Health Committee on Dec. 12th, 2011

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you, Madam Chair.

Thank you to each one of you for repeating again and again that what is important is prevention, and that it is something collective in which the federal government can participate.

I think there are attitudes... We live in a society where productivity and overconsumption are king. Everything has to be fast. That is a whole other issue, but it means that we are probably not necessarily tackling the right problems.

Each one of you has talked a bit about the social determinants of health. You said that they lead to 20% of health care spending in Canada. In fact, they are inequalities on which we can take action.

Is there a strategy we can focus on to reduce these inequalities that will ensure that people will finally have access to healthy food, food that will probably be more affordable, and to affordable and accessible public transit?

What do you propose to us? Are there plans? Are there industrialized countries or places whose examples we could follow? Are there models? How much does it cost? Are there strategies? What were the time frames involved?

Could we propose something concrete on which we could work to develop a model that reflects us better, but is collective?

[The Chair, Conservative, Joy Smith]

Who would like to take that question?

Mr. Haldane.

[Scott Haldane]

We included, in our report that I presented, really concrete recommendations that, we think, will change things. There is just one that I did not have the time to mention.

Sometimes, to come back to the idea of health determinants, it is necessary to invest in other sectors. For example, the unemployment rate for young people has repercussions... If the employment rate for a group of young people is not high, there will be health repercussions in the future. That is to say that youth unemployment policy also has an impact on health.

Regarding health determinants, we have to invest not only in health care, but also in other sectors that will improve things.

[The Chair, Conservative, Joy Smith]

Mr. Morency.

[Dr. Patrick Morency]

Thank you. That is a very interesting question.

We have known for 40 years that we must also invest in other areas, not just in the health care system, as you said. We draw a great deal of inspiration from Scandinavian countries like Sweden and Finland. As for the problems I mentioned today, I like to be inspired by other Canadian or U.S. cities. Unfortunately, we rarely see consistent integrated planning here. We rarely see here what we see in Scandinavian countries.

Here, we see interesting one-time initiatives. Some cities have removed a highway. Other cities, like Vancouver, implement traffic calming in some neighbourhoods. Montreal has developed a safer bicycle path network. North America tends to use more isolated initiatives, rather than consistent planning. We do know, however, that planning would be helpful.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

You talked about health promotion. I think Ms. Grantham said that only 0.9% of investment by the three levels of government went to health promotion.

Are you proposing another percentage? Does that exist? We have talked about reallocating funding within the budgetary envelope. We have to start with the chicken or the egg. We do more prevention. So that will eventually have to extend to primary care.

Is there an ideal percentage? You mentioned an extra 5%. What shape would that take? Are you basing that on something? People always make things seem easy. We still need a model. What should be eliminated and where should the funding be reallocated to? Can the federal government show leadership with 5%, even if I am in favour of that? Where should it come from?

[The Chair, Conservative, Joy Smith]

We're going to run out of time. We have about 10 seconds. I'll give you a little more than that. Can someone answer that question?

Mr. Jones.

[Chris Jones]

The number was taken as a notional amount to try to illustrate that if we took a mere 5% and reallocated it, we could do some quite progressive things with it.

[The Chair, Conservative, Joy Smith]

We'll now go to Mrs. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair.

I really do appreciate your being here and sharing your presentations with us. There is so much for us to think about. I've said this a few times at this committee.

My background is in health care. Certainly I was involved in a number of health boards, and I have had this issue in front of me for at least 15 or 16 years.

I'm a baby boomer. I think I share a birthday with medicare. I understand that there was a second phase to medicare that we actually never got to, which was health promotion and disease prevention.

Mr. Jones, I've heard you say that we need to make Canadians more responsible individually. I'm going to throw it out there. How do we do that?

[Chris Jones]

You are talking about a very complex situation, in which a lot of different forces are acting on individuals and their capacity to make rational choices.

Some of the points about the way our built environment is set up are true. You look at the way video games have addictive components built into them. There is some material out there now about how video game designers are deliberately making them addictive to kids. You look at the prevalence of fast-food advertising to children on Saturday mornings and at how they use that to lobby their parents to purchase. You're talking about so many different dimensions of this that to tackle it in a systematic way would be quite complex.

We're talking about trying to deal with some of the issues in the school system. I think it's the one place that.... Healthy eating would be another one. There is no silver bullet with which to tackle this immediately.

[Scott Haldane]

At the risk of taking a little too much time, I'm going to describe a study we were involved in, which concluded in 2000—and I can provide it to the committee.

We looked at what forms of intervention would work to get sole-support mothers on social assistance to go off social assistance, and what would be the economic benefit of doing that. What we discovered was that the most frequently chosen option—because this was an option that mothers could select—was to have their children placed in a subsidized recreation program.

What we discovered was that within one year, twice as many moms got off social assistance. On every measure of the mom's use of the health care system, her use of the health care system went down, so fewer emergency department visits and less use of social workers.

So basically by getting her kids into recreation programs, the child's behaviour improved significantly in a measurable way, mom's use of the health care system went down dramatically, and twice as many moms got off social assistance within one year. So even an indirect investment in prevention and promotion of health actually saved us millions and millions of dollars as a society—and that's just in the direct cost of getting the mom off social assistance, let alone the indirect costs from less use of the system.

I know the government has been thinking about things like social impact bonds as a way of funding these kinds of interventions. I think there's a lot of evidence that a return on investment, as Kelly said, in prevention, very specific prevention, not just.... Health promotion is important, but I think it has to be specific interventions in addition to health promotion, and those specific interventions can actually have results in the very short term. Some people say prevention will take us forever. In fact, we have evidence that we can make it pay off within one year.

The reason we haven't done it is that the investment is made by one level of government, and the benefits accrue to other levels of government. So we just can't get our act together in Canada to make those kinds of choices.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much.

I have to say, Mr. Haldane, I'm very impressed with the breadth and the engagement of your organization in a number of initiatives, nationally and internationally, in addressing the health of Canadians.

You mentioned a number of things you were involved in, such as chronic diseases. You mentioned your work as the chair of a national panel addressing the health of first nations, and you also briefly mentioned the healthy weights initiative. I'm wondering if you would talk a little about that initiative.

[Scott Haldane]

It's actually not a YMCA initiative. It was actually a federal government initiative in partnership with the ministers of health of all the provinces. What we did in that event was simply host the launch of the initiative at our downtown YMCA in Toronto. But we have been a partner in that effort for some time.

The federal minister, along with the Minister of Health for the Province of Nova Scotia, Dr. Butler-Jones from the Public Health Agency of Canada, and the head of the Canadian Cancer Society, went to the UN to present Canada's position to the UN committee on health promotion and disease prevention, so we've been involved in those ways.

Our greatest involvement, in partnership with many other organizations, is actually on the ground in local communities day after day, and that's where we base our work.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Haldane.

We'll now go to Dr. Morin.

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

My first question will be to Mrs. Grantham. I was so disappointed when I noticed that my own province, Quebec, seriously underfunds health promotion, compared to some other provinces, like Ontario, Saskatchewan, Alberta, and British Columbia. Do you have any idea why that is the case?

[Chris Jones]

I can take that, because we compiled this table.

Quebec does have a program of support for public health. We called the ministry, but they refused to disclose the amount they spend on that. So we're assuming that it's probably in the ballpark of what Ontario is spending, but they wouldn't divulge the figure.

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

Okay, thank you very much. You're reassuring me.

My next question is for Mr. Haldane.

You mentioned that the head start program for aboriginal populations only covers about 20% of aboriginal communities. Why is that?

[Scott Haldane]

I don't know exactly. I would assume that it's based on funding limitations. There are 634 first nations communities in Canada, and only 20% of them receive aboriginal head start funding from Health Canada.

We didn't visit all of those communities, but we did see evidence that when there is an aboriginal head start program, children are more ready to learn when they arrive in kindergarten. So that kind of investment—one factor among many—could make a significant difference in educational outcomes for first nations children.

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

Thank you.

Mrs. Murumets, I have a question for you. The new year is coming up, so of course a lot of Canadians will make good resolutions to be active in 2012, and of course the vast majority of those resolutions will fail.

[Voices]

Oh, oh!

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

That is true, and I'm also guilty of it.

People know they have to exercise and they have to eat well, but even though people want to, they cannot. Your organization is doing a good job overall. Without tying it to your different programs, how can we help Canadians who want to be healthier to be active, to do what they want?

[Kelly Murumets]

The problem with new year's resolutions is that people think they need to don spandex and head to the gym. Fewer than one third of Canadians will ever even step into a gym. Once they do step in--I don't know what the number is--seldom do they return to the gym, because it's daunting, overwhelming, and in fact actually quite scary for many.

At ParticipACTION, we do three things. The first is the messaging. It is designed to say that physical activity needs to be very simple. It's to just build physical activity into your everyday world. You don't actually have to don spandex if that's not your thing, but just jump off the subway one stop earlier and walk the difference, or step off the bus one stop earlier and walk the difference, etc.

We also work with the YMCAs of the world, though, so that our messaging isn't just up here in this space, but it actually gets translated and then into working with community-based organizations, so that once people get the message, we send them to the community-based organizations. Then they can have that support right there on the ground to help them continue making physical activity part of their everyday world.

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

Mr. Haldane.

[Scott Haldane]

As a charitable organization, one of the things the YMCA does is that we don't turn away anyone who can't afford the fees, so somewhere between 20% and 30% of members across the country, depending on the Y, receive financial assistance in order to participate. What we have found, in fact, is that low-income people, once provided with that access opportunity, actually have a much stronger adhesion to the program. I think it comes from having a sense of someone helping them out.

We also have the experience that many of them, at some point in their lives when their situation changes--if it does--will begin not only to pay the full fee but will be among our most generous contributors in helping other people have access. On access, one of the key determinants here is to make sure the programs that are available are affordable and are accessible by people, regardless of their circumstances.