Bill C-31: Having Good Oral Health is Crucial for Healthy Children

On November 1, 2022 Senator Omidvar spoke to Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing. Watch her speech:

Hon. Ratna Omidvar: Honourable senators, I rise today to speak on Bill C-31, an act respecting cost of living relief measures related to dental care and rental housing. I support this bill in principle, and today I will focus my remarks on the dental benefit portion of the bill.

I wish to congratulate my colleagues, Senator Yussuff and Senator Seidman, for their excellent speeches. For my part, all this talk about dentists and kids takes me back to my own childhood of being dragged to a dentist. I was very traumatized. I have a vague memory of a lot of persuasion being at play. I think hard candy was involved, but I have my own teeth today, all of them. I’m very grateful that my parents had the means to insist on this essential care. It’s not the same for all Canadians. I speak from a bit of first-hand experience.

In 2016, just eight years ago, a Syrian refugee family with eight children under the age of 15 landed in Toronto. As their sponsor, the first three months were completely hectic for them and for us. We soon discovered a challenge we had not prepared for: the oral health of the eight children. Their teeth were in terrible shape. They were rotten, frankly, because apparently there were rivers of hard candy running through the camps, as opposed to healthy food.

Even to our untrained eyes, we could see there was a problem. However, although the federal government picks up the costs of health care for refugees in the first year of arrival, this coverage does not extend to routine dental care, only to emergency dental care. In other words, the family would have needed to wait for a dental emergency to get the care they needed or until they qualified for the Healthy Smiles program, which was a year.

Left up to our own resources, the sponsoring team had to dig into our pockets, and we relied on the good will of many volunteer dentists.

Oral health for all children, as we have heard today, is very important. Let me quote some further facts for you.

According to the 2010 Canadian Health Measures Survey, well over 50% of 6 to 19 year olds have or had at least one cavity and have, on average, 2.5 teeth affected by tooth decay. Bad oral health is the most common chronic disease in children, five times more prevalent than asthma.

Poor oral health also increases gum disease, and has been linked to cancer — as Senator Yussuff has pointed out — Alzheimer’s, diabetes and heart disease. A study has shown that:

Across OECD countries . . . 5% of total health expenditures originate from treatment of oral diseases. Direct treatment costs due to dental diseases worldwide have been estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. . . .

Having good oral health is good for the kids. It’s good for our health care system. It’s certainly good for the economy.

Colleagues, I know that during questions and debate today, we have talked about concerns that this bill moves into provincial jurisdiction. We know that provinces and territories in Canada have pre-existing dental care programs for children. However, according to the Canadian Dental Association, while several of these programs have a solid infrastructure in place, others are currently underfunded, and, as a result, do not respond to the individual oral health needs of pediatric patients.

They noted that P.E.I. does oral health fairly well, whereas the outcomes don’t seem to be so good in my province of Ontario.

In an ideal world — I do not dispute, Senator Seidman — it would have been preferable to use the plumbing of existing provincial agreements and sign agreements with the provinces to bolster their own programs to get the money faster, through existing machinery, to the people. I do not dispute that. However, as we well know, such agreements are hard to negotiate. They take a very long time. Every agreement with every province and every territory is different, and, inevitably, we would see a patchwork of services.

As we have heard from Senator Seidman, Quebec does this, Ontario does this, Newfoundland does this, et cetera.

With this initial two-year program, the government accomplishes a number of objectives. First, it covers the whole nation regardless of where you live. If you have a child aged 1 to 12 years old, they will benefit from the program. It is contingent only on income levels.

Second, it takes effect almost immediately, bringing much-needed relief to poor people in a timely manner.

Third, I believe it allows the government to assess the efficacy of a two-year initial pilot program, let me call it that, as they consider rolling out the permanent program.

Whilst we are on federal-provincial agreements, let me clutch a bit on the province I live in. Even when agreements are signed, there is no assurance of accountability. In Ontario, parents are still waiting for $10-a-day daycare program, although the agreement was signed, I don’t know, maybe even a year ago. Again in Ontario, we have seen a government accrue a budget surplus of $2.1 billion when our health care system is in shambles. It is the same government that is using the “notwithstanding” clause to deal with the labour issues. It makes sense to me that the federal government will trust families to make the right decisions for their children. That given a chance, given a little extra money, the extra boost in financial confidence, they will call their dentist and make appointments for their children and use the money to bridge whatever gaps there may be in provincial programs.

To those who say that $650 is not enough, honestly, you may well be right. But the government has not dreamt up this figure out of thin year. At pre-study at the National Finance Committee, we heard from the Parliamentary Budget Officer that the average cost of dental care for children under 12 — remember under 12 they still have milk teeth — is under $650. The same was confirmed by the Canadian Dental Association.

In comparison to other jurisdictions — you may be interested in this — we are playing catch-up. We are always playing catch-up, I feel. Australia rolled out a very similar program in 2014. Its program functions very much the way this program is designed to function, except it extends to children up to 19 years old. Of course, the gold standard would be the National Health Service in the U.K., which covers all dental costs and encourages parents to start with dental appointments as soon as milk teeth appear.

We all know that this is a time-sensitive program. This interim program of two years will eventually develop into a more permanent program; at least that is the hope of many Canadians. It targets those in highest need. Parents who have private dental insurance are not eligible, and those who are covered by a provincial program are only eligible to have out-of-pocket expenses compensated. Provinces and private plans will always be the first payers, and the federal dental program will come after that. At committee, we were informed by officials that there will be no clawback from provincial governments, as this bill does not touch on or harmonize with any of theirs.

I do have some concerns about the bill. Some of these have been raised by other people, but I think it doesn’t matter if we raise concerns again and again; maybe the committee will take note of them. We know that about 10% of Canadians are non-filers. How will they access this benefit? For those who are already in the system and receive the Canada Child Benefit, it is fairly simple. The individuals have a CRA My Account and they simply have to use it to apply for the new benefit. My concern, though, is for the non-filers, and this is not an insignificant number, 10% to 12%.

I don’t know who these non-filers are. I know they are low-income, as studies have pointed out, but we don’t know if they have children. We don’t know if they are working or not; likely they are, but they are not filing their tax returns. I do believe it is time that the CRA address this very important question in a serious manner. To my question to the officials at the committee, I was told that they have a strategic plan called “Get ready,” but they don’t appear to have set any standards or benchmarks against this plan to assure the people of Canada that they are reaching non-filers, and that non-filers are beginning to file. I would like to see a benchmark, an objective put in place that after the end of their “Get ready” program, on evaluation, at least 3% more are filing. That would be a success.

The second question is about capacity. We know that certain parts of the country, especially rural and Northern communities, do not have good access to dental care. There are shortages in dentists and hygienists. The extra demand from the South — I hesitate to say “South” in the context of Canada, but I think you all know what I mean — creates a concern that supply of dental services and dental professionals may migrate to the South. One unintended outcome could be the loss of dentists and dental hygienists from small and rural communities.

The federal and provincial governments should think long and hard about using an untapped source of workers, and those are internationally trained dental health care professionals. We know that many of these internationally trained professionals come here through the Express Entry program, which favours people whose skills are badly needed. However, when they arrive, they get in what I call “credentialism hell,” which takes a great deal of time and a huge amount of resources to pull yourself out of.

This is a national problem which is complicated by the fact that regulated occupations such as dentistry are under the jurisdiction of provincial governments, who, in turn, maintain, “This is not our business — these are self-regulating, independent occupations. We cannot force them to do anything.” It is a veritable maze.

However, the issue of capacity in the context of dental care in remote and rural communities could be addressed by providing a restricted licence to those dentists who have passed some portion of their exams as long as they work in a restricted location, restricted practice. Clearly, this would have to be done province by province, but it does provide an impetus for provinces to consider this or other proposals. Perhaps the federal government could even play a role in incentivizing such behaviour. This practice is followed by Australia, for example.

In conclusion, colleagues, the absence of dental coverage for poor people, especially children, is a blemish on Canada’s avowed aspiration to be a nation of inclusion and opportunity. This bill takes the first small but very important step in building a healthier future for our children.

Thank you.