Health Committee on Oct. 5th, 2009

[The Chair, Conservative, Joy Smith]

Good afternoon, ladies and gentlemen.

I want to welcome all our guests to committee today. It is indeed a pleasure to have you here. We're certainly looking forward to your insightful comments on this very important topic. I was noting the fact that we've never had this topic at the national health committee for Canada, so I think we're breaking new ground here today. This is great.

Before we start the meeting, I want to adopt the budget for this afternoon's briefing on sodium. A copy of the proposed budget has been distributed to the members of this committee. The motion states that the proposed budget in the amount of $16,500 for the briefing on sodium consumption in the Canadian diet be adopted. Do I have agreement?

(Motion agreed to)

Thank you.

We're going to begin right now. We have quite a complete panel today, so we're going to ask that the presentations be for five minutes each just so we can cover everybody. The clerk has informed me that because of the number of people presenting, we do have to do it that way.

We will start with the witnesses from Blood Pressure Canada and begin with Dr. Norman Campbell, president.

[Dr. Norman Campbell, President, Blood Pressure Canada]

I'm Dr. Norm Campbell, the president of Blood Pressure Canada. Blood Pressure Canada is a coalition of 29 national organizations dedicated to the prevention and control of hypertension in Canada.

My colleague, Dr. Kevin Willis, is with the Canadian Stroke Network. The Canadian Stroke Network is one of the more important partners of Blood Pressure Canada in the effort to reduce dietary sodium.

If one looks at World Health Organization reports, one will see that they believe elevated blood pressure is the leading risk for premature death in the world. Elevated blood pressure damages the blood vessels and causes strokes, heart attacks, heart failure, kidney failure, and other blood vessel damage such as dementia. In Canada, approximately one in four Canadian adults has hypertension and 90% of us are estimated to develop hypertension within our life spans.

Importantly, hypertension, or increased blood pressure, is preventable. One of the major factors in increasing blood pressure as we age is high dietary sodium. In Canada, it's estimated that Canadian adults are consuming around 3,500 milligrams of sodium per day. Most of this is added to our diets in the processing of foods.

We have done some analyses. About three in 10 Canadians with elevated blood pressure have high blood pressure because of high dietary sodium. This translates to between one million and two million Canadians with high blood pressure who would have normal blood pressure otherwise. That's estimated to contribute to about 10% of the cardiac and stroke events that occur in our country.

The cost savings of reducing dietary sodium from its current 3,500 milligrams today down to levels that are recommended, which is around 1,700 milligrams per day, would save the health care system about $400 million to $500 million per year in direct hypertension costs and about $2 billion per year if one takes into account the reduction in cardiovascular events that would occur.

From our organization's perspective, about 75% to 80% of the sodium in the diet is coming from the processing of foods. Therefore, we believe that strong government action and resources are required to address this issue, in particular by setting targets and timelines for food categories to reduce dietary sodium, with close government monitoring, such that Canadians are eating a healthy quantity of dietary sodium.

This should be supplemented by secondary activities such as regulations to facilitate reduction in dietary sodium that may enhance industry compliance, education of Canadians, and addressing certain research needs to evaluate the success of the program in particular, but also the challenges faced in reducing dietary sodium.

I'll end my comments at that. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

I was just asking the clerk, Dr. Campbell, if you had brought a presentation with you, and the clerk informs me that you haven't.

[Dr. Norman Campbell]

I didn't write my notes down, if that's what you're asking.

[The Chair, Conservative, Joy Smith]

We just want your sage words in writing, sir. It would be very nice if you could now distribute your notes among the group here.

We now have, presenting from the Canadian Restaurant and Foodservices Association, Ron Reaman, vice-president.

Thank you.

[Ron Reaman, Vice-President, Federal, Canadian Restaurant and Foodservices Association]

Thanks. I'm going to hand it over to my colleague, Joyce Reynolds, who will begin. We'll share the presentation time.

[Joyce Reynolds, Executive Vice-President, Government Affairs, Canadian Restaurant and Foodservices Association]

Thank you for the opportunity to speak to you today about the issue of sodium and the active role of Canada's restaurant and food services industry in playing a part in the solution.

The Canadian Restaurant and Foodservices Association is the largest hospitality association in the country, with 33,000 members. We comprise the quick and full-service restaurants, hotels, social and contract caterers, clubs, coffee shops, and pubs, as well as institutions such as hospitals, schools, and offices. We represent a $60 billion industry that employs over one million Canadians. Every dollar spent at a restaurant generates an additional $1.85 in spending in the rest of the economy, well above the average of all industries in Canada.

Food service is a very competitive business that operates on razor-thin margins. Rising food and labour costs reduce the pre-tax profit margin of the average operator to only 4.4% of operating revenue in 2007. In contrast, the average business in Canada enjoys a pre-tax profit of 7%.

Canada's restaurant and food services industry recognizes the challenges Canadians face managing busy, active lifestyles in a complex, modern world. That's why the restaurant industry offers a wide range of menu items to satisfy an increasingly diverse set of consumer demands.

[The Chair, Conservative, Joy Smith]

Ms. Reynolds, I'm sorry to interrupt, but we can't keep up to the translation. I know you only have five minutes, but perhaps condensing it would be a better idea. If you could do it so the translation could prevail, we'd appreciate it.

Thank you.

[Joyce Reynolds]

Okay. I will try.

Restaurants are responding to a growing number of dietary concerns and eating preferences, including low-fat, lactose-free, vegetarian, and locally sourced. Restaurant operators have diversified their menu mixes to ensure that Canadians have choices in menu offerings to meet their many needs.

We've established a nutrition and fitness round table. We've established voluntary nutrition disclosure through our nutrition information program, so many of our members with standardized menu items are able to provide nutrition information at point of sale as well as on their company websites, and can meet the many dietary concerns of our customers.

The restaurant industry has been a leader in addressing other nutrition and food safety related issues. For example, extensive work has been undertaken by the restaurant and food services industry to dramatically reduce and eliminate trans fats in the Canadian food supply.

In addition to committing a tremendous amount of resources to trans fat reductions, the industry has also begun the process of exploring opportunities for sodium reduction. We recognize that sodium is a serious and complex issue and that we are part of the solution. We commend you for studying it and look forward to working with you and other stakeholders on effective and workable solutions.

I will turn it over to Ron Reaman now.

[Ron Reaman]

Thanks again for the opportunity to speak with you today.

I want to assure all the members of this committee that Canada's restaurant and food services industry recognizes the importance and challenge of reducing sodium intake levels for Canadians. Many of our member companies are already working on product reformulation and testing of sodium-reduced products.

As you know, a process has been established in which government, industry, and the public health NGOs are working together under the aegis of Health Canada's multi-stakeholder working group on sodium reduction. We're fully committed to that process that is already under way, and we are hoping to play an active role in collectively achieving our shared goal, which is to reduce the overall intake levels of sodium by Canadians.

My industry has been working very hard to identify opportunities for success on a number of health-related reforms, as Joyce has already noted. While the industry is committed to doing our part and working collaboratively to achieve the reduced dietary sodium intake levels of Canadians, it is imperative to note some of the key challenges that face the food service industry as we move towards that success. You'll hear from some quarters that reducing sodium is a simple matter and that the food industry should just get on with doing it. While the industry has already begun to reduce sodium and develop lower sodium projects, the fact is that sodium plays a multi-faceted role in food, and we should not be misguided and oversimplify the complex. Among other things, we need to know that sodium is used as a stabilizer. It's used as a flavour enhancer. It's also used as an antimicrobial agent in support of food safety protocols.

I can't underscore strongly enough that the restaurant industry in particular is, above all, a consumer demand-driven business. We supply what our customers want, and we respond to meet those demands. For any sodium reduction strategy to be successful, we first need to educate the general public so they are able to shift their demand and acceptance of sodium-reduced products. This is a critical point in the overall equation of sodium reduction.

For the food services industry, sodium is a critical component in the taste profile of many signature menu items, a fact that cannot be dismissed when considering sodium reduction strategies. We must move judiciously to reduce sodium and reformulate products in order to ensure consumer acceptance of those projects. If we move too quickly, the consumer will reject the product and/or increase salt use after the point of purchase, in which case the only thing we would have achieved is the twin failure....

Do you want me to go faster now?

[The Chair, Conservative, Joy Smith]

No, I want you to look at wrapping up, because I've given you extra time.

[Ron Reaman]

Okay. Again, let me underscore our commitment to the process, that we are actively engaged with the sodium working group that has already been established by Health Canada. We're prepared to do our part in achieving greater sodium reductions by Canadians.

Thanks for the opportunity to speak with you today.

[The Chair, Conservative, Joy Smith]

There will be lots of time as we get into questions.

Thank you, Mr. Reaman.

Now we go to Bill Jeffery, national coordinator for the Center for Science in the Public Interest.

[Bill Jeffery, National Coordinator, Centre for Science in the Public Interest]

Thank you, Madam Chair.

The Centre for Science in the Public Interest is a non-profit consumer health advocacy organization specializing in nutrition issues, with offices in Ottawa and Washington, D.C. Our Ottawa health advocacy is funded by 120,000 subscriptions to the Canadian edition of our monthly Nutrition Action Healthletter, which you all receive. CSPI does not accept funding from industry or government, and Nutrition Action does not carry advertisements.

Last month the Centre for Science in the Public Interest published a report called “Salty to a Fault: Varied Sodium Levels Show Lowering Salt in Processed Foods is Feasible”. Experts agree that excess sodium intake kills more Canadians every year than does any other chemical substance. But in countries like Canada, three-quarters of the sodium comes from salt added to foods by food manufacturers and restaurants.

In “Salty to a Fault”, we reported samples of products in 41 categories of groceries and nine categories of restaurant foods that Health Canada and others consider to be major sources of sodium. These categories include soups; sandwiches, especially bread, cheese, and meat; salad dressings; cereals; sauces; and restaurant foods generally.

“Salty to a Fault” reveals that brands of foods often vary widely in sodium levels within otherwise comparable categories. For example, we found sodium levels ranging from 40 milligrams of sodium in a 70-gram serving of french fries at a Swiss Chalet restaurant, which leaves salting to the customer, to 555 milligrams in fries at Harvey's. Likewise, there were 320 milligrams of sodium in a half-cup serving of Classico tomato and basil pasta sauce, compared with 710 milligrams in Antico organic tomato and basil sauce.

Twofold variations were common among products that we surveyed.

Despite industry claims that large amounts of salt are needed to make dough rise, act as an emulsifying agent or anti-caking agent, or preserve and improve the taste of foods, these variations in our report reveal that it is demonstrably possible to make countless foods with less sodium, and many foods with much less sodium.

The expectations for success in Canada's efforts to reduce sodium are justifiably higher than for the United Kingdom or Finland. Those countries were both pioneers, and Canada has been able to learn from their experiences. Also, the Government of Canada has legal authority to refine regulations governing nutrition labelling, high-sodium warning labels, compositional standards for standardized staple foods such as cheese and pickles, and food additives, including low-sodium substitutes for salt, while Finland and the United Kingdom must defer to the European Union authority over many aspects of those regulatory options.

Nutrition labelling also has been mandatory for most foods in Canada since December 2005. This helps officials and our organization monitor sodium levels in prepackaged foods, though not in restaurants, and identify the range of sodium levels within categories of comparable products.

Our report makes 12 recommendations. I will highlight a few.

First, setting and monitoring category-specific sodium reduction targets must be combined with mandatory front-of-pack warning labels for high-sodium products.

Second, the daily value for sodium specified in the food and drug regulations--used as the basis for nutrition facts label information--should be reduced from 2,400 milligrams to 1,500 milligrams.

Third, serving sizes upon which nutrition facts information is reported on food labels should be based on the standardized reference amounts specified in schedule M of the food and drug regulations, or other appropriate standardized sizes, and not left to the unfettered discretion of manufacturers.

Fourth, the food and drug regulations limiting the scope of the nutrition facts requirements to prepackaged foods should be expanded to ensure that at least the amounts of calories and warning labels for high-sodium foods be posted on the menus or menu boards of large chain restaurants with interprovincial operations.

And last, Canada's Food Guide should be revised to highlight the importance of, and strengthen advice about, reducing sodium intake.

In closing, setting and monitoring achievement of sodium reduction targets for at least several dozen food categories is the cornerstone of an effective sodium reduction strategy.

Companies' efforts to achieve those targets should begin now. They should not wait until the sodium working group report is published.

However, to ensure that Canadian sodium reduction targets are successful, regulatory amendments are needed to eliminate some impediments to reductions, and new regulations may be needed to mandate targets currently envisioned as voluntary if the call for sodium reductions is not taken seriously by affected companies.

Minister of Health Aglukkaq needn't wait to impress upon companies the importance of reducing sodium levels. Health Canada's message should be clear: salt should be used judiciously in foods, not gratuitously. Persistently gratuitous use of salt should be met with regulatory action.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Phyllis Tanaka, vice-president of scientific and regulatory affairs.

[Phyllis Tanaka, Vice-President, Scientific and Regulatory Affairs (Food Policy), Food and Consumer Products of Canada]

Good afternoon.

Food and Consumer Products of Canada welcomes this opportunity to speak to the Standing Committee on Health. FCPC is the largest industry association in Canada, representing the food and consumer products industry.

The points I will make in the next few minutes, while more succinct, capture the key elements of the full FCPC submission in support of briefing this committee on sodium, and I will focus on looking at the Blood Pressure Canada recommendations, the CSPI recommendations, and the work of the multi-stakeholder working group.

The recommendations out of Blood Pressure Canada's policy statement and the Centre for Science in the Public Interest report, as is evident in appendix 1 of these speaking notes, have common elements, and both direct their recommendations to Health Canada. From FCPC's perspective, Health Canada has listened.

Blood Pressure Canada's policy statement was made available to Health Canada in 2006. Their recommendation to establish a multi-sectoral task force to address this public health matter was taken very seriously. I received my invitation to become part of the Health Canada-led multi-stakeholder working group on sodium reduction in 2007.

Health Canada was very thoughtful in shaping the working group. The stakeholders invited to take part ensured that all perspectives and expertise required to develop an effective strategy were involved. Representatives from the scientific and health professional community, health-focused and consumer non-governmental agencies, the food products and food service industry, and government agencies sit on the working group. The actions of the working group are in line with recommendations common to both Blood Pressure Canada's policy statement and the more recent CSPI report.

The working group is establishing goals based on the dietary reference intakes reports of the Institute of Medicine at the National Academy of Sciences. The working group has listened to experts from Finland and the United Kingdom on their sodium reduction strategies. This has helped the working group develop consensus on the need for a strategy that's built on graduated targets.

The working group has established a three-pronged approach, one that involves education, voluntary reduction of sodium levels in processed food products and food sold in food service establishments, and research. From FCPC's perspective, a three-pronged approach is critical to success.

The food-manufacturing industry is engaged in product reformulation and product development research to reduce sodium levels in processed food products. In fact, at the public consultations held by the working group in February of this year, a number of food manufacturing companies spoke to the work they are undertaking. However, the food manufacturing industry knows that such endeavours will succeed only if accompanied by a concurrent consumer awareness education campaign. The successful reduction of sodium in the diets of Canadians will only happen if, in concert with changing the food supply, Canadians are informed on why this is happening. Also, this information must come from a respected third-party source, such as Health Canada, if it is to resonate.

Finally, the working group knows that a monitoring and assessment process is integral to success. The requirement is captured within the working group's terms of reference. There are four stages to the terms of reference: the preparatory or information gathering stage; the assessment or review of data gathered stage; the strategic framework development stage; and the implementation stage, which has built into it the mandate to oversee implementation and monitor progress.

As a point of reference, the working group is currently winding up its assessment stage and moving into the strategic framework development stage.

In summary, FCPC believes that the leadership being provided by Health Canada in leading this multi-stakeholder working group process is resulting in a strategy that will lead to the successful reduction of sodium levels in the diets of Canadians. FCPC believes the driving concern behind both Blood Pressure Canada's policy statement and the CSPI report is being addressed.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Tanaka.

We'll now go to Dr. Mary L'Abbé from the University of Toronto.

Welcome.

[Dr. Mary L'Abbé, Earle W. McHenry Professor, Chair, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto]

Thank you very much, Madam Chair and members of the committee.

I am pleased to attend this session, and I appreciate the opportunity to speak to you today about the sources of sodium in our food supply. I'm a professor at the University of Toronto and the chair of the department of nutritional sciences there. I'm also the vice-chair of the sodium working group.

In preparation for my remarks today I've provided you with two figures that I thought might be useful to help you understand where sodium is in the foods we eat. This data is from the Canadian community health survey, and it's very valuable to help us understand where the sodium is in our food supply. It's also the first national survey of nutrition that has been done in Canada in the last 30 years.

I would like to draw your attention to the first data I've presented to you on the pie chart and explain what was done here. I believe it was handed out to members. This is data from the community health survey where the food sources of sodium have been divided into the various groups. You can see that sandwiches have been split into the components of bread, meat, and cheese. All of those have been divided into the various food components.

When we do that we see that the major source of sodium in the diets of Canadians is bread products. This is followed by processed meats, vegetable juice, vegetable products, soups, and then pasta dishes. Even foods such as cheese and milk products contain significant amounts of sodium. You can see that in the bottom of the circle. This is followed by a number of meat and poultry dishes. In the case of these mixed dishes, the sodium usually comes not from the meat itself but from many of the other ingredients, such as sauces and batters, that are added to these mixed dishes.

It is also worth noting some of the other food categories on the left-hand side. Things like breakfast cereals, potatoes, fish, rice dishes, and eggs are not normally products that Canadians would consider salty, but in actual fact they provide more sodium in our diets than things like potato chips and salty snacks, which the consumer might think of as being the salty sources of foods in the food supply.

In summary, there are two important features about this data that I have presented to you. One is it reflects the total amount of sodium that people consume. Things like bread may only be moderate in their level of sodium, but Canadians consume substantial amounts. On the whole, they eat relatively large quantities of a product like bread and they consume it virtually every day. Secondly, there's no one food group or few food groups that provide most of the sodium. Reducing sodium will mean changes have to occur in virtually every food group and food product in the marketplace if we are to achieve meaningful reductions in our sodium intake.

The second figure gives you a snapshot of some of the ranges of sodium that we see in these foods that I've spoken to you about. They're not meant to single out any one particular brand because these are fairly typical of the types and levels you'd see in a food category, although, as Mr. Jeffery has pointed out, there is still tremendous variability within each of these groups.

So you can find high-sodium cereals or low-sodium ones, or vice versa, in the salty snacks. If you look at this table you can see that the breads have only about 300 milligrams of sodium, which is a moderate amount. Some of the soups, pogos, and hot dogs will have about double that amount, about 500 or 600 milligrams. That's approaching one-third to one-half of the sodium that's recommended for a whole day.

Then you can get into some of these mixed dishes. The product in the corner provides almost the total recommended amount that you would consume in a day.

A consumer might think the mixed sandwich is a healthy product because it has whole wheat and less than six grams of fat. But that product contains almost the upper level for sodium for a whole day. You might have a couple slices of bread with that or a dessert, or some other food as part of your meal.

So the take-home message here is that sodium is found throughout our food supply and consumers do not necessarily see these as salty foods.

With these remarks, I would like to thank you for giving me the opportunity to speak to you today about the sources of sodium in our food supply.

Thank you very much.

[The Chair, Conservative, Joy Smith]

I want to thank our guests for their insightful comments today.

We'll now go to the first round of questions and answers. It will be seven minutes for the question and the answer, per person.

We'll start with Dr. Bennett.

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

Thank you very much, and thank you all for coming.

As you know, we are in level six of a pandemic and we sort of have some concern that we need to get back to that.

I understand you are all part of the sodium working group--is that right?--and that it was established by the minister in October 2007. Obviously, we want to know what the working group will come up with. I would like to know when it will report.

In looking at the terms of reference of your working group, it seems to say that you will develop, implement, and oversee a population health strategy based on the recommendations of the Institute of Medicine. It then says that there will be a three-pronged approach: education, a voluntary reduction of sodium levels in processed foods, and research.

I have some concerns. To me, a strategy is what, by when, and how? We already have the what, which is that you want to have Canadians at the Institute of Medicine level. I guess I want to know what's been happening over the last two and a half years. And how do we get going? Is this mandate broad enough for you to do what you need to do? How long did it take to figure out that Canadian All-Bran shouldn't be three times as much as the All-Brans around the world? Do you have enough money to do it? How come you're working in such an invisible way that if it weren't for the Globe and Mail, nobody would even know that there's salt in bread, I don't think.

Without a citizen engagement strategy, without a transparent process for your working group, without some targets, and without adequate resources, I'm a bit concerned that you're not going to get where you need to be, if indeed you're supposed to report in the spring.

I'm not really sure whether the members of this committee knew that this group was already working and is supposed to report. Talk about a silent killer--this is a silent working group that doesn't seem to have the profile it needs to do the job. Do you need more money? Do you need a better process? How are you going to engage Canadians in this job? How on earth would you sit on a committee where you're restricted to voluntary approaches only if that's all you're allowed to report?

[The Chair, Conservative, Joy Smith]

Who would like to take this myriad of questions?

Perhaps a couple of people would like to engage. Dr. Campbell, do you want to begin?

[Dr. Norman Campbell]

Sure, I can address some but not all of those issues.

I think one thing that's very clear is that the working group needs very substantive resources to mount an education campaign for Canadians so that they understand the health risks of high dietary sodium, they understand where the sodium is coming from, and they understand what they can do. I think that much is very clear.

From the point of view of our organization, we've been very active in trying to educate Canadians within the means and mechanisms we have at our disposal. We have an extensive network of health care professionals across Canada, including all primary care disciplines. We've been developing resources for those health care professionals to educate them, and we have provided resources that they can provide to their patients. I think this is insufficient to do the trick, but it is certainly one of the things that's available to our particular community.

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

Maybe Dr. L'Abbé could tell us what the budget is for the working group and what, so far, has been spent on public education.

[Dr. Mary L'Abbé]

I can't speak directly to the budget, but Health Canada has spent in excess of several hundred thousand dollars a year supporting the work of the sodium working group, and that was through our early stages. I appreciate the comments of Dr. Campbell. I think the working group spent, at the last meeting, a significant amount of their time looking at what a good education campaign to develop a strategy and awareness campaign about sodium and blood pressure in Canadians would be. And that would take significantly more resources than has been dedicated to this.

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

But are you not a bit disappointed that after two years...? This is an advertising agency's problem, not a problem with the science. The science is there. Why can't we just start?