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National Strategy for Eye Care Bill

Second Reading--Debate Continued

May 28, 2024

Honourable senators, I am pleased to speak in support of Bill C-284, An Act to establish a national strategy for eye care. There are currently 1.2 million Canadians living with vision loss and more than 8 million living with an eye disease that could lead to blindness.

This is an issue that affects Canadians of all ages. Indeed, my own father is one of them. His lack of access to preventative information and therefore to early intervention left him with an advanced state of macular degeneration, which prematurely robbed him of the joys of reading, videotaping family events — the latter perhaps not so missed by some members of the family — and denied this man, who drove for a living, the freedom of driving himself, including to pursue his favourite pastime: purchasing second-hand garden furniture and equipment.

How his family misses that freedom too. We each dread the call to retrieve and deliver another table, mower, swing or heaven-knows-what, which rarely fits in our vehicles and involves scenes of Clampett-style transportation all over the Ottawa River Valley. You get the picture, but I digress.

Increasingly frequent screen time is impacting the eye health of young people. Canada’s aging population also faces particular and increased risks of vision loss and blindness. For these reasons, it is more crucial than ever that we make vision care accessible and affordable in Canada. The implementation of a national strategy must be a priority.

Despite this country’s medicare system, access to eye care services is an out-of-pocket expense for most Canadians. Most provincial coverage only includes medically necessary eye care services, and routine eye examinations are not universally available. Only 55% of Canadians have private insurance eye care coverage. Those with the least amount of coverage include newcomers, at 47.3%; those who are racialized, at 49.3%; and seniors. In fact, despite the increased needs and risks that older Canadians face, only one in three have private coverage.

Public health promotion of eye health is sparse and sporadic. This increases risks of harm that could otherwise often be prevented by early detection and exacts greater human and fiscal tolls due to resulting requirements for more expensive remedial treatment and rehabilitation costs.

Age-related macular degeneration, or AMD, can significantly impact day-to-day tasks, such as reading or driving, and is the leading cause of vision loss and blindness in Canadians over the age of 55. Although, as the name implies, AMD is certainly age‑related, the risk of developing it can be reduced by precautionary measures and early detection via regular eye exams.

Access to eye care specialists is far from equal across the country, especially when it comes to rural and Indigenous communities. The Canadian Association of Optometrists rightly insists the lack of equitable access to vision care for Indigenous peoples is a pressing public health issue. According to Statistics Canada, Indigenous people are less likely to visit an eye care professional. In fact, one third of Indigenous people have not had an eye examination within the last two years. Too many Indigenous people face multiple barriers to accessing these services, including lack of transportation, financial constraints and overall abysmal investment by Canada in support of adequate health care on reserves.

First Nations people who live on a reserve also have the highest rates of diabetes in Canada. Over the last 20 years, there has been a 20% increase in the number of Indigenous people living with diabetes. You may be wondering what that has to do with this bill.

Diabetes comes with an increased risk of diabetic retinopathy, which can lead to vision loss. It is the most common eye disease correlated with diabetes and costs the health care system about $1.2 billion every year. It is also preventable. Early detection can reduce the risk of vision loss by 95%. How could we not want access to eye care, given the current system’s human, health and financial costs?

The government is failing to meet many of its obligations to Indigenous peoples. When it comes to providing adequate access to vision care, a major component of overall health and well‑being, Canada is behind both the United States and Australia in making these services available for Indigenous peoples.

Canada is failing to meet its obligations under the United Nations Declaration on the Rights of Indigenous Peoples, especially Articles 21, 23, 24.2 and 29.3. These articles outline the government’s obligations to provide “. . . the highest attainable standard of physical and mental health. . . .” and ensure that programs to maintain and restore the health of Indigenous peoples are implemented.

This gap in care also fails to meet the terms of Truth and Reconciliation Commission Call to Action 19, which calls on the federal government to “. . . establish measurable goals to identify and close the gaps in health outcomes . . . .” Call for Justice 3.2 of the National Inquiry into Missing and Murdered Indigenous Women and Girls similarly calls upon the government to “. . . ensure that health and wellness services are available and accessible within Indigenous communities . . .” so that they are not forced to relocate in order to access treatment.

This national strategy framework, particularly the requirements for consultations with Indigenous peoples, can and must result in Canada working nation-to-nation with Indigenous governments and in support of improved access to eye care for Indigenous peoples. This work must also address the impacts of this strategy on First Nations and Inuit communities under the Non-Insured Health Benefits Program.

The national strategy must also consider and address the limited number of optometrists in Canada, given that there are currently only two schools of optometry in the country: one in Waterloo and one in Montreal.

The benefits of eye care extend far beyond the health system. Vision impairment is correlated with increased social isolation, lower community involvement and strain on caregivers. Investing in a national strategy for eye care benefits everyone as improved vision for Canadians means increased educational opportunities, improved employment rates and a boost in productivity and economic growth.

In 2019, vision loss resulted in $32.9 billion in costs for Canada. Direct health system costs of $9.5 billion included costs associated with hospitals, surgeries, services provided by ophthalmologists, optometrists or opticians, pharmaceuticals and eyewear. Costs relating to reduced productivity at work, loss of future earnings and loss of caregivers’ income added up to an additional $6.1 billion. Lost well-being resulted in costs of $17.4 billion. If nothing changes, the cost of vision loss in Canada is expected to grow to $56 billion in 2050.

In these challenging economic times, too many are struggling to access housing, food, health care and other essentials. Leaving people to struggle is not only morally wrong but also fiscally irresponsible. It creates preventable and costly crises within the health care system and countless other sectors.

Bill C-284 is yet another representation of the simple yet too often overlooked fact that all of us stand to benefit — socially, financially and in terms of health — when we ensure that no one is left behind and in need.

A national eye care strategy can help to strengthen Canada’s social safety net as we work toward national, universal single‑payer pharmacare, an adequately funded Canada disability benefit, a national guaranteed livable income and countless other policies that enhance equality and point the way to a future where no one’s health is contingent on how much money they have in their bank account.

Action must be taken to determine and implement the policies necessary to ensure adequate eye care access across Canada. Creating a national strategy for eye care is an important step toward ensuring prevention and early detection and toward upholding health as a human right.

Thank you, Senator Ravalia and member of Parliament Judy Sgro, for your leadership in this regard. Meegwetch. Thank you.

Hon. Victor Oh [ + ]

Honourable senators, I stand today to speak to Bill C-284, An Act to establish a national strategy for eye care, sponsored in the Senate by our honourable colleague Senator Mohamed-Iqbal Ravalia, and in the other place by the Honourable Judy Sgro of Humber River—Black Creek.

First, I would like to acknowledge this bill intends to ensure access to quality eye care for all Canadians. It also aims to designate a month to raise awareness of age-related macular degeneration. Through this awareness, Bill C-284 also emphasizes the importance of promoting research and improving data collection on eye disease prevention and treatment, improving eye care advancements.

The major eye conditions affecting millions of Canadians and disproportionately impacting our aging population include macular degeneration, cataracts, glaucoma and diabetic retinopathy.

Macular degeneration impacts around 2.5 million Canadians. Increasing awareness and promoting preventive measures can significantly reduce its prevalence. Cataracts, which are the leading cause of vision loss, can be effectively treated with modern surgical techniques. Glaucoma, often undiagnosed due to a lack of early symptoms, requires increased public awareness and regular screenings.

There are more than 8 million Canadians who have one of these four common eye diseases and are at high risk of losing their vision. According to the Canadian Association of Optometrists, “. . . 1 in 3 Canadian adults have not sought vision care or purchased corrective lenses due to cost,” and 75% of vision loss is preventable or treatable through proper preventative measures.

This is a shocking statistic. In 2019, vision loss cost the Canadian economy $32.9 billion. Vision health is fundamental to nearly every aspect of our daily life. This includes everything from reading and driving to working and participating in activities. Vision loss can profoundly impact a person’s quality of life, reduce independence and increase the risk of accidents. It can also contribute to social isolation and depression.

Colleagues, I don’t need to stress how important vision health is for Canadians. Bill C-284 aims to alleviate the hurdles many Canadians face in their access to quality eye care. We must ensure that Bill C-284 doesn’t fall short in key areas, such as ensuring fiscal responsibility and transparency and providing a clear, actionable strategy for raising public awareness and ensuring accessibility to eye care for all Canadians, particularly those in remote and underserved communities.

It is imperative that this bill address the regional disparities and inequitable access that many remote and underserved communities often face. It is imperative that a national framework bridge this gap and ensure that all Canadians, whether in urban centres or rural areas, will benefit equally.

It is also important that this bill respect the balance of federal and provincial roles and that the federal government do not encroach on provincial authority. Collaboration with the provinces and territories is vital to avoid duplication of efforts and ensure the smooth implementation of the framework.

Further collaboration between the federal government and vision experts in the private sector, such as ophthalmologists, optometrists and researchers, is also important so that evidence‑based strategies are developed. This ensures that a comprehensive and effective approach is developed and addresses the needs of Canadians.

A framework is essential for monitoring and evaluating the impact of Bill C-284 so that its success can be measured accurately and areas of improvement can be identified.

In conclusion, Bill C-284 addresses an important public health issue and provides the opportunity for better accessibility to eye care services, protecting and enhancing the vision health of Canadians. Establishing a framework to monitor and evaluate the data and research and having a clear strategy for public awareness are vital steps toward improving this health sector in Canada and benefiting our citizens.

Thank you.

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