THE STANDING SENATE COMMITTEE ON NATIONAL FINANCE
EVIDENCE
OTTAWA, Tuesday, November 1, 2022
The Standing Senate Committee on National Finance met with videoconference this day at 9 a.m. [ET] to study the subject matter of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.
Senator Percy Mockler (Chair) in the chair.
[English]
The Chair: Honourable senators, I wish to welcome all senators as well as viewers across the country who are watching us on sencanada.ca.
[Translation]
My name is Percy Mockler, senator from New Brunswick and Chair of the Senate Committee on National Finance.
Now, I would like to ask my colleagues to introduce themselves, starting on the left.
Senator Gignac: Clément Gignac, senator from Quebec.
[English]
Senator Pate: Kim Pate, the unceded and unsurrendered territory of the Algonquin Anishinaabeg, Ontario.
Senator Loffreda: Tony Loffreda, Quebec.
[Translation]
Senator Galvez: Senator Rosa Galvez from Quebec.
[English]
Senator Bovey: Patricia Bovey, Manitoba.
Senator Duncan: Pat Duncan, Yukon.
Senator Yussuff: Hassan Yussuff, Ontario.
Senator Smith: Larry Smith, Quebec.
Senator Marshall: Elizabeth Marshall, Newfoundland and Labrador.
[Translation]
Senator Dagenais: Jean-Guy Dagenais from Quebec.
The Chair: Thank you, honourable senators.
[English]
Honourable senators, today we resume our study on the subject matter of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing, referred to this committee on October 20, 2022, by the Senate of Canada. To help us with this study, we continue with the following witnesses. As an individual, Dr. Walter Siqueira, Dean and Professor, University of Saskatchewan, by video conference; and from the National Right to Housing Network, Carolyn Whitzman and Garima Talwar Kapoor, Expert Policy Advisors, by video conference. Welcome to the witnesses, and thank you for accepting our invitation to appear before the Standing Senate Committee on National Finance.
[Translation]
On behalf of all Canadians, I thank the witnesses. Your testimony will help us focus on four key principles.
[English]
Transparency, accountability, reliability and predictability.
I am told that Dr. Siqueira will make some remarks, followed by Ms. Whitzman and Ms. Kapoor, experts with the National Right to Housing Network. Following the presentations of our witnesses, we will have the senators ask questions.
Dr. Walter Siqueira, Dean and Professor, University of Saskatchewan, as an individual: I would like to say it is an honour for me as a Canadian to be in front of the Senate to share my expertise in dental and dental education. As the chair said, my name is Walter Siqueira, and I am a dental clinician scientist. As such, I hold a DDS with an area of expertise in pediatric dentistry and a PhD with an area of expertise in biochemistry. I am the dean of the College of Dentistry at the University of Saskatchewan and a tenured professor. In addition to teaching as a professor and in academic leadership serving as dean, I lead the Salivary Proteomics Research Laboratory at the College of Dentistry, and my program in diagnostics and therapeutics using saliva is unique in Canada and one of the few in the world. My lab work using saliva for diagnostic applications for oral and systemic conditions, as well as using saliva and salivary proteomics for the prevention of the two most chronic diseases in Canada, dental caries and periodontal disease. The funders of my research include the Canadian Institutes of Health Research, or CIHR, the Medical Research Council of Canada, or MRC, the Canadian Foundation for Innovation, or CFI, the Saskatchewan Health Research Foundation, or SHRF, and the COVID-19 Immunity Task Force, or CITF.
I have received several prestigious teaching and research honours, for example, I am a fellow of the Canadian Academy of Health Sciences, one of the three national academies that comprise the Council of Canadian Academies, the highest honour granted to scholars in Canada. To date, only 11 dentists have been elected as a member of the Canadian Academy of Health Sciences. I am also a recipient of the 2019 Distinguished Scientist Award from the International Association for Dental Research, the most prestigious oral health research award globally.
I came here today to provide my expert view on Bill C-31 and how the Canadian dental schools are ready to be engaged in this critical initiative. In Canada, we have 10 dental schools. One in British Columbia, one in Alberta, one in Saskatchewan, one in Manitoba, two in Ontario, three in Quebec and one in Nova Scotia. I would like to talk about what our dental schools do. Our activities are divided into training, service and research. For training, the 10 dental schools train dentists, dental specialists, dental hygienists, dental therapists, dental assistants and researcher trainees in oral health research, master, PhD and postdoctoral fellows. Per year, we graduate 500 dentists across the country, 75 dental specialists, 75 general practice dentists, 200 dental hygiene graduates. In August 2023, the University of Saskatchewan College of Dentistry will resume the activity of a new program in the country called the dental therapy program, where we will graduate 21 students per year. We also have graduated per year around 200 research graduates across the 10 dental schools in masters and PhD programs.
The service of the dental schools is divided. As I said, there are 10 dental schools, and in these 10 dental schools we have 110 clinics, 1,500 dental chairs, 85,000 active patients and we have the capacity to serve 370,000 patient visits per year. I would like to highlight in this service that, unlike the medical, nursing and other health professional schools that train, our facilities are not supported by the public health care system. We have to create and run our own dental hospitals and community clinics. The funds for that come from the provincial ministries of education, the university, the student fees and tuition, patient fees and philanthropic donations. Also, part of our service is related to research. We have a full range of fundamentals to population and public health research related to oral craniofacial research, including evaluation of clinical care and dental care programs for people with special needs.
Now I would like to highlight some potential challenges of the new program to the dental schools. One of the potential challenges that I, as both a dean and an expert in this field, and my colleagues across the country — that is, fellow deans and faculty members — saw is that we serve the same clientele as the new program. Most of our patients are charged reduced fees. Basically, the fees that our dental school charges are between 10% to 15% of the suggested fee that the provincial dental associations suggest.
Here I would like to highlight this: Why would they pay when the care is free and in a private office? The treatment takes much longer when provided by this training compared to one in a private office. There is a real danger here that dental schools will have a significant challenge in attracting enough patients once this program starts. This will really compromise both the education of our students and the quality of our oral health care providers that serve the Canadian population. There are about 500 dentists per year as well as those in the other areas that I mentioned before.
I have some ideas on how dental schools could help with this new program. One of our ideas is in terms of training and service delivery. We were given resources as part of the new program and as part of the health system. We could expand our training programs to training professionals who work with people who have difficulty accessing care and, at the same time, provide that care.
A second idea is to integrate internationally trained dentists. As I mentioned, in our dental schools we graduate around 500 dentists per year. These 500 obtain a license to practise, but there are 250 dentists training around the world who have further training and are qualifications exempt to practise in Canada. Dental schools can expand to help these internationally trained dentists while we help fulfill the needs of Canadians and the new program. I estimate that in the country at the moment, as permanent residents or as Canadians, we have more than 1,000 internationally trained dentists who don’t have licences.
Also, I would like to highlight that we have the expert advice. We have the country’s best experts in a whole range of fields that can help advise the government with this new program. For example, I would like to highlight research. We can perform research to evaluate elements of the program to enable the adaptation, as necessary, as the program is initiated. In terms of a quick win, dental schools are ready with the resources, the structure and the expertise to support the new program.
As dean of one of the 10 dental schools, our dental schools could expand the training and service delivered together with this new program.
The Chair: Dr. Siqueira, can you now conclude because of the time factor, please?
Dr. Siqueira: Yes. Absolutely.
To conclude, I am open for your questions. What we need as dental schools to support this important initiative — and all dental schools want to initiate and support because the mouth is part of the body; it has a close relation — are funds to pay for free dental care in both the dental schools and the dental school community clinics. We need to discuss the expansion of personnel, professors and staff and expansion of our training.
Thank you for the time and for allowing me to talk on behalf of my colleagues and the dental schools.
The Chair: Thank you, doctor. Now, from the National Right to Housing Network, we will hear from Ms. Whitzman, to be followed by Ms. Kapoor.
Carolyn Whitzman, Expert Policy Advisor, National Right to Housing Network: Thank you for the opportunity to speak today.
I am the expert advisor for the Housing Assessment Resources Tools, or HART, project and provide expert support to the National Right to Housing Network. HART, funded by the CMHC’s Housing Supply Challenge, is developing rights-based, comparable, replicable and equity-focused tools to support better housing policy at all levels of government. We have framed our work in terms of the legislative requirements of the National Housing Strategy Act, 2019. The act commits all governments within Canada to the progressive realization of the right to housing as recognized in the International Covenant on Economic, Social and Cultural Rights. It prioritizes those who are in greatest need. It means that all levels of government must commit maximum available resources and all available means to improve housing and homelessness outcomes.
Core housing need, or CHN, means a household is in unaffordable, uninhabitable and/or overcrowded condition. They would have to spend more than 30% of their pre-tax household income in order to find adequate local housing.
Our housing needs assessment tool breaks down CHN by income category, size of household and priority population. According to the 2016 census, there were almost 1.7 million households across Canada in Core Housing Need. The goals of the National Housing Strategy are to reduce that number by 530,000 households and to eradicate chronic homelessness by providing adequate homes with supports to 25,000 individuals and households by 2028. At that rate, it would take over 30 years to eradicate that deficit — assuming that the housing crisis doesn’t get worse.
Our analysis of the 2016 census shows that 12.4% of households in CHN could afford less than $356 per month. These are the individuals and households most vulnerable to homelessness.
In the 2021 census, there was a significant drop in CHN, especially among renters, for the first time since 1991: from 1.7 million households to a little under 1.45 million. Was this the impact of federal government reinvestment in affordable housing policy for the first time in 30 years? Much as we would love to believe this, Statistics Canada has laid the credit for the positive impact instead to Canada Emergency Response Benefit, or CERB. Indeed, our statistical analysis suggests that this is the case.
Among the 13 governments that HART works with — municipalities, regions, territories — the primary beneficiaries were very low-income households, those most at risk of homelessness. So we would argue that CERB was a tremendous natural experiment. If the question is: “What happens when we increase incomes among lowest income households?” The answer is “core housing need and homelessness are reduced.”
Direct income support does make a positive difference. A one-time $500 rent relief payment is an important short-term remedy for inflation, and housing insecurity among precariously housed tenants. However, it is only a start in addressing the housing rights violations that tenants are facing across the country in this hugely inflated, unaffordable and financialized housing market in Canada. A rights-based approach requires bold and long-term remedies in the forms of systemic change that tackles the roots of unaffordability.
Garima Talwar Kapoor, Expert Policy Advisor, National Right to Housing Network: Members of the Standing Senate Committee on National Finance, good morning. I provide policy advice to the network as part of my role as Director of Policy for Maytree, a charitable foundation advancing systemic solutions to poverty through a human rights-based approach.
My remarks focus on recommendations for improvements to Bill C-31 and, more specifically, on how the proposed one-time $500 rent relief payment can be strengthened to help progressively realize the human right to adequate housing.
Efforts to realize the right to housing require that governments consider their maximum available resources, including investments and legislative measures. At a time of high inflation, the principles of a rights-based approach to social policy may seem counter to economic policy. But in reality, they are not.
The measures before you to address inflation may be criticized as contributing to further inflationary pressures. But we know that the cost of inflation, and related policies to reduce public spending, will have the greatest impact on communities in deepest need. The proposal in Bill C-31 to provide a one-time rent benefit of $500 recognizes that high shelter costs disproportionately impact the budgets of lower- and moderate-income households, albeit temporarily.
While we are pleased to see the introduction of this benefit, a rights-based approach to rent support would make it permanent, recognizing that renters with lower incomes — regardless of the inflationary environment — experience higher rates of core housing need. To this end, we advise that amendments be made to Bill C-31 so that the rental supplement better addresses the needs of people living in poverty.
From a framing perspective, this means renaming this support from the Canada Housing Benefit top-up to a new name to avoid confusion with existing portable housing benefits provided through the National Housing Strategy. Such clarity may sound like a small matter, but it is incredibly important for people to understand what supports they receive and why.
From a technical perspective, this means the following:
Making the benefit a permanent, refundable tax credit based on income criteria.
Clarifying this new support’s assessment and delivery method so that all lower-income renters who are eligible will apply.
Removing section 2, the clause pertaining to people living in multi-tenant dwellings, such as rooming houses and boarding rooms, which allows only 75%, rather than the full cost, of their housing to being counted towards benefit eligibility. This clause would further increase inequities between those with lower incomes who rent in multi-tenant dwellings compared to private dwellings. This type of housing is often the only deeply affordable market housing available to people living in poverty, and this additional calculation is deeply inequitable.
Removing the requirement for applicants to attest that they are paying 30% of their income on shelter costs, since income can be used as a proxy for need and further attestation would be both cumbersome for governments to administer, and for applicants.
Ensuring there are no clawbacks in other forms of income support — especially provincial and territorial social assistance programs — in future years. That is, the federal government should work to ensure that people who receive income supports through this one-time rental supplement do not see reductions in their future benefits.
The federal government should also work with its provincial and territorial counterparts to ensure that other related policies, such as rent controls, don’t undermine these supports.
The Chair: Thank you, witnesses, for your comments.
I would like to ask senators and witnesses in the room to please refrain from leaning too close to the microphone, or remove your earpiece when doing so. This will avoid any sound feedback that could negatively impact the committee staff in the room.
Honourable senators, now we will proceed to questions. You will have a maximum of five minutes in the first round and three minutes in the second round. Therefore, please ask your questions directly. To the witnesses, please respond concisely. The clerk will inform me when the time is up. I will now recognize Senator Marshall.
Senator Marshall: I will start with Dr. Whitzman or Ms. Garima Talwar Kapoor, whoever can answer the question.
Exactly who are your stakeholders? Are you representing only individuals who rent or do you also represent mortgage holders? I ask the question because I know rent has gone up significantly in the past year, but with rising interest rates, it is also having a big impact on mortgage holders. Could you carefully that point, please?
Ms. Whitzman: When we’re looking at core housing need, we’re including all forms of housing costs, whether it be rent or mortgage, or even utility costs or energy costs, as part of the housing costs. In our analysis, we look at the way core housing need is defined in the census, which includes homeowners as well as renters. We might break down the data further because we know that renters are four times more likely to be in core housing need. Absolutely, there are people who are house poor, who own a house but can’t afford to do that.
Senator Marshall: Okay, so you would include them also?
Ms. Whitzman: We would in our analysis, yes.
Ms. Kapoor, do you have anything you want to add?
Ms. Talwar Kapoor: Senator, I think your question also pertains to the network stakeholders and to the work of the National Right to Housing Network.
To speak to that more specifically, our rights-based approach to housing focuses on those in deepest need, those facing the most significant housing precarity. Given what Dr. Whitzman said, we know through the data that it is renters who tend to face the deepest need and highest rate of need. When we talk about our rights-based approach to housing, our fundamental core and where we start our analysis is to look at where the data takes us, which is to focus on renters.
Senator Marshall: But if there are mortgage holders who have struggled to purchase a home — and now, with rising interest rates, are at risk of losing that home — you haven’t reached a point where you are saying you are not concerned about them — that they would be scooped up in whatever analysis you are doing?
Ms. Whitzman: No. We’ve seen in the U.S. the horrific impacts of widespread evictions of homeowners over nonpayment of mortgages. I would add that financialization, which is a concern of the network, is beginning to affect single-family homes that are being bought up and rented, as well as contributing to price inflation for homes.
Senator Marshall: Thank you very much. I did have on my list of questions any suggestions that you would like to see in the fiscal update. Ms. Talwar Kapoor covered that area, but could you speak to the adequacy of the $500 benefit? There is no sliding scale, but do you have any comments? When you look at the significant increase in rates and mortgages, $500 doesn’t seem like a lot of money. Could you speak to the adequacy and what you would like to see there?
Ms. Talwar Kapoor: I think it depends on how the one-time $500 rent supplement is delivered. If we look at Toronto, according to Statistics Canada data, a one-bedroom unit, on average, is around $1,600. But if we look at the downtown core in Vancouver or Toronto, it is about $2,000. That’s about 25% of one month’s rent. Does it make an impact? Will it help people feel a sense of relief? I think, for sure, there is a small sense of relief, but that sense of relief is not going to play out over the long term.
I think the challenge here, senator, is that the federal government is trying to balance what we notionally think of as appropriate measures for highly inflationary environments, while also addressing those in deep need. The ways in which this $500 rent supplement will be tested and therefore delivered, in our view, almost errs too much on the side of targeting in that it becomes administratively cumbersome and is not necessary to get to the target population, but also, in trying to stave off criticisms that this is going to fuel further inflation, might not be as reflective of the need that actually exists out there. I think what we’re seeing play out through this rent supplement in Bill C-31 is a reflection of that balance.
[Translation]
Senator Gignac: My first question is for Ms. Whitzman or her colleague.
My question is about federal housing assistance. You mentioned that the $500 is a first step, but it’s a small step, because it’s a one-time payment; it’s only for one year.
Don’t you think, as I do, that since the provinces are placed closer to the people to help with housing, it would have been better for the federal government to give a billion to the provinces than to establish this program? I’m curious to hear your views on this.
While $500 is certainly welcome, revenues are not the same from region to region, province to province. For example, $30,000 means something different in New Brunswick than it does in Ontario, especially in Toronto. Do you agree with federal intervention in this area?
[English]
Ms. Whitzman: It’s a complex issue because of the Constitution. I would say that the federal government has the requirement to uphold people’s rights, including the right to housing. We know that the provinces and territories, according to the research of the organization my colleague works with, have had punitively low rates since the 1990s where housing benefits particularly or shelter allowance has not been sufficient.
Just handing it to the provinces without any requirement as to reaching the poverty rate might not be a great idea. If there was some sort of requirement that this be part of a larger rights-based program to lift people out of poverty and eliminate homelessness and housing need, that would be a different matter entirely.
We saw with CERB how rapidly and effectively we were able to deal with desperate needs, and I think that’s a model.
Ms. Talwar Kapoor: Thank you, senator, for your question. I think this model that the federal government is undertaking on the $500 one-time supplement is adjacent to what already exists through the National Housing Strategy. There is a portable housing benefit which entails 13 different agreements that the federal government has undertaken with provincial and territorial governments to provide a portable housing benefit to people within their jurisdictions. The way that this program works is that it’s a cost-shared program, and provinces negotiate what the parameters of this portable housing benefit are going to look like, and every province has their own program. But to do that takes time, and I think that the utility of what the federal government is proposing through this one-time benefit is to get the benefit out quicker to all renters.
We know through the existing portable housing benefit, for example, in Ontario, that not every renter receives it. Because of the parameters of the program — inevitably because of the fiscal envelope, there are limitations to who gets this support and how much — actually negotiating this out, in light of inflationary pressures, is going to be too long.
You’re absolutely right that provincial governments are very close to their populations, so outside of fiscal investments, it is the responsibility of subjurisdictional governments to create the legislative environment that keeps rent affordable, and we’re not seeing that right now in provinces like Ontario.
Senator Gignac: The criticism has been that it’s not everybody who files income tax. Very often among poor people, a percentage isn’t filing income tax. If you do not file, you won’t receive any money. That’s why I asked if provincial governments, which are closer to the population, are the best way. Do you agree with that criticism and the number of 10%? In Nunavut, we talk about 25% to 30% of people not filing income tax. Is that something you share as a concern?
Ms. Talwar Kapoor: Absolutely. I think non-filing is a big challenge in tax-delivered benefits and credits. We know that those living in deepest poverty are working-age single adults, and they correspondingly have the highest rates of non-filing.
Again, I think the question is about balance and trade-offs. There is an efficiency, quickness and ease that come with tax-delivered benefits. There isn’t a heavy administration that comes with that, but what you are missing, then, is people who are more difficult to reach.
I think we correspondingly need those structures that enable people to receive benefits even if they don’t tax file.
Senator Smith: Dr. Siqueira, in your opening remarks you said that dental schools can help in the new program. It can perform research to evaluate the performance of the program. The issue of data collection has been coming up in our pre-study of the bill, a significant challenge for the government to collect good quality data to measure the success of the program. Could you please expand on this research and how can it help the program?
Dr. Siqueira: Thank you very much for the question. The challenge is how to do this study. At the moment, we don’t have good data in Canada for that. For example, the last dental survey that was done in the country was more than 10 years ago, so we don’t have any recent data about oral health of Canadians.
This is researcher by researcher and not comprehensive across the country.
What I am saying is that with the proper investment in this area, we have the expertise to make quality management and to advise the government on what is correct and what is not correct in the initiative. As I said, we have the best experts in the country in the areas of population health, dental public health and evidence-based research. We would like to have the government engage the dental schools and the oral health researchers in this initiative.
It’s not just by providing $290 or $650 per child that we will solve the problem of oral health in Canada. As I mentioned in my statement, we deal with the two most common chronic diseases in Canada: tooth decay and gum disease. We need to invest in prevention. It’s not just therapeutic. This $290 or $650 will not go far in terms of treatment and therapeutics. We need our dental schools to invest in prevention. These people can use this research money to provide quality of life for Canadians.
Senator Smith: Do you think you have an opportunity to mobilize the other leaders like yourself to influence the government to step up and start to do some proper data collection and research that can come back and assist you? In other words, can you take a leadership role with the other leaders in the other dental schools across the country to start that movement? Governments have a tendency to talk a lot but not necessarily deliver a lot.
Dr. Siqueira: Absolutely, senator. On June 2, 2002, the Association of Canadian Faculties of Dentistry that represent the 10 dental schools sent a letter to the Minister of Health highlighting that all the dental schools and the specialists in this country in the area of dental craniofacial research are engaged and willing to participate to help create data that can maximize the use of the resources and maximize the quality of life of Canadians.
Yes, we have the leadership and the experts in the country that can provide this support.
Senator Smith: Thank you, doctor.
The Chair: Before going to Senator Boehm, Dr. Siqueira, can you provide the committee, through our clerk, the letter that you sent to the Minister of Health?
Dr. Siqueira: Absolutely. I can send it by email after this meeting.
The Chair: Thank you.
Senator Boehm: I’d like to continue with Dr. Siqueira in the same vein as my colleague Senator Smith.
Dr. Siqueira, about two years ago, you gave an interview to the Saskatchewan Health Research Foundation, and you were asked what you found to be the most challenging aspect of your work. You said it was to convince reviewers that my research is essential to the population’s life.
I’m wondering whether two years later you feel the same thing. If you found it difficult to convince fellow scientists of the importance of oral health to the overall health of the population, how is the average Canadian parent convinced to make oral health a priority for their children, especially those who don’t have insurance?
Dr. Siqueira: Thank you for your question and for mentioning my interview from two years ago.
Yes, I feel absolutely the same. Dentists, dentistry and oral health deal with important conditions like dental care, periodontal disease and oral cancer, that significantly affect the quality of life of Canadians. However, this is not recognized by my peers in the dental field.
For example, in this country we don’t have, as other countries like the United States do, a specific group that supports oral health research. When we apply for grants here, we apply together and compete with the same money in the areas of heart disease and cancer. Of course, this has more appeal for the lay population because, as you said, they don’t understand the importance of oral health and how it affects systemic health. As I said, gum disease, periodontal disease, is the most prevalent chronic disease in Canada and can significantly affect the systemic health in terms of diabetes and several big issues and conditions.
In addition to this, we need to have a significant educational component. Again, I wanted to highlight the preventative component and to educate the population that oral health can provide quality of life in terms of mental health and social relations. This is not being done by the government, but dental schools are trying to advocate for more say in the health system.
Senator Boehm: Thank you, Dr. Siqueira.
I’d like to go to our witnesses from the National Right to Housing Network. This is more of a strategic question.
The National Housing Strategy Act of 2019 legally recognized adequate housing as a fundamental human right as affirmed under international law.
Does the National Right to Housing Network believe the Canada Housing Benefit is aligned with the human rights aspects of housing? In other words, can this help to combat one of the root causes of unaffordability and other problems for renters, particularly the financialization of purpose-built rental housing or is it simply reading a system?
Ms. Whitzman: Senator Boehm, that’s a good question.
Senator Boehm: Thank you.
Ms. Whitzman: There isn’t a magic bullet. If we are going to achieve a future where all Canadians have adequate affordable housing, it’s going to need to be a combination of supply interventions such as greatly increased non-profit and affordable private rental plus some form of better income support.
We see this bill as a step in the right direction, not the wrong direction, but only a very small part of the solution, partly because, as you mentioned, of its one-time nature.
Ms. Kapoor, do you have anything you want to add to that?
Ms. Talwar Kapoor: Senator, I think your question also alluded to the broader program in the National Housing Strategy for a $1 billion portable housing benefit which is then cost matched across provinces and territories in the country.
With respect to income supports, whether it’s for rent or for general cost of living, fiscal investments in income supports don’t stand a chance in maintaining their value when the broader “rules of the game” don’t keep up. If we’re making investments in rent support without actually having a better handle around the legislative mechanisms by which rent can increase year over year far faster than wages, the value of the government’s actual investments in income supports and rent supports wane over time.
We’re seeing this more acutely in deep poverty among people who receive social assistance in that we’ve really tried to keep benefit rates low without actually thinking about the value of the investments over time.
Senator Yussuff: I thank our witnesses for being here this morning. I thank them for their advocacy, and the hard work they’re doing in the two areas we’re touching on.
I’ll start with the housing benefit. I guess the challenge is in terms of trying to get this benefit to the people who are the most in need, and quickly, through the Income Tax Act.
Who might be excluded from this opportunity, recognizing that most people who are poor obviously need support? It goes to the question about people who are on social assistance, and the data for social assistance resides with the municipal government.
Is there a way to assist those folks who equally deserve the benefit but may not be able to access it because they haven’t filed an income tax return? Your expertise would be helpful.
Ms. Talwar Kapoor: Thank you, senator. Across social assistance programs in the service delivery part, efforts are being made to increase tax filing through the involvement of tax clinics, for example.
You’re right in that when we deliver measures through the tax system, we’re missing many people who are in deep need. How we convince provincial and territorial governments to increase social assistance rates is a magical question that we are trying to advance and advocate for but have not yet been successful.
The federal government’s fiscal power and ability to reach most people in need, as we see through the Canada Child Benefit, for example, is helpful. It’s instrumental in telling us about the role that such income supports can have in reducing the depth and rate of poverty that households experience.
More broadly, what can be done right now with Bill C-31 for those in deep poverty is to remove clause 2 of the bill. Multi-tenant homes — that is, rooming houses or boarding rooms — are the last deeply affordable market units available, and a majority of those tenants are receiving income supports. The calculation that is done in Bill C-31 in terms of calculating only 75% of the tenant’s rent, as opposed to 100%, makes it more challenging for these tenants to be able to access this $500 benefit.
When we look at the long game on social assistance, you’re absolutely right and that’s something we’re advancing right now. I would also suggest and advance the idea that there is something this committee can do right now to help those who are living in deep poverty.
Senator Yussuff: Thank you very much for your suggestion.
I have a question for Dr. Siqueira. With regard to the issue of data collection, you said that the data we’re operating from is about 10 years old and that we need to recognize the expertise that the colleges have in trying to deal with these challenges.
In working with Statistics Canada, are we able to bridge this problem, recognizing that we will need new data if the federal and provincial governments are to collaborate on a national program? Would bridging the initiative that the federal government is providing help to alleviate this challenge we currently have, with a 10-year data lag in the system?
Dr. Siqueira: Thank you, senator, for the question. You are absolutely right. Indeed, the leadership of the dental schools engaged Statistics Canada. Together with Statistics Canada, we applied for a federal CIHR grant. Ten dental schools were successful in this grant. We are planning a new national dental survey, together with Statistics Canada, for next year. This was supposed to start a year ago, but unfortunately because the pandemic hit, we decided to postpone the start of this survey. Definitely this new data will help to illuminate how Bill C-31 could be used by Canadians.
I want to highlight a point for senators. In terms of $290 per year or $650 per child per year, we know that the average cost of a tooth decay restoration is more than $200 at a private dentist. How do the dentist, the oral health care provider and the family go to this site when treatment is stopped? Based on my 24 years of experience working with dental schools, usually this type of clientele has more than one tooth decay; they have three to six. Treatment is stopped after one tooth decay restoration is completed and then you wait until the next year. This needs to be thought through.
The other thing I would like to highlight for you, senator, is in terms of reimbursement and upfront payment. Again, based on my 24 years of experience dealing with dental patients, they don’t have the resources to pay upfront. This also needs to be discussed. Thank you.
The Chair: Thank you, doctor.
As a reminder to the witnesses and the senators, Senator Yussuff is the sponsor of the bill in the Senate.
Senator Loffreda: Thank you to our panellists for being here this morning. They were very insightful presentations.
My first question is for the National Right to Housing Network. Ms. Whitzman, you stated that you would prefer to see an expansion of the program in Bill C-31 with regard to relief of the cost of living and renting housing. You stated that the impact would be nominal as it now stands. Your goal is to eradicate homelessness, and we all have the same goal. We all wish there was no homelessness in Canada.
Do you feel that more needs to be done on a personal level in terms of helping individuals, like Bill C-31 is doing, as opposed to community support and social housing or community centres and shelters?
I’m referring to a recent statement by Gillian Petit, an economist and research associate at the University of Calgary’s School of Public Policy. Many of us share her concern that low-income Canadians, homeless people and people on social assistance have low tax filing rates and low take-up of benefits. We’ve all discussed the 10% unattainable Canadians, but if we take the low-income earners, I think that percentage is much higher.
I would like to hear your thoughts on that, Dr. Whitzman.
Ms. Whitzman: Thank you, Senator Loffreda. I would reiterate that it will not be demand-side interventions — like housing benefits, raising social assistance rates or Bill C-31 — that will be all of the answer; nor will it be rapid construction of affordable, social and supportive homes — which is entirely possible and really a matter of political will as much as anything — that will be the solution. It has to be both together.
As for the matter of tax filing, my colleague, Garima Kapoor, has suggested there should be support for legal advice for tax clinics to support filing. I agree that the more we make it easy to take advantage of these benefits, the better.
I will pass it over to Ms. Kapoor now. I think she probably has a better answer than I have.
Ms. Talwar Kapoor: Thank you. We know that tax filings from families with children increased as benefits got better over time, so I suggest that incentives matter. Where we see the deepest level of non-filing, again, among working-age single adults or single adults, we might want to think about what incentives people have to file taxes. If you are a low-income person who will not receive much in terms of benefits, you are less likely to feel compelled to tax file, as compared to a family with children that might be eligible for a benefit, like the Canada child benefit.
I would also suggest something more innovative that other jurisdictions are doing, which is the idea of automated tax filing, and I would say that Canada is slow so respond to it. The CRA has all the information it needs on people who have simple tax files. There are jurisdictions with more automated filing, where the tax agency fills in the form, and you receive the form to endorse whether everything looks right. That helps with higher rates of tax filing. There are some more incentive structure issues, but also I would say there is room for innovation in Canada’s approach to tax filing and tax benefits more broadly.
Senator Loffreda: Thank you for those answers. I think it comes down to more than just tax filing. Many of the homeless have larger issues than not enough income. To get in my 10,000-plus steps a day, I walk and I talk to many of them. As you said the fiscal supports diminish over time based on inflation, the increase in cost of living and what have you. Obviously, a stronger economy would help everyone.
Resources are not endless. The taxpayers can’t endlessly pay for resources. My question was more on focus. What should we focus on, in the future? Would it be individual support? Community support? Social housing is a huge issue. There are inflationary concerns. Are there any more thoughts on that? If the economy suffers, the problem of poverty is accentuated rather than alleviated. Those are the concerns.
But if you make an investment in community support centres, then it is a different issue. When I do talk to the homelessness — because your goal is to alleviate homelessness — and do I talk to many of them, even in my great home city. We have great centres, such as the old brewery mission, and I could go on and on. The problem is deeper than just more income. Sometimes it creates other issues like the ones we are all seeing right now.
Ms. Whitzman: I would completely agree with you, Senator Loffreda. The previous government had an evaluated program called At Home/Chez Soi that decisively backed up thousands of international studies showing that a housing-first approach works. If you build or provide affordable housing with appropriate supports, it’s going to be cost-effective, and it had a huge impact on the homeless people in five cities that participated, including Montréal.
We have the evidence. We know what works. I would say that adequate income is part of the solution, but I would completely agree with you if you are saying that there is no substitute for permanent supportive housing to meet needs. We have to understand that homelessness started growing in the late 1980s and early 1990s, and it is not a coincidence that it started growing at the time that the federal government started backing away from social and supportive housing, and it has gotten much worse since then.
It is a systemic problem. It requires a systemic response. If you are asking whether Bill C-31 is that systemic response, the answer is no. Would it help? Yes.
The Chair: Thank you, Dr. Whitzman.
[Translation]
Senator Dagenais: My question is for Dr. Siqueira.
Dr. Siqueira, can you give us more information about the difference in cost between the treatments offered by the dental school and the fees charged in a professional clinic?
[English]
Dr. Siqueira: Thank you for the question. It is an important question about the difference between what dental schools charge for patients and what private dentists charge.
Let me explain how the process of a fee is decided. Each province, along with the dental regulators and associates, creates a list of suggested prices for the dental treatment. Usually, dentists in private offices go with the suggested price or sometimes above the price. At dental schools, we charge between 10% of the suggested price to 50% of the suggested price. I can give one example of the College of Dentistry at the University of Saskatchewan. For kids 0 to 12 years old, we have a flat fee of $20 per visit. If the treatment service is $1,000, we continue to charge $20 for kids aged 0 to 12 years old.
For other treatments such as endodontics or root canal that is outside $1,000, in our dental school, we charge $100. It is a significant discount, because we want to have the patients here in all 10 dental schools to provide service and, at the same time, quality education for our students.
[Translation]
Senator Dagenais: I don’t want to take you on a slippery slope, but how do you explain the fact that the government has not thought to turn to the academic world — where possible, of course — to implement its dental care program?
Schools need patients to enable future dentists to complete their apprenticeships. If I understand correctly, the government program could jeopardize the training of future dentists who are still in universities. As you mentioned, the situation is the same in all provinces. I would like to hear your comments on this. I think this is a program that could help the universities. I don’t understand why the government hasn’t approached you more.
[English]
Dr. Siqueira: Thank you very much for your question. You are absolutely right in your comments. We are expecting the federal government, at one point, to contact the 10 dental schools and work with us, because, as I said, we have the expertise and the infrastructure and the resources to quickly start the project, the initiative of Bill C-31.
Yes, you are absolutely right that the way we have it now will create significant challenges in all 10 dental schools, because we are not going to have the same number of patients. In this way, in the long term, the quality of the dentists and the oral health care providers in Canada will be reduced. This will create a challenge in all 10 dental schools.
I hope there is still time for the government to contact the dental schools and work with us, because, as I said, we have the infrastructure to support this program and maximize the value that is in Bill C-31. In the dental schools here, we charge 10 to 15% of the suggested fee in any of the provinces and territories.
Senator Bovey: I would like to thank our witnesses.
Dr. Siqueira, I would like to follow on the line of discussion that you had with Senator Dagenais. I am well aware of the role and importance of dental schools and the service that they give to their community, and I think I am correct that you support this program but you are concerned about the longer-term benefits to the dental schools and to the training of dentists going forward.
Can you just go over for us again where the dental schools get their funding to support their programs? Then I have a follow-up, because I don’t quite understand how you feel that the impact — you may be losing your current clientele to private dentists, but I do understand, if you lose them, the negative impact on your training. So I would like you to dig a little deeper for me.
Dr. Siqueira: Thank you very much for the question.
Yes, myself and my colleagues, on behalf of the ACFD — that is the Association of Canadian Faculties of Dentistry — we supported this initiative 100%, but this doesn’t embed us to make some comments on how to improve this initiative.
Our major concern is that we are competing for the same clientele that is in Bill C-31 and that this will affect the education of our students, because, by regulation and by accreditation, the students need to see a minimum number of procedures to become competent in one specific area of dentistry. This is one of our major concerns.
Regarding your question on how the dental schools are funded, it is a mix of provincial Ministries of Education; the universities’ funds; the student tuition and fees and patient fees that I spoke about before; and philanthropic donations.
Senator Bovey: Am I right in saying that the universities get their support from the provinces, which may be why the federal government didn’t go directly to the universities with this program? Digging deeper than that, I’m well aware of the dental school in Manitoba and the work they do with inner-city Indigenous children and how important that is.
Do you see some crossover between this program and the work being done by the various ministries that positively affect the Indigenous community?
Dr. Siqueira: Thank you again for your question.
Yes, I saw a lot of crossover here that, in terms of education and health care, as I mentioned before, is other health professionals, schools like medical and nursing. In addition to receiving provincial funds by education, those entities also receive support for health care because they use the facility of the hospital.
In terms of Indigenous support, yes, I also saw some issues here. This is another concern, specifically now for the University of Saskatchewan College of Dentistry, because we are opening a dental therapy program that will be focused on Indigenous students and Indigenous patients. I saw that this can cause some challenges getting support from provincial or federal governments.
Senator Bovey: If I may ask a quick question to Dr. Whitzman.
I applaud the work you are doing. I would like to know how you feel this program will help the overcrowding in homes in our Northern communities, where the concept of renting and owning in some of the Inuit communities is quite a different concept, and have you worked with them?
Ms. Whitzman: It is really important to take a “for Indigenous, by Indigenous” approach, including reconceptualizing the idea of overcrowding, because we know, in Indigenous families, there’s quite often a large extended family, and there needs to be flexibility for that. Again, it isn’t as much an issue of a one-time rent benefit as it is some larger systemic issues of making sure that housing is built by, for and with Northern communities. There are many technologies out there, such as modular housing, that could make a huge difference, but it is beyond — I can’t, as hard as I might try, relate it to the matter of Bill C-31.
The Chair: Thank you.
Senator Pate: Thank you to all the witnesses for participating.
As someone who has worked in this area for decades and is part of the Women’s National Housing and Homelessness Network as well as the UBC Housing Research Collaborative, I know you have made many recommendations about how we could address these issues. I want to bring you back to a comment you made about homelessness increasing with the pulling away of social and economic supports in the late 1980s and early 1990s. If the government had come to you and asked you to make a recommendation of what should be in Bill C-31, what would you have recommended to them?
Ms. Whitzman: Wow. How long do you have? I think, at the very least, it would have involved an acknowledgment of the roles of the different levels of government. So although rental assistance is definitely income support and is something that the federal government could do, a large part of the combatting of inflation, which housing costs are a part of — probably the major part of it — would involve a look at how to decrease the tremendous financialization of housing that’s going on right now. It would have involved a pretty significant look at real estate investment trusts. It would have involved a look at how we can start to scale up social and supportive housing again as an alternative to commodified rental housing and ownership housing. It would have involved a stronger sense of multilateral agreements with provincial-territorial governments that would include issues like adequate income support, and with municipal governments, it would include simplified forms of planning approval, including looking at zoning, looking at overcoming NIMBY through delegated approval, and as of right zoning.
The answers are very much out there. The evidence is very much out there as to what works, and a focused emphasis on ways to address housing inflation at the federal level would have looked at taxation and infrastructure funding and at agreements with other levels of government. As I said, with the province, it would be income support renters’ rights; with municipalities, it would be planning approvals. One more thing would be the use of government-owned land, land banking, land trusts, because we know from governments such as Finland and France, that have done tremendous work in diminishing homelessness, increasing affordable housing, that land is a key part of the question.
Thank you for that question. Ms. Kapoor, do you have anything you want to add?
Ms. Talwar Kapoor: No. Thank you so much, Dr. Whitzman. That was great.
Senator Galvez: Thank you to our guests today. The advantage of being the last to ask questions is we have had time to hear all the answers to the pertinent questions asked by my colleagues, the other senators. I would like to take advantage of my time to ask you some more global questions.
We see that this bill is in the right direction, and, of course, it is going to pass. However, it is sort of a Band-Aid and it is not good enough to solve the problems we have in front of us.
Very-low-income people don’t do their taxes. They may have criminal records. They are in the streets, and we need to help them. We see that the CERB did have a positive impact, so we know that it did get help to them. Can you please talk again about a larger guaranteed liveable income, services on food, health and housing, and if there will be a more systemic, global, permanent solution to the pressing problems that we face today? Thank you.
Ms. Whitzman: I’m sorry, was that question directed to me, Senator Galvez?
Senator Galvez: Yes, to the three of you, but you can start, Dr. Whitzman.
Ms. Whitzman: It is important to remember that the federal government has intervened far more strongly at two particular points that I would like to point out. One was during World War II, but immediately after World War II, when a commission report on reconstruction after World War II, the Curtis commission, called for intervention in housing, building 1.5 million new homes for returning servicemen. Also, during World War II, there was national rent control because of tremendous overcrowding and rent gouging that was going on in cities.
Similarly, in the 1970s, there were a number of initiatives, including national wage and price control, which included rent control, and tremendous investment in building low-cost social rental and low-cost private rental. We have the precedents of the federal government responding to affordability crises within its populace. There is absolutely no reason why 2022 can’t be a similar inflection point. We know that homelessness has never been a greater problem in Canada, and we also know that core housing need has stubbornly persisted from 1991 until present, at least according to the census.
It is really important to note that this is the first significant decrease we’ve seen in core housing need, particularly among low-income groups. Again, I want to reiterate my remarks. I wish it was because of housing policy but it wasn’t. It is clearly because of emergency income support. So we know we can make a huge difference to the lives of the lowest-income Canadians. We know we can do it quickly and we know we can do it in recent history — that is, 2020. I would love it if the Senate of Canada reflected on that fine history and the capacity that the federal government has in order to make more substantive change.
Ms. Talwar Kapoor: Thank you, senator, for your question. I want to break this up into two parts. When we think about the CERB, it is important to remember that CERB acted as an EI replacement. It was not what we typically think of income support in the world of social policy but wage insurance replacement because our EI system was too antiquated to respond to the need that was there at the beginning of the pandemic.
Who received the CERB? While it is clear that the CERB had a huge impact on reducing the level of core housing need and other measures of poverty, it did not go to the people who live in deepest poverty because they did not have labour market attachment. I think it is important to isolate what the CERB did and didn’t tell us about our guaranteed liveable income or basic income.
That brings me to the second part of my answer: Basic income means something. A basic income inherently means that there will be some type of streamlining or replacement of existing supports and services in replacement of a cheque.
We need to be thoughtful about what we are advancing and whom we affect when we think about a basic income. Our own analysis at the Maytree of the Parliamentary Budget Officer’s analysis of what the cost of a basic income in Canada could look like would mean, actually, that the working poor would be made worse off by a basic income. Again, this is because of the inherent decisions and trade-off decisions are made because of what a basic income entails.
To get to that place of a guaranteed liveable income for people across Canada, we have a missing middle problem. We have basic incomes for seniors. We have basic incomes for families with children. However, what we are missing is among the working-age population. The data from Maytree tells us that working-age single adults face both the highest and the deepest rates of poverty. If we want to achieve the goal that I think you are speaking to, I actually think that we have many of the infrastructure pieces needed to get there for this missing middle group. I am happy to talk further about more ideas around that.
The Chair: Thank you, Ms. Kapoor.
Senator Duncan: Thank you very much to the witnesses for your presentation. I would like to follow up on the line of questioning of Senator Bovey and perhaps others regarding services to Indigenous people.
Regarding the housing benefits, we’ve learned and heard that this top-up payment will benefit 1.8 million renters across the country. Through your research, do you have a sense of where, regionally, these renters might be located?
Ms. Whitzman: I see, senator, that you are from Yukon. Yukon is one of the governments we are directly working with. I actually had the pleasure of attending the Yukon Housing Summit 2022 via Zoom a couple of weeks ago.
Statistics Canada isn’t perfect. The census isn’t perfect. I could go on and on about some tweaks to the census that would make it a bit more useful, certainly, in terms of Indigenous populations, which is one of the specific groups that you spoke about. However, we could be using — and we must be using — census data much more consciously as we go forward with our policy.
I note that the National Housing Strategy took the core housing need figure from the census, but then it didn’t break down core housing need by tenure, or by income category, or by priority population. For instance, we know that single mother-led families are the households most at risk of core housing need. Indigenous households are the households most at risk of homelessness.
I think that there is an enhanced role for data. As I say, the data could do with being reconceptualized a bit in terms of adequate housing, which has specific legal definitions under the covenant on social rights, but I think there is a lot of data out there on the needs of renters in the North, for instance, that we aren’t using very well.
Senator Duncan: What I hear you saying, then, is that it would be better to direct the question about where the $1.8 million number comes from to government officials and have them show me where this will benefit Canadians, regionally?
Ms. Whitzman: Oh, yes. The data is absolutely there, Senator Duncan, and it is a very good question to ask, for instance, the Canada Mortgage and Housing Corporation or Statistics Canada. I know the answer, but it would probably be better to ask them.
Senator Duncan: This leads me to my question in terms of the Indigenous relationship, in that it’s different throughout the country. We have reserves. We have off reserves. As you noted, in the Yukon we have self-governing First Nations with an entirely different relationship.
In your research have you done a separate study to indicate how Canada might best address — in terms of its relationship with Indigenous people through Indigenous Services Canada — these issues of housing? Because it’s different everywhere in the country, and one size does not fit all, in programs.
Ms. Whitzman: I would commend my colleagues in British Columbia with the Aboriginal Housing Management Association, who are also involved with the National Right to Housing Network and are part of a series of groups that have launched a human rights complaint with the Federal Housing Advocate, specifically around the issues of Indigenous women in relation to housing.
There is a recent report by AHMA, the Aboriginal Housing Management Association, and even though it pertains specifically to British Columbia, it is such a good piece of research that has mechanisms, price tags and a comprehensive view of policy that it could easily become the model for the next stage of work. Of course, one of the things that is wonderful about the piece of research is that it was conducted and is held within an Indigenous organization.
I think that, again, the answers are out there. The Indigenous caucus of the Canadian Housing and Renewal Association also has a good plan going forward. It’s been increasingly disappointing to see the current government talk the talk about reconciliation without walking the walk, in terms of the structures and listening to the Indigenous research that’s out there, which includes First Nations on and off reserve, Métis and Inuit people, about what would be the solutions to some of the really horrific housing conditions that exist on and off reserve.
Senator Marshall: This question is for Dr. Siqueira.
You spoke about the services provided by the various dental schools, and then you also spoke about the amount of funding that’s going to be provided by this dental program. It’s a $650 maximum. You did say in one of your remarks — I hope I’m not misquoting you — that the money won’t go far.
Given your concerns about the experience now that the dental schools may have with regard to this program, how can the new dental program be integrated with the existing programs that are provided by the dental schools? There has to be some sort of connection put in place. What would you like to see in order for that connection to be made?
Dr. Siqueira: Senator, thank you very much for your questions.
Yes, I have some concerns about the value that is provided in this bill for kids from 0 to 12 years old and how this will be paid. That it is paid upfront is also a concern for us, because this group of people has challenges in having this paid upfront for reimbursement.
The way I saw it is that — basically, what I am here to advocate for — we have the experts, and we have the infrastructure — the dental schools — and we can do much more than just providing the service. Our major mandate is to provide education for the students and create the next generation of oral health care providers.
Saying that, we are basically running our dental schools and our clinics to have no deficit, but we are not looking for surplus. This is because, with other resources that we have detected, if we shut off the student and university support, that we can really charge any flat fee for kids here in the University of Saskatchewan College of Dentistry, and my colleagues across the country do the same thing in the dental schools.
I would like to have a proposal where the government makes one agreement with all ten dental schools, and we can provide free service for this group that is in Bill C-31 and also expand this for other groups that are the underserved population here, that is the Indigenous population and the elderly population that significantly needs dental care.
In terms of how far we go with $650, this is one of my major concerns. Let’s take an example: Let’s say that we have a person that has four tooth decays, and each tooth decay is $200. How will it be ethical for the dentist and for the family to decide, “Oh, I treat Tooth Decay Numbers 1, 2 and 3, and I wait until next year to treat Tooth Decay Number 4?”
We are dealing with biology with the human body. The tooth decay will continue to progress, and this is going to affect the mental health of the person and will also affect the systemic health of the person.
This needs to be very well discussed. To maximize this value now, I think the first approach is to use the dental schools that we are talking about here. At the moment, without any support, we saw 370,000 patients visit per year. Without question, we have the conditions to duplicate this number if we have support from the federal government. This is one way that I think we need to go. Thank you.
The Chair: Thank you, doctor.
Senator Gignac: My question would be for Dr. Siqueira as well. Please try to spend only one minute when you answer, in order to give more time for my colleagues.
You raise an important question and concern, doctor, including the fact that a lot of people — possibly the poor people — the lower income revenue that don’t have the $300 or $400 upfront to spend on that.
Secondly, the concern that you have not been consulted, and the provincial government has not been consulted before the federal government launched this new initiative. Keep in mind, as you know, it is just an interim measure before the development of a long-term national public dental care program.
The question is simple: Since this bill, or part of this bill, does not seem to be well designed or articulated, do you have concern about its impact on your dental school? Would it be better for the government to postpone by six months or one year, and have time to sit with provinces and dental schools to design a more well-articulated bill than to proceed quickly with this one? In one minute, please.
Dr. Siqueira: I’m sorry, I’m a professor. I’ll try to keep it within one minute but usually professors like to talk and talk.
Basically, absolutely not. I think this is a good start and this needs to be initiated as soon as possible. Because dental care is a public health issue in Canada and was never done for any government. I’m very pleased to see the government has taken the initiative to start.
Of course, this is not perfect, but it is a good start. I hope that after this meeting, the government and the senators understand that the dental schools and the specialists, the experts that we have in the dental schools and the infrastructure need to be involved in this project. One minute.
Senator Gignac: Thank you.
Senator Smith: Another question for Dr. Siqueira. You noted that currently dental schools have capacity to accommodate about 300,000 to 350,000 patients. The program increases demand for dental services. Will dental schools be prepared to absorb it, especially in the rural and remote areas? We haven’t talked about that. Can you also speak to the quality of dental services and dental schools as compared to private clinics?
Dr. Siqueira: Absolutely. Thank you. As I mentioned before, at the moment, we see around 350,000 to 370,000 patient visits per year. We have the capacity to duplicate this with the resources.
Yes, this is another concern that all the dental schools have that the rural and remote areas that, as you know, is very difficult in these communities, especially Indigenous communities, that live in the rural and remote areas to attract dentists to provide service there.
I can give you an example from Saskatchewan. In the north of Saskatchewan, basically 80% of dental care is provided by our dental school clinics.
Senator Smith: Is there an opportunity to create the eleventh dental school in one of the three territories in the North? When is that going to happen? Because it makes it more difficult for us to have a national program that covers the vast majority of our population.
Dr. Siqueira: Thank you very much. It’s not my mandate here to advocate for one more dental school, but I think we need more dental schools distributed across the country.
I would like to highlight for you and the senators, a project that we are going to initiate in August 2023. That is the dental therapist program. Basically, this program will be — classrooms will be online and the clinics will be satellite clinics with a very minimal number of staff and faculty members in each satellite clinic. This can be expanded not just here in Saskatchewan but also expanded for the territories and other parts of the country without duplicating resources.
Senator Yussuff: Very quickly given the limitations of time, I do have one question as a result of something that was raised earlier in regard to the housing allowance.
There was an amendment to the bill that certainly will increase the housing allowance — not increasing but also the charge from 75% to 90% for room and board payments. This was an amendment made by the NDP, and it was added to the bill.
Dr. Whitzman, I want to ask if you see that as a positive development, recognizing some of the points you made earlier in your intervention.
Ms. Whitzman: I think that my colleague, Ms. Kapoor, is going to respond.
Ms. Talwar Kapoor: Thank you, senator, for your question. Based on our reading of the bill, the way that the text of the bill is written is that it appears that it would be more difficult for people who live in multi-tenant dwellings or households to qualify. So, for example, if a tenant had a $400 rental rate per month in a private dwelling, the qualifying income for that amount per the other guidelines of this rental supplement would mean that somebody needs $1,200 in income to qualify. But at 75% of $400, that would mean that $300 of this multi-tenant housing rent is being taken into account, which would lower the qualifying income to $900.
The spirit might be in trying to maybe expand eligibility for people who live in this deeply affordable housing, but based on the text, it actually sounds like it’s more constrained and that tenants who live in rooming houses or boarding rooms would have to have lower qualifying incomes to be eligible for the benefit.
Senator Yussuff: Dr. Siqueira, in regard to the points you were making about access to your dental schools, you’re not suggesting we limit lower-income Canadian families to simply going to your school to access benefits? Obviously, we want them to access dental care and dental hygiene wherever they can, of course, get that service, but equally I do recognize there is a significant cost from your dental schools and private clinics, but we do want to ensure that Canadians have access to these services regardless of where they might be available.
Dr. Siqueira: Absolutely, senator. I am advocating here only for the 10 dental schools to be part of this great initiative.
Senator Loffreda: I have a question for Dr. Siqueira, but before doing so, I’m curious and interested and would like to receive a report in writing from the National Right to Housing Network, which has a goal to eradicate homelessness and to share some insights, proposals and reports in writing on how to do so, and further comment on what would have been more effective than the current Bill C-31. Because Dr. Whitzman did suggest during a question from Senator Pate that she had a lot to offer. So I would be interested, if we don’t cover some points here, to have that in writing. Thank you for that.
Dr. Siqueira, you did mention that Bill C-31 would compromise the education of students and quality of candidates, and it will put at risk the integration of international students. Do you think that Canadian universities should modify their recruitment strategy going forward with respect to the balance between Canadian students and international students?
I say that because I do know — having sat on the board of a major Canadian university — that international students are a significant part of their budget. There’s also a statistic that says that 50% of international university graduates don’t file Canadian tax returns. So we are not retaining 50% of those students.
So in order to increase capacity, which is a concern, to retain the quality of service that we do have and that Canadians deserve, do you feel that Canadian universities should change that balance going forward?
Dr. Siqueira: Thank you, senator, for your question. I think that, yes, this should be very well studied, and in one minute it would be very difficult to answer your question.
I’m also in support of having international students in the universities because we need to increase the diversity, inclusion and expertise that the international students and scholars bring to Canada.
Senator Loffreda: So you feel the capacity going forward, changing the balance between Canadian students and international students is not the solution. You would retain the balance that is present there right now?
Dr. Siqueira: In terms of the dental schools, we have a minimal number of international students. After graduating, to get a licence to work in Canada, you basically need to be a Canadian citizen or permanent resident. In our dental school, we limit the number of international students to 10%. The same thing applies across Canada.
What I’m saying in my talk is we have internationally trained dentists who graduate from dental schools outside of Canada, they immigrate to Canada and are now permanent residents or Canadian citizens, but they cannot work as dentists in Canada. These dental schools can help this group of people with gap training of one or two years to allow these people, who are well trained in other countries, to become qualified to work as dentists in Canada. This is what I would like to advocate as another important aspect.
Senator Loffreda: Thank you.
[Translation]
Senator Dagenais: I’ll keep this brief. I don’t want to make you cringe.
Dr. Siqueira, can you give us a picture of the speed of care offered in the university setting and that offered in private clinics? My question is about the speed of care and the frequency of appointments for a child, because I sincerely think that the government should have a modicum of efficiency in its bill.
[English]
Dr. Siqueira: Thank you very much. The quality of the dental schools and private dental offices is absolutely the same because all the dentists in the dental offices graduated from our dental schools here, and we have a very high standard.
In terms of making an appointment, it’s absolutely fast. We don’t have big wait times for appointments, so if you have a kid who needs to be seen today, we can see them in our dental schools tomorrow. That is not a big issue.
Senator Bovey: I’m still on the dental question, if I may. I’m well aware that some of the treatments that children need are done better in hospitals and emergency rooms.
Can you tell me how quickly a child can be admitted to hospital from a dental school for that service, whether it’s facial surgery or more, versus a private clinic? Will this funding assist in those situations?
Dr. Siqueira: Thank you very much for your question, senator.
Yes, you highlight a very important point here. Some procedures for kids or for adults need to be done in the operating rooms of hospitals, which will take a little more time. It doesn’t depend on the dental schools but on the provincial government, health care system and appointment availability. That is similar to a private dental office. Private dental offices don’t have operating rooms, which means these procedures need to go through the health care system.
Senator Bovey: Thank you.
Senator Pate: I’d like to come back to Dr. Whitzman and Ms. Kapoor. I’m curious as to what recommendations you would make to the government in terms of national standards with respect to not just this initiative but the broader economic initiatives that you spoke to.
Second, do you see some measures that could be introduced in this bill to prevent some of the clawbacks that we’ve seen in the ways that provinces have benefited from the resources paid out by the worker benefits and the emergency response benefit? Can you see some mechanisms that could be put in place to improve this bill?
Ms. Whitzman: Excellent questions, Senator Pate. I’ll start and then I’ll hand it over to Ms. Kapoor.
I think that just as there are national standards related to long-term care and to primary and secondary education, there needs to be national standards related to housing which ensure that there isn’t a clawback. One of these has to do with better rent controls at this particular time when there are very low vacancy rates. I’m not saying there doesn’t need to be much greater rental supply; there does.
It would be a shame to see this kind of benefit cut back in terms of short- or long-term rent changes, which can sometimes happen easily in unlicensed rooming houses, just to give that specific example.
I’m now going to pass it on to Ms. Kapoor because I know there’s only a minute.
Ms. Talwar Kapoor: Thanks so much, Dr. Whitzman. Thank you, senator, for your question.
More specifically on housing, I would say that the right-to-housing framework offers us security of tenure, safety, adequacy and affordability as some of those standards.
More broadly on social policy, I would say the ways in which the federal government works with provincial and territorial governments can lean on what happens through the Canada Health Transfer, or CHT. So we know for provincial and territorial governments to have access to funding for health care, they must meet the five principles of the Canada Health Act.
I’d say that some unpublished work that I have on how much the Canada Social Transfer, or CST, would need to increase to be at the same proportional level as the CHT when it was first introduced in 2008 suggests that billions more in CST funding would need to come online, not to replace CHT funding but actually to keep the same proportional amounts that we had back in 2008. If this money were to come online, I would suggest that adequacy continue to be the standard and that people not be at 40% of the market basket measure, which is the case for many people receiving social assistance.
I would also suggest preventing clawbacks because often people are people; they don’t operate in the silos and the different orders of government and departments that governments operate in. I think that limiting clawbacks would be another standard.
The Chair: Thank you, Ms. Kapoor.
[Translation]
Senator Galvez: I would like to ask the same question I asked at the last meeting.
[English]
Professor Siqueira, with the high cost of dental treatments, $650 will not pay for much, depending on the size of the restoration needed. As you have already pointed out, it might cover an exam, X-ray and a couple of restorations per child.
Can you tell us what the typical cost of dental care for a child is?
Dr. Siqueira: Thank you, senator. That is a very difficult question to answer, the typical cost of dental care for a child, because it depends on the treatment. I can say that $290 to $650 is not enough to provide comprehensive dental care for a child, specifically the clientele who come to the dental schools. As I said, they don’t come with just one cavity; they come with three to five cavities and other oral health conditions that need to be solved. It’s difficult to give you a number. That is because it is case by case, but $290 is not enough to cover oral health care.
Senator Galvez: Thank you.
The Chair: Before we adjourn, honourable senators, there are a couple of minutes left. I will ask Senator Duncan and Senator Boehm if they have questions in order to ask the witnesses to send their answers in writing.
Senator Duncan: I’ll be very quick. My question is for Dr. Siqueira.
Have you examined the government’s recent announcement in these discussions that the billing process for the $650 credit would be similar to the non-insured health benefits process and their schedule of services? If Dr. Siqueira could answer in writing if the dental community has had a look at that scale of services and if he has any recommendations for us.
Senator Boehm: I just wanted to come back to a question that Senator Marshall asked at the very beginning of today’s meeting and just a final word on whether the one-time $500 payment to eligible renters is really not much more than just a drop in the bucket? Thank you.
The Chair: Honourable senators, this is the end of our time. To the witnesses, thank you very much for appearing today. Your testimony has been very much appreciated and very informative. I would ask the witnesses to please submit your written answers by the end of the day on Wednesday, November 9, 2022.
Honourable senators, our next meeting will be tomorrow, Wednesday, November 2 at 6:45 p.m., to continue our study on the subject matter of Bill C-31 and to hear from three ministers, Minister Jean-Yves Duclos, Minister of Health; Minister Ahmed Hussen, Minister of Housing and Diversity and Inclusion; and Minister Diane Lebouthillier, Minister of National Revenue of Canada.
Once again, I would like to thank the entire support staff for this committee, those in the room, as well as those behind the scenes who are not visible. Thank you for all your work which permits us to do our work as senators.
(The committee adjourned.)