Evidence of meeting #5 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was industry.
A recording is available from Parliament.
9:10 a.m.
Liberal
The Vice-Chair Liberal Lui Temelkovski
I call the meeting to order.
I'd like to welcome everyone. Just so everyone knows, I will be chairing today's meeting as well as Thursday's meeting. The chair is away for a family situation this week.
We were scheduled to table our report this week, and Joy has asked if we would table it next week when she comes back. Does anybody have any objections to that, to delay tabling the report to next week?
Yes, Carolyn.
9:10 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
I think we need to make sure it's tabled before the break. I don't know what's going on, but I think we would.... No one knows what's happening, so I would say that if we do this, then it should be on Tuesday, right after committee.
9:10 a.m.
Liberal
The Vice-Chair Liberal Lui Temelkovski
The clerk says Tuesday doesn't work because we're sitting in committee at the time that tabling of reports occurs in the House.
9:10 a.m.
Liberal
The Vice-Chair Liberal Lui Temelkovski
So either Monday or Wednesday. But are we in agreement to delaying it until Joy comes back?
9:10 a.m.
Some hon. members
Agreed.
9:10 a.m.
Liberal
9:10 a.m.
Liberal
The Vice-Chair Liberal Lui Temelkovski
As early as possible next week.
Thank you very much.
Now we'll move to our regularly scheduled agenda. The committee is studying the government response to the report entitled “Healthy Weights for Healthy Kids”. The report was presented in the House on March 22, 2007, in the previous session. The Minister of Health tabled the government response to the report on August 22.
I'd like to welcome officials from the Public Health Agency of Canada, Health Canada, and the Canadian Institutes of Health Research, who are here with us today.
Could we begin with an opening statement from you and your officials, Mr. Ball, if you'd like to introduce them to us. We will give you 10 minutes, the regular time, and then we'll go into questions.
Please.
9:10 a.m.
Jim Ball Director General, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada
Thank you very much, Vice-Chair and members of the committee.
I'm very pleased to be here today along with colleagues from the health portfolio. With me is Kathy Langlois from the first nations and Inuit health branch; Diane Finegood from CIHR, the Canadian Institutes of Health Research; Claude Rocan, director general of the Centre for Health Promotion; and Janet Pronk from the health products and food branch, director in the office of nutrition policy and promotion. I am director general in the health promotion and chronic disease prevention branch in the Public Health Agency of Canada.
As I mentioned, I am very pleased to be here to discuss the government's response to the parliamentary standing committee's report on childhood obesity, “Healthy Weights for Healthy Kids”.
Your report provides an important assessment of the issue in Canada. It identifies many of the key determinants that contribute to excessive weight gain in children and youth, and highlights the implications of obesity for the health and well-being of young Canadians and, indeed, for the long-term welfare of Canada.
Through its analysis, the committee makes it clear that childhood obesity is a serious public health issue with links to a range of chronic diseases as well as premature death. Moreover, it effectively illustrates that halting further increases to Canada's overweight and obesity rates is a shared responsibility. It rests not only with the health system, including public health and health care actors, but jointly with players from across many sectors. As such, you call upon the Government of Canada, specifically the health portfolio, to provide leadership in raising awareness about the complexity of the issue of childhood obesity and in coordinating the efforts of diverse sectors, particularly those under federal jurisdiction.
In its response, the government highlights a range of key initiatives and actions already in place to address the problem of childhood obesity. These were organized under the six recognized core federal responsibilities in public heath, including leadership, coordination, and strategic policy, among others that you are familiar with.
While I will not go through the entire range of initiatives detailed in the response, I would like to draw your attention this morning to the following policy measures and initiatives that have been introduced by the government in recent months to help children and families live active healthy lives, namely: the children's fitness tax credit; the funding of the new ParticipACTION campaign; the revised Canada's Food Guide, including a tailored version for first nations, Inuit, and Métis; Canada's physical activity guides for children and youth; as well as funding for the initiatives of nine non-governmental organizations through the Public Health Agency's physical activity and healthy eating contribution program that specifically target children and their environments. These initiatives will help to reduce barriers and increase access to convenient, safe, and affordable opportunities to integrate physical activity and healthy eating into daily living.
The government's response recognizes the importance of information and evidence in helping to monitor the health of the population and evaluate policy objectives and interventions. To this end, investments have been made to support activities that enhance the health portfolio surveillance and research capacity, including the Canadian Community Health Survey, the Canadian Health Measures Survey, the Health Behaviours in School-aged Children Survey, and the Non-Communicable Disease Surveillance Infobase, as well as funding strategic university-based research across the country through the Canadian Institutes of Health Research.
As pointed out in the committee's report, the sharing of information on specific initiatives, including established best practices as well as promising practices, helps accelerate effective program uptake across the country. To this end, the government has established initiatives and mechanisms to share information with key stakeholders, including the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention, the Canadian Task Force on Preventive Health Care, and the National Collaborating Centre for Aboriginal Health.
In addition, the federal-provincial-territorial public health network provides an effective infrastructure that allows the two levels of government to share information and best practices and collaborate on public health issues such as childhood obesity. For example, in September of this year, the deputy ministers of health from all jurisdictions held a retreat that dealt with this issue in order to share successful approaches and identify ways of tackling the problem of unhealthy weights.
We understand that children living in lower socio-economic conditions are more likely to be obese than those living in families with higher education and income levels, and those living in rural or remote communities are also more likely to lack access to quality services for health promotion and related health interventions. The government response therefore notes key investments in several community-based programs, such as the community action program for children and the Canada prenatal nutrition program. These programs mitigate and improve the life circumstances of these children, as well as provide families, communities, and health professionals with access to the information and support they need to make healthier choices in the areas of physical activity and food selection.
The committee also draws attention to the issue of obesity and the overall poor health of aboriginal populations, which results from a complex array of historical, economic, and societal factors. The government response highlights the programs, services, and initiatives that respond to the unique circumstances of first nations, Inuit, and Métis peoples. These include, for example, continued investments in the maternal and child health program, aboriginal head start, the Canada prenatal nutrition program, the aboriginal diabetes initiative, as well as other key initiatives such as the food mail program.
Further, new data is being gather through the first nations regional health survey. The next cycle of this survey will go into the field early in 2008 and it will collect important information on food security, physical activity, height, and weight. Collectively, the policies, programs, and initiatives, as outlined in the government response, provide an important foundation upon which to continue to build and inform our current and future actions, not only with respect to children but in all segments of the Canadian population.
In moving forward, we are taking an approach to overweight and obesity with an increased emphasis on the complex interplay of underlying factors and environmental conditions that influence the choices and behaviours of Canadians. We also recognize, similar to the approach taken to achieve the success demonstrated on tobacco control and smoking cessation, that counteracting obesity will require long-term, multi-sectoral efforts involving many of the key partners and stakeholders highlighted in your report.
The Government of Canada is just one player among many that must be engaged on childhood obesity. We are, however, in a position to provide a key leadership and coordination role, based on the foundation of work to date and our public health and related expertise. In this regard, we appreciate the need to work collaboratively within the health portfolio and, in turn, to engage all federal departments and agencies that can support efforts to enhance existing and potentially new policies, programs, and services.
I would like to highlight to the committee that we have created a new directorate within the Public Health Agency of Canada. This new capacity will advance action on the social determinants of health--those determinants that are fundamental to addressing overweight and obesity--and coordinate efforts to address this area as a core priority.
I am also pleased to report that since the tabling of the government response in August, we have continued to advance and build on the initiatives outlined in the response.
As you know, in June of this year, the Minister of Health announced that Health Canada adopted the recommendations of the Trans Fat Task Force and called upon the food industry to reduce the levels of trans fats in foods within two years. The minister also announced that if significant progress is not made in the next two years, Health Canada will develop regulations to ensure that the recommended levels are met. Health Canada is closely monitoring industry actions in this area via a trans fat monitoring program and will inform Canadian consumers of industry progress approximately every six months through the Health Canada website.
We recognize the importance of providing nutrition and healthy eating information to help support healthy food choices in an environment saturated by food industry marketing messages and confusing information. To help address this, the government is a partner in organizing a national policy consensus conference on the impact of marketing on the unhealthy weights of Canadian children and youth, scheduled to take place in Ottawa in March 2008. The results of the conference will be used by the government to address concerns about marketing to children.
In its report, the committee provided recommendations on front-of-package labelling. This issue is now being considered as part of Health Canada's public consultation on a modernized framework for health claims for foods, given that front-of-package labelling can be seen as a form of implied health claim. A discussion document on health claims has been developed, and face-to-face consultations will take place in six cities across Canada early next year.
Feedback from stakeholders as well as consumer research on this topic will guide the final proposed framework. This information will also be used as the basis for future targeted consultations on the issue of front-of-package labelling alone. Moreover, a healthy eating campaign, to be launched in the winter of 2008, will promote healthy eating concepts and encourage the effective use of nutrition information on food labels to enhance the ability of Canadians to make healthy food choices. This campaign builds on the TV ad campaign launched last winter, which promoted the revised Canada's Food Guide.
In addition, we have taken further actions consistent with the overall direction of the committee's report and recommendations. For example, to help foster the conditions that facilitate lifelong active living, we will be supporting implementation of the World Health Organization's age-friendly cities initiative in several communities across Canada.
One important focus of the project is changing the physical environment in communities, including the built environment, as a key factor that influences opportunities and/or creates barriers to physical activity participation. In addition, there is growing awareness of the impact of trade, particularly in regard to agricultural commodities and the increased availability of packaged foods as a possible factor in the escalating prevalence of obesity.
To further our understanding of these global trade dynamics and their impacts on children and families, the health portfolio partnered with the World Health Organization to host an expert forum in Montreal this past November. Specifically, the purpose of the forum was to synthesize current knowledge and identify opportunities to promote and develop sustainable and healthy policies and actions on the part of industries, governments, and other stakeholders.
In a similar vein, the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes will in the new year bring together representatives from the food industry, health sector, ethics, marketing, and agriculture policy to build trust and work collaboratively to reduce obesity and identify potential solutions. As the committee and the government have clearly recognized, obesity, including childhood obesity, is a complex issue. Therefore, it is important to develop innovative approaches and a stronger base of Canadian evidence to address the drivers of this issue and ensure that we systematically learn from these.
To support this need, the Public Health Agency of Canada has created an innovations and learning strategy. This strategy will provide funding support to design and test inter-sectoral initiatives applicable to the underlying causes of overweight and obesity. For its part, the CIHR Institute of Nutrition, Metabolism and Diabetes has undertaken significant new work to improve the knowledge base in the area of childhood obesity. For example, in partnership with the Heart and Stroke Foundation, CIHR recently funded initiatives in the area of the built environment and obesity, including studies focused on the features of the built environment in residential neighbourhoods that influence excess weight in a group of children at risk for obesity, and a longitudinal study of environmental determinants of overweight among children.
In addition, the Canadian Institutes of Health Research have created a new type of funding opportunity that supports intervention research, including the study of programs, events, or policies initiated by others. For example, CIHR has funded two studies to assess the impact of the relaunching of ParticipACTION. This new approach demonstrates how the government is efficiently linking research investments to help evaluate the effectiveness of new policies and programs. The range of initiatives currently under way by the health portfolio and in collaboration with other stakeholders illustrates how we are continuing to take action and build the partnerships that are needed to address the causes of childhood overweight and obesity in Canada.
To conclude, the standing committee has been instrumental in helping to underscore the serious nature of the issue of childhood obesity in Canada, as well as the need to act. The government concurs with the committee that childhood obesity, and indeed obesity in general, requires continued attention by governments and other stakeholders. The foundation that has been created through existing and new initiatives and partnerships, as described in the government response and further clarified today in my remarks, positions the government to effectively move forward to address this very serious societal issue.
Thank you for the opportunity to highlight our continued and expanded work in this area.
9:30 a.m.
Liberal
The Vice-Chair Liberal Lui Temelkovski
Thank you very much, Mr. Ball.
As a reminder to all members, we'll be starting with the seven-minute rounds. Every party will have seven minutes. Then we'll move into the second round of five minutes.
We'll start with Dr. Bennett.
9:30 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Thank you very much.
I thank all of you for coming.
First, thank you for updating us on the deputy ministers retreat, which I think is a positive step. I think the fact that there will be a national consensus conference on the marketing pieces is progress.
However, I don't think I speak just for myself in saying that the government response was pretty thin gruel in terms of saying anything we didn't already know from the hearings themselves. I think the government's response is supposed to say what you're going to do about the committee's concerns, not what you've already done. I think we have to get out of the habit of the government response to a committee report being just a reiteration of what we already heard at the hearings and a laundry list of things you're dabbling in at the moment. We know about ParticipACTION. We know about the tax credit. We know about these things. We want to know what you are you going to do, based on the concerns raised by the committee, that is different from what we have already heard at the hearings.
In the ongoing quest by this government.... I have to say that when I arrived here 10 years ago, the women's health strategy was a laundry list of what we were dabbling in at the time. It was not a real strategy in terms of what would be done, by when, and how, with targets and methodologies for doing things, whether it was Caesarean section rates or whatever. So here, I have to say, I was pretty disappointed that the response was very much a regurgitation of what we'd already heard.
Things like, we “will have to partner with”, and in terms of setting measurable targets, “Beginning in 2007, progress towards these targets” set for adults “will be reported through”.... Well, it's already the end of 2007, and I don't actually see that happening.
On the social marketing campaign, it's December, and we've not seen anything. On trans fats, we don't have a clue what's holding people up in terms of what it was very clear had to be done, and we're back to the government response being that industry will be “encouraged to voluntarily reduce”.
That's not what we wanted. We wanted to know, because of the real importance in our country of canola oil, whether the fooling around should make it 2% or 3%, because of what is naturally occurring. We wanted to know when we are going to actually have trans fats banned at a realistic rate for our country.
I'm a bit dismayed that there's not anything in here, other than a couple of the things I just talked about, that actually says yes, we'll do the trans fats; yes, we will set some targets; yes, we will respect the direction of this committee in terms of doing new things. What we as a committee may find we have to do is re-table this report and ask for a better response. This is just the same old, same old, and it's disappointing.
I would like to know the things you think you have done since you saw this report that actually show that you've heard the committee and that you're taking this issue seriously. It's not that you weren't taking the issues seriously before, but what have the wishes of Parliament done to catalyze funding, catalyze commitments, or catalyze anything?
Even in terms of research, I guess I'm still very upset about the lack of funding to CIHR and the fact of the difference between investigator-driven research and what it says in our recommendation about ensuring a research focus on quality physical activity. How do we sort out what we really know needs to be done now in this country?
I was pleased to see that the CIHR is doing some research on which interventions work and which don't. I myself would love to see a research project on the frigging food guide as to whether it's ever changed anybody's behaviour in this country. In terms of just redoing the same old, same old, it looks like the same thing that was hanging on my bulletin board when I was in grade 7.
I would like to know what's new, that you're proud of, since this committee tabled this report.
9:35 a.m.
Director General, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada
Perhaps to clarify the nature of a government response to a report from a parliamentary committee such as yours, our understanding was that the report would express what the government is currently doing within existing authorities and resources. That is in fact the approach that was taken to the report, our understanding being that it was the appropriate manner in which to respond.
Vice-Chair, perhaps you could correct me if I'm wrong.
9:35 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Within your existing capacity, I think you have to do something about trans fats. I mean, there are some things we want to know: when?
We're very clear that we're not happy. We asked for regulations by 2008. They should have been done a year and half ago. Your expert panel tabled the report a year ago June. We don't really know what's been waiting.
In the government response it says “industry be encouraged to voluntarily...reduce”. That's just insulting to the committee. Did we waste our time? Why do we even come if all you will do is bring us back to what you told us during the hearings? There's no real point. This place has to be more than a place to hang Christmas lights on. I don't get it.
9:40 a.m.
Director General, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada
As mentioned in my opening remarks, and further to my remarks, industry has already demonstrated a commitment to reducing trans fats in the food supply. A voluntary approach at this point would allow the food industry time to reformulate products while at the same time maintaining goodwill by acknowledging that significant progress is being made by industry in this area.
9:40 a.m.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
So you're going to ignore the results of the task force and ignore the results of this committee in not establishing regulations.
9:40 a.m.
Director General, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada
No. To further explain the approach, to ensure that industry is making progress in meeting its commitments, Health Canada, as I mentioned, will closely monitor the actions by industry over the next two years. As the Minister of Health has pointed out, if that progress has not been made, then he would proceed to regulate levels of trans fats in food products.
9:40 a.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Mr. Chairman.
I simply want to conclude on trans fats. The industry has in fact known for a long time that these fats must be banned. It is therefore time to take concrete action in that direction. Unless I'm mistaken, Mr. Ball, initiatives have been taken since the government's response was filed.
Based on this morning's statement, I'm going to ask you some more concrete and direct questions on what you said so that we can in fact know what to expect in the coming months because it is really time to take action against childhood obesity.
So you told us that children who live in more difficult socio-economic conditions are more inclined to be obese. Unfortunately, it isn't with the tax credit that these children, whose parents' incomes are reduced, can do more activities.
I simply wonder—and I haven't found any information on this subject—what the government intends to do to solve part of the problem of activity among children whose family incomes are more limited.
9:40 a.m.
Director General, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada
As I said in my opening remarks, the government does have a number of programs in place for first nations, Inuit, and Métis peoples, who are living, most often, in lower socio-economic conditions, to mitigate the effects of lower income and lower education and related conditions. These are programs we can mount and address through the health system and with other stakeholders that support children living in families that experience those difficult conditions.
We also have a number of other programs that are aimed at the broader population that lives in conditions such as you're mentioning. As I mentioned in my opening remarks, they try to mitigate these effects, which is the role we can play within the health portfolio.
To address that issue, I'll call on my colleague from the first nations and Inuit health branch and Claude Rocan, who is responsible for some of these programs.
9:40 a.m.
Kathy Langlois Director General, Community Programs Directorate, Department of Health
Thank you. I'd be very happy and actually proud to also respond in terms of the work we have been doing within the base of our programming in first nations and Inuit health branch.
I've done a quick calculation. We spend about $150 million annually in four programs alone that are aimed, in large part, at the issue of childhood obesity. Those programs have already been named by my colleague, Mr. Ball: the aboriginal diabetes initiative, the aboriginal head start program, the Canada prenatal nutrition program, and our new maternal child health program.
Some things are new since the report was drafted. We continue to invest within that base of funding. We have put in place 63 new maternal child health community projects, and we are expecting an additional eight by the end of this fiscal year. That program is meant to connect mothers on reserve with the supports needed to improve parenting skills and to also address the needs of their children.
As well, our aboriginal diabetes initiative is now rolling out in terms of putting into place community-based diabetes prevention workers. We've been working in three regions of the country. We trained 46 community workers last year, and we have recruited an additional 86 to train this fiscal year. Our goal is to have 300 to 400 trained community workers on reserve who basically will be community mobilizers. They will be out there mobilizing the community around healthy eating, physical activity, and bringing activities to the community.
Also, in our aboriginal diabetes program we have just awarded 16 new diabetes prevention projects that are for the off-reserve population. And that's on top of an existing 32. We're spending about $1.9 million on those 16 projects this year.
I'll give you a few examples of what they are. In the Ooknakane Friendship Centre in B.C., there'll be a breakfast for learning program. Again, it's for off-reserve aboriginal kids. The Dauphin Friendship Centre will see school youth engagement in healthy food choices and physical activity. In the Ki-Low-Na Friendship Society we'll see food programs directed to youth and elders, making that linkage that is so important for cultural continuity.
Those are some of the main things we're doing. I have some other items, but it gives you a sense of it, I think.
I'll defer to my colleague.
9:45 a.m.
Claude Rocan Director General, Centre for Health Promotion, Public Health Agency of Canada
I want to add to what my colleagues mentioned. There are two national programs in particular for children living in high-risk conditions: the Community Action Program for Children and the Canada Prenatal Nutrition Program. As I just mentioned, these programs target children living in high-risk conditions. We consider these measures important in improving those conditions.
As a participant in the Canadian public health network, I can add that an expert panel, which is particularly concerned with health promotion, is examining and studying the question of health inequalities in Canada. They are discussing it as well. These are long-term problems that represent very significant challenges. It is definitely a major concern for this federal-provincial/territorial group.