Bill C-252

Child Health Protection Act

An Act to amend the Food and Drugs Act (prohibition of food and beverage marketing directed at children)

This enactment amends the Food and Drugs Act to prohibit the marketing of prescribed foods directed at persons under 13 years of age.

[The Chair, Liberal, Sean Casey]

Thank you.

Is there any discussion or any opposition?

(Motion agreed to)

Thank you.

For Bill C-252, which is Ms. Lattanzio's bill that is coming to us next Tuesday, we are required to set a deadline for the submission of amendments because unrepresented parties also have a chance to propose amendments. I would like to suggest this coming Friday in order to have time to have them circulated.

Do we have the consensus of the room to set a deadline for the submission of proposed amendments as this Friday? I need a motion to set the deadline for Friday at noon.

Mrs. Goodridge, thank you.

Is it the will of the committee to adopt the motion?

(Motion agreed to)

Thank you very much. Those are the housekeeping items that I wanted to deal with.

I understand there may be at least one or two other motions. The floor is open.

Mr. Lake.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McKinney.

Thank you to all of our witnesses.

As I indicated at the outset, this is the final witness panel for the children's health study. It's been a fascinating and varied course that we've taken through the various panels, so I guess it's appropriate that we end with one that was both fascinating and varied.

Thank you all for being with us. Thank you for being so patient in sharing your expertise. We wish you a good day and many thanks.

Colleagues, we're going to move now to committee business in public, unless the will of the committee is to do otherwise. I don't propose to suspend because, although the original plan was just a couple of housekeeping items, there are a couple of other items that are going to be raised.

I will ask you to deal with the housekeeping items first.

One is the study budgets that have been circulated to you. The other is simply a deadline for the submission of amendments on the private member's business that's coming to us next week. Is it the will of the committee to deal with these study budgets as a group or do we need to talk about...? Okay, I see at least some heads nodding.

Could I have a motion to adopt the project budget for the main estimates, which is Thursday's topic; for Bill C-252, which is coming before us next Tuesday; and for Bill S-203, which might be coming to us next Thursday unless something else happens today?

Is it the will of the committee to adopt these budgets as presented? Because we're in public, I think we actually need a mover.

Mr. Davies, do you care to move the motion?

[Dr. Andrew Lynk]

Thank you, Mr. Chair.

I want to thank the committee for inviting me to present today.

I am speaking on the traditional, unceded lands of the Mi'kmaq here in Halifax, Nova Scotia. We are all treaty people. My department of pediatrics, the Canadian Paediatric Society and the Pediatric Chairs of Canada are all committed to advancing the truth and reconciliation recommendations as they apply to families, children, youth and health.

I'm going to build my remarks on some of the September 27 presentations that were made to this committee by my colleagues from the Canadian Paediatric Society, Children's Healthcare Canada and the Quebec association of pediatricians.

In addition to my current pediatric leadership roles, I spent 26 years practising as a community pediatrician on beautiful Cape Breton Island in Nova Scotia. I had the privilege to serve thousands of children from across the island—from first nations communities to children with cancer, children with autism and those who were born prematurely and with dozens of other conditions. I also served the one in four children and families living in poverty there.

I'll always remember a family who came to me. They were a young couple who were probably in their early twenties. Both had lived lives of adversity and were down on their luck. They had a new baby girl. They brought the baby into my office. After I had examined the baby and we had talked a bit, I asked them what they wanted for their daughter. They said they wanted a better life for her than they'd had. I said, “Okay.”

I've thought about that ever since, both as an individual practitioner and as a leader. Obviously I have to rely on my political colleagues to make some of the big system changes to make that happen.

It's quite clear that political discussions around health and health care always get mired in and confused over jurisdictional issues between the provinces and the federal government. It will probably always be like that—at least for the next little while.

I thought to myself, if I'm going to present today and if I were a member of Parliament or a senator, what would be the top 10 things I would focus on if I wanted to try to advance the well-being and health of children and youth here in the country? That's what I'm going to give you. It's my top 10 things in pretty quick succession. You've heard some of them before.

First, when it comes to mental health transfers, commit at least 25% of that, representative of the child and youth population, to services for child and youth health. We still have too many families, children and youth who cannot access mental health services in a timely fashion.

The second thing is one you've heard from the Canadian Medical Association. I think there's movement on it, but it's really crucial. The federal government should take the lead on a national health human resources centre. They could collate provincial data on the number, distribution and mix of nurses, physicians, mental health workers and allied health workers like lab techs and respiratory technicians, as well as the ages of those health workers and the number of trainees in various programs. This data would allow for planning to meet the increasing demands of the Canadian population now and in the years to come. We're dropping the ball on this one. We're flying blind. It reminds me of what happened to PPE during the early phases of the pandemic, when the provinces and the feds thought everybody had it under control and we didn't coordinate. This is a major issue.

Number three is that I would support the establishment of a national school meals transfer program, so that all children in schools receive a healthy breakfast and/or lunch without stigma. Currently, about one in five children—this is higher for newcomers and indigenous children—live in relative poverty. This would be a major benefit. Senator Rosemary Moodie and her colleagues have been trying to advance this. We would back this.

Number four is a really important one. In 2016, the federal government and Parliament passed the Canada child benefit. In Nova Scotia, in the year prior to that 2016 date, about one in five children lived in absolute poverty—below the market basket measure. In 2019, which is the last year I have data for, that's gone down to just one in nine. One in nine is still too many, but it has been almost cut in half. It's most likely because of the Canada child benefit. That needs to be indexed to real inflation.

When you look at the UNICEF rankings, right now Canada ranks 26 out of 38 rich OECD countries, with the worst child poverty rates. There's no vaccine for poverty. Doctors can't do this. We need everyone to work on this.

In the United Nations Convention on the Rights of the Child, which Canada passed in 1991, article 27 states that all children should be entitled to adequate standards of living.

Are we really living up to that if one in nine children are still living below the absolute poverty line?

There's another quick point from the Hospital for Sick Children, which was recently published in The Globe and Mail. They're talking about the complexity of the tax forms for poor families and families entitled to apply for some of these measures. They're saying they're difficult for some to navigate and asking if we can make them simpler.

Number five, I would encourage you to pass Bill C-252, which puts restrictions on the advertising of foods high in sugar, fat and salt to children under the age of 13.

Quebec has the lowest incidence of child obesity and children who are overweight in the country, and they have such regulations in law. We know that one in three children in Canada is obese or overweight. They have a higher risk of going on, as young adults and even as teenagers, to have problems with heart disease, liver disease and diabetes—and these are significant problems.

Number six, establish a child-friendly national pharmacare program. One in six families in this country find it difficult and struggle to pay for their children's prescriptions. Also, fund a national, evidence-based and pediatric-sensitive formulary that all practitioners in Canada can use.

Number seven, prioritize housing, water, health and educational opportunities for all indigenous children and youth. I have seen some of the benefits of this among our first nations communities in Cape Breton. When given the opportunity, these children and youth thrive, blossom and make huge contributions to our society.

Number eight, Canada should continue to take a leadership—

[Don Davies, NDP, Vancouver Kingsway, BC]

Got it. Thank you.

Dr. Warshawski, Bill C-252 would restrict food and beverage marketing directed at persons under 13 years of age, and I think you've done an excellent job of explaining why children under that age are particularly vulnerable.

However, I'm wondering about children 14 to 18. They may not have the same vulnerability in terms of their belief systems about what they see on TV, but these are kids who have money. They're the ones who are independently able to go purchase their foods, including junk foods. Do you have any thoughts on restricting food and beverage marketing to children between 14 and 18?

[Brendan Hanley, Liberal, Yukon, YT]

Thank you very much.

Thanks to all of the witnesses for the really interesting testimony.

Dr. Warshawski, I'd like to start with you.

I think you've made it pretty clear what we could do from a policy perspective in terms of marketing without putting into force what's already in the Gazette in addition to anything that Bill C-252 may add.

Maybe expanding on or moving beyond what we should be doing in restricting marketing and maybe picking up a bit on the literacy from Ms. Ferreri's questions, this question is really about nutritional literacy. How do we get better at it?

As a physician, I don't think I was at all well educated in nutrition and what to say or what to advise. Most of what I've learned has been in the reading that I've taken on. There's health practitioner literacy and also general literacy for parents to guide children. There's such burgeoning literature and media on nutrition, yet some of the kernels of good, basic eating practices can be missed.

I wonder if you could comment on how we could, from a policy point of view, do better in nutritional literacy.

[Dr. Tom Warshawski]

The short answer is no.

Under the age of five, kids cannot distinguish advertising from content. Even under the age of 12, they don't really understand the persuasive nature of the advertising. Advertising is getting more sophisticated.

A recent report came out of the Heart and Stroke Foundation about social media and social media user-generated ads. These are young people basically advertising to other young people, which is even more surreptitious. Yes, children have a very hard time recognizing advertising.

From my perspective, as someone who's worked at this since 2014, many areas of government at the federal level have worked towards getting effective restrictions on the marketing of unhealthy foods and beverages to kids, and they were somewhat blindsided in 2019 when it died in the Senate. I just don't want to see us repeat the same mistake now. I do not want to see us putting all our eggs in one basket with Bill C-252. The regulatory process through the Canada Gazette needs to go forward on a parallel track, and if they can converge on a common destination, that would be great. If not, then we have the regulations in hand.

[Dr. Tom Warshawski]

I think it's important. Polling has indicated that between 75% to 80% of parents want to see restrictions on the marketing of unhealthy foods and beverages to children. The government back in 2015 tried to get this moving. Conservative Senator Nancy Greene Raine introduced a private member's bill to the Senate—Bill S-228—that had very strong support in the House of Commons. It initially had unanimous support in the Senate and wound its way back to the Senate in 2019, but then died on the order paper. It was filibustered by certain senators and died.

That is one of the concerns we have as government waits for Bill C-252 to wind its way through Parliament. We think it could very likely suffer the same fate as Bill S-228 and die in the Senate. We think it's important that this bill be allowed to go through. Hopefully it will pass, but a parallel track would be for government to implement the regulations I mentioned in the Canada Gazette.

[Dr. Tom Warshawski, Chair, Childhood Obesity Foundation]

Thank you and good morning.

One of the most significant risks to the health of Canadians and to the viability of our health care system is the current prevalence of unhealthy weights in children and youth. Over 30% of our children are either overweight or obese, and because of the lifestyle habits ingrained in childhood, the situation worsens with age.

Currently, over 60% of Canadian adults have unhealthy weights, putting them at increased risk for heart disease, type 2 diabetes, hypertension, stroke and cancer. On average, obese adults die seven years earlier than healthy-weight peers. Obesity is thought to cost Canada's health care system over $7 billion per year.

The root of this epidemic begins with the unhealthy dietary habits learned in childhood and, to a lesser extent, low levels of physical activity. The COVID pandemic worsened the situation. Sales of unhealthy food increased. Children spent more time on screens, which commonly market unhealthy foods and beverages to children, and youth spent less time being physically active. While Canadian data is sparse, American studies indicate that children demonstrated an increased weight gain velocity during the COVID pandemic.

Having overweight core obesity is detrimental to the health of children and youth. It is associated with increased rates of depression and anxiety, secondary to weight stigma; increased rates of hypertension and metabolic syndrome in adolescence; increased rates of chronic disease in adulthood; and increased costs to the health care system. Each teen who remains obese into adulthood triggers an additional cost of $25,000.

Obesity worsens health disparities. It disproportionately affects indigenous communities, as 87% of first nations women will develop type 2 diabetes due to unhealthy weights, versus an incidence of type 2 diabetes of 46% in non-first nations women.

Obesity hits lower-income Canadians harder. Obesity rates are 28% in the lowest-income quintile versus 24% in the highest. It impacts rural communities more than urban, with obesity rates of 31% in rural areas versus 25% in urban.

Canada needs to take steps to both prevent and treat unhealthy weights in children and youth. However, treatments are expensive and hard to access, and are primarily under provincial jurisdiction. The federal government should focus on effective prevention steps, which are under federal jurisdiction.

The Childhood Obesity Foundation supports the call for the federal government to finalize front-of-pack nutrition labelling and for the implementation of a national school nutrition program. However, the most pressing need, and to some extent the obvious low-hanging fruit, is for government to introduce regulations to restrict the marketing of unhealthy foods and beverages to children.

The remainder of my presentation will highlight the rationale for this important step, which is explained in more detail in the brief submitted to HESA by the Stop Marketing to Kids Coalition.

Ninety per cent of the foods and beverages marketed to children promote unhealthy weight gain. In adults, consumption of these products is associated with ill health regardless of weight status. Persuading children to consume food that will ultimately damage their health is unethical. Most children under the age of five years cannot distinguish ads from content. Most under the age of 12 years do not understand the persuasive intent of advertising.

Unfortunately, marketing works. It influences kids' food preferences and food choices. That's why the food and beverage industry spends over $1 billion per year in Canada in marketing to kids. As a result, over 60% of the calories children consume are from ultra-processed, unhealthy foods. Parents are being outgunned by big food and beverage, who are spending massive amounts to produce sophisticated marketing that is flooding the airwaves and the Internet.

Many parents, if not most, are ill-equipped to compete: 10% have mental health issues; 10% live in poverty; 15% have poor literacy skills; 15% are single parents; and 17% are immigrants, a percentage that is growing each year. Recent immigrants are particularly vulnerable as they strive to embrace Canadian culture.

Parents are asking for help. The overwhelming majority want government to help them keep their kids healthy by enacting restrictions on the marketing of unhealthy foods and beverages to their children.

Voluntary codes are not effective. For the past 10 years, industry has set its own standards in self-regulated marketing. In June 2021 the industry revised its voluntary code. Although the nutritional criteria are robust, the rules of application have significant loopholes, rendering substantially less protection than the regulatory regimen currently in place in Quebec. The new rules would not even prevent child-directed marketing for such products as Lucky Charms. The fox should not be trusted to guard the henhouse.

Canada's healthy eating strategy, under its objective to protect vulnerable populations, includes restricting marketing and advertising of beverages high in salt, sugars and saturated fats to children. This commitment was included in the government's 2015 and 2021 election platforms, the 2019 federal budget, and four health minister mandate letters.

Health Canada has draft regulations that are poised for implementation. We strongly recommend that they be introduced in Canada Gazette, part 1, by the fall of 2023, as per Health Canada's forward regulatory plan. Government need not and should not wait for the private member's bill, Bill C-252, to wind its way through Parliament. Implementing a regulatory framework to restrict the marketing of unhealthy foods and beverages will positively impact the health of our children and must not be delayed.

Thank you.

Committees of the House

[The Speaker, Liberal, Anthony Rota]

Pursuant to order made on Thursday, June 23, the House will now proceed to the taking of the deferred recorded division on the motion to concur in the eighth report of the Standing Committee on Health concerning the extension of time to consider Bill C-252.

Health

[Sean Casey, Liberal, Charlottetown, PE]

Mr. Speaker, the eighth report is entitled “Bill C-252, An Act to amend the Food and Drugs Act (prohibition of food and beverage marketing directed at children)”.

[The Chair, Liberal, Sean Casey]

I see no debate. We're ready for the question.

Are we in favour of requesting a 30-day extension for the consideration of Bill C-252 and Bill C-224 before the committee?

All those in favour, raise your right hand, please.

(Motion agreed to [See Minutes of Proceedings])

Is it the will of the committee to adjourn the meeting? I see consensus.

The meeting is adjourned.

[The Chair, Liberal, Sean Casey]

There's a motion on the floor to request an extension of time for the consideration of Bill C-252 and Bill C-224, and the motion is in order. The debate is on the motion.

Mr. Davies.

Child Health Protection Act

[The Speaker, Liberal, Anthony Rota]

The House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-252 under Private Members' Business.

The question is on the motion.

Before the Clerk announced the results of the vote:

The House resumed from September 27 consideration of the motion that Bill C-252, An Act to amend the Food and Drugs Act (prohibition of food and beverage marketing directed at children), be read the second time and referred to a committee.

[Patricia Lattanzio, Liberal, Saint-Léonard—Saint-Michel, QC]

Madam Speaker, I am pleased to rise in the House today in support of my private member's bill, Bill C-252, known as the child health protection act, which aims to help the youngest and most impressionable Canadians maintain and improve their health by restricting the advertisement of certain foods to them. I am confident that hon. members in this chamber can agree on the harms that diets with excessive amounts of sugar, sodium and saturated fats can have on the health of Canadians.

Research has shown time and again that unhealthy diets with excessive consumption of these nutrients of concern are linked to a higher lifetime risk of obesity, high blood pressure, diabetes and other chronic diseases. We also know that developing healthy eating habits early in life is important to help protect children from developing these health problems in adulthood.

Each year, hundreds of millions of dollars are spent on food advertising in Canada by the food and beverage industry. Evidence shows that food advertising strongly influences children's food preferences and consumption patterns. Children in Canada are exposed to thousands of food advertisements every year across their daily settings and, unfortunately, most of these ads are for foods that contain excess sodium, sugar or saturated fats.

Opportunities to advertise to children have expanded with television and digital media. Children today are more digitally connected than ever before. Their screen time has increased and advertising directly to them has become easier. Tackling chronic diseases and maintaining public health is a whole-of-society issue and everyone has a role to play.

Since 2007, some of the largest food and beverage companies in Canada have been self-regulating certain types of food advertising to children. Recognizing that the current self-regulatory initiative did not go far enough, some industry associations have recently introduced a code. The code outlines criteria that the food and beverage industry will use to determine which advertisements are considered primarily directed at children, and it is the same industry that will determine the nutrient criteria in order to assess which foods are subject to the self-regulatory restrictions.

Although the proposed code is a step forward, it clearly demonstrates that the industry acknowledges the health consequences that food advertising can have on children. However, let us be clear. We know that voluntary codes are not enough to tackle and solve the issue. The first challenge of solely relying on industry self-regulation is simply that they are voluntary in nature. This allows restaurants, food companies and advertisers to abstain from signing on or simply to withdraw their adhesion at their convenience.

Also, criteria used for these codes often omit to stipulate important advertising techniques, tactics and sources of exposure that are known to appeal to and/or influence children. There is also a lack of transparency in the enforcement of these codes with no enforceable sanctions for non-compliance and, more importantly, it does not provide an independent monitoring.

It is clear from experience that self-regulatory initiatives do not go far enough to safeguard the health of our children. Canada's experience with industry-led self-regulatory initiatives have been similar to those of the United States, Australia, the United Kingdom and Spain. Research in each of these jurisdictions has clearly shown that self-regulatory marketing codes have limited impacts in curtailing children's exposure to the marketing of food and beverage products. Consequently, the U.K. and Spain are pursuing new mandatory restrictions following the observed limited impact of self-regulatory initiatives. This government agrees and believes industry self-regulation is not enough to protect children from being exposed to the harmful and incessant advertising of certain foods.

The Minister of Health's mandate includes a commitment to protect vulnerable populations, including our children, from a range of harms, such as the stream of commercial messaging and endorsements that trigger the most basic eating instincts, especially for foods containing excess levels of sodium, sugars and saturated fats. Supporting Bill C-252 is well aligned with this commitment and will help address many of the shortcomings of the current landscape of the industry-led self-regulating codes.

Our children, just like the one that is in the gallery with us today, are our priority and concrete action is needed now in order to ensure that they are not subject to and do not succumb to the aggressive advertising of foods that contain excess levels of nutrients of concern and that pose unnecessary risks to their health and the health of future generations.