Chief Commissioner’s keynote address to the National Healthcare Labour & Employee Relations Forum

Speaking notes for

Marie-Claude Landry, Ad. E.

Chief Commissioner
Canadian Human Rights Commission

Is Canada’s health care system failing the most vulnerable? 

Keynote address to the
National Healthcare Labour & Employee Relations Forum

Tuesday, November 24, 2015
Toronto, Ontario

Thank you, for that warm introduction, and thank you to everyone who has helped make this conference possible.

It is an honour and a pleasure to be here today.

I must tell you that as the head of Canada’s human rights commission, it is encouraging to see people working together to create respectful and healthy workplaces.

In business, a healthy workplace can contribute to the bottom line. 

In the healthcare sector, the well-being of your workplaces can have a profound impact on peoples’ lives.

As a former Chair of the Board of Directors of the Brome Missisquoi Perkins hospital, I can proudly say that I am speaking from personal experience. 

This hospital is the smallest in Quebec. 

In an effort to improve the quality of services that the hospital provides to the community, we focused on making it a better place to work.

Inclusion, a high standard of ethics and respect for differences were our priorities. 

We gave everyone a voice. And we listened.  

Today, it is still the smallest hospital in Quebec, but one of the most recognized for its high quality of care.

Before I go any further, I’d like to take a minute to tell you a little bit about the Canadian Human Rights Act.

Parliament designed the 1977 Canadian Human Rights Act as a tool to fight discrimination. The intention was to level the playing field, and provide equality of opportunity to everyone in Canada.

The Act has helped to shape a society that is more just and more equal. 

The Canadian Human Rights Commission has a mandate to ensure that the spirit of the law is realized within society.

We receive complaints based on grounds of discrimination such as race, sex, and disability.

We promote Parliament’s vision of an inclusive society through research, policy development and outreach.

The Commission provides employers with tools and guidance on creating inclusive workplaces, accommodating employee needs, and resolving conflict. 

For example, we offer guides for accommodating the needs of caregivers and for managing the return to work after a serious event. 

The issues we can deal with are wide-ranging. We have spoken out on medical issues – from helping workplaces accommodate disabilities, to advocating for better protections from genetic discrimination.

We are independent . We are a watchdog with the authority to speak out on any matter related to human rights in Canada.

I take this role very seriously.

With that said, I would like to use this time to speak about the millions of people in Canada who need better access to our healthcare system.

I’m referring to the vulnerable members of our society.

...People living on the margins.

...People facing stigma because they are different.

...People who can’t speak up for themselves.

The most vulnerable members of society often face barriers to accessing the justice system. And they often face barriers to healthcare.

In that spirit, my message to you today is this:

We are failing many of the most vulnerable members of society when it comes to healthcare.

Let me be clear. I am not here to criticize people who work in the healthcare sector.

I am here to ask for your help.

I am here to ask for your help because you are in an ideal position to be agents of change. 

I say this because you are the only group of professionals who interact face-to-face with everyone in this country – from cradle to grave.

You are in a position of privilege. People trust you. They drop their guard when they come to see you. 

They share their problems, their concerns, their fears. 

And you can bring about real, meaningful change because you can give your most vulnerable patients a voice. You can speak out on their behalf.

And together, as healthcare professionals, you have a powerful voice. And you have credibility.

Let me give you an example.

When the Canadian government cut funding to healthcare for people claiming refugee status, many saw this as discriminatory.

The Federal Court called it “cruel and unusual.”

We were failing people who had come to this country in the hope of finding freedom from persecution.

Healthcare professionals saw this, and many spoke out against the cuts.

They brought this issue to the national discussion. 

And their voices were heard.

They were able to raise the profile of this issue during the recent election campaign, to the point that it was mentioned during the leaders’ debates.

And now, the new government has announced that it will “quickly” reinstate full healthcare for refugees.

This is an example of tangible change brought about by the efforts of healthcare professionals—perhaps by some of you in this very room.

This brings me back to my main message.

My hope is that you can lend your voices to raising awareness and improving the situation for other vulnerable members of society.

We all have an equal right to healthcare.

But we don’t all have equal access.

I am certain that each of you can think of an example from your own experience when someone in need of help did not receive that care.

...when the healthcare system failed a vulnerable member of your community.

There are many pressing human rights issues that I could share with you. 

Today I want to focus on three of the most vulnerable groups in Canada: 

Indigenous people, transgender people, and people with mental illness who end up in our prison system.

The persistent condition of disadvantage facing Indigenous people in Canada is among the most pressing human rights issues today. If not the most pressing.

Chronic underfunding for basic services, especially healthcare, contributes to complex social problems. The poverty that exists in many First Nations communities has been compared to conditions in Third World countries.

When looking at the numbers for Indigenous people in Canada, the health indicators paint a stark picture of how inequality and discrimination can affect individual health.

Deeply entrenched undercurrents of racism compound the problem. Racism, sadly, still exists in many corners of our society.

A recent study by the Wellesley Institute called First Peoples, Second Class Treatment points to racism in the healthcare system as a major factor in substandard health among Indigenous people in Canada.

The study suggests Indigenous people feel discriminated against so often, that they strategize on how to deal with it before visiting emergency departments.

Others just avoid seeking care altogether.

Many transgender people report similar experiences.

While high profile stories in the media are making more people aware of the challenges facing transgender people, they continue to be the victims of discrimination, hostility and violence.

A recent Ontario study reported that transgender people often avoid healthcare because they experience discrimination at the front door.

According to the report, ten percent of transgender people who have gone to an emergency room received only partial care or were refused care outright, because they were transgender.

The same report found that one in five transgender people have avoided going to emergency when they needed care, because they were transgender.

One in four reported being ridiculed by an emergency care provider for being transgender.

This does not just happen in hospitals. 

Among those with a family physician, about 40% of transgender people said they had experienced discriminatory behaviour from a doctor at least once. These experiences included refusal of care, refusal to examine specific body parts and use of demeaning language.

The same study found that when a transgender person considers suicide, the experience of discrimination is a contributing factor.

Finally, we are also failing people with mental illness who end up in our prison system.

I am sure that you are all familiar with the story of Ashley Smith.

Ashley Smith ended up in jail for throwing a crab apple at a postal worker.

Her story illustrates what can happen when people with mental illness do not receive adequate support. 

The Office of the Correctional Investigator of Canada explained the situation well in his annual report. He wrote, and I quote:

“We are criminalizing, incarcerating and warehousing the mentally disordered in large and alarming numbers.

“The needs of mentally ill people are unfortunately not always being met in the community health and social welfare systems.”

He added:
“As a result, the mentally ill are increasingly becoming deeply entangled in the criminal justice system.”

Once in jail, things can go from bad to worse.

Without proper support inside, a person’s mental health can worsen.

If they are not able to meet the expectations placed on them by the correction system, they are put in solitary confinement. For days, weeks – and some cases – months.

Research – and common sense – tell us that placing people with mental illness in solitary confinement can have a devastating impact on their well-being.

This practice can lead to a destructive, downward spiral. 

It is our position at the Canadian Human Rights Commission that people with serious or acute mental disabilities should be housed in treatment facilities or hospitals. Not in prisons.

And that solitary confinement should never be used for inmates with serious or acute mental disabilities.

As I mentioned earlier, this is not an indictment of the healthcare system. It is an appeal for your help.

Human rights laws give people the ability to speak out against discrimination.

But I do not believe that we can leave the call for justice to those who experience discrimination. 

They should not have to carry that burden alone.

As I said earlier, the most vulnerable are often the least able to speak for themselves.

When someone is marginalized, scared, and struggling to make it through the day, standing up to injustice can seem out of reach. And fighting for basic rights is a luxury many just don’t have.

That is why I believe it is important for all of us to speak out against prejudice and discrimination. To challenge indifference, ignorance and intolerance. 

As Canadians, we take great pride in the inclusive society we have created. 

I hope in your deliberations and discussions on how to create healthy and inclusive workplaces, you also consider how your work can improve the lives of the most vulnerable members of society.

As healthcare professionals, you have a powerful voice. You have credibility. You have ability to drive change within your industry, and within Canadian society. 

You have dedicated your lives to helping others. 

This includes Indigenous people. 

This includes Transgender people. 

And this includes people with mental illness in our prison systems. 

This is why I appeal to you. Compassion, dedication and a desire to help people are at the core of the work you do.

Your efforts and your voices can make a difference – in your workplaces, and for the most vulnerable members of society.

I believe you know what kind of difference you can make. 

You should also know that I am here to work with you. 

You can count on me as a partner and an ally in driving positive social change...

… to make this inclusive society even more so. Because our Canada includes everyone.

Thank you.

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