Health Committee on Feb. 14th, 2007

[The Chair, Conservative, Rob Merrifield]

We'll call the meeting to order.

I want to thank everybody for coming. We have a fairly aggressive meeting as far as number of witnesses and I hope we hope numbers of good questions and answers.

We want to start fairly quickly. We're coming close to the end of our study on childhood obesity, but we want to ask some of the witnesses some further questions before we issue our final report, which we hope to have completed by the end of the month. Then we'll be issuing a report when we come back into session in March. That's the game plan right now. If there are no delays, that should be our schedule.

We want to thank the witnesses for coming. We have an interesting session with a panel on healthy schools. I will introduce you as I give you the floor. Maybe that will be the easiest, and if there are others with you, then we can introduce them.

I see Madame Gagnon has a question.

[Christiane Gagnon, Bloc, Québec, QC]

Mr. Chair, I want to introduce a motion in committee concerning the study of the Common Drug Review. I sent it to the committee this morning. May I introduce it before the briefs are presented and before question period?

You haven't received it?

Can't we just table it?

[The Chair, Conservative, Rob Merrifield]

You just want to give notice of motion? That's fine. You can give the notice of motion today, and we'll pick it up in 48 hours.

[Christiane Gagnon, Bloc, Québec, QC]

Does it have to be read? No?

So I'm giving notice of motion and we'll see whether it can be seconded at the next meeting.

Thank you.

[The Chair, Conservative, Rob Merrifield]

That's right.

Let's move on to our witnesses.

We will start with the Public Health Agency of Canada, Kelly Stone. The floor is yours, and if you would introduce the people with you, it would be appreciated.

[Kelly Stone, Director, Childhood and Adolescence, Centre for Health Promotion, Public Health Agency of Canada]

Thank you.

I have brought Marie-France Lamarche, director of chronic disease prevention and community programs directorate at the first nations, Inuit, and health branch in Health Canada; Ann Ellis, who is with the office of nutrition policy and promotion, health products and food branch, Health Canada; and Joan Katz, director of education planning and policy in the education branch at INAC. Those are my government colleagues.

Our Nova Scotia partner is unfortunately not here yet, I see. I hope she will be able to join us, because I'd like to hear from her, as I'm sure you would.

Thank you, Mr. Chair and members of the committee. I'm pleased to be here to discuss the involvement of the federal government around school health, with particular regard to obesity. It has been well established that the problem of overweight Canadians and obesity is escalating, particularly in children, as the overweight and obesity rates have tripled over the past 15 years.

Addressing this complex phenomenon requires a coordinated effort linking the main actors across settings and across sectors, not only at the national but also at the international level. Eating habits and physical activity patterns are clearly important determinants of healthy body weight. Further, interactions between a range of behavioural, social, and physical determinants are largely associated with the rise in obesity.

The federal, provincial, and territorial ministers of health endorsed the pan-Canadian healthy living strategy in 2005 to promote healthy weights through a focus on physical activity and healthy eating. It has a particular emphasis on childhood obesity in the school setting. Under the auspices of this strategy, the recently established Joint Consortium for School Health is an example of collaboration and coordinated action involving the health and education sectors.

Such collaboration on the part of the joint consortium is supportive of the World Health Organization's comprehensive school health approach, which calls for the integration of health perspectives into all aspects of school activities and engages communities as a whole. The four main elements of the WHO approach are teaching and learning, health and other support services, supportive social environments, and a healthy physical environment.

The joint consortium is an intergovernmental consortium developed to act as a catalyst in strengthening cooperation among and within governments and those they partner with in this field. The joint consortium can provide leadership and facilitate a comprehensive coordinated approach to school health, as well as enhance the capacity of the health and education systems to work more effectively in the promotion of health through the school setting.

Membership to the consortium exists on a voluntary basis. It remains open and inclusive. Member jurisdictions of the joint consortium currently include the Public Health Agency of Canada and all provinces and territories except for Quebec and Alberta. It is supported by a small secretariat responsible for the organization of national activities, and a network of school health coordinators designated and directed by each jurisdiction. The secretariat is housed within the lead province. That function will rotate between members; the current lead is the province of British Columbia, as represented by its Ministry of Education.

Governance is provided through a deputy minister committee and a management committee. These committees help ensure systemic integration by having, again, health and education sector representation from each member jurisdiction. The Government of Canada is represented on the deputy minister committee by the chief public health officer of Canada, Dr. David Butler-Jones.

The consortium model fits well with an intersectoral approach. The joint consortium is premised on the understanding that schools play a critical role in the positive relationship between health and learning, and that effective health promotion can only take place within the school setting through an integration of both health and education sector resources and ongoing cooperation and coordination at the local, provincial, and national levels.

In pursuing its mandate to strengthen the health and education sectors' capacity to work together, the joint consortium is initiating efforts towards knowledge transfer, surveillance and monitoring of data, and the sharing of best practices. This typically involves building partnerships within and across governments, as well as with NGOs and community organizations. As the joint consortium evolves, the number of partners is also likely to grow towards achieving, again, a more comprehensive school health approach.

The joint consortium also dedicates time for creating tools to assist its members in developing programs and policies related to priority issues and risk factors in their schools. During the consortium's initial development phase, there are four working groups: nutrition, physical activity, sexual health, and social behaviours. These working groups are just now getting up and running.

As the only federal representative on the consortium, PHAC created the Federal Coordinating Committee for School Health. This federal committee acts as a single window to access relevant federal research initiatives and specific programs around school health issues. In support of this function, so far the committee has completed its draft inventory of federal activities that might be or are directly related to school health.

A particular challenge currently faced by the consortium is the issue of aboriginal school health. Aboriginal student health is certainly a priority for the consortium. However, at this time its role and focus specific to this population is not yet defined.

The current structure of the consortium is likely suited to addressing the unique needs and considerations of aboriginal students living off reserve and, in particular, aboriginal students living in the territories, but because health services and education are delivered differently on reserve, a separate approach may be required to advance school health specific to first nations.

In this regard there was early discussion among federal partners, namely the Public Health Agency, Health Canada, and INAC. INAC and Health Canada have had the opportunity to follow the consortium's progress, particularly any work that has been directed toward the needs of aboriginal students. In the future, opportunities might evolve for some collaborative work on some of our projects.

It is also clear that national aboriginal organizations and communities will need to be engaged in addressing the needs of aboriginal students. In the interim, Health Canada continues to support the health of aboriginal students through its existing community-based programs. For example, healthy eating and physical activity are promoted through the aboriginal diabetes initiative.

The joint consortium is also increasing its international focus. It is delivering a presentation this coming June at the International Union for Health Promotion and Education conference, as well as hosting a World Health Organization technical meeting on school health in Vancouver just prior to the IUHPE conference. The joint consortium is also contributing to Canada's efforts in the development of a WHO policy framework for the prevention of chronic diseases in schools.

An effective school health strategy needs to go beyond the classroom into the halls, the lunchrooms, the schoolyards, meetings, and certainly connect with local communities. The consortium, with its public health focus, can provide a stewardship role by harnessing action from the myriad of actors and potential players both within and outside of government.

The responsibility for school health lies solidly with provincial and territorial governments and their school boards. However, national and provincial and territorial agencies and non-governmental groups are also key contributors to the comprehensive approach to school health. The challenge is going to be to draw together the knowledge and the capacity of all these actors.

The federal government, particularly through PHAC and Health Canada, is committed to maintaining and improving the health of Canadians and recognizes the important role that this comprehensive school health approach plays in the health of children and youth, particularly related to childhood obesity.

The joint consortium is still a new entity, but it holds a lot of promise as a positive way we can work together toward improving the health of school-age children.

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now move on to Joan Katz, from the Department of Indian Affairs and Northern Development.

[Joan Katz, Director, Education Planning and Policy, Education Branch, Department of Indian Affairs and Northern Development]

Thank you.

Good afternoon, I would like to thank the chair and committee members for the opportunity to speak on the subject of healthy schools.

At Indian and Northern Affairs Canada, the department's primary role is to support first nations and Inuit in developing healthy, sustainable communities and in achieving their economic and social aspirations.

We are responsible for delivering provincial-like services such as education, community infrastructure, and social services to status Indians on reserve. The vast majority of these programs and services are delivered in partnership with first nations, who directly administer 85% of the department's program funds with the goal of ensuring that programs and services on reserve are comparable to those available to other Canadians. For education, the Government of Canada has the financial responsibility for first nations elementary and secondary students living on reserve who attend first nation, provincial, federal, or private schools.

The elementary and secondary education of Inuit learners falls under the direct jurisdiction of the province or territory they live in. Over the last ten years, the number of schools managed directly by first nations has increased from 372 to over 500, with only seven federally operated schools remaining. This means 99% of the schools are controlled by communities themselves. Approximately 60% of first nation students attend first nation schools, with the remaining 40% attending provincial, federal, or private schools.

INAC plays a support role through its education and capital programs to Health Canada's First Nations and Inuit Health Branch for the development of healthy schools. INAC's main role in education is as a funder. While the department itself is not involved in the development of curriculum, it does stipulate that the schools being funded must provide education that is comparable to what is required in provincial schools by the statutes, regulations, or policies of the province in which the reserve is located.

INAC's special education program provides first nations with funding for student assessments, the development and monitoring of individual education plans, and professional services such as education psychologists and speech and language therapists. The department also has supplementary proposal-based sources of funding that schools can draw from in order to promote a healthy school environment. “New Paths for Education” is a proposal-based initiative used in a variety of ways to improve the school environment and classroom instruction and to strengthen overall school governance. In past years, some participating schools have used this initiative for breakfast and lunch programs.

Parental and community engagement strategy is another proposal-based program that contributes to healthy school environments through funding for activities such as highlighting the importance of screening for detection of any special education needs of a child, and reinforcing the importance of regular check-ups, such as hearing, vision, dental, nutrition, immunizations, and hospitalizations.

INAC has a capital facilities and maintenance program, which supports infrastructure investments in schools and recreational facilities. For school facilities, communities may build gymnasiums, sports fields, and playgrounds, as specified in the departmental level of service standards for schools and school site development. Specifically, INAC's school space accommodation standards allow for the construction of a gymnasium where a first nations school has a projected enrolment of more than 87 students.

As of 2006, there were 250 schools that had at least one gym, and 173 schools that had a multi-purpose room that could serve as a gym. This program also allows for the provision of funding for educational furniture, equipment, and furnishings, including playgrounds and other similar equipment for schools. In addition, the capital facilities and maintenance program can contribute towards the construction of community buildings, including recreational facilities and community halls like arenas, community recreational centres, and indoor pools.

In 2006, 504 first nation communities had at least one type of recreational facility. This includes 142 arenas, 57 gymnasiums, and one indoor pool. The department is also committed to working with other departments that have a similarly vested interest in healthy youth and in particular healthy school environments. For instance, the department is not a member of the Joint Consortium for School Health, but supports the Public Health Agency of Canada as the federal representative.

Thank you, Mr. Chair and committee members, for giving me the opportunity to speak on this important subject.

[The Chair, Conservative, Rob Merrifield]

Thank you for being here.

We'll now move to the top of our agenda. We'll hear from Dr. Heather McKay, principal investigator, Action Schools! BC, professor at the University of British Columbia, and interim director of CHH, Vancouver Coastal Health Research Institute. That's quite a handle.

Welcome. The floor is yours.

[Dr. Heather McKay, Principal Investigator, Action Schools! BC; Professor, University of British Columbia; Director, Vancouver Coastal Health Research Institute]

Thank you very much.

I would like to extend my thanks to the members for allowing me to share with you what I think might be one strategy or one model that we have introduced in British Columbia. We hope it may be considered as a solution to the problem that I think we've all agreed has to be addressed, which is obviously why we're all here today.

I'm going to spend the next ten minutes talking to you about Action Schools! BC.

To begin, there's no need to go into the problem, except to say that I think we accept that the culture we live in has never been more conducive to supporting obesity. It is very positive in that regard. Again, I think it's time for solutions, and I'm absolutely thrilled that's what you're all here for.

On the Action Schools! BC model, I brought some handouts, but being naive, they're in English only. I've left them to be translated for you.

The vision of Action Schools! BC is not a program. It's a framework and a model within which there's great diversity. The idea is to integrate physical activity and healthy eating into the fabric of our elementary schools. It's about introducing physical activity and healthy eating into every part of schools, not into only one component of schools.

We define Action Schools! BC as a model on best practices in physical activity and healthy eating, which is designed to assist elementary schools to create individualized action plans. The words I want you to key into are “best practices”. We scoured the world literature, and we brought together resources and a variety of diverse best practices for educators to offer in classrooms and schools. For example, within this framework, a school in the north might have different programs from a school in the downtown east side of Vancouver. It might be very different from other parts of the province or the country. It's a framework of an option of best practices.

The idea is to facilitate what schools are already doing and assist them to customize this model to suit the individual needs of the school or the district. Again, as long as the main components are honoured, which I'll tell you about in a minute, there can be great diversity in what is offered. Again, in northern climates this would look very different from what is in Vancouver.

There are six action zones, and I only have ten minutes. I will rattle them off for you and then focus on one.

Physical education is one zone, and it's a very important zone. Andrea will talk about that in a minute.

The school environment, extracurricular activity, school spirit, family and community, and our type of cornerstone are called “classroom action”. This is quite novel because teachers are provided with the training and resources to offer 15 minutes of physical activity in the classroom, every day of the week, in addition to their physical education. We call this “snacking on physical activity”, as you've heard in the past about snacking on healthy foods. Again, the idea is to offer students 150 minutes of physical activity in each of these action zones, across a variety of choices. This is a very choice-based model.

Teachers are our entry point. We invest in teachers. The Action Schools! BC model in part is to offer every teacher a training workshop. We empower teachers in the best way we can to deliver this model. They are usually generalist teachers, and I believe the generalist teachers probably hated physical education as kids. The idea is to provide them with something they will actually engage in. They're given resources to keep in the classroom, a classroom action bin, and they're again offered training workshops. Support is at the end of a telephone in this model.

You've probably heard about many other models across the country. Programs have been introduced over time, and many of them have been shelved. Often it's due to a lack of resources and, in some cases, it's due to a lack of evidence to support that they work. What's different about this model?

The unique aspect of Action Schools! BC, as I've already mentioned, is that it's a model, not a program. It's non-prescriptive, it's choice-based, and it benefits every child regardless of skill level.

Our thinking is that we don't really need to engage those children already involved in sport. We're more keen on getting those children who would not otherwise be active. We feel the only way to find these kids is through the schools, as we don't often see them at other places.

Delivered by the generalist teacher, there is a huge evaluation component. I will give you just a snapshot of what we found when we evaluated this model.

In British Columbia I felt very fortunate to be in on the ground level, but this represented a unique partnership between the ministries of education, health, tourism, sport, and the arts in collaboration with 2010 Legacies Now, and all of these players came to the table. Again, I am not a politician, but I was absolutely thrilled to see the level of dialogue among these three ministries to make this program a reality in British Columbia. Funding for the model came from the Ministry of Health and the Ministry of Education in partnership with 2010 Legacies Now.

We evaluated this program with the highest level of evidence. We undertook a randomized control trial, and we tried to look at whether the model worked on three levels. In the first instance, we wanted to see whether teachers were providing more opportunities for children to be more active in the classroom. Second, we wanted to see, given those opportunities, whether children did in fact become more active. Third, we wanted to see whether, if they became more active, they became healthier people.

We looked at their levels of physical activity in the action schools versus the non-action schools, and then we looked at whether their bone health was improved, healthy eating was changed, whether their cardiovascular health was improved. We looked at their psycho-social health, and we measured their academic performance because of the interest from the Ministry of Education in that.

Here is what we found. Teachers in the Action Schools! BC schools delivered significantly more physical activity during the school week. It was between 53 and 65 minutes additional physical activity, compared to the non-action schools. That was a significant difference. There were more opportunities being provided. This translated into boys being especially more active every day if they were in an Action Schools! BC school than if they were in a control school. We measured this with pedometers. We saw this in girls as well, to a lesser extent, and that was measured with a questionnaire. So children became more physically active.

Surprising to us, the big winner here was cardiovascular health. You recall that obesity is a risk factor for cardiovascular health, so if we can overstep obesity and get right to where the money is, we have actually achieved a lot. Children in the Action Schools! BC schools increased their cardiovascular fitness by 25%--this is significant, it has clinical significance--compared to the children who were not in Action Schools! BC schools. We were thrilled by this. It was a bit surprising.

Academic performance: We really wanted these children to become much more brilliant children, but they didn't. They performed at least as well as the children in the non-action schools. What this means is they were spending less time in curricular activities, more time being physically active and becoming more healthy, and they performed just as well. That is an important finding as well.

To wrap up, in October of 2004, when we began Action Schools! BC, we had 275 registered schools. I think the response is unprecedented, in that we now have over 1,100 schools that have self-identified and registered for this model in the province of B.C. This is over 10,000 teachers. Workshops have been delivered to over 1,000 teachers, and 266,000 children are currently benefiting by this model that is being delivered in their school. We have schools in 100% of school districts around the province that have registered for this model.

I am going to leave you with a few recommendations, if I may.

Our obligation and our responsibility is to invest in evidence-based models. It is good to have a good idea, but it is important to have the evidence that supports that idea. There is accountability in that. We have to know that something works in order to invest. That is my feeling: invest in evaluation.

I tell my research group that there is no shame in not showing an effect, because that allows you to go back in, tweak the model, adjust course, and actually introduce something that is in fact effective. So it's ongoing evaluation, course adjustment, and on we go. Obesity did not happen overnight. We need to make a long-term investment in this. It is going to take a long time to turn this around, and it is going to take absolutely everybody at the table.

As we heard from Kelly, this is a partnership model where not just the schools are involved, but all aspects of our community. The model should cross pre-elementary, middle, and high schools, so students have the opportunity throughout their school careers to engage in these opportunities.

Linked with community-based programs, the evidence suggests that it's larger than the schools. We need to reach out to communities as well. Integration across provinces, and within provinces across initiatives, doesn't happen by itself; there has to be a targeted effort to achieve integration. I encourage that investment.

It's my optimistic but firm belief that Canada really can be a leader in evidence-based programs, practices, and policies. I've spoken around the world, and Action Schools! BC has been acknowledged and is currently being introduced in Australia. I've spoken with groups in South Africa, Scotland, and Ireland. There's a lot of interest internationally. So I think we do have a home-grown model that can be at least entertained and discussed, which might provide some benefit to children in schools.

Thank you very much.

[The Chair, Conservative, Rob Merrifield]

Thank you for sharing that with us. I'm sure we'll have some more questions later.

We now have Ms. Gabbani with us from the Nova Scotia Department of Health. The floor is yours.

[Farida Gabbani, Senior Director, Office of Health Promotion, Sport and Recreation Division, Nova Scotia Department of Health]

Thank you very much.

I just came from Toronto. I was doing a presentation to the Public Health Agency of Canada. I co-chair one of their committees on the pan-Canadian healthy living strategy.

I'd like to make an opening comment around the term obesity. In Nova Scotia we really feel that the problem of obesity is very complex, and effective approaches require action at many levels. An integrated strategy targeting the common risk factors for current disease and socio-economic determinants of health will in the long term achieve improvements in health, including reducing obesity. A narrow focus on obesity does not necessarily recognize the multiple health and social environmental benefits of physical activity and healthy eating, regardless of weight management.

Obesity strategies, compared to approaches looking at healthy weight, do not address the health impacts of inactivity or being underweight. This is in line with the pan-Canadian healthy living strategy, which focuses on physical activity, healthy eating, and healthy weights. We prefer to use the terminology of healthy weights rather than obesity.

I did pass a handout to you. I'm going to speak to quite a few of the things here.

In Nova Scotia we have the Department of Health Promotion and Protection. It includes all the risk factors of healthy eating, injury prevention, addictions, chronic disease prevention, and physical activity, sport, and recreation. We work together with public health and the medical officers of health. So we are all in one department. We really feel that this integrated approach gives us a good view of where to go.

We're involved with childhood obesity prevention initiatives, but through healthy public policy and supportive environments related to healthy eating, physical activity, and sports and recreation in schools and other settings. I will speak to schools because you're looking at schools particularly.

On the next slide there is a whole plethora of things in which we're involved. We're doing a comprehensive program.

[The Chair, Conservative, Rob Merrifield]

You're referring to slides and we don't have them. But that's okay.

[Farida Gabbani]

I passed them out.

[The Chair, Conservative, Rob Merrifield]

Yes, but they're in English only.

[Farida Gabbani]

They're only in English. I apologize.

I'm going to talk about quite a few of the things we're doing. We have what we call an active kids and healthy kids strategy, and that strategy was based on evidence collected in 2002 and repeated in 2006 in a study we did with our children and youth in grades 3, 7, and 11. When we did it in 2002, we collected physical activity data, but not just through pedometers. We used accelerometers, and that gave us data not only of number of steps, but it talked about the intensity of the activity and how often that activity took place. When we repeated again in 2006, we added questions on healthy eating so we could see the correlation between the physical activity and the healthy eating.

What we found was that the children and youth in grade 3 met the standard of 60 minutes of physical activity a day in 2002, and they increased that after a lot of the programs we did between 2002 and 2006. Unfortunately, the children and youth in grade 7 were less active in 2006 than they were in 2002, and those in grade 11, the same, they're less active, particularly the females.

Based on the research, we put programs and initiatives into place through the active kids/healthy kids strategy and we tried to do a lot of capacity building. We have a program developed by our fitness leaders' association in Nova Scotia, a youth fitness module. We brought in grade 11 students from all across the province and we trained them to become fitness leaders so they could then go back to their communities and be fitness leaders in their schools and in their communities--so, again, trying to build capacity rather than just one-off programs.

We also have instituted a health promoting schools program. Every school board in Nova Scotia is receiving funding from the Department of Health Promotion and Protection to develop a health-promoting school, based upon their particular needs in that area and using a community development model. The initial focus is on physical activity, healthy eating, and healthy weights, and we encourage school boards to choose where they want to go next, as time goes on. In their particular area, if they've got a real problem with teen pregnancies or tobacco or drugs or addictions or whatever it might be, they'll pick up, but we ask them to focus on physical activity and healthy eating.

Initially, we gave half a million dollars to school boards based on the proposals they put forward to us, and those proposals were based on their needs. We also are involved in the joint consortium for school health and so we have a school health coordinator who is jointly hired by the Department of Education and the Department of Health Promotion and Protection. So, again, we're working very closely with the Department of Education. Schools are an important setting for us because all children go there. It is inclusive, it's equitable, it's not like an after-school program where there are issues with transportation, access, and cost, and so on.

We're also very pleased with the bilateral agreements with Sport Canada, and we have three currently. One of them is a program called a sport animator program. We placed a person in each school board so they could then work with the community, with the municipality, to be able to bridge that gap. As we say, it takes a whole community to raise a child, so that person's job is to work with the school, with the district health authority, with the municipality, to make sure that resources, both human and physical, are available for our students to be active. That has resulted in a lot of different programs in different regions. We have a lot of after-school programs taking place. We've got schools running late buses for students to attend after-school programs. Our sport animator in the Mi'kmaq community has negotiated with all the Mi'kmaq schools in Nova Scotia, and they now have 20 minutes of daily physical activity.

We just recently got a second bilateral from Sport Canada specifically for the Mi'kmaq community, for the aboriginal community, and we have pilot projects taking place in all 13 communities.

Also, we have a piece of research from Saint Mary's University in Halifax, which was doing consultations with communities to find out what their needs are, so that they can identify what they need to be able to increase physical activity opportunities and offer healthy choices.

As far as healthy eating is concerned, we have a huge amount going on. We were the first province in Canada to have a healthy eating strategy. We have four areas we focus on. Breastfeeding is a very, very important one. The research around breastfeeding shows that the risk of developing obesity is directly related to the length of exclusive breastfeeding--this is World Health Organization data.

Also, we work with children and youth. We have a school program, Healthy Eating Nova Scotia. We set it up consultatively, again working with the communities we're trying to affect.

So we met with all of the schools, and all of the parents and the children. We drafted a policy, and they thought it was rather harsh. So we worked with them, and we phased things in over a five-year period. What we found now is that many of the schools are way ahead of where they should be because they've really engaged and embraced this school food policy. No fat fries in schools any more: making the healthy choice the easy choice is the thing we're looking at doing, and it's really working well.

A lot of our local producers are working with us. The apple producers in the Annapolis Valley are bagging up apples. All of the pizza producers in the area are now moving to whole-wheat flour for their pizza crusts. It's just amazing, once you engage the whole community, the private sector as well as everyone involved.

Many, many interviews have been done over the past few months with our children and youth, and they love the salads, and they love the yoghurt, and they are really doing well with that particular piece.

We're also involved, as everyone else is, with increasing fruit and vegetable consumption. There's a whole food security issue around fruit and vegetables. Again, we're working with the local producers in Nova Scotia to try to solve that problem.

Other things that we do.... We have a tripartite forum in Nova Scotia. We work with the aboriginal community. We have committees set up. One of the committees is a health committee, and one is a sport and recreation committee. There's a cultural committee, a social committee, an economic development committee.

There are three co-chairs for every committee. There's a federal co-chair from INAC, a provincial co-chair from our provincial government, and then a co-chair from the council of chiefs. We meet on a regular basis, and we work together to identify what needs to be done for the health of the communities. We're really working hard in the area of physical activity and healthy eating.

We're trying to collect as much data as possible on numbers of people. Again, we need to know where we need to go. We want to use evidence and informed decision-making in order to be effective, because we are investing a large amount of money in Nova Scotia.

We also have regional offices for physical activities, for sport and recreation across Nova Scotia. Those regional offices work in the area of community development, and they work with communities to try to enable them to increase opportunities for physical activity and to work with the local groups, particularly the district health authorities and the schools. So we're trying to bring people together.

We have great interdepartmental cooperation. We're also working with volunteers, because we're finding that.... Our minister of health promotion and protection was just made the minister of volunteerism. We now have a ministry of volunteerism, so it's part of our department. Physical activity, sport and recreation, is built on the backs of volunteers, so we're finding that this is going to be a really helpful piece for us.

We help communities with building recreation facilities, and we do it in a collaborative way with municipalities and communities. If your school came to us and said “We need a playground”, then we offer planning assistance to them. Then we will pay one-third, work with the municipality to pay one-third, and then the school and the community would raise the other one-third. So there are all kinds of opportunities to increase, improve, refresh, and build physical activity infrastructure.

I'll stop there and see if there are any questions. I could go on for probably another two hours, but I realize I only have ten minutes.

[The Chair, Conservative, Rob Merrifield]

That's right. Thank you very much.

We have one more presenter. We'll hear from the Canadian Association of Health, Physical Education, Recreation and Dance.

Ms. Grantham, executive director, thanks to you for being here. The floor is yours.

[Andrea Grantham, Executive Director, Canadian Association for Health, Physical Education, Recreation and Dance]

Thank you, Mr. Chairman and esteemed members of Parliament.

On behalf of the Canadian Association for Health, Physical Education, Recreation and Dance, I am pleased to be here to address the issue relating to the mounting childhood obesity rates and the critical role of quality physical and health education programs in assisting to curb the obesity epidemic.

A main theme of my presentation will be the recommendation to the federal government of the need to endorse and support the provision of quality physical and health education programs to ensure that all children have the opportunity to develop fundamental skills, knowledge, and attitudes that they require to make healthy lifestyle choices and to be physically active now and throughout their lives.

CAPHERD is a national charitable voluntary sector organization whose primary concern is to influence the healthy development of children and youth through quality school-based health and physical education programs. We were formed in 1933, and CAPHERD's programs and initiatives have been branded in schools across Canada and have been used as models internationally.

CAPHERD has a comprehensive delivery system that includes provincial affiliates in each province, as well as a database to every school, school board, university, and ministry of education in Canada. In addition, CAPHERD has a very strong partnership base, with many provincial and national organizations mandated to improve the health and well-being of Canadians through healthy living and physical activity.

Mr. Chairman and esteemed members of Parliament, I am well aware that many other individuals have come before you to discuss the very critical issue of childhood obesity. With that, I'm very certain that you have heard many statistics and reports that indicate that we are living in the midst of a very grave epidemic that, if left unaddressed, will worsen beyond our expectations. For example: in the past 15 years the occurrence of overweight boys has increased by 92% and the occurrence of overweight girls has increased by 57%; only 43% of children and youth age 5 to 17 years of age are not active enough to meet optimal growth and development; and most alarmingly, our children stand to live a shorter lifespan than we do.

Clearly, action must be taken now to impede this obesity and physical inactivity epidemic before it erodes further and has an even more devastating impact on the Canadian health care system. We already know that Canadians spent $5.3 billion in 2001 on health care costs due to illnesses, injuries, and diseases associated with physical inactivity. As this epidemic grows, so too will the cost to our health care system.

CAPHERD strongly believes that physical and health education are critical health interventions that need to be addressed. Although education is a provincial jurisdiction, health is a federal priority. There is no denying the critical role of school physical education and health education in ensuring that every single child in Canada has the opportunity to develop the knowledge and skills that they need to be physically active now and for life. This includes physical literacy, healthy eating, and the knowledge that they need to make healthy lifestyle choices.

There is strong international support for the importance of physical education. The World Health Organization and the United Nations have both recognized the integral role of physical education to achieving health. Recently the United Nations declared 2005 as the international year of sport and physical education, to raise awareness of the critical role it plays in the healthy development of children. The UN's Report on the International Year of Sport and Physical Education 2005: Sport for a Better World indicates that:

Education is a fundamental human right provided for in almost all international human rights treaties. Furthermore, in accordance with the declarations of various international human rights treaties, sport and Physical Education are also fundamental rights for all.

It is important to say that children are not born physically literate. They must develop skills sequentially. Physical literacy is cultivated through states that build on a foundation of motor skills and knowledge. These skills continue to develop and form the basis for specific physical activities and sports. When this fundamental learning is not provided, children lack basic movement skills as well as the understanding of the importance and practice of being physically active each and every day.

The need for the development of fundamental movement skills learned sequentially has been clearly identified in the long-term athlete development model that has been developed by Sport Canada. The LTAD identifies seven key stages a person must go through in order to nurture athlete development, as well as to lead physically active lifestyles. The first three phases of that model--active start, fundamentals, and learn to train--specifically emphasize the critical role of quality physical education in ensuring that this foundation is established. Without such learning, all future stages of the LTAD will be negatively affected.

The reality in Canadian schools today is that quality health and physical education programs are extremely lacking. Currently, provincial and territorial ministries of education have outlined and recommended times for physical and health education, with general outcome statements by each grade. These suggested times are not mandatory; thus, school boards and individual schools are not bound to meet these targets. In reality, schools in many provinces do not come close to providing Canadian children with the recommended times for physical education.

Often viewed as frilly subject areas, physical and health education programs have fallen victim to budget restraints and competing priorities within the school curriculum. Over the last two decades, Canadian schools have seen reduced time allotted to physical education and a move from specialist physical educators to generalist teachers who lack the skills and training required to deliver quality programs.

It is important to recognize that assigning time for physical and health education does not have a detrimental impact on students' grades. Quite to the contrary--participation in quality physical education has been linked to enhanced student academic performance and has been shown to improve social cohesion at school and to enhance concentration and to improve student self-esteem and self-confidence. Moreover, children benefit from physical education classes by developing personal physical fitness, which promotes healthy lifestyles—a foundation of skills that ensures their ability to participate in a wide variety of physical activities, and which reinforces life-long healthy living.

ln this era of childhood obesity stemming from unhealthy eating and physical inactivity, the poor quality of school health and physical education programs is of extreme concern. Statistics are cropping up on a daily basis reminding us of the grave health epidemic we are facing, yet funding and federal support for health interventions seem to diminish.

More federal action is going to be needed in order to improve the overall health of Canadian children. To assist schools in setting priorities and implementing opportunities for change, CAHPERD has set national standards that define quality physical education. These standards include 150 minutes per week of quality physical education, taught by a teacher who is qualified to teach the subject, a variety of learning opportunities, and are supplemented by a range of interscholastic and intramural program opportunities.

There is an obvious and undeniable correlation between obesity and inactivity. Quality physical and health education programs work to enable and encourage participation in physical activities and equip students with the ability and knowledge to make healthy choices.

Ensuring the overall wellness of Canadian children is a serious matter. As can be seen through the committee's attention to childhood obesity, the health of Canadian children is of fundamental importance to the Government of Canada and to the distinguished members of the committee. There have been a number of instances in the past when the federal government took positions on provincial education matters, including implementation of the metric system and on the French language. We implore you to recognize that ensuring the health of our children merits federal attention. More than ever, it is vital that the federal government and this committee endorse the need for quality physical and health education in schools, and that they go further to take a leadership role in ensuring that all schools across Canada are able to meet or exceed recommended provincial and territorial times.

During the 2005-2006 federal election campaign, the Conservative Party's platform, “Stand Up for Canada”, indicated that “The most important part of health care is prevention, including ensuring that Canadians, especially children, have proper diet and exercise”, and stated that a Conservative government would promote a wellness and physical fitness agenda to help Canadians and their children stay fit and healthy and committed to spending at least one percent of total federal health funding annually on physical activity. That translates into $435 million invested annually in sport and physical activity initiatives.

CAHPERD encourages the honourable members of this committee to work towards achieving this momentous victory for the future health and well-being of Canadians, and so ensure that Canadian schools are equipped to provide the best possible opportunity for all children to become both physically and health literate. Schools are the only public institution with the ability to reach every child in Canada, regardless of culture, socio-economic background, ability, or gender. Schools are clearly the most important institution to offer equal access to health and physical activity programs.

Honourable members, physical and health education needs to be valued and implemented as a core school subject area in order to offer its full potential and to play a role in combating childhood obesity.

I have left you with two important documents, Time to Move, and What is the Relationship Between Physical Education and Physical Activity?

I would like to say thank you once again for allowing us to speak.

[The Chair, Conservative, Rob Merrifield]

Thank you very much for your presentation.

I take note of your insistence on physical activity in school. I remember that in my days at school that was the class I enjoyed the most and did the best in.

We'll go now to questioning and start with Ms. Brown, followed by Ms. Bennett.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you, Mr. Chair.

I knew we had something in common: we're people who went to school because there was a phys. ed. class that day or some practice for a sporting team of some sort.

Mr. Chairman, I'm going to pass this on to Dr. Bennett, who, as a former minister responsible for the public health agency, has watched some of this activity evolve. She will lead for the Liberals.

Thank you.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you.

Thank you all for the presentations.

As we know, from what Nova Scotia and British Columbia are doing.... Health ministers and indeed the first ministers all agreed in their communiqué at the first ministers meeting in September 2004 that healthy schools would be an initiative they would work on together, in terms of sharing best practices.

I'd like to know how far we've come since this country's first ministers' commitment to share best practices, taking the lead from the WHO. Can we define by the consortium or in any other way across this country what a healthy school is? Also, are there indicators that all of the provinces and territories have agreed upon, in terms of how you would define a healthy school, in terms of either the six criteria in British Columbia or...?

Also, how would you in an ISO 9000 kind of way get your banner on your school about whether it's healthy or not? How can we move forward to measure this? Can we do that without biometrics, as to whether we're winning or losing with the kids, in terms of healthy weights and a physical literacy standard that we all know we need—as if it were reading, writing, or arithmetic, can they throw a ball, run, or swim?

Mainly I would like to know, how often is this collaboration happening? Do you feel comfortable that you're sharing best practices?

I think the parents of this country would want to know why what's happening in Nova Scotia or B.C. isn't happening in their neighbourhood. Is there a website where there's one-stop shopping for parents? Is there a 1-800 number for the teachers to be able to find out what's happening somewhere else? Is there a resource that, as the federal government, we are helping with?

Also, how would you see us going forward? I happen to believe that the health of Canadians is a federal issue. How much money do you think we are spending on physical activity, compared to the 1% that was promised by the Conservatives?

[The Chair, Conservative, Rob Merrifield]

That's four or five questions. Let's try to answer one or two.

Does anyone want to start?

[Andrea Grantham]

In response to the question of how much is being spent on physical activity, in the 1990s there was an investment by the federal government of about $10 million a year towards physical activity. Just a few years ago it was $3.2 million, and this year there was a call for physical activity and healthy eating proposals with an envelope of $2 million. It's actually been declining.

[Farida Gabbani]

I would suggest that the integrated pan-Canadian healthy living strategy would be a vehicle that is supposed to set up a network across the country, and a network of networks: all of the NGOs and all of the provincial and territorial governments. But we've been struggling because of lack of funding to do the work that needs to be done. We have the document and the strategy, but there's been no action on it. Some funding was given to heart, some was given to diabetes, some was given to cancer—

[Carolyn Bennett, Liberal, St. Paul's, ON]

We know that doesn't work.