Health Committee on Dec. 12th, 2011

[The Chair, Conservative, Joy Smith]

We're going to begin.

We're doing a study on health promotion and disease prevention. I want to welcome our witnesses today.

We have with us Ms. Kelly Murumets, the president and chief executive officer of ParticipACTION. Welcome.

From YMCA Canada, we have with us Mr. Scott Haldane, president and chief executive officer. Welcome.

From l'Agence de la santé et des services sociaux de Montréal, we have Dr. Patrick Morency. Welcome.

From Physical and Health Education Canada, we have with us Mrs. Andrea Grantham, executive director and chief executive officer, and Mr. Chris Jones, representative and senior leader of the Sport Matters group. And sport does matter, so it's nice to see you.

We will begin with our presentations. We'll have ten-minute presentations, and after that we'll go into questioning.

We will begin with Ms. Kelly Murumets, please.

[Kelly Murumets, President and Chief Executive Officer, ParticipACTION]

Great, thank you.

Good afternoon. I am absolutely honoured to be here, so thank you very much for the invitation. On behalf of ParticipACTION, we thank you.

For the next ten minutes, I'll just tell you a little bit about ParticipACTION, and why we are back. We were relaunched in 2007, so we'll let you know why we're back, what we have done for the last four and a half years, and the results we have achieved.

ParticipACTION is a national, not-for-profit organization solely dedicated to inspiring and supporting active living and sport participation for Canadians. We were originally established in 1971, and we're a pioneer in social marketing; we have become internationally recognized for our compelling communications to promote physical activity. Throughout the 1971-2007 period, there are indisputable data that point to physical activity levels increasing as ParticipACTION was alive and well and promoting physical activity.

In the late 1990s, core funding for the sector funding began to wane. Without financial support to continue to its campaign, ParticipACTION closed its doors in 2001. With the generous support of Sport Canada and the Public Health Agency of Canada, we were revitalized in 2007 as the national voice of physical activity and sport participation in the country. Our vision is that Canadians will be the most physically active on Earth. That's our vision, and I'm sticking to it.

We were a Canadian icon, and we remain a Canadian icon. Looking at people between the ages of 35 and 54, 88% know ParticipACTION's brand, while 80% of all Canadians know our brand. I come from the private sector, and I moved to the not-for-profit sector because I'd like to go and change the world; I would have died for those brand equity numbers years ago.

ParticipACTION is the galvanizing force that moves Canadians to move more. As a catalyst for action, we really create change through communications, through capacity-building, and through knowledge exchange. Under communications, ParticipACTION promotes active living through multimedia for the purpose of raising awareness, educating, and inspiring—a million-dollar word—behaviour change.

In addition, ParticipACTION works with its partners to coordinate communications and ensure consistent, unified messaging—which is very important in this country—across and within the sector. ParticipACTION's goal is to inspire Canadians to be more physically active and to inspire society to make it easier to do so.

Within capacity-building, it's important that there are programs to support people. To this end, ParticipACTION helps build capacity by generating investment and leveraging assets within the sector. Under that pillar called “knowledge exchange”, ParticipACTION ensures Canadians and its partners are informed by gathering, translating, and disseminating the most relevant information, data, and research on physical activity and sport participation.

We also believe strongly in measurement. We measure everything we do before, during, and after, and measurement is also part of that knowledge exchange pillar. Whatever you remember about ParticipACTION—whether you remember the 60-year-old Swede, the flexed arm hang, or Hal and Joanne—most of you will remember ParticipACTION fondly, so it's wonderful that we're back.

The reasons that we are back are not so wonderful. I'm going to give you some stats, because I strongly believe we have an inactivity crisis in this country. Left unattended, it will have a destructive impact on our health, our economy, and our society in general.

Fewer than half of all Canadians are as active as they need to be. Kids who are active are smarter, happier, and have better self-esteem and mental health. They are better team players. They are less prone to bullying and other negative behaviours. They eat in a better and healthier way, and are less likely to smoke and engage in early sexual activity. However, according to the recent Canadian health measures survey, only 7% of our kids meet the daily physical activity guidelines, which is only 60 minutes of physical activity per day. Only 9% of boys meet that number, and only 4% of girls meet that number—that's disastrous.

Fewer Canadian youth aged 15 to 18 are participating in sport. Sport participation levels have dropped 18 percentage points since 1992. At the same time, chronic disease has been on the rise. Some conditions previously thought to be restricted to older adults—like high blood pressure, heart disease, and type 2 diabetes—are showing up in our young.

The link between physical activity and physical health is certain: the less we move, the more likely we are to become sick and to shorten our life expectancies. In fact, physical inactivity is the fourth leading cause of chronic disease mortality, contributing to over three million preventable deaths annually worldwide.

If you think that's bad, let me tell you about the costs of inactivity. A recent report, Obesity in Canada, prepared by the Public Health Agency of Canada and the Canadian Institute for Health Information, confirms that physical inactivity is the greatest predictor of obesity. In the past 30 years, the percentage of obese adults in the population has doubled, while the prevalence of obesity in children has tripled. Obesity costs the Canadian economy between $4.6 billion and $7.1 billion a year in direct health care costs and in indirect costs such as lost productivity in the workforce.

[The Chair, Conservative, Joy Smith]

Excuse me. Could you slow down just a little bit? The interpreter is having trouble keeping up with you.

[Kelly Murumets]

Yes. I had this happen last year as well, and for me, I'm going slowly.

[Voices]

Oh, oh!

[Kelly Murumets]

Physical inactivity imposes substantial social costs in the form of increased hospital stays and the increased use of physician and nurse services.

Some of these statistics will knock your socks off.

Compared to an active person, an inactive person will spend 38% more days in hospital, use 5.5% more family physician visits, use 13% more specialist services, and use 12% more nurse visits. On an annual basis, the additional use of health care associated with physical inactivity results in approximately 2.37 million family physician visits, 1.33 million other physician visits, 470,000 nurse visits, and 1.42 million hospital stays.

Twenty-five chronic diseases are directly linked to physical inactivity. We know that physical inactivity can increase the risk of coronary heart disease, stroke, hypertension, breast cancer, colon cancer, type 2 diabetes, and osteoporosis.

According to a 2010 report from the Conference Board of Canada, we could save $76 billion over the next 10 years by tackling the five main risk factors for heart disease: smoking, physical inactivity, obesity, high blood pressure, and a lack of fruit and vegetable consumption. Physical inactivity is tied to three of those five.

As has been widely reported, health care costs are consuming a greater proportion of provincial budgets, and we know that here in Ontario if we continue on the same trajectory, within the next 11 to 12 years health care will consume more than 70% of the provincial budget. It's clear that solving the inactivity crisis is a social and economic imperative.

As for solving the inactivity crisis, as a society we are currently failing our children and our youth. The tragedy--and I will use that word, but also the opportunity--is that we're crippling ourselves with diseases and negative outcomes that are truly preventable. But we do have the power to change. As I mentioned, I left the private sector to come to the not-for-profit sector because I would like to go out and change the world. It is possible. We can go out and change the world if we focus on this.

In 2011 the Toronto Charter For Physical Activity was developed, with extensive worldwide consultation, and in that Toronto charter, the Global Advocacy for Physical Activity Council stated its ten different best investments for physical activity. Three of them are those ParticipACTION focuses on.

Number one, through our communications and social marketing campaigns, ParticipACTION uses mass media to raise awareness and change social norms on physical activity. Studies indicate that mass media communication campaigns can influence awareness of the physical inactivity issue and bring about long-term behaviour change.

Our social marketing campaigns do measure everything before and after. We know that our most recent campaign influenced the behaviour of more than 50% of the population in regard to taking action as a result of seeing those ads.

Through its capacity-building initiatives and partnerships with other physical activity, sports, and recreation organizations, ParticipACTION supports community-wide programs that mobilize and integrate community engagement and resources.

Finally, ParticipACTION brings value to the sport and physical activity sectors by assisting organizations to further their mandates through the development and coordination of initiatives. I'll give you just three examples here.

One initiative is Sports Day in Canada. Last year we held our very first Sports Day in Canada. It was a national event. The whole idea is designed to celebrate amateur sport in this country and to increase sport participation. In 2010 we had 35 different sports profiled, a thousand organizations participated, and we were in every province and territory. There were 1.3 million Canadians who participated and we had over 60 million media impressions.

Survey results confirm that the initiative resulted in increased registration and participation in sport programs, 26.5%; increased awareness of sport organizations and programs, 46%; and increased local media attention for events, 23%.

A second initiative is Sogo Active. Sogo Active is for youth, by youth, and is designed to get our youth more physically active, as only 7% of our kids meet the daily physical activity guidelines, and in terms of teenagers meeting those guidelines, even fewer than that. Sogo Active was able to increase teens' physical activity levels by 30 minutes per day on average.

[The Chair, Conservative, Joy Smith]

Thank you, and we'll hear more about that through the questions and answers.

We'll now go to Mr. Scott Haldane, president and chief executive officer.

[Scott Haldane, President and Chief Executive Officer, YMCA Canada]

Madame la présidente and committee members, my name is Scott Haldane, and I am the president and CEO of YMCA Canada.

On behalf of the YMCA and its 53 member associations in Canada, thank you for giving us the opportunity to discuss priorities in the area of health promotion and disease prevention.

The YMCA has a history of over 160 years working on the front lines of health promotion and disease prevention with Canadians of all ages. Our membership now exceeds 2.13 million Canadians, and in 2012 our network of health, fitness, and recreation facilities across Canada will top 120 centres.

The YMCA is the largest non-profit organization in the country that offers services for children. It is a major provider of after-school programs, summer camps, youth exchanges and youth leadership programs. We offer a wide range of employability training programs for people of all ages. We also provide services to newcomers and many other social services in our communities.

As associations, we're committed to strengthening the foundations of communities; nurturing the potential of children, teens, and young adults; promoting healthy living; fostering a sense of social responsibility; and delivering lasting social and personal change.

The YMCA endeavours to find solutions to these issues nationally and internationally.

In March 2011 we hosted the launch of the federal government's healthy weights initiative, “Our Health Our Future: A National Dialogue on Healthy Weights”. This year I've had the privilege of chairing the national panel on elementary and secondary-level first nations education for students on reserve. We've just finished our engagement process, and we are in the process of writing our final report for the Minister of Aboriginal Affairs and for the national chief, Shawn Atleo.

Ida Thomas, the vice-president for children, teens, and young adults at YMCA Canada, is serving as the chair of the Chronic Disease Prevention Alliance. This year she represented them at the UN summit on non-communicable diseases with the Minister of Health.

Recently, we organized a series of workshops for the Canadian Nurses Association on the future of health care in the country. We participated in the annual general meeting of the Canadian Medical Association. We were recently quoted in The Globe and Mail supplement on health determinants.

We know from research and practice that the major determinants of health we must work together as a country to address include education, employment, healthy child development, income levels, personal health practices, the social environment, and social support networks. These health determinants interact in complex ways, a fact that policy interventions often fail to address.

In light of studies on the economic and social determinants of health, we are increasingly concerned by recent trends affecting the health of Canadians, trends whose economic and social consequences have a high cost for Canada and its citizens. Chronic diseases constitute a heavy burden. They cost the Canadian economy nearly $93 billion every year.

Childhood obesity rates have nearly quadrupled in the past three decades. One factor among others is the fact that children and teens are spending only 14 minutes in the after-school hours in active physical activity, according to recent Statistics Canada data.

The number of children with chronic disease is nearly four times the rate it was a generation ago. A flood of chronically ill young adults with weight-related illnesses, such as diabetes and heart disease, is foreseeable. Yet the World Health Organization argues that 90% of type 2 diabetes, 80% of coronary heart diseases, and one third of cancers can be avoided by healthy eating, regular exercise, and non-smoking.

Vulnerable populations--and this is where the determinants of health really come in--are at even greater risk. The Ontario Association of Food Banks pegged the poverty-induced costs related to health care at $2.9 billion in that province alone.

The educational achievement gaps for first nations youth--something I've learned about as chair of the national panel--sets up an ongoing cycle of poverty, disease, and other social issues within those communities, with impacts that multiply at the family and societal level. It has been estimated that closing the education gap could add $179 billion over 25 years to Canada's GDP.

On the economic and employment side, personal bankruptcies are on the rise, and unemployment, including youth unemployment, is increasing. We are increasingly at risk of a whole generation of young people suffering underemployment, with all the concomitant implications for long-term health outcomes.

Canadians are living longer but not better. While life expectancy has steadily increased, the number of years lived in good health peaked in 1996 and has declined every year since.

Some of these statistics might seem surprising, but when you look at it from the perspective of the social determinants of health, you see that they have a significant impact on health outcomes.

TD Economics warns that unless something drastic changes in our approach to health care, it will comprise 80% of total program spending at the provincial level by 2030.

Governments have a crucial role to play in health.

They must propose new solutions and make those that exist even more accessible and affordable. They must be leaders to ensure that health promotion and disease prevention policies take into account the main health determinants, determinants that are interconnected. They must also set targets and assess the results of their actions on health.

I want to make sure that I go to my recommendations, so I'm going to go ahead a couple of pages; it will be in the document.

Our first recommendation from the YMCA is related to the early years strategy. A substantial body of evidence already exists on the impact that early years investments have on later health determinants, particularly through improved learning outcomes and as a predictor for school attachment. For example, YMCA's associations across the country are collaborating with Dr. Paul Kershaw of the College for Interdisciplinary Studies at UBC's Human Early Learning Partnership, a part of the global knowledge hub for social determinants of early development.

As the provinces struggle in this area, there is a strong need for renewed federal leadership, so we recommend that the federal government should immediately re-engage with provincial and territorial counterparts in discussing an early years strategy for Canada in advance of the upcoming health accord renewal.

We also recommend that Health Canada should consider funding an expansion of the aboriginal head start program that currently exists in only 20% of first nations communities, something that would make a significant difference in giving kids a chance to learn when they enter school and a very important investment in first nations health.

Second in our recommendations are opportunities for accelerated support for health prevention. In our 2011 pre-budget submission to the government, the Canadian YMCA asked the government to make the children's fitness tax credit a refundable tax credit and to embark upon a multi-sector strategy to raise awareness of the credit's existence and benefits. This policy was included within the Conservative platform “Here for Canada”, as was doubling the credit's value to $1,000 for eligible activities. Also included was the creation of an adult fitness tax credit covering $500 of registration fees for adults, to be enacted once the budget is balanced around 2015, if all goes well.

But the payback on encouraging physical activities for all ages is clear. We know that extending the program to adults offers both personal health impacts for individuals and financial health impacts for Canada in health costs reduction. So the recommendation is that the federal government should accelerate the introduction of the announced federal adult tax credit to realize early gains from improved health outcomes.

The third area of recommendation is actions to improve health outcomes for vulnerable populations, which again is very strongly supported by the determinants of health. We know that certain groups of Canadian children are at even greater risk than others when it comes to the whole range of health determinants, among them children from low-income households, newcomer populations, and first nations and other aboriginal communities, as we've seen so visibly in the last little while in the press.

I guess I should jump to recommendations.

[The Chair, Conservative, Joy Smith]

Yes, please.

[Scott Haldane]

I'll do that.

[The Chair, Conservative, Joy Smith]

You have 15 seconds, Mr. Haldane.

[Scott Haldane]

Our recommendations in this area are that the federal government must also work across departments, with its partners in provincial and territorial governments, and with the broader Canadian society, to accelerate efforts to address those other health determinants that impede positive education and life outcomes for first nations children and youth, both on and off reserve.

Finally, while improvements to the children's fitness tax credit are applauded, policy changes by governments are also needed to ensure that the resources and training for physical activity promotion in the after-school period are available and sustained.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Haldane.

[Scott Haldane]

Thank you. I'll put the other recommendations forward.

[The Chair, Conservative, Joy Smith]

We'll now go to Dr. Morency.

[Dr. Patrick Morency, Public Health Physician, Urban Environment and Health, Direction de santé publique, Agence de la santé et des services sociaux de Montréal]

Thank you.

We are honoured by this invitation from your committee.

I represent the Montreal Public Health Department. I am here to talk about the transportation system and our efforts in the area of public health to improve public transportation, to facilitate walking, cycling, and physical activity, and to reduce the number of people injured on the road.

Our team is made up of some twenty professionals, including doctors, specialists, geographers and urban planners. We also work with civil engineers. We focus on problems with the built environment and health.

We conduct research with universities. We are also involved in intervention and community action. So we support all efforts to reduce health impacts related to the built environment, such as unhealthy housing conditions, poor outdoor air quality, lack of physical activity and road accidents.

Today we are here to deliver two messages. Our presentation will be brief. The two messages deal with the public transportation system in Canada and in Canadian cities more specifically.

Many health problems are linked to the transportation system and to mobility. Lack of exercise is one of them. Road accidents are another. If we want to facilitate walking, cycling, and physical activity, we must start by developing safer environments.

That sounds easy, but in all Canadian cities, pedestrians and cyclists are exposed to significant volumes of car and truck traffic. The number of injuries is staggering. It is the leading cause of death among young people aged 1 to 35 in Canada and the U.S.

You will be receiving a number of additional documents by email at a later date, but I have attached a map of Montreal Island to the short document. On Montreal Island alone, 1,000 pedestrians, including 300 children, are struck each year and require an ambulance. Safety is the main reason people mention for not walking in Canadian cities.

You will receive graphs, but safety clearly varies with traffic volumes. That is obvious. The more traffic there is at an intersection, the more injuries will occur. More injured pedestrians mean more injured drivers. More injured young people mean more injured older people.

These incidents occur primarily on large arteries. We have seen the problem in Edmonton, Vancouver, Toronto and Montreal. In short, we have seen the trend in all large-size and medium-size cities or smaller cities in Canada. Arteries or busy streets are built primarily for vehicle traffic, and often, not enough time or room is left for pedestrians to cross or for cyclists to ride through. Our first message, therefore, is that safer environments need to be built.

The second message is also simple but nevertheless somewhat radical. We need to see a paradigm shift in the planning of urban transportation. First, we must stop exacerbating the problem by increasing road capacity. We must stop developing the road network and prioritize public transportation. People who use public transportation often walk enough to meet Canada's recommended physical activity levels.

Urban and transportation planning must be integrated. In metropolitan regions, the transportation system needs to be reviewed, or at the very least, development of the road network must be stopped.

At the neighbourhood level, traffic calming plans must be developed and implemented. Curb extensions, medians and shelters must be built. People walking and living in neighbourhoods in Canadian cities must be protected.

The third measure specifically targets pedestrians and cyclists. We must build safer pedestrian crossings which encourage drivers to slow down and stop, which reduce pedestrians' exposure to vehicle traffic so that it is as short in duration as possible, and we must build a network of dedicated cycling lanes to enable cyclists to ride in our cities.

Canada, along with the U.S., is one of the places in the world where people walk the least. Increasing the number of people walking and cycling requires safer layouts and improved transportation systems.

The main obstacle to more walking and cycling in Canadian cities is public space and the fact that automobile traffic is a funding priority. When a highway or a major thoroughfare is built, there is unfortunately not often any space or money left over for bicycle lanes or safer pedestrian crossings.

Over the past 10 years, we have published many scientific articles, briefs and positions on this topic. I would be pleased to answer you, in English or in French, and to provide them to you afterward.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much, Doctor. We appreciate your presentation.

We'll now go to Ms. Andrea Grantham from Physical and Health Education Canada.

[Andrea Grantham, Executive Director and Chief Executive Officer, Physical and Health Education Canada]

Thank you, Madam Chair, for the opportunity to speak to you and your colleagues today.

For the last 18 years I've spent my days trying to ensure that every child in this country can benefit from quality health and physical education programs within health-promoting school environments. For those of you who have worked in health care or education, what I'm discussing won't be news to you and certainly reiterates what my colleagues Kelly, Scott, and Patrick have said today around the rising incidences of physical inactivity and obesity in this country.

Madam Chair, your past work on child trafficking demonstrates care for the well-being of children and youth. Like you, my passion is also the well-being of children and youth, but in terms of preventing obesity and physical inactivity in our kids.

Physical and Health Education Canada is a national voice for physical and health education. We work with educators on the ground and on-the-ground professionals to develop the resources, tools, and supports to ensure that every child in this country has the knowledge, the skills, and the habits that enable them to be physically active right now and in the future. Given that every child in this country goes to school regardless of their background or their circumstances, schools play a key role in ensuring that every child in this country has what they need to be physically active.

Our work at PHE Canada focuses on three key areas. One area is setting standards and advocating for the quality of daily physical education within schools. The second is raising awareness and supporting schools in becoming health-promoting schools, schools that ensure the entire school environment supports and nurtures health and physical activity through its programs, services, policies, and partnerships. The third area is leadership development: supporting leadership in elementary, secondary, and post-secondary education to ensure that our future teachers and community champions can certainly be supporting a physically active lifestyle for their communities.

The best medicine when it comes to improving the health of Canadians and cutting health care costs is prevention. Research shows us again and again the benefits of a physically active nation. Physically active people are less likely to be obese or to suffer from chronic conditions such as cardiovascular disease, cancer, diabetes, and osteoporosis. Their mental health is also improved. Active people have higher self-esteem, less stress, less depression, and strong, supporting networks of peers and friends.

For children who are physically active, we know that they are better learners. They develop good habits early on and lead productive lives--all the more reason why we need to be deeply concerned with the current statistics relating to physical inactivity, obesity, and unhealthy practices.

We know that the status quo in the Canadian health care system involves the federal and provincial levels of government throwing approximately $200 billion annually at remedial or therapeutic forms of care. Much of this is well intentioned, and a good portion of it is critical investment in primary care, emergency care, and hospitals. Nobody would seriously dispute that.

But the costs of physical inactivity are staggering. The economic costs of obesity are estimated at $4.6 billion in 2008--up about 19% from $3.9 billion in 2000--based on costs associated with the eight chronic diseases most consistently linked to obesity. Estimates rise to close to $7.1 billion when based on the costs associated with 18 chronic diseases linked to obesity.

In the packages I handed out today, there is a chart that indicates some of the costs. It basically says that analysis provided to you today shows that, in contrast, all levels of government combined spend the equivalent of 0.9% of this $200 billion on health promotion, physical activity, and sport. The system is grossly imbalanced toward treating the consequences of the obesity and sedentary behaviour crisis rather than preventing it in the first place. The inertia in the system and the incessant demands of the provinces for more dollars means that prevention gets short shrift.

But ultimately, I would contend, there is no other sustainable answer. Social, cultural, and economic realities vary widely across the country, but regardless of this, the needs of adults, youth, and children are the same. They require healthy food choices, access to physical activity, and possibilities for sporting and recreational pursuits. How they are delivered can vary, but the needs remain the same.

As the federal government embarks upon the negotiations leading to the new Canada health transfer agreement, I would strongly suggest that it look to attach conditions to the dollars it sends to provincial governments around the need to demonstrate significant and growing investments in prevention, health promotion, and physical activity.

If you could reroute just 5% of the existing health care expenditures envelope to prevention-based initiatives, my organization and others, like ParticipACTION and the YMCA, would develop the kind of innovative, on-the-ground programming that would arrest the crisis and bring real savings to the system in the medium term.

We all know that education falls under provincial jurisdiction, but the inactivity crisis facing Canada is a health issue and it afflicts every region of this country. Given the national scope of the problem, it seems to me that there is a national responsibility to address it. Leadership is needed to ensure that the policies, programs, services, and supports are in place to ensure that all children are equipped with the skills, values, and habits that they need to be physically active.

Let me take a few moments to illustrate a few of the initiatives PHE Canada is involved with that try to address this problem. Increasingly, the physical activity sector is working together to support efficiencies and to ensure greater impact. One specific example involves the leadership of PHE Canada, working with eight other national partners—the YMCA being one of them—to address the crucial after-school time period and ensure that we develop quality programs that promote physical activity, healthy eating, and leadership development.

The after-school time period, which is from 3 p.m. to 6 p.m., is a critical determinant of childhood physical activity. Approximately 50% of daily steps are taken by children during this time period. Many children and youth left alone during the after-school time period tend to watch television, be on the computer, or play video games, instead of playing outdoors.

Researchers also report poor eating habits and increased crime and anti-social behaviour during that time. Already, the Canadian Active Living After School partnership is showing signs of success. For example, as one part of this project, the Boys and Girls Clubs of Canada has been able to implement an active transportation program, which gets students walking from school to their clubs. The program leaders find that this walking time allows them to engage with the youth and augment the program to address their needs. Teaching kids how to become responsible for their own health early is key.

Secondly, PHE Canada is leading the development of a pilot initiative that supports the development and advancement of physical literacy among children and youth through the creation of resources and tools to assist teachers and other intermediaries in assessing levels of physical literacy, while working with those children to set individual goals to help them to make improvements.

We are seeking to impart skills that enable individuals to make healthy, active choices that both benefit and respect their whole selves, others, and their environment. The pilot is being run in Ontario, Alberta, and Saskatchewan in grades 4 and 5, beginning in January 2012. We are seeking very modest federal funding for this initiative of $13 million over six years. It was contained in our pre-budget submission to the Standing Committee on Finance.

These and other similar initiatives, such as those developed by my colleagues at ParticipACTION and Jumpstart, help children and youth develop an appreciation for physical activity and a confidence to engage that stays with them throughout their lives.

In conclusion, I believe that the timing is right for the federal government to begin to reshape the terms of the health care debate, so that we place a greater emphasis on prevention and physical activity, and on programming that gets to the roots of conditions before they become problems.

As I conclude, I would like to reiterate that we need a greater investment in preventative activities by taking the bold and audacious step of rerouting just 5% of existing health care expenditures to prevention-based approaches, including after-school programs, greater leadership opportunities for youth at risk, and a national program that promotes physical literacy among children.

We can begin to turn this ship around.

Education, consciousness-raising, and dissemination in the school system, at the community level, and within immigrant settlement agencies—these are the ways to break our health care system out of its current spending spiral.

Thank you.

[The Chair, Conservative, Joy Smith]

We thank you, Ms. Grantham. That was a very good presentation.

All of you have given excellent presentations today and have contributed to our study on health promotion and disease prevention.

We'll go into the first round of seven-minute questions and answers, and we'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

Thank you to the witnesses for coming today. You all made great presentations. The statistics you gave us are truly alarming, if not scary. I think we hear that loud and clear.

Mr. Morency, in one of your diagrams here, there's one area of Montreal that looks solid red in terms of injured pedestrians. I come from Vancouver, and I know the city of Vancouver has done a fantastic job of enhancing pedestrian and bicycle pathways and trying to enhance safety. I think our cities have actually done a really good job of trying to do that. Thank you very much for the information from Montreal.

A number of you mentioned the health accord that we have and the one that will come up. I guess that's really where I'd like to focus my comments, because so much of what you've told us we know to be the absolute truth. I don't think we can rely on tax credits to turn the ship around, although refundable tax credits obviously would be better. So even in terms of the existing accord, which is not yet over, I do think that this issue of healthy outcomes, which you've all spoken about, is critical.

I wonder what you might put forward specifically. We know that in January there will be a premiers conference on health care. If you were at that table, what would you be banging your first on the table about? If we want to make that shift of 5%, do we do it through incentives? Do we do it by focusing more on early childhood development and healthy children? Do we do it more by looking at the social determinants of health Mr. Haldane spoke about? If you were at that table, what would you say? Where would you say the money should go? Where should it be shifted to get that buy-in, both at the national and at the provincial and territorial levels?

[The Chair, Conservative, Joy Smith]

I guess you all want to make a comment on this.

Mr. Haldane, please begin, and then we'll hear from Dr. Morency.

[Scott Haldane]

I think it has to do with the frame that we use to think about health. I think the health accord as it existed previously had a frame of curing disease and responding to illness, which is important, but it is a vicious circle, in that the more we respond to disease and the more we're in a reactive kind of mode, the more difficult it is to get ahead of the game. So I think we need to change the frame to a more preventive approach, and, as my colleagues have mentioned, to balance the expenditures to a greater degree. It's a tough situation to get out of, because when you're sick, you want care, but somehow we need to push to the other side.

I also think the social determinants of health are a very important part of that frame, because health outcomes are dramatically skewed, partly by healthy lifestyle choices by all of us, but to a much greater degree by people who are in low-income situations, people who have low education who are facing other kinds of vulnerabilities. So it's the frame that I think needs to change.

[The Chair, Conservative, Joy Smith]

We want to make sure that others get a chance.

Dr. Morency and then Ms. Murumets.

[Dr. Patrick Morency]

Thank you.

The problem as we see it is that the health sector tried to cure and prevent, but other sectors, such as the transportation sector, spent billions to increase the problems: mobility problems, physical inactivity, air pollution, and pedestrian and cyclist injuries. So if you ask me what the first target should be, we feel it should be to stop spending money to increase the problem. It involves a sector other than the health sector. It's a transportation sector issue as well.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Murumets.