Health Committee on Dec. 12th, 2011

[Parm Gill, Conservative, Brampton—Springdale, ON]

I have one quick question for YMCA Canada.

Your organization is dedicated to the growth of all people in spirit, mind, and body. How does the spirit component affect health? What does the YMCA do to promote growth in spirit?

[Scott Haldane]

Thank you.

While our roots are connected to the Christian religion, today we are actually an organization involving people of all denominations. In fact, our incoming board chair is Muslim by faith. So we're an organization that celebrates all faiths today.

On the spiritual side, we look at it as the spirit of philanthropy, the spirit of generosity, and the spirit of community, so we look at it from a values point of view. I think the research is quite clear that when people have a sense of community—and this is a part of the determinants of health—they feel that they participate in the spirit of their community; they're engaged in helping others and in providing service to others, and those kinds of things, such as volunteerism. These are all very important aspects of health.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Haldane.

We're having a very interesting dialogue today.

Ms. Sgro.

[Judy Sgro, Liberal, York West, ON]

Thank you very much, Madam Chair.

Welcome to all of you.

The work you do is probably never appreciated enough. Keeping Canadians healthy is probably the only way we're going to save some money for the future so we'll have enough money in our health care system. Continuing to focus on that is extremely important.

How are the needs for healthy programs and good nutrition--for instance, the breakfast programs we have in many of our communities--tying in with after-school activities, which are also needed to ensure our kids are getting that activity, rather than sitting in front of the computer, which tends to be what most of them are doing, even in the after-school programs? How closely are you working with those different organizations that are producing those programs? How much are you working with our school boards, which have the great opportunity to deliver them and to influence them?

Whoever would like to answer first can go ahead.

[Andrea Grantham]

I can say that the main focus of our active after-school partnership, on which we are working with eight other national partners, is to ensure that we can integrate physical activity and healthy living as core aspects of the program. We're looking to influence policy, programs, knowledge awareness, and capacity-building among leaders so they can deliver programs that are true to physical activity and healthy living, as well as to create access to the resources and tools that are available to them. One of the things we are developing is a hub, in which we can house all the information on things like breakfast programs and other excellent tools delivered through the YMCA, the Boys and Girls Clubs, and others, so that anybody who's delivering an after-school program, whether it's within a school, a community, even a home-care environment, can access information on how they can take that after-school program to a healthy level.

[Scott Haldane]

The YMCA is involved in probably 700 or 800 schools across the country every day, working with young people in after-school programs.

I would say that in recent years—and I think that this is an important opportunity—our after-school programs have moved from having more of a child care focus to including both care and lifestyle promotion. We, much more today than before, have integrated healthy eating, healthy active living, physical activity, and so on into our child care programs. There are many organizations working on this, and I think this is a real opportunity to make sure that all after-school programs—and they should be expanded—incorporate healthy living into them.

The other thing that we have seen again in the first nations communities is that having meal programs, like you mentioned, is.... In some cases in low-income communities, as first nations communities mostly are, the need for having nutritional programs to help kids not only be healthier but also be able to learn is extremely important.

[Judy Sgro, Liberal, York West, ON]

Many of the after-school programs that operate in the city of Toronto, to my knowledge, don't have a physical component to them, other than if a few of the kids decide to play a bit of basketball, and if the opportunity is there.

For the most part, there doesn't seem to be that push to have your snack and then you do something other than maybe a bit of homework—which is always a good thing. But it's that physical component, which would help them to achieve better grades, that really is lacking in many of those programs, based on your conversations today.

It's for whoever would like to address it. Kelly?

[Kelly Murumets]

Sure. I'll come back to your question directly.

I presented at my board the other day—and I have some really smart people on my board—and someone said, “Just do this.” I said, “Yes, we are doing that.” And he said that it would cost x millions of dollars, and I said that we don't have x millions of dollars.

I would say that in the not-for-profit sector, we are very good at partnering, working together, and figuring out how to really capitalize on respective sets of expertise. More and more, because we don't have resources, we come together. We bring nutrition together with physical activity, and we're getting smarter at how to do that, because one plus one can equal 26, as opposed to two.

As for the after-school issue, I think that's true. I think that there has been a gap in terms of the physical activity focus. The federal, provincial, and territorial ministers came out earlier this year—or late last year—talking about the importance of that after-school period. Scott gave some statistics around the levels of physical activity during that period. More and more, I believe that the nutrition organizations are working with the physical activity organizations to say that this is an important period, that this is actually critical to getting our kids healthier, and that this includes better nutrition but also physical activity.

I think people understand that physical activity is important. But I don't think they understand that without physical activity, kids won't learn as well, and all of the other benefits that several of us have mentioned this afternoon.

[Scott Haldane]

I think there has been a concerted effort in the after-school programs—I'm thinking particularly of the Toronto area, because I was CEO of the Toronto YMCA before my current role—to add physical activity into programming.

The dilemma we've had is that the support for that—back to the point around prevention investment—has come from the Ministry of Health Promotion in the province of Ontario, and the funding has been very short-term in nature. While we have been able to do some training to get our staff able to do more physical activity programming with children, it's been difficult to sustain that funding over time.

I do think that there is a greater recognition among providers of after-school programming to build in those healthy activities. It's just a question of getting that capacity up to the level necessary.

[Judy Sgro, Liberal, York West, ON]

Mr. Morency, would you comment specifically on the cycling issue? I don't have much time left here.

We recently had the loss of a beautiful young cyclist in Toronto in an accident. All of us who are not cyclists say, “Fine, they can cycle, but they have to be somewhere where it's safe.” It's very difficult for those of us who are driving cars to have cyclists next to us, and you have to worry about their health and about them getting into an accident.

I'm not sure how we're going to make it safer for all of our streets to be able to allow cyclists on them, especially when you have the kind of accident that happened with the young woman in Toronto.

[Dr. Patrick Morency]

Yes. The issue is to provide opportunities to make healthy choices easier. Around schools, it would involve providing access to healthy foods and access to parks. On the roads, it would involve access to safe infrastructure.

It's not a matter of behaviour, because everybody is stuck on a road. I'm sorry. On est pris avec...

So when it's not designed properly for pedestrians and cyclists, it's really hard for drivers as well. The issue concerns, first in priority, civil engineers. I work with civil engineers—

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Morency.

[Dr. Patrick Morency]

All right.

[The Chair, Conservative, Joy Smith]

Now we'll go to Mr. Williamson.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you.

I'm a bit gobsmacked to hear these big numbers being thrown out about budget allocations. Five percent of a health budget would be about $10 billion, which is five times what is currently being spent here, at a time when we're hearing that the health care system already doesn't have enough money and five million Canadians don't have a family physician. According to the Fraser Institute report today, wait times have never been longer in this country.

We're coming up on a health accord that is supposed to address some of this, and you're suggesting that we should pull money out of the front lines of the health care system. I have to ask you, what is $10 billion going to buy that it's not buying now? How on earth can that be a greater priority than dealing with health care, whether it's seeing a family physician, or, heaven forbid, going to an emergency room and being told that you're going to have to wait longer, or trying to get a knee or hip replaced and being told that instead of three months it's going to take six months?

[The Chair, Conservative, Joy Smith]

Mr. Jones.

[Chris Jones, Representative, Senior Leader, Sport Matters, Physical and Health Education Canada]

Thanks for the question, Mr. Williamson.

Sport Matters marshalled some of that data on the spending on health prevention and promotion. I hear where you're coming from, and this has been the problem traditionally: there's always an acute and immediate demand to provide further services to existing programs. There are, let's face it, vested interests around the provision of certain types of health care--very powerful, very vocal, and very articulate groups--but what I think we're trying to say is that if you spend more on prevention, you may not immediately see the results in a year or so, but you may see them within five or six years. We believe that you can significantly reduce the consumption of health services.

I think the important point here is that if we make Canadians more responsible individually for health choices, dietary choices, and physical activity choices, that will lessen the demand on the system, so for some of the points you're making about requirements for more emergency physicians or more oncology wards, that kind of stuff will be lessened. I see what you're saying, which is that the political imperative in the short term is to put more dollars into beds, but with respect, I think that in the long run that will just take us down a spiralling road where there's a never-ending demand for those things.

[The Chair, Conservative, Joy Smith]

Can we have Kelly Murumets answer?

[Kelly Murumets]

Sure. I come from the business world, so I think of everything in terms of return on investment. That's how my brain works. The current economic realities are completely unsustainable. The stat that the Honourable Judy Sgro mentioned earlier was that within 11 years' time in Ontario alone the health care budget will consume almost 80% of the total provincial budget. So that's not going to last. That's in 11 years. That's in our children's lifetime. So we need to be thinking about how to deploy those dollars most efficiently.

So it's not an additional $10 million; it's a redeployment of dollars. And I would offer not “love ParticipACTION” but “love Kelly Murumets”; I could offer a couple of ideas that would help make our health care system on the treatment side a lot more efficient as well, and you could easily find, I believe, $10 million to redeploy to prevention. Now we're thinking not only in the immediate term, but for five years, eleven years, and the next generation.

[Scott Haldane]

I have just a couple of comments.

I would agree with the responses here. It's not just organizations like ours that have been focused on the prevention side of the equation for a long time. Actually, the Canadian Medical Association is also calling for an investment in the prevention side of this situation.

Most of the people using the acute health care system are actually there as a result of lifestyle choices--or, in the case of lower-income people, an inability to even have a choice. Addressing issues of prevention, particularly those social determinants of health that we mentioned earlier, will begin to change the demand on the system. It is really the only way out of a spiralling demand on the acute system: to try to affect the demand side, as opposed to keeping on putting money into the supply side.

[John Williamson, Conservative, New Brunswick Southwest, NB]

You said something about living longer but not better. I would suggest that living longer is better, particularly when you consider the alternative, which is not living at all. If people are healthier, it's not a question of never having that acute health care cost. It's going to come at some point. It might just come later on in life.

Where's the individual in this? Where is my responsibility, as a parent or an uncle or whatever, to take care of my health myself so that throughout my life I'm healthy? The government is there when I need help when I am ill, but it's up to me to take care of myself.

I have to say that I have a problem with calling obesity a “crisis” when the solution is to get off your butt and do something. There is a real crisis in the world today, and I just don't see this as being one.

Also, I find that the focus on what families have to do is not always enough. I'm curious to know.... Where do we help those families? Someone made a disparaging comment about the tax credits trying to incentivize people, but I'm not sure you can instill personal responsibility. It comes from the individual, from the family, from the community up, I guess.

[Dr. Patrick Morency]

Sometimes people just don't have a choice; it's too far to go other than by car. They just don't have a choice sometimes.

People travelling or commuting by public transit are walking enough to meet the recommendations, and their injury risk is 95% lower than people travelling by car, so it means a healthier lifestyle and fewer people at the emergency room. But for this you need to have a choice. If you live in a lower-density area, you have no choice but to use your car, and if you live in the poorer inner city, you walk, but you are exposed to the threat of traffic.

Thanks.

[The Chair, Conservative, Joy Smith]

Ms. Murumets.

[Kelly Murumets]

I agree with you 100%, actually, and I would say that on obesity it's not melodrama or hyperbole: it's an economic matter, so it is a crisis as it relates to the economy.

If you're thinking about individuals making the right choice, the best parallel situation would be smoking and smoking cessation. The way we got Canadians to smoke less, or to have fewer Canadians smoking--perhaps that says it better--was through a series of prevention kinds of initiatives, so that we helped guide the individual to make the right decisions. It was through policy. It was through programming. It was through social marketing. So I think it's a combo of those things--

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Murumets. I'm sorry, but you're way over time.

We'll now go into our second round of five minutes. We'll begin with Madam Quach.