Hon. Raymonde Gagné (Legislative Deputy to the Government Representative in the Senate): Esteemed colleagues, when we adjourned yesterday I was about to conclude my speech. I simply wanted to remind you, one more time, that GC InfoBase is available for you to consult online. It makes it possible for parliamentarians and Canadians to access information on the estimates and other government financial and performance data.

I appreciate your attention. Thank you. Meegwetch.

Hon. Kim Pate: Honourable senators, a substantial amount of the spending in Bill C-15 and the Supplementary Estimates (C) concerns Canada’s ongoing response to the COVID-19 pandemic. Yet again, we must reckon with the significantly worse health outcomes faced by low-income Canadians both prior to and during the pandemic.

Data from the Public Health Agency of Canada underscores that those with the least have been twice as likely as those most well off to die of COVID-19. The Public Health Agency links this horrific disparity to social and economic inequalities faced by people below the poverty line — from greater risk of underlying and disabling health conditions and lack of safe housing, to unsafe working conditions and not being able to afford to stay home from front-line gig work or minimum wage jobs.

In human, social and health terms, these unequal health outcomes are unconscionable. They also carry significant financial consequences. As the Parliamentary Budget Officer reminded the National Finance Committee during his testimony on the Supplementary Estimates (C), the financial burden includes:

. . . first, the costs on the individuals themselves by being prevented from working due to poorer health outcomes. . . . it reduces income and employment gains, and it also reduces attachment to the workforce. . . . individuals with poorer health outcomes tend to have weaker social networks, which can lead to further isolation . . . They often have to incur additional expenses: medication, drugs, supports, at-home supports and others.

There are also costs that have to be borne by society. . . . If people with poorer health outcomes have to withdraw from the labour force, that imposes costs on each and every one of us when jobs go unfilled.

There are also the costs of treating people. Those costs would be lower if they had better health outcomes in the first place. It is much more expensive to treat diseases and illnesses than it is to prevent them, generally speaking.

The most significant spending measure in Bill C-15 arises from the need to treat the results of health inequalities that we have neglectfully failed to prevent. Thirty per cent of the spending proposed by the bill — $4 billion — earmarked for procurement and distribution of additional COVID-19 rapid tests is linked specifically to trying to address COVID-19 risk among so-called vulnerable groups.

At the National Finance Committee, the Public Health Agency of Canada identified these populations as including groups such as Indigenous peoples, those of African descent, other racialized populations, those with disabilities, front-line service providers and essential workers. The committee had the opportunity to ask government officials whether these latest proposed measures are projected to close the gap in COVID-19 mortality for Canadians who have the least. Particularly, we asked how they would compare to income support measures that might have addressed underlying inequalities and allowed people to afford measures, from PPE to physical distancing, necessary to better protect themselves, their families and communities during the pandemic.

We also asked about the portion of pandemic spending, from the cost of PPE to vaccinations to mental health supports and so many other measures, related to the need to respond to emergency health situations created by social and economic inequalities that predated and were exacerbated by COVID-19.

In response, the Public Health Agency acknowledged its own previous research revealed “robust associations between income and health in Canada” and that “the direct economic burden of health inequities on health care costs is substantial.”

In 2016 alone, socio-economic inequalities cost at least $6.2 billion annually, or over 14% of total expenditures on acute care in-patient hospitalizations, prescription medication and physician consultations.

The Public Health Agency also indicated, however, that it had not conducted health policy modelling studies to determine the effects on pandemic spending and health outcomes if measures such as robust income supports had been in place to try and redress pre-existing inequalities for those most at risk of COVID.

We could find no department that has conducted such analyses. The failure of the government to provide this type of assessment results in a massive gap and wholly inadequate ability to plan, much less prepare for, future challenges. It thus significantly erodes confidence in the foundation upon which the Canadian health, social and economic policy decisions are being made. When policy is debated in Canada, whether here in Parliament, around kitchen tables, in the metaverse or on the streets, many are acutely aware of the consequences of the continued reaction to emergencies.

Too often, though, the real cost of failing to take proactive, preventative action is not in the balance when we weigh the challenges of decades of inaction. Instead, focus is zeroed in on the initial costs of bold measures to address poverty and inequality — from guaranteed livable basic income to housing strategies, disability benefits, universal mental health care, pharmacare, dental care, child care and education.

Too rarely do we consider the costs of failing to act, the costs we are repeatedly being asked to approve in order to patch some but not all of the wounds and not for everyone.

Poverty and related inequalities cost Canadian taxpayers tens of billions of dollars every year, particularly in emergency health care measures, the criminal legal system and responses like shelters or food banks that dangle the hope of survival while reminding people that they are constantly on the brink of crisis.

These are the hidden costs of policies characterized as pursuing fiscal prudence but which do not reach everyone in need or fail to provide enough support and further stretch social and health systems that already leave too many people behind. Much worse than financial cost, as we have seen during the pandemic, failure to redress these inequalities also costs lives.

I want to urge therefore that we recognize many of the measures in this bill as not only vital to COVID-19 responses but also the costs that Canadians continue to pay as a result of our country’s failure to shore up health and social safety nets, to redress social, health and economic inequality and, particularly, to work to support people in finding pathways out of poverty.

The costs of our inaction need to factor into how we analyze and evaluate government spending. They must also push us to consider how resources can be invested differently to bring about healthier, more just and equal communities for all of us. Meegwetch, thank you.

Senator Marshall: I think the government should look at earlier tabling of some of the documents, like the Main Estimates and the supplementary estimates. I think they should also look at the possibility of doing pre-study on some of the bills that are over in the House of Commons. For example, Bill C-8 is over there now. I expect the National Finance Committee will get it. It’s a very complicated piece of legislation, but its arrival, I expect, will coincide with our study of Main Estimates, and possibly Supplementary Estimates (A). I would like to see more time given to the pre-study.

I’d also like to see more frequent meetings. I find that the pandemic has had a terrible effect on the National Finance Committee. One meeting a week is not sufficient. We should go back to our two time slots, and we should also have the ability to have those extra meetings when the Senate sits.

Senator Marshall: No, it’s not because of COVID. It might have intensified with COVID because some of the COVID spending was statutory. However, it has always existed, and I think I have spoken about the issue in the Senate a number of times. In fact, I have drafted a letter — it’s not quite ready to go; I’m waiting for the translation to be done — asking that the National Finance Committee undertake a review of the spending of this $308 billion. My concern is that perhaps the members of the Finance Committee think that all the spending is in the Main Estimates and supplementary estimates, and that’s not correct. There is a lot of spending outside that process, and members of the committee should be aware of it. We should be tracking it, providing oversight and making our colleagues in the Senate aware of it.