Evidence of meeting #38 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was vaccine.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Hasan Hutchinson  Director General, Office of Nutrition Policy and Promotion, Department of Health
Samuel Godefroy  Director General, Food Directorate, Department of Health
Kim Elmslie  Director General, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada
Danielle Grondin  Acting Assistant Deputy Minister, Infectious Disease and Emergency Preparedness Branch, Public Health Agency of Canada
Elaine Chatigny  Director General, Communications, Public Health Agency of Canada
Paul Gully  Senior Medical Advisor, Department of Health

3:40 p.m.

Conservative

The Chair Conservative Joy Smith

Good afternoon. I'm so pleased to have everyone here today. We're in a new room today and there's more room to spread out.

We're so pleased to have our witnesses come today from the Department of Health. We're having Samuel Godefroy, director general of the food directorate; Hasan Hutchinson, director general of the office of nutrition policy and promotion; and from the Public Health Agency of Canada, we have Kim Elmslie, director general for the Centre for Chronic Disease Prevention and Control. Welcome.

We'll start with Hasan Hutchinson, director general.

3:40 p.m.

Dr. Hasan Hutchinson Director General, Office of Nutrition Policy and Promotion, Department of Health

Thank you for the opportunity to address the committee today.

I'm sorry that there hasn't been quite enough time to translate fully all of our opening remarks for today's meeting. They are currently in translation and will be provided to the clerk by the end of this week.

In October 2007, the Minister of Health announced that the Government of Canada would establish an expert working group. The Sodium Working Group, the SWG, was established in early 2008 to develop and oversee the implementation of a strategy to reduce the overall consumption of sodium by Canadians. The SWG is working on a three-pronged strategy, which will include education, research and voluntary sodium reduction in processed foods and restaurants and food services products.

The SWG mandate, its terms of reference and membership list are available on the website. I believe you all have these documents. There is an error in the list of members: I am not on the list. As president of this group, my name should be added to the list.

The group has met in person or by teleconference 6 times in the last 18 months, initially focusing on establishing a common knowledge base for all members including supplying information on current activities across Canada.

The preparatory stage was completed by May 2008. Baseline data on sodium levels in the diets of Canadians and on the primary sources of dietary sodium were obtained from the Canadian Community Health Survey. The synopsis of the U.K. Food Standards Agency's program on salt reduction was prepared, and an It's Your Health fact sheet was also developed. I believe we distributed as well the It's Your Health document on sodium for all of you.

The assessment stage is also being completed. An important element of this data-gathering phase was an expert public consultation held in February 2009, where invited experts described the challenges and opportunities in sodium reduction, including those from the United Kingdom and from the European Union, who describe their experience with and plans for sodium reduction in their jurisdictions.

The sodium working group also heard from industry groups, social marketing experts, and health organizations.

Work on the strategic framework phase began in the spring of 2009 at the May 2009 meeting where the SWG identified the elements under each of the three prongs of the strategy and formed focused subcommittees for every prong. Substantive progress was made through the summer and the subcommittees reported on their progress at the September SWG meeting.

The first subcommittee, which deals with the voluntary reduction in foods, has embarked on developing a Canadian approach on reducing sodium in foods by using best practices from other countries such as the United Kingdom. Consultations are also under way with health authorities from New York City.

Information sessions were held in September to inform industry about the need for sodium reduction, sources of sodium in the diet, and the various approaches to reducing sodium in processed foods and foods sold in restaurants and food service establishments. As a follow-up, discussions with food industry stakeholders will be undertaken shortly to set sodium reduction targets and a schedule for the voluntary reduction of sodium levels in food products.

For the education prong, work is under way to develop a national public awareness and education campaign to educate and inform Canadians on sodium and the health consequences linked to high levels of sodium intake and to increase consumer demand for foods lower in sodium.

With respect to research, a research agenda is being developed to support the food industry in reformulating foods lower in sodium, to facilitate behaviour change in Canadians, and to monitor and evaluate the effects and impacts of the strategy on the health and well-being of Canadians. In conjunction with CIHR, a research summit is being planned for January 2010.

At our September 2009 meeting, the working group members also agreed to an interim sodium intake goal of 2,300 milligrams per day by 2016. We must say that right now the levels of consumption for Canadians are around 3,400 milligrams. In the long term, we are moving towards a goal of approximately 1,500 milligrams.

A detailed draft of the three-pronged strategy will be discussed by the working group members at a meeting in December 2009. The working group expects to complete its report by mid-2010.

3:45 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much.

We'll now go to Samuel Godefroy, director general of the food directorate.

3:45 p.m.

Samuel Godefroy Director General, Food Directorate, Department of Health

Thank you, Madam Chair.

Good afternoon, honourable members.

At the outset, like Dr. Hutchinson, I would like to apologize to committee members for being unable to table my opening remarks with you today. Unfortunately, again time did not allow for translation to be completed on time and before the meeting. I'd like to also assure the committee members that translation is under way and that the opening remarks will be provided to the clerk by the end of the week.

3:45 p.m.

Conservative

The Chair Conservative Joy Smith

We'll make sure they're all distributed.

Thank you.

3:45 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

That's excellent. Thank you.

I would like to use this introduction to focus on some of the actions, including the regulatory actions, that will help address the serious public health concerns related to overconsumption of sodium in the Canadian food supply. These actions include both actions that the government has already undertaken and further actions that Health Canada is considering.

Health Canada is the federal health authority responsible for establishing policies, setting standards and regulations, conducting health risk assessments, and providing advice and information on the safety and nutritional value of foods available for sale in Canada. These tools, whether they are regulatory or non-regulatory in nature, are used to ensure the safety of the Canadian food supply and to ensure that this food supply, as safe as it is, continues to be a major contributor in protecting and promoting Canadians' health.

The serious adverse health outcomes related to overconsumption of sodium have been a concern for Health Canada for a number of years. During the development of the labelling regulations that came into effect in 2007, it was clearly recognized that providing clear information to consumers on the labels of prepackaged foods could be an important first step in reducing consumption and intake of sodium by Canadians.

Mandatory labelling regulations were therefore established. These regulations require the total sodium content in the product to be included in what we know as the “nutrition facts table”. It is also required that a second value be included on the nutrition facts table, and that's the percentage of the daily value of sodium that a single serving of food would provide. This allows consumers to identify products that are higher or potentially lower in sodium content, and of course enables consumers to make choices among these products.

A second labelling tool is also included in the new labelling regulations. Rules were established about the amounts of sodium in foods labelled as "low in sodium", "salt-free" and "reduced in sodium".

Further, a health claim was established that could be used on products that are low in sodium and high in potassium, linking a diet high in such foods with a reduced risk of high blood pressure. With these additional claims, consumers can easily identify and choose foods that are low in sodium. These claims allow food manufacturers to highlight the positive aspects of their products, and motivate competition and low-sodium product reformulation. Labelling and information to consumers was only a first step. It was felt that it could be a powerful tool to help reduce sodium intakes, but would probably only take us part of the way.

It was recognized that further action may be needed to use additional regulatory and non-regulatory tools to intervene at the food supply level.

In support of the work of the sodium working group, Health Canada scientists have also undertaken analysis to help improve our understanding of the sources and the levels of intake of sodium in Canada. It is clear from this analysis that over-consumption of sodium is a problem for both children and adults.

Canadians age one year and older on average consume about 3,400 milligrams of sodium per day. This is to be compared to the upper limit of intake that has been set for sodium, which is at 2,300 milligrams per day for adults and 1,500 to 1,900 milligrams per day for children. In fact, the amount of sodium that is considered to be adequate to support its role for normal healthy functioning actually ranges between 1,000 and 1,500 milligrams, and that's of course again depending on age.

Clearly, and to no one's surprise, the intakes of sodium in Canada were found to be higher than what is recommended and continue to represent a public health concern.

Additional analysis was undertaken to determine the sources of sodium intake and again to help us to identify where intervention in the food supply might be the most effective. In fact, it has been reported that in the North American diet the vast majority of the sodium is coming from processed food. It's approximately 77% that comes from processed foods. Only about 11% of the sodium intake comes from additions by the consumers at the table or during cooking. This confirmed that additional action was needed to intervene at the level of the food supply.

As Dr. Hutchinson mentioned, last month the food supply subcommittee of the sodium working group, along with Health Canada, held several meetings with several food industry stakeholders, including major food industry associations in the country. These meetings aimed to initiate discussions on sodium reduction targets for processed foods and foods that are sold through food service establishments. There was a clear willingness by industry to work together to set targets and develop steps to achieve these targets.

Also, at the end of September 2009, the sodium working group recommended an interim goal for reduction of average sodium intakes in Canada, and this interim reduction goal was set as 5% per year between now and 2016. Achieving this goal, as was mentioned earlier, would see the average intake in adults be reduced from the current value, estimated at 3,400 milligrams, to about 2,300 milligrams. This is again seen as a first step, and a longer-term goal will still aim to reduce the intakes to about 1,500 milligrams, which is the recommended intake.

It is recognized that government cannot do this alone, and to be truly successful we will need to work with industry and health professionals to take the concrete steps that are needed to reduce sodium in the food supply, steps that are achievable and that will not compromise the ability to reach our public health goals. A number of actions are planned in order to reach this goal.

We are learning how to achieve these goals by looking at some of the best practices internationally. In particular, we are looking at the U.K. In 2006, the U.K. published their first set of targets for sodium levels in foods. Working with industry since then, they have steadily moved toward reducing sodium in their food supply and recently published updated targets.

While the U.K. started from higher intakes than the levels in Canada, we are looking at the steps that they have taken in cooperation with industry to see how these practices might apply in Canada to help us achieve similar gains.

As recommended by the sodium working group, Health Canada will also be reviewing a number of potential regulatory barriers that could impede the food industry from using healthy alternatives to salt and sodium-containing additives. We will also be looking at options on how we can make label statements to highlight gradual sodium-level reductions—for example, to be able to highlight reductions of less than 25%.

Again, November 2009 will be a very active month for consultation with industry in Canada to develop the steps necessary to complete this particular prong of the sodium-reduction strategy. Health Canada will be working with technical experts from the food manufacturing and the food service sector to look at the proposed sodium targets.

Data collected by Health Canada on the current sodium levels in foods will be shared also with the food industry to support setting those reduction targets. These discussions will of course consider the challenges that industry may face to meet these targets and explore possible ways to overcome those challenges. From these and from ongoing discussions with industry, targets will be finalized and a set of feasible and realistic steps will be developed to achieve these targets.

It's clear that there are challenges before us to achieving changes to the food supply—for example, the ubiquitous nature of sodium in the food supply; finding affordable replacements; the use of salt as a tool in food safety applications; and also consumer acceptance. While we appreciate these challenges, the government is committed to reaching these targets using all the tools at our disposal, whether it be the regulatory tools or non-regulatory options.

Thank you.

3:55 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you very much for all your insightful comments. It's quite shocking when one hears some of this information, and the processed foods piece has been very useful. Thank you to both of you.

We'll now go to the Public Health Agency of Canada, and Kim Elmslie, who is the director general for chronic disease prevention and control.

3:55 p.m.

Kim Elmslie Director General, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada

Thank you, Madam Chair.

I think you have received my comments in both English and French and they've been distributed to committee members.

As Madam Chair has indicated, I'm from the Public Health Agency of Canada. Working with my health portfolio colleagues, we share a common objective--that is, reducing sodium in Canada's food supply and supporting the health of Canadians.

I'd like to stress in my comments today the health impacts that we know result from excessive sodium consumption and highlight some of the statistics and research that has been done, as we have a very well-developed body of research in Canada and internationally to draw on to help us understand this complex problem. As my colleagues have already indicated, it truly is a complex problem that will require us to use multiple levers and multiple partnerships in order to reach our goals.

Cardiovascular diseases are the leading cause of death and disability in Canada. Elevated blood pressure is a major risk factor for cardiovascular diseases and the most powerful predictor of stroke and heart failure. Elevated blood pressure has been identified by the World Health Organization as the leading risk factor for premature death in the world.

Nine in ten Canadians will develop hypertension if they live an average lifespan. Preventing or delaying the development of elevated blood pressure by reducing the population's average blood pressure is an important way of reducing the health consequences and costs associated with cardiovascular diseases. We know that high dietary sodium increases blood pressure, which poses a health risk.

Sodium consumption over 2,300 milligrams a day has been shown to have an immediate as well as a long-term effect on blood pressure and cardiovascular outcomes. We know that societies that consume low levels of sodium have modest or no increase in blood pressure over time.

There is a direct and progressive relationship between the amount of sodium we take in and the increase in our blood pressure. The increase in blood pressure is most evident among those who have a cardiovascular disease or who have one or more cardiovascular disease risk factors, which include hypertension, obesity and diabetes.

Most deaths attributable to elevated blood pressure actually occur in those with blood pressure levels in the upper half of the normal range; that is, 130 over 85. There is also evidence that lower sodium intake in childhood results in lower blood pressure later in life. In children and adults alike, a modest reduction in salt intake has been shown to have a considerable effect on lowering blood pressure.

Research on high sodium intake in animals and in humans has demonstrated that, besides its indirect effect on the cardiovascular system through an increase in blood pressure, it has a direct effect on the heart and blood vessels. These studies have shown an immediate increase in the stiffness of blood vessels and their changed ability to react to stress. Further, we know that research on the cost-effectiveness of interventions tells us that sodium reduction is the most cost-effective way of reducing the burden of cardiovascular disease.

A recent study that we conducted at the Public Health Agency has shown that a gradual annual reduction of sodium intake by 10% could result in close to 30,000 fewer cardiovascular events and a cost savings of about $330 million over 10 years.

Another Canadian study from 2007 has shown that a reduction of 1,800 milligrams in sodium intake could potentially decrease the prevalence of hypertension by 30%, resulting in over a million people not needing hypertensive medication and an annual direct cost savings of about $430 million. High sodium intake is also associated with non-cardiovascular diseases such as the development or severity of asthma, stomach cancer, obesity, renal stones, and osteoporosis.

I'd like to stress that we have programs and initiatives in place in the country that, along with the efforts that are currently being directed at sodium reduction in the food supply, are necessary for us to fix and maintain Canadians' attention on this important health problem. The Canadian hypertension education program plays a significant role in increasing professional and public understanding of the impact of sodium on health.

Thank you.

4 p.m.

Conservative

The Chair Conservative Joy Smith

I thank you. It's quite astounding, some of the things we've heard this afternoon.

We're now going to go into our first round of questions and answers.

Dr. Martin.

4 p.m.

Liberal

Keith Martin Liberal Esquimalt—Juan de Fuca, BC

Thank you very much Madam Chair.

Thank you all for being here today.

In looking at your assessment stages, it seems to me that you're still at the assessment stage, which means that we're about a year behind. If that is so, could you let us know what's holding back our progress?

Secondly, we know that cardiovascular and other health problems are associated with salt. It's like saying smoking is bad for you. We know this. And we know that excessive salt intake is a causative agent of this. What I find interesting is that if you take a casual walk through the grocery store, you see that the foodstuffs are just packed with salt, even things that are considered “healthy”. Can you let us know, specifically, how you anticipate trying to limit the salt in the foodstuffs that most people who eat in a healthy way are consuming? What solutions are you proffering? Even though consumers are very knowledgeable about the excessive consumption of salt, the practical matter of going through the grocery store and picking up something that is low in sodium is actually quite difficult. If you have some solutions, that would be very worthwhile.

I think Mr. Valeriotte's going to pose a question too. Thank you.

4:05 p.m.

Conservative

The Chair Conservative Joy Smith

Who would like to take that question?

Mr. Godefroy.

4:05 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

Yes, I could start maybe with some elements of answers—

4:05 p.m.

Conservative

The Chair Conservative Joy Smith

Yes, please. Thank you.

4:05 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

—and maybe my colleagues could complete it.

Definitely you're highlighting the complexity of the problem, because essentially we have an ingredient here that is ubiquitous in the food supply, that is present in a number of commodities. So given the health impacts that were identified, it's clear that one approach will not be enough. That's why, essentially, the sodium working group has identified this three-pronged approach, one of which is definitely education, gathering the information.

Now, as for the stage where we are right now in the strategy, I would say that we are past the assessment stage in that we are right now in the process of developing the strategy. That being said, it doesn't mean that the knowledge base that we have and that we rely on is complete. We have identified that actually from the outset and through the expertise that was brought to the sodium working group and that was gathered by scientists from Health Canada and other groups.

It was clearly identified that we have made some analysis. We have already some of the data that support the development of the strategy, but we have also identified a number of data gaps. For example, we have made an estimation right now on where sodium is coming. We have identified its ubiquitous nature. We have clearly identified that we cannot target one specific food commodity, and there are a number of food categories that we'll have to look at, because essentially this would come from all sorts of processed foods, whether they be soups, juices, for example—which is the healthy option you've mentioned—potentially vegetable mixes, and so on, or whether they be highly processed—

4:05 p.m.

Liberal

Keith Martin Liberal Esquimalt—Juan de Fuca, BC

It is one year behind, and at a charitable level, you're still one year behind. Is there something you can share with us that's preventing this from being on track?

4:05 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

There are definitely some delays in accomplishing the goals, and perhaps I would say there are several reasons for that. Some of it is related probably to the way the goals were set. There may have been over-ambitious goals originally when the sodium working group developed the different prongs of the approach that it would go through and realized while implementing that the data and the analysis that is required would be more thorough than originally anticipated. There were some elements related to that.

4:05 p.m.

Conservative

The Chair Conservative Joy Smith

Mr. Godefroy, I'm just going to say Mr. Valeriote is sharing his time with Dr. Martin, so you might like to incorporate in some of the question Mr. Valeriote had.

Go ahead.

4:05 p.m.

Liberal

Frank Valeriote Liberal Guelph, ON

Thank you for appearing before the committee today.

I have a very brief question. It's probably a little more comprehensive and not directly related to sodium as such. I'm one who believes that we need a national food policy that incorporates not just the issue of food sustainability and sovereignty and security but also wellness. This fits in nicely with a national food strategy, and I'm wondering to what degree Health Canada is able to facilitate a comprehensive review of not just sodium but all additives and chemicals and elements and whether or not you would see that as a strategic part of a national food policy.

4:05 p.m.

Conservative

The Chair Conservative Joy Smith

There's just a minute left, so if you want an answer you're going to have to stop.

4:05 p.m.

Liberal

Frank Valeriote Liberal Guelph, ON

That's fine. Go ahead.

4:05 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

I could start.

4:05 p.m.

Director General, Office of Nutrition Policy and Promotion, Department of Health

Dr. Hasan Hutchinson

Okay. He's the starter here.

4:05 p.m.

Director General, Food Directorate, Department of Health

Samuel Godefroy

I guess there are two segments in your question, honourable member. You mentioned chemicals and additives, but you mentioned as well any types of issues related to food that have an impact on health. The answer to the second part of the question—whether there is an interest in developing a comprehensive approach to tackle various issues related to the food supply that are linked to chronic diseases and health and wellness—is yes. This is being incorporated with the approach that is developed throughout the health portfolio, both with the involvement of the Public Health Agency of Canada, which is actually monitoring the state of our health and also identifying the reasons related to that and the linkages—for example, to food-borne issues—and our work within the Department of Health and also with the agriculture portfolio, in order to come up with potential solutions that would address that.

Sodium reduction strategy would be one of those. Transfat reduction would be one of those. Reduction of exposure to chemicals in food would be one of those. Reduction of food-borne illness related to microbial hazards would be one of those. So the intent is definitely to incorporate that into a comprehensive strategy that would enable us to achieve these goals.

4:10 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

I would ask the witnesses to keep an eye on the light that goes on to signal you that you've reached your time. There are so many questions that people would like to ask right now.

Now we'll go to Monsieur Malo.

4:10 p.m.

Bloc

Luc Malo Bloc Verchères—Les Patriotes, QC

Thank you, Madam Chair. Thank you to all our witnesses.

Ms. Elmslie, thank you for your statistics even though they are not very encouraging. I'm thanking you for them because it is important that the public be given a clear picture and be aware of the effect of salt and high blood pressure on their health.

Could you tell me how long we have known about the effect of salt on blood pressure, and the effect of hypertension on cardiovascular health and on the mortality rate?