Health Committee on Sept. 26th, 2006

[Dr. Mark Tremblay]

I would also suggest that the relative weight of the evidence, I think, would be the reciprocal of the way you presented it. You're concerned about having a very aggressive anti-fat campaign, which none of us are advocating. We're promoting physical activity and we have no campaign at all, so we're a long way from having something overly aggressive, I think. But anyway, your concern is whether, for some of the kids who have issues that are insurmountable under their circumstances, this is going to lead to additional mental health problems.

Indeed, a successful campaign that achieves a lower prevalence of obesity on a population level will improve the mental health of the population, and that evidence is quite strong. So the opportunity to do good, in my view—and I think the literature substantiates it—far exceeds the likelihood of doing harm.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Now, Ms. Priddy, you have five minutes.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, and thank you for your presentations.

I want to begin with a couple of comments and then ask a couple of questions.

Having not mentioned my grandson in at least one or two meetings, I'd hate not to do it now. There will be slides at the end. He's just moved back from three years living in England where this child was never in the house. He was always out. He was always running around because his village was set up such that he could do that. So I wish we had the FCM, Federation of Canadian Municipalities, and people in charge of late high school at the table as we're having this discussion, because there's so much work that could be done by municipalities in how they do land development.

I come from a city that has done the worst land development you can imagine, as it relates to this, where, as long as you pay the development costs charge that includes a piece for leisure activities, they just put it in a big pot and build a rink seven miles away, which is of no help to the actual development that just went up. Those are the kinds of partners that we need at the table to make those substantial changes in how we look at that.

There's a woman in Langley who did a really nice survey on environmental barriers that keep children safe outside, for example, using thorny hedges instead of fences to keep kids in, but to make it fun. Langley has outdoor friendly buildings, not that the children even go in, but the outsides are friendly and cause children to play and run and jump. It is not really hard thinking. It's just making sure that for every building that's built thought has gone into it.

I feel we're having this conversation--and it's not a critique--but there are a couple of critical partners that can help us in this that aren't at the table.

The other is high school in terms of late high school. Everybody drops phys. ed. because they can't fit it in, because they can't get enough courses to get into university if they do phys. ed. in grade 12--at least in the province of British Columbia anyway--so it's gone.

The thing that you mentioned about behaviour I think is interesting, because behaviour management principles tell us you cannot remove one behaviour, such as not watching TV, without replacing it with another behaviour or, you're right, you'll get sedentary, which is nothing. It's really not a behaviour in any real way.

I'd like to ask whether the federal municipalities have been active partners with you in this in terms of actual land planning issues that would encourage children to be outside safely and in leisure activities that don't require mum to drive you there, because if you don't have money or a car, you're probably not going to get your child to the rink, since it's too far away--it's probably too expensive--so those activities closer to home.

Can I ask about their participation with you or their willingness or their response?

[Cora Craig]

I would say they are quite willing in the sense that they worked with us when we were doing our municipal survey. Some of our questions were around land use policies because we are concerned about the environments in which people are living. We know that environments like the ones in England you were talking about that are more dense, in the sense that people are closer together, and that have shops and a variety of different types of destinations nearby are at least associated with being more active.

Another organization that works as a very strong advocate in this area is Go For Green nationally. Again, it's one of the organizations that Dr. Tremblay was mentioning is having difficulty getting funding, but they are a strong advocate for transportation, for urban design.

I think that one thing that's happened over the last five to ten years is municipalities and FCM, as a representative of the municipalities, are becoming much more concerned about land use issues. Our knowledge in that area is still fairly young. There's much we need to do in that area, but we need to start to make changes, because when you look at the Old Order Mennonite communities and that type of approach, where we look backward to our communities when we didn't have some of these problems, they were much more compact and laid out to encourage purposeful walking to shop and to work, etc.

[Penny Priddy, NDP, Surrey North, BC]

Much like suburbs that were built after the war in the early fifties.

[The Chair, Conservative, Rob Merrifield]

Your time is up. Your time has gone on that.

Mr. Batters, you have five minutes.

[Dave Batters, Conservative, Palliser, SK]

Thank you very much, Mr. Chair, and again, congratulations on your appointment.

Thank you very much to the witnesses for appearing before this committee. You've already offered some very keen insights that will be valuable for our report. I also thank you for shedding some light on the Saskatchewan experience--my home province. I was going to ask you to speak to the average physical fitness and average physical activity in Saskatchewan, and you've already done so.

I have three quick points, the first one being a bit longer. Picking up on what Ms. Priddy had to say, I want you to comment--you can pick who--on the importance of sports complexes and of that critical infrastructure, facilities where kids, and all Canadian citizens, can play and have fun and get some much-needed exercise. In Moose Jaw, Saskatchewan, one of the biggest priorities right now is the construction of Moose Jaw's multiplex facility. There is a hockey rink, a curling rink, and also an indoor soccer facility and walking track. Certainly this is much needed in minus 40 degrees, which we'll see shortly. I'm a big proponent of building this facility.

I believe that all three levels of government must commit to building facilities that foster physical fitness and improve the health of all Canadians. I think this has to be a priority. These facilities help to develop healthy habits in terms of physical activity, which will benefit individuals at home--outside these facilities. I know in my own example, I think of the endless hours that I used to play shinny on the driveway, literally from sun-up to sundown. If my father, Al Batters, had not introduced me to competitive hockey, would it have been all that thrilling to spend eight hours or more on a driveway with a couple of clumps of snow? Probably not. Certainly you can gain a lot of good habits in such facilities. That's my first point.

Second, I would ask you to comment on the value that you perceive--give us your honest impression--of the children's fitness tax credit. I'm fully aware you're not here to stump for the government, but I want to know what you think of that.

Third, I think I heard you say earlier that you're strong advocates for physical fitness in our schools. I'm a big believer that mandatory physical education or activity in our schools is imperative. I agree with Ms. Craig when she says that a physical activity campaign is absolutely crucial.

Those are my three points, if you don't mind.

[Dr. Mark Tremblay]

I'm sure it will be wonderful for Moose Jaw to have a new multiplex facility. I would never speak against that; it's important. Unfortunately, you always get into “this versus that.” That facility will attract middle- and upper-SES kids. The same kids who play hockey will probably play indoor soccer, and their parents will use the indoor track. It will miss a segment; it won't completely solve the problem. I think it will be good, and it will hopefully increase the number of kids playing shinny on the driveway and so on, but it's not the only answer, for sure.

With respect to the children's fitness tax credit, Active Healthy Kids Canada submitted a brief and met with the committee about it. We're certainly supportive of it. It needs to be studied; we need to assess whether it's going to have an impact. Nova Scotia implemented something like this, but put no evaluation component into it. They're only two years ahead of the federal government. We can't learn from them, because no one did any robust audit to see whether this is increasing enrollments or whatever. So I would strongly recommend that.

I would also recommend, as our submission suggested, that we think outside the box and not just institutionalize it. We believe that the $15, in the case of a family going public skating together, should be included in that, not just signing Billy up for hockey or Sally up for dance and those sorts of things.

[Dave Batters, Conservative, Palliser, SK]

I would agree.

[Dr. Mark Tremblay]

And I don't think there's anyone in the area who wouldn't support mandatory physical education for K to 12. It comes out of every think-tank and every investigation. It's ironic that as the situation worsens, we've marginalized physical education more and more. It continues to happen to this day in the schools that my kids go to. Each year is worse than the last. I can't understand it. Federally, it's difficult, because you have no jurisdiction over that particular domain, but certainly I can't imagine my colleagues wouldn't support it.

[Dave Batters, Conservative, Palliser, SK]

But anything we could do to help foster that as a federal government....

I agree with you completely in terms of the children's fitness tax credit. Without some robust studying as to the results of that, some measurables, we're not going to know the effect it has. Your point is well taken, sir.

Ms. Craig.

[Cora Craig]

I'll just comment on the tax credit, and we did address the committee as well.

I'm quite concerned about it, because the way it's set up, people have to spend the money in advance and then get a refund for it through the credit system. To me, that means we're going to increase inequities in the country. Low-income families are not going to be able to put out $500 in the beginning, especially if, let's say, they have four children, and then get a credit at the end.

I'm concerned that it will be most used and most advantageous to middle-class and higher-income earners.

[Dave Batters, Conservative, Palliser, SK]

What about Dr. Tremblay's comments--

[The Chair, Conservative, Rob Merrifield]

Sorry, your time is up. I will allow the witnesses to add more answers to the question, but I won't allow another question.

[Cora Craig]

The other point I wanted to make is that in Nova Scotia they have done an evaluation only on the finance portion, not on the participation level increase. They found that on their $150-tax credit, the average credit received by a family for that $150 was $17.

I think it's a great first step, and it's good to think about tax policies, but we really have to evaluate it and see what else we can do to tweak it.

[The Chair, Conservative, Rob Merrifield]

Are there any further comments from the witnesses? Okay.

We don't have any other names on the.... Okay, that's why I was trying to get your attention, Pat, to see if you....

Guy, do you want to question as well?

[Guy André, Bloc, Berthier—Maskinongé, QC]

Yes.

[The Chair, Conservative, Rob Merrifield]

Okay, fine. We'll go with your question, and then we'll go back to Ms. Davidson.

Mr. André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

I will try to be brief.

I've been listening to your comments and I find your research very interesting. Of course, this is such a complex problem that I'm not sure how we are ever going to resolve it. As you also pointed out, the industry is very powerful. The television, video game and Internet industries are very powerful indeed.

This is the social context: parents work and arrive home tired, they're busy, and young people end up in front of the television or on the Internet. In a way, this suits their purposes. I experienced that when I worked in a CLSC. There are prevention programs in Quebec and we found ourselves grappling with this. What interventions do you have in mind?

I really think we have to act collectively. You talked about raising awareness of obesity at an individual level and among parents in the community. But there is also a problem in the community. It may be beautiful weather outside, but you never see children outdoors anymore. They're all inside the house. Even if someone tells a child to go outside, often he'll end up being alone, because the others are all inside. So I really think we have to take collective action. In my opinion, the trend in our society is to value physical inactivity, as evidenced by the use of all kinds of different games, the Internet and television watching.

What action can we take in that regard? If we don't take any action in that area, we can conduct all the studies and research we want, but we won't ever find a solution, in my opinion.

[Dr. Mark Tremblay]

Those are very good points. I certainly couldn't agree more that the issue is incredibly complex, and perhaps nothing could be more complex. It's not discrete, like wearing a seat belt or even smoking, and so on, because it's fundamental to all parts of lives. So the intervention needs to be at the individual level, the family level, the community level, the school level, and all levels of government.

Maybe we spin our wheels a little bit because it's overwhelming to people. We're often asked, “What's the one thing we need to do next?” I always answer that by saying that approach won't work. Don't bother, if it's the one thing you're going to do. It's bigger than that and we need to go at it more.

At a community level I think there are things we can do. I firmly believe that the migration into the home and away from kids being actively transported to school was a mass action thing. People started to withdraw, there were fewer bikes on the road, it became more dangerous, cars started driving faster, more bikes were withdrawn, cars drove faster, and so forth.

I think the momentum can go the other way as well. If there are bikes and kids all over the place, cars will drive slower. People will demand that the speed limits be reduced, and more kids will walk. When more kids walk or bike to school, it is safer. The freaks of the world who are going to abduct the kids, harm people, beat them up, or steal their lunches won't be there because there will be kids everywhere.

I think it's the same with parks. There are different approaches we can take to attract people back there. We can have park supervisors. They weren't in my town when I grew up, but my wife said she spent whole summers and all of her spare time at the park. Park supervisors, paid through the municipality, provided supervision there. I think there are approaches, and doing nothing is an unacceptable response.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Ms. Davidson.

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

Thank you, and thank you to the presenters. I certainly enjoyed the different aspects you've brought to this very complex issue.

My questions are much along the same line as Monsieur André's.

In the 2005 budget, the federal government put $300 million over five years toward the integrated strategy on healthy living and chronic disease. There are three parts to that, and the one that falls into this category promotes health by addressing the conditions that lead to unhealthy eating, physical inactivity, and unhealthy weights.

When I read that statement, I think that's our whole lifestyle. I honestly don't know where we start to address changing an entire lifestyle. We have two parents who work, or we have single-parent families where one works, in most instances. We have facilities that are not within walking distance in a lot of cases. It's not practical to think that municipalities can afford to have them in areas where they can be accessible to everybody by walking. It only stands to reason that these things cost millions of dollars to build, so they're going to be in areas that serve a lot of people.

We have parents or caregivers coming home from work tired. They walk in and don't want to start making a great big nutritious meal. It's pretty quick and easy these days to drive past a fast-food place and pick up something, or go to the supermarket and buy convenience foods that perhaps are frozen. They're much easier to deal with. They're quicker and don't take a great amount of energy.

There are the community-wide activities we've talked about, but there are issues too where children are not allowed out to play. They're not allowed to be on trails and do much biking because of the safety issues we've talked about. These are all part of a whole lifestyle, and we're not going to get at the root of it without getting at the root of either trying to change the lifestyle or putting something in its place that's going to change the direction for these kids and adults.

We talked about the Saskatchewan and Manitoba model, and I don't know if it addresses a multifaceted approach. I'm not familiar with it. You talked about the data and how the standards for it weren't appropriate; that the data could be confusing because there wasn't consistency there in how it was done. How do we get predictable data to deal with? What is the federal role, if it comes down to different lifestyle choices and community planning?

[Cora Craig]

Wow.

I'll start, and hopefully I'll touch on a few of the points; you've raised quite a number. Then we can go across the panel.

Yes, it is a daunting task ahead of us. I'd say it's taken us really fifty years on this track to engineer everything out of our lifestyles and to make them easier. We've had a lot of advantages from that. When people say, “Oh, I'll do more physically active chores,” it's not something that we necessarily are going to respond to. Nonetheless, by mowing the grass, etc., people may put it back in. We really have to take a long-term view.

One of the things the federal government could do in terms of leadership is really promote that this isn't a four-year solution but a twenty- or fifty-year solution. The Coalition for Active Living has said that to make a difference, really we should be looking at an investment of about $500 million over five years, taking a broad-based approach. We should move the markers and start monitoring how that happens. It is going to take us a long time, and if the federal government could show leadership here--that it is a long-term commitment, that we're looking at fundamental societal and urban change--and could start having a vision of sustainable communities that would allow everyone to feel safe in their environments again, I think we would go a long way toward that.

It isn't going to be an easy task, and we're going to have to learn as we go, which is why I was asking that 15% to 20% be put toward evaluation on any project so that we can really learn and share what works.

[Dr. Mark Tremblay]

I'd like to make two very quick points.

First, easy is seductive but destructive. We need to get that across to people. We've socialized the “I can't cook my dinner” thing to be the norm, but you know, people were tired in the past, when they actually did stuff physically all day, and they didn't have Lunchables and so on. So we need to get that message out and teach people that.

The second point is in terms of data collection. The Canadian health measures survey at Statistics Canada, which will go into the field in February, has been funded--one time only--to measure 5,000 people in the country to get direct-measures health data in Canada. This will be the first and only comprehensive direct-measures health survey the country has ever done.

Ian spoke to the embarrassment when we compare not just to the U.S. but to most of our peer countries in the world. We're way behind in this regard. We could fund the Canadian health measures survey on an ongoing basis, because we get not just physical activity data; we get spirometry data, we get anthropometric data, we take bloods, we get bio-monitoring data. It's a very comprehensive survey, and it needs ongoing funding.

Our funding currently is in the order of magnitude of one-tenth of what the U.S. funding is. And that's already adjusting for the difference in country size.

[Dr. Ian Janssen]

I want to raise just one quick point on the issue of time, which is what everyone uses as their excuse to be not physically active.

People spend 25% less time doing chores now than they did 15 years ago. They spend hours more on the computer and in front of the TV than they did years ago. So to me, that's a poor excuse. It is an excuse, not a reason.