Proceedings of the Standing Senate Committee on
Aboriginal Peoples
Issue 3 - Evidence - February 4, 2014
OTTAWA, Tuesday, February 4, 2014
The Standing Senate Committee on Aboriginal Peoples met this day at 9:35 a.m. to examine and report on the federal government's constitutional, treaty, political and legal responsibilities to First Nations, Inuit and Metis peoples, and on other matters generally relating to the Aboriginal Peoples of Canada.
Senator Dennis Glen Patterson (Chair) in the chair.
[English]
The Chair: Good morning. I'd like to welcome all honourable members of this committee, senators, and members of the public who are watching this meeting of the Standing Senate Committee on Aboriginal Peoples, either here in the room, via CPAC or on the web.
I'm Dennis Patterson, chair of the committee, from Nunavut. Our mandate is to examine legislation in matters relating to the Aboriginal peoples of Canada generally. In order to understand the concerns of our constituents, we regularly invite witnesses who can educate us on the topics that are currently of importance.
These sessions are valuable in helping the committee decide what future studies it will undertake in order to best serve the Aboriginal community. Most recently, we've been holding briefings where witnesses have provided general background information on the broad question of financing infrastructure on reserves, which could relate to capital projects, schools and housing, among other things.
This morning we'll hear from Health Canada and the Canadian Institutes of Health Research. Our witnesses have particular expertise in the area of housing insofar as environmental health is concerned. Health Canada maintains initiatives to address contaminant issues, such as the problem of mould in housing in First Nation communities.
Before hearing from our witnesses, I'd like to go around the table and ask the members of the committee to introduce themselves.
Senator Moore: Good morning. My name is Wilfred Moore. I'm a Liberal senator from Nova Scotia.
Senator Munson: I'm Jim Munson, a Liberal senator from Ontario.
Senator Raine: I'm Senator Greene Raine, from B.C.
Senator Beyak: Good morning. I'm Senator Lynn Beyak, from Dryden in northwestern Ontario.
Senator Black: Doug Black, from Alberta.
Senator Wallace: John Wallace, from New Brunswick.
Senator Ngo: Senator Ngo, from Ontario.
The Chair: Members of the committee, let's welcome our witnesses from Health Canada: Ivy Chan, Director, Environmental Public Health Division; and Debra Gillis, Acting Director General, both from the First Nations and Inuit Health Branch.
With them at the table are their colleagues from the Canadian Institutes of Health Research: Nancy Edwards, Scientific Director, Institute of Population and Public Health; and Malcolm King, Scientific Director, Institute of Aboriginal Peoples' Health.
Witnesses, we look forward to your presentations, which will be followed by questions from the senators. Please proceed, Ms. Gillis.
Debra Gillis, Acting Director General, Interprofessional Advisory and Program Support, First Nations and Inuit Health Branch, Health Canada: Thank you, Mr. Chairman. I would like to first express my appreciation for the opportunity to speak today before this committee about Health Canada's role, responsibilities and actions taken to date on mould as it relates to First Nations housing. Health Canada recognizes that mould in First Nations housing is a problem and an issue that needs to be addressed in a comprehensive manner for public health reasons.
As you are aware, First Nations housing is a shared responsibility between First Nations home occupants and community leadership, Aboriginal Affairs and Northern Development Canada, the Canada Mortgage and Housing Corporation, as well as Health Canada.
While Health Canada is not responsible for the provision of housing on reserve, the department plays a supportive role to protect public health. Health Canada carries out this role through the environmental public health program of the First Nations and Inuit Health Branch. The objective of this program is to identify and prevent environmental public health risks that could impact the health of First Nations community residents and to recommend corrective action to reduce these risks. Mould in homes and other facilities on First Nations reserves is one area of work of the environmental public health program.
The scope of the work is twofold. First, upon the request of First Nations community leadership, home occupants and/or local health authorities, Health Canada's environmental health officers conduct housing or facility inspections from a public health perspective and provide advice and recommendations to the chief and council. On average, Health Canada conducts over 2,000 such visual public health assessments of on-reserve housing every year.
In cases where mould is identified at a level that will have a detrimental health effect, Health Canada gives advice on how to protect personal and public health, recommending specific remedial actions that should be undertaken to address this issue.
Second, Health Canada also provides public education materials and information sessions on various public health issues related to housing, including mould prevention and remediation.
Health Canada has a long history of collaborating with the Assembly of First Nations, the Canada Mortgage and Housing Corporation, and Aboriginal Affairs and Northern Development Canada on mould-related issues. The First Nations Indoor Air Quality Committee, composed of representatives from these organizations, was tasked to develop and implement the National Strategy to Address Mould in First Nations Communities as a direct result of recommendations made by the Office of the Auditor General in its 2006 report.
Under the leadership of AANDC, the national strategy was developed to improve awareness and capacity among First Nations home occupants, communities and institutions. There were four strategic directions: to communicate the national strategy to stakeholders and First Nations leadership; to raise awareness on mould prevention through education and information; to identify communities with critical mould problems, assist in determining the scope and identifying support measures for remediation; and, finally, to provide guidance, training and support for the capacity- building for mould prevention and remediation.
Each collaborating partner identified its responsibilities in implementing various aspects of the strategy. Health Canada committed to implementing the following five aspects from the national strategy: first, to develop and implement a health promotion campaign geared towards raising awareness and education about what can be done about mould in First Nations communities; second, to review existing educational and training packages for users in collaboration with the Canada Mortgage and Housing Corporation to ensure that public health aspects are covered as part of a comprehensive approach; third, to convene a working group of environmental health officers and technical service providers to review existing methods of inspections and to ensure that public health aspects are included, as necessary; fourth, we were to provide environmental public health input into CMHC as they develop a self-assessment tool that First Nations could use to assess the extent of the mould problem in their communities; and, finally, to coordinate the gathering of First Nations self-assessments and verify the identification of communities with critical mould problems through regional dialogues.
Health Canada has met to the extent possible its commitments under this strategy. More specifically, in anticipation of this national strategy, Health Canada conducted public opinion research to determine First Nations' attitudes, behaviours and levels of knowledge related to mould in housing in 2007.
The results of this research revealed that mould is considered by First Nations people living on reserve to be a significant health issue. More than half — 57 per cent — of First Nations people living on a reserve felt they knew at least something about mould, and this was demonstrated by their reasonably good understanding of what causes mould, how it can be identified and the associated health risks. However, no more than one in five could correctly identify any of the established methods for preventing mould, such as reducing moisture and increasing ventilation, and no more than one in three of those without experience at trying to remove mould could suggest any established strategy for doing so. Furthermore, a significant number of individuals could not identify any method to prevent mould from growing in the home or to remove mould should it occur.
Based on these results, Health Canada then implemented a Mould Health Promotion Campaign in 2009 to provide First Nations with information on mould in order to improve health. The materials we developed included a video with four three-minute modules to be made available online and distributed directly to First Nation communities. These videos covered how to recognize mould, practical methods for removing mould, practical methods for preventing mould and education about the impacts of mould on air quality and health. These four videos were viewed more than 100,000 times on Health Canada's YouTube page.
A booklet that summarized and reinforced the messaging in the videos was produced, and 55,000 copies of this booklet were distributed. A poster to promote the video and booklet in communities was also distributed.
Health Canada and the Canada Mortgage and Housing Corporation developed a self-assessment checklist, including technical housing standards and public health considerations, for the use of First Nations to assess the extent of the mould problem in their communities. This checklist has now been converted into an electronic application for use on mobile devices, and we are supporting its distribution.
Currently, Health Canada is conducting an assessment of the effectiveness of its health promotion campaign. This work will assess the change in First Nations' knowledge and awareness of the relationship between prolonged exposure to residential mould and the risks to personal and family health; knowledge of how to identify mould; knowledge of simple things that can be done to prevent mould; and knowledge of what can be done if a problem is found. This information will inform future activities on the development of materials on health and housing related to the ongoing National Strategy to Address Mould in First Nations Communities.
I trust that I have provided you with the detail you are seeking regarding Health Canada's role and activities with respect to mould in First Nations housing. I would like to once again thank the committee for the opportunity to speak on Health Canada's actions to date, and I would be more than happy to answer questions.
The Chair: Thank you.
Do I understand that Ms. Edwards and Mr. King have further presentations? We'll hear from everyone before we go to questions, if that's agreeable.
Mr. King, please.
Malcolm King, Scientific Director, Institute of Aboriginal Peoples' Health, Canadian Institutes of Health Research: Mr. Chair, Nancy Edwards and I will share the presentation on behalf of the Canadian Institutes of Health Research.
Honourable members, on behalf of the CIHR, we would like to thank you for the invitation to speak with you today and share how CIHR and its Institute of Aboriginal Peoples' Health and the Institute of Population and Public Health can contribute to providing evidence to assist you in your reflection, specifically on mould in housing for Aboriginal peoples, generally on housing quality and its impacts on the health of First Nations, Metis and Inuit peoples, and finally on how CIHR is poised to help inform your deliberations.
The root causes of poor health for indigenous peoples and others are well understood. Factors such as income, education, gender, employment, living conditions, social class, social support and access to health services are all part of determining whether people are healthy or not. Housing is one of many key determinants of health, specifically quality of housing as it relates to mould, and may affect the health and wellness of Aboriginal peoples in Canada more so than the non-Aboriginal population.
Nancy Edwards, Scientific Director, Institute of Population and Public Health, Canadian Institutes of Health Research: As Ms. Gillis from Health Canada shared, housing is an issue requiring a comprehensive approach for many public health reasons. Housing problems affecting Aboriginal peoples — and perhaps most specifically First Nations and Inuit populations in community settings — include shortages, overcrowding, lack of plumbing and electricity, poor insulation, mould and the need for repairs.
According to the First Nations Regional Health Survey, a nationwide on-reserve survey of 216 communities undertaken in 2008 to 2010, approximately one quarter of First Nations adults live in overcrowded housing. The proportion of adults living in overcrowded housing is higher among those whose household income is less than $25,000 per year, and among those who live in band-owned housing.
Additionally, a small number of First Nations adults reported not having the basic amenities in their homes, such as hot running water, 3.4 per cent, and flush toilets, 2.7 per cent. Half of First Nations adults surveyed stated that they were living in homes with mould or mildew, representing an increase from 44 per cent since the previous survey in 2003.
Mould is the common word for any fungus that grows on food or damp materials. Mould needs moisture and a material it can live on and is commonly caused by excessive humidity, lack of ventilation or low temperature — in essence, poor housing. Mould per se doesn't cause health problems. People, rather, are affected by the spores produced by mould. A spore is a reproductive structure that is adapted for dispersal and survival for extended periods of time in unfavourable conditions. Spores are small enough that people can actually breathe them in. Breathing in large amounts of these spores and the by-products they produce can negatively impact health.
There is a relationship between indoor mould and increased risk of eye, nose and throat irritation, coughing, wheezing and shortness of breath, bronchitis, asthma development and exacerbation, and allergic reactions. Some people are more vulnerable to the effects of mould than others. This includes children, the elderly and those with a weakened immune system or other medical conditions, such as asthma, severe allergies or other respiratory conditions.
Mr. King: The Canadian Institutes of Health Research, CIHR, was established in 2000 by Parliament to position Canada as a world leader in the creation and use of knowledge through health research to improve the health of all Canadians and of the wider global community. More specifically, CIHR's objectives are, first, to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and, second, to translate new knowledge into improved health for Canadians and more effective health services and products.
CIHR integrates research through a unique interdisciplinary structure made up of 13 virtual institutes. Each institute shares responsibility for achieving the fundamental objectives of CIHR and to work with stakeholders to forge a health research agenda across disciplines, sectors and regions that embraces scientific opportunity and reflects the emerging health needs of Canadians.
Through its strategic investments and investigator-initiated programs, CIHR devoted over $31 million in fiscal 2012-13 to research on Aboriginal peoples' health-related issues and specifically, $2 million in research projects related to mould and housing issues over a five-year period.
Ms. Edwards: Currently, CIHR has two strategic initiatives which are relevant to the health and wellness of Aboriginal peoples and the issues surrounding housing, mould and its effects. The first is called Pathways to Health Equity for Aboriginal Peoples. This is currently under way and is a partnership of three lead institutes: the Institute of Aboriginal Peoples' Health, the Institute of Population and Public Health, and the Institute of Gender and Health.
The overall goal of the Pathways initiative is to develop a better understanding of how to design, launch and scale up interventions in four exemplar areas: suicide, tuberculosis, diabetes and obesity, and oral health. The most relevant for our discussion today is tuberculosis. Pathways research will help create better preventive health services, healthier communities and health equity for Aboriginal peoples in Canada.
Mr. King: As the Public Health Agency of Canada has done an excellent job at documenting, ``TB rates continue to be a major public health problem in Canada in First Nations, Métis, Inuit and foreign-born populations. First Nations people living on reserves have an 8-10 times higher TB notification rate than do non-Aboriginal Canadians; they also have a higher than average household occupancy density and a poorer quality of housing than other Canadians.''
Among the factors contributing to the high rates of TB amongst First Nations are socio-economic factors, including poverty and housing conditions. Overcrowded houses and poor ventilation increase both the likelihood of exposure to Mycobacterium tuberculosis and the progression to disease. TB infection is spread when an individual with active respiratory TB coughs or sneezes the tuberculosis bacilli. An increased density of moisture in the air leads to an increased risk of infection.
Homes that have inadequate ventilation are often damp or have mould growth resulting from high humidity and condensation.
Encumbered space may also contribute to mould growth in a house. While dampness and mould have not been directly linked with the acquisition of TB infection, they have been implicated in increased susceptibility to respiratory infection, asthma and allergies among Canadian children. It has also been found that the presence of mould and fungi in homes is associated with suppressed T cell production, which has been linked to slower recovery from tuberculosis.
Ms. Edwards: Our second initiative, Environment and Health, is currently under development and is led by the institute I lead, the Institute of Population and Public Health, with many other institutes involved. It is closely aligned with one of CIHR's current strategic plan research priorities, which is to ``prepare and respond to existing and emerging global threats to health.''
Physical and social environments intersect and contribute to both positive and negative effects on health. These interconnections require the application of systems-oriented approaches in order to prevent and mitigate environmental threats and promote positive healthful environments. This strategic initiative will address gaps in environment-related health research in Canada, encouraging the study of positive and negative environmental effects on health, and the interventions that mitigate, prevent, reduce and/or enhance resilience of communities and populations to harmful environmental exposures.
For instance, the initiative is expected to support research on urban form, and this could include studies examining how urban housing conditions could be improved and contribute to the health and wellness of Aboriginal peoples.
Besides these initiatives, the Institute of Aboriginal Peoples' Health consistently invests in research addressing housing conditions for Aboriginal peoples, the determinants of those conditions, and relationships to health and health equity outcomes.
The Chair: You mentioned research that has been undertaken by the institutes, including $2 million allocated over five years to study mould in housing. I wonder if that research could be made available to our committee. You also mentioned that the Institute of Aboriginal Peoples' Health has also done work on urban housing, if I understood you properly. I'm wondering if that research also might be available to the committee.
Mr. King: Yes, Mr. Chairman. We have with us a detailed document of four pages that outlines some of this research. We'd certainly be happy to make it available to this committee. It includes a variety of programs and includes, as you mentioned, work on urban Aboriginal housing — in Winnipeg, in this case.
The Chair: If that could be made available to our clerk, it would be appreciated.
Senator Munson: Thanks for being here this morning. It's important information to have.
To put things into context — I don't know if you can do this for us — but the First Nations adult survey stated the number of people living in homes with mould or mildew was up from 44 per cent to almost 51 per cent. To put this in context in comparison to the rest of the country, do you have any idea what that would mean for people who live in Ottawa, Vancouver, or Campbellton, New Brunswick? Do you have any idea what those numbers are?
Ms. Edwards: The proportion you are seeing from the survey is certainly considerably higher. I think it's at least double the rate we would see in cities, from some of the studies I have looked at. One of the issues here is that with flooding and other kinds of natural events that are happening, we're actually seeing some increases in mould exposure in housing across the country. We could anticipate we might see more with climate-change effects.
Senator Munson: That's a startling stat, isn't it?
Do you have any idea — I'm sure you do and maybe you can answer this question — how these homes were built? Who built these homes on reserves across the country, and why was this situation allowed to happen?
Ms. Gillis: Aboriginal Affairs and Northern Development Canada is probably best positioned to answer those questions, along with CMHC. As I mentioned, Health Canada's role is really one of environmental public health as opposed to a role around housing construction or repair.
Senator Munson: We have the Auditor General's report from 2011, I believe, that indicates the magnitude of the mould problem. It has increased. I understand the surveys and the interventions, which are extremely important; you need to have statistics to back up any action for sure. But what efforts have been undertaken to measure the magnitude?
It seems that it's increasing, and it will increase even more. You have talked about some of your efforts in identifying the issue, but the problem still remains. It seems it's getting worse.
Ms. Gillis: I can't speak to the issue of trending analysis, but based on some of the work that our public health inspectors do — they are asked to come on request if there is a suspicion by either an individual or a band member of a house or facility that they would like inspected for the presence of mould or other environmental health conditions. So public health inspectors do that on request of the band. They will come to the community and visually inspect a home for a number of conditions, such as the ventilation, groundwater concerns for water and a number of things. As I said, they do approximately 2,000 of those a year.
We do have some information that, out of the homes inspected in 2012-13, about 64 per cent did have risks of mould. Risks are potential things that could cause mould. Of those homes that had potential for risk, about half of them did have some type of mould.
Mould can vary in terms of the amount and quantity in a home. You've got small areas of mould, which is less than one square metre; you have moderate, which is one to three square metres; and then you have extensive mould.
Remember, these were just of the inspections conducted on request. It's not representative of what the overall picture could be. I want to stress that.
Out of all of the inspections that did have some mould, about half of them had a small amount of mould that could be remediated relatively easily within the home through appropriate cleansing and other things; just over a quarter of them had moderate mould problems; and the other quarter had more severe mould problems. That gives you an idea of the extent. Less than half of the homes did have some type of mould problem in them. But of that, half of them could be relatively easily remediated.
Based on the findings that the environmental health inspectors possess, they speak with whoever requested the inspection — it could be the home owner or chief and council — and they provide advice on how to remediate, and lay out what some of the conditions are. It then becomes the responsibility of those individuals or the chief and council to carry out the remediation.
Senator Munson: I have one final question. I appreciate the indulgence of the committee.
I don't want to sound like an alarmist, but these are real people with real issues. Sometimes we forget how serious this is. In the CIHR report, some people are more vulnerable to the effects of mould than others. This includes children, the elderly and those with a weakened immune system or other medical condition such as asthma, severe allergies or other respiratory conditions.
I don't want to sound alarmist, but are people dying or are their lives shortened because of this? Asthma is very serious in this country, no matter where you live, and I don't see any stats that would reflect the lifespan considerations for our Aboriginal and Inuit peoples.
Ms. Edwards: We certainly know that asthma affects quality of life. In looking at some of the currently funded studies with the CIHR, we have researchers who are looking, for example, at school absenteeism and how that relates to their experience of asthma and then to mould in the homes and other factors that might be exacerbating asthma.
Whether or not it affects life expectancy is a separate question, but undoubtedly asthma effects quality of life of both children and adults.
Ms. Gillis: Yes, at this point in time we don't have any evidence related to an impact of mould on life expectancy or to vital statistics.
The Chair: I would like to welcome Senator Black, who is joining the committee today as a replacement.
Senator Black: Thank you all for the presentation this morning and also for the tremendous work you are doing on all our behalves in what is clearly a complicated area. I have a specific question first and my second is general.
Ms. Gillis, my specific question relates to the languages in which you run your communication programs. Can you share that with the committee?
Ms. Gillis: Yes, all of our documents are in both official languages. I have brought examples specifically around the mould issue. They are in both French and English.
Senator Black: Would you put material out in languages that the Aboriginal communities are speaking?
Ms. Gillis: Occasionally we will do that, but there are many languages that Aboriginal people speak. In fact, there are over 57 languages in Canada and 6 different Inuit dialects. However, we have put out some publications in a variety of more commonly spoken Aboriginal languages.
Senator Black: The root of my question is whether you are satisfied that your communication program is getting at your target audience.
Ms. Gillis: We believe it is. We have over 100,000 views on YouTube of our videos. As well, the publications in French and English have been well received and are being viewed and read by thousands of First Nations people across the country.
Senator Black: As the chair has indicated, I am a guest. I am filling in today, so I have not seen the narrative of these hearings over a period of time. My take-away from this morning is that absolutely tremendous work is being done by both of your organizations, but I don't see that it's making a difference. As Senator Munson indicated, I see that the problem is in fact getting progressively worse, not better. That is in not in any way to point fingers or to blame because you are doing what you need to do, but what is the answer?
Ms. Edwards: On the research side, there has been quite a bit of investment trying to establish if there is an association and a causal relationship between mould and some health conditions. At this point there is agreement that there is a strong association, but the causality is still in question.
That remains a source of research. Another area is how to measure mould, and I think Ms. Gillis' comments alluded to this as well. You have heard a pragmatic visual inspection of mould in terms of the area it covers, which is commonly used, but an awful lot that still needs to be done in terms of how we measure this. Is mould that has been there for a long time producing more spores than mould that is more recent? How does the mould and spores in indoor air compare to outdoor air? This has also been an area of study. In the research we are funding, we are seeing more and more work being done on interventions and what we can do about it. A number of those studies are quite new.
An interesting example is a study being undertaken by Dr. Linda Larcombe with a couple of Dene communities. They are looking at how to engage youth in the process of not only identifying mould in housing but the appropriateness of housing in general and how it fits with our cultural identity. What is the vision of those youth going forward in terms of the housing they would like to see in the future? These are interesting and novel areas of study that will hopefully address the things you are getting at.
Senator Black: Thank you.
Mr. King: If I could add to that, one extremely important factor is community engagement. We have a number of good examples of things that work to improve the quality of air in housing, but there are some 800 Aboriginal communities in Canada and so making progress in a few communities will not affect the statistics as much. As Senator Munson has questioned, we need to be able to implement and scale up the knowledge that we have and that's the essence of the Pathways to Health Equity Program that Ms. Edwards and I and our colleagues are leading.
I will briefly give an example, if I could. It does not directly relate to mould but does relate to the idea of scale up and translation. A study was carried out in Nunavut by a colleague, Dr. Tom Kovesi, a pediatrician from here in the city. The primary sponsor was CMHC, not CIHR. He found by retrofitting houses in Nunavut villages to provide fresh air through a recirculating system that wheezing, which is a prime symptom in young children, was greatly reduced and essentially the quality of air in the whole house was much improved. Mould was not such an issue there because Nunavut is very cold and dry but applying that same kind of retrofit and providing fresh ventilation in houses where mould is an issue one would hypothesize that it would correct a lot of mould as well as the health effects.
These kinds of studies need to be translated and scaled up, and they need to be contextualized. Taking something from Nunavut and trying to translate it into northern Manitoba is not immediately obvious. There is a science to it. We are trying to support and encourage that as well.
The Chair: I understand that what we've heard about this morning is inspection of houses relating to mould, and so you've done a lot of work on responding to complaints and getting into houses. I wonder if you'd make any observations. I know this is beyond your mandate, but we have heard in this committee evidence about a lack of building codes or compliance in First Nations communities. We've heard evidence of inadequate inspection during construction of homes. As I say, I know this is not your province — the quality of construction, building codes and the inspection — but your people have been in a lot of homes where there has been mould. Would you be able to make any comments about whether mould occurs or whether the incidence of mould is related to the quality of construction, the amenities in a house?
Ms. Gillis: Unfortunately we don't have any of the evidence related to the quality of the construction. Our inspectors look at what is present there but we don't have the information and I really can't comment on how homes are constructed.
The Chair: I suspect some of your inspectors may have their own views on that, but I understand that is not data you've collected so we'll leave it at that.
Senator Moore: Ms. Gillis, you said in your remarks that, on average, Health Canada conducts over 2,000 visual public health assessments of on-reserve houses every year. What is the total number of houses on reserves in Canada?
Ms. Gillis: There are approximately 100,000 homes.
Senator Moore: When you do these assessments, where do you do them? Are they mostly in the West or are they pan-Canadian?
Ms. Gillis: They are across the country.
Senator Moore: You mentioned the Auditor General's report in 2006 and that four strategic directions were developed in response to it. In response to that report, you committed to implementing five aspects from the national strategy. Most of the stuff is pretty obvious. I find a lot of duplication of what each of your authorities does here. One of them is ``provide environmental public health input to CMHC as they develop a self-assessment tool for First Nations.''
What is the role of CMHC? Are they distributing your materials?
Ms. Gillis: No, these are their materials. It is important to develop information or a tool for individual homeowners to identify whether they have a mould issue in the home, what is the extent, what can they do.
CMHC has developed the tool. We ensured that it addresses the public health aspects as well so that it not only looks at some of the physical issues but also the public health aspects.
Senator Moore: You end by saying that Health Canada has met, to the extent possible, its commitments under the strategy. The Auditor General in the 2011 report found that progress on addressing mould was unsatisfactory for several reasons. To paraphrase: No additional funding was allocated to address mould as a result of this strategy; the magnitude of the problem was not determined; the costs to remediate existing mould were not estimated; no performance indicators for the strategy were developed; and the strategy does not address overcrowding, which is a significant contributor to the problem.
I'm trying to figure this out. If you didn't address what I feel are obvious issues, what have you done, besides developing videos and pamphlets? How many people are working on this, and what is your annual budget?
Ms. Gillis: It's very difficult to estimate an annual budget because of the type of work being done with respect to mould. As I mentioned, the public health inspections are being done by public health inspectors, and it is a fairly large portion of the work they do, considering the breadth and extend of First Nations communities across Canada and responding to the requests.
Depending upon individual public health inspectors, of which there are well over 80 or 90 across Canada working in First Nations communities, their travel and the amount of time they take in inspecting, but also in providing advice and guidance to communities, is a huge portion of the work that Health Canada does with respect to the identification and remediation of mould problems. That falls within our purview.
With respect to the information work that we've done, the production — of which I've brought some copies — and public opinion research, we have spent around $200,000.
Senator Moore: In light of the report of the Auditor General, it seems to me that the focus of your work has to be realigned to address those issues and to come up with hard numbers and solutions to help these people. It continues to be a drain on our budget, health-wise, and I think some of this is unnecessary and can be addressed.
Mr. King, you mentioned that the Canadian Institutes of Health Research has two institutes: the Institute of Aboriginal Peoples' Health and the Institute of Population and Public Health. How many people are employed in each of those institutes, and what is the annual budget of each?
Mr. King: The number of employees is actually extremely small because we are a virtual institute that funds research in universities, primarily. There are three staff in Ottawa, and in Burnaby, British Columbia, where I have my academic position, there are an additional two. I have only five employees. We have an annual budget of approximately $9 million as an institute.
Senator Moore: Which one?
Mr. King: This is the Institute for Aboriginal Peoples' Health. Ms. Edwards could probably give similar figures.
Senator Moore: So you are not involved in the Institute of Population and Public Health?
Mr. King: It is my colleague.
Ms. Edwards: To clarify, there are 13 virtual institutes within the Canadian Institutes of Health Research. We all have essentially the same budget — the $9 million that Mr. King mentioned — and a similar staffing ratio, with some staff based in Ottawa and some in the host institute. That funding is for extramural funding, so it does not fund any research we're doing; it's funding researchers to do research, primarily in academic institutions as their base.
Senator Moore: The chair mentioned the research. You said that the CIHR devoted $31 million in 2012-13 to research on issues related to Aboriginal peoples, and $2 million over five years. Which institute is doing that, or are you sharing it?
Mr. King: It's shared. Some of that funding, up to the extent of our own institute budget, comes specifically from my Institute of Aboriginal Peoples' Health. The majority of the funding on Aboriginal health research comes from the CIHR as a whole, from other institutes and from what we call ``open operating grant competitions.''
In the data that I'll make available to the clerk, you'll see a variety of projects, the majority of which actually come from investigators who are designing their projects and carrying them out, applying for funds and so on.
Senator Moore: Ms. Edwards, when you were closing your remarks with regard to preparing and responding to existing and emerging global threats to health, you said the initiative ``will address gaps in environment-related health research in Canada . . . .'' Then you said, ``For instance, the initiative is expected to support research on urban form.'' I don't know what ``expected'' means. ``This could include studies examining how urban housing conditions could be improved and could contribute to . . . .'' It's ``expected.'' It may; it's not definite. It ``could'' relate to urban. It ``could'' help. How will a study in a city help in an urban context the health and wellness of Aboriginal peoples? I don't understand that.
Ms. Edwards: First, 50 per cent of Canada's Aboriginal peoples actually live in urban areas, so this is a large segment of that population. Because of rates of poverty and so on, they are more likely to live in substandard housing within our urban centres as well.
With respect to the weasel words you identified — ``expected,'' ``could,'' and so on — the process for approving strategic initiatives within CIHR involves a wide consultation, in this case involving Aboriginal people, among others, and the development of what we call a business case, which then has to be approved and funding has to be allocated. We're in the process of developing the business case right now for the Environment and Health initiative, having done a wide consultation. We've identified three likely areas where we'll be working, urban form being one. It relates to Aboriginal peoples' health because a large proportion of Aboriginal people live in urban areas.
A second area is around resource development and a third area is around agriculture and food security.
Senator Moore: That's interesting. Is this the first time you've looked at the urban context? If you knew that 50 per cent of the Aboriginal peoples are living in urban centres, and you said a lot of them are in substandard housing, is this the first time this has been looked at?
Ms. Edwards: Malcolm may want to respond to that.
The Canadian Institutes of Health Research has funded a considerable amount of research looking at urban health issues, such as air pollution and its effect on health, walkability of our communities, et cetera. Your institute has funded some in this area specifically.
Mr. King: Yes. Right from the beginning of CIHR, our institute has recognized that Aboriginal peoples live in a vast range of places, from urban to remote. Some of our research that we've funded has dealt with urban housing, and certainly urban Aboriginal issues. There's a researcher in Winnipeg named Dimos Polyzois who has studied urban Aboriginal housing issues from as early as 2004 to present. He's still continuing to work in this area.
I have another colleague named Richard Long who studies tuberculosis. His work covers both on-reserves in Western Canada but also the city of Winnipeg, which has significant issues with tuberculosis.
Our researchers are aware of urban and on-reserve issues. I wish we could do more. That definitely is something that we need to —
Senator Moore: Is this the first time you've done a focused study on First Nations peoples living in urban centres? I take it this is a pan-Canadian study; you're not looking at Winnipeg only? I expect it's a national look here. Is that correct?
Mr. King: Yes. The particular studies I've mentioned are not pan-Canadian.
Senator Moore: I realize that.
Mr. King: The Pathways to Health Equity program that has just been rolled out in this fiscal year, which will continue, is a pan-Canadian program. Its focus is not specifically on housing, though; it's on Aboriginal health. Housing is just one of many determinants. But that is a pan-Canadian program that covers both urban First Nations, Inuit, and Metis communities.
Senator Moore: I understand that, but if the issue is poor housing with unhealthy conditions, it's at the very core of what you must be looking at. That's what we're talking about here.
Mr. King: It's at the core, but unfortunately the larger issue is that many other factors are also at the core, including poverty, lack of education, employment opportunities, and social conditions in general.
Senator Wallace: Ms. Gillis, as I understand it, Health Canada is the arm of the federal government that's responsible for assessing the health aspects and health issues involving the infrastructure in on-reserve circumstances and providing recommendations to alleviate those issues. From what I've heard today, it's compelling that there's no shortage of brainpower around those issues of understanding them and using best practices as to how to address them.
When I stand back from it and think of the different Aboriginal and Inuit communities in the country, I'm wondering how we assess whether or not we're making progress in alleviating these health issues and addressing them properly.
Senator Munson made a comment earlier that it seems like circumstances are getting worse; they're not improving. I'll ask what your view of that might be. It would seem to me in order to assess that, you have to know what you are comparing today with. What are the circumstances? Where's the benchmark that you're comparing the circumstances to today?
Has Health Canada been requested or has it ever prepared assessments of the health-related issues, say, in terms of mould? It could also involve conditions of water — groundwater, drinking water, water treatment — which I understand comes within your authority. Has that ever been assessed on a comprehensive basis throughout the country so that we would know the circumstances that exist in each Aboriginal and Inuit community, and then we can assess circumstances in the future against that benchmark? Does that comprehensive approach exist?
Ms. Gillis: I was just conferring with my colleague because that was a complex question, senator.
I can say that with respect to water, waste water and water supplies, there have been comprehensive assessments done, working with Aboriginal Affairs. They hold that responsibility.
You can see that this is not an issue that can be addressed by one group alone and that it is multi-faceted. Many players play a role. Our role is much more of a public health review, advice-type role. Aboriginal Affairs has a role and so does CMHC, but so do the communities and homeowners. As far as I'm aware, there has not been a national, comprehensive assessment related to the air quality in the homes on reserve.
Senator Wallace: As a leader in Health Canada, and obviously a person concerned about the health of Canadians, wouldn't it seem logical that we should have that type of assessment in all Aboriginal and Inuit communities?
Ms. Gillis: To do that work is very complex; I'm not saying it wouldn't be important and helpful to have baseline indicators to see where we're going. For example, in the water work, it took many years to do the work and you have to identify exactly what you're going to be assessing. It may not be that definite in each location across Canada.
At this point in time in Health Canada we don't have any plans to assess nationally the homes and air quality, but we are fulfilling our mandate of responding to requests coming from individuals and communities to provide them with public health advice as they are constructing, renovating or living in homes about which they have concerns.
Senator Wallace: Let's go back to Senator Munson's question. I'll take the mould issue and leave water aside. Are we making any progress in this country in addressing the mould issue in Aboriginal and Inuit communities? Are we making progress in addressing those real health concerns?
Ms. Gillis: We have to define ``progress.''
Senator Wallace: No, you have to define ``progress.''
Ms. Gillis: That's what I mean: ``We'' in terms of it being internal. It's important that we define ``progress'' well.
As I mentioned in my remarks, we are conducting some further research at this point in time to assess the impact of the work that we have been doing. In the future, we will have some information from which we can assess that.
Also, we have just begun that time-series analysis — looking at it over a period of time on the housing inspections — now that we have some data. We need to follow that on a regular basis, so we can assess over time whether there have been improvements.
It has not been a long time in the implementation of this national strategy. Less than five years is not a long time. We are assessing one point, but we will be following and tracking so we can have the information at a later date to answer those questions.
Senator Wallace: I hear you say that the departments — somewhere between CMHC, AANDC and Health Canada — should have benchmarks in this country. They haven't been developed yet, but they're in the process of doing so; is that right?
Ms. Gillis: We're in the process of developing some of that information, such as performance.
Senator Wallace: Are we making progress in addressing the mould issue in these communities? What's your instinctive answer? You don't have to give me a deep analysis. Are we making progress or are we treading water?
Ms. Gillis: That's a difficult question to answer because it depends on where you go in the country. There are so many communities, and they're all quite different. With some communities, you may be able to say, ``Yes, things have improved;'' other communities have been maintaining. One answer doesn't really give you a complete picture of the country.
Senator Wallace: Thank you for that, but I would say that is the key question.
Senator Raine: I know this is a very big issue. Mould has been identified as a cause of ill health among Aboriginal people, and we can all understand that the problems are exacerbated when you live in substandard housing and crowded conditions.
I want to know two things. First, whose responsibility is it? We're looking at Aboriginal Affairs, the CMHC and Health Canada. Whose responsibility is it to come up with doable solutions that can be given to the individual homeowners and the First Nations to actually fix the problems?
I understand your inspections have identified that a lot of houses that are substandard. Will follow-up be done? Have you recommended specific, detailed remedies? Will you follow up on them?
I don't think this is a problem that can be solved overnight, but one by one, if each house is fixed and changed, then we can make progress.
Ms. Gillis: I can speak to part of the question. Every time one of our health inspectors is requested by the community or homeowner to come in and provide an inspection of their home for health conditions, they look at air quality, the crowding of the home and safety hazards that could pose immediate risks to the health. They look at the surrounding area, which includes potential environmental health concerns; for example, water around the foundation, water around the home, debris, et cetera.
They give an initial verbal debrief of their findings to whomever requests it. Then they follow that up with a detailed written report, outlining what they have found and what their suggested remedial actions are.
Many of the environmental health officers go into the communities on a very regular basis. They know the people in the community, and they can often follow up on actions that are taken. It's done on a very personal level.
Senator Raine: In their inspections, they obviously get to know the common causes of mould. Again, I don't think it's rocket science to know that there is a problem if you live in a building that's designed to handle maybe 6 or 8 people but you have 12 or 16 people and they're all breathing, there's water on the stove and the ventilation system isn't designed for that many people in the house. Would they recommend, then, to double the size of the ventilation system or cut in half the number of people in the house? And who makes the recommendation?
Ms. Gillis: They look at what the conditions are, but they don't have any responsibilities around the number of people living in the house or the size of the houses.
The ventilation piece is part of the building of that. That's done through a lot of the building codes, for which we don't have responsibility.
Senator Raine: Do you think there should be special building codes for Aboriginal housing, knowing, as we do, that they are overcrowded?
Ms. Gillis: I can't speak to that.
Senator Raine: Maybe the researchers could speak to that.
Ms. Edwards: It's a really good question. I think it might fall more into the domain of research being funded through the Natural Sciences and Engineering Research Council, where there's quite a bit of work going on related to housing and mould; they're looking at the physical parameters of building structures. A lot of that work informs building codes.
Mr. King: Yes. NSERC does a lot of research related to healthy housing in general. They're certainly a good source of information. Whether you need specific building codes for First Nations housing —
With ventilation, the amount of air exchange per cubic metre of house is actually an important parameter. That's been found in some health studies, such as the one I mentioned that Dr. Kovesi carried out. This kind of thing should be looked at in an assessment because it is a relevant parameter to health.
Senator Raine: This committee has heard that there's an extreme shortage of housing on reserves, and we can all see that the amount of resources needed to fix that is almost unfathomable. If we continue to build the same kind of houses that don't have sufficient air exchange, we aren't really going to make healthy houses.
In terms of the Institute of Aboriginal Peoples' Health, would you have a role to play in recommending to NSERC that special studies or special research be done into the design of Aboriginal housing? I would like to think we would involve Aboriginal people in the design of future housing, and not just take an urban CMHC-designed house that's obviously not working. How do we make the homes in remote areas of Canada on reserves culturally valuable to the people so they can live the way they want to live and be healthy?
Mr. King: Thank you for that excellent question, senator. One of the studies that Nancy Edwards mentioned being carried out by Linda Larcombe of the University of Manitoba is doing essentially what you're suggesting. She's working with communities directly, and working with them to come up with designs. I'm not sure exactly who they are, but it's not just the academic researchers; there's also housing people involved in that study. Most importantly, there are community people in the two Dene communities in northern Manitoba that are working with the researchers on what that kind of healthy housing needs to be from a community perspective.
We need a lot more like that, I think, but we do have this one study at least going on. We need to build on the results of those kinds of studies to be able to translate that knowledge into different contexts, into British Columbia, Nunavut, and so on.
Senator Raine: Do you know if there's any baseline information on whether mould was a problem in Aboriginal communities before contact?
Mr. King: No, I'm sorry; I don't know about that. People like to think that it only started after contact, but I don't imagine the mould came from Europe.
Senator Raine: No, no. I don't mean that it came from Europe, but I think the way people lived is that they lived more open.
Mr. King: Yes. I think we know more about that in terms of tuberculosis, that tuberculosis really became a problem when people came in contact, and particularly in regard to the fur trade and living in close quarters. That seems to be when tuberculosis arose. I don't know about mould, though.
Senator Raine: Thank you very much. I hope that our clerk made a note that we should perhaps have Linda Larcombe come and let us know how she's doing.
The Chair: Following up on that theme, Ms. Edwards, we've heard about how Aboriginal Affairs, CMHC and Health Canada worked on the National Strategy to Address Mould in First Nations Communities in 2008, and we've heard about your identification and inspecting work on mould and the research that's going on.
I think the question committee members are trying to get at is: Does the work that you're doing — identifying the problem and defining it — feed into the decision making at AANDC and CMHC on how housing can be built to prevent or reduce mould? You collaborated on the national strategy, and we fully understand your limited role, but are you involved in making sure that your research and your inspection has benefits for those who are building, constructing and developing housing programs? Is there collaboration going on?
Ms. Edwards: Thank you for that question. Perhaps I'll start off talking about the research aspect of that in relationship to Pathways, and then Ms. Gillis can pick up on the other portion of the question.
With respect to Pathways to Health Equity for Aboriginal Peoples, we're actually working very closely within the health portfolio on this, for essentially some of the purposes you've outlined. We have a coordinating group that involves the Canadian Institutes of Health Research, FNIHB from Health Canada, and also the Public Health Agency of Canada.
We recognize that there are different players in this, and we're trying to look at ways to expedite the cross-learning that's happening. As FNIHB is rolling out work on their inspection, that can inform how we're putting together a funding opportunity for researchers to try to stimulate research on these kinds of issues, and then, in turn, how we can look at ways to expedite the translation of that research back into programs and policies that Health Canada and the Public Health Agency of Canada are involved in. That type of coordination function is one way to try to address that, and that's a bit of a newer way of working for us but one that we feel is extremely important around this issue.
The Chair: Some of your acronyms threw me off a bit here, but my question is this: I know there's collaboration within the health and research community, but are you interfacing with the people who are building houses, AANDC and CMHC? That's what I was trying to get at.
Mr. King: Maybe I could tackle that, senator. Our strategic research programs — not just Pathways but other ones at the Canadian Institutes of Health Research — are more and more requiring the incorporation of knowledge users and decision makers as part of research teams, so that they're not just purely academic people but include the end-users of the knowledge. This is one means that we think will speed up the uptake of knowledge.
The other thing that Pathways and other initiatives require is a multidisciplinary approach. In a way, it's almost expected that a team dealing with housing will include housing experts, not just health experts.
The Chair: So it's happening, you're saying?
Mr. King: Yes, we believe so. We've essentially redesigned our way of funding strategic research to require multidisciplinary and end-user participation right in the project.
The Chair: Did you have a further comment, Ms. Gillis?
Ms. Gillis: I was just going to mention, in terms of your question around how are we working together: I believe that you can demonstrate across a number of areas that Health Canada is working very closely with Aboriginal Affairs and with CMHC, but I think importantly with the community, the home occupants, the leadership, in addressing and making suggested changes to actions and activities that they are doing. That's where you can really influence.
For example, many of our public health inspectors in the communities work directly and hand in hand in looking at home inspections with the community's home inspector. For example, if there are repairs that may need to be done, by going together, the public health inspector can point out and identify important things that need to be done in particular homes to address issues that could cause poor health outcomes. It's on the ground, working together and influencing change where I think you'll see a lot of progress being made.
The Chair: You're interfaced with AFN. That was mentioned briefly in your remarks. Could you elaborate on that?
Ms. Gillis: First Nations across the country, the AFN in particular, are very important partners for Health Canada. We work very closely together on a number of fronts in terms of developing approaches and strategies. As you'll see, the AFN was a full partner in the development of the national strategy on mould, the actions that were being recommended were developed with them, and they continue to work with us and bring forward to us issues of their concern on a regular basis.
The Chair: In 2011 the Auditor General did find that progress on addressing mould was unsatisfactory, that the strategy did not provide for additional funding allocated to address mould, the magnitude of the problem was not determined, the costs to remediate existing mould were not estimated, no performance indicators for the strategy were developed, and the strategy does not address overcrowding, a significant contributor to the problem. Have we made progress in those areas since that observation of the Auditor General in 2011? I imagine you would be familiar with that.
Ms. Gillis: There are performance indicators, which we'd be happy to provide to you, that have been developed for the national mould strategy.
The Chair: Okay. Thank you.
Senator Beyak: I'd like to echo my fellow senators' thanks for your exceptional research and your excellent presentations. It's been very enlightening for me.
Ms. Gillis, I noticed you said that the inspectors come in at the request of the individuals or the bands and they identify the problems. Is there a special mould fund? Should there be? Do the people repair the mould on their own with their own funds, on their own incentive? If there were a special fund, would it give them more reason to do it quickly and find a solution?
I also concur with what you said about the inconsistencies across Canada. That is the question that has confounded me for years. With the 52 First Nations bands north of me and in my residential communities, some are so well run, so clean and so beautiful, and some are so pathetic. I have never been able to figure out why. I suppose it's the chiefs and band councils, and that should probably be where we're looking. Who's in charge of the money? Is it going to the right places? How do they remedy the mould? There are so many questions, but your thoughts would be very much appreciated.
Ms. Gillis: I think your major question is: Should there be a fund to address mould? Mould is only one of many issues related to housing. There is funding provided through either Aboriginal Affairs or CMHC related to home rehabilitation already. There is funding already provided to bands to do that.
As I mentioned in my answer to one of the questions, about 50 per cent of the issues that have been identified in mould can be easily addressed by a homeowner in their own home. Part of our role is to ensure that they have the education and they have the information of how to look after it.
Others may take more effort and work, and that's where we also come into play in working with the band and council or the housing group that works on housing construction or repair and providing them advice. We go back to check and ask how things going and, as I said, yes, there are already funds. Sometimes it's the education and the training that's required to address and remediate the problem.
Senator Wallace: Ms. Gillis, does Health Canada have the same responsibility to Aboriginal communities south of 60 as compared to those north of 60? Do the responsibilities and roles vary at all or is it the same throughout?
Ms. Gillis: Our roles and responsibilities differ north of 60 and south of 60. We have transferred all responsibility for First Nations and Inuit communities north of 60 to the territorial governments. Our primary responsibilities in this area are south of 60.
I believe, as you're aware, in October of this year we also transferred responsibility of all health programs to the First Nations Health Authority in British Columbia.
Senator Wallace: Is there any sharing of the responsibility south of 60 for health related matters between Health Canada and provincial governments? Do the provincial governments factor into that as well?
Ms. Gillis: We work very closely with provincial governments and, in fact, are working more and more closely as provinces become more engaged in addressing Aboriginal health issues across the country. Our medical officers of health, our public health inspectors, and our nurses and administrators meet with regional health authorities and provincial health authorities on a regular basis to collaboratively identify ways they can work together and with First Nations involvement, absolutely, to address some of the health issues in First Nations.
The Chair: I would like to thank the witnesses for very helpful information about a complex and multi-faceted problem. Your assistance is appreciated, and we do thank you for providing some information about reference materials that our capable staff can follow up on.
(The committee adjourned.)