Thank you, Mr. Chair. I appreciate the invitation to appear before the committee.
The Centre for Science in the Public Interest is a non-profit consumer health advocacy organization, specializing in nutrition issues, with offices in Ottawa and Washington, D.C. Our health advocacy is funded by over 100,000 subscribers to the Canadian edition of our monthly Nutrition Action Healthletter, which is read by more than 1,000 residents in most federal ridings. CSPI does not accept funding from industry or government, and Nutrition Action does not carry advertisement.
Diet-related disease is an urgent public health problem in this country. Most Canadians consume too many calories and too much saturated and trans fat, salt, refined flour, and added sugars, and not enough vegetables, fruit, whole grains, and legumes. Every year, diet-related cases of cardiovascular disease, diabetes, and certain forms of cancer prematurely end the lives of tens of thousands of Canadians and rob the Canadian economy of $6.6 billion, according to Health Canada, due to health care costs and lost productivity. These numbers describe real avoidable deaths and financial losses, both on a grand scale, yet the Government of Canada has done little to help reduce them.
Health Canada could use its nutrition expertise to help provincial education authorities develop school curricula for health, nutrition, and cooking courses, and nutrition criteria for school food service offerings. The federal government could also use its spending power to become the last OECD country to publicly subsidize a national school meal program, so that every child, regardless of means or region, is fed a nutritious meal suitable for optimal health and learning. By comparison, in 2005, the United States federal government spent the equivalent of $11 billion Canadian in subsidizing school meals.
Parliament should revisit advertising rules in the Food and Drugs Act and the Competition Act to ensure that they adequately protect children against a barrage of commercial advertisements promoting nutrient-poor foods and products that promote sedentary living, such as video games and television programs. Parliament's prompt intervention is preferable to years of test case litigation that might determine that all ads directed at children are inherently misleading and therefore illegal, because of children's unique susceptibility to manipulation.
Rather than resting on the laurels of mandatory nutrition labelling for most prepackaged foods, as have some of the government witnesses, we hope the government, members of this committee, and their caucus colleagues will support the expansion of existing nutritional labelling rules when Bill C-283 comes to a vote in the House on November 8.
Current regulations are predicted to reduce the burden of diet-related disease by approximately 4%, by producing $5 billion in cumulative economic benefits in the coming two decades at a non-recurring cost of about one-fifth of one percent of food sales for a single year, during the phase-in period—a minimum of 2,000% return on investment.
Children and adults generally eat the same foods manufactured by the same companies and restaurants, and live in the same physical and social environments. As population health experts says, they swim in the same stream. So restricting remedies for childhood obesity to settings such as schools, where children can be targeted exclusively, would produce only partial success.
Many of our recommendations are echoed in the World Health Organization and the pan-Canadian healthy living strategies. But the federal government has made little progress in implementing the policies or funding programs recommended in these two strategies, despite having endorsed both.
Health Canada's scientific clout could also be used to urge food companies to reduce the amount of salt added to processed and restaurant foods, which are the sources of three-quarters of the sodium in our diet—as the United Kingdom and France are now doing, and as the World Health Organization is actively encouraging at a technical meeting in Paris this week, which starts today.
Extrapolating from a U.S. study, a 50% drop in the sodium intake in Canada would cut heart attack and stroke deaths by more than 15,000 annually. Ridding the food supply of trans fat could avert hundreds and possibly thousands more premature deaths.
Recommendations to reform food taxes have been advanced by expert reports published by--and I won't list them all--the Canadian Institute for Health Information; the World Health Organization; the Chief Medical Officer of Health for Ontario; and the U.S.'s Institute of Medicine, with two reports. Notably, the federal-provincial-territorial The Integrated Pan-Canadian Healthy Living Strategy, which was supported by ministers of health of all political stripes, recommends that Canadian governments “undertake [a] feasibility study on fiscal measures to encourage healthy living (i.e., tax credits/penalties, subsidies, price supports, etc.)”.
Our recommendations involve both taxation and tax relief, depending on the nutrient profiles of food. The federal government now collects GST from about one-third of all food expenditures, drawing about $2 billion in tax revenue annually. At present, the Excise Tax Act appears to partly acknowledge the importance of nutrition by imposing taxes on soft drinks, candy, and snack food, but promotes unhealthy diets by taxing low-fat milk and vegetable dishes when sold in restaurants, as well as club soda, salads, vegetable fruit trays, and small bottles of water when sold in retail stores.
Meanwhile, many unhealthful foods sold in retail stores are tax-free, such as sugary breakfast cereals, trans-fat-laden shortening, high-saturated-fat cheese, chicken wings, coffee, cream, and even unhealthy luxury foods such as salty caviar.
The federal government should consider whether economic disincentives to choose healthy foods and tax relief on health-eroding foods comport with this or any government's commitment to reduce the burden of chronic disease. Quite frankly, tax incentives should be smart, not dumb. They should help prevent disease and promote efficiency, not prevent efficiency and promote disease.
A British epidemiologist estimated, in a study published in the British Medical Journal, that applying his country's 17.5% value-added tax to a few categories of food that are high in saturated fat would reduce saturated fat intake enough to prevent between 1,800 and 2,500 heart attack deaths per year in the United Kingdom. Researchers examining conditions in the United States, Denmark, Tanzania—coincidentally—China, and Norway have lent credence to the potential of tax price incentives as a means to help achieve population-level dietary change. Even researchers critical of food tax reform predicted similar effects on dietary fat intake, but failed to appreciate the huge numbers of lives that could be saved by such dietary changes.
Like the successful Canadian experience with tobacco taxes, sensibly designed food tax incentives could help internalize the cost of food choices and promote nutritious eating. Moreover, the effects of adding GST to nutrient-poor foods could be amplified by requiring manufacturers of taxable foods to indicate on the label that the product is subject to GST. This would send both information and price signals to consumers and create incentives for manufacturers to reformulate foods by, for instance, including less added sugar and salt, more whole grains, fruits, and vegetables, or replacing saturated fats with unsaturated fats.
The average Canadian now spends about $56 per year paying GST on food purchases. In 2006-07, the GST credit reimburses $354 to the average single individual earning $20,000 per year and $708 to a family of four with the same income. These rebates could be increased by a few dollars per person to offset further regressive effects, if any, of GST reform, or increased even more ambitiously to help reduce food insecurity.
In conclusion, plainly policy-makers can't turn the clocks back to a time before obesity rates began to rise. They must consider the causes of the causes of childhood obesity and other diet-related diseases and then focus on solutions that the best available evidence indicates will protect population health benefits.
Some food and media companies defend their behaviour by wagging fingers at poor parenting or overstating the capacity of children for sound judgment by embracing notions like “kid power”. These are efforts to shirk responsibility and excuses for doing nothing. In reality, dramatic national--indeed global--changes in sales tax policies, government dietary advice, food manufacturing and marketing practices, school curricula, and the unprecedented growth of sedentary media and computer technologies used for marketing, entertainment, and work have likely all contributed to eroding environments for children and adults. Governments should actively develop programs and policies to repair and prevent the adverse health and economic effects of these major societal transformations.