Health Committee on Oct. 26th, 2006

[Dr. Valerie Tarasuk]

One of the difficulties in doing research in this area is that the numbers differ. If you take Ontario, as an example—that's where I live, so I know their welfare program best—there are two kinds of welfare programs. There is something called Ontario Works, and then there's something called the Ontario disability support program. So there are two tiers of welfare, differentiated by notions of the ability of the recipient to join the labour force.

People receiving these higher levels of welfare payments are presumed, through some medical diagnosis, to be unable to join the labour force in the same way that those in the lower levels perhaps could. So there are differentials. They're all over the map. It varies depending on the household type and size.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

But there is a basic amount in Ontario.

[Dr. Valerie Tarasuk]

But your question is what these thresholds are. They vary across provinces.

I love your idea that federal members would sit down with your provincial colleagues to start to talk about how to repair this mess. While the levels vary by province, nutritionists do these calculations and look at the cost of a nutritious food basket locally and contrast that to the welfare rates and ask whether people can afford to buy that basket. What we see is that it doesn't matter whether that nutritionist is sitting in Alberta, or whether she's sitting in Peterborough, or whether she's in St. John's. The answer is the same: no, they can't. And they're out by hundreds of dollars.

So while the numbers vary, so do the costs of living in these jurisdictions.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Do the differences in thresholds in the different provinces show any correlation with the differences in the numbers of childhood obesity cases in those provinces?

[Dr. Valerie Tarasuk]

I don't know. We've tried to look at the differences in the thresholds and the relationship to food security rates. We can see some patterning, but we haven't got it mapped out yet. Part of the problem is that even when we do those calculations, we're getting different levels of welfare in different parts of the province. And we're trying to factor in housing costs, because we know that a difference in housing costs between areas has a huge impact on the usefulness of that welfare rate in relationship to food. So it's a very complex system.

From everything else that we've done, in my heart I believe that yes, we must be able to eventually see an effect where higher welfare rates in the context of affordable housing will give us less food insecurity and therefore less childhood obesity and fewer other kinds of health problems that are associated with abject poverty and unhealthy eating habits. But methodologically, this is a very hard thing to get our hands around.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Madam Demers, go ahead, please.

[Nicole Demers, Bloc, Laval, QC]

I have two questions, one for Dr. Grover and another for Ms. Tarasuk.

Dr. Grover, I really liked your presentation. I think that what you said about young people from Southeast Asia who from a very young age tend to be more likely to have serious illnesses later in life is very important. I know that in some Southeast Asian countries, I would probably win beauty contests because obesity is considered a very important criterion. If you are rich, you are obese, and the fatter you are, the richer you are.

I don't know how you could address this problem. I believe that education must begin very early in life at every level.

The Internet site for the hospital where you work mentioned that last year, 92,000 cups of coffee, 42,000 pounds of french fries and approximately 10,000 pounds of hamburger were served, all of which are foods that cause the diseases you treat. Doctors, hospitals and dieticians need to be the first to be informed and to ensure that proper diets are served.

Ms. Tarasuk, I listened carefully to what you said, because it is important. You are right to see a correlation between poverty, child obesity, inactivity, etc. However, we are speaking here not only of obesity, but also about Canada's Food Guide, which is about to be published.

In this guide, Health Canada does not factor in the 25% of calories we eat that come from foods other than those described in Canada's Food Guide. These are things like ketchup and condiments, wine and sugary food, including candies and other similar items. Health Canada tells us that it is not important and that if we do not mention these foods, people will not eat them.

Do you think that this is wishful thinking? Is Health Canada correct in not including these items, which represent 25% of all calories, on grounds that if they are not mentioned, people will not eat them?

[Dr. Arvi Grover]

Thank you, and I'm flattered that you did research on my hospital. However, before you point fingers at my hospital, you should point fingers at the cookies you guys are serving.

[Voices]

Oh, oh!

[Dr. Arvi Grover]

Actually, on a number of occasions I have met with our hospital CEO and the nutrition department in dealing with this very issue. To be quite honest, the answer I kept getting back was money. They feel this is what most people want. They want French fries and burgers; they want the high-caloric, high-fat meals that will fill their bellies. However, they have started a change because I've threatened them on several occasions, and a lot of the threatening had to do with educating them. We have to educate ourselves.

To answer the other question you were asking, how can we institute some change within the various communities, it is a multi-tiered approach, and we have to educate the masses. We have to get into their community places of worship perhaps and do some form of educational sessions or seminars that at one sitting will provide them with education, not just for the parents but for the children, so that they can have some semblance of an idea as to what disease state we're speaking of.

Again, as you said, for most people it is the shape of affluence. The bigger you are, the more affluent you are. In Africa and in some parts of Asia, this is what is felt, but we have to change this. Even in the South Asian communities, it has changed. If you go to India, Bangladesh, or some of the other countries, they have already adopted that change. They've already started to exercise; most of the children have become more fit.

However, the immigrants who came from those countries have held onto their values from whenever they came, and they maintain that this is the way they're going to live.

So we have to do a lot of groundbreaking to help change these habits.

[Nicole Demers, Bloc, Laval, QC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

The time is gone, but I'll allow a very quick answer, if you like.

[Dr. Valerie Tarasuk]

Very quickly, in response to your question about Canada's food guide, it is important to recognize that this thing is not a prescription. It's not the same as if you went to a dietician and were given a diet that was a menu plan. All it's doing is mapping a pattern of eating that to the best of our knowledge would meet with nutrient requirements, so that it would ensure nutrient adequacy.

As for that other foods category, should there be more direction there? Probably there should be. But what we know from the very careful modelling work that was done with the people in Health Canada to generate those other numbers—the number of servings for fruits and vegetables, for milk products, and those kinds of things—is that this is a very rational model. If people were to follow it, it would certainly achieve the nutrient levels we want.

Whether there should be some caveats in terms of the other foods category is debatable. Remember, it is not a prescription. Probably if we want to make those kinds of caveats, a more important place to do that is on the label.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Lunney, you have five minutes.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Great. Thank you very much.

Thanks to the witnesses.

That was a very nasty but astute observation, Dr. Grover, about the trans fat cookies, which have snuck into the room here. But I give you kudos for picking up on that. We sometimes hope the witnesses won't notice those.

I want to take it another way here.

Human Resources and Social Development Canada has undertaken and examined, among other socio-economic factors, the issue of food insecurity and the growing number of families that require emergency food aid:

Health experts have noted than an alarming number of obese children are also malnourished. The phenomenon is being reported amongst the poor where diet is dominated by “empty calorie” snack foods and sodas, which are both inexpensive and filling. Despite consuming significantly more calories per day than recommended, these children are not obtaining much-needed nutrition from their food.

If you agree with this observation, please address the phenomenon of the malnourished, obese child.

I'll address this question first to Dr. Grover. Might we liken this to a pregnant woman who has a growing child within her, with great demands on her to supply for that child, and the cravings she is experiencing may in fact be the appestat looking for nutrients that are missing in her diet?

[Dr. Arvi Grover]

Valerie addressed this in her—

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Can I finish my question? I'm almost there.

Would you see value in providing simple multiple vitamin and mineral supplements for low-income families to help them overcome some of the deficiencies?

[Dr. Arvi Grover]

While what you're saying does make sense, and I think supplementation is important, I don't think it replaces the proper meal and the proper intake. It would be giving them the wrong idea, that it may be okay to eat the junk food and then simply take the supplements.

The same thing happens in the medical field. For example, when I give an individual anti-obesity medication--there are a couple of pills out there--what tends to happen is they go back to eating their own junk food, they start eating their pastries and cake, because now I've given them the magic cure. I fear this may occur if what we do and how we educate the lower socio-economic groups is telling them to eat what they want, eat the junk, eat the empty calories, and then take the vitamins.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I'm not saying instead of the other advice, but we're all recognizing the challenges of getting good nutrition into low socio-economic people. My question actually is a serious one, in spite of the laughter from others at the table. It's a serious question.

Might this not help get some nutrients into people who have serious deficits and whose appestat is requiring them to eat a whole lot of empty calories? It may in fact improve their clinical outlook.

[Dr. Arvi Grover]

In fact, supplementation is indicated, and the guidelines do support their use in a variety of groups. Whether they are suffering from malnutrition, whether they are obese, or whether they are actually healthy, they still require some form of supplementation. Pregnant women require supplementation of folic acid, for example, or some iron.

I do agree that this is required, but the majority of what I think...and what Valerie was also getting at was that as our understanding and as our socio-economic status is increasing, we tend to buy better types of food. We tend to buy foods that are more nutritious. I think that is really where we should focus, to be quite honest.

[Dr. Valerie Tarasuk]

I have nothing to add to the comments by Dr. Grover.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Finance Canada has asked the committee to evaluate taxation of unhealthy foods. Let's call it a fat tax, a snack tax, or a junk food tax. Is that an approach that you think might be helpful?

[Dr. Valerie Tarasuk]

I have read some of the earlier submissions to the committee, so I see that the idea of a fat tax or something like that has been bandied about in this group. I think the price tag of food is only one part of the packaging, and before you go down that path you should explore the other aspects of the package.

Certainly, from a low-income perspective, anything that makes food more expensive is a bad idea, if it's food those people need. From that perspective, I think there's no question--and I know others have spoken to you on this point--that to make the foods that low-income people purchase more expensive is only to exacerbate their food insecurity.

At a broader, population-wide level, the question about whether a fat tax would have an impact on diet...I would strongly urge you, before you go any further on that, to take cigarettes as the model--which clearly it is for this discussion of a negative tax--and remember that long before we started raising the price of cigarettes, we had warning labels on them. We don't have anything like that on food. You can buy cookies and crackers that advertise themselves as being trans free. You can get twizzlers that are fat free, as always. So there are a lot of mixed messages now with the current food labels. Way before you start to tinker with the price tag, I think a lot could be done with the rest of food packaging to start to send messages around what foods might be conducive to a healthy body weight and which ones really aren't.

[The Chair, Conservative, Rob Merrifield]

We've had one round of questioning. Mr. Martin has asked for a quick one-minute question, and then I remind the committee that we have three motions to deal with before the end of our committee meeting.

[Pat Martin, NDP, Winnipeg Centre, MB]

Thank you, Chair.

I only wanted to get it specifically from you folks. We're looking for concrete recommendations to put into the report. One of the things that has been brought to our attention is that in British Columbia, P.E.I. and Norway, they have a free fruit and vegetable program in their schools.

They were pilot projects in B.C., P.E.I., and I think in some of the northern regions of Ontario. Jamie Oliver in the U.K. is a champion for trying to get healthier food in the schools.

Would you make that a recommendation to this committee, that this is one direction we should take?