Health Committee on May 4th, 2010

[The Chair, Conservative, Joy Smith]

Good morning, ladies and gentlemen. It's very nice to see everybody out this morning for this very important topic.

I want to especially welcome our guests this morning. We're very much looking forward to your insight on the topics we're dealing with this morning.

Pursuant to Standing Order 108(2), we are doing a study on sodium consumption in the Canadian diet, and for that study we have, from the Dairy Farmers of Canada, Nathalie Savoie, the assistant director of nutrition, national programs. Welcome.

We will also have, from the Canadian Restaurant and Foodservices Association, Mr. Reaman. He is not here yet, but we're hoping he will arrive a little later.

From Food and Consumer Products of Canada, we have Phyllis Tanaka, vice-president of scientific and regulatory affairs, food policy. That sounds very onerous, Phyllis.

From the Heart and Stroke Foundation of Canada, we have Stephen Samis, the director of health policy. And from the University of Ottawa Heart Institute, we have Dr. Andrew Pipe, chief of the division of prevention and rehabilitation, and professor in the faculty of medicine, University of Ottawa. Welcome.

From the University of Toronto, we have Dr. Mary L'Abbé. Mary is a professor and the chair of the department of nutritional sciences in the faculty of medicine.

Witnesses, I'm going to ask each of you, from each organization, to give a five-minute presentation. Following that, we'll go into our questions and answers, which is a very useful part of the presentations, because committee members do ask the questions they really need to know the answers to.

We'll begin with the Dairy Farmers of Canada, and Nathalie, please.

[Nathalie Savoie, Assistant Director, Nutrition, National Programs, Dairy Farmers of Canada]

Thank you, Madam Chair.

At the Dairy Farmers of Canada, we recognize the public health importance of reducing Canadian sodium intakes and appreciate the opportunity to address the committee this morning on this important subject.

We are the national organization representing Canadian dairy farmers who produce the basic ingredient that is used in the manufacturing of dairy products. The nutrition and health aspects of dairy products are of great importance to us. This is why we have made it a priority to follow this policy development along with others being led by Health Canada.

Moreover, as an interested organization committed to nutrition research and the promotion of healthy eating and living, we have provided comments to Health Canada on their proposed sodium reduction targets and have shared our research with them. We have collaborated and continue to collaborate with dairy processors, in particular cheese manufacturers, as we all assess the proposed Health Canada sodium reduction targets.

The nutrition department at DFC is staffed by some 20 registered dieticians like me, whose goal is to increase awareness of the nutritional values and health benefits associated with milk products as part of a healthy, balanced diet, and to encourage Canadians to consume the number of servings of milk products recommended by Health Canada.

The findings of the Canadian community health survey published in 2006 indicate that a large proportion of Canadians in all age groups is not meeting the minimum recommended servings of milk products. Therefore, if reducing sodium in cheese affects consumers' acceptance of cheese and leads to a reduction in cheese intake, the result will be a worsening of the problem of under-consumption of milk products, with negative consequences for the overall nutrient intakes of Canadians, especially calcium.

It is important to mention that while sodium is a natural constituent of milk and other dairy products, salt or sodium chloride is also added during the cheese-making process to serve many functional properties, such as enzymatic and microbial control, humidity control, and taste and texture; but it's also an essential ingredient to ensure food safety. After consulting researchers specialized in food science and the microbiology of cheese-making, we came to the conclusion that there is currently a lack of knowledge on whether the proposed targets for cheese are achievable and whether they present food safety issues.

In order to provide those scientific data to address the issue of levels of sodium in cheese, we are funding research that deals with the technical and food safety issues associated with salt reduction. Since May 2008, the dairy industry has been supporting research by the Université Laval on the impact of variation in salt in cheddar cheese on organoleptic properties and microbial growth.

In addition, with the help of newly attained funds from the agri-science clusters initiative, we will also jointly finance with Agriculture and Agri-Food Canada a major two-year study starting this year looking into reducing salt in different types of cheese while maintaining product quality and ensuring food safety.

These two studies represent an investment of $750,000 toward the advancement of science in this area. The first study will be completed in April of next year, while the second one will be completed in early 2012. Once the results of these studies are available, the dairy industry will be in a better position to access the level of sodium reduction that is both achievable and safe for different types of cheese.

We are committed to offering nutritious dairy products that meet the highest standards of quality and safety, as well as the demands of consumers. We strongly believe that these high standards must be maintained in any effort to reduce sodium. To ensure that salt reduction in cheese is accomplished while maintaining product quality and without putting the population at risk of food contamination, we have asked Health Canada to provide the dairy industry the proper time needed to conduct the necessary research before establishing targets for cheese, and timelines for reaching these targets.

We believe that special rules should be established for products like cheese, where salt is required for important aspects like preservation and aging. Otherwise, the process needs to account for target revisions and/or re-adjustments if the set targets prove to be unachievable or unsafe. We will be happy to provide the committee with our feedback to Health Canada on these targets.

For technical and food safety aspects related to reducing salt content in cheese, we have turned to the scientific expertise of Dr. Paul Paquin and Dr. Steve Labrie from Université Laval, who have provided a written scientific opinion based on their longstanding expertise in food science and microbiology related to cheese-making. We provided their document, along with our DFC response, to Health Canada. We would be happy to provide the committee with that document as well.

Again, thank you for this opportunity to share with the committee the undertakings that Dairy Farmers of Canada is taking on this important health subject. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Phyllis Tanaka.

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

Thank you.

Food and Consumer Products welcomes this opportunity to meet again on the efforts to reduce sodium consumption in Canada. When we met last October, FCPC indicated its support for the work being done in the multi-stakeholder working group process. We continue to supports its work, and I continue to take an active role as a member of the working group.

The multi-stakeholder working group is the driving force developing a fulsome strategy toward reduced sodium consumption in Canada. FCPC members manufacture the majority of the processed food products found on retail shelves in Canada. They are committed to offering a variety of healthy products. For many years they have been developing new products with reduced sodium, and reformulating processed food products to reduce their sodium levels. They will continue to make advances in doing so.

However, as has been stated before, it is important for the committee to understand that lowering sodium levels in food and beverage products is a complex undertaking and takes time. As you already know, sodium performs a number of functions in food manufacturing, so it can't just be removed without having a suitable alternative. There is no one replacement for sodium to meet the varied functions it plays in a food product. That is why successful product reformulation takes time. A rough estimate for a straightforward change is approximately two years, and that's for one product.

It must always be remembered that consumer acceptance is critical to the success of any new product or reformulated product with lower sodium levels. It takes consumer awareness of why the changes are occurring, and consumer acceptance of the changes in the products.

The working group has established a three-pronged approach to achieve the goal of lowering sodium levels, with these very complexities in mind. The strategy involves education, the voluntary reduction of sodium levels in processed food products and food sold in food service establishments, and research. All of the stakeholders involved in these efforts agree that salt reduction in the food supply and overall reduction in the dietary intake of sodium by Canadians will only succeed if it is done in a staged process.

Industry requires time to successfully model sodium reductions in food products. Consumers need time to acclimatize to a new taste profile. Above all, for any initiative to succeed the targets must be realistic, feasible, and sustainable. This last point is a theme that is recognized globally.

FCPC members have been engaged in the process with the working group since it formed. This engagement is driven through FCPC's own sodium committee, which is made up of the scientific-technical representatives from its member companies. Member companies participated in the working group's public consultation in February 2009, providing information critical to understanding the issues industry faced in addressing the challenges they need to overcome to succeed. Right now they are actively engaged in the dialogue with Health Canada to establish sodium reduction targets that will support the working group's interim goal of bringing the population average sodium intake to 2,300 milligrams per day.

In closing, the challenge of reducing sodium is not unique to Canada; it's a global problem. Many other jurisdictions around the world have been contemplating how to do it. While some have initiated steps earlier than Canada, there isn't any one that is further ahead than we are now. Most have come to the conclusion, like Canada, that it's a process that will take time, must be based on collaboration among the many stakeholders, and must be based on realistic and achievable targets.

I believe the Canadian approach stands out as a model that is strategic and reflects good leadership.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Tanaka.

We'll now go to Stephen Samis, from the Heart and Stroke Foundation.

[Stephen Samis, Director, Health Policy, Heart and Stroke Foundation of Canada]

Thank you, Madam Chair.

On behalf of the Heart and Stroke Foundation of Canada, I would like to thank you for the opportunity to appear here today to share with you the foundation's perspective on the issue of sodium consumption in the Canadian diet.

The Heart and Stroke Foundation is one of Canada's largest volunteer-based health charities. We lead in eliminating heart disease and stroke in Canada and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.

Here are a few facts about cardiovascular disease and sodium.

Heart disease and strokes are the leading causes of death, hospitalizations, and drug prescriptions in Canada and cost the Canadian economy an estimated $22 billion a year in direct and indirect costs.

About five million adult Canadians have high blood pressure, the number one risk factor for stroke, and a major risk factor for heart disease.

Among Canadians aged 19 to 70, over 80% of men and 60% of women have sodium intakes exceeding the recommended upper limit.

About one in seven deaths from stroke and one in 11 deaths from coronary heart disease could be prevented if Canadians reduced their dietary sodium intake by about 1,800 milligrams per day.

Recent studies estimate that there would be direct cost savings of approximately two billion dollars per year as a result of decreasing average sodium consumption to recommended levels. And dietary sodium reduction could eliminate hypertension for over a million Canadians, with a resulting savings of at least $430 million annually in direct high blood pressure management costs. So the costs are significant.

The Heart and Stroke Foundation is committed to reducing Canadians' sodium intake. We continue to provide Canadians with health information, resources, and recipes to help them lower their sodium intake.

The foundation was one of 14 health organizations to sign on to Blood Pressure Canada's policy statement on sodium reduction, the goal of which is to reduce Canadians' daily sodium consumption to between 1,200 and 2,300 milligrams by 2020.

Our Health Check program continues to work directly with food companies and restaurants to improve the nutritional quality of our country's food supply through stronger nutrient criteria. And since 2007, Health Check has announced changes to its nutrient criteria, which have resulted in 25% to 70% reductions in the sodium levels of products in the program.

Since that time, and by meeting those new Health Check criteria, 14 companies alone have removed 500,000 kilograms of salt from their products. This is the equivalent of about 20 dump trucks of sodium being taken from our food supply. And as we continue to lower sodium levels in our criteria in the Health Check program to meet those 2020 levels, more dump trucks will be filling up with salt.

The foundation is also a member of Health Canada's multi-stakeholder sodium working group. We are looking forward to the working group's report and their recommendations anticipated in June 2010.

What can the federal government do? The Heart and Stroke Foundation would like to take this opportunity to outline a few steps we believe the federal government should take to help address sodium levels in the Canadian food supply.

First, continue to support the work of Health Canada's sodium working group and, more importantly, ensure a timely response to the working group's report and timely implementation of its recommendations.

Second, conduct regular national nutrition surveys to establish an effective and timely monitoring system to track sodium levels in the diets of Canadians and report on progress toward achievement of the 2020 goal.

Third, improve food labelling regulations to make the portion sizes on the mandatory nutrition facts panel consistent across similar products to help Canadians compare products better and make better informed and healthier choices.

Fourth, educate Canadians about the health risks of high sodium intake and on how to reduce their sodium consumption within the context of a healthy diet.

What can the food industry do? In addition to the government's support and leadership, the foundation recommends that Canada's food industry continue to take a leadership role and continue to reduce sodium levels in all foods sold in Canada, support efforts to educate Canadians about the health benefits of consuming foods that are low in sodium, and make nutrition information, including sodium content, available at points of purchase in food-service outlets.

In closing, the Heart and Stroke Foundation appreciates that this committee continues to make sodium reduction a priority. We urge the federal government to quickly respond to and implement the working group's recommendations once they report. And we thank you for the opportunity to provide our perspective today.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now hear from Dr. Andrew Pipe.

[Dr. Andrew Pipe, Chief of the Division of Prevention and Rehabilitation, Professor, Faculty of Medicine, University of Ottawa, University of Ottawa Heart Institute]

Good morning, Madam Chair. It is a great pleasure for me to be here this morning.

Good morning.

This is probably one of the more important clinical conversations that I have had this year. I say that because I want to have a conversation with you. I'm not going to be speaking from prepared notes.

Probably one of the most useful things that I can do as a physician is to accelerate the development of an environment in which healthy behaviours become easy behaviours. Probably one of the most important things I can do as a clinician is to look you squarely in the eye and tell you that you can do things with your pens, your signatures, and your legislation that will dramatically enhance the health of our community in ways I cannot even dream of.

In one day, as a consequence of thoughtful deliberation, you can transform the environment such that the health of Canadians becomes significantly improved and enhanced.

For more than 40 years, we've known about the deleterious health consequences of sodium. I would argue, perhaps being a little provocative, that for 40 years we've shrugged our shoulders and wrung our hands and asked what we can do. That's despite the fact that there is evidence from around the world where communities very similar to ours have addressed this problem in ways that are thoughtful, engaging, constructive, and that have shown dramatic changes in terms of enhancing the safety--and I want to underscore the word safety--and quality of our food supply.

Daily in my position at the University of Ottawa Heart Institute, I see people who suffer from cardiovascular disease. The nature of the expression of that disease is changing. We've done a very good job, if I may pat my profession on our backs--and Dr. Bennett can also wallow in the approbation I'm offering ourselves--in reducing the incidence of heart disease since the 1960s. On the other hand, there are still very large numbers of Canadians who have heart disease, and as they get older the incidence of heart failure is going to increase dramatically.

Why is that germane and important to our discussion today? It's very simply that one of my patients can leave my clinic, walk down the stairs or take the elevator in the Heart Institute, have a simple lunchtime snack, which he or she perceives to be healthy, from a fast-food enterprise in the foyer of my institute, and as a consequence of the sandwich and soup be in the emergency department eight hours later. He or she could be admitted for several days as the consequence of the fact that the sodium intake represented by that simple lunch tips that individual into unstable heart failure, requiring days of admission in a hospital setting.

I'm also conscious that when I speak to you about these issues, I'm not only speaking about the health of Canadians, in some respects I'm addressing the viability of our health system.

I'm constantly assailed by the rhetoric that speaks to the need for prevention. Prevention is more than fridge magnets and catchy little posters. It's the development of an environment that makes healthy behaviours easy behaviours--and I know I'm being repetitive.

You can tell by my grey hair that I'm now approaching the twilight of my career. Throughout the course of my career, I have been involved in a number of endeavours designed to enhance the health of Canadians. Each time I have heard that we can't do this, this is going to take time, the public isn't ready, it's going to require thoughtful consideration over the course of several years. Substitute seat-belt legislation, reducing the blood alcohol levels for drinking and driving, the time that it took us to get a handle on tobacco legislation, and you see where I'm coming from.

Sodium intake contributes dramatically to blood pressure, which as you heard from my colleagues at the Heart and Stroke Foundation contributes dramatically to the incidence of stroke and coronary artery disease, and deaths from both of those situations. It also contributes dramatically to what is an emerging, pressing public health problem, which is end-stage kidney disease. Nobody anywhere is talking about how we are possibly going to be able to provide dialysis services to the countless Canadians who in the years ahead, as a consequence of their kidney failure, will require dialysis. They will require that dialysis because their kidneys have been destroyed as a consequence of the degree to which hypertension has supervened in their particular personal health setting.

We know that salt is an issue, and most Canadians agree this is an important public health issue. I wish I could share an article with you that my colleagues and I will be publishing in the Canadian Journal of Cardiology a few weeks hence. It is currently under--whatever that word is--embargo. But it shows—

[The Chair, Conservative, Joy Smith]

Dr. Pipe, you're going to have to wrap up.

[Dr. Andrew Pipe]

I'm moving very rapidly to a conclusion.

Ninety percent of the public we surveyed know that they should reduce their sodium content; 90% of them recognize processed foods as being an important source of sodium; and 50% of them say that they are already taking steps to reduce their sodium content, which of course is inaccurate, because we know that what people say and what they do are very different. They are unable to make those steps because they don't understand where sodium comes from.

So I would hope that you would—

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Pipe.

[Dr. Andrew Pipe]

—move quickly to respond to the report, which will be forwarded to you in the weeks ahead.

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. L'Abbé.

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

Thank you, Madam Chair.

I'm here today as professor and chair of the Department of Nutritional Sciences at the University of Toronto and as vice-chair of the Canadian Sodium Working Group.

The sodium working group is a multi-stakeholder task force that has been mandated to oversee a population health-based approach for the successful reduction of the sodium content of the diets of Canadians. As a nutritional scientist and a member of the sodium working group, I'm concerned about the high levels of sodium in the diet. I thought it might be useful to quantify this for you.

Data from the Canadian community health survey that was conducted in 2004 indicated that on average, Canadians consumed more than 3,400 milligrams of sodium a day. The upper level of sodium is set at 2,300 milligrams. So you can see where we are. Over 90% of men and 66% of women exceed this upper level.

But sodium isn't just a problem with adults. It's also a problem for children: 76% of children aged one to three, and 90% of children aged four to eight, and 97% of adolescent boys exceed their upper intake level for sodium.

More than three-quarters of this sodium comes from manufactured and processed foods, which we eat at home or outside the home. Very little of this sodium is either naturally occurring or added at the table or during cooking.

During my remarks to this committee last fall, I shared two figures with you that gave you an overview of the sodium and the sources in the food supply that provide this sodium to Canadians. There are two important features about sodium in the food supply. Firstly, some foods, like bread, are only moderately high in sodium, but they can provide substantial amounts because we eat so much of them. We eat them every day in relatively large quantities. Other foods—and last year I showed you things like soups, frozen meals, hot dogs, some prepared sandwiches—have very high quantities of sodium. Some of those foods in one serving can provide almost your daily recommended amount, and some can even approach the upper level. For example, that submarine sandwich I showed you approached the upper level in a single serving in a day.

Secondly, I think it's important to know not only these levels of sodium in the food supply but that there's no one food, or one food group, that provides most of the sodium. So reducing sodium will mean changes in virtually every food, and nearly every food product in our food supply, if we are going to have meaningful reductions in our sodium intake. Also, for consumers, taste is paramount, so these changes will have to occur at approximately the same time across all foods so that Canadian consumers can get used to reduced levels of sodium. We expect that such approach will take a number of steps phased in over a number of years.

With these numbers in mind, the sodium working group looked at ways to reduce sodium intake by Canadians. Our report, which we expect should be out shortly, focuses on voluntary reductions in sodium levels in foods; an extensive education program to inform consumers, manufacturers, distributors, food service operators, and policy-makers about the need to reduce sodium; as well as identifying the research that will be needed to support these changes.

We announced our interim first target of a reduction in the population average sodium intake to 2,300 milligrams as the upper level by 2016. This first goal is felt to be aggressive and challenging, but one that we are confident that the Canadian food supply collectively can meet. We are actually encouraged by some of the progress that has already occurred.

Lastly, I want to explain to you what we envision by targeted, voluntary reduction, which you've heard about. We hope and we plan that these targets would be published for virtually the whole food supply for prepackaged and manufactured foods, as well as for foods sold in restaurants, cafeterias, and elsewhere outside the home. Not only will these targets be published, but our terms of reference call for developing a monitoring plan. In other words, we expect that the levels of sodium in Canadian foods should be measured regularly and the results of this progress published regularly as well, so we, and in fact all Canadians, will be able to monitor our progress over time.

Now, it's the start of May, and our report is just about nearing completion. We expect it shall be submitted to the Minister of Health early this summer. We hope we have charted a clear path forward for reducing the sodium intakes of Canadians, and we await the opportunity to share our report with you in the near future.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Mr. Reaman, from the Restaurant and Foodservices Association.

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

Thank you, Madam Chair.

Thank you, members of the committee, for having us here today.

My name is Ron Reaman, and I represent the Canadian Restaurant and Foodservices Association. We represent approximately 33,000 restaurants across Canada. I did have the pleasure of appearing before the committee last fall, so I will keep my remarks very brief and not be too repetitive.

I just wanted to underscore for you today that the Restaurant and Foodservices Association and our membership are fully engaged in the issue of sodium reduction. We are a member of the Health Canada sodium working group, and we have continued to participate and support that group in its efforts to look at developing a national strategy for sodium reduction and ultimately to reduce the overall sodium intake of Canadians. We support the three key prongs of the terms of reference for that committee, which are, as I'm sure you are aware, a research component, a voluntary reduction in the sodium levels in food products, and also a comprehensive public education and awareness campaign.

I want to remind the committee that many food companies are already fully working on reducing and reformulating their products, their menu items for offer. We recognize our role in making that contribution to bringing down the overall sodium levels of Canadians. But we have to recognize some of the operational realities that confront our industry. As some of my colleagues have already mentioned, the really critical piece here is to ensure that we are working on a gradual, achievable strategy that actually reduces the sodium that Canadians are consuming.

One of the challenges that we face in the restaurant setting is if those products are not to the taste acceptance of our customers. At the end of the day, we are a consumer-demand-driven business. We offer for sale what our customers ask of us. It's really critical that we ensure that the palates of Canadians actually evolve to a point where that demand shifts to products that are actually saleable. Consumers have a choice at the end of the day, and they exercise that choice on a daily basis in our operations.

We're doing our part through voluntary reduction of sodium in menu items.

The other key point that I wanted to make to the committee is that with respect to the public education and awareness campaign it's our feeling that this is an absolutely critical piece the government needs to support through dedicated funding that actually achieves the public health outcome that we all share, which is to try to reduce the overall intake of sodium by Canadians.

I'll leave it at that and be open to questions.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you.

I'd like to welcome to our committee Ms. Megan Leslie, who is replacing Judy Wasylycia-Leis. Welcome to our committee.

[Megan Leslie, NDP, Halifax, NS]

Thank you.

[The Chair, Conservative, Joy Smith]

We'll now go into the first round, seven minutes Q and A. We'll begin with Dr. Bennett.

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

Thank you all for coming.

I share Dr. Pipe's frustration. The story that Dr. Pipe told of patients actually not knowing what they're getting and ending up in hospital was the story of my father, who in one summer had three hospitalizations, even with a daughter as a physician. I had no idea that the All-Bran he had every morning was three times as salty in Canada as it is in the United States; I had no idea that the soup he was eating was laced with the stuff. We just threw the book at him, and we kept him out of hospital for three years until he died, by being really strict about this.

This is a daughter who had toxemia in my pregnancy, who drank the soup and then thought, “I don't think I should have eaten this”, and then two hours later was being induced with pre-eclampsia.

This Is so serious. It's the reason I'm a doctor: I ended up with acute glomerulonephritis and on a salt-free diet for three months when I was in grade nine, and I felt that no one else should have to live through that.

Dr. L'Abbé, I actually thought I wanted to be a nutritionist first, because Dean Barbara McLaren brought me shortbread that had no salt in it, and I thought she was an angel of mercy, coming to me with delicious foods that actually had no salt in them.

I just have to say first that, with the frustration you must feel, Dr. L'Abbé, having watched what happened with transfats, how on earth can the sodium working group spend all of this time and not even have mandatory regulations in your terms of reference, so that all you're allowed to come up with is voluntary reduction? It seems quite shocking. I don't see the education program coming.

What are we waiting for? Do they have to wait for your report to do a public education campaign to tell people to reduce their salt or lay off the soy sauce or whatever it is? I don't really see a huge amount of money going into research. This is enough, already. I wonder how on earth we can get at this when what Dr. Pipe is saying is absolutely true. We've heard all this before. I don't know that the Canadian palate is different from the American palate. What are we waiting for?

I would rather have Dr. Pipe ask the people who are saying “yes, but..., but....” Maybe Dr. Pipe could finish his presentation and have a go at the rest of the panellists.

[The Chair, Conservative, Joy Smith]

Okay. Is it Dr. Pipe who wants to have his...?

[Dr. Andrew Pipe]

I'm not sure that's my role, Madam Chairman.

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

You wanted a conversation, Doctor. Let's have the conversation.

[Dr. Andrew Pipe]

Let me be conversational.

What we need to do is learn from the experience of others. When we look at the experience in Finland, we see a country that had among the highest rates of cardiovascular and other sodium-related diseases in the world, and in the course of a few years turned it around. They did that by a combination of education, voluntary leadership from the food industry—and we have some examples in Canada of food industry leaders who have transformed the nature of their products because they wanted to be leaders—and as well with appropriate public health legislation. Any successful public health approach generally is comprehensive, but to rely solely on education and voluntary approaches is in my respectful view to delay the inevitable, and while we delay, which others might politely term “dither”, more Canadians will die.

If individuals consumed certain food products and were admitted to hospital because of infections derived from those food products, there would be an incredible uproar, and we would move very quickly to deal with it. This is another food quality and food safety issue, and so we need to be prepared sensitively, thoughtfully, but nonetheless forcefully to address this in the best tradition of intelligently designed public health policy.

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

If you had a chance to ask the industry what they're doing.... Or would you rather just dictate to the researchers here what the recommendations for this group should be in our report?