Health Committee on Feb. 2nd, 2012

[The Chair, Conservative, Joy Smith]

You have about a minute.

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

I know you have a high number of newcomers to Canada, new immigrants, as well as young aboriginal women participating in your program. I want to get back to what I mentioned about the guiding principles and the relationships that emphasize strengths and facilitate empowerment. I'd just like to give you an opportunity to speak a little bit more to that, if you wouldn't mind.

[Nancy Klebaum]

I think the fact that we approach everybody using a strength-based approach is a huge part of that. We look at all of the women and we know that no matter how challenging their circumstances might be personally, in every family there are strengths. Sometimes it is hard to ferret those out, but you can find them if you try. That family needs to learn how to build on their own strengths, and sometimes it's just personal resilience. They may have come through some really difficult situations in the past, and we know that deep within, if we support, nurture, and encourage, they are going to find a way to walk through this particular circumstance as well.

So I think it's just that general atmosphere of respect for all of the women. It's very non-judgmental of where they might be at that time and it really supports the nurturing and empowerment we spoke about as well.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

I'd like to thank all of the witnesses. I really appreciated your presentations.

Dr. Jeffery, I'd like to talk about student nutrition. As you know, 42% of elementary kids and 62% of secondary students go to school without breakfast. In Toronto we feed 142,000 children every morning, which means one in four of our children goes to school hungry.

There is an organization in Toronto called the TFSS, the Toronto Foundation for Student Success. They asked principals in an at-risk community what help they wanted to deal with issues that were the result of poverty and gun violence. They expected the request would be for after-school programs. It was unanimous among the principals across the board that they needed food for the children. Hungry children have concentration issues. If they have concentration issues, there are behaviour issues, and they have myriad health issues.

I'm wondering if you could talk a little bit about how a child's learning capabilities are affected by how recently they have eaten, and how malnutrition in early life can potentially limit long-term intellectual development.

[Bill Jeffery]

I'm not an expert in pediatric nutrition--I will say that from the outset--but I've read enough of the high-level studies to know that the health benefits and the academic achievement benefits are pretty much beyond question. It's just a matter of mobilizing the political will to better fund these programs. In the United States decades ago, shortly after the Second World War, they determined that it was worthwhile to subsidize these programs. For several years they had weak nutrition standards. The big transition they've made there recently is to set high nutrition standards so you're not feeding kids a bunch of high-fat milk and white bread and that sort of thing, which are going to exacerbate a lot of the public health problems. But the case...I think the jury is out on that.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

As you said, our own chief public health officer, Dr. Butler-Jones, said one of the best ways to improve health is to feed our children so they don't go to school hungry.

Can you talk a bit about what impact inadequate childhood diet has on the risk of adult chronic disease?

[Bill Jeffery]

There's a lot of evidence to demonstrate that poor dietary practices that start in childhood persist into adulthood. One of the things we've noticed in recent years is early-onset diabetes. It used to be called adult-onset diabetes, but it happens so early now that they had to rename it. We've heard reports of physicians detecting plaque build-up in children's arteries even at a young age. This committee has reported before on the problems with childhood obesity, and of course that's a prelude to problems with adult obesity. It's not an isolated problem any more. Almost two-thirds of Canadians are overweight or obese, and 90% of Canadians will at some point in their life have high blood pressure. Fruit and vegetable intake is very low. These are problems that are affecting everybody. It's not just a kind of isolated community that we can provide special programs to. We have to think of broad measures to make our society healthier and to compress the period of illness at the end of life. This could be very expensive for medicare.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Dr. Jeffery.

I think it's really important for people to understand that Canada is one of the few industrialized countries in the world without a national food program for children. In my riding, we have the highest rates of type 2 diabetes in the province, and they are linked to poverty. If the choice is between a $5 litre of orange juice or a $2 double litre of orange pop, the choice is clear when you're trying to stretch that dollar.

Could you explain how feeding hungry kids, so they go to school, so they can learn, makes good economic sense, and how it will reduce health costs down the line?

[Bill Jeffery]

I'm not sure how strenuously the case for feeding children has to be made from an economic perspective. The children have to eat one way or the other, so it's really just a matter of whether we can organize ourselves as a society to have everybody contribute a little bit so children eat while they are in school, and improve their health outcomes in the long run, and of course improve their school performance.

I think I'll just leave it at that.

[The Chair, Conservative, Joy Smith]

Thank you.

You have about a minute left.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

There's new data out from the Toronto Foundation for Student Success showing that making it to grade 10 is a good predictor of whether or not someone will graduate. They have new data showing that if children are given breakfast in the morning, their chance of graduating increases. So there's an economic case that increasing graduation rates can have an impact on our economy.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go to Mr. Gill.

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

Thank you, Madam Chair.

I also want to thank the witnesses for being with us and for the wonderful presentations.

My first question is for Phyllis. Could you tell us a bit about the nutrition facts education campaign that was launched in 2010?

[Phyllis Tanaka]

Yes. It was, as I note in my presentation, launched in 2010. It is a collaborative effort among Health Canada, food manufacturing companies who are members of FCPC, and McDonald's, who is not a member of FCPC.

It is basically designed to help consumers look at the nutrition facts table on food products and start to understand it better, because, as Bill Jeffery has pointed out, it has not always been easy to look at the label and decipher everything. The percentage of daily value was the one thing that caused confusion for consumers, and before we initiated the program it was the one identified by consumer outreach as an area where they wanted to have better understanding. It's focused on the percentage of daily value, and it's going into its second year.

By reaching out to consumers through TV and through in-store advertisement, the reach is fairly extensive, and we think it is a very good contribution to helping consumers make informed decisions.

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

Thank you.

Energy drinks have become increasingly popular over the last few years, especially with young people. Could you comment on the impact of energy drinks on health?

[Phyllis Tanaka]

I'm not sure how to answer that question. As everybody knows, energy drinks have been the subject of a consultation process with Health Canada. Industry has, through the Canadian Beverage Association, been very engaged in discussions on how to make sure that the product on the shelf has the complete information that somebody needs in order to make a decision on consumption of that product.

Because energy drinks currently fall under natural health products regulations and because they are presented in that format in the marketplace, the bottom-line concern that has been put forward is that some consumers—especially younger consumers—might not realize that they need to factor in how much caffeine they are consuming. Basically, that's where the discussion is right now: how to facilitate the consumer being informed in making that beverage choice.

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

Thank you.

My next question is for either Donna or Nancy. What would you say are the key barriers to healthy eating and to a more active lifestyle for low-income women?

[Donna Nelson]

Access to food is a big barrier. Often women have more than one child, and although they live in the cities they don't have vehicles or access to grocery stores. I think fast food gets consumed often because they have far more access to fast-food outlets than to grocery stores. That is probably the biggest barrier to healthy eating.

Nutrition knowledge is a barrier as well. Sometimes I'm surprised by how appreciative of the information people are, because I sometimes take for granted that people know more than I think they do about nutrition.

[Nancy Klebaum]

To reiterate what Donna said, we know that in our community, in particular, the vulnerable women who are attending our program tend to live in what we refer to as grocery store deserts: they live many kilometres from a grocery store, but they live just a few metres away from a 7-Eleven store or another convenience store. Often there are really small food budgets for folks who are living in poverty, so when they have to spend seven dollars on four litres of milk and, as someone else pointed out, you can buy two litres of pop for $1.99, it's sort of done out of necessity. They are often making choices that they may even realize are not the healthiest, but because of their access that's what they are forced to do. You cannot feed a family very well when all you can do is go to a convenience store or when you're buying a single apple at a time, whereas a grocery store is miles away and you don't have a vehicle to get there. I think that's a big part of it.

In terms of activity, what we see often with our participants is that poverty tends to really defeat people. When they are living constantly in a cycle of trying to make do with not quite enough, they seem to almost end up in a state of ennui, where they kind of continue to do what they are doing and they don't make those attempts to improve their health unless they're encouraged. That's why I think we see programs such as ours that are taking that strength-based and non-judgmental approach to support people to make small changes—a little bit at a time with what families can manage—and then they build on those.

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

What would you say are some of the key nutritional concepts that you try to convey in the Food for Thought program?

[Donna Nelson]

One of the biggest things we focus on is the importance of breastfeeding, because we are a prenatal program. The majority of the women we work with are pregnant and will need to make a decision on how to feed their infants. We recognize the importance of breastfeeding, so that would be a priority.

The next priority we would focus on is feeding your six-month-old baby food. Lots of times people think that baby food comes from jars, and I have to teach people that baby food comes from food, not jars, and that it's simple to make your own. We do baby-food-making workshops twice a year--it works out to six or seven a year--to teach the concepts of baby food.

[The Chair, Conservative, Joy Smith]

Thank you so much, Donna, and thank you, Mr. Gill.

We'll now go to our next round of questions, five-minute rounds. We will stay within that time parameter as tightly as we can to get as many people up for questions as we can.

We'll begin with Madam Quach.

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

Thank you, Madam Chair. I will endeavour to be brief.

Thank you for all your testimony. It was as interesting as it was dynamic and varied.

I would first like to speak to the two ladies from Québec en Forme.

Your initiatives are extremely effective. I come from a teaching background, and as a teacher, I have seen many young people benefit from your actions.

You spoke about changes we can make to our environment and I would like to know if you can give us concrete examples of changes to natural environments, for example parks and gardens.

And as for economic environments, I would like to know the cost of your services, and what results you have achieved. Do you hope that the federal government will get involved in order to increase the impact of your initiatives?

[Manon Paquette]

Thank you very much.

We do indeed document all activities in the field, at various levels. There are currently 140 communities involved, with plans to support healthy eating in Quebec.

For example, in the nutrition field, there are many programs that seek to improve the skills of youth and their families, including their parents. Mentioning parents reminds me of the program Food for Thought and of peer support groups who purchase food or cook together and whose clientele is young mothers or fathers who are single parents and wish to learn how to cook. The community sector is very active in this regard.

But there are also public markets which are gaining popularity in Quebec. For example, the seasonal markets in schoolyards that are unused during the summer. These initiatives are spearheaded by community organizations. And then there are farmers' markets which are springing up just about everywhere and make fresh food more easily accessible.

Then there are also new distribution networks, parallel, short-distance distribution networks. This is an emerging phenomenon in Quebec and is extremely popular. For example the initiative Bonne boîte, bonne bouffe. We are just bringing producers and city dwellers closer together and removing the middleman.

As for the economic aspect, which you referred to, there is the lending of spaces. This means sharing or promoting the use of school facilities with community organizations. For example, a community organization can be invited to cook in a school's kitchen. This type of initiative might interest you since you do come from a school background.