes you have to double up on other programs.

    In Akwesasne, for example, where they have a population of 7,000, they get $2,700. It's just not quite enough. So that's why they have to double up on other programs.

    The Chair: Thank you very much.

    Did you want to add something to that, Elaine?

    Ms. Elaine Johnston: Yes. I think you're asking about whether the model works. I think that's the question.

    The model works as long as there are enough dollars and there's also capacity. When I say capacity, I mean do you have the people to deliver the program. I think the group in Quebec do have that. They do have the capacity to do that. Now it's a question about whether there are enough dollars. That is another question they will raise. But I think the model itself could be something that could be expanded on.

º  (1610)  

    The Chair: I think that's a very useful and helpful answer to us.

[Translation]

    Ms. Monique Guay: That is what we wanted to hear.

[English]

    The Chair: Yes, you said the right thing. We'll get back to that.

    Mr. Tirabassi.

    Mr. Tony Tirabassi (Niagara Centre, Lib.): Thank you, Mr. Chairman.

    I just would like to thank the presenters for coming out this afternoon. This is certainly something that we've spent a great deal of time on, listening to many witnesses, both those who represent the communities such as yourselves and those who represent the programs.

    I was quite interested in your comparison about programs that are available. But really, what does a program mean to those on reserve when you've gone into places and the basic needs aren't getting met? You referred to the illustration of the barrel in the middle of the floor providing heat or being used as a cooking tool.

    I was watching television, and I wish I had been a little more careful--I was probably doing my usual scan with my remote--and had tagged the channel and the program. But there was a reserve, and I can distinctly remember it was Human Resources Development Canada that set up a suicide hotline on this reserve. They manned it with somebody off reserve, because there were just so many calls coming where they originally had the suicide hotline--I would imagine out in an urban centre--that they thought they could have one just for this reserve. They put this in place, and there were so many calls coming in that the person manning it literally couldn't leave, knowing that the phone was still ringing when he or she left or when they took a day off. So they asked for volunteers from the reserve to help relieve this gentleman, and they couldn't get volunteers.

    Now, that illustrates to me that maybe in an urban centre you would have a suicide hotline, but the person also understands that it isn't the cure. That it's just a bridge, a shoulder when you might need it. But on the reserve what was happening was the more the calls came in, the more calls came in. It seems that word got around, instead of getting to the root of what was the problem that was causing people to be in this state.

    So it goes back to this. The programs being offered here, which are intended to be very good programs, probably do work elsewhere. But the needs are here. Does that further speak to exactly some of the problems you're facing with the presentation of the programs on reserve? Would you care to comment on that?

    Ms. Elaine Johnston: I can certainly do that. Getting back to the community I mentioned earlier, Pikangikum, as I mentioned I had an opportunity to go back there after 10 years. The reason we had gone up there is that the national chief and I had gone up there at the request of the community because of the high rates of suicide.

    The observation I made this time around...because the first time I was there I was a nurse working in this full time, so this was my life. I ate, breathed, did this for 24 hours a day, seven days a week, and I have to admit that when I came out of there, I was burned out. This time going in I wasn't eating and sleeping this work. I was an observer coming in and looking at the community.

    The issue is that when you're in a community that's going through those kinds of things--the basic needs you talk about--you can't think outside the box because you're in crisis. So in terms of trying to get volunteers to be there, they can't. Interestingly enough, I had a chance to talk to a former mental health worker who picked us up at the airport. I said, you're not working in mental health any more; and he said, I can't, I can't be everything to everybody. I have to take care of my own child, because she's talking about suicide. I can't take care of these other kids. I have to focus on my own child.

    The problem is, they're immersed in it, and until they can think outside the box and look at that and say, enough is enough.... I can say that since we've been in Pikangikum...because I had an opportunity to talk to the youth, and I said, you are the guys who have to make some hard choices here, and decisions, and they're starting to do that.

    So the solutions do come from them, with maybe someone outside tapping them on the shoulder, so to speak. But I think it's very hard when you look at these programs that come in and say, we want you do to do this, when the needs are basically something else. There is a divide there.

    I can speak as a community health nurse also, because when I was a nurse in the community, I did that training with Health Canada. They told us about needs assessment. They said, you need to go and do that and the community will decide what the needs are in the community based on your needs assessment. I decided as a result of doing this needs assessment that I needed to tackle this, this, and this. When I went into the community they said, that's fine to say those are the needs in the community, but this is the way the programs come down. And I had to do this, this, and this. So I had to balance it and ask, what can I realistically achieve?

º  (1615)  

    Mr. Tony Tirabassi: Absolutely, and it was interesting how this wrapped up. It comes to mind how this particular hotline worked. It actually set a deadline that after two years of this hotline, problems should start to go away, because people now have a hotline to call and feel better about themselves. It did the reverse, and then of course the particular supervisor of that program decided, well, this isn't achieving what it was supposed to, so we're going to terminate it. It was just incredible.

    So I just share that thought.

    The Chair: Thank you very much. That's using absolutely the reverse logic of what you'd expect.

    Mr. Tony Tirabassi: Exactly.

    The Chair: Having established a need that was growing, we'd better end the program, because it didn't end the need.

    Mr. Tonks.

    Mr. Alan Tonks (York South--Weston, Lib.): I have a question for Ms. Johnston. When you were a community health nurse, you were employed by Health Canada?

    Ms. Elaine Johnston: Yes.

    Mr. Alan Tonks: Are there community health nurses employed by community-based organizations that are part of the on-reserve organization?

    Ms. Elaine Johnston: Yes, there are.

    At the time I was employed by Health Canada, Health Canada's First Nations and Inuit Health Branch used to have a policy statement to transfer health programs to first nations control, and it still is there but it was a big emphasis 10 years ago.

    What communities do is a needs assessment. Once they've done the needs assessment, there are negotiations about transferring that program to a first nation's control. If they have done that and the negotiation occurs between Health Canada and the first nation, they can either transfer it as an individual community or a group of communities--for example, through a tribal council or other group of communities.

    Some communities have transferred, although not all, so you can be employed in those communities that have not transferred and you're employed by Health Canada, or you can be employed by the community in other communities that have signed health transfer agreements.

    Mr. Alan Tonks: With regard to those communities that have health transfer agreements, have you worked in those environments?

    Ms. Elaine Johnston: Yes, I have.

    Mr. Alan Tonks: How do you compare the two models in terms of resource backup and the confidence of the community to deal with its issues?

    Ms. Elaine Johnston: I can compare the models. It has been a very interesting experience, because, as I said, I've worked in communities like Pikangikum that were funded by Health Canada and where the employees were employees of Health Canada. I've also worked for first nations communities and a tribal council, and I've noticed a difference, the difference again being capacity. I noticed that with the first nations communities that were in a health transfer agreement there seemed to be an open awareness now of the needs. If I know what the needs are in the community, then how do I expend my dollars to meet the needs, realizing that there is this stove-top programming? Can I do something with these dollars to meet those needs that are in the community?

    I noticed a real learning curve from the communities that were in a health transfer agreement. They started to say, wow, we never knew any of this before. There was a real learning curve as people asked, what do we as first nations have to do?

    In the communities I worked with prior to coming to the Assembly of First Nations, I was the executive director for health and also the chief executive officer for the North Shore Tribal Council. What we did was develop a partnership with the Friendship Centre in Sault Ste. Marie, in Ontario, to develop a health access centre. We got funding from the province to do that.

    On top of that, we looked at other programs, because we recognized the needs in our community and asked, how do we meet them? What do we have to do? We recognized that data collection was also going to be critical, so we started to develop our own database. We ourselves did that. It was not the government groups who did that.

    I noticed that the dynamics in the community are changing. There now seems to be more economic development. Health services--I can speak from a health perspective--seem to be the biggest economic development as far as providing the human resources for staffing is concerned. We were able to employ our own people. You know about the snowball effect; I noticed that.

º  (1620)  

    Mr. Alan Tonks: With regard to those that have health transfer agreements--I think you've touched on it, but I'd just like to pursue it a bit--is the evaluation done internally, is it done by Health Canada, is it done externally to the organization, or is it done both ways?

    In terms of the programs that exist and where the gaps are, in terms of budget support, if it's FAE or FAS support, if it's the prenatal program that needs the instruments that are required in the view of the community boards under the health transfer agreement, is the evaluation done internally, externally, or both, and in your experience does it provide the basis for additional resources?

    Ms. Elaine Johnston: I can speak to the evaluation. It is done by the first nations, but they are mandated by Health Canada to do the evaluation after five years. They have to give their plan to Health Canada, and Health Canada has to agree to the plan. I would say that it's not a very extensive evaluation, because they're not given a lot of funds to do it.

    The thing first nations are noticing is that they have identified gaps but they can't deal with those gaps. Just in the past year, as a result, there is a group of communities that have come forward to the Assembly of First Nations and said, we like health transfer; however, there are not enough dollars.

    The problem is that there are a number of issues. One is that there are no escalator clauses in these health transfer agreements. As the population grows and as things change in the community, the costs stay the same in terms of what Health Canada is willing to pay. It doesn't change with the escalating cost or the escalating population. So that's a problem.

    The other issue is that not all programs are transferable. Only those programs that can be transferred are transferred. Things that don't have a transfer mandate are not transferred. Things like home and community care, as an example, are not transferable.

    Mr. Alan Tonks: That's very interesting, Mr. Chairman. It seems to me that information would be helpful to the committee as we try to build that model.

    Thank you very much.

    The Chair: That would be very useful.

    I'd like to pursue that, in fact. I don't want to lead too much here, because it's not good to lead the witnesses.

    We've been looking at this issue for some time now, and we get the impression that at the Ottawa end, where we are, the pipes begin. So we have programs that don't really coordinate with each other. We have programs from HRDC that deal with child care but only for people who are in training or have a job, not for other people. They don't connect with the Health Canada programs, by the way. So you have all of these different programs, prenatal nutrition, Head Start, and so on and so forth, and they're coming out of different ministries, from DIAND to Health Canada, you name it. At the receiving end, so to speak, where the pipes come down into various communities, again they're all divvied up. I think you mentioned that you need to be an expert in grantsmanship, government programs, and God knows what else to figure out how to do it. It's almost impossible to make them coherent and connected.

    We are going to be writing a report on this issue pretty soon, and I want to test this hypothesis.

    I also, by the way, very much take your point in view of the arguments about the determinants of health, that we can't assume there's a silver bullet on the early childhood service side that's going to make up for lousy housing. It's not going to get rid of the mould.

    We're not offering a holistic solution that deals with everything from economic development to housing. That would be rather a lot for this committee. Maybe we should, but we're just dealing with one issue at a time.

    Beginning from the point of view of children's services, let's say we recommend that the Government of Canada use the logic of the health transfer agreements and take that model for all the money we're turning over right now through the various pipelines and try an experiment, with the full cooperation of and in consultation with the AFN, the various regional groupings of chiefs, communities, and so on. Let's say that in six communities with very different cultural conditions but where there's a capacity and a will to do this kind of thing we had a physical centre that essentially brought all of the resources on the health transfer model together, and we said we essentially want to cover off all kids who are born because we want to absolutely eliminate fetal alcohol syndrome if we can. So it's not just targeting at-risk moms. Just target everybody. Try to make smoking-cessation programs as universal as we can. Have one place for child care and parenting and all the things the National Youth Conference talked about. A lot of the things are there, anger management and all the rest of it.

    Focusing on prenatal to six, we could show what we could do if we really had the resources in an integrated fashion. It would take, of course, quite a lot of cooperation at the Ottawa end to get those guys to surrender their different programs. We would make the point that if we do it right and we resource it right, we can make a difference even if we don't change right away the housing and so on.

    Are we crazy to think that this is a good idea?

º  (1625)  

    Ms. Elaine Johnston: No, I don't think it's a bad idea. And I can speak as a nurse, but this question had been asked of me as well....

    My community has asked me to be the chief, and I backed down for a number of years. One of these days you will see me here as a chief.

    The Chair: You're a chief for us right now.

    Ms. Elaine Johnston: I am a nurse, and I come from a long line of healers. My grandmother was a traditional healer. My family are healers and leaders.

    I believe the answers come from the first nations. We just need the resources. I think there are very good models out there, as you mentioned. There are some things that first nations are doing very well.

    I agree that there are some concerns. There are some issues with regard to, as I say, escalator clauses for the growth of population and to look at the services. But if we really want to look at the determinants of health and how we're going to resolve some of these issues, I think we have to have the resources. If we could look at something like that, I would support that. However, there is the whole issue of fiduciary responsibilities and treaty rights. That is something the political leaders will come forward with.

    I think from a purely administrative point of view of trying to deal with the issues you're describing as far as wanting to have some healthy outcomes, we need to put it into the hands of the first nations so that we can have these positive models. I think that once we start to share those with the communities that do not have the capacity, it will start to snowball.

º  (1630)  

    The Chair: I want to make sure that you understand our point of view. We focus very much on children and youth at risk; we don't claim to be the aboriginal affairs committee, which I also sit on. We in no way wish to diminish or delay any of these other conversations on treaty rights. We also certainly don't want anything delayed because of other conversations in other places about governance issues.

    What I would hope is that should our report go along the lines we're suggesting, it's a way of getting going with something that would have a demonstration effect and make the case for the use of intelligent deployment of resources in an integrated, culturally sensitive, respectful manner, so that it would be possible to work with organizations like the Assembly of First Nations in developing the model. It would not be put on hold, waiting until some of these other issues are resolved, but would move in a parallel fashion and help also to identify communities that display differences in different parts of the country but where we have the best chance of success, because we're building on some good models.

    I don't want you to pre-commit the national chief. But I would hope that should we move along these lines, we would find ways of working together, whether it's us or the Government of Canada, should we manage to persuade them to go along this line. Do you think we have a chance of success of doing that?

    Ms. Elaine Johnston: I think we do. I can say that the portfolio-holder we have in health is very committed to looking at partnerships and how we can work together. What he has said to the Romanow commission and to others is that we're all committed to working towards the same goal. How we get there is maybe where we're having some discrepancies. So if we're committed to resolving children's issues, then let's work together, because that's important for the final outcome.

    The Chair: And it may be, as you say, in your model and I hope ours that children are at the centre of it all in all traditional models.

    Are there other questions or comments from other members of the committee?

[Translation]

    Ms. Monique Guay: I would like to ask one final question. Thank you for your interventions. There has been much talk of statistics here. We had Stats Canada here, among others. We do not have any recent statistics on the effectiveness of the programs and on what is going on in the first nations reserves.

    Do you have any figures on this? If so, the committee would greatly appreciate receiving them. It would help us in planning for the next report. We have not managed to get any recent statistics on what is happening on the reserves and on the programs in general.

[English]

    Ms. Elaine Johnston: Statistics Canada's stats are not very accurate when it comes to first nations. What is happening right now is that we are in the process of working with the National Aboriginal Health Organization. The communities are going out next month to start to collect data on a number of issues such as housing, economic development, and health conditions. They're going to be starting this spring to go out to do that data collection. We did do a national regional health survey, and it was completed five years ago. So we're now going out on another forum; Health Canada has contributed some dollars and Stats Canada has contributed minimal dollars to this. But the intention is to collect that data you're asking for. We're hoping that over the next year we will have that data. Unfortunately, it may not be in time for your report.

    The whole point of the Assembly of First Nations working on the CPNP evaluation is also to collect the data that is not there. What I've noticed in my years in health is that we're not very good at evaluation, and government has not been very good at putting evaluation as one of its key tools to collect data. I think they're starting to slowly realize that we need to do that.

º  (1635)  

[Translation]

    Ms. Monique Guay: It is my impression that Statistics Canada has not managed to convince the first nations people that this was a positive exercise, that the information was being collected for their own good. Doing so should be up to you, the first nations people, and in a positive way. They need to understand that it is for the purpose of improving their well-being and that you need this information in order to help them through programs. I feel you should collect the data yourselves and then provide it to Statistics Canada, where its professionals would compile it and do the necessary calculations. You really should do this yourselves, on each reserve.

[English]

    The Chair: I want to thank you very much for coming. We look forward to working with you in the future. We're glad our instincts are not unsound in thinking that we're moving in a good direction. We want to do this in partnership.

    I would like to bring the formal portion of the meeting to an end. I know Madam Guay has another appointment.

    Before we adjourn, I do want to have a brief chat in camera with members of the committee about future business. It's nothing very exciting, but it might be easier to suspend.

    [Editor's Note: Proceedings continue in camera]