Health Committee on Sept. 21st, 2006

[Janet Beauvais]

On the literacy issue, we know 60% to 80% of Canadians are reading them, but as to whether they understand them or not, I don't have data. In our focus group testing, we did the best we could to get them at the right reading level.

Maybe, Mary, you can speak more to literacy.

[Mary Bush]

Yes. When that policy was being developed, part of the reason it was a standardized presentation was that the literacy community said there's enough complexity to the terminology and the numbers; put it in a standardized presentation and we will be able to build on that. And it becomes a tool that's in the environment, that is integrated into the nutrition education programs of provinces and communities across the country. It's not just about “here is labelling and here is how you use it”; it becomes a tool that's referred to as people are educating across the country.

[Dr. Diane T. Finegood]

Can I offer a quick response on the better data question? I think that's an important one, certainly.

There are two areas around data that are important. One is surveillance. We don't have very good surveillance in this country. Not only is this the first national nutrition survey in 35 years, but we don't even measure heights and weights very often. I think that's really important. It isn't even just about body weight; it's also about surveillance of food and physical activity behaviours, and it's about surveillance of policies that have an effect. That's important.

The other aspect of data collection that I think is important is to support more community-based research and even community alliances for research, where you have researchers working with communities for which this is an issue and the communities play a significant role in the whole process of articulating what their needs for information are, the researchers working with them to get that information in a coherent way and feeding it directly back to those communities, as well as to the greater pool. Those are the kinds of key things we need to do and the kinds of things we have done, albeit in a limited way, through the Canadian Institutes of Health Research.

[Penny Priddy, NDP, Surrey North, BC]

Thank you; that's helpful.

[Dr. Gregory Taylor]

Let me add, on surveillance with respect to weights, that we try to make it more comprehensive for all our disease collection things and risk factors.

The other thing to think of is that surveillance is a mechanism to actually evaluate what you've done. Surveillance isn't sophisticated enough yet. If you go into a community or a province or a region and have an intervention, how do you measure whether or not it's made a difference? That's the kind of surveillance that's necessary.

[A voice]

It's more longitudinal now.

[Dr. Diane T. Finegood]

We're supporting researchers to do that kind of work, although not enough.

[Dr. Gregory Taylor]

So on your third question....

[Kathy Langlois]

All right.

I would just say on the labeling that we have—I'll follow on from Mary—an approach in terms of the first nations and Inuit as well in labelling for literacy purposes.

In terms of direct resources on reserve, there are a number of programs that are aimed at this at different ages and life stages. The aboriginal Head Start program working with children 0 to 6, the prenatal nutrition program, and the aboriginal diabetes initiative are all aiming at building these skills across different life stages.

[Penny Priddy, NDP, Surrey North, BC]

And those are real people. Head Start is, but....

I'm done?

[The Chair, Conservative, Rob Merrifield]

Yes, your time is actually quite a bit over, but I allowed them to finish answering that first question. I did it out of grace because—

[Penny Priddy, NDP, Surrey North, BC]

Kindness and grace. Thank you so much, Mr. Chair. It's very kind.

[The Chair, Conservative, Rob Merrifield]

We'll move on to Ms. Davidson, for five minutes.

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

Thank you, Mr. Chair.

I'd like to say thanks to all the presenters. Certainly I enjoyed each of them, and we've heard some very good information here this afternoon.

I have one question and I'm going to put it to all of you. I'm not sure if anyone has any ideas.

We talk about the increased incidence of obesity, and we're all well aware that that is the case. We've got huge numbers; whether it's native, non-native, it's right across the country.

But I've also been involved in politics at the municipal level for a long time and I know that at the lower levels of government there have been increased programs--healthy children's programs and things set up through public health agencies and units, and cooperation and partnerships with education people and institutions. We've had all these initiatives. We've had fitness incentives at the federal level; we've seen that. Certainly some of those are quite recent, and we probably have not had time to see any results. We've seen better labelling, much more information being supplied; this is an ongoing thing, and I agree that consumers are really starting to pay attention to that. I know probably ten years ago most people never read a label and now they do, and I think the standardized form is extremely beneficial. Whether or not people understand what it all means, they can at least compare this product to this product because it is in a standardized form. I think that's good.

I know there are education programs for smarter shopping; they do supermarket tours and teach lower-income families how to shop smart. Those things have been going on for a long time. There are healthy breakfast programs in schools.

You've talked about redesigning Canada's Food Guide again. It was done a few years ago; it's going to be done again.

But where are we going wrong? We've been taking several initiatives, but the incidents still keep increasing by leaps and bounds. So what are we doing wrong, and what direction should we be taking?

We talk about sports, and a lot of people are involved in sports. Certainly at the municipal level people are getting more involved with hiking trails and biking trails and all of those types of things. A lot of initiatives are happening, but we don't seem to be touching the problem.

[Dr. Gregory Taylor]

I'll begin to try to address that.

I'm not sure we can say this is where we're going wrong. I come back to the tobacco analogy--multiple interventions over a sustained period of time. Forty years ago tobacco began the work that led us to where we are now.

In the last few years what's been very exciting for us is looking at things totally outside health. For example, there's really good evidence looking at urban design. How you build your communities has a profound effect on obesity, believe it or not, because of safe places to walk, the types of stores that are available, etc.

We had some think tanks in Toronto a couple of years ago when we invited urban design people who believe they're acting for good health, and they have evidence to say they are acting for good health and it does promote that.

There's a new community being designed on the top of a mountain in SFU, an ideal community, which is incredible in terms of the open spaces and the ability to walk instead of taking the car, etc.

Certainly in the aboriginal communities, as Kathy alluded to, safety issues are huge; you can't get out and walk like you used to do. I think we're really beginning to recognize it's the environment...it's the determinants that we really need to influence more.

As we mentioned earlier, simple labelling by itself isn't enough. It may not be that we're failing; we're on the right track, and maybe lots of these interventions are working, and maybe if we hadn't done them the problem would be a lot worse than it is now.

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

Is the seed money that we talked about to form partnerships? What would be directly involved with that?

[Dr. Diane T. Finegood]

Certainly we do need partnerships across all portfolios--across agriculture, transportation, across all sectors. That's really critical because it affects everybody. When I talk about seed money I talk about getting efforts to intervene under way, to have work happen, and then understand it.

I'd like to comment also that the scale of our response is the problem. When you weigh the scale of our response against how much money the food industry that generally markets--we market high-energy-dense, low-nutritious-value food. We just compare those two things? They're out of orders of magnitude different, with the enormous expenditure around that.

There's a significant underlying problem in that our food supply puts the least nutritious, most energy-dense food, and also the cheapest foods.... That goes back to issues of socio-economic status, but it also impacts the degree of marketing we see, because the highest-profit foods are the ones that are the most highly processed, containing the cheapest ingredients. So you end up in a situation where not only are they the cheapest foods, but they're the most marketed and they're the most available food.

We're responding a little, but the scale has to change.

[The Chair, Conservative, Rob Merrifield]

I am going to allow Mary to respond.

[Mary Bush]

I just love your question, because it's so bang on in the sense that it's not about telling people what to do. This problem is way beyond that. I get this all the time with Canada's Food Guide: it affects obesity. No, we're not. It's not about all these little individuals. It's coming to grips with the profound change that has happened over the last 20 years in terms of a society that is now functioning in a way that it has never before...faced with food. You can't even go to Home Depot without passing food. It's in your face 24/7, 365 days a year.

We're also in a time where we're sitting in rooms like this. I look at the artwork on the wall and see an era when people actually worked and expended energy.

It's a profound challenge, and it's not simply about tinkering at the edges with education. There has to be a much more comprehensive approach to this.

[The Chair, Conservative, Rob Merrifield]

As an example of how powerful peer pressure really is, you notice the remarks about cookies and you notice how many cookies were picked up. The tray is still full.

Madame Demers, you have your time.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Mr. Chairman.

Thank you for appearing before the committee. I'm pleased to see representatives of both the Department of Health and the Public Health Agency of Canada. That doesn't happen very often. I will be asking you questions which will certainly be more interesting for you.

Mr. Taylor, you mentioned that there are fewer problems with obesity among the middle class and the affluent than among those struggling with poverty. Personally, I think that all young people have problems with obesity, regardless of their social class. We are seeing that obesity problem among boys but it is also very important not to forget that there is also problem with anorexia among girls, on the one part, as well as extreme thinness among young girls.

We are very familiar with the effects of obesity, but as we've been saying for some time now, we don't understand all its causes. Perhaps we should examine the relevance of informing people on the effects rather than trying to make them understand the causes. The effects are known. For instance, in the case of cigarettes, we have explained that it can cause lung cancer, among other things. That way, people understood much more quickly. We point out that cigarettes can perhaps cause erectile dysfunction and of course that makes people think.

Therefore, I'm wondering whether it wouldn't be preferable to opt for a public awareness campaign, providing information and education and targeting parents first and foremost. Regardless of their budget, they are the ones who are usually responsible for buying food for their children. Has such an initiative been considered? Maybe it could help people understand better the importance of healthy nutrition. Pointing out the number of calories in such and such a food is not sufficient, in my opinion.

[Dr. Gregory Taylor]

I think you're talking about educating the outcomes and the risks of being obese to families, so that they can make sure they're feeding their children appropriately.

There is evidence that education is important, but as with tobacco it's not sufficient. There's lots of good survey evidence in tobacco, and Canadians know obesity is bad and probably for the most part know that it's related to diabetes. But their actual behavioural changes are very difficult.

So part of the nutrition labelling is an attempt to get there, and part of the work we've been doing is an attempt, specifically in diabetes and obesity, to say that these are some of the bad outcomes—and Dan alluded to this.

But it's not enough by itself because of the terrible environments people live in. They're just not capable, or they're not receptive, or they're not ready to actually make changes. It gets into the stages of change theory, which I'm sure you're aware of, where if you're not aware of this at all, you're not going to hear the messages.

It means that part of what we have to do in our social marketing campaigns is target and direct them better. Regarding some of the ethnic groups, we haven't even begun to get the messages into the right perspective. In Kathy's area, the messaging has to be very culturally specific.

The BMI, the body mass index, that's used for some groups doesn't work at all, so they're probably not even interested in this. We have to tailor our messaging, but at the same time recognize that it's not enough by itself. I think you're right. Just because this is high calorie, then being aware of the bad outcomes.... Again, I keep coming back to tobacco because people were well aware that tobacco was terrible and they were going to get lung cancer, but they still continued to smoke because they were addicted, because they couldn't change—it was a whole myriad of reasons.

So we have to do both at the same time, as well as educate people and parents to be responsible.

Part of the problem you also alluded to was that when the healthy living agenda was developed, it was obesity-driven, where obesity was the concern. The feedback after two years of consultation is moving away from blaming the victim. Instead of calling it obesity and “you're a bad person”, it became about healthy living and was given a positive environment and a positive spin, with the thinking that it's much easier for people to adopt positive behaviour than to say to children you're bad, you're fat—and there's so much pressure on children.

Regarding your comment earlier about anorexia, I'm very concerned. I have a 15-year-old daughter who is probably about 30 pounds overweight, and it's very difficult. I don't want to be telling her about that, since the last thing I want to see her do is make herself throw up because she wants to be attractive to the boyfriend she's now getting.

In the general population I don't know if there's good evidence to suggest—and maybe Dan could comment—that we may actually be going too much in that direction if we move too hard...so it's a positive body image and a positive environment that children are exposed to rather than a negative one.

[Dr. Diane T. Finegood]

Leaders in this field recognize that focusing on the word and the target “obesity” is actually a problem, particularly for children. That's not what we want to do. What we want to move away from is the tremendous linkage in our population between food and fun.

So what the leaders in this field suggest is that we don't want programs to target obesity; we want to target physical activity and fun. In essence they're calling it a stealth intervention. We need to get children more active through the recognition of fun—that being physically active can be fun. The outcomes of the studies in which this has been done have been much stronger than those in which the target was telling children or their parents that they needed to do something about it.

Eighty percent of Canadians want to change their behaviour to improve their eating habits, but they're not able to make those changes either because they live in an environment where they can't or don't.

Certainly parents have a responsibility here because they have control over a large part of their children's environments, but I don't think just telling them that is the solution. I think it's a lot more about going around and making it more about fun.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Batters, you have five minutes.

[Dave Batters, Conservative, Palliser, SK]

Thank you very much, Mr. Chair.

I would like to thank all the witnesses for being here and for their time today on a very important topic as we start our study.

I'm going to pick up on my friend's question and leave you with this thought. If not everyone got their comments on the record, we're going to have this report after eight meetings of this committee. Are there things that maybe haven't been discussed today, or specific things that if we don't have them in our report we will have completely missed the boat and dropped the ball? This is the opportunity for you, the experts in your specific areas, to ensure you've addressed those areas. Just think about that, if you haven't put them on the record. I know the last time Dr. Finegood was here I asked that question and she gave an excellent answer.

Dr. Finegood, you talked about seeding provinces, territories, and communities in order to make the changes we desire to help combat what looks like an epidemic. I'd like you to comment a little bit on what you mean by seeding, in our role as the federal government. Perhaps you'd like to comment on seeding individual Canadians.

I'm very proud to be part of a government that intends to have a $500-a-year physical fitness tax credit, which I believe is for children under the age of 16. I see that as a way of going right down to individual Canadians. On a really simplistic level I see this as being a matter of physical activity in our schools, and education in schools about healthy eating. I think that goes some distance toward accomplishing the goal of physical activity.

Dr. Finegood, perhaps you could talk about seeding.