Health Committee on Nov. 9th, 2006

[The Chair, Conservative, Rob Merrifield]

I'll call the meeting to order.

This is our twelfth meeting on childhood obesity. We're looking forward to it. Actually, I think this will likely be our last one, but not definitively. It certainly appears to be, when you look at our schedule.

We have a great line of witnesses this afternoon and we're looking forward to their presentations before the committee. With us today we have the Honourable Jim Watson, Minister of Health Promotion, Government of Ontario. He is with us for a little over an hour. I believe that at a quarter to or so, he will have to leave us. We also have Mr. Ostry from Infrastructure Canada. He is not with us now, but will be shortly.

We'll start with the four presenters who are here. We'll open it up to one round of questioning, and then we'll go to Mr. Ostry when he comes in around 4:30.

We want to welcome again all of you who are witnesses.

We will start with Mr. Watson; I will introduce the others as we give you the floor.

Mr. Watson, you have ten minutes.

[Jim Watson, Minister of Health Promotion, Government of Ontario]

Thank you very much, Mr. Chair.

Good afternoon, ladies and gentlemen. I am very pleased to be here today.

I'm certain that at this stage in your committee hearings, you don't need to be convinced of the major challenge that childhood obesity has become for health policy-makers throughout Canada.

In late 2004 Dr. Sheela Basrur, who some of you know is our Chief Medical Officer of Health in Ontario, released a report on childhood obesity entitled Healthy Weights, Healthy Lives. It first rang the alarm bell for Ontario's policy-makers.

Specific to the main inquiry of the committee on childhood obesity, the statistics really are quite staggering. The Canadian Medical Association released a report this summer that stated that 28% of children between the ages of two and seventeen are now overweight or obese. That's one in every four children. Additionally, only half of Ontarians aged 12 and under maintain an active or moderate physical activity level. This landmark report challenged all relevant stakeholders and sectors in the province, including government, to step forward and take action.

The creation of the Ministry of Health Promotion was part of Premier McGuinty's response to this call to action. The Ministry was established to act as a catalyst in meeting Ontario's objectives with respect to wellness. Less than two years after its creation, we have already accomplished a great deal. This Ministry has an extraordinary opportunity to help us make fundamental changes that will ensure the future good health of the people of Ontario.

We have assumed programs and responsibilities for injury and chronic disease prevention, as well as sports participation, from other Ontario ministries. These functions now have one central home in government, which I feel provides a natural link between the study and the application of health promotion.

We have discovered ways of encouraging Ontarians to adopt healthier lifestyles, thereby preventing or slowing the onset of chronic diseases.

By doing so, we may be able to create an atmosphere of awareness that will prevent injuries and illness, limiting the toll, both human and financial, that chronic disease exacts on our population. To this end, it's been estimated that obesity costs the province's economy $1.6 billion annually.

To ensure that strategic goals brought forward by the Ministry of Health Promotion are not developed or executed in isolation, Premier McGuinty created an interministerial committee on healthy living chaired by myself and comprising Ontario's Ministers of Health and Long-Term Care; Public Infrastructure Renewal; Education; Agriculture, Food, and Rural Affairs; Children and Youth Services; Community and Social Services; Municipal Affairs and Housing; Labour; and Environment.

The committee structure recognizes that the value of health promotion runs across ministry lines. For example, through the Ministry of Education, the government has removed junk food vending machines from schools and mandated a minimum of 20 minutes of daily physical activity at the elementary level. We're determined to improve the coordination and communication on health promotion issues, policies, and programs through horizontal discussions.

The Government of Ontario's first focus in the area of health promotion is on tomorrow's generation, our province's youth. We know that instilling the values of healthy eating and active living at a young age is important for many reasons. Studies show that increased physical activity and good nutrition before, during, and after school results in improved student performance. Physical activity and good nutrition reduces the risk of illness. It's also been shown that improving overall health has the potential of significantly reducing health care costs.

As baby boomers become senior citizens and as our younger population deals with the onset of chronic diseases that are being brought on by factors like low levels of physical activity and poor eating habits, our government has acted in a very proactive way. The Ministry of Health Promotion has taken a three-pronged approach to address the important issue of childhood obesity. Our program can be broken down to three broad areas--programming, promotion and prevention, and capital investment--which I will address in turn.

First, on programs that get youth eating and moving, I'm referring specifically to our government's Active 2010 program on sport and physical activity, and our healthy eating and active living plan. A copy of that plan has been distributed to members of the committee.

Active 2010 is the McGuinty government's strategy to increase Ontario's rate of participation in sport and physical activity with the goal of getting 55% of the population active by 2010 when Canada welcomes the Olympics. The key component of this strategy has been the creation of the communities in action fund. This is a $5 million fund that aims to increase the level of physical activity and sport participation rates in Ontario by assisting local provincial non-for-profit organizations in the area of community sport and recreation.

As elected officials, you all know first-hand it often takes just a small amount of seed funding to take a great idea, a dream, and turn it into a reality. Over the last three years, more than $15.8 million has been awarded to over 500 organizations. That amount is not a lot in the scope of things, but a $20,000 or $30,000 grant is important to the group that wants to start a basketball league or buy equipment for a field hockey team. In many instances the organizations have leveraged the funding they have received and have partnered with various actors to deliver programs to approximately 500,000 Ontarians in the first two years alone.

The program doesn't just subsidize the cost of soccer balls or teach people to play basketball. A great success story is the Big Sisters of North Bay and District, who used an $8,900 grant to implement their Go Girls! programs into the core services to offer 80 girls from 12 to 14 the opportunity to participate in a mentoring program designed to encourage participation in physical activity, learn about choices for healthy eating, and encourage the development of positive self-image.

We recognize that only through a comprehensive approach can we lay the foundations for children and youth to grow up to recognize the importance of leading healthy lives, and our ministry is proud to support programs that accomplish this goal.

I'd also like to acknowledge the importance of the Sport for More program. It's a four-year $6.1 million bilateral agreement that we signed with the previous government in 2005. This program is providing weight training equipment, for instance, to an aboriginal high school in Thunder Bay, leadership clinics for aboriginal coaches, and is supporting the 2006 and 2008 Ontario Paralympic Winter Championships.

This agreement is an excellent example of federal-provincial partnership that increases sport participation and physical activity among under-represented groups such as youth from low-income families, ethnic minorities, women, people with disabilities, older adults, and aboriginal communities.

Our next strategy is our healthy eating and active living plan. This is in response to Dr. Basrur's report. It's a $10 million action plan designed to provide the tools for all Ontarians, with special emphasis on children and youth, to encourage healthy, active living. The cornerstone of this strategy includes EatRight Ontario, our province's dietary advisory service. It improves access to timely and reliable nutrition and healthy eating information for families and health professionals through a website, currently available at www.healthyontario.com, if you'd like to try it out, and a phone platform, a 1-800 number that is coming.

I must say, I tried the program. You can write to a registered dietitian and within three business days get an answer to your question. It's very user-friendly, and we thank B.C., because they were the instigators of that concept.

Our healthy schools recognition program, which is a partnership with our Ministry of Education, is almost considered an ISO 9001 for schools, a designation. If you have so many bike racks, a milk machine, so many kids involved in physical activity, you will be awarded the flag or the banner to say you are a healthy school.

Finally, the northern fruit and vegetable pilot program is a program designed to help 25 schools in northern Ontario in the Porcupine school board district on a pilot basis. It's going to provide fresh fruit and vegetable snacks three times a week. We're very excited about this program. It's going to get up and running in the next few weeks. It's very much modelled on the U.K. example. Prime Minister Blair brought in a program whereby in almost every elementary school in the U.K., a child receives a fresh fruit or vegetable.

Finally, we're hosting a major conference November 29 and 30 on healthy eating and active living. Roy Romanow and Dr. Andrew Pipe of the Ottawa Heart Institute are among the many distinguished speakers who are going to talk to us.

I'll just go ahead a little bit, because I don't want to run out of time.

The second pillar of the ministry has been the promotion of healthy living habits through public education campaigns. Many of you may be familiar with our anti-smoking youth campaign, which was called stupid.ca. It was designed by young people for young people. I encourage you to go to that website.

This youth anti-smoking campaign has been highly successful. In the first year, over a million people visited the site, which is quite remarkable for a government website aimed at young people.

In keeping with this approach to youth engagement, this past week the Ministry of Health Promotion launched a new public education campaign, aimed at the critical 'tween population, teenagers and pre-teens. It's my ministry's notgonnakillyou.ca campaign.

How many of us remember our parents saying “Eat your vegetables, it's not gonna kill you”, or “Go out and play, it's not gonna kill you”? If you go on to www.notgonnakillyou.ca, you will be quite impressed with the interactivity of the website, including a message that pops up—I believe after 15 minutes—that says “Stop using the computer and go out and play”. So it's really quite exciting, and the television commercials have gone over very well. They can be seen on stations like YTV, MTV, and Much Music.

We're focusing on using online tools, as well as unique television advertising to expand the message to get through to young people in campaigns designed by young people.

The final aspect, Mr. Chair, that I'd like to talk about for the last few minutes is the fact that we have a serious sport and recreation infrastructure deficit, not only in Ontario, but throughout the country.

The vast majority of Ontario sport and recreation facilities are more than 25 years old. Not since the 1967 centennial infrastructure program has there been a comprehensive program supporting the design and construction of sport and recreation facilities in Ontario. As we all know, next year is the 40th anniversary of the centennial.

A study conducted by Parks and Recreation Ontario and commissioned by the Ministry of Health Promotion revealed that between 30% and 50% of Ontario's community centres, pools, and arenas are close to the end of their useful life. The study also identified the capital cost to renew or replace just these existing facilities—not new ones—to be at approximately $5 billion.

At the August 2005 and June 2006 meetings of ministers responsible for sport, physical activity, and recreation, my provincial and territorial colleagues identified sport and recreation infrastructure as our number one priority, and came to a consensus on the importance of convening a special federal, provincial, and territorial meeting to address this single issue.

My colleague from Quebec, the minister who is also responsible for education, and I were instrumental in taking the issue from the bottom of the list and bringing it to the top, because we recognize the importance. There's no sense in encouraging kids and others to get involved in physical activity if they don't have any infrastructure.

To put it in perspective, Sydney, Australia, has 16 Olympic-size swimming pools. The city of Toronto has two, and one of them leaks.

During our provincial and territorial meeting, the ministers agreed unanimously to the creation of a national sport and recreation program, with an investment separate from existing infrastructure programs to ensure that this priority is addressed without competing with other infrastructure needs. The group also estimated that the national sport and recreation infrastructure deficit was in the range of $15 billion.

The federal government was invited to this meeting, but chose not to attend. I believe there is much work to be done. But if the federal government takes a leadership role and begins to work in partnership with provinces and territories on a multifaceted approach to address the issues I've raised today, I believe we can halt, if not reverse, the trends of childhood obesity.

To conclude, Mr. Chair, the creation of Ontario's Ministry of Health Promotion and our current investments to increase physical activity rates and encourage healthy living take a very proactive and comprehensive approach.

We are working to mobilize and engage other ministries, other levels of government, the educational sector, community organizations and the private sector, while at the same time building on the public's active participation.

I firmly believe that a coordinated and cooperative approach will lead to better outcomes in young people and that our work as a provincial ministry will be complemented through a future partnership with the federal government.

We are promoting ongoing commitment to healthy lifestyles, which includes healthy eating, physical activity, accident prevention, as well as preventing direct and indirect exposure to smoking, at all ages and at every stage of life.

We're targetting the youngest Ontarians in order to get the message out and make the biggest difference and the biggest direct impact for the sustainability of our health care system. It is in this way that investment in prevention and promotion should not be viewed as a feel-good social policy but as necessary and critical expenditure to ensure that younger Canadians adopt and maintain a lifelong healthy and active lifestyle.

Mr. Chair, I'd like to thank the committee very much for the opportunity to speak to you. I commend you for taking on this issue, and I look forward to working with you at the provincial level.

Merci.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

I want to commend you for actually going to some of the students and getting the names of your websites, like stupid.ca and notgonnakillyou.ca. They say the House of Commons can be like kids in a sandbox. This is very parliamentary language. We hear it all the time, so I think Canadians will relate.

Thank you very much for your presentation. I know there will be some very good questions as we move into the question and answer period.

We'll now move to Northern Health. Joanne Bays, the floor is yours for ten minutes, please.

[Joanne Bays, Regional Manager, Northern Health]

I spent a great deal of time preparing a lovely PowerPoint presentation, but I'm going to look at it myself and just use it as a speaking tool, and hopefully I'll send it to you so that it can be transcribed. In the north, we would be transcribing it into 64 aboriginal languages, so we'll see what we can do.

Today I'm going to talk about community food security. That's different from food security, and I'm going to talk about it in terms of childhood obesity.

When we talk about community food security, fundamentally we're talking about redesigning the systems that feed us, in order to prevent childhood obesity.

Most people are familiar with the FAO definition of food security. It states that when all people at all times have physical and economic access to sufficient, safe, and nutritious foods to meet their dietary needs and food preferences for an active life, they are food secure. As they say, if you have the food you need for health and if you can access it, then you're food secure.

But in B.C., we think of it differently. We think of food security not only as access to food, but as being about food supply. You can't really be accessing the food if you don't have the supply of food, so we see those as very much intertwined concepts and we do not differentiate. But we then have to zero in and look at our systems that feed us and the policy that underpins those systems.

We talk about a healthy sustainable food system and community food security in the same breath. A healthy sustainable food system is one that does not compromise the land, air, and water for future generations. It does ensure that all people have access to the foods required for their health. It is a system that is economically viable over the long term. It's one that recognizes food as a part of culture and community. You can't separate these things. They're all together. We say food security is dependent upon that.

We talk about food policy even at the grassroots level. We talk about food policy as being a framework within which decisions are made, and it provides the context for those food systems that impact our access to and supply of food.

Even at the grassroots level, even in the little villages in Haida Gwaii, we're very aware that Canada does not have a coherent food policy. We have all kinds of bits of policy, regulations, and guidelines around food, nutrition, and agriculture, but we don't have what we would call a coherent food policy at the federal level. We also don't have that at the provincial level and we lack it at the municipal level, so we're thinking big when we're thinking about making changes. But we recognize that it's very complex.

When we talk about a coherent food policy, we're talking about one that has the optimal nourishment of the population as its highest purpose, one that makes agricultural production and distribution a servant of that purpose, and one that ensures that the food system is environmentally, socially, and financially sustainable. It's a policy that is putting health first.

There are other things we look at when we think about food security—and I wish I could show you some of these beautiful little PowerPoint slides here. We think about the consolidation of power in the food system and the fact that the top four producers of packaged food in the U.S. are Nestlé, Unilever, Philip Morris, and PepsiCo. They are the proud makers of foods such as Butterfinger, Lean Cuisine, Carnation Foods, Lipton Tea, salad dressings, JELL-O, Pepsi, and chips. In 2000 alone, we were looking at almost $100 billion in the U.S. That's how much money went into those kinds of products.

We look at that wealth in the food system, and then we compare it to the fact that a lot of people living here in British Columbia or living here in Canada can't afford to eat. I don't know if you've seen the cost-of-eating reports put out by the Dietitians of Canada. Basically, once the rent and the other things are paid, for people who are living on social assistance, there isn't enough money left over for food.

We talk about the proliferation of fast foods. If you think about trends, McDonald's was at $19 billion worldwide in 2002. The top ones are McDonald's, Burger King, Pizza Hut, Domino's, and Kentucky Fried Chicken.

And by the way, I moved to Prince George ten years ago. They had three Tim Hortons restaurants, and now they have twelve. The population hasn't changed, but we sure have a lot of fast food.

Around the world, the top two food products are McDonald's and Coca-Cola. If you go to Australia or China, it's McDonald's and Coca-Cola. In Hong Kong, McDonald's and Coca-Cola. Indonesia, McDonald's and Coca-Cola. Thailand went way out there on a limb; they eat KFC and drink Pepsi.

You have a proliferation of fast foods and you have a proliferation of food banks. There is a lot of information in here that it would be difficult to speak to without you actually seeing the slide, but we've had an exponential growth in the rate of food banks in this country. We have fast food fare and we have food bank fare. Interestingly enough, when you go to the food banks, they're getting the leftovers of what we have to offer in this food system. The leftovers from the KFC? That kind of stuff goes to the food bank. In Prince George, it's donuts, donuts, and more donuts. If you have a child who is at risk for diabetes, what are they going to get when they're at the food bank? Donuts.

We're disconnecting from our food, and in a phenomenal way. Less than one percent of the foods in our grocery stores in the north are actually produced locally, so we're completely reliant upon foods being shipped in—and we're in the hub of the north in Prince George, so I'm not talking about our more rural and remote communities. If there was actually an emergency, like a snowstorm or something that closes down the highway, we would run out of food in one to two days. Our major grocery stores only keep stock on the shelf that long.

We did have a major snowstorm a few years ago in Boston Bar, and they actually sent CBC in there to film the grocery shelves that were empty of food. The little old senior citizens with their pantries of pickled preserves and things were the ones who had food. The average food product travels 3,000 kilometres to get to where we live.

We're disconnecting with our food and we're connecting with our couch, right? I have an estimate here that we spend 9.55 years on the couch by the age of 70.

And then there's the proliferation of fast food marketing and all of that stuff that we're getting on television. I know other people have spoken to advertising targeting children. What are kids eating? Slurpees before veggies. More pop and candy than ever recorded in history: 30% of their total energy intake and 30% of their total fat intake comes from the “other” food group. I don't even know if the food guide has the “other” food group on it any more. How do we keep track of that?

When I was looking at the types of foods that make up Canadian children's nutrient intake, I was shocked to see that not only is all that energy over there for fat and that type of thing, but there's quite a bit of fat in those fruits and vegetables. I was looking at those fruits and vegetables and I thought, how do we get fat in fruits and vegetables? When I was looking at this data, I found out that they actually put french fries in there. When you're looking at food groups and how much food the children are consuming from different food groups, french fries get put into the fruit and vegetable group. Something is wrong with this data. Also, condiments like ketchup and relish are actually considered something that would go into the fruit and vegetable group. If you've had enough of them, you're considered to have had a fruit and a vegetable. So when we say our children aren't eating enough fruits and vegetables, remember that what they are eating is probably mostly french fries.

What do we have? We have a huge issue of malnutrition. And when I say “malnutrition”, I'm talking about over-nutrition. I'm talking about overweight, about obesity. But we have the paradox of hunger at the same time in this country.

In B.C. we have what we call a community food security movement. The grass roots are really active about making some changes and are aware of these problems with their food systems.

Am I running out of time?

They want to see a system that pushes against the one we have, so they're looking for localized food systems. Instead of urban–rural divisions, they're looking for urban–rural partnerships. Instead of a long trade route, they're looking for a short trade route. Instead of fast food, we want slow food. Instead of packaged and processed, we want fresh and whole. Instead of burgerization, we want local food specialities. Instead of biotechnology, we'd like to see indigenous knowledge, wisdom, and those types of things respected. Instead of food just for profit, what about food for health? Instead of just being consumers, what about being citizens?

We do a whole continuum of things with our communities. If the status quo is that you go to the food bank if you have a problem, or we give you a pill and we'll take care of it that way.... We're engaging communities in reshaping and redefining their food systems. They're doing things like community kitchens, community gardens, food co-ops, and farmers' markets, and they're trying to rebuild those localized food systems.

We're not saying to do without the industrialized food system, because we want our coffee, but we also want to have a localized food system beside it.

Communities are even working at creating food policy councils. Like the interministerial committees, that's bringing municipalities and the health sector and a variety of people together at a local level to create policy that will support this environmental change that they're wanting.

There are lots of beautiful pictures here of the things that are happening in the north.

I'm really excited, because the B.C. provincial government has gotten on board with ActNowBC. We have the Olympics coming; the premier has said this is going to be the healthiest province in Canada, but our Minister of Health has said something like, “Let me tell you something about the health of our people here in B.C. They're not very healthy.” And he came up with what I call this doomsday slide.

Basically, by 2017, if we keep continuing to spend the way we are on health care--and a lot of it is on preventable diseases--and we keep the flat 3% growth rate in education and an 8% growth rate in expenditures on health, all the other ministries' money--all of it--will be going to health. There'll be no money left.

This slide was shown to every minister, and all of a sudden this interministerial committee has been created; it's to act now. They have five goals they're working on. Food is one of them; there is active living, tobacco, obesity reduction, and--I don't know, I forget the other one. Anyway, there are five, but it means we have an interministerial committee, and they're working on food policy.

I'm hoping the federal government can build on some of the lessons we've learned in B.C. If we want change, substantial change, we've got to look at things from an environmental and a policy perspective, not just, “Eat your fruits and veggies.” We've got to support the grassroots in what they're doing. Health Canada has done a wonderful job with supporting a number of beautiful initiatives that are sustained because community has taken them on. We've got to create a national coherent food policy. We need a national coherent food policy.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

I appreciate your presentation. Your time is gone; we're a little bit over.

[Joanne Bays]

Sorry.

[The Chair, Conservative, Rob Merrifield]

The reason I'm squeezing it so much is that I know the minister has some timelines, as I mentioned earlier, but thank you very much for your presentation.

We'll now move on to the Institut national de santé publique du Québec. Ms. Lyne Mongeau, the floor is yours.

[Lyne Mongeau, Professional Coordinator, Institut national de santé publique du Québec]

Good afternoon, Mr. Chairman, ladies and gentlemen. I want to thank you for your invitation to appear before the Committee to talk about new developments in Quebec with respect to the prevention of obesity.

I work at the Institut national de santé publique du Québec, a paragovernmental organization. I do not represent the Government of Quebec. I am someone with expertise. I will try to answer your questions with respect to our government action plan, but I also have a number of concerns that I would like to share with you as part of the Committee's study.

Almost 60% of the adult population in Quebec and 25% of young people are overweight. We are among the provinces with the lowest prevalence, but at the same time, we recognize that it is much too high. This is clearly a serious public health issue, particularly since we anticipate lower productivity and significant health costs for our society with the onset of chronic diseases caused by obesity.

I want to draw your attention to the fact that, after centuries of relative stability as regards people's weight, the phenomenal increase we are seeing has occurred over a very short span of time. That is why are calling it an “epidemic”. That suggests that this issue is more of a societal issue than it is a health-related issue. So, there is a need to look very seriously at the reasons for that increase and avoid simple, or simplistic answers.

If it is viewed only in terms of the number of calories ingested and expended by the body through the action of eating and moving, such an approach precludes a more in-depth and multidimensional analysis, which is absolutely essential if we are to make the right decisions.

Higher body weights are the result of profound transformations that have occurred in our way of life. Nothing is the same anymore. We're talking about such phenomena as urbanization, automatization, and massive sedentation as regards work, travel and recreation. We're talking about the industrialization of our food system, and our colleague's presentation earlier was very good in that regard. We're seeing large portions, increased food energy density, such as fat and sugar, profound changes in the way we communicate, omnipresent electronics, recreation that revolves around monitor time — in other words, technology, or modernity is everywhere.

And yet some of the behaviours that are a result of this social transformation — such as the fact that children no longer play outdoors, for example — can be explained by a number of significant factors that warrant consideration. Profound social changes are taking place. Let's take the example of two parents who work — which is the case for most families — and who are not really available to meet their child's needs. There are other examples as well: broken families; the fact that families have fewer children, which doesn't really allow children to prepare themselves for group play, which is what we were exposed to; the fact that children attend schools with a particular vocation in faraway neighbourhoods, meaning that they no longer attend neighbourhood schools. All of that is transforming the social fabric and people's lifestyles, and thus influencing behaviours that affect health.

So, there is a very clear consensus among experts, who are supported by the World Health Organization. I imagine that you have looked at the WHO's strategy on nutrition, physical activity and health, which points to the simplistic nature of an approach that relies on counting the calories that are ingested and expended. The weight problem is possibly the greatest challenge facing humanity. It certainly is of the same scope as global warming and other major issues.

The WHO is currently the lead organization guiding global action on obesity and lifestyles, through its strategy. I would just like to mention a number of the WHO's major policies, although I will let you read about them yourselves. Quebec has drawn extensively on those strategies in developing its own plan. So, I will be referring to them indirectly.

Many countries have developed plans with a view to preventing obesity and promoting healthy lifestyles. Two weeks ago, a symposium was held in Quebec that brought together twelve or more countries.

I will leave you a copy of the brochure that we have produced, which includes a table laying out f the various plans.

Now I would like to talk about what is being done in Quebec. Unfortunately, from World War II until the year 2000, Quebec, like many provinces and countries, was not particularly active in promoting healthy lifestyles. So, we are all aware that we have a lot of catching up to do, because we have probably missed an entire generation.

Since 2000, various initiatives in Quebec have turned out to be the precursors of the government plan launched three weeks ago by Minister Couillard. However, I would remind you that this is a government plan. I would like to list those different initiatives and leave some documentation with you, because they have been an essential source of inspiration for a vision that is broadly shared by stakeholders in Quebec and that is along the lines of what I talked about a couple of minutes ago.

First of all, there is the work carried out by the provincial task force looking at the problem of overweight, this being an expert group that has been sitting for the last five years, probably very much like this Committee, as well as a task group on healthy lifestyles which was put in place by Jean Charest following the Generations Forum. You will find a report prepared by that task group in the documents I have provided.

The Perrault Task Group was supported by interministerial working groups. This is an important point that was raised in the WHO policy. The fact is that this issue involves a number of different areas — indeed, probably all areas of civil society. Therefore, governments also need to work on an interministerial basis. Six ministries, six deputy ministers, as well as six content professionals worked closely with the Perrault Task Force as it carried out its work. The interministerial thrust was provided through the work of the Perrault Task Group. A government plan was quickly developed that relied on seven different ministries and three government organizations.

I will leave you a copy of the government action plan entitled “Investing in the Future”. We are now in the process of printing it, but I would like to talk about the main features of the plan.

First of all, it is a government plan. Although it is extremely difficult to implement a strategy that is meaningful for the ministries and sectors involved, it is absolutely essential. We have to get as many sectors involved as possible; we cannot simply implement a couple of programs, because the problem is too important and becoming too entrenched in a great many sectors.

The good news is that resources have been set aside for this. We all know what happens to government plans for which there are no resources. So, new resources are to be made available, even though some ministries have already made commitments along those lines. The Fondation Lucie et André Chagnon, which is the primary philanthropic organization in Quebec, has also taken a deep interest in this issue and is assisting the government with its public-private partnership approach.

Although it aims to reduce the very targeted phenomenon of obesity, the plan also includes a much broader vision of the causes, consequences and solutions, as I was saying earlier, by providing a broader definition of such issues as obesity and overweight, as well as all the problems associated with thinness.

At the present time, Minister Couillard is very interested in the issues raised by very thin models — not only anorexia, bulimia and eating disorders, but also people's concern with thinness. People who experience that concern find themselves in a rather paradoxical situation, in the sense that they are exposed simultaneously to both abundance and ultra thin models.

An important feature of the plan relates to the locus of responsibility. The plan places a great deal of emphasis on such concepts as the environment, as opposed to individual behaviours. I think that is extremely important. It is also fully in keeping with the WHO strategy.

The plan does identify children, but it does not focus only on them. They are not really responsible. Rather, families and other social actors who care for them are the ones to be mobilized.

There is also another very important factors the rules underlying implementation of the plan; a central authority responsible for general coordination — namely the Public Health Branch; the identification of outcomes based on shared responsibilities within Cabinet.

In Quebec, there is also some reliance on section 54 of the Public Health Act, which gives the Minister of Health some very significant levers for mobilizing other ministers within Cabinet.

In closing, I would just like to identify the five main thrusts of our intervention. I was asked very specific questions, but I can't really answer them because of the very limited time available.

The first thrust is to promote and support the development of environments that encourage health eating habits.

The second thrust is to promote and support the creation of environments that foster a physically act of lifestyle.

The third thrust is to carry out societal campaigns and encourage changes in social norms so that they support healthy lifestyles, healthy eating, a physically active life, and a variety of body images.

The fourth thrust is to intensify and improve services available to people with weight problems and to help intervenors adapt their practice to this particular issue; also, to place restrictions on the sale and use of diet products, services and other means that are increasingly available; the more we talk about obesity, the more there are of these kinds of products and services.

Finally, the fifth thrust is to foster research and knowledge transfer with respect to healthy lifestyles, based on the complexities of weight related issues.

I could perhaps provide you with more detailed information about certain programs and certain activities associated with the these policy thrusts that could be of interest to you.

Thank you very much.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your presentation.

We'll now move on to the Childhood Obesity Foundation of British Columbia, Christina Panagiotopoulos.

[Christina Panagiotopoulos, Executive Director, Childhood Obesity Foundation of British Columbia]

First of all, I'd like to thank the health committee for inviting me here to speak.

The Childhood Obesity Foundation of B.C. is a new charitable organization with a mission to identify, evaluate, and promote the best practices in the prevention and treatment of childhood obesity. We aim to be the leading provincial authority on issues related to childhood obesity in B.C. We promote a best practices approach to reduce the prevalence of childhood obesity in Canada. We promote and collaborate on valuable research that will help, halt, or reverse the current trends of overweight and obesity at the local, provincial, and national levels.

What are the key actions that will help, halt, or reverse the trends about overweight? First, let's decrease the intake of sugar-sweetened beverages. We know that one of the major contributors to the childhood obesity epidemic is the over-consumption of sugar-sweetened beverages. One can of soda per day increases a child's risk of obesity by 60%, and studies show that between 30% and 50% of Canadian teenagers drink at least one can of soda per day. It is difficult to exercise off the excess calories consumed in pop and juices. A 13-year-old boy needs to jog 50 minutes to burn off the 260 calories contained in each 591 millilitre bottle of pop.

Parents and children need to become educated on this important issue. This is a critical piece of social marketing that needs to be pervasive and sustained in order to counter the powerful marketing campaigns funded by the soft drink manufacturers. Here is a vital component of obesity prevention for which the federal government is ideally suited.

Second, decrease monitor time. The latest Canadian community health survey data indicates that children who spend more than two hours per day in front of a monitor--that's TV, computer screens, Game Boy--have double the incidence of overweight and obesity when compared to children who watch less than one hour per day. Monitor time displaces essential physical activity, and we know that more than half of five-year-olds to 17-year-olds are not reaching activity levels sufficient for optimal growth and development. In addition, children eat while watching TV and they eat what they see advertised. Therefore, the missed opportunity for exercise is compounded by overeating and the promotion of junk food and junk drinks.

It is recommended that children get no more than one hour to two hours of monitor time per day, that children do not have regular monitor time until two years of age, and that no child has a TV in their bedroom. Once more, this important message to parents is ideally suited for a social marketing campaign funded by a robust, sustainable source such as the federal government.

Third, institute comprehensive school health programs and policies that support them. School programs reach across all socio-economic status sectors and therefore are efficient at targeting vulnerable populations. Research evidence suggests that school-based interventions that adopt a comprehensive approach have the highest likelihood of achieving changes in health behaviours in childhood.

In Canada, the Annapolis Valley school program and Action Schools B.C. are examples of comprehensive school health programs that promote healthy weights. These programs address both physical activity and healthy eating, and address behaviours through policies and programs before and after school, in the classroom, in recess, and in partnerships with family and community. It's not just curriculum-based. The school community is involved in planning and implementing activities that are appropriate for their school.

Fourth, provide treatment for childhood obesity. The recent CIHR report entitled Addressing Childhood Obesity: The Evidence for Action, has stated:

Any treatment intervention is associated with significantly increased chance of improvement or resolution of obesity, and is favoured over no treatment.

Despite this endorsement, there are few obesity treatment centres in Canada. We know that a child who is obese when they enter into adulthood will likely die seven years earlier than their normal-weight peers. However, the younger intervention begins, the better chance of BMI dropping. For example, a boy of eleven who maintains his weight while growing will have effectively lowered his BMI. Family-based treatment for childhood obesity is effective and will likely have beneficial effects on the BMIs of caregivers and siblings, so there's a collateral effect to this.

The latest Canadian community health survey indicates that over 7% of our nation's children could benefit from obesity treatment, yet there are only a handful of treatment centres across the country. The federal government can play a key role in helping to correct this dismal situation.

What are some of the provincial government's actions? In British Columbia we have a lot to celebrate at the moment. The provincial government has taken great strides to change the landscape of the incidence of childhood obesity in B.C. by investing in a number of programs through the B.C. government's award-winning ActNowBC initiative and its partners. These include Action Schools BC, the healthy eating plan, the B.C. fruit and vegetable snack program, voluntary guidelines for food and beverage sales in B.C. schools, the active communities initiative, the municipal recreation food environment audit, and Centre for Healthy Weights treatment centre.

What is the role of the federal government here? We commend the provincial and federal governments for their support of initiatives that will work to halt or reverse the trends of childhood overweight and obesity through their focus on prevention. These initiatives include the Chronic Disease Prevention Alliance of Canada, the Canadian strategy for cancer control, the Canadian diabetes strategy, and the newly announced cardiovascular disease strategy. However, we feel that the federal government can enhance the battle against childhood obesity through four key actions.

The first is increased support for research and evaluation for childhood obesity prevention and treatment initiatives. Provincial programs such as Action Schools! BC have benefited from CIHR funding, but as the program expands, there is an urgent need for ongoing evaluation to demonstrate implementation effectiveness. Our ability to take advantage of the natural experiments that are under way in many provinces is limited. For example, as more obesity treatment centres are created, there will be a need for a well-funded research and evaluation arm. The CIHR and its new RFA are very appropriate conduits for such funds, but the CIHR needs more federal support in order to expand its role.

In addition, the federal government can ensure that the current chronic disease strategies incorporate adequate funding for evaluation and that there is adequate support for surveillance initiatives such as the physical health measures survey.

The second key action is to provide the crucial social marketing campaign to enhance the public's interest in changing their own intake of sugar-sweetened beverages and reducing excess time in front of electronic media.This social marketing campaign would provide the essential complement to the planned ParticipAction campaign. In addition, the federal government could explore policy options to control food advertising targeting children, similar to those now in place in Quebec, where advertising of some products to children under 13 is prohibited.

Third, promote the expansion of childhood obesity treatment centres and of research as to their efficacy and cost-effectiveness. The Government of Canada can facilitate a meeting of representatives from each of the various provincial programs in order to enhance knowledge transfer. The government can also help by funding a comprehensive research package to identify the most effective and cost-effective intervention. The government could fund pilot clinics in the provinces to act as best-practice resources and to stimulate the provincial governments to fund additional programs.

Fourth, continue to support organizations that facilitate cross-province knowledge exchange and capacity-building efforts, such as the Chronic Disease Prevention Alliance of Canada.

In conclusion, we believe the federal government has a role to play in the prevention of childhood obesity. In the need to support and enhance provincial approaches, we need you to enhance evaluation and surveillance efforts to underpin provincial and local activities with a vibrant and well-planned social marketing campaign, and to support collaboration and knowledge exchange within and across provinces.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We appreciate all of the testimony and presentations. They are all very good and have stimulated, I'm sure, some very good questioning.

We'll move into the question period, noting that the minister has given us an extra five minutes. Hopefully we'll get our first round of questioning in.

Madam Fry, the floor is yours.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I would like to address this question to the Minister of Health Promotion. As we've listened to people come and talk about promoting health and preventing obesity, we have heard over and over that it has to do with all the pieces of health promotion, starting with education in the schools, with public education and awareness, and with education about nutrition.

More importantly, given we've heard from a lot of people that poverty is the greatest determinant of ill health, it's really important to facilitate access for all people. I note that a large part of your presentation had to do with the need to develop that kind of infrastructure in order to facilitate healthy and active living among young people. That obviously has to start from the very beginning.

You talked a lot about an infrastructure program. I agree very much with your concept of a jurisdiction shared among the federal, provincial, and other levels of government and NGOs. I think it would be very important if you could tell us how you see us working together to achieve that. What are some of the ways you think we could work together to create the kind of access you talk about for all people, regardless of their socio-economic position in life and whether or not they have access? As we know, if you're poor, you do not have access to playing sports, so the infrastructure piece is very important.

How do you see the provincial government--which has jurisdiction over education--looking at quality daily physical education in schools? Is there some way we could start to talk about this kind of joint partnership that we should be developing?

[Jim Watson]

Thank you, Dr. Fry, for the question.

This is an issue that's near and dear to my heart, because, as a former mayor of Ottawa, I understand one of the challenges that face municipal governments, particularly when it comes to the upkeep of recreation facilities and arenas and pools. As I pointed out, nationally there's an approximately $15-billion infrastructure deficit for sport and recreation. The kinds of facilities that many of us grew up using are reaching the end of their lifespan, and we have to do something about that, because we're competing with a lot of different interests that kids have today. If we don't provide modern, clean, proper athletic facilities, they're going to go do something else that's probably not as good for them in terms of physical activity.

There are a couple of things I think the federal government can do. I sit in these committees at the provincial level and meet with stakeholders, and sometimes I feel like an automatic teller machine after I've met with groups. There are always people coming and looking for money. There's no question there's a need for federal participation with respect to a sport and recreation infrastructure. We met with former Minister Stephen Owen in Regina in August of two years ago at the Summer Games, and he undertook that he would go back and come forward with a joint federal-provincial infrastructure program. In the interim, the election occurred.

We've had meetings with Minister Chong, but we haven't received a clear signal as to where the federal government is going with respect to sport infrastructure. I do commend the government on the sport and fitness tax credit. I think it's a good start to try to break down some of those barriers, because for those of you who have children in amateur sports, it's very expensive. You're sending kids out and a lot of time and financial resources are required to make sure that this child gets to swim meets or hockey practice and so on.

There's a need. The statistics are pretty staggering in terms of the number of facilities that are reaching their lifespan. I think in Ontario 13% of hockey arenas are 50 years old and older. There are lots of centennial projects around the country--centennial pools and centennial halls and so on. I'd like to challenge the federal government. Let's start planning now for some sesquicentennial projects eleven years from now. Next year is the 40th anniversary of 1967, and in ten years hence it will be the 150th anniversary. What a great legacy it would be for provinces, municipalities, and the federal government to be able to start planning now to open some of these facilities in 2017.

If I could just mention one other thing that we recognize in Ontario, there are financial obstacles for groups to get involved in extracurricular activities because of rental fees. We recognized that early on in our mandate and we created the community use of schools program. It's $20 million and it's money that helps to subsidize the use of schools after hours and on weekends. What was happening was because the school boards were tight for cash, they would try to make up for it by jacking up the rent of gymnasiums and so on in schools. This has now brought down on average the rental fees in Ontario schools by 70%, and in 26 of our 72 school boards they've eliminated the fees altogether. These buildings were paid for by taxpayers, yet they were closing up after school and weren't open on weekends, and they have wonderful gymnasium facilities.

[The Chair, Conservative, Rob Merrifield]

Do you have a further question? You have time for one more.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I want to ask a question about schools, because you have a jurisdiction for education. How do you see the schools playing a role? You've talked about them extracurricularly, but how do you see the schools developing K to12, integrated, sequential, and comprehensive programs in terms of teaching nutrition and changing behaviour, as well as bringing about daily quality physical education? Do you see that as a possibility for provincial governments to push, with help from the federal government if necessary?

[Jim Watson]

I do. Actually, I am a fan.

Just to go back, there are two aspects to your question.

At the elementary school level, we instituted 20 minutes of mandatory daily physical activity, in addition to physical education class, which on average is three times a week in Ontario.

We have to work with our education ministry to see what we can do in the high schools, because it stops at high school, and you're only required to take one physical education credit.

But we also have to make sure that gym, or physical education class, is fun. I was the kid who was always chosen last in class to join a team. And I could never make it up the rope—you know, that terrible rope you climb. Then when I did try to make it up, I burned on the way down. It wasn't a pleasant experience. A lot of kids get turned off physical education, because it's not a fun experience. We've got to change that.

The other thing is that with respect to nutrition, there are very few school boards in the country, of which I'm aware, offering what used be called Home Ec, where you were taught nutrition, and so on. In many respects, we have to go back and look at those kinds of programs, because parents are busy, as my colleague from Quebec pointed out. Two members of the family are working. There aren't as many home-cooked meals. It's a lot easier to call a pizza company and get a pizza delivered than it is to have a healthy meal.

The schools play a vital role. That's why we took junk-food vending machines out of elementary schools. That's why we also took out the pop machines. A lot of those machines were revenue generators for school programs. But they were replaced with water, 100% juices, and so on, and there hasn't been a discernible difference in revenue.

The other thing I do want to say is that I've had discussions with Tony Clement and Michael Chong with respect to ParticipAction and the old Canada fitness award program, in which we used to get the bronze, gold, and silver patches. I think it should be competitive, but based on how you've improved over the year, as opposed to how many sit-ups you do next to someone who's more talented, and so on.

I think ParticipAction is a good idea, but it should be coordinated with the provinces, so that we're not out spending money on one series of commercials and you're spending money on another.

We've left you our commercial. I think we have disks of the notgoingtokillyou.ca commercial, which I hope you get a chance to look at.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Madam Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you very much for enlightening us and for the data you have provided to help us gain a better understanding of the obesity issue. As you said, you see this holistically and believe we should not be minimizing the connection between obesity and health lifestyles.

We know that Quebec has moved ahead in this area. I believe his plan has been relatively well received, but it has also been criticized — for example, with respect to monitoring certain programs. People have said that the government moved a little too quickly, without knowing exactly how to target interventions.

What is your view in that regard, Ms. Mongeau? Perhaps you are in a better position to defend the plan. There has been some criticism in the newspapers. I have read those criticisms because as a member of this Committee dealing with obesity, I and my colleagues are very pleased that Quebec has taken some action. At the same time, if we're asking the federal government to take action as well, we can't forget that Quebec has decided to go ahead. How can the federal government get involved in a program that is already underway? I believe that the program per se is a good thing, but could you tell us a little more about the criticisms that have been made, so that we have a more enlightened view of things?

[Lyne Mongeau]

To begin with, I can tell you that I feel relatively comfortable talking about this, because the plan was not developed by my institution. Indeed, I myself made certain criticisms on a number of newscasts and, unfortunately for me, all that was reported were my negative comments. On the other hand, the Minister did not take my comments the wrong way.

One of the criticisms that I did make was the abundance of verbs such as “raise awareness“, “encourage“ and “foster“, which I declared to be “soft” verbs, given that it is difficult to associate indicators with them. It is difficult to know how to develop any concrete actions to implement these kinds of things, and that is definitely a weakness, even though the most serious weakness would be to have no plan whatsoever.

I also saw criticisms in the newspaper to the effect that the government had perhaps acted hastily. Some said the plan is disjointed, but the fact remains that seven ministries and three government organizations took part in developing it. That was not easy to accomplish, because certain departments really wondered what they were doing at the table preparing a plan that deals with healthy lifestyles and the prevention of weight-related problems. At first glance, they were being asked to express an opinion on issues that are not really of an economic nature. They are not used to that, and that is not part of the established tradition and culture. So, this is a first step towards changing that.

Change is occurring, and I think we are starting to acknowledge the importance of working in this area; so, we must take advantage of that. This plan will allow us to take the initial steps and then go much further.

Of the actions being proposed, there is a whole series of projects that are already underway, as well as new projects. Furthermore, a great many community groups in Quebec will work in parallel and concurrently with the government plan, thereby ensuring that people will be watching the government carefully to see that it takes specific measures to get things moving and achieve results.

It is important not to underestimate the commitment of other sectors of civil society. The government must show leadership, and the other sectors have to get involved in order to complement what the government is doing. So, although some actions are not laid out in the plan, because I am aware of what is going on, I know that other organizations will take responsibility for them.

Did I answer your question?

[Christiane Gagnon, Bloc, Québec, QC]

Yes, partly, but I would like some clarification.

For example, you say that a number of ministries were called upon to contribute to the plan, and some really wondered what they were doing there. Could you tell me which ministries were supposed to be there and perhaps explain why? That way we would be better able to understand what the overall thinking was behind this plan.

[Lyne Mongeau]

A first example I could mention would be the Ministry of Agriculture, Fisheries and Food. Even though its title includes the word “food”, that ministry's primary concern, until very recently, was food safety. This is a ministry with a primarily economic focus, that works very hard in such areas as the biofood chain and the continuum of production all the way to distribution. But health-related issues are not really part and parcel of that ministry's activities. So, it began to do its own analysis about two years ago, and when the time came to draft a plan, it became more heavily involved; it had a better sense of what its role was.

As I've just said, this is a step in the right direction and we have to not only keep up the pressure, but sustain intersectoral work and collaboration. The other example is the Ministry of Transport. Generally speaking, when you're talking about physical activity, you have a tendency to see it in terms of—

[The Chair, Conservative, Rob Merrifield]

Very quickly answer it, and then we'll move on. Our time is gone. Go ahead.

[Lyne Mongeau]

—individual behaviours. But it's important to understand that certain behaviours will be adopted by individuals insofar as the appropriate infrastructure is in place. In terms of public transit, biking, bike paths, and the way streets and neighbourhoods are laid out, the Ministry of Transport and the Ministry of Municipal Affairs and Regions have a slightly better understanding of their role and are now getting involved.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Dykstra, for five minutes.