Health Committee on Feb. 1st, 2011

[The Chair, Conservative, Joy Smith]

Good afternoon, everyone. I'm Joy Smith, your chair, and I welcome you today. We're going to be examining, pursuant to Standing Order 108(2), the study on healthy living.

Some familiar faces are in front of us today. It's really good to see you.

We have, from the Public Health Agency, Kim Elmslie, director general, Centre for Chronic Disease Prevention and Control, Health Promotion and Chronic Disease Prevention Branch. We have Nabanita Giri, the executive director, joining her as well. Welcome.

From the Department of Health we have Dr. Samuel Godefroy, director general, from the Food Directorate, Health Products and Food Branch. Welcome back, Mr. Godfrey. We also have Dr. Hasan Hutchinson, director general, Office of Nutrition Policy and Promotion. Welcome as well. Joining them is Dr. William Yan, acting director, Bureau of Nutritional Sciences, Food Directorate.

I am going to begin with the Public Health Agency of Canada, with Kim Elmslie. You have a ten-minute presentation, Ms. Elmslie.

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

Madam Chair, honourable members, thank you for the opportunity to frame today's discussion on healthy eating and next week's discussion on physical activity.

I am going to provide you with an overview of the Government of Canada's healthy living agenda. My colleagues from Health Canada, Dr. Hasan Hutchinson and Dr. Samuel Godefroy, will then speak about their important work that contributes to the healthy eating component of this agenda.

I don't have to tell anyone in this room that the burden of chronic disease is significant and growing. Chronic diseases and injuries are the main causes of death and ill health in Canada. However, we also know that a large proportion of these chronic diseases can be prevented or delayed.

The Public Health Agency of Canada works in very close collaboration with our health portfolio partners to support healthy living and to deliver on specific actions that promote healthy eating and physical activity.

The commitment to helping Canadians lead healthier lives is illustrated through the federal-provincial-territorial endorsement of the declaration on prevention and promotion in September 2010. At that time, federal, provincial, and territorial governments also launched a framework for action to promote healthy weights. This particular framework is focused on concrete action by governments in partnership with other sectors to address the childhood obesity epidemic.

The declaration outlines principles to guide efforts to ensure Canadians have access to health promotion and disease prevention services. Among these principles, the recognition of prevention as the hallmark of a quality health system along with the importance of implementing various approaches to address public health issues and work across sectors are prominent.

The integrated pan-Canadian healthy living strategy is a mechanism by which federal, provincial, and territorial governments work together on these priorities.

You will hear today a consistent theme as we describe the work that's under way, and that's the theme of partnership. I'm talking about partnership with our federal, provincial, and territorial partners through the declaration and through the framework to combat childhood obesity as well as partnerships with other sectors, including the business community, including the education sector, and including communities, all of which have fundamental roles to play, enabled by governments, to provide Canadians with the opportunity for healthy living.

Rates of unhealthy weights among children have risen steadily in recent decades. Today more than one in four children in Canada are overweight or obese.

Reducing obesity levels and promoting healthy weights is critical to the prevention of ill health and to helping Canadians lead healthier lives.

We all know that obesity is a complex issue that requires innovative solutions from government, from industry, and from non-governmental organizations. We, like countries around the world, know that this will not be a quick fix. It will require a sustained effort.

Through the federal-provincial-territorial framework, we are working together in three specific areas: creating supportive environments for children for physical activity and healthy eating; identifying and intervening early for children who are at higher risk; and increasing the availability and accessibility of nutritious foods and decreasing the marketing to children of foods and beverages that are high in fat, sugar, and/or sodium.

These are all very large and complex areas of work, and we know that they require many sectors to come together, working together collaboratively and in a sustained way. That's why we're working with our provincial and territorial colleagues on a strategy that will engage youth, non-government partners, and business partners to identify solutions and joint actions.

We will be able to provide more details on this engagement strategy very soon, as the plan is to have it roll out in mid-February.

While we're moving ahead on a new approach to childhood obesity, we're building on a strong foundation. Let me just summarize for you the key pieces of that foundation.

There's Canada's Food Guide, well recognized as a trusted resource used by many Canadians. And we've just supported the development of new physical activity guidelines, which provide advice and recommendations to increase physical activity levels among Canadians.

We make significant investments in federal research that provides the evidence base for future programs and policies and helps us evaluate ones that are currently in play.

Our focus is on effective interventions to better support Canadians to make healthy choices that promote healthy weights. That's a very important point for us.

We're focused on ensuring that the things that are being done in the country to help Canadians eat healthy and to remain physically active are supported by evidence, so that we're investing in things that are effective for Canadians.

We support community-based action by funding programs that promote healthy lifestyles and include opportunities for parents, caregivers, and children to learn and practise healthy living skills.

As well, we're investing in important partnerships such as the Canadian Partnership Against Cancer, which links organizations and communities across Canada working on cancer prevention, including childhood obesity.

The initiatives that we are partnering with the Canadian Partnership Against Cancer on are allowing us to advance shared priorities in areas that are innovative and tangible--for example, improving active transportation to schools to get our children physically active, improving access to nutritious foods in northern communities in a way that's sustainable and affordable, and providing opportunities for learning from each other, sharing knowledge for improved youth health.

We are gaining momentum in this effort to reduce and prevent childhood obesity. We know that reversing the obesity trend will take time, but it can be done. That has been shown by our success in tobacco control. We know that it took 40 years of concerted efforts to get us to a place where Canada has one of the lowest smoking rates in the world.

Making healthy choices easier requires a comprehensive set of actions that address both the social and physical environments, provide consistent information, increase awareness of Canadians, as well as develop new knowledge and surveillance to underpin our work.

Madam Chair, with that introduction, I'm now going to turn to my colleagues from Health Canada, who will describe in more specific detail the work they are doing to advance healthy eating.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Elmslie.

We'll now go to Dr. Hutchinson.

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

Thank you, Madam Chair.

I am pleased to be here today with my colleagues. Both the Food Directorate and the Office of Nutrition Policy and Promotion are situated within the Health Products and Food Branch of Health Canada, and we work closely to support and promote the nutritional health and well-being of Canadians.

The office of nutrition policy and promotion is the focal point and the authoritative source for nutrition and healthy eating policy and promotion in Canada. We support the nutritional health and well-being of Canadians by collectively defining, promoting, and implementing evidence-based nutrition policies.

We know that healthy eating is a crucial contributor to overall health at every stage of development, and is equally important in reducing the risk of many chronic diseases. Food choices are complex decisions, influenced by the relation between individual and collective factors, including social and physical environments.

A population health approach, which we use as the base of everything we do, uses evidence to assess health, identify priorities, and develop strategies to improve health. For example, Canada's Food Guide was developed using the best evidence to translate the science of nutrition and health into a healthy eating pattern for Canadians. Health Canada currently distributes approximately 3.5 million printed food guides in both English and French each year. I think more than 20 million in total have been distributed since we released it in 2007.

In 2010, the food guide home page was the second-most-viewed page on the Health Canada website. It's the most popular document downloaded from the website. I think it's second only to the tax forms, I guess, in terms of what gets downloaded by Canadians. So I guess you could say we're probably the most popular, if you think of it that way.

[Voices]

Oh, oh!

[Dr. Hasan Hutchinson]

The work currently under way in our office to provide health professionals both with the latest nutrition advice related to prenatal nutrition and infant-feeding guidelines are examples of how our office uses best practices to support and promote healthy eating through the lifespan of Canadians.

We have recently revised our gestational weight gain guidelines for health professionals, and will soon be launching consumer materials to help both health professionals and expectant mothers manage weight gain during pregnancy. Reaching out to other groups, such as health professionals, researchers, policy-makers, and academics, is a way by which we aim to increase our efforts and to maximize their potential. Action to improve nutrition is a shared responsibility--picking up on what my colleague Kim Elmslie was saying--and working collaboratively with a broad range of partners and stakeholders is key to our efforts to improve the nutritional health of Canadians.

The office of nutrition policy and promotion provides leadership and coordination to the federal-provincial-territorial group on nutrition, which brings together professionals working in nutrition policy and program development in federal, provincial, and territorial governments to advance national healthy eating efforts. Through our network on healthy eating, which includes consumer groups, voluntary health organizations, industry representatives, and other non-governmental organizations, we aim to enhance collaboration, cooperation, and alignment of efforts to support healthy eating in Canada.

The office of nutrition policy and promotion has initiated and led the development of many policies and initiatives that focus on improving the nutritional health of the population. The best-known of these, of course, is Eating Well with Canada's Food Guide, which was released in 2008. It really serves as a policy document and underpins nutrition and health policies, standards, education programs, and meal planning initiatives across the country.

Other major Health Canada endeavours include the analysis and sharing of nutrition data from the Canadian community health survey; our nutrition labelling education initiatives, such as the nutrition facts education campaign; the promotion of healthy eating through, for example, the “Eat Well and Be Active” educational tool kit; and policy-related work to support broader Government of Canada initiatives, such as the healthy living strategy.

Population health interventions call for collaboration across all sectors and levels. Our most recent public education initiative, the nutrition facts education campaign, is an example of how stakeholders who share responsibility for healthy eating promotion--the food industry, health professional associations, and non-governmental organizations--can work together. This campaign is being done in collaboration with Food and Consumer Products of Canada, which is the largest industry association in Canada representing the food and consumer products industry.

The campaign aims to increase Canadians' understanding and use of the nutrition facts table to help them make informed food choices. It's a multi-faceted education campaign that uses various means to provide messages to consumers, including food packages in the retail setting, national television and print advertising, the Health Canada website, and social media.

You may have seen some of the TV commercials that are running right now, and that will be running for the next couple of months. The print ads have been going for a couple of months now.

Switching over to the provinces and territories, we are talking with the provinces and territories about the possibility of creating consistent school food guidelines across Canada. Working with our provincial-territorial colleagues and the Public Health Agency of Canada, we've released a literature review that outlines the current state of cooking and food preparation skills and the implications on nutrition health.

This release was also accompanied by a case study that profiles 13 Canadian and two international programs aimed at improving cooking and food preparation skills among children and families. It's a guide for individuals and organizations to develop cooking and food-skill programs in their own communities.

The Eat Well and Be Active educational toolkit developed with our colleagues at the Public Health Agency of Canada is another example of our collaborative efforts. The toolkit includes the “Eat Well and be Active Every Day” education poster, resources, and downloadable activity plans, and it's intended for use by health educators to increase Canadians' knowledge about healthy eating and physical activity and encourage them to take actions to maintain and improve their health.

As Kim Elmslie has already talked about, in September the FPT Ministers of Health endorsed the framework document entitled “Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights”. One of the key policy priorities of this framework is increasing the availability and accessibility of nutritious foods.

I'm chairing right now an FPT task team that has been created to recommend concrete actions to increase access and availability of nutritious foods--

[The Chair, Conservative, Joy Smith]

You don't have to rush so much, Dr. Hutchinson. If you want to take a breath here and there, I promise I won't cut you off.

[Dr. Hasan Hutchinson]

Okay, you're not going to cut me off. I thought the last time we got cut off, didn't we?

[The Chair, Conservative, Joy Smith]

That was last time.

[Voices]

Oh, oh!

[Dr. Hasan Hutchinson]

Here I thought I was getting a little long, but I can go on for quite a bit longer if you'd like.

[The Chair, Conservative, Joy Smith]

You can go on for three minutes.

[Dr. Hasan Hutchinson]

Okay. So there are parameters around this so you won't get cut off.

I am chairing, as I mentioned, the FPT task group that's been created to recommend concrete actions to increase access and availability of nutritious foods, with the focus on remote and northern areas of Canada.

Another key policy priority that is contained in the Curbing Childhood Obesity framework is focused on decreasing children's exposure to the marketing of food and beverages high in fat, sugar and sodium.

A task team has also been created for this policy priority, and Health Canada is working in close collaboration with the Public Health Agency of Canada to develop concrete actions that can be taken to address this issue.

All the projects that I've mentioned today have identified outcomes that we believe have and will have an impact on the health of Canadians.

Let me conclude by stating that healthy eating not only plays a role in the prevention and control of chronic diseases, but it is also a key determinant of human health and development throughout life.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Hutchinson.

We'll now go to Dr. Samuel Godefroy. You have ten minutes.

[Dr. Samuel Godefroy, Director General, Food Directorate, Health Products and Food Branch, Department of Health]

Thank you, Madam Chair.

Bonjour, mesdames et messieurs.

Honourable members, I'd like to thank you for allowing us the opportunity to appear before you today and to speak with you about some of the activities that Health Canada has undertaken to help Canadians make healthier food choices and therefore also have a healthier lifestyle.

As my colleagues Drs. Hutchinson and Elmslie have indicated, we work very closely together to support the nutritional health and well-being of Canadians. Specifically, the food directorate in Health Canada sets the standards for the safety and nutritional quality of all foods available for sale in Canada. Therefore, when it is determined that there is any hazard or risk associated with our food supply, it is our responsibility as regulators to determine how best to eliminate, reduce, or manage that risk.

For instance, there has been a growing recognition that Canadians are consuming more sodium than they need to maintain good health. As a result, our directorate in Health Canada is currently implementing the recommendations of the sodium reduction strategy that are specific to its mandate as a food regulator. We are already pursuing a number of regulatory approaches that support some of the sodium reduction initiatives outlined in the strategy, including the necessary updates to the nutrition labelling regulations and the streamlining of approvals for food additives that can successfully replace sodium in food products, specifically in processed foods.

With regard to enabling new food products and innovative healthy food alternatives, Health Canada's Food Directorate is also responsible for the assessment and authorization of new and novel products, which, in some cases, can provide additional nutritional benefits for consumers.

For example, our experts and scientists have assessed foods with improved properties, such as the enhancement of lutein in egg products, and have allowed the marketing of those foods. Lutein, by the way, is an antioxidant that helps to prevent macular degeneration.

As a food safety and nutrition regulator, our role is to assess and where possible enable safe and nutritious novel products such as these, which can further assist Canadians by providing them with more healthful food choices.

Another area of our work is to ensure that the information related to foods, either on the label or used for advertising purposes, is scientifically substantiated and provides consumers with the knowledge base needed to make informed decisions and choices.

Canada was in fact the first country in the world to have mandatory requirements of nutrition labelling on our food products. These regulations came into full effect in December 2007, and require that calories and the content of 13 core nutrients be listed on most pre-packed foods in a standardized format.

It is this type of information, combined with education programs such as the recently launched campaign mentioned by Dr. Hutchinson, that offers an opportunity to improve the nutritional health and well-being of Canadians by providing them the information they need to make those food choices.

Health Canada continues to monitor the effectiveness of these labelling requirements, particularly those that pertain to health and safety, and which are under the department oversight to ensure that they are achieving their objectives, and particularly their public health objectives.

As mentioned earlier, Health Canada is currently evaluating the nutrition labelling regulations as well as its regulatory oversight of health claims.

Following public consultation in early 2008, a five-year action plan was developed to modernize how health claims on foods are managed. The objectives of the plan are to allow greater flexibility for highlighting the health benefits of food products, and to improve the efficiency and transparency of premarket review and regulatory processes for health claims.

Another objective of the plan is to increase industry's capacity to make function claims, with the most important and ultimate goal being to enhance consumer confidence in how health claims are used and regulated.

A modernized process to manage the approval of disease risk reduction and therapeutic health claims is also being explored. The process emphasizes the need to have a thorough safety assessment and confirmation of the scientific underpinning and substantiation of the claim before enabling its use.

We have also updated guidance that is to be provided to industry as to the types of studies that will be required and the quality of the data that will need to be achieved before making a submission to Health Canada for our scientists to evaluate these submissions.

I do hope that I have highlighted some of the initiatives that Health Canada is pursuing to support Canadians in making their food choices in a way that will contribute to the overall healthier lifestyle.

We are all committed to continuing our work to enhance not only the safety of our food supply but also consumers' understanding of how the choices they make can actually positively impact their health and well-being.

Thank you for allowing us the opportunity to appear before you.

[The Chair, Conservative, Joy Smith]

Thank you so much for the very helpful and insightful comments.

We'll now go to our seven-minute questions and answers, and we'll start with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you to the officials, and happy new year, everybody.

Thank you for the information. You said your focus is on the nutritional health and well-being of Canadians, so I'm going to talk about an issue that's near and dear to me, and that's breakfast programs.

If we look at the research, we know that school breakfast programs are highly effective in providing children with more nutritious diets and better cognitive abilities. They're more alert, they pay attention, they do better on standardized tests. They have a stronger basis to learn in school, with better cooperation, discipline, and interpersonal behaviours. You also see an improvement in emotional and physical health, and less sick days.

Dr. Butler-Jones, in his 2008 report, observed the following:

When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school.... As a result of being hungry at school, these children may not reach their full developmental potential--an outcome that can have a health impact throughout their entire lives.

I'm a former vice-chair of the breakfast programs in Toronto. We fed 110,000 children every morning.

One in four go to school hungry, and hungry children cannot learn. Is there a plan to develop a national breakfast program? We're one of the only industrialized countries without them.

[Kim Elmslie]

Perhaps I can start.

Thank you very much for the question. It's a really important issue that you've highlighted.

I'd like to start by indicating that under the community action program for children that the Public Health Agency of Canada administers, there are currently over 440 organizations across Canada receiving funding. That funding is provided to support food security for vulnerable populations, to help people develop the tools they need to eat healthy, and to teach them and train them on how to cook nutritious foods. So there are programs like that in place.

As we move forward, I'd like to bring us back to the work that was initiated last fall under the auspices of the federal-provincial-territorial declaration on prevention and promotion, and specifically the work to combat childhood obesity. In that context, one of the priorities is looking at the ways that we as a country can move forward to provide access to healthy and nutritious foods for Canadians.

That of course includes looking at the settings in which those foods can be provided, and the ways that we as a federal government can enable those working in provinces and territories--

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Sorry, Dr. Elmslie, can I interrupt?

[Kim Elmslie]

Go right ahead.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I appreciate this, but I think you're talking about community programs. I'm asking very specifically about breakfast programs. Education is key, and if children are hungry they cannot learn.

Very specifically, will the government be looking at rolling out a national breakfast program? We have numerous programs across the country that we could be building on.

[Kim Elmslie]

Right. In that context, we're in the early stages of working with our provincial and territorial counterparts around what we need to do in order to be providing access to nutritious and healthy foods. Given the provincial-territorial jurisdiction in this area, we're coming together as a collaboration that includes working with the joint consortium on school health, which you may know about. It's a really important piece of this question of how to get food--

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So we're starting to work on it? We're starting to work on developing a national breakfast program?

[Kim Elmslie]

We're not starting to work specifically on developing a specific national breakfast program at this stage. What we're doing under our new federal-provincial-territorial program to advance prevention of childhood obesity is we're considering the whole area of food security. That's what we're doing at this point in our development.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

What does the Canadian government currently fund for breakfast programs?