Status of Women Committee on Dec. 10th, 2013

[The Chair, NDP, Hélène LeBlanc]

There seems to be—

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Could my time be stopped?

[The Chair, NDP, Hélène LeBlanc]

If any of the witnesses has figures that would approach an answer to Ms. Duncan's question, please provide them. Send them to the clerk and we will provide them to the members.

Thank you.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

The point I'm making is the witnesses are having difficulty finding those numbers and I wanted to make the comparison between what was specifically mandated for eating disorders for CIHR, not the broader picture, not mental health, which was $40 million, but eating disorders, $4.5 million. I would like to show that comparison.

I have another concern. We heard from PHAC and Health Canada that there is a real focus on prevention. We all want prevention, obviously. It's key. My concern is there are Canadians living with eating disorders right now. They're hurting. Their families are hurting, and I'm going to ask you, point-blank, how do we do diagnosis, treatment, and prevention of relapse better? And I would like real recommendations, please, to this committee.

[Marla Israel]

There is no doubt that I take your points very seriously with regard to those who are suffering right now. You want to ensure that the health system writ large is able to deal with this issue, that health professionals are acclimatized to this issue. I think the whole issue of healthy eating, quite frankly, has gained greater ground in recent years.

Obviously, for the Public Health Agency of Canada, our mandate is one of prevention, and so that is where the focus of our efforts lies. That said, I do think that within provinces and territories this issue is something that is addressed and that the focus of our work really is one where we try to do the best we can in terms of highlighting issues, including all mental disorders, with a view to greater prevention.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Dr. Israel, can I pick up on that?

For my next question, I'm going to ask about wait times. Can the data be provided, or does anyone have it here? What is the wait time for treatment for eating disorders for girls, I'm going to say under 16, if we look at a CHEO or a Sick Kids?

Then over that age, what are the waiting times by province and territory and by eating disorder? Do we have that information?

[Marla Israel]

The Public Health Agency of Canada does not collect that kind of information on treatment or in terms of wait times. The wait times to arrive at diagnosis and treatment of eating disorders would be data that is captured, I believe, within provinces or territories—

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Would that be checked by CIHI as other diseases are tracked?

[Marla Israel]

I'm not aware of that.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Can anyone find that out for me? Who is tracking wait times for girls and women by province and territory and by eating disorder, and if we don't have those answers, should that be a recommendation?

Then I'll ask Dr. Hutchinson a question, if I may. You were very clear to say, our mandate is around healthy eating. There are Canadians who have disordered eating. Does this need to be addressed?

[Dr. Hasan Hutchinson]

The way we address that is to make sure that the policies, the programs, and the interventions that we put forward do not have that unintended consequence of creating or going toward disordered eating. We work very closely with experts in the field to make sure that this is built into everything that we put forward.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

How much time do I have?

[The Chair, NDP, Hélène LeBlanc]

You have 45 seconds. You just have time to squeeze in a little question.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thanks.

I guess what I'm getting at with the question about CIHI is that, for example, we're going to have an MS monitoring system. We have other systems where we're collecting data by certain conditions. Does this exist for eating disorders? Do we actually know the numbers? Do we know how long people are waiting for diagnosis, how long they are waiting for treatment, time intervals between relapse, how we're doing on preventing relapses?

If that information could be tabled with the committee, I would be grateful.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much, Ms. Duncan.

Ms. Bateman, you have five minutes.

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

Thank you so much, Madam Chair.

Thank you to all of our witnesses for being here. This is such an important study.

I just want to clarify one of the comments made by you, Dr. Hutchinson, at the very start. A lot of your preamble was focused on health, not on weight. I appreciate you making that distinction, because I think we've all often in the past—I have a 15-year-old daughter—thought about the weight piece. But then in your comments, in response to my colleague Niki Ashton, you said that you've done work on the issue of healthy weights, that you're educating people about their healthy weight.

How do you combine those two issues? If you're not talking about weight, you're talking about health, and then you're saying, “By the way, your healthy weight is x.” How do you manage that?

Please don't be too long; I want to move on to the other witnesses as well.

[Dr. Hasan Hutchinson]

Okay.

For the past few years, as we've been concentrating on the issue of healthy weights, both overweight and obesity, we have tried very hard not to talk about weight per se, or about BMI per se. Having said that, of course you can go to our website and look up BMI measurements and figure out your BMI so that you know what it is.

But where we're trying to go with all of this is to get to the behaviour change that we like to see. We talk about food skills, and about trying to develop good food skills for Canadians, which would apply really across the board, at least from disordered eating over to overweight and to obesity as well.

So when I'm talking about food skills, I'm talking about the basics: understanding nutritional guidelines, understanding the labels, having those planning and shopping skills so that when you're out there, and you're trying to plan your meals—

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

I guess I misunderstood your comment about the focus on healthy weights, then.

[Dr. Hasan Hutchinson]

We take that into consideration as we develop our policies and programs, but what you won't see on our policies and programs is a preoccupation with weight, or with BMI—

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

With numbers.

[Dr. Hasan Hutchinson]

—or with numbers. What we're trying to do is help Canadians make healthier food choices. That would apply across the board.

[Joyce Bateman, Conservative, Winnipeg South Centre, MB]

That's a great thing.

To the other witnesses, it would appear that there is a mounting body of information regarding the fact that these weight disorders, these food-related disorders, are in fact mental health issues, or are often related to mental health concerns. Is that fair to...?

I'm just curious; is the approach of considering mental health in relation to body image and healthy eating habits, as we have just heard about from Health Canada, relatively new, or have public health agencies long been aware of the link between mental health and eating disorders? I'm really curious about that.

Perhaps we could start with Marla Israel.

[Marla Israel]

That's a great question.

I would say that Dr. Johnson is probably a better expert than I to actually come up with the evidence. Just anecdotally in terms of mental health issues writ large, I would argue that there has been a sea change in the country in terms of our understanding, and not only our understanding but also our ability to talk about it publicly.

It's not that long ago that people were reluctant to even talk about mental well-being, even within the agencies. As a public health issue, I would say it's still relatively new. We work with public health nurses and others within the public health community to situate these issues from a public health perspective, from an area of more upstream interventions so that we can prevent the downstream effects, so that we don't have to deal with people in treatment.

Obviously that's not to discount the provincial and territorial roles of the systemic issues that are at play, but when you talk about public health, our interest is in understanding many of these illnesses, or these disorders, as those where, utilizing the right interventions, we can prevent something from happening down the road.

That involves healthy image, that involves self-confidence and self-esteem, that involves prevention of child abuse, prevention of sexual abuse—all of the things that are risk factors, as Dr. Johnson talked about, for the types of disorders that take place later in life.

[The Chair, NDP, Hélène LeBlanc]

Thank you.

Mrs. Sellah, you have the floor. You have five minutes.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

I want to thank all the witnesses with us here today, even though the people from Status of Women Canada have not yet spoken.

My question has to do with mental health and each one of you is free to answer it.

Dr. Johnson said that there is a wide spectrum of eating disorders, such as anorexia nervosa. These are chronic, complex and multidisciplinary conditions. This is a mental health issue.

Our understanding is that the Mental Health Commission of Canada created a national strategy for Canada two years ago, and that this strategy has yet to be implemented. Is a mental health strategy on track for implementation? If so, how is the progress on that being measured?