Hon. Mohamed-Iqbal Ravalia moved second reading of Bill C-284, An Act to establish a national strategy for eye care.

He said: Honourable senators, it is my pleasure today to speak to you as the sponsor of Bill C-284, An Act to establish a national strategy for eye care, and designate an age-related macular degeneration awareness month.

Our vision allows us to experience the beauty of our world, to connect with others and to navigate the complexities of daily life. However, for too many Canadians, vision care is a luxury. Access to essential vision care services remains a challenge, and it’s one that we must address with both urgency and compassion.

Advances in technology and virtual care have opened pathways in this regard. Vision care is an integral part of a comprehensive health care system, and we should make it a priority to ensure that high-quality vision care is accessible for all.

In my clinical practice, I have witnessed the tragic sequelae of preventable ocular diseases in many instances purely on the basis of a lack of access or affordability. Vision impairment, whether through experiencing visual challenges or requiring assistance such as glasses, contacts or other aids, has touched the lives of virtually everyone either directly or through loved ones.

Before I begin, I want to express my gratitude to MP Judy Sgro, who has championed the efforts towards a strategy for vision care in the other place and has been a national advocate for people with age-related macular degeneration and various vision health issues.

I also applaud the careful thought and consideration of my members on the Standing Committee on Health in the other place. This past spring, members carefully studied this bill and helped maintain the federal and provincial jurisdictional limits on health care, professional training and guidelines. This bill passed with resounding unanimity, underscoring the collective recognition of the importance of vision care in our society.

We are presented with a unique opportunity to champion a cause that touches the lives of individuals, families and communities across our country.

The vision loss crisis in Canada requires a coordinated response, and this is what the national eye care strategy is all about. Over 8 million Canadians — or one in five — have an eye disease. There are 1.2 million Canadians who live with vision loss or blindness. There were over 1,200 deaths associated with vision loss in 2019 alone.

Meanwhile, 75% of vision loss cases can be prevented if patients are diagnosed early and have access to treatment.

Colleagues, the need for a national strategy is necessary to address the gaps and inconsistencies in access and delivery of vision care across the country. As we know, with our 10 provinces and 3 territories, it can feel like we sometimes have 13 separate health care silos or that we’re living in 13 fiefdoms.

Basic eye examinations are not universally covered under provincial health care plans. Some provinces provide coverage for specific groups such as children, seniors or individuals with certain medical conditions. Many Canadians rely on private insurance plans to cover the costs of routine eye exams, glasses and contact lenses. But even with private insurance, there might still be out-of-pocket expenses for vision care, especially for individuals who have no coverage. The cost of eyeglasses, contact lenses and certain eye treatments can be a significant barrier for Canadians accessing the necessary care.

Accessibility also depends on where you live, with urban areas generally having better access to eye care facilities than rural or remote ones. Practically speaking, this can impact the ability of individuals to access preventative care and may contribute to delayed diagnosis and treatment of eye conditions. By detecting these early, the health care system can avoid the costs associated with advanced treatments and complications.

The challenges associated with the delivery of vision care services have been exacerbated by COVID with many Canadians missing regular eye appointments, surgeries and other treatment plans, increasing the risk of more complications.

Vision loss has a profound impact on individuals, their families and society, costing our economy an estimated $32.9 billion a year. Of this cost, $4.2 billion is attributed to reduced productivity in the workplace. Over half the cost — $17.4 billion — is attributed to the reduced quality of life, which is primarily due to a loss of independence, especially in our aging demographic. Over $983 million was spent last year across Canada on injections to treat macular degeneration.

Losing one’s vision increases mental, financial and social hardship. It can lead to a loss of mobility, an inability to live independently, to drive, to read or to participate in physical activity. It can result in the loss of social interaction, which can often lead to loneliness, isolation and the mental sequelae thereof. A national strategy can promote cost-effective and efficient use of health care resources and dollars to help combat vision loss across the country.

The bill before us today is straightforward. It calls for the Minister of Health in consultation with representatives of provincial governments responsible for health, Indigenous groups and other relevant stakeholders, including health care researchers and practitioners, to develop a national strategy to support the prevention and treatment of eye disease as well as the vision rehabilitation plan to ensure better health care outcomes for all.

It outlines the strategy that encompasses preventive care, early detection, treatment and accessibility. The strategy would aim to raise awareness of the impact of vision loss and blindness, improve eye health care and support and foster innovative research to advance new therapies for vision loss and rehabilitation. The bill is also calling on enhanced access to eye health care for Indigenous people.

While there are benchmarks, including timelines, by design, it is not overly prescriptive in what the strategy should entail. The government must be allowed the flexibility to respect the consultative process of this legislation. This legislation would ensure a coordinated national strategy aimed at ensuring Canadians have access to vision care regardless of where they live.

It also recognizes Canadians’ experiences and struggles with age-related macular designation through a designation of February as age-related macular degeneration awareness month.

Age-related macular degeneration is a condition that affects many Canadians over the age of 55 and is the leading cause of blindness among these Canadians. I know that many of us are in this demographic.

This condition affects the central vision, which is the most important part of an individual’s eyesight. It is a progressive condition that leads to vision loss and may increase the risks of other health concerns such as anxiety, depression and progression to dementia.

As our population ages, we must be vigilant in promoting awareness around age-related macular degeneration, increasing accessibility to currently available treatments and supporting the necessary research for developing new treatments needed by many Canadians across our provinces and territories.

We have the opportunity to be one of the global leaders in the delivery of vision care. We can draw from strong examples in other nations for service delivery and accessibility in vision care. While we know that there is no one-size-fits-all model for the delivery of care across different countries, the strategy will examine existing strategies, frameworks and best practices, as well as lessons learned from other jurisdictions.

Honourable colleagues, a national strategy would address the wide inconsistencies in access to care; work to prevent and slow the progression of vision loss, where possible; help us tailor services to the needs of all Canadians in a culturally appropriate manner; and allow us to foster research and innovation to better inform policy-makers on this issue.

This bill is important to millions of Canadians and is long overdue. Let us acknowledge the tireless effort of health care professionals, advocacy groups and individuals who have championed this cause and called for federal leadership. Their commitment to the well-being of Canadians deserves our utmost respect and support.

Making eye health and vision care a health priority requires all of our support. Colleagues, we can work together to ensure that 1.5 million Canadians with sight loss are provided with the necessary supports and the opportunity to live productive, healthy lives. Meegwetch. Thank you.

Hon. Mohamed-Iqbal Ravalia moved the adoption of the report.

(On motion of Senator Housakos, debate adjourned.)

[English]

On the Order:

Resuming debate on the motion of the Honourable Senator Pate, seconded by the Honourable Senator Duncan:

That the Standing Senate Committee on National Finance be authorized to examine and report on a road map for post‑pandemic economic and social policy to address the human, social and financial costs of economic marginalization and inequality, when and if the committee is formed;

That, given recent calls for action from Indigenous, provincial, territorial and municipal jurisdictions, the committee examine in particular potential national approaches to interjurisdictional collaboration to implement a guaranteed livable basic income; and

That the committee submit its final report no later than December 31, 2022.

Hon. Mohamed-Iqbal Ravalia: Honourable senators, it is my privilege to rise to speak to Inquiry No. 5, which draws attention to the budget entitled A Made-in-Canada Plan: Strong Middle Class, Affordable Economy, Healthy Future.

In response to an increase of police-reported hate crimes, including the hate faced by 2SLGBTQI+ communities, Budget 2023 has included plans to introduce a new action plan to combat hate in this country.

We live in a time of increased polarization, with the rise in hateful messages and misinformation targeting many, but in particular our queer and trans communities, fostering fear and isolation. The federal government recognizes this, and steps have been taken, including the development and implementation of the 2SLGBTQI+ plan. The plan in 2022 helped advance equality and the rights of community members throughout Canada and is helping several queer and trans organizations and communities across the country build resilience in the wake of increasing hate.

Just this past August, in my home province of Newfoundland and Labrador, the federal government announced funding through the action plan to two local organizations, First Light St. John’s Friendship Centre and the Quadrangle LGBTQ Community Centre, whose respective goals are to support, among others, Indigenous women and 2SLGBTQI+ communities. The projects receiving support are focused on ending gender-based violence and providing affirming health care.

The 2SLGBTQI+ communities contribute immeasurably to Newfoundland’s cultural fabric, arts and business communities. They are our friends. They are our family. They are our neighbours. They continue to play a leading and ongoing role in the broader movement for their rights and acceptance in our country through advocacy, education and visibility. Colleagues, we must stand by them.

In May, the Newfoundland and Labrador Queer Research Initiative launched a collection of rare documents and photographs detailing the province’s LGBTQ+ past. With credit to Sarah Worthman, the non-profit’s Executive Director, the new archive tells the hidden stories of gay, lesbian, bisexual and gender-diverse Newfoundlanders and Labradorians throughout our history. As Ms. Worthman eloquently stated in an interview, “. . . it’s much harder to hate on someone that you know as opposed to someone that you don’t.”

In my own career, I have witnessed the devastating impacts on the mental health of 2SLGBTQI students — students who are stigmatized by name-calling, microaggressions, marginalizations, exclusion and sometimes violence.

The implementation of this plan to combat hate is an essential next step to continue on the progress that we’ve made. This plan signifies a continuing commitment to tackling the systemic issues that have perpetuated discrimination and violence against these communities. It recognizes that in order to secure a prosperous future for all Canadians, we must confront the hatred and prejudice that undermine our values of equality, diversity and inclusivity.

The significance of this plan extends far beyond its immediate impact on hate crimes. It goes to the heart of what we stand for as Canadians — a nation that values the dignity and worth of every individual, regardless of who they are or whom they love. By addressing hate, we are not only helping safeguard the lives of 2SLGBTQI+ Canadians, but also reinforcing our commitment to building a society where everyone has an equal opportunity to thrive.

Honourable senators, I look forward to seeing the development and implementation of this plan with specific measures to combat hate as we move towards a more equitable, inclusive and, hopefully, prosperous future for our 2SLGBTQI communities and other marginalized groups. A prosperous future in the truest sense is one where every Canadian can live their lives authentically without the fear of discrimination or violence.

Thank you, meegwetch.

Hon. Mohamed-Iqbal Ravalia: Honourable senators, it is my pleasure to rise today to speak to the inquiry initiated by Senator Woo. The purpose is twofold: to celebrate the invaluable contributions that Chinese Canadians have made but also to reflect on the prejudice, exclusion and discrimination that Canadians of Chinese descent have faced and continue to face.

I would like to thank Senators Jaffer, McCallum, Simons, Oh and Kutcher for speaking to this important matter — and, of course, to our speakers today as well.

The contributions of the Chinese community in Newfoundland and Labrador are a significant but often overlooked aspect of our province’s history. The Chinese community has played — and continues to play — a vital role in shaping our cultural, economic and social fabric.

The first Chinese immigrants arrived in Newfoundland in the 1890s, and word spread throughout St. John’s that two Chinese immigrants would be opening a laundry business. Over the next few decades, the city and the province would continue to attract Chinese immigrants.

Colleagues, this was at a time when Newfoundland’s population was almost entirely White, Christian and English-speaking. In 1906, the province had legislation — the Act Respecting the Immigration of Chinese Persons — that imposed a $300 head tax on each Chinese immigrant entering the colony. This equalled between one and three years’ earnings and was a significant barrier to entry for Chinese immigrants. Despite the challenges and prejudice faced by Chinese Newfoundlanders, their perseverance and strength as a community remained remarkable, and their contributions to our society and growth continued to be exceptional.

In the 1920s, the Chinese community turned towards opening restaurants and is now credited with helping build the dining-out culture in our province. Early Chinese restaurants served foods Newfoundlanders knew about and loved, like fish and chips and roast chicken. Despite this, Chinese immigrants maintained their traditional cuisine at home and faced the challenges of sourcing traditional ingredients. In downtown St. John’s in 1968, Mary Jane’s was the first health food store to carry some Chinese groceries. Today, there are multiple grocery stores in St. John’s as the community continues to grow and thrive.

When Newfoundland joined Confederation in 1949, the Chinese head tax came to an end. With changes to immigration policy in 1967, Chinese immigrants to Newfoundland and Labrador became more diversified in their professions, backgrounds and practices, including health, science, engineering, mining and the fishing industry.

In 1976, The Chinese Association of Newfoundland & Labrador was established to promote Chinese culture and tradition throughout our province and nurture communities in preserving and celebrating Chinese heritage. The association is operated by volunteers who organize and promote events, including Chinese New Year celebrations, performances and memorial services. In 1981, the association, along with their community partners, erected a memorial in Mount Pleasant Cemetery in St. John’s to honour the Chinese immigrant community in Newfoundland from the time of their first arrival in the 1890s.

Elsewhere in St. John’s, a different memorial stands to honour the 300 Chinese men that had to pay the head tax in Newfoundland. This monument was created in 2010 by the Newfoundland and Labrador Head Tax Redress Organization, a group working to educate on and preserve the awareness of this dark chapter in our history. The monument is placed on the site of Saint John’s’ first Chinese hand laundry, which was opened in 1895.

In 2006, the Government of Newfoundland and Labrador made a formal apology for the Chinese head tax, delivered by then‑premier Danny Williams.

Today, our Chinese community is the largest visible minority, representing 1.3% of St. John’s’ population, or approximately 1,500 people. In broader Newfoundland, there are approximately 2,300 people of Chinese ethnicity, making up 0.5% of the population of our province. Despite these seemingly small numbers, the Chinese community in Newfoundland is strong, active and heavily influential.

I’m also proud to say that the growth of Memorial University has been a source for an increase in Chinese immigration to Newfoundland, with students and academics being drawn to the province for their education and for educating us.

Members of the community have continuously brought their traditions to Newfoundland and Labrador and generously shared their culture with the non-Chinese community. Recently, members of the community have brought traditional music to St. John’s audiences with performances featuring the traditional instrument, the guzheng. The YY Guzheng Ensemble has been performing for the St. John’s community and spreading the love for Chinese music throughout the community. The group has 15 members with ages ranging from their early teens to their 70s with a common love for music and tradition.

Honourable senators, despite a dark chapter and the incredible difficulties that the community faced, today they are an integral part of our province’s history. Chinese immigrants and their descendants continue to play a crucial role in our economic, cultural and social development. Their legacy of resilience and determination serves as a testament to the importance of recognizing and addressing historical injustices, like the head tax, while celebrating the rich diversity that makes my beloved province a unique and inclusive place to call home. Thank you, meegwetch.

(On motion of Senator Petitclerc, debate adjourned.)

Hon. Mohamed-Iqbal Ravalia, Joint Chair of the Standing Joint Committee on the Library of Parliament, presented the following report:

Tuesday, June 20, 2023

The Standing Joint Committee on the Library of Parliament has the honour to present its

FIRST REPORT

Your committee recommends to the Senate that it be authorized to assist the Speaker of the Senate and the Speaker of the House of Commons in directing and controlling the Library of Parliament, and that it be authorized to make recommendations to the Speaker of the Senate and the Speaker of the House of Commons regarding the governance of the Library and the proper expenditure of moneys voted by Parliament for the purchase of documents or other articles to be deposited therein.

Your committee recommends:

(a)that its quorum be fixed at six members, provided that each House is represented, and a member from a non-government party or recognized parliamentary group and a member from the government are present, whenever a vote, resolution or other decision is taken; and

(b)that the joint chairs be authorized to hold meetings to receive evidence and to have that evidence published when a quorum is not present, provided that at least three members are present, including a member from a non-government party or recognized parliamentary group and a member from the government, provided that each House is represented.

Your committee further recommends to the Senate that it be empowered to sit during sittings and adjournments of the Senate.

A copy of the relevant Minutes of Proceedings (Meeting No. 1) is tabled in the House of Commons.

Respectfully submitted,

MOHAMED-IQBAL RAVALIA

Joint Chair

Hon. Mohamed-Iqbal Ravalia: Thank you, Your Honour, and let me add my name to the list of congratulations to you. It’s wonderful to see you in the chair.

Honourable senators, I rise today with a deep sense of respect and gratitude as we recognize the remarkable achievements of Dr. Ian Bowmer, who is joining us today. A highly skilled clinician, medical educator, researcher and trailblazing leader, Ian has carved out a career that has influenced an entire generation of medical practitioners.

As an internist, infectious disease specialist and HIV/AIDS care provider and researcher for 40 years, Dr. Bowmer is recognized as an international authority and global expert in this field. He has held several pivotal positions throughout his career. He was elected president of the Royal College of Physicians and Surgeons of Canada in February 2019. Effective March of this year, he accepted the role in an interim position. His resolute and steadfast commitment navigated the Royal College through the turbulent waters of the recent pandemic. Ian has also served as executive director and CEO of the Medical Council of Canada for 11 years, retiring in October 2018. He is the recipient of several honours, including Canada’s One Hundred and Twenty‑Fifth Anniversary of the Confederation of Canada Medal; election to the Royal College of Physicians of London, England; and the Senate One Hundred and Fiftieth Anniversary Medal for contributions to the community — just to name a few.

Beyond his professional accomplishments, Dr. Bowmer is known for his compassion and dedication to serving underserviced communities. He has been actively involved in outreach programs, volunteering his time and expertise to help improve access to health care and reduce health disparities, making a significant impact on the lives of many.

My own career has been profoundly influenced by his vision and support of enhancing rural and remote medicine. Dr. Bowmer is professor emeritus and the former dean of medicine at the Faculty of Medicine at Memorial University. He appointed me to the faculty in 1992, meaning that, yes, he is indeed my former boss and someone who I continue to admire and respect. He laid the foundation for medical training in a longitudinal fashion outside of a tertiary care environment in my province. Ian has a deep passion for the arts and literature, superb culinary skills à la Gordon Ramsay and a truly altruistic and caring persona balanced by a mischievous sense of humour.

My colleagues in this chamber and I applaud you for your many contributions to our home province of Newfoundland and Labrador and to our country and for your global achievements.

Thank you. Meegwetch.

Hon. Mohamed-Iqbal Ravalia: Thank you, minister, for being here today.

Canada is facing an unprecedented shortage of doctors, nurses and many other health professionals. In our home province of Newfoundland and Labrador, our government has recently announced new measures to recruit internationally educated registered nurses, who can fill health care vacancies. Our government has also introduced legislation that will make medical licensing more streamlined.

Recognizing the provincial-federal jurisdictional divide, can you speak to what measures the Government of Canada is taking to help address these critical labour shortages, including in health care but also other sectors?

Hon. Mohamed-Iqbal Ravalia: Honourable senators, my arrival on the Hill, like many of yours, was a vortex of confusion: phone calls, endless meetings, signatures, security screenings, group canvassing and an overwhelming sense of dislocation. On day two, while wandering around in a state of disassociation, Senator MacDonald kindly directed me to my hotel on Kent Street. On my way there, I decided to grab a bite of comfort food — spaghetti and meatballs — from the Bier Markt.

Out of the corner of my eye, I noticed a rather dapper gent making his way towards me. Flowing locks and a bright bow tie reflected in the bright sunshine. “Oh, my god, it’s Eric Clapton,” I thought. You look wonderful tonight. He said, “Hello, senator. I’m Dennis Dawson, one of your colleagues in the chamber. May I join you?”

We spent the next two hours covering a wide array of topics: politics, our role as parliamentarians, the subtleties of the chamber of sober second thought and life in general. The weight of confusion that I was feeling at the time began to dissipate and felt that this moment of serendipity was truly seminal. In the face of my perceived confusion and despair, Dennis had appeared as a compass and beacon in his quiet, unassuming way, a political stalwart who had taken the time to reach out to me with kindness, warmth and camaraderie, his mischievous sense of humour demonstrated repeatedly with a twinkle in those eyes. You held my hand when I most needed an anchor.

In the next chapter of our friendship, I had the privilege to witness his remarkable political skills on the international stage. At an Inter-Parliamentary Union meeting in Serbia, accompanied by Senator Saint-Germain and Senator Ataullahjan, I witnessed Dennis seamlessly navigate the complexities of an international parliamentary gathering where contentious issues were debated, and I marvelled as he expertly navigated these issues with aplomb and clarity. He defined and protected the rights of the LGBTQ2S community, supporting universal health access and minority rights.

His passion for his beloved Quebec and his unwavering Liberal roots have shaped a remarkable career. Dennis, my friend, you have impacted and influenced so many of us in this chamber, and I will always reflect fondly on your kindness and generosity to me personally. I wish you nothing but the best in your next chapter. Our loss will be your beautiful family’s gain.

[Translation]

Good luck, my friend. Thank you. Meegwetch.

Hon. Mohamed-Iqbal Ravalia: Honourable senators, I rise today to recognize the outstanding career of Craig Pollett, CEO of Municipalities Newfoundland and Labrador, as he is set to retire at the end of December.

Formed in 1951, Municipalities Newfoundland and Labrador, or MNL, represents the interests of the growing number of municipal councils in the province, representing nearly 90% of the provincial population.

Throughout Craig’s 21 years of service, MNL has supported small town and urban constituencies to further enable them to respond to the ever-evolving issues raised by residents.

With the support of the hundreds of municipal leaders, including the board of directors of MNL, Craig has enriched the landscape of municipal governance. He has developed MNL into a leading organization for research and advocacy. MNL engages directly with municipalities, including by facilitating workshops and hosting an annual symposium to explore the pressing issues that communities are faced with, such as changing climate and an aging population.

Craig has taken steps to strengthen the municipal legislative framework to give councils more and clearer authority to respond to residents’ concerns. He has strategized how to achieve long‑term sustainability for the province by exploring regionalization. He continues to advocate for governments to amend their waste water systems effluent regulations to allow hundreds of communities to come into compliance. Honourable senators, the Organisation for Economic Co-operation and Development, or OECD, has recognized MNL’s regional economic development work as a best practice.

Craig gives his deepest thanks to his family for their support, specifically his parents, Earl and Ruth Pollett, his partner, Gail, and his children, Grace and Abby.

Colleagues, healthy and sustainable communities are the building blocks of a prosperous province and country. Please join me in thanking Craig for his tremendous accomplishments, and for directly helping to support our vibrant communities that we all know and love on our beautiful rock of Newfoundland and Labrador. We wish you all the best in your next chapter, sir.

Thank you, wela’lioq.

Hon. Mohamed-Iqbal Ravalia: A pleasure to see you, minister, and thank you for being here today.

My question today is regarding health in general and fetal alcohol spectrum disorder, or FASD, which is a diagnostic term used to describe the broad spectrum of presentations and disabilities resulting from exposure to alcohol in utero.

There are little or no FASD multidisciplinary diagnostic teams in rural regions of Canada. Families often have difficulty accessing their services, and, because of the lack of clinics available and the distance rural residents have to travel, it is often a huge burden to them.

As outlined in Canada’s Rural Economic Development Strategy, since 2015 the federal government has made investments in rural communities, including efforts to improve connectivity through affordable high-speed internet and enhanced infrastructure to improve education and health facilities.

Would you please speak to what measures are being taken to improve access to health diagnostic clinics in general but, in particular, for support for individuals with FASD and other more complex health issues?

Hon. Mohamed-Iqbal Ravalia: Honourable senators, I rise today to recognize Canada’s long-standing and valuable friendship with the United Arab Emirates, just ahead of the U.A.E. National Day on December 2, which marks 51 years since all seven emirates unified into one nation.

Canada and the U.A.E. have an important, mutually beneficial relationship focused on building prosperity for both of our societies in a sustainable manner. Our countries have partnered together to strengthen regional and global security, and to foster sustainable economic and social development in developing nations.

The U.A.E. is Canada’s largest export market in the Middle East and North African region, with over $2.5 billion in two-way trade in 2021. The U.A.E.’s investment in Canada is estimated to be at least $30 billion, and there are over 40,000 Canadians living in the U.A.E.

I am honoured to be Chair of the Canada-United Arab Emirates Friendship Group, which currently has over 60 members from both houses of Parliament, representing all political affiliations. I would like to acknowledge the tremendous efforts of my predecessor, past chair Senator Percy Downe, and look forward to working closely with him in this next chapter. I would also like to acknowledge the support of two executive members, Senator Salma Ataullahjan and Senator David Wells. Since His Excellency Fahad Saeed Al Raqbani, Ambassador of the U.A.E. to Canada, has been posted to Canada, the U.A.E. and Canada have further developed and deepened their strong bilateral relationship. We thank you for this, Your Excellency.

Canada has removed the visa requirements for all U.A.E. nationals to travel to Canada, and our two countries have signed memorandums of understanding on joint space cooperation, as well as expanding the existing bilateral air transport agreement. His Excellency has also taken the initiative to learn more about Canada and our people by travelling across this vast country from British Columbia to Newfoundland and Labrador. I would like to thank him for his commitment to enhancing bilateral ties, with the integral support of Ms. Melissa Valks, his executive assistant, who is accompanying the ambassador today.

Honourable senators, since its independence, the U.A.E. has been a dynamic, multicultural and forward-thinking nation, and a valuable ally to Canada. Please join me in extending my best wishes to the ambassador and to the people and government of the U.A.E. on their National Day, as our two nations continue to build a relationship of respect, cooperation and mutual prosperity.

Thank you, wela’lioq.

Hon. Mohamed-Iqbal Ravalia moved second reading of Bill S-253, An Act respecting a national framework for fetal alcohol spectrum disorder.

He said: Honourable senators, I rise today as the sponsor of Bill S-253, An Act respecting a national framework for fetal alcohol spectrum disorder.

This is a subject that is particularly important to me, as I know it is to many of my colleagues here. It is a subject that I became well acquainted with as a rural family physician.

I would like to express my gratitude to Senator Pat Duncan, who has been involved in this disorder community in the Yukon for decades, and who has shared her experience and expertise on this issue. Thank you, Pat.

I would also like to thank Senator Anderson and Senator Christmas for their sage advice as I worked through this bill.

Colleagues, Bill S-253 was developed through extensive consultation with the Canada Fetal Alcohol Spectrum Disorder Research Network — CanFASD for short — which is a collaborative, interdisciplinary research network with partners across the nation.

The network brings together a diverse array of professionals: academics, specialists in women’s health, individuals who are involved with criminal justice, developmental pediatricians, psychologists, psychiatrists, social workers and Indigenous advisers.

These professionals work with, or as part of, CanFASD’s staff and board of directors, as well as its Family Advisory Committee, who have lived experiences as caregivers of people with the disorder across Canada.

I’d like to start by providing context on the subject that this bill is seeking to address. The consequences of prenatal alcohol exposure were first described more than 40 years ago. The term “fetal alcohol syndrome,” or FAS, was first used to describe the cluster of birth defects due to prenatal alcohol exposure, including growth restriction, craniofacial abnormalities and intellectual disabilities — all with lifetime consequences.

The term “fetal alcohol spectrum disorder,” or FASD, has since been adopted as a diagnostic term to actually describe a much broader spectrum of presentations and disabilities resulting from exposure to alcohol in utero. The impact of alcohol varies with the amount, timing and frequency of alcohol consumed and depends on a number of other factors, including the genetics of the fetus and mother and the overall state of health of the mother, as well as other social, economic, physical and environmental factors.

The disorder can manifest in a wide variety of symptoms, but those with the disability often face difficulties in areas that include a wide spectrum and wide arena. They include motor skills, physical health, learning issues, memory, attention, impulsivity, communication issues, emotional regulation and social skills. While every individual is unique and possesses their own strengths and abilities, dealing with these challenges can very much be a dilemma for those with the disorder, and one that requires varying degrees of ongoing support from family and other sources.

It’s a complex, multi-faceted issue that affects Canadians in all walks of life in all regions of the country. It is, for context, the leading neurodevelopmental disorder in Canada, affecting 4% of the population. That’s more than people with autism, cerebral palsy, Down syndrome and Tourette syndrome combined.

However, there are indeed two key distinctions when it comes to the disorder. First, it is much harder to diagnose than most other neurodevelopmental disorders, and second, it is preventable.

The fundamental goal of this bill is to promote better outcomes in both prevention and diagnosis as well as to improve support for those affected and to ensure that they can live their lives to the fullest potential without carrying a stigma.

Colleagues, the issue that this bill is aimed at addressing is the lack of a comprehensive, coordinated national framework. As we know, with Canada’s 10 provinces and 3 territories, it can feel like we sometimes have 13 separate health care silos or that we live in 13 fiefdoms. As it currently stands, access to FASD prevention, diagnosis, interventions and supports across our provinces and territories is patchy and, unfortunately, uncoordinated at best. Making a diagnosis of the disorder requires a multidisciplinary team and involves complex physical and neurodevelopmental assessments.

In 2005, the Canadian Medical Association Journal published an international, collaborative and evidence-based guideline for diagnosis related to prenatal alcohol exposure. Since then, the field has evolved and mushroomed and additional evidence, expertise and experience has emerged. An updated recommended guideline was published in 2016 that underscores the importance of pre-pregnancy counselling and prevention.

The guideline includes standardized screening and referral and early intervention measures, as well as the composition of the core diagnostic team. This team must include a child development psychologist, pediatrician, speech language pathologist, psychiatrist, occupational therapist and a physician overseeing the team, depending on the age of the individual assessed. In the current context of our health care crisis, you can only imagine how difficult that would be.

Colleagues, there are 73 diagnostic clinics across Canada, and those clinics are not evenly distributed. There are provinces that currently don’t have a single diagnostic clinic. Even if a province has these clinics, most have lengthy waiting lists or very limited capacity and are almost never located in rural or remote areas. As you can imagine, it can be particularly challenging in these areas to find all the specialists required to properly operate a clinic. That was indeed much of the challenge in my practice lifetime.

There is no consistent, pan-Canadian tracking system in place, so CanFASD, the national research network, relies on smaller provincial studies and extrapolates its data. Less than half of the diagnostic clinics participate in contributing to the national database, typically due to staffing shortages and significant time constraints. As a result, the numbers we rely on from the database cannot possibly accurately reflect the prevalence or distribution of this disorder across our country. This means that there is a significant but ultimately unknown number of Canadians with FASD who are unidentified and therefore undiagnosed. The problem is particularly acute in those populations that have compromised social determinants of health, including those in the child welfare system, justice and corrections and our Indigenous communities.

Colleagues, we are fully aware of the role our esteemed colleagues at the provincial level play across Canada. Some provinces and territories, including Alberta, Manitoba and the Yukon, already have a specific strategy or framework in place to promote FASD prevention, improve measures for diagnosis and increase supports for those affected. These three strategies share broad foundational goals such as increasing awareness of the consequences of drinking alcohol while pregnant, promoting prevention of drinking while pregnant, increasing access to assessment and diagnostic clinics, supporting new research to ensure strategies are informed by evidence-based practices and providing other supports and services for people with the disorder and their families and caregivers.

Other provinces and territories have other past or present strategies that could help inform the federal government with their own FASD framework. For example, British Columbia had a strategy from 2008 to 2018. Saskatchewan has the Cognitive Disability Strategy, which is meant to provide services to address the unmet needs of people with a broader cognitive disability and their families. Ontario’s 2017 budget included money for FASD supports, but the strategy was not released. P.E.I. has the Mental Health and Addiction Strategy 2016-2026, and there is the Changing the Culture of Alcohol Use in Nova Scotia strategy of 2007, which incorporates FASD into its broader provincial strategies of alcohol awareness and prevention. New Brunswick is building on the experiences of other provinces and territories and is currently developing an interdisciplinary provincial strategy. In my own province of Newfoundland and Labrador, we recognize that the support of provincial FASD networks in the Provincial Alcohol Action Plan has gone a long way. The intent is to reduce harms and costs within our province, and the report was released in July 2022. Nunavut is currently working toward a strategic disability plan.

Senators, this bill is not designed to reinvent the wheel but to build on the existing work that has been conducted. It can go a long way to informing us on a going-forward basis.

Since the early 1980s, a patchwork of awareness campaigns has grown to support women at risk of using alcohol during pregnancy, as well as to meet the needs of peoples and communities affected by the disorder. Informed by research, rhetoric has shifted toward destigmatizing mothers who have used alcohol during pregnancy. Let me say that again because, unfortunately, many women bear this burden and stigma in a lifelong manner. The rhetoric has shifted toward destigmatization, and an effort is being made to ensure that there are early intervention measures readily available. The earlier the diagnosis is made and the earlier interventions take place, the better the outcomes in the long term.

Research, monitoring and evaluation of individual initiatives has also gradually increased.

Given the complex nature of this disorder, it is not strictly a health care issue. Rather, it impacts other areas that are very much the responsibility of our federal government, including, in particular, criminal justice and the economy. As a result, successive federal governments have made some efforts to support specific projects or programs.

For example, in 2003, the Government of Canada released the Fetal Alcohol Spectrum Disorder (FASD): A framework for action. The Framework for Action is a tool to guide future action on FASD in Canada and is the result of national consultation efforts that initially took place in 1999 and again in 2002 to 2003. It stands as a vision for how jurisdictions can work together to improve the lives of those impacted by the disorder and, critically, to prevent alcohol-affected births.

The framework outlines five main goals: increasing awareness of the disorder and the impacts of alcohol use during pregnancy; increasing the capacity for resources and training for response to FASD; creating tools to increase screening, diagnostics and data collection; expanding knowledge and information gathering; and supporting critical action on the disorder.

The framework also specifically outlines the role of the federal government and states that it will continue to focus on developing and strengthening the coordination functions that ensure access to the necessary tools, expertise and resources right across the country.

In addition to forming the basis for action plans at the federal level, the framework was intended to guide interdepartmental work to address gaps and issues that are not currently undertaken in other sectors, including developing a national guideline — a wealthy country like ours should be able to do that — expanding scientific and social science knowledge relevant to both prevention and effective support for those affected; building the evidence base and establishing mechanisms for knowledge exchange between different jurisdictions; and, critically, increasing awareness of FASD among professionals across the array of sectors who work with people, families, communities and those affected by the disorder.

There is also a companion federal document entitled It Takes a Community, which was launched following discussions in 2000 with experts, provinces and territories and First Nations, as well as Inuit community representatives. The framework is based on the values, principles, objectives and needs identified by First Nations and Inuit communities across Canada, recognizing the impact of fetal alcohol spectrum disorder and strategizing on how it can be best addressed.

Honourable colleagues, that was over 20 years ago. The advocates, experts and those with lived experience are still calling on the federal government to take a leadership role in these areas.

Improving FASD prevention, diagnostic and other supports has actually thoroughly been studied in both Houses of Parliament. For example, in September 2006 in the other place, the Standing Committee on Health tabled a report entitled Even One is Too Many: A Call for a Comprehensive Action Plan for Fetal Alcohol Spectrum Disorder.

The main thrust of the recommendations put forward can broadly be summarized as a call to the federal government and the health portfolio specifically to develop a comprehensive action plan with clear goals, objectives and timelines. The committee reported that there was:

. . . little evidence of any progress beyond the 2003 National Framework on FASD. Despite the repeated efforts to see a comprehensive action plan . . . .

The government response agreed that a comprehensive pan‑Canadian action plan, developed in collaboration with the provinces, territories and stakeholders, is key to addressing the disorder.

Within our own chamber, the Standing Senate Committee on Social Affairs, Science and Technology has included recommendations in its report to improve prevention, diagnosis and treatment supports, including in the 2006 report Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada.

As our colleagues Senator Pate and Senator Cotter have pointed out to me — and may hopefully elaborate upon this — a lot of what we know about individuals with FASD comes through their involvement in the criminal justice system.

Our colleagues who are members of the Standing Senate Committee on Human Rights will recall the 2019 Interim Report — Study on the Human Rights of Federally-Sentenced Persons: The Most Basic Human Right Is to Be Treated as a Human Being. Nancy Lockwood, Program Manager at Citizen Advocacy Ottawa, discussed some of the problems that individuals with FASD encounter in penitentiaries. This helps paint a practical picture. I’ll put it in her words:

They are vulnerable to predators. They may experience sensory overload which makes them prone to outbursts and negative behaviours. They largely do not learn from previous mistakes and have difficulty understanding the rules of social interaction. People diagnosed with FASD also have difficulty with organization and time management, meaning they often do not arrive on time — or at all — for probation appointments.

She argued for the development of “alternatives to incarceration such as supervised residential settings and work placements” and “models that emphasize changing the environment not the person.” This sentiment was echoed again in the 2021-released fourth report Human Rights of Federally‑Sentenced Persons.

Honourable colleagues, as the Truth and Reconciliation Commission recognized, the criminal justice system’s inability to properly accommodate individuals with this disorder is an issue that disproportionately affects Indigenous people, who are being incarcerated at an ever-increasing rate, given longer jail sentences and are subject to harsher punishment in prisons than others in Canada.

Under the Truth and Reconciliation Commission’s Calls to Action, Action 34 states:

We call upon the governments of Canada, the provinces, and territories to undertake reforms to the criminal justice system to better address the needs of offenders with Fetal Alcohol Spectrum Disorder (FASD), including:

i. Providing increased community resources and powers for courts to ensure that FASD is properly diagnosed, and that appropriate community supports are in place for those with FASD.

ii. Enacting statutory exemptions from mandatory minimum sentences of imprisonment for offenders affected by FASD.

iii. Providing community, correctional, and parole resources to maximize the ability of people with FASD to live in the community.

iv. Adopting appropriate evaluation mechanisms to measure the effectiveness of such programs and ensure community safety.

I had the privilege of asking Minister Lametti, when he appeared before our chamber during Question Period a few weeks ago, about the screening methods available for FASD for offenders in the criminal justice system. He was unable to give me a clear answer about what options were available. This is an issue that requires further investigation, and we continue to collaborate with his office in this respect.

Outside of the criminal justice context, the Truth and Reconciliation Commission recognized the need for FASD prevention and treatment, specifically in Indigenous communities. Specifically, Call to Action 33 states:

We call upon the federal, provincial, and territorial governments to recognize as a high priority the need to address and prevent Fetal Alcohol Spectrum Disorder (FASD), and to develop, in collaboration with Aboriginal people, FASD preventive programs that can be delivered in a culturally appropriate manner.

The federal government has indeed made several investments in programs that help support First Nations and Inuit communities in preventing FASD births and treating those affected. For example, with financial support from the First Nations and Inuit Health Branch, what is now known as Indigenous and Northern Affairs Canada, the Pauktuutit Inuit Women of Canada — the national representative organization of Inuit women in Canada — released the Inuit Five-Year Strategic Plan for Fetal Alcohol Spectrum Disorder 2010-2015. The plan set out a vision statement, mandate, priorities and strategic directions that would guide how the community would collaborate with governments and other regional and local stakeholders over five years with respect to the problem of fetal alcohol spectrum disorder within Inuit communities across the country.

Since 2014-15, the federal government has put in place a Fetal Alcohol Spectrum Disorder National Strategic Projects Fund, which allocates $1.5 million annually to contribute to national projects supporting prevention, education and knowledge exchange and coordination of fetal alcohol spectrum disorder activities, for a total of $12 million over eight years. A list of funded projects is available on the program’s web page.

The Pauktuutit Inuit Women of Canada have since built on their tremendous efforts by developing a community-based awareness campaign to promote FASD prevention across their communities. I had the privilege of asking Minister Miller in our chamber a few weeks ago how recent programs were being evaluated and, again, I couldn’t get a clear answer. This is another area where we need to continue to dialogue with the federal government.

Despite these government initiatives, studies and report recommendations, many people affected by the disorder do not receive adequate and consistent support and services. The lack of an integrated national strategy, standardized diagnostic and screening tools and comprehensive epidemiological research has meant that progress toward consistent and effective prevention and support has been slow.

Honourable senators, I believe the time is now. We all know that substantive change is incremental — on the Hill it is glacial at times rather than transformative. However, delays in action are costing us. In considering inflation, recent reliable research has shown that the societal cost of fetal alcohol spectrum disorder in Canada is significant, topping $10.5 billion annually. This is without accounting for the ongoing global pandemic and any potential changes to these costs because of the pandemic. These costs are divided up into criminal justice costs, health care costs, educational services, social service costs and other indirect financial losses, including lost productivity.

The bill I’m proposing is very straightforward. The enactment of the bill would require the Minister of Health, in consultation with other ministers and stakeholders, to develop a national framework designed to support Canadians with the disorder, their families and their caregivers. The framework would include measures to standardize guidelines, improve diagnostic and data reporting tools, expand knowledge bases, facilitate information exchanges and increase public and professional awareness, amongst other things. This would be achieved within a specified time frame, with the express intention of working with the provinces, territories and stakeholders, including self-advocates, as well as Indigenous communities and organizations with predominantly Indigenous leadership. In addition to a specific time frame, the framework would be subject to parliamentary oversight.

While there are benchmarks, including timelines, Bill S-253, by design, is not overly prescriptive in what the framework itself should entail. The government must be allowed the flexibility to respect the consultative process of this legislation. This legislation would ensure a coordinated national framework aimed at supporting — critically — Canadians with the disorder, their families and their caregivers.

Honourable senators, a national framework to address FASD is long overdue. Given the complexity of this issue and the breadth of its effects, the existing patchwork of provincial and territorial approaches is simply not enough, as we’ve seen. Since 2020, the Government of Canada has recognized September as Fetal Alcohol Spectrum Disorder Awareness Month, and I’m proud to say that in my own province of Newfoundland and Labrador, the mayor of St. John’s, His Worship Danny Breen, has also made this declaration this past September. You may have also noticed on your Twitter feeds that many communities are beginning to recognize FASD. We can and should ensure that the federal government continues to take the appropriate steps to address a pressing, multifaceted issue affecting millions of Canadians.

Honourable senators, we all know this is not a partisan issue. We, as well as our elected colleagues, have heard from individuals affected by the disorder, their families, their caregivers, as well as experts and advocacy groups, that a coordinated national framework would help to improve their lives. This bill would mean one step toward increased, equitable access to diagnostic assessment and support services across Canada so that all Canadians with the disorder can achieve their full potential no matter where they live in this country. It would be one step closer to having a trained workforce that is FASD-informed across health, social, justice and education systems. It would be one step to support economic and social inclusion, and help to reduce the stigma associated with this vulnerable population.

Honourable senators, this bill is one step in the right direction. Thank you, meegwetch.

(On motion of Senator Martin, debate adjourned.)

The Senate proceeded to consideration of the sixth report (interim) of the Standing Senate Committee on Agriculture and Forestry, entitled Treading Water: The impact of and response to the 2021 British Columbia floods, deposited with the Clerk of the Senate on October 27, 2022.

Hon. Mohamed-Iqbal Ravalia: Minister, thank you for being here today.

Addressing fetal alcohol spectrum disorder is one of the Truth and Reconciliation Commission’s Calls to Action. Specifically, Call to Action 34 states:

We call upon the governments of Canada, the provinces, and territories to undertake reforms to the criminal justice system to better address the needs of offenders with Fetal Alcohol Spectrum Disorder (FASD), including:

i. Providing increased community resources and powers for courts to ensure that FASD is properly diagnosed, and that appropriate community supports are in place for those with FASD.

As you’re aware, access to diagnostic clinics is patchy at best across Canada. Making a diagnosis of FASD requires a multidisciplinary team and involves complex physical and neurodevelopmental assessment.

Could you please speak to the screening methods available for FASD for offenders in the criminal justice system?

Hon. Mohamed-Iqbal Ravalia: Honourable senators, I rise today to recognize Easter Seals’ one-hundredth year of operations in this country.

Easter Seals is Canada’s largest local provider of programs and services for persons with disabilities. Since 1922, the organization and its 10 provincial members have been working to create a more inclusive and accessible society that honours the contributions of Canadians of all abilities.

For 100 years now, Easter Seals organizations have been serving a broad range of individuals — both children and adults — with varying physical, intellectual, sensory and learning disabilities to help to ensure that every person has access to the equipment, programs, services and support that they need to make the most of their abilities and live their lives to the fullest.

Easter Seals provides a wide range of services and supports, including access to assistive and adaptive technologies, specialized education and job training programs and services, sport, recreation and leisure programs, rehabilitative and occupational therapy, residential and respite programs, day and overnight camps.

For 100 years, Easter Seals has represented the best values of our country by working to build a more inclusive and more welcoming Canada — a Canada where every person can thrive, contribute and live the life they choose with independence and dignity.

I had the pleasure of meeting with the Easter Seals delegation this morning in my office, and I’d like to welcome them and thank them for coming to Ottawa to share in this momentous occasion. In particular, I welcome our youth ambassadors.

I have no doubt that for the next 100 years, Easter Seals will continue to honour and support the needs and aspirations of Canadians living with disabilities and their families by providing vital services and promoting access, inclusion, opportunity and community.

Please join me in thanking Easter Seals for their century of service. With all that has already been accomplished, I am eager to see what the next century of achievement will bring.

The Easter Seals’ one-hundredth anniversary celebrations will continue tonight at the Métropolitan Brasserie. I hope to see you there. Thank you, meegwetch.