Health Committee on Sept. 21st, 2006

[Dr. Diane T. Finegood]

When it comes to Canadians, I think the word I would use is “support” as opposed to “seed”. So when you talk about individuals, the key here is to support them in their environments to be able to make healthy choices.

In some cases they don't have access, as my colleagues have told you, and in some cases it's just not the easy choice. So the more we can make the healthy choice available, possible, and the easy choice--that's clearly critical for Canadians.

On seeding, I would go to the example of what CIHR has done. In the creation of CIHR we created a number of programs that were called community alliances for health research. We gave funding initially to a researcher, who was working directly with communities, to tackle the research component of that problem.

A good example is a program called Saskatoon In Motion: Building Community Capacity through Physical Activity and Health Promotion, which was started by a researcher at the University of Saskatchewan who had an idea that they needed to build the capacity of the community there to undertake more physical activity.

An investment from CIHR of $1 million per year for five years was leveraged tenfold by this researcher. So once we put the money on the table and said this was a good thing to do, their city and province came to the table with additional funds for the intervention activity that was under way. So when I talk about seeding, from my perspective it's doing that kind of activity.

On your first question about what the evidence tells us we should do, we should ban advertising of junk food to children. I recognize that's a very difficult task to undertake and may not be something we want to do, but there is good, strong evidence that it would have a huge impact on our environment.

[Dave Batters, Conservative, Palliser, SK]

Does anyone else have any recommendations for our study that we'll have just missed the boat if we don't include?

[Mary Bush]

Diane has used the word “seeding” down to the individual; I would use “empower”. I'm not sure you should think there's just a huge capacity at the local level to have change happen.

You went through a number of programs, and you need to know that as we looked at this seriously from the federal level, we were trying to figure out how we could enhance capacity at the local level. At the same time, cities were amalgamating, including our own city of Ottawa-Carleton. I got a call from someone who was trying to bring in physical activity and healthy eating and influence the environment. They were being asked by their council what the impact would be if their budget was cut by 50%, 70%, and 90%. I don't think you should think there's capacity.

Diane raised the issue of the Saskatoon in Motion program. One of the biggest issues is that when you go outside of some of these centres, there's no capacity. So the whole seeding down to individuals and empowering individuals is important, but I think you need to appreciate that to do this and do it well it's going to be....

I'm trying to imagine an example for you that would be an analogy to your physical activity....

[Dave Batters, Conservative, Palliser, SK]

One last little point--

[The Chair, Conservative, Rob Merrifield]

Your time is actually gone. It's actually a little over, but that's okay.

Mr. Dykstra, five minutes.

[Rick Dykstra, Conservative, St. Catharines, ON]

Following up on that, Mary, could you expand a bit on the reference you made to capacity? Driving down and trying to figure out how each person is going to think about that seems, at the end of the day, to be what's important here. It's not big programs that we can speak about from a federal perspective, or provincial or municipal; it's about how does an individual.... I think Kathy or Diane mentioned the whole elevator theory--seeing that note on the elevator--is a personal way of kind of reaching it and maybe relating capacity in an individual.

[Mary Bush]

Thank you.

I think there are some exciting potentials on the horizon. Dr. Taylor mentioned this joint consortium on school health and the interface between where the environments are that children use and what we can do. The reality is for things to happen at that level. You need somebody who cares about health, who interfaces with education and is making some changes within the system. In fact, I can tell you, three children later, that over the lifetime of having three children, there isn't even an interface between those two systems that's operative right now. Those are some of the early steps that are being taken out of the new joint consortium on school health. But there's so much more that needs to be done. So if you meet Canadians where they're living, you need them to be supported so that they have environments.

Dr. Taylor mentioned the environments that can encourage physical activity. Those built-in environments are equally important for healthy eating. You need to be able to support Canadians. When they get on an airplane--you people travel; have you tried to eat? Let me tell you, it's a huge challenge in the area of what you're given, how you even access foods that are going to meet your nutrient needs and do it at a reasonable calorie level and allow you to get on.

I guess I'm simply trying to say that when you're doing this, the capacity for me is that I think we've decimated public health systems in this country to a level where even when you're at our levels, trying to figure out how you are going to do this, you become a country of demonstration projects. Monique Bégin said that to us not long ago, and that's what we've become. We've got to move past that. We have to get down to making sure that there are systems in place at the local level that can support people.

[Rick Dykstra, Conservative, St. Catharines, ON]

That kind of fits into the--

[The Chair, Conservative, Rob Merrifield]

Was there any more to that question? Do other witnesses want to answer that?

[Kathy Langlois]

Yes, Mr. Chair, I had hoped to add something to the list of requests. If you didn't study this, would you have missed the boat?

If I may, from a first nations and Inuit perspective, I think the committee really needs to look at the issue of food insecurity, particularly for first nations and Inuit. We know that high rates of overweight and obesity are linked when there are food-insecure situations. I think the committee could add tremendously to the efforts we need to take in this country around that issue for first nations and Inuit.

[Rick Dykstra, Conservative, St. Catharines, ON]

The point kind of leads to my next. As a younger individual in grade school, I recall that one of the punishments we received was...you know, in class, if you do something wrong, you won't be allowed to go to phys. ed. I remember that to this day, only because--and I recall it now and I remember it on a regular basis--how upset our phys. ed. teacher got, because he obviously questioned what kind of punishment that was. It was all about physical activity. I wonder about that in terms of my next question, which we all struggle with. And I think I hear from you as well that you're struggling with the aspect of whether it is about what you eat or whether it is about physical activity, and which one takes priority. I wonder about that.

Greg, if you could, advise us a bit on where we as a group and as a committee focus in terms of recommendations. Does physical education for young people become that first priority, or is it what we eat? I know you're going to say both, but I think one needs to take precedence over the other.

[Dr. Gregory Taylor]

You can't have one take precedence; it has to be both. The approach can be independent, and some of the approaches to get physical activity are different from some of the approaches for nutrition, but it's pretty tough to pick and choose which one. They're so interrelated, and I think that's what the evidence has shown us. That gets into the interventions you do. You can't pick one particular intervention or magic bullet; you've got to do a myriad of interventions.

I want to follow up on Mary's comment earlier. My wish list--I think this is what you're getting at--is going to take a long time. This is going to take a large investment of a long period of time. We're all in this for the long haul because what this is reflecting is the fabric of our society. Little interventions aren't going to do the trick. It's going to take societal change; it's going to take differences in terms of how we build, how we structure, how we school, rewards and punishments. Your example is quite interesting. Daily physical activity used to be in schools and it's gone. Now it's starting to come back, and we're realizing we've gone backwards there. But that daily physical activity can't be isolated without having some of the junk food taken out of schools, etc. So it really has to be both. I'm sorry, I can't answer one or the other.

Mary is dying to say something.

[Mary Bush]

I'm absolutely dying, because I really think it would be a huge error to do one over the other. I'd urge you to go to the Annapolis Valley example, because in fact they had both a food nutrition policy, a comprehensive school health initiative, and rigorous evaluation. Those schools that were participating in this comprehensive health program were less than half as likely to have children who were overweight and obese; the students ate more fruits and vegetables and had a higher overall diet quality than students without the program, and it was the comprehensive health nature of the program.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We're going into the second round. Ms. Keeper.

[Tina Keeper, Liberal, Churchill, MB]

Great. Thank you.

Do I only have five minutes?

[The Chair, Conservative, Rob Merrifield]

Yes, at the very most.

[Tina Keeper, Liberal, Churchill, MB]

Okay, very quickly, I would like to thank Ms. Langlois for mentioning food security because it was one of the questions I had wanted to ask you. The food mail program, which used to operate in some of the fly-in communities in my riding, where a four-litre jug of milk can often cost $16, $19--it's just unbelievable, the cost of healthy food--has been eliminated over the last number of years. I'm wondering whether FNIB has a relationship with INAC, because primarily INAC has been in charge of that, and whether it's a direction you think is really important.

[Kathy Langlois]

Yes, Health Canada FNIB does have a relationship with the food mail program, and I'm not aware that it was removed from any communities, so that is something I'll have to check on.

The role we play there is to provide guidance on nutrition and, for example, which foods to include in the subsidy. That is the role we play, plus we have since 2001 been involved in three pilot projects to look at nutritious perishable food, where we've actually further increased the subsidy rate or reduced the cost of transportation, and we've done some other interventions to see if we're able to have an impact on healthy food consumption.

[Tina Keeper, Liberal, Churchill, MB]

Has there been an analysis of the pilot projects yet, and have you decided how you're going to move forward?

[Kathy Langlois]

Yes, there has been. We are in the process of finalizing the evaluations of those projects. One of the major lessons from them is the work we need to do at the retail site in the store with the public coming in to buy the foods in terms of education, reading labels, and giving ideas and showing how to prepare, perhaps, different foods.

[Tina Keeper, Liberal, Churchill, MB]

In my riding it's definitely a matter of access. We don't have the food mail program anywhere in my riding, and I have 19 fly-in communities.

I would like to ask one more question of the panel. One of the things, Mary Bush, you mentioned is the overhaul of how we think about our lifestyle in terms of the impact. Could I ask, is one of the...?

You said you can't go anywhere without passing food, and it seems to me that because we have so much fast food, and not only in the franchise stores but also in terms of what we're buying, putting in our homes for ourselves and our children.... I don't know who this is for, Janet or Mary, but is what we're thinking of as food maybe part of the problem too? I'm thinking of all the frozen foods we feed ourselves, our children, as you said, on planes....

[Mary Bush]

I'll start and then pass to Janet, because that is a very important issue. The reality is you can stop by on your way home and slug back a frappuccino, a cappuccino, and have as many calories as you would have if you sat down to, say, a plateful of vegetables, fish--a dinner. People need to reacquaint themselves with the energy content of food, absolutely. That's why the program of food labels in the grocery stores is so important.

[Tina Keeper, Liberal, Churchill, MB]

Right. I'm just thinking that often things we consider food are not even really food a lot of the time.

[Janet Beauvais]

Do you have an example?

[Tina Keeper, Liberal, Churchill, MB]

Like a pizza pop or something--do you know what I mean? Or you think of corn dogs, these types of things, the hot dog stands that are on the busy streets, outside people's businesses. I'm thinking about how the overhaul you're talking about is not just in terms of physical activity but what we look at as food. There might be a label on the hot dog, but is it really food?