Health Committee on Feb. 17th, 2011

[The Acting Chair, Conservative, Tim Uppal]

Welcome, ladies and gentlemen, to the Standing Committee on Health, meeting number 51, pursuant to Standing Order 108(2), a study on healthy living.

Welcome, witnesses. Today we have with us the Canadian Cancer Society, Heather Chappell, director, cancer control policy; and Rob Cunningham, senior policy analyst.

We have the Canadian Chiropractic Association, Dr. Eleanor White, president, and Dr. John Tucker, director, government and interprofessional relations.

From the Canadian Restaurant and Foodservices Association, we have Garth Whyte, president and chief executive officer, and Joyce Reynolds, executive vice-president of government affairs.

We have NUTRIUM, Stéphanie Côté, dietitian, public nutrition and communication/media.

And by video conference from Vancouver, British Columbia, we have BC Healthy Living Alliance, Barbara Kaminsky, chair, and Mary Collins, director of the secretariat.

We will open with five-minute remarks from each organization. We will begin with the Canadian Cancer Society.

[Heather Chappell, Director, Cancer Control Policy, Canadian Cancer Society]

Thank you very much.

Good afternoon, Mr. Chair and committee members. On behalf of the Canadian Cancer Society, I would like to thank you for inviting us to share with you our perspective on healthy living.

The Canadian Cancer Society is a community-based organization with 1,200 staff and 170,000 volunteers. We work in and support communities across the country at the local, provincial, and federal levels. And we fight cancer by doing everything we can to prevent cancer; by funding research to outsmart cancer; by empowering, informing, and supporting Canadians living with cancer; by advocating for public policies to improve the health of Canadians; and by rallying Canadians to get involved in the fight against cancer. We have been a leader in fighting cancer for almost 75 years.

Healthy living is a broad issue that includes a number of lifestyle factors impacting overall well-being and disease development. I'm going to focus my comments specifically on healthy body weights and physical activity, and my colleague will focus his comments on tobacco.

Currently in Canada, we know that 61% of adults and 26% of children are overweight or obese. In looking at the physical activity numbers, most recently, just in the last month, we found that 15% of adults and 7% of children are meeting the physical activity guidelines. Even more startling is that half the children are not even reaching five minutes a week of vigorous activity.

With regard to this impact on cancer, we know that up to 35% of all cancers can be prevented by being active, eating well, and maintaining a healthy body weight. That means in the year 2010 there were an estimated 60,000 Canadians diagnosed with cancer as a result of these lifestyle factors. More specifically, looking at two more common cancers, 45% of colorectal cancers diagnosed and 26% of colorectal cancer deaths are linked to these risk factors, and 38% of breast cancers diagnosed and 19% of breast cancer deaths are linked to these risk factors. After smoking, unhealthy body weight is the next largest risk factor for cancer development.

Obesity is a complex issue that encompasses social, economic, physiological, environmental, and political factors. It's not equally distributed across communities in Canada. Rather, it's more concentrated in communities that are economically, politically, and socially disadvantaged.

A strategy is needed with sustained political commitment and multisectoral collaboration. This cannot be done by a single organization, sector, or government alone. Policy actions can impact obesity in a number of ways. The first is by shaping the environment so that healthy choices are easy choices for Canadians. This can include food access, security and labelling, built environments for supporting physical activity, as well as tackling some of the broader socio-economic disparities. Second, they can directly influence behaviour. This can include public awareness so that individuals and communities know the magnitude of the problem and the solutions that can help combat it. And third is by supporting health services and clinical interventions for those who are already overweight or obese.

[Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society]

Regarding tobacco control, I'd like to begin by expressing support and congratulations for two very important measures that have been brought forward: Bill C-32 on flavoured tobacco and the new, enhanced picture warnings for cigarette packages. Both of these measures show world leadership. The Minister of Health, all political parties, and members of this committee deserve praise and thanks.

For this committee's current study on healthy living, and as part of achieving broader healthy living objectives, I simply want to underline the ongoing crucial importance of tobacco control.

Tobacco remains the leading preventable cause of disease and death in Canada.

Le tabac tue. Tobacco kills 37,000 each year.

We've made clear progress in reducing smoking, but an enormous amount of work remains to be done. Fully 18% of Canadians and 13% of youth aged 15 to 19 were current smokers in 2009.

The 10-year-old tobacco control strategy announced in 2001 expires very soon, March 31, 2011. It is essential that this strategy be continued. We need, as always, an approach to tobacco control that is comprehensive in nature. Within Health Canada's comprehensive strategy, the programming component is vital. The minister has referred to $15.7 million in funded cessation, youth prevention, and other initiatives. These should continue; we cannot let up. And new initiatives must be pursued, such as the very commendable social media campaign that will be linked to package warnings. Ensuring that the federal strategy is continued without any gap would ensure that the preparatory work for the social media campaign as well as many other initiatives would be carried out in full without interruption.

Given high aboriginal smoking rates, including 59% for first nations individuals on reserves, additional aboriginal initiatives of course are needed.

In closing, tobacco control remains pivotal for what we will achieve in the years ahead in terms of overall healthy living for Canadians.

Thank you for the opportunity to appear before you today.

[The Acting Chair, Conservative, Tim Uppal]

Thank you very much.

We'll now hear from the Canadian Chiropractic Association.

[Eleanor White, President, Canadian Chiropractic Association]

Thank you.

The Canadian Chiropractic Association appreciates the opportunity to appear before the committee. Healthy living is fundamental to our profession.

The promotion of a healthy lifestyle is an important objective of chiropractic care. As primary contact health care providers, the chiropractic profession supports public health promotion and prevention strategies that encourage physical and mental health well-being, such as programs that address smoking cessation, obesity, physical activity, and nutrition.

Historically, at its core the chiropractic profession has embraced its role as health promoters and champions in healthy living. By engaging patients as active partners in managing their own health outcomes, chiropractors aim to improve overall function and well-being. Consequently, the adoption of healthy living approaches by patients helps them achieve greater capacity. The average chiropractor spends a considerable amount of time recognizing and managing capacity issues at their early stages. As chiropractors, we can assist our overworked fellow health care providers in acute care by providing health and prevention in the framework of our patient plan of management.

The CCA's initiatives are founded on chiropractic's strength to implement such strategies. Our recent programs have included Fit-in 15, which encourages Canadians of every age and fitness level to devote 15 minutes a day to a physical activity. Recognizing the aging population, the CCA has also developed Best Foot Forward, which is a program targeted for seniors to reduce falls and their associated negative outcomes. An initiative of the CCA and its provincial divisions in conjunction with Chatelaine magazine has produced the Chatelaine back health promotion, both in print and online. In addition, our provincial divisions have also developed a number of creative public health initiatives, including Alberta's bad back campaign, British Columbia's WorkSafe, Ontario's Lift Light, Shovel Right, Quebec's Santémania, Newfoundland's Straighten Up, and so forth.

Canadian chiropractors are involved on a daily basis in widespread activities to promote healthy living to our patients and Canadians in general.

Our efforts do not stand alone, but rather are implemented in a collaborative framework with other health care professions that encourages the creation of public policies that reflect our vision of health promotion in Canada. The CCA has partnered with the Canadian Coalition for Public Health in the 21st Century, ThinkFirst, Osteoporosis Canada, etc., on a number of innovative projects. Moreover, the chiropractic profession has fostered and supported team-based clinical affiliations, notably at the National Spine Care program in Calgary, St. Michael's Hospital in Toronto, Mount Carmel Clinic in Winnipeg, and the Rosedale Medical Clinic in Hamilton. Patients benefit when health care providers are grouped together to offer the best practices available. These examples have clearly demonstrated the increase in patient satisfaction and savings in care when providers collaborate synergistically.

Moreover, our commitment to health equality has inspired the CCA, in association with local governments and communities, to support the provision of chiropractic services to Nunavut residents in an effort to move their health status closer to that of the general Canadian population. The proposed project, entirely funded by the CCA, will benefit the residents of Nunavut by offering an alternative, hands-on form of health care and treatment for neuromusculoskeletal complaints. As an example of our potential community engagement in Nunavut, the CCA was recently approached by ThinkFirst, a non-profit organization dedicated to the prevention of brain and spinal cord injuries, to collaborate on the implementation of injury prevention strategies for elementary-aged children in the north. Planning is well under way on this initiative.

The CCA also supports such advances as HealthForceOntario, allocating funds for health promotion for physicians within a primary contact care setting. The Ontario Ministry of Health and Long-Term Care aims to support a model of care that encompasses health promotion and disease prevention as well as treatment and disease management. In addition, the system accommodates a wide range of practice models, specifically team-based and interdisciplinary practices. We commend the Public Health Agency of Canada's recent release of Canada's new physical activity guidelines and the revised Canada food guide.

Such a paradigm shift towards health promotion must stem from efforts from all sectors, including regional, provincial-territorial, and federal governments, complemented by public and non-profit sectors.

The CCA recognizes that good health requires more than good health care and supports national public policies and initiatives that address the socio-economic determinants of health, such as early childhood development, poverty, education, and safe and affordable communities.

As Canadians, we must unite to support projects and enterprises that encourage health and well-being. Such an agenda should not be limited to population-based public health programs but extend also to individualized rewards for good choices through an array of governmental incentives. Notwithstanding, the provincial-territorial and federal governments must put forth incentives that aim to address the needs of patients, practitioners, and health care collaborative teams. Direct reinforcement for positive behaviour, in the form, for example, of the proposed adult fitness tax credit, would encourage Canadians to increase their level of physical activity. The children's fitness tax credit has also demonstrated the economic sensitivity of Canadians toward financial incentives.

Economic Benefits of an Adult Fitness Tax Credit, a study conducted by the Centre for Spatial Economics on behalf of the Fitness Industry Council of Canada, concluded that it would only take three years for health care cost savings to be observed that were due to the increase in physical activity within the population. The amount of total savings resulting from improving a population's general health would far outweigh any loss in net personal tax incurred by the government.

Essentially, the CCA's mission is to help Canadians live healthier lives by informing the public about the benefits of chiropractic care, facilitating chiropractic research, and advocating for health care system reform, ensuring quality health care for all Canadians. Consequently, the CCA believes in a vision of every Canadian having full and equitable access to chiropractic care. Similarly, every Canadian should have access to the same opportunities to make positive behavioural choices that will allow them to be healthier individuals and in turn be exemplary role models for their families and communities.

Thank you.

[The Acting Chair, Conservative, Tim Uppal]

Thank you very much, Dr. White.

We'll now hear from the Canadian Restaurant and Foodservices Association.

[Garth Whyte, President and Chief Executive Officer, Canadian Restaurant and Foodservices Association]

Thank you, Mr. Chair.

We want to thank the committee on health for inviting the Canadian Restaurant and Foodservices Association to speak on healthy living. We're a non-partisan national organization that has more than 30,000 members representing restaurants across the country.

You should have before you a package of information that Joyce and I will be presenting during our presentation.

There's a saying in our business: “If you're not at the table, you're on the menu.” With an important issue such as healthy living, it's essential that the restaurant sector be included at the healthy living policy table. Our key message is that we should be seen as an important part of the healthy living solution, not as part of the problem.

Healthy living is a major imperative for CRFA and its members. Last year, we developed a healthy living vision with 10 principles, which was endorsed by our board and our membership across the country. It is included in your package. Recently, we've been working with several provinces, including Ontario and B.C., in this area. We've also been involved in national strategy sessions with key senior representatives from the agriculture, health, and food sectors. And over the past several years we've worked closely with the federal government, and specifically Health Canada, on such key issues as sodium, trans fat, and nutritional information in our establishments.

In March, the Canadian Restaurant and Foodservices Association is participating in a nutrition disclosure think tank with Health Canada and other leaders in this area, and we want to bring some of that information to the table today.

I'm going to ask Joyce, my colleague, to speak specifically on those areas.

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

Thanks, Garth.

I'm going to focus on nutrition disclosure in restaurants, since it dominated one of your previous sessions. We do appreciate the opportunity to clarify the industry's position on this very important subject.

First, you should be aware that CRFA is in discussions with Health Canada and individual provinces about a national policy framework for nutrition disclosure. Included in your package are the guiding principles informing these discussions. One of the challenges for both government and industry is ensuring that this initiative will have the desired impact on the food choices and ultimately on the health of Canadians.

A recent witness acknowledged that “The evidence that menu labelling will influence people's eating habits is not conclusive”, but went on to say that “most recent studies have found significant, though modest, effects”. I haven't seen any studies that have found significant effects. I can cite many studies that have found weak, inconsistent, or no effects. Most recent studies, based on real-world experience, not hypothetical, show no impacts.

A study in the current issue of the American Journal of Preventive Medicine tracked purchasing behaviour at a fast food chain before and after calorie posting was regulated, comparing sales between a chain establishment within and adjacent to the regulated jurisdiction over a 13-month period. It found that the regulation had no impact. Trends in transactions and calories per transaction did not vary between the control and intervention locations after the law was enacted. A study released just this week in the International Journal of Obesity came to the same conclusions.

Because the evidence to date is inconclusive, Health Canada is planning a think tank on nutrition disclosure at the end of March that will bring together academics, NGOs, industry, and governments. One of the objectives is to identify research gaps, needs, and opportunities.

From the industry's perspective, the objectives of a nutrition disclosure policy framework are, first, to provide consumers with meaningful nutrition information so they are able to make informed choices that reflect their individual dietary and lifestyle needs; second, to help consumers make healthier food choices that will improve their health.

Building on CRFA's voluntary nutrition information program, a national nutrition disclosure framework would include the consistent, prominent, and visible display of nutrition information for standardized menu items in store, prior to point of sale. The manner in which this information is displayed may vary, depending on the individual restaurant's unique environment, but must meet the test of being visibly prominent and available at point of sale.

Some examples of how restaurants may prominently display nutrition information include: wall poster, menu insert, brochure stand, computer kiosk, etc. Technology is changing the face of society and the way we interact and consume information. Nutrition information is no exception. Many CRFA members are developing new electronic applications so that customers can view nutritionals simply by pointing their BlackBerry or their iPhone at the menu or menu board. This is already operational in some chain restaurants in Canada.

So CRFA is opposed to the oversimplified provision of single-nutrient information, such as the posting of calories, for several reasons.

The first reason is the difficulty of presenting the information in a way that is meaningful to consumers. Restaurants offer menu choices in multiple varieties, flavours, and options for customization. This makes it impossible to fit nutrition information on menus and menu boards in a way that is accurate, complete, legible, and enforceable. A sandwich, a pizza slice, a burger can vary in caloric content by a margin of 50%. Customers may have thousands of options that aren't listed on the menu, and this is the reason so many chain restaurants use nutrition calculators on their websites. Jurisdictions in the U.S. that have mandated calorie posting allow broad ranges of calories on their menus that aren't permitted in Canada.

Second is the singular focus on calories, rather than on nutrition and balance. This approach delivers a mixed message to consumers. For example, a small serving of milk will show more calories than a small soft drink; a yogurt with granola will show more calories than a bag of chips; a flax seed bagel will show more calories than a cookie. And it should be noted that Weight Watchers, which has helped millions of people throughout the world lose weight, uses a point system based on fat, carbohydrates, fibre, and protein—not calories.

Third is the shifting public policy concern about posting information on menus.

Over the years, the industry has been faced with public policy initiatives requiring posting on menus and menu boards of specific allergens, fat, trans fats, calories, and, most recently, sodium. Recognizing the normal shifts in public health concerns, we are amenable to a policy that highlights specific nutrient information on calories and sodium in our nutritional information in an effort to draw particular attention to them at this time. The industry is concerned about the precedent of requiring specific information per menu item on menus and menu boards.

To conclude, CRFA is interested in working with government on a made-for-Canada national policy framework that will ensure that Canadians have meaningful information for making healthy choices when they visit their favourite chain restaurants.

In the interests of time, I'm going to provide clarification on our positions on trans fats and sodium during the Q and A.

[The Acting Chair, Conservative, Tim Uppal]

Very good. Thank you.

We'll go to NUTRIUM, please.

[Stéphanie Côté, Dietitian, Public nutrition and communication/media, Nutrition reference centre of Université de Montréal, NUTRIUM]

Good afternoon, my name is Stéphanie Côté, and I am from the nutrition reference centre at the Université de Montréal. Our mission is to educate and inform the public to help people make informed nutrition decisions. Ours is a positive approach that takes enjoyment into account.

I want to talk to you today about diet. And I want to speak to you as eaters, because we all eat, and so diet affects us all, to some degree or another. But we have a problem when consumers think they need a degree in nutrition in order to eat well. Sometimes it feels like you need a degree just to read a nutrition label, especially when faced with an enormous amount of nutrition information, which often does more to confuse than inform.

Nutrition-related communication is an essential tool for prevention. Appropriate and well-directed communication can build nutrition skills, food skills, cooking skills and even parenting skills. But that is not currently the case.

I want to share with you two key communication concerns when it comes to food choices and nutrition.

The first is confusion, due in part to the overabundance of nutrition-related information. There are numerous forums that deal with diet and nutrition, and much of the information and advice comes from unreliable sources and non-experts. Furthermore, the way that reporters and people in the media handle that information is also questionable. Many of the claims that appear on food products only add to the confusion, not to mention the private logos that companies put on many of their own products.

The second concern is the anxiety generated by some of the communications out there. The current approach to nutrition is likely to cause feelings of stress and guilt, especially since products are lumped into two very distinct categories: foods that are good for you and foods that are bad for you. What's more, the approach is often expressed in terms of right and wrong, which can backfire when you are trying to get people to eat healthily. For the past few years, we have been hearing about orthorexia, a fixation with healthy or righteous eating, a relatively new disorder.

I have three major recommendations to address these concerns.

The first has to do with segmentation. Segmenting messages is paramount in order to better engage with the various target groups. Canada's is a very diverse population, and communications need to reflect that. It would be worthwhile to focus efforts on enhancing our knowledge of the various segments of the population, so as to tailor not just the messages, but also the way they are communicated. Numerous factors affect people's needs, receptiveness and understanding with respect to the message being communicated, including literacy, education, ethnic background, language, socio-economic conditions and family. We should not limit our communication to groups who are already interested; it is equally important to target all groups.

My second recommendation is to create an accessible no-charge service, which could take the form of a call centre or an electronic service, where members of the public could, at their convenience, ask nutritionists questions about nutrition, diet or food preparation. This type of initiative would use oral communication and therefore help to target groups with lower levels of literacy. Furthermore, it would also serve as a reliable source of information. People would not have to wonder whether the information came from a credible source, given that they would be speaking with trained nutritionists. Both Ontario and British Columbia currently provide such a service.

And last but not least, my third recommendation has to do with educating children. Teaching children from an early age about foods, healthy eating principles and basic food preparation is key. And obviously, it is important to continue with that education as children get older, to instil in them the knowledge essential to developing healthy eating skills.

Taste-based education is another approach worth exploring. Experts in Europe are particularly interested in the effectiveness of that approach versus one based solely on nutrition. It involves developing a child's joy of eating, helping foster a stronger appreciation of food and possibly healthier eating habits and portion control, which would solve two problems at once.

In conclusion, I would remind you that eating is a natural act. Mealtime should be an enjoyable time. But unfortunately, for many Canadians, the simple act of eating involves constant calculations and stress.

Clearly, our current approach to communication is not working. Not only must we come up with better ways to communicate with a diverse population, but we must also measure the effectiveness of those communication methods.

I want to thank you for the opportunity to be here today. I also want to thank you for your consideration.

[The Acting Chair, Conservative, Tim Uppal]

Thank you.

We will now hear, by video conference, from the BC Healthy Living Alliance.

[Barbara Kaminsky, Chair, BC Healthy Living Alliance]

Good afternoon, Mr. Chair and committee members.

On behalf of the BC Healthy Living Alliance, we would like to thank you for the opportunity to share our experience and views on what can be done to promote healthy living in Canada.

By way of information, BCHLA is an alliance of nine provincial organizations that have been working together since 2003 to address the common risk factors and health inequities that contribute significantly to chronic disease.

While our work has focused specifically on British Columbia, our experience in overseeing $25 million worth of initiatives to address these risk factors and our involvement in policies to reduce health inequities have provided us with a wealth of knowledge that we believe has applicability to Canada as a whole. We have provided copies of a number of our reports to the committee. We hope you'll have an opportunity to peruse them in more detail.

In the limited time available today, we would like to highlight three main areas.

First, to effectively change social norms related to healthy living, we need a holistic and comprehensive approach. We call it a “whole of society” approach. No one sector can do it alone. To see real results, we need to align our priorities and work on a common agenda.

Within governments at all levels there also needs to be a “whole of government” approach. Whether to redress the underlying social and economic determinants of health or to enact specific policies or actions, the health ministry alone cannot do it all. We need accountability requirements for all departments to address the health and health equity impacts of their policies and programs. We also need a commitment from the Prime Minister, premiers, and mayors to put this issue at the top of their agendas. Only in this way will we move towards a healthier Canada, which will also be a wealthier and more productive Canada.

Second, as you well know, whether you will be healthy or not, in many cases, depends less on the health care system and more on your economic and social circumstances. Without focusing on these determinants of health, including income security, food security, housing, early childhood development, and a healthy built environment, among others, we will never really redress the health inequities that continue to plague us or the ever-increasing levels of chronic disease, with the attendant costs for the health care system, currently estimated at $93 billion a year.

Finally, we need to focus on specific policies and actions that can assist Canadians in changing behaviours and in engaging in healthier lifestyles. We would like to share with you some specific examples of where we believe the federal government can play an important role in making this shift.

[Mary Collins, Director of the Secretariat, BC Healthy Living Alliance]

We'd like to focus our suggestions on the issue that is of growing concern in Canada and elsewhere and that you've been hearing about at the committee, the increasing levels of unhealthy weights among both adults and children.

As you've heard from others, currently a quarter of 2- to 17-year-olds in Canada are overweight or obese, and it is estimated that 70% of 35- to 44-year-olds will be in this category in 20 years if nothing changes.

Although the problem is complex, there is a fairly broad consensus on some of the actions necessary to curb it. To make progress on this issue, we need to start shifting the physical and socio-cultural environments that shape our consumption and activity patterns. In our experience, this requires a combination of carrots and sticks—regulation and taxation as well as health-promoting actions that focus on access, education, and skills development required for Canadians to engage in healthy living.

A priority is to ensure Canadians have nutritious food and the ability to make good choices about what we eat. Children in particular need healthy food in order to achieve optimal development, to succeed in school, and to develop lifelong healthy habits.

The federal government can play an important role by restricting the marketing to children of unhealthy foods and beverages. We would suggest to include banning television advertising of unhealthy foods and beverages during programs viewed by children age 12 and under; banning or restricting unhealthy food at grocery store checkouts; banning the use of celebrities or cartoon characters to promote products to children; and banning sponsorship or marketing of unhealthy foods and beverages within school settings. If this can be achieved in cooperation with industry, that would be great. But if not, we would recommend a strong regulatory regime be introduced at the federal level, much as was done for tobacco.

Information is key to decision-making, and in order to make healthy choices, consumers need to have clear information about what they are purchasing. We recommend strengthening the requirements for clear and consistent front-of-package labelling of the contents of packaged foods, providing appropriate information on sugar, fat, and sodium, and clearly relating these to servings. As well, we need to gradually reduce the acceptable levels of sodium and sugars in many of our foods.

While we are pleased that some industry groups have made a start in this direction, there is still much work to be done.

We have been particularly concerned with the overconsumption of sugar-sweetened beverages among young people. One of BCHLA's initiatives, Sip Smart! BC, enabled more than 6,000 school children in British Columbia to learn about the sugar content of what they were drinking and encouraged them and their families to make more appropriate choices. This program is now being expanded to other jurisdictions across Canada with the support of the Childhood Obesity Foundation, CDPAC, and a CLASP grant.

Education is important, but in this case easy access is also a concern. When sugary drinks are often the cheapest and most convenient option, it is no wonder they have been consistently linked with overweight children. Taxation is never a popular choice, but with respect to the challenges we are facing with childhood obesity, we believe an increased tax applied to non-nutrient foods and beverages could limit overconsumption in the same way that tobacco taxes have reduced smoking rates.

Of course, physical activity must play a larger part in the lives of our children and adults. Through the tax system and in other ways, governments can play an important role in supporting measures to promote and facilitate families of all income levels to be able to engage in physical activity. In particular, we suggest the federal government should support other levels of government in ensuring that there is the appropriate physical recreational infrastructure to meet the physical activity needs into the next generation.

Finally, we would like to congratulate Health Canada on its recent health promotion campaign to raise awareness of the links between sugar-sweetened beverages and childhood obesity. But much more needs to be done. We urge the federal government to take a leadership role in working with the provinces and territories, the private sector, and the not-for-profit sector in a joined-up approach to promote, support, and inspire the next generation of Canadians to live not only long lives but healthy ones as well.

[Barbara Kaminsky]

In conclusion, while we know that tobacco is not the main focus of the work of the committee at this point, like many of the other groups that have presented to you, we would like to urge you to support the continuation of the federal tobacco control strategy, which is scheduled to end at the end of this fiscal year. While we have made great progress in reducing smoking, there is still much to be done, particularly with specific target groups such as youth, which we have worked with in our BCHLA initiatives. We would be pleased to share the results of our work, which may help to guide future activities in tobacco reduction.

Thank you all very much, and we look forward to being part of the question and answer period.

[The Acting Chair, Conservative, Tim Uppal]

Very good. Thank you very much.

I will mention that the documents you had provided are being translated and will be distributed to members once they are translated. So thank you.

We now give the members an opportunity to ask questions. We will start with Mr. Dosanjh.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Thank you very much.

All of you, thank you for being here, particularly the British Columbian friends by video conference. It's good to see you, Mary. It's good to see you, Barbara.

[Mary Collins]

Great to see you.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Yes. I'm going to ask you a question first. You've made some good suggestions—obviously more government involvement—and I agree with many of them. I want to ask you a question about menu labelling. You may have a view. What is your view on menu labelling?

[Mary Collins]

We have, in fact, in our proposals to the provincial government, recommended that this is something that should be considered. Certainly, hearing what we did today from the restaurant association, we know it's not easy, and I think we need to look at it somewhat differently, perhaps, than how some of the other jurisdictions have in the U.S. Let's make sure that whatever we do actually will have an impact on consumers.

While much of this is under provincial jurisdiction, we certainly would agree that it would be better for everyone if there were a national approach, so no matter where you are in Canada, you would have a similar opportunity to become more aware of the nutrient values of foods you're going to consume in restaurants.

[Barbara Kaminsky]

Just to further that point, the example that one of the other speakers raised earlier this afternoon is that in some menus there is a huge range of calories that are cited for particular items. That's not very useful information to the consumer, so that would be, I would say, not a best practice and not one worth emulating.

But no doubt it started with the right spirit in mind.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Okay. Thank you.

You mention the tobacco control strategy, and that's the question I want to ask. I'll go to Mr. Cunningham.

Can you tell me what you're hearing with respect to whether or not that strategy is going to continue? You tell me that it's going to expire very soon.

[Rob Cunningham]

Yes. I mean, it's scheduled to expire. The government has engaged in consultations. I think the government is conscious of the deadline. You've heard from the minister her perspective on the importance of tobacco control. Of course, we are getting close to a deadline, and we just want to ensure that everything continues successfully.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

But in terms of any specific decisions, you don't know whether a decision has been made or not, do you?

[Rob Cunningham]

We are not aware.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

By the way, I share your congratulations to the minister. We extend our congratulations from the committee as well for actually coming forward and doing the labelling as it was supposed to be done—in a non-partisan way.

I have a question with respect to the adult fitness tax credit. I think it was raised by the chiropractic association. How do you see that functioning? Who measures whether or not you're actually legitimately claiming the tax credit? How does it function? Have you thought about that?