Evidence of meeting #27 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was prevention.
A recording is available from Parliament.
Occupational Therapist, Liaison with the Canadian Obesity Network, Canadian Association of Occupational Therapists
Oh, I'm sorry. I'm looking at nodding heads. There's absolutely no problem.
Conservative
The Chair Conservative Joy Smith
I'm sorry about that, but it's just to be fair to everybody. I'm not trying to interrupt you.
You’ve made some very good comments. Thank you.
Now we'll go to Mrs. Block.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
Thank you very much, Madam Chair.
I want to thank all of our witnesses for being here today. I definitely concur with my colleague across the way that it has been a great cross-reference of different viewpoints that have been represented.
I know I have limited time, so I'm only going to ask questions of a couple of witnesses, but I want to thank you, Rita, for your presentation. I'm from Saskatoon, so I think you've made a great choice in the university that you've chosen to do your doctorate studies at.
Having said that, my first question will be for Mr. Wilk or Mr. Cooke, whoever would like to answer.
To put it into context, I'm from Saskatchewan. We have 74 first nations in Saskatchewan. I have two urban reserves that are just basically business ventures in my riding, and while I don't have any large reserves in my riding, I do have the largest population of first nations and Métis urban constituents in the city of Saskatoon, so I know full well the challenges that you've described.
What I want to do is follow up. I know you talked about the grants you've received that focus on obesity among aboriginal people Canada, including the off-reserve first nations children. I want to ask you if you could outline what some of the biggest challenges are for preventing obesity among first nations children off reserve.
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
I should preface my answer by saying that our intervention plan is focused mainly on improving the way that the system serves these kids. The reason is that the evidence, such as it is, tends to show that the things that are effective are usually developed locally in response to local needs, using local resources and taking local cultures into mind.
We have a collaborative project. Most of our partners are service providers who know what their communities need, be it urban or on first nations, but what the challenge seems to be, as this committee has heard before and was actually said in your 2007 report, is that the system that serves these kids tends to be fragmented and it tends to be siloed. Often neither funding nor general thinking about it doesn't focus on all of the multiple providers that serve these kids, including local educational providers, local public heath agencies, local first nations organizations, the people who design neighbourhoods in the municipalities, and so on. From our perspective, it's important to get these organizations to all have a focus on aboriginal child health and to make a little bit of an organizational change such that they include thinking about first nations and Métis populations when they're designing programs and embed that approach in their organizational culture.
What we're trying to do is to focus on how that whole system works, not necessarily by adding resources but by making the resources that are there work better, essentially.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
Are you familiar with the health disparities report written by Dr. Cory Neudorf and Dr. Mark Lemstra from Saskatoon?
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
I'm not, not off the top of my head.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
It would be a great report for you to take a look at in the work you are doing.
My next question is for Ms. Collins.
I want to thank you for the observation you made earlier that there is an opportunity for the provinces and territories, along with the federal Minister of Health, to continue the dialogue around setting standards, indicators, and measurements that will make sure we are getting the results that we want to see and that Canadians deserve out of our health care system. I want to thank you for that observation. We've simply provided some stability and predictability in terms of the funding, but that doesn't preclude the conversation that still needs to happen over the next few years, so I thank you for saying it.
In Saskatchewan we moved forward from a system in the early 1990s that had 400 different boards providing oversight of health care in 32 districts. We went to 12 health regions. When we moved to districts, they implemented a funding formula that was needs-based but that also took into consideration demographics, which changed the funding based on the number of children, women, seniors, and aboriginal people.
They also built in what they called a one-way valve. There was a certain amount for acute care and a certain amount for community care or those community-type programs that were meant to focus on health promotion and disease prevention, and while money could move from acute care to the community-based services, it could not move back. However, the lion's share of the funding always went to acute care, so we felt tension between having to fund acute illness care while trying to look at health promotion and disease prevention. I know my colleague picked up on my exact quote that “prevention needs to drive the system”.
You also said that a shift has to happen and that prevention needs to be fundamental to that shift. My colleague referenced the very good work you are doing in B.C.; I'm wondering if you would take a little bit of the time that's left to tell us about that work.
Director of the Secretariat, BC Healthy Living Alliance
Cathy may want to join me.
I want to mention, because I think it relates to some of the other--
Conservative
The Chair Conservative Joy Smith
You just have a minute. If she's going to join you, I think it has to be pretty soon.
Director of the Secretariat, BC Healthy Living Alliance
Some of the most important work we did in our project was around community capacity-building. We looked at aboriginal communities in B.C. and recognized that a top-down approach wasn't going to work. You had to do it from the bottom up. The Canadian Cancer Society led this effort with community development folks. Within those aboriginal communities, they decided what was most important to them to focus on, whether it was youth leadership, community gardens, or some kind of healthy eating program. There were some really wonderful outcomes from that initiative.
The challenge is—and this has come up in our conference—that Canada is country of pilot projects. We do all these things for two and a half or three years and say, “Isn't this great?” Then the money is gone. Therefore, we need to have greater continuity of funding for a lot of the most promising and best practices.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you.
I want to thank the witnesses for coming. I especially want to welcome Mary Collins, who, as everyone would know, was a Minister of Health at one time, so she knows about all the federal-provincial jurisdictional issues and about pilot projects not leading to sustainable funding. I want to congratulate her on doing some very good work over the years since she's left politics.
There are a couple of things I wanted to ask about. Libby mentioned sodium strategy, and Mary talked about having a provincial buy-in to it. The thing about the sodium strategy is that the provinces have all agreed on what that strategy should look like, and they agreed to it in meetings with the federal government, so the Department of Health and the provinces all have an agreement on regulations for sodium and a sodium strategy.
However, as we sit here and talk about health promotion being important, it has to be more than talk. We have to put some teeth into it. I think that if we want to really do something, we should be looking at regulations, and regulations have not come about, even though the provinces and the Department of Health have recognized this problem and have recommended regulations. That's rather interesting.
Obesity is another one. I'm saying this because we talk about regulation and about having a rule, and although we don't want to regulate everything, sometimes voluntary strategies don't work. Then we have to move into regulations. We've done it very well with alcohol. We did it very well with smoking. You can see good results, and we really need to look at obesity, which causes a huge amount of disease, and at all of them.
I wanted to ask you to expand a little more on the role of regulation in making sure that people have a little tool to help them, because people are going to choose. I wanted to ask you about that.
I also wanted to thank Ms. Orji for her really innovative idea. We're talking about innovation being what drives health care, and this is innovative, because we can reach all youth. We know that sedentary lifestyles and sitting around a computer playing video games, unless you play Wii, really do increase obesity, because you're not doing the exercises you need. Using social networking and an iPhone to help you do that is brilliant. If you have shares, Ms. Orji, I'll buy some, because it's really a fantastically innovative idea.
I also want to thank Ms. Forhan. I wonder if she'd have time to expand a little bit on the idea of measurable goals. This idea was floated about 35 years ago by a health minister, and it has never come about. Everyone is afraid of measurable goals because they're afraid they won't reach them. Well, if you don't know where you're going, as the great Yogi Berra used to say, how are you going to know when you get there? If you set a goal and you fall short, it still means that you know you're getting somewhere, and you can start. Indicators and all of that are useless unless you have measurable goals.
Perhaps Ms. Collins could comment on regulations and the role of regulations.
Director of the Secretariat, BC Healthy Living Alliance
I have just a quick comment, because Cathy would like to join in.
We think there needs to be a joint approach. You need to control the environment for obesity as well as personal behaviour and personal responsibility, and in the environmental side there is a role for regulation, as in tobacco, where it worked well. You need regulation, you need taxation, and you need promotion programs.
In some cases, actually, the private sector prefers regulation, because there's a level playing field. Everybody has to play by the same rules. We actually support regulation in terms of marketing to kids. We think it's going to require regulation. Labelling, as well, should be done through regulation.
Cathy, you wanted to comment.
Representative, Vice President, Cancer Control, Canadian Cancer Society, BC and Yukon Division, BC Healthy Living Alliance
Mary, you really spoke to it.
Fundamental to health promotion is the combination of regulation, education, community mobilization, and community capacity-building. Really, to have one strategy without the other is going to lessen the chances of success in any of these areas. Tobacco is a very good example.
Liberal
February 9th, 2012 / 9:40 a.m.
Occupational Therapist, Liaison with the Canadian Obesity Network, Canadian Association of Occupational Therapists
I think if we're looking at the individual, at the level of the person—I really enjoyed Rita's presentation—and if the goals are more than just knowing whether we achieved those goals or not, but are about finding a nice fit between what is meaningful to that individual--what is consistent with their values, their abilities, and their resources within their communities and within themselves--then all those individual aspects need to be part of that measurement. It's not just one outcome; there are several outcomes within that goal-setting.
In the Canadian Occupational Therapy Association, we use a guide and a tool called the Canadian Occupational Performance Measure, which allows us to quantify goals while taking all of those dimensions into consideration. Then, at the level of a larger population, we can extrapolate to generalizable goals across subsets and subpopulations, based on age as well.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I didn't mention the aboriginal issues that you brought up, but I think one of the biggest things we need to look at is whether aboriginal communities, especially on reserve and in urban areas, have the ability to have the kind of local community centres where there are gyms and exercise programs with good coaches who can teach them how to exercise well and bring about exercise as one of the components that may or may not be missing in a strategy.
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
Certainly, from what we've seen—and others know much better than we do—there are resources that our local partners are missing or would like to have. That said, part of what we're trying to aim at is finding ways in which the community, and the system as a whole, can make use of the resources that already exist in the community. I agree that access to things like spaces for healthy physical activity is really important; at the same time, in a lot of cases those can be arranged. They do exist in one way or another; otherwise, with access to some specific funding, they can be developed. It's more about the networks and the way the system itself works to get those spaces used by the people who need to use them.
Conservative
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Thank you very much.
Thank you all for your presentations. It's good to see B.C. represented here as it is at the table in this committee.
Mrs. Block talked about 74 first nations in Saskatchewan. I think I have 40 in my riding alone. I have visited a number of them and I have seen the difficulty. Ms. Fry asks whether they have access to the same level of leisure activity, leisure centres, and recreation centres; some communities in my riding have 1,000 people who are an hour's drive from a community that has 2,000 people in it, so it's very difficult for them. They have a band office with a health centre attached to it, and that's about it.
My questions are about that kind of situation. How do we reconcile that? You talked about local services. Often the community itself is, as I said, 1,000 people and does not have a lot of local infrastructure. How do we overcome those challenges? As you say, you want it to be community-driven, but there's not the expertise, there's not the capacity. How do we go about serving those aboriginal Canadians?
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
As I said, our focus is on children who are living primarily in off-reserve areas, although we recognize that those children are often connected in important ways to nearby first nations. Certainly others would know much more than I do about the situation on reserves, and especially more geographically distant reserves. For example, our colleague John Henhawk, from the Southern Ontario Aboriginal Diabetes Initiative, is here in the audience. They would know much more than I would about that aspect.
If you look at London, Ontario, as a community in general, there's a lot of capacity, and there are lots of possibilities for better cooperation between provincially funded programs and municipal organizations and the local first nations. There are important historical reasons for the difficulties in that area, which we acknowledge, but that's what we're trying to change.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
We've heard from numerous witnesses that the socio-economic status of the family in which a child finds himself or herself affects the the child's health. How does an off-reserve aboriginal child compare to the same child living down the street in a similar situation, in terms of their current health outcomes? Is it comparable or is it different?
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
We can only speak in terms of averages, of course. The outcome we're interested in here is obesity, and in this case it looks as though an off-reserve aboriginal child probably has about twice the risk of obesity. We can't really think of obesity as separate. Obesity comes bundled with a whole bunch of other health risks. In some ways it's more of an indicator than it is an outcome itself.
In any case, the risks are much higher, and we think that's related to neighbourhoods and resources in neighbourhoods, as well as to the income of those neighbourhoods. For example, it's related to living in a neighbourhood where there may not be safe space to play. It's related to family income as well, time available for supervision—if you think of lone parents, for example—and to access to healthy food in the neighbourhood. It's a complex multi-level issue for sure.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
Rita, I was interested in your presentation as well. I'm sorry that Patrick wasn't here; I know he has developed some mobile applications as well, although not, I believe, at the same level as what you're looking at. I am aware that some apps already in existence can track your calories and your fitness and all the rest of that.
What have you seen? What is the uptake? How many people are using these apps? How effective are they? What is your research doing to go beyond this stage? Are you looking to coordinate those sorts of things? There are some products out there already. How are you looking to take this development to the next level?
Ph. D. Student, University of Saskatchewan, As an Individual
The main difference between what I'm going to be doing and what I am doing—what exists now—is that the apps to track calories or to do some other stuff, such as motivate people to exercise by measuring their goals, as in making them commit to probably a weekly goal and track it, might not touch what is important to the person.
What we're doing differently is that we want to study the human being and understand the person's behaviour—the behaviour of either the group or the individual—to understand what is of interest to the person.
One of the models we have is trying to understand the eating behaviour within a group. We want to understand the determinants of eating behaviour. What is interesting is that we found that what motivates that group of people is gaining weight. What we want to do is to motivate people along the lines of their interest. We're building the model primarily based on behavioural change theories or health theories. It's going to be different from what you see outside, because it's going to be practically based. It will be based on how behaviours are formed and how they can be changed. You'll be using something that is motivating to yourself personally and that talks to your own particular need.
Most of the apps out there are generic, aren't they? I just use it for me; it doesn't do anything to me. It doesn't even act on what I believe. However, if what motivates you is the probability of gaining weight, whereas another person cares a lot about disease and some other person cares a lot about the physical outlook, if I want to talk to you, I'm going to project the outcome of your behaviour based on what is of interest to you. That is the trigger; that is what makes the magic.