Health Committee on Dec. 5th, 2011

[The Chair, Conservative, Joy Smith]

We'll convene the committee now. I want to welcome our witnesses and thank you so much for your patience, as we were conducting a brief but very important business meeting prior to your entry.

We are studying, as you know, health promotion and disease prevention.

From Health Canada, we have Ms. Catherine MacLeod, associate assistant deputy minister of the health products and food branch. Welcome, Ms. MacLeod. We also have Dr. Hasan Hutchinson, director general, office of nutrition policy and promotion. Welcome, Dr. Hutchinson.

From the Public Health Agency of Canada, we have Ms. Kim Elmslie, director general, Centre for Chronic Disease Prevention and Control. Welcome again. I'm glad to see you here.

From the Canadian Institutes of Health Research, we have Dr. Nancy Edwards, scientific director, Institute of Population and Public Health. Welcome, Dr. Edwards. And we have Dr. Philip Sherman, scientific director, Institute of Nutrition, Metabolism and Diabetes.

We're very happy that you're here to give testimony. As you know, one of you from each organization will give a 10-minute presentation and then we'll go into the Qs and As.

From Health Canada, who would like to present there? Ms. MacLeod.

[Catherine MacLeod, Associate Assistant Deputy Minister, Health Products and Food Branch, Department of Health]

Thank you very much, Madam Chair. I am very pleased to be here today with my colleagues from the Public Health Agency of Canada and the Canadian Institutes of Health Research.

Eating plays an important role in promoting health and reducing the risk of nutrition-related chronic diseases. The federal health department has been providing leadership in nutrition since the 1930s and has a long history in health promotion and chronic disease prevention. Documents like the Ottawa Charter for Health Promotion brought in the traditional view of health and spurred ground-breaking advancements in health promotion. Nutrition was an integral part of the health promotion thinking then, as it is today.

We know that Canada is a different place than it was 30 years ago and that our socio-demographic and cultural profile has changed. Today Canadians live in an environment that poses unprecedented challenges to the goal of healthy eating. There has been a significant evolution of the range of foods available in the marketplace. Time pressures faced by busy families have changed the way Canadians eat. That's why we need to create social and physical environments that support healthy eating and make healthy choice the easy choice for Canadians. This requires a comprehensive, multi-sectoral approach that uses a range of policy and program tools and levers.

Canada is already making important strides. As Mrs. Elmslie mentioned, the endorsement of a Declaration on Prevention and Promotion by Ministers of Health further emphasizes the importance of making the promotion of health and the prevention of disease a priority for action in all jurisdictions across the country.

The endorsement of the first report entitled Actions Taken and Future Directions 2011 on curbing childhood obesity at the November 2011 Health Ministers Meeting is also an important milestone in helping to advance healthy eating efforts in Canada.

Action to improve nutrition and healthy eating is a shared responsibility among different levels of government, non-governmental organizations, industry and Canadians. Health Canada has a critical national leadership role to play in supporting healthy eating through the development of national nutrition policies and guidelines, enhancing the evidence base to support policy decisions, monitoring and reporting on what Canadians are eating and providing Canadians with information, through education and awareness initiatives, to help them to make informed healthy eating choices.

The most well-known national nutrition policy developed by Health Canada is likely our Eating Well with Canada's Food Guide. The food guide promotes a pattern of eating that will meet nutrient needs, promote health, and minimize the risk of nutrition-related chronic diseases. It's not only designed to help explain to Canadians what healthy eating means, it's also an important policy that underpins nutrition and health policies and standards across the country and serves as a basis for a wide variety of nutrition initiatives. The 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 has distributed nearly 22 million copies of the food guide since its release in 2007. In 2010 the food guide's home page was the second most-viewed page on the Health Canada website.

While the food guide is an important policy that defines healthy eating, it's only one component of a range of actions needed to improve the nutritional health of Canadians. Health Canada's work to provide health professionals with the latest nutritional advice related to prenatal nutrition and infant feeding guidelines are other examples of how the department translates evidence to support and promote healthy eating through specific life-stage guidance. For instance, this year we released revised gestational weight guidelines for health professionals, and consumer materials to help both health professionals and expectant mothers manage weight gain during pregnancy. We're currently working on revising infant feeding guidelines for health professionals through a joint process with the Dietitians of Canada, the Canadian Paediatric Society, and the Breastfeeding Committee for Canada.

Policies and programs that support healthy eating require a strong evidence base and a capacity to measure progress and outcomes. The external community is a significant source of information, nutrition science, and evidence on effective interventions, allowing us to tap into the best and brightest for any given nutrition issue. This broad reach enhances our leadership capacity in nutrition and ensures that the most effective nutrition solutions are delivered to Canadians. A key example is the collaboration between Canada and the U.S. through the Institute of Medicine to support dietary reference levels. They are the scientific underpinnings for national dietary guidance.

Monitoring and reporting on what Canadians are eating, and on the factors that influence food choice and nutritional health outcomes are also major components of Health Canada's work, including the analysis and sharing of nutrition data from the Canadian community health survey, which focused on nutrition in 2004. It was the first time in 30 years that a comprehensive survey was done on what Canadians were eating. This survey will be repeated again in 2015, which will help us to understand changing food and nutrient consumption patterns and see how eating patterns in Canadians align with our efforts to support healthy eating.

Healthy eating education and awareness activities are also key components of work at Health Canada. In collaboration with the provinces and territories, we are developing multi-year Healthy Eating Awareness and Education initiatives that will provide clear and consistent healthy eating messages for Canadians. We continue to enhance efforts to improve consumers' understanding of nutrition labelling, through initiatives such as the Nutrition Facts Education Campaign. Earlier this year you may have seen our ads on TV that promote the understanding and use of the Nutrition Facts table, specifically the % Daily Value found on packaged food labels, and encourage Canadians to look for more information on Health Canada's Web site. This campaign is an innovative example of how stakeholders who share responsibility for promoting healthy eating, such as the food industry, health professional associations and non-governmental organizations, can work together.

The Eat Well and Be Active Educational Toolkit, developed with our colleagues at the Public Health Agency of Canada, is an example of integrating healthy eating and physical activity. The toolkit includes the Eat Well and Be Active Every Day educational poster and downloadable activity plans. It is designed to help health educators teach children and adults about healthy eating and physical activity and to encourage them to take action to maintain and improve their health.

Reaching out to other groups, such as health professionals, researchers, policy-makers and academics, allows us to leverage expertise, enhance collaboration, cooperation and alignment of efforts to support healthy eating in Canada. This includes working closely with our provincial and territorial government colleagues.

Let me conclude by stating that healthy eating continues to play an important role in promoting health and reducing the risk of chronic disease. We're committed to continuing our efforts to promote the nutritional health of Canadians.

Thank you very much for the opportunity to present today.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. MacLeod. It seems like such a simple thing, but it has become very complex now, hasn't it, with our childhood obesity rates in this country.

Thank you for presenting.

We'll go to Ms. Elmslie, from the Public Health Agency of Canada.

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

Thank you very much, Madam Chair.

I'm very pleased to be here today to discuss the importance of health promotion, and to describe some of what we've achieved in this area.

I want to say that your interest in health promotion is very timely, given that 2011 marks the 25th anniversary of the Ottawa Charter for Health Promotion. Some of you may remember—and many of you will not—that this landmark document was the defining moment for us in Canada by establishing a new way of looking at health and at ways to promote health.

I just want to remind you, because it sets an important stage for our discussion, that the Ottawa Charter for Health Promotion identified five areas for action, namely: the development of personal skills so that people could stay healthy; the strengthening of community actions so that communities could support people in staying healthy; the creation of supportive environments; the reorientation of health services to focus and balance the emphasis, so that we include health promotion and disease prevention in them; and, of course, the building of healthy public policy. Twenty-five years later, we can look back and say that we've made a great deal of progress in this country.

Our approach has evolved and continues to evolve so that we are not just treating individuals who are sick, but are placing a strong emphasis on the promotion of good health and the prevention of chronic disease. These factors are becoming more and more part of the way Canadians and their health care providers are talking about health.

Evidence of the leadership role that Canada has played includes the development of the recent Rio Declaration on the Social Determinants of Health. Our leadership role in Canada is also apparent in the Declaration on Prevention and Promotion, wherein Canada's health ministers have committed to work together and, with their partners in other sectors, to build and influence physical, social, and economic conditions that promote the health and wellness of Canadians. There is a spirit of collaboration that has certainly become ingrained across the country, as we recognize that we must work together and must bring other sectors into our collective objectives of helping Canadians to live longer and healthier lives. That foundation is serving us well.

We all know that Canadians experience better health outcomes than citizens of many other countries. Statistics Canada recently reported that the life expectancy in Canada had reached a new high of 80.9 years. We also are proud that our infant mortality rate has declined steadily in Canada since 1982. Based on data from the Canadian community health survey, we know that Canadians are reporting that they believe their health is good, very good, or excellent. Almost 90% of us are reporting that.

Even so, we know that much more needs to be done, and we know that not all Canadians enjoy the same level of health. When we talk about health, we're talking about both the physical and, very importantly, mental health of all Canadians.

The burden of chronic disease—as I've told you before when I've been at this table—is growing. Chronic diseases and injuries are the main causes of death and ill health in Canada. However, we know that a large proportion of that burden can be delayed or prevented. As you also know, the government recently participated in a United Nations meeting at which Canada and other countries around the world unanimously endorsed a political declaration that placed a priority on the prevention of chronic disease, and recognized the need for many sectors to work together to achieve our objectives.

Today I'd like to focus on the upstream action that we are taking, that is, how we are working together to make the healthy choices the easier choices for Canadians, as Ms. MacLeod referenced earlier, so that we can enjoy long and healthy lives.

Let's start with some of the basics. Experience and research tell us that health promotion should begin early, and must continue throughout the someone's life course. Promoting healthy living in children sets the stage for good health and reduced risk of chronic diseases in later years. The prenatal period offers a unique opportunity to set a child on a path to lifelong good health. Canada has done well in providing comprehensive prenatal care and promoting positive prenatal behaviours. For example, we disseminate The Sensible Guide to a Healthy Pregnancy, a tool that supports pregnant women in making healthy lifestyle choices. Recognizing that fetal alcohol spectrum disorder, or FASD, can have a profound effect on Canadian families and society, we have also supported the development of the world's first consensus clinical guidelines for alcohol use in pregnancy and a tool kit to identify children and youth affected by FASD.

Just as there is great benefit to supporting healthy pregnancies, we know that investing in early childhood is extremely valuable. Indeed, the World Bank estimates that for every dollar invested in children, $3 in future health savings is realized. Among our investments in maternal and child health are over $112 million annually to support vulnerable children and their families through the community action program for children, the Canadian prenatal nutrition program, and the aboriginal head start program in urban and northern communities. Together, these programs represent important upstream investments. They reach over 100,000 vulnerable Canadians each year.

Along with these important programs, we are also investing in strategic initiatives that support maternal mental health, reduced childhood exposure to tobacco smoke, improved oral health, and the prevention of unintentional injury.

On the latter issue, unintentional injuries are an incredible threat to the health of children and youth. Many of these injuries are related to sports and recreational activities. While we want to ensure and promote activity among Canada's children and youth, we also want them to be active safely. To that end, in March of this year the Government of Canada announced a $5 million investment over two years to support initiatives that empower Canadians to make safe choices. The active-and-safe initiative will focus on preventing concussions, drownings, and fractures and on promoting the safety of children and youth in high-participation physical activities.

We also know, sadly, that mental illness and suicide begin to appear in adolescence and early adulthood, and we recognize the importance of improving the mental health of all Canadians. Through the investment in the Mental Health Commission of Canada, a dialogue has been initiated about these sensitive issues. We're learning more about how to reduce stigma and how to better support Canadians. We continue to invest in programs that increase awareness, strengthen protective factors, and build resilience.

We have invested over $27 million through the Public Health Agency of Canada's innovation strategy to support projects that reduce health inequalities, promote positive mental health, and develop protective factors for children, youth, and families. For example, we are providing funding to support collaboration among the Canadian Mental Health Association, the British Columbia Association of Aboriginal Friendship Centres, and the University of Northern British Columbia to improve the mental health of young aboriginal families. This multi-stakeholder, community-wide approach is intended to counter anxiety and depression among youth and to prevent problem behaviour, such as substance abuse, delinquency, and teen pregnancy.

Similarly, together with the provinces and territories, earlier this year we initiated a pan-Canadian dialogue about childhood obesity. Not only have these conversations raised awareness about this critical public health issue, but they have also served to get people thinking about the part we all must play in a made-in-Canada solution.

As I mentioned earlier, Canadians are living longer than ever before. We know that a longer lifespan comes with an increased risk of chronic disease. But the pressures of an aging population are not unmanageable. We know that health promotion interventions benefit people of all ages, even the very old. Research shows that health promotion for older adults not only improves health behaviours and, as a result, health outcomes and quality of life, but also has very a real impact on reducing health care costs.

Quite simply, healthy seniors makes less use of health care services, and they live longer and better. Studies show, for example, that long-term care residents, often the oldest and frailest of our citizens--

[The Chair, Conservative, Joy Smith]

Ms. Elmslie, you've gone quite a bit over time. Can you wrap it up, please?

[Kim Elmslie]

I'm sorry. I'm going to wrap this right up.

Our oldest citizens can benefit from health-promotion activities.

Let me finish with an acknowledgement that, first and foremost, we must recognize that public health is not just a health issue. Promotion and prevention involve all of us, in many different sectors, at a level of collaboration that perhaps we haven't seen before in this country.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Elmslie.

[Kim Elmslie]

It was my pleasure.

[The Chair, Conservative, Joy Smith]

Thank you. I'm sorry, but there will be lots of time for questions. It was a very good presentation, but I let you go quite a bit over to try to finish it. Thank you.

We'll now go to Dr. Nancy Edwards of the Canadian Institutes of Health Research.

[Dr. Nancy Edwards, Scientific Director, Institute of Population and Public Health, Canadian Institutes of Health Research]

Thank you, Madam Chair.

I'd like to thank the House of Commons standing committee for this opportunity to speak to you as you prepare for your study on chronic disease prevention and health promotion.

Chronic diseases are a leading cause of death and disability worldwide and, according to recent World Health Organization statistics, kill 36 million people globally each year. In Canada, it is estimated that 89% of all deaths can be attributed to chronic diseases.

Health promotion and primary prevention are key approaches to changing these numbers. Regular physical activity, healthy eating, eliminating smoking, and reducing excessive alcohol use could prevent up to 80% of diabetes and cardiovascular diseases and 40% of cancers.

The magnitude of the current and anticipated burden of chronic disease is Canada's largest public health challenge. It will require new approaches. Evidence shows that interventions need to consider the broader social, cultural, and environmental factors that determine the health of Canadians. For example, the places where we live, work, play, and learn have profound impacts on our health.

Every child deserves the best start, irrespective of his or her socio-economic circumstances. Social and structural determinants, such as income and income distribution, education, job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety, access to health services, aboriginal status, gender, race, and disability are all critical drivers of health inequalities in Canada and must inform effective interventions.

Because these factors may be present from early childhood and accumulate over time, a life-course perspective is required. Research provides the evidence for the development of effective public health measures that will prevent chronic diseases. The Canadian Institutes of Health Research is committed to the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system.

Notably, one of CIHR's research priorities is to promote health and reduce the burden of chronic disease and mental illness. CIHR has further recognized that health and illness are distributed in inequitable ways across populations. Therefore, CIHR also has a research priority aimed at reducing the health inequities faced by aboriginal people and other vulnerable populations.

These research priorities are being realized, in part, through large new projects that we call signature initiatives. In particular, the signature initiative in community-based primary health care covers a broad range of primary prevention, as well as public health and primary care services within the community, including health promotion and disease prevention; the diagnosis, treatment, and management of chronic and episodic illness; home care; rehabilitation support; end-of-life care, and more. The initial focus of this initiative has been to support research into better systems for chronic disease prevention and management and access to appropriate care for vulnerable populations.

A second signature initiative relates to pathways to health equity for aboriginal people. This initiative aims to increase the capacity of aboriginal communities to act as partners in the conception, oversight, and application of high quality research to reduce the health disparities of aboriginal peoples. Rather than just describing the extent of the problem, the focus at the CIHR Institute of Population and Public Health has been on generating evidence on what policy and program interventions work, for whom and under what conditions and at what cost. This is the only way to curb the burden of chronic disease and to learn about the impacts of existing measures.

The urgent need for intervention research has been recognized by the WHO Commission on Social Determinants of Health and by the Senate Subcommittee on Population Health in its 2009 report, “A Healthy, Productive Canada: A Determinant of Health Approach”.

CIHR has made investments in policy-relevant research related to chronic disease risk factors. For example, Dr. Geoffrey Fong and his team at the University of Waterloo recently received one of the largest operating grants ever awarded by CIHR for the team's ground-breaking work on tobacco control policies around the world.

CIHR's efforts have not been limited to Canada. As noted in the recent United Nations political declaration on non-communicable diseases, chronic diseases are a global health and development challenge.

CIHR is a founding partner in the Global Alliance for Chronic Diseases, and through this international collaboration, we are funding research to support the effective scaling up of interventions related to chronic disease risk factors, such as hypertension. In sum, CIHR is committed to both the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a stronger health care system.

Research can contribute to the generation of evidence-informed, cost-effective, and sustainable solutions that make a difference to Canadians and prevent chronic disease. This is a key area of focus for CIHR within Canada and globally.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Edwards.

We have very interesting presentations today.

You were going to split your time with Dr. Sherman, so we'll now go to Dr. Sherman for his presentation.

Thank you.

[Dr. Philip Sherman, Scientific Director, Institute of Nutrition, Metabolism and Diabetes, Canadian Institutes of Health Research]

Thank you very much, Madam Chair. I'd like to thank the Standing Committee on Health for this opportunity to speak about the Canadian Institutes of Health Research's contributions toward health promotion and disease prevention.

CIHR proudly supports basic biomedical and patient-based research. These are essential to improving our current understanding of the causes and the underlying mechanisms of chronic disease. By better understanding the causes, we can determine more effective strategies to address underlying risk factors and thereby prevent disease. CIHR also funds clinical patient-based research to determine the best ways to manage and treat chronic diseases. This type of research provides high-quality evidence to improve clinical practice, enhance patient care, and optimize health outcomes. CIHR is working together with provincial and territorial governments, health charities, academic health care organizations, and representatives of industry to develop a comprehensive strategy for patient-oriented research. This strategy aims to strengthen clinical research and improve the transfer of research evidence into evidence-based practice so that the right patient receives the right treatment at the right time.

This strategy offers the opportunity to move bench-top discoveries to the clinic or bedside and has the potential to radically improve the lives of Canadians suffering from chronic disease.

A compelling Canadian example to illustrate such an impact is the discover of insulin. I recently participated in events to commemorate the 90th anniversary of the discovery of insulin, done in Canada by Drs. Banting and Macleod, who were awarded the Nobel Prize in Physiology or Medicine in 1923. Thanks to this discovery of insulin, today many Canadians with diabetes live long, healthy, and productive lives.

CIHR provides funding to support research across the country that addresses chronic disease. For example, CIHR provided $44 million in 2010 to support Canadian diabetes research, and millions more to support research related to cancer, heart disease, and strokes.

Dr. Edwards already spoke about the risk factors associated with chronic disease, such as lack of physical activity, poor diet, smoking, and excessive use of alcohol. Together with my colleagues from the Public Health Agency of Canada, I want to add obesity to the list of risk factors, because obesity is now a world-wide epidemic. Since 1980, obesity rates have doubled or even tripled in many countries. Indeed, in more than half the countries in the Organisation for Economic Co-operation and Development, more than half the population is classified as being overweight. We don't have reason to be complacent in Canada, because in 2007–08, roughly one in four Canadian adults was obese, and a quarter of Canadian teenagers were obese or overweight during the same time period. A recent international review of the CIHR confirmed that our institute's strategic focus on obesity has had a transformative impact on this field of research in Canada, and that our institute has built a community of obesity researchers of international visibility and international stature.

Much of the obesity research funded by CIHR focuses on prevention. For example, CIHR funds research projects on how the built environment and neighbourhood design impacts obesity, on how tax incentives affect children's physical activity, and how a family intervention program for obese and overweight women during pregnancy and the first year after delivery affect childhood obesity. As examples of outstanding research CIHR has funded, I will cite the work of two researchers who are both undertaking research related to the school environment and its impact on childhood obesity. Dr. Rhona Hanning is looking at the impact of a school-based education program on the consumption of sugar-sweetened beverages and body weight in children. Dr. Veugelers is performing an economic evaluation of a school-based program aimed at the prevention of childhood obesity.

Moving forward, our institute has prioritized research in the area of food and health. According to the World Health Organization, nutrition and micro-nutrient deficiencies continue to be a widespread problem globally, especially among women and children. These deficiencies often co-exist with obesity and diet-related chronic diseases. A diet high in sugar, salt, and saturated fat and low in nutrients is linked to some of the most prominent chronic diseases in Canada, including type 2 diabetes, high blood pressure, cardiovascular disease, stroke, and cancers.

In November of last year, our institute hosted a national workshop to identify research gaps and opportunities in the area of food and health research. This workshop highlighted research related to nutritional vulnerability, emerging food technologies, food policies, food security, and human nutrition. We will soon be launching a research funding opportunity to catalyze food and health research in Canada and build on a recent funding opportunity that we supported in the area of sodium reduction and how it impacts human health.

CIHR's ongoing investments in research will serve to transform health promotion and disease prevention efforts, as well as impact clinical practice so as to improve the health of Canadians and contribute to a stronger and sustainable health care system.

Thank you for your attention. My colleagues and I would be pleased to take your questions, comments, and feedback. Merci.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Sherman.

As I said, everyone here has given very insightful presentations today.

We'll now start with our first round of Qs and As for seven minutes.

We'll begin with Dr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Madam Chair.

First of all, when I think of prevention, I think about the food we eat. In my opinion, the main problem with food currently, especially where young people are concerned, is the level of sodium contained in food products.

The average amount of salt consumed by the population is 3.4 mg per day. Ideally, according to the recommendations, this should be around 1.5 mg. The maximum level is 2.3 mg; beyond that, there are health risks involved.

Given that the daily consumption average is 3.4 mg, the health of the population is in jeopardy. Indeed, a working group was struck by the federal government precisely to examine that issue. According to the recommendations of this group, the government should impose targets on the food industry. Unfortunately, last month the federal government refused to do so.

My question is addressed to Ms. MacLeod.

Can you attempt to justify that position? It seems to me to be a matter of simple common sense. Mr. Sherman also mentioned the issue of salt. I know that you negotiate with the food industry, but how is it that there are no targets and that the federal government does not want to strengthen targets? This is so important for the Canadian population.

[The Chair, Conservative, Joy Smith]

Who would like to take that question?

Ms. MacLeod?

[Catherine MacLeod]

Yes. Thank you very much.

That is a very good question. Where salt is concerned, we have a lot of activities that are ongoing. I will give you an overview.

On sodium, it's a multi-partnership initiative to move forward. This government is very committed to reducing the levels of sodium that Canadians are eating. We've set a target for 2,300 milligrams per person per day by 2016. Working together with provinces, territories, non-government organizations, and industry, we have a three-pronged approach.

The first part, of course, is education and awareness. Individuals have to be aware of what they're eating and of portion control, making healthy choices based on the nutritional value of the food they select to eat. That is the first part. We support education and awareness, of course, and the federal government, with non-government organizations, is developing messages and so on about healthy eating and sodium.

Second is the research component. It was touched on by my colleague a little earlier, who can go into that in more detail, but it has to do with surveillance of the how much sodium the Canadian population is currently eating, and monitoring that as we move forward. That is very important.

Finally, we are working closely with industry, as we have been doing over the last year particularly, to focus on providing technical guidance to help them reduce sodium in processed foods and so on, so that different choices are available to Canadians.

Those are the three key areas in terms of progress for the government on sodium.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Well, that is one avenue. However, I think that you are underestimating the problem. Last month, the Heart and Stroke Foundation had some very harsh words for you and your lack of action.

Of course your first objective is to better inform the population and to raise awareness. But currently research shows that children as young as one year old are consuming twice the recommended amount of sodium. In the case of young children awareness-raising is not the issue. The food industry has to have some binding targets. The fact is that it costs less to put salt in products to give them flavour. However this is very damaging for the health of the Canadian population.

[Catherine MacLeod]

The facts table now contains percentage points for sodium, which will help parents to make informed decisions for their children about which foods are appropriate and where they can make those healthy choices.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'm going to change topics.

There is another controversial decision. You decided to go against the opinion of your expert panel with regard to energy drinks. You decided to put these drinks in the food category.

Now that energy drinks are considered to be food, where are they in Canada's Food Guide? All the more so since this would lead one to think that they do not have adverse effects on the children who consume them? And yet the expert panel had strongly recommended that they not be consumed by children. Since they are currently being considered as food products, just like any other food product, where would one find them in Canada's Food Guide?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

Ms. MacLeod.

[Catherine MacLeod]

Thank you very much, Madam Chair.

That's a very timely question as well. We are very concerned about the use of caffeinated drinks, particularly among children and youth. We recently announced our proposed policy moving forward for energy drinks, and that would be to move them under the food regulatory framework.

We've analyzed a number of sources of information. Yes, the panel also looked at many other countries and jurisdictions, and reviewed the science and evidence base and usage patterns, and so on. We've determined that the food framework will allow Canadians moving forward to make the best decisions around consumption of these drinks, particularly for their children.

It's very important to recognize the need for clarity on the labelling, whether it be warnings for pregnant women or children and teenagers under the age of 18, including how not to substitute the energy drinks for other beverages, and so on. If that is clear, we feel that we'll have more clarity on that front under the food framework. We're also going to monitor over time the consumption patterns and make course corrections as needed.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I'm going to change topics again.

So we are really talking about health promotion; one thinks of exercise and nutrition. However, when we talk about prevention in the area of mental health, what sort of concrete advice can you give people to improve prevention? I'd like to open up this question in order to find the best possible answer. How does one encourage prevention when it comes to mental health?

[The Chair, Conservative, Joy Smith]

Who would like to answer that?

Ms. Elmslie.

[Kim Elmslie]

Thank you very much for that question.

First, as you know, the government has put resources into the Mental Health Commission of Canada to ensure that we're paying attention, in a pan-Canadian way, to very important issues around stigma and improving the dialogue about mental health. Importantly, the Mental Health Commission is developing a strategy for the country that we expect will be released early in the new year.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Elmslie.

We'll now to go to Mrs. Block.