Thanks, Cathy.
It's a great pleasure to be here with you.
In the short time available, I'm going to highlight several areas we think are of importance. I won't read the brief.
I wanted to start by saying that Cathy and I have just come from the Chronic Disease Prevention Alliance of Canada conference at the Delta Ottawa City Centre, where we heard from an array of experts on these issues. There's a lot of new information coming out of that work, so I would certainly recommend it to you.
Yesterday Dr. David Butler-Jones, the chief public health officer of Canada, spoke at the opening. He talked about how prevention needs to drive the system. This message is increasingly capturing both the understanding and the imagination of policy-makers and of those across the country. Increasingly, finance ministers and health ministers are realizing that the costs of health care are potentially unsustainable if we don't do something to shift that curve over the longer term, and prevention has to be fundamental to those changes. It's not easy, but we are hoping that your committee and your colleagues will help us to achieve that goal.
There was a very interesting recent study in the United States about modelling the health care system. It's in Health Affairs. It looked at whether investments in care or investments in prevention really brought about cost changes over the long term. They showed, in their modelling, that within the next 25 years—and we realize that this is long term and that these changes will not take place overnight—investment and prevention are projected to save 140% more lives and reduce costs by 62%. Now, we know that our environment is somewhat different from that of the States, but we would suggest that you could look at similar objectives.
We recognize that we need to integrate the health care system and the health prevention system and that primary health care is fundamental to this objective. An integrated approach to primary care, which includes prevention and an array of health practitioners, is something that many jurisdictions are working on and something that we hope the federal government will continue to support.
We also recognize that the health sector isn't going to do this alone. We continue to preach, I guess you could say, that the issues about chronic disease, which are consuming over 40% of health care budgets, need what we call a “whole of society, whole of government, whole of person” approach. Perhaps you could just think about it in terms of those parameters.
“Whole of society” requires not only the involvement of government, but also of the private sector and of all the not-for-profit health care providers as well. We need better mechanisms by which we bring people together—we're not there yet—to come to good decisions and good conclusions. Again, we would encourage the federal government to help to facilitate those kinds of partnerships of bringing people together.
Also, when I say “whole of government”, I don't mean only the health ministry. If you look at infrastructure funding, for example, you need to understand what the impact of any particular infrastructure project may be on the health of citizens, and whether it in fact helps us to lower the curve around health equity. That's one of our biggest concerns: there's a huge gap in health and health outcomes among people of different socio-economic strata.
We would encourage all levels of government, including the federal government, to require that their ministries have performance plans to show what they are doing to contribute to better health among Canadians, and to require that these plans be assessed on a regular basis, in part to review whether there are, in fact, good health impacts stemming from major projects. These assessments must look not only at the environmental factors, which are important, but also at the health impacts of major projects.
When we talk about the determinants of health, which of course we've all known about for so many years, we know that these include where you work, where you play, and where you live. Your economic and social circumstances make a huge difference to your health. We need to think about initiatives that will understand the difference. We tend to be rather skeptical of the kinds of campaigns that use broad advertising; they may help those who are already healthier, but they don't necessarily address the needs of those who are in the poorest health or at the greatest risk of poor health. Sometimes we need to look at more segmented approaches to reach those people.
I know that you're particularly interested in the issues of healthy weights and childhood obesity. We've actually moved our language from saying “obesity” to saying “healthy weights” instead, because there is increasing evidence that saying “obesity” tends to stigmatize people, and we don't really think that's a good idea. There are already enough challenges involved in that area.
I won't go through all of our recommendations; we have quite an array. We have other reports available through our website.
There are a couple of things that are really important. One is to ensure that all Canadians can have nutritious foods, and this is particularly important for children as they're developing. There is a lot of opportunity through school programs to advance those interests.
One thing that's really of concern is that children are being bombarded by television and video messages about unhealthy foods, and there's evidence that this advertising tends to increase.... Children, of course, are not yet sophisticated enough to really know the difference.
Ideally this could be managed on a voluntary and cooperative basis. Unfortunately, the reality to date is that it hasn't really worked. While we would encourage that approach to continue, we really think it ultimately will require regulation. Quebec has done it, and we think what is needed in a more comprehensive way across Canada is restrictions on marketing to children, not only on television, but in commercials, cartoon characters, video games, and things like that. I know we don't necessarily want to regulate everything, but in this area evidence shows that it certainly can have an impact.
Another area has to do with designated taxes. As we know, nobody likes taxes, but there's increasing evidence, which we heard a lot about in the last two days at the conference, about designated taxes. We would suggest excise taxes on sugar-sweetened beverages--not just soda pop, but all sugar-sweetened beverages. Sometimes people think it's just soda pop, but we're not just going after that. Such a measure can make an impact by facilitating people in making wiser choices. In some cases provinces could do it, but there's also an opportunity for the federal government to try to help people make those better choices.
We can't forget the role tobacco and alcohol play; we would urge the federal government to renew the tobacco strategy, which we know is coming to an end fairly shortly. We've made great progress and we have lots of lessons, but we can't let up. We still have too many people smoking, particularly young women, who often associate it with low weight and think it's going to keep them slim. Of course, there's also alcohol; increasingly people are recognizing alcohol as a risk factor contributing to obesity, and also recognizing its connection with chronic diseases right across the board.
In conclusion, we recognize that over the years the federal government has played a leadership role in working with the provinces, the private sector, and the not-for-profit groups in a joined-up approach to promote and inspire the next generation of Canadians to live not only long lives but healthy ones as well.
We thank you and look forward to your questions.