Health Committee on Feb. 2nd, 2012

[The Chair, Conservative, Joy Smith]

Good morning and welcome to committee. I have to say we've been very pleased with the study we've done on our topic of health promotion and disease prevention, because we've had a lot of witnesses who have given us some really good input and we're delighted you're here today.

We have with us, from the Centre for Science in the Public Interest, Mr. Bill Jeffery. Welcome, Bill.

From Food and Consumer Products of Canada, we have Ms. Phyllis Tanaka. Welcome, Phyllis.

From the Saskatoon Health Region, we have Ms. Nancy Klebaum, who is the manager, and Ms. Donna Nelson, the nutritionist for the Food for Thought program. We're very pleased to have you here.

And from Québec en Forme, we have Madame Diane LeMay, assistant manager. She is testifying via video.

Can you hear me?

[Diane LeMay, Assistant Manager, Partnerships, Knowledge Translation and Innovation, Québec en Forme]

Yes. Yes, I can.

[The Chair, Conservative, Joy Smith]

If you want to make any comments, just raise your hand so I can see you to make sure that we get you on the agenda.

We also have Madame Manon Paquette, provincial adviser for nutrition, partnerships, knowledge translation and innovation. Welcome.

We will begin with ten-minute presentations from each group and we will begin with the Centre for Science in the Public Interest with Bill Jeffery, please.

[Bill Jeffery, National Coordinator, Centre for Science in the Public Interest]

Thank you, Madam Chair.

The Centre for Science in the Public Interest is a non-profit consumer health advocacy group specializing in nutrition and food safety issues, with offices in Washington, D.C., and Ottawa.

We don't accept funding from industry or government. We are fortunate to be very well funded by our 100,000 subscribers to the Canadian edition of Nutrition Action Healthletter, which does not carry advertisements. We have, on average, one subscribing household within a one-block radius of every Canadian street corner.

Every year, nutrition-related diseases cost the Canadian economy—mostly provincial treasuries—at least $5 billion, and some estimates are as high as $30 billion. Applying World Health Organization estimates, they caused 48,000 deaths in Canada due to cancers, diabetes, heart disease, and stroke related to nutrition.

Dozens of expert reports have called for regulatory changes to enhance the nutritional quality of the food supply, and thereby improve health, protect medicare, and improve economic productivity. Last September a special session of the United Nations General Assembly, which included 33 heads of state, adopted the political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases.

That commitment resulted in a unanimous agreement to—and I'm going to simplify the United Nations text a little bit—reduce the impact of tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol through the implementation of relevant international agreements and strategies, and educational, legislative, regulatory, and fiscal measures.

To support a comprehensive review and report to the General Assembly in 2014, the Secretary General of the United Nations and the Director General of the World Health Organization will develop, by December 2012, a global monitoring system for relevant, non-communicable disease indicators and time-limited targets; develop options for strengthening action through effective partnerships, which the World Health Organization has interpreted as including safeguards against commercial conflicts of interest; and finally, submit to the General Assembly, by May 2014, a report assessing national progress in implementing the global strategy and action plan.

We recommend the following specific federal government policy reforms, and I would underscore that these are the same reforms, for the most part, that we recommended when we were before the committee last February.

One, strengthen food-labelling regulations, including mandatory front-of-package nutrition labelling. In practice, nutrition facts labels on prepackaged foods are very useful to interested and educated shoppers, but might be more aptly named “back-of-pack, complicated nutrition facts”. Harried shoppers should be able to quickly scan the front of the package on a shelf to pick a nutritious choice, and repeat that process for dozens of weekly choices without stretching a simple shopping trip into a tedious, time-consuming research project.

Two, extend the Quebec ban on advertising to children—the vast majority of which promotes sedentary play and non-nutritious foods—to the other 75% of children in Canada, and help Quebec stem the flow of non-compliant advertisements leaking across the borders through the Internet, U.S. cable networks, and other media. Since 1980, the Government of Quebec has been a world leader in protecting children from the unfairness and adverse health effects of commercial marketing that targets children under the age of 13. That law was challenged in the 1980s, and in upholding the law the Supreme Court of Canada said that advertising to children is “per se manipulative. Such advertising aims to promote products by convincing those who will always believe.” Unfortunately, only token safeguards are applied to protect children outside of Quebec against advertising.

Three, shift the GST and HST from foods that promote good health—like fruits, vegetables, and whole grains—to foods that increase the risk of disease. It is indefensible to tax foods that help prevent disease, but the Excise Tax Act often does just that. Federal and provincial levels of government each collect about $3 billion from GST and provincial sales tax, or their portion of the HST, when applied to food.

To be fair, the act taxes soft drinks, candy, and snack food at the rate of about 13% in most provinces but discourages healthy eating by taxing low-fat milk, whole grains, and vegetable dishes when consumed in restaurants, as well as club soda, salads, and vegetable and fruit trays when sold in retail stores. Meanwhile, many unhealthy foods sold in retail stores are tax-free, such as sugary breakfast cereals, transfat-laden shortening, high-saturated-fat cheese, chicken wings, fatty burgers, even salty caviar. You get the idea. That makes no sense. Taxes should be focused on unhealthy foods and eliminated for healthy foods.

The average Canadian now spends about $95 per year on GST for food purchases. In 2010-11, the GST low-income credit reimbursed $631 to the average single individual earning $20,000. These rebates could easily be increased by a few dollars to offset further regressive effects, if any, of nutrition-promoting food tax reform and increased even further to help reduce poverty.

Four, the federal government should join most provincial and some municipal governments in subsidizing school meals for Canadian schoolchildren K to 12, provided those foods meet strong nutritional standards. As a major study from Harvard University and our chief public health officer acknowledged, subsidized school meals may also improve school attendance, completion, and equalize opportunities for life success among children from families with unequal financial means.

Last month the U.S. Department of Agriculture finalized binding national nutrition standards for food that are much stricter than the old ones. They are used to qualify for more than $14 billion in federal government subsidies for school food, or approximately $1.30 per student per school day. On a per-student basis that commitment is more than 30 times the four cents per student that the Canadian government spent on school meals. To my knowledge, the federal government still spends nothing or virtually nothing; it's mostly provincial governments. In Canada, only Ontario has binding school nutrition regulations.

Five, mandate the disclosure of calorie counts and notices about the amounts of sodium for menu items in outlets of large restaurant chains, where Canadians spend $60 billion annually, which is one-fifth of all food consumed. Nutrition information for restaurant menus has been exempt from the nine-year-old regulations mandating numbers for calories and 13 nutrients on packaged foods sold in grocery and convenience stores but not at restaurants, where Canadians spend so much of their food dollar.

While Health Canada continues to discuss menu labelling, governments in New York City, California, and elsewhere have required calorie labelling on menus, and soon regulations will extend that requirement nationally in the United States.

Dozens of Canadian groups and expert reports have called for mandating calories and sodium on restaurant menus. Studies indicate that fewer than 1% of consumers go out of their way to obtain onsite nutrition information prior to ordering. By contrast, one carefully conducted New York City study found that calorie labelling on menus helped reduce calorie totals by 14% per non-beverage food transaction. That's when the numbers were actually on the menu board.

So Canadians finding that a Tim Hortons sausage, egg, and cheese breakfast sandwich has nearly double the calories, 530, of the English muffin with egg and cheese, with 270 calories, or a McDonald's mighty Caesar entree salad with warm crispy chicken has nearly five times as much sodium, 1,320 milligrams, as the spicy Thai salad, 260 milligrams, might choose differently or eat elsewhere if they find that all the nutrition numbers look grim.

[The Chair, Conservative, Joy Smith]

Wow, that's my favourite. Sorry.

[Bill Jeffery]

Six, commit to fully implement Canada's strategy for sodium reduction, which is now 18 months old. As the committee is aware, the sodium working group made 33 recommendations, including some recommendations for regulatory reforms. Ninety percent of Canadians will have hypertension during their lifetime, and a lot of this is attributable to excess sodium intake, which may cause as many as 16,000 premature deaths a year.

I expressed concern at this committee hearing last February about the sodium working group being disbanded. I will renew my concern by drawing the committee's attention to the fact that despite the provincial and territorial officials coming up with an alternative plan, which essentially stripped out most of the regulatory recommendations, the federal government still hasn't implemented that plan.

[The Chair, Conservative, Joy Smith]

Mr. Jeffery, I'm sorry, but your time has long passed.

That was a very compelling presentation. Thank you so much. You certainly got all of our attention. That's very useful information. Thank you.

We will now go to Phyllis Tanaka.

[Phyllis Tanaka, Vice-President, Scientific and Regulatory Affairs (Food Policy), Food and Consumer Products of Canada]

Good morning, everyone.

Food and Consumer Products of Canada welcomes this opportunity to contribute to the Standing Committee on Health's study on health promotion and disease prevention as it relates to healthy eating.

For those who don't know us, FCPC is the voice of Canada's leading food, beverage, and consumer product companies that manufacture or distribute the products that sustain Canadians and enhance their quality of life. FCPC and its member companies routinely work with governments and other stakeholders to develop effective solutions on public policy issues.

As we all know, a seminal report was released by the World Health Organization in 2004 entitled “Global Strategy on Diet, Physical Activity and Health”. It spells out the major risk factors for non-communicable diseases and lays out recommendations to all stakeholders on how to contribute to reducing NCDs in two pivotal areas of concern: unhealthy diets, and physical inactivity. The recommendations specific to the food industry are noted in my submission in table 1.

It is in the context of these recommendations from the WHO that I share with you the key activities in which FCPC food manufacturing member companies, through their international affiliations and at the national level, are engaged. They are activities that ultimately support Canadians in creating their own healthy eating regimes.

At the international level, global multinational companies are members of the International Food and Beverage Alliance. It collaborates with the WHO and other relevant stakeholders to address globally the health and well-being challenges identified in the global strategy.

IFBA member companies have made commitments related to product reformulation and innovation, providing useful contextual information for consumers on foods and beverages, strengthening voluntary measures on marketing and advertising, and promoting healthy lifestyles. Table 2 outlines these commitments.

The most recent annual progress report was published in March 2011, and it can be found on the IFBA website. It documents the significant progress that is being made.

At the national level, similar actions are being taken.

FCPC members have articulated their longstanding commitment to healthy active living through a voluntary statement that factors in the key recommendations made to the food industry in the global strategy.

The FCPC statement of commitment on healthy active living focuses on product choice, innovation, and selection, consumer education, responsible advertising and marketing practices, and promoting healthy active living in the workplace and community. The full commitment is outlined in table 3.

I will quickly walk through some initiatives that have already been done or are under way in support of this FCPC member commitment.

FCPC, representing its food manufacturing member companies, had an integral role in two very significant multi-stakeholder initiatives established to bring about beneficial changes to the food supply, namely the transfat task force and the sodium working group. The multi-stakeholder transfat task force recommendations were designed to effectively eliminate or reduce processed transfat in Canadian foods to the lowest level possible.

The last set of monitoring data collected to reflect the marketplace in 2008-09 found that 80% of the products in the marketplace were compliant with the task force recommendations. In a news release sent out at that time by the minister's office, Minister Aglukkaq acknowledged food industry's achievement, saying:

Our government is pleased to see that industry has reduced the level of transfat in many pre-packaged foods. This was achieved by finding healthier alternatives without increasing the levels of saturated fat.

The food industry was also represented on the sodium working group that developed the sodium reduction strategy for Canada. I was one of the members. In addition, FCPC member companies have worked with Health Canada on proposed voluntary sodium reduction targets for processed food products in support of the strategy's interim goal of shifting the dietary average intake of sodium to 2,300 milligrams per day.

The operating premise for the food industry in working on targets has always been threefold: changes must always factor in food safety; they must recognize the real functional and technical challenges associated with reducing sodium levels in some food categories; and they must take heed of the role of consumer acceptance. To that end, changes to the food supply must be in concert with awareness and education campaigns that target Canadians to inform them of what is happening to their food supply and why it should matter to them.

The attached figure 79 from a World Health Organization report gives context to the challenge before us. Thirty-three countries are listed. All have salt consumption patterns above the World Health Organization's recommended five grams per day, Canada included. You will note, however, that relative to most countries, our salt consumption is low. That is the good news. The bad news is that this graph illustrates that we are embarking on unchartered territory. Solutions to lowering salt levels in the diets of Canadians and in the Canadian food supply are not already out there for us to take advantage of. We will be leading the way.

While the sodium reduction strategy for Canada has not yet been fully implemented, it has not deterred food manufacturers from making sodium reduction in processed food products an ongoing priority. In fact, in a recent survey of members, 65 of the respondents reported that they were reformulating products in their product portfolios to reduce sodium levels, and 35% were introducing new products that have reduced sodium levels.

FCPC member companies also take a lead role in helping consumers make informed decisions. Since 2005, food manufacturers have provided nutrition facts tables on their processed food products using a standardized format. They list calories and nutrient breakdown for 13 key nutrients. The ingredients list tells consumers what the products contain. Additional information in the form of health claims, from nutrient content claims to disease risk reduction claims, in line with regulations, further provide the consumer with details that help them make informed purchasing decisions.

An initiative I'm particularly pleased to highlight is the groundbreaking, collaborative, and award-winning campaign called the nutrition facts education campaign, which was launched in October 2010. It is a collaboration between Health Canada and FCPC. The initiative is multi-faceted. It explains the percentage daily value to consumers through messaging on food packages, in stores, and in national media, including print, television, and online.

Building on the success of phase one, phase two was recently launched. Thirty-four major Canadian food companies are participating in this initiative. Because of the nature of the program, it provides a fantastic reach to Canadians.

The next commitment I'll speak to gets a lot of attention, and it is about responsible marketing and advertising practices as they relate to children. There is a broadcast code for advertising to children. Its purpose is to guide advertisers in developing messages directed at children 12 years and under. Across Canada, except for Quebec, advertisers follow the guidelines under this code. Quebec, as Bill Jeffery has noted, does not allow advertising to children.

[The Chair, Conservative, Joy Smith]

I'm sorry, Phyllis, your time is up.

[Phyllis Tanaka]

Okay.

I will close by saying thank you for the opportunity. There is more detail in the full submission that you've received from us.

Thanks again.

[The Chair, Conservative, Joy Smith]

We will now go to Nancy Klebaum.

[Nancy Klebaum, Primary Health Manager, Saskatoon Health Region]

Thank you.

We are really honoured and privileged to be here today. Donna and I represent the Food for Thought program in Saskatoon, Saskatchewan. We are a Canadian prenatal nutrition program project, and therefore we are gratefully funded by the Public Health Agency of Canada. We are also jointly funded by the Saskatoon Health Region. We are here to really share the success story that Food for Thought is.

Food for Thought is a program that has been running for 16 years. Our target population is low-income pre- and post-natal women living in conditions of risk. Our aim is to guide them to achieve better health for themselves and their children. The conditions of risk include poverty, adolescence, women who use alcohol, drugs, and tobacco, women living with mental health issues, women living with violence, aboriginal women, recent immigrants to our country, and women living in isolation with limited access to services.

Our program is guided by an overarching value of respect. We emphasize respect for others by creating a friendly, non-threatening environment in which Food for Thought participants meet other individuals with similar issues and they can freely discuss concerns. We use a strength-based approach that recognizes that each woman is the expert on how to bring about changes in her own life. Participants are encouraged to work toward small changes that are realistic within the context of their everyday lives. We also strive to facilitate empowerment, which we define as helping our participants to discover the power that they possess within themselves.

[Donna Nelson, Nutritionist, Food for Thought Program, Saskatoon Health Region]

How do we do this? Well, we are a unique program in that we use the kitchen as a venue for health education. Program sessions take place on weekdays and are typically two and a quarter hours in length. On-site quality child care is provided. Transportation in the form of taxis to and from the program is also provided.

During the sessions, participants cook together, and information is shared that addresses a variety of topics. These include, on a regular basis, planning and preparation of economical, nutritious, and delicious meals; food budgeting and grocery shopping strategies; and baby-food-making workshops. We explore pre- and postnatal nutrition, infant nutrition, and the benefits of breastfeeding. We also provide education on fetal growth and development, as well as labour and delivery, to prepare the women for the births of their babies.

In addition, we discuss healthy sexuality and what that means in the lives of our participants, as well as family planning, effective parenting, and healthy relationships. A snack is always served, and participants proudly take home the food they have prepared.

We are guided by strong nutritional practices, and incorporate healthy nutrition into most activities. Good nutrition is modelled by staff, and is seen in all areas of programming, including menu planning, food safe skills in the kitchen, food preparation and education, and feeding of infants and children.

We teach not only that when life gives you lemons, make lemonade, but when the food bank gives you canned tuna and stale bread, make tuna melts.

[Nancy Klebaum]

Food for Thought has developed some key partnerships with other groups and organizations that greatly benefit the participants who attend. For example, the Saskatoon Open Door Society, which provides resettlement services to new immigrants and refugees, works closely with us and helps us to offer our program to that population specifically.

We have partnered with READ Saskatoon, a local literacy group, to provide resources to our women. We have developed a strong and a very key partnership with mental health and addiction services in our health region. A worker with those specialized skills attends half of our program sessions. That individual can provide short-term counselling, and also assist with timely access to service.

By programming out of primary health facilities, we have also partnered with many other health providers such as nurse practitioners, public health nurses, family physicians, and others.

Food for Thought is also unique because of our nationally recognized peer leadership program. Peer leaders are program participants who are identified as being able to model some of our key program values. These women are selected by the staff and are provided with additional training, ongoing support, and an honorarium. They work with the staff to help deliver the sessions to the participants.

The peer leader experience has been a stepping stone for many of our former clients into other community work, into paid employment, and to further education. In addition, it provides the new women a role model with whom they can identify and who has shared a similar life experience. Our peer leaders play a key role in the planning and implementation of the program by contributing to our program advisory board and also by providing us with regular feedback on program activities.

[Donna Nelson]

We like to break away from our regular routine from time to time to do special projects. These projects draw on the strengths of women and mothers from across generations and cultures.

Some special projects done in the recent past have been canning and homemade bread workshops, making baby blankets, making baby slings, making wreaths at Christmastime, crafting memory boxes, sewing fleece mitts, toques, and scarves, and we are about to embark on knitting baby booties.

These special projects help mothers to bond with their babies and learn new skills and it provides mothers with a sense of accomplishment.

Where is the proof that this works? How do we know the Food for Thought program is meeting our goal of achieving better health for pregnant women and their children? Much of what we consider to be successful outcomes is difficult to measure. We believe that the most powerful proof of the success of Food for Thought is in the stories.

[Nancy Klebaum]

Please allow me to share a story of one of our Food for Thought participants who is now a peer leader. I hope you'll find this explains our program. This is Courtney's story:

I came to Food for Thought in December of 2005. I was single, pregnant, and had absolutely nothing to my name. I had just gotten out of a treatment centre and was pregnant for the first time. I was desperately afraid of everything. I had gone to treatment for drug addiction because I had been struggling with addictions for many years, and finally hit bottom using crack cocaine. I had dropped out of high school and left home at a young age, and had been using drugs and alcohol—

[The Chair, Conservative, Joy Smith]

Excuse me. Could you slow down a little bit? The interpreters have trouble keeping up to you. Thank you.

[Nancy Klebaum]

Oh, I'm sorry. Sure.

Would you like me to back up a couple of lines? No?

I had been using drugs and alcohol for 7 years. I was just 19 years old at this time. I had no skills to know how to live a productive life, let alone how to take care of a child. I was also paranoid, and in a constant state of panic.

When I came to Food for Thought, I felt like I was welcomed and more importantly, I felt safe. I felt like I could come to the program and I was respected (which was odd for me, because at this point I did not even have respect for myself.) It was also one of the first experiences that I had that I could go somewhere and nobody wanted anything from me. My transportation was paid for, I was able to help prepare a meal to take home for free, and I could participate in discussions with other people as much or as little as I wanted. I loved the truly positive environment of Food for Thought. I have learned how important it is to feed my children quality food, and how to afford to do so. I have learned how to make babyfood and what my kids and I need to eat to be healthy. Looking back I can see how extremely beneficial it is to have that wealth of knowledge at my fingertips.

Honestly, my cooking skills were the least reason I came to Food for Thought. I came because it was somewhere safe to go, and I was able to access things I couldn't on my own. My babies were able to get immunized, I had support with breastfeeding, I could talk to a nurse or doctor about any concerns, and I created friendships with women who I could relate to. What had the most impact on me however, was the information. I learned how to treat myself with love, with respect and that I had value.

A huge part of what made Food for Thought feel like a safe place was the peer leaders, I still remember looking at them in awe and admiration, they all had been through similar hardships and difficulties, and were in the same social class as me, and they were volunteering and helping out and providing a bridge for me to talk to and relate to, and I figured if they were trusting of the staff members I might be able to trust the staff too. It was so cool to perceive people who had a position in the program as equals, not all just grownups with degrees.

Over the next while, I did come to trust the staff, and they also became (and definitely continue to be) pillars of support to help me with whatever life threw at me. When I was asked to become a peer leader I was so honoured, and at the same time I couldn't believe that someone saw the qualities in me that I saw in the other peer leaders.

I am now eleven months away from receiving a degree in social work. I am a trained labour doula, a mother of three children and engaged to be married. I have material possessions that I never even dreamed of owning. I am still a peer leader with food for thought. The past 6 years have been hard, full of trials and tribulations. When I thought I should go back to school and get my grade twelve, I had a group of women tell me, I know you can, and you will succeed. When I mentioned I thought it was cool to be a doula, I was told I know you can do that and you would be great at it. When I thought I should go to university, and maybe I could be a social worker, I was again told, you can do that, and I did.

From the manager, to the program facilitators, to peer leaders to participants, my life was created within this program. I did not know how to live a productive meaningful life when I first came here. Sometimes I still am unsure of what that means or how to do it... But I always know where the door is always open, and love, respect and kindness will be in abundance. That's why I haven't left, and why I probably never will.

Thank you for your time and attention.

[The Chair, Conservative, Joy Smith]

Thank you, Nancy. That was wonderful.

[Some hon. members]

Hear, hear!

[The Chair, Conservative, Joy Smith]

It just shows how caring and practical work and planning can change lives. I've heard stories like that many, many times with the groups I've worked with. It's amazing to see them develop the way they do and for all of us to be a part of that, so congratulations on your very astute program.

I would like to go now to video conference with Trois-Rivières. We'll have Diane LeMay, assistant manager, partnerships, knowledge translation and innovation, and Manon Paquette.

I assume you would like to share your time, with five minutes each. Is that what you would like to do? Okay, great. So we'll begin with Diane.

[Diane LeMay]

Good morning. To begin, we would like to thank you for having invited us to make a presentation on the prevention of illness and health promotion, and more particularly on healthy eating habits.

I will give you a brief overview of our organization, Québec en Forme, and my colleague, Manon Paquette, will speak to the strategies we have adopted to promote healthy eating habits.

Québec en Forme is a non-profit organization which is the result of a partnership agreement with the Government of Quebec. It includes seven departments, three governmental organizations and one private foundation, the Lucie et André Chagnon Foundation.

Funding for Québec en Forme comes from the Fund for the promotion of a healthy lifestyle. This fund has $480 million for a 10-year period, which extends from 2007 to 2017.

Québec en Forme supports projects which promote healthy eating habits and a physically active lifestyle at the local level, that is, at the community, regional and provincial level.

The board of directors has 12 members, half of which represent the Government of Quebec, and half of which represent the Lucie et André Chagnon Foundation.

Our mission is to mobilize people and all of Quebec society to adopt and maintain a more physically active lifestyle and healthy eating habits, which are essential to the development of Quebec youth.

Our vision is that young Quebeckers eat healthy foods and be physically active, two lifestyle habits which local communities, decision-makers, all of society, and the parents of young people, recognize as being essential elements to their full development and success at school.

This is the vision we wish to translate into reality. So what we are talking about are young people who are active and who eat well, communities that are mobilized and do what it takes to achieve that goal, healthy eating habits and an active lifestyle, things which are recognized as being essential elements to the full development of young people.

We have just finished the new strategic planning exercise, in which we developed three strategic orientations. The first is the mobilization of communities, and the second revolves around changing the environment in which young people live. My colleague will speak more fully to what we are doing with regard to changing living environments, as well as transforming social standards.

The choice of these themes is based on the many experiences we have had on the ground since 2002, as well as on what the scientific literature recommends to introduce real changes in our society. It must be understood that our objectives complement the Plan d’action gouvernemental de promotion des saines habitudes de vie et de prévention des problèmes reliés au poids 2006-2012 — Investir pour l’avenir, of the Government of Quebec.

The objective is to increase, especially in underprivileged areas, the percentage of young people who eat well and are physically active.

I will talk about the first objective, which is the mobilization of communities. In our view, mobilizing communities means bringing people together to achieve something, to commit towards a common objective, and to become responsible for one's actions with the intent of reaching a common goal. It means making the decision to participate in a movement which brings organizations and people together, who are concerned by these two lifestyle habits.

We have people on the ground who work with local groups of partners to increase their ability to help influence the behaviour of young people. It is also a matter of mobilizing regional, provincial or national actors, to help them meet the needs of local communities, and to help them pool their resources in response to these needs, or at least to complement each other in their work. We are ultimately trying to break down silos, to get people to share our vision and to contribute their resources, as well as provide our support, to Québec en Forme, so that together we commit to a collective plan for change.

So, we both support local groups—

[The Chair, Conservative, Joy Smith]

Excuse me, Diane. You wanted to share your time. I just want to tell you that you're at halftime right now, so it depends on how much your partner has to say. You have five minutes left.

[Diane LeMay]

This is where we were at.

[Manon Paquette, Provincial Nutrition Advisor, Partnerships, Knowledge Translation and Innovation, Québec en Forme]

Thank you. I will continue with the second objective of Québec en Forme.

We have spoken about changing our environment. When I speak about the environment, I am speaking of everything that surrounds human beings, young people. We know there is an interaction between people and their environment.

This is why Québec en Forme has worked with the Ministry of Health on a vision of positive environments. We have divided our environment into four categories: physical environment, i.e. all the natural and man-made items; the sociocultural environment, i.e. anything having to do with social structures and the way people interact with other people or groups; the political environment, i.e. all of the measures and laws that structure our environment; finally, the economic environment, i.e. anything having to do with production, consumption, or even the cost of services. Working with partners to change our environments helps us posit a diagnosis regarding our communities, municipalities, or region.

Québec en Forme's third objective has to do with social norms. We need to go from an approach that goes from “we must eat well” to “it is the norm to eat well”. Québec en Forme is taking measures in order to devise a social marketing plan including a communication plan with our partners. This will encourage this kind of activities within local communities, regions, and all over the country. This is a far-ranging communication and awareness-raising plan.

More recently, Québec en Forme has acquired a new platform, or a tool to complete its strategic planning. This tool allows us to clarify why we must work on nutrition. This platform allows us to clarify the changes we hope to achieve. It allows us to have a common vision which we share with our partners and that we can propose to Canadians. This is not a restrictive approach; we do not seek to impose it. The idea is to offer a whole range of choices.

We are lucky enough to have had a certain experience in this field and to be able to document it. We can also use this documentation to make our proposals. Through this platform, we suggest that all our partners, at all levels, develop young people's skills, increase access to quality food, and contribute to the fostering of positive social norms.

How does this translate into a strategy? By developing young people's skills, by giving them chances to learn and experiment, by giving them programs in their communities, and by training trainers. I spoke about giving them access to quality services; by this I mean improving services offered by the community, whether in regard to physical activity, nutrition, or our man-made environment. For example, building new parks, green spaces, gardens, or breast-feeding areas. As I said earlier with regard to social norms, we want to raise awareness, communicate with people and defend these causes in their community.

In conclusion, all of Québec en Forme's partners, be they local, regional, or national, share with us the desire to improve young Quebeckers' nutrition and lifestyles. Thanks to the great diversity of our representatives, and to the solid partnerships that they weave with decision-makers, and finally to the awareness they have of the consequences of their decisions, we believe that our partners are key stakeholders in improving our youth's health.

Thank you for your attention.