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.
Conservative
Mark Strahl Conservative Chilliwack—Fraser Canyon, BC
I'm looking forward to using that when it comes out.
Conservative
The Chair Conservative Joy Smith
Thank you so much.
We'll now go into our second round. It will be a five-minute round. We'll begin with Ms. Quach.
NDP
Anne Minh-Thu Quach NDP Beauharnois—Salaberry, QC
Thank you, Madam Chair.
I thank all those who have come to provide us with some crucial and, I would say, original, information.
Most of you have talked about social determinants and their effects on diet, as well as on activity. You also talked about the importance of acting very early, right from childhood, regarding advertising, access to places to move, and healthy eating habits.
Where diet is concerned, we have been trying for years to take more preventive action. There is Canada's Food Guide and campaigns promoting physical activity in schools. In light of the growing obesity epidemic in Canada, many experts say that we should have more regulation. According to them, we can no longer rely solely on voluntary action, on everyone doing his bit. It is no longer enough.
There is talk of agri-food regulation designed to promote access to healthy and nutritious, and at the same time local, food. Indeed Canada has lots of farmers, truck farmers, growers and breeders. Do you have any thoughts on this? Do you know of any plan under which Canada-wide regulation has promoted access to healthy food, but whose funding has been stopped?
Conservative
Director of the Secretariat, BC Healthy Living Alliance
I can comment on that a bit. There are lots of projects going on across this country. If you come to our conference, you'll see posters and presentations of all kinds on fascinating things that are going on around food security.
I don't think there's a magic bullet. I think it requires a number of different approaches. As examples, a lot of places in northern British Columbia are looking at new ways of growing food. I was meeting with folks recently on how to use waste from some of the wood products to fuel greenhouses in the north so that they could be producing fresh food there. These kinds of innovative approaches need to be addressed.
As for food in schools, we had some very successful farm-to-school projects in northern and remote communities in British Columbia. They really helped to change behaviour in the children and they influenced their parents as well to get children to eat healthier foods.
A huge amount of work is going on in the area of food security, but underlying it, when you talk about the social determinants of health, is still the ability of people to buy fresh food and good food. That continues to be a challenge, particularly in northern and remote areas. The B.C. government has been working on a pilot project to subsidize food; I'm not sure that approach is necessarily going to answer the problem. I think it may help, but you still have to get people motivated to buy the fresh food.
The other side of that equation concerns how we can help raise those with the lowest incomes. In B.C. we've been advocating increases in the minimum wage, which has happened, and living wages. My dear colleague from the Canadian Cancer Society is from one of the first organizations to implement a living wage, and they did so not only for their employees but for all their contractors. We have other examples in B.C. We think this is something that is going to keep growing out there too. It will make a big difference.
NDP
Anne Minh-Thu Quach NDP Beauharnois—Salaberry, QC
You talked about incentives, consumer prices. Might the government have a role to play with regard to prices in restaurants and grocery stores? Could it promote access to local markets? You talked about community gardens. All that is linked to physical activity. If there are more local markets, people are going to get there by means other than cars, and this is going to get them moving.
Ms. Orji, I find your approach truly original. Today's young people all have cell phones and play a lot of electronic games. I wondered whether you had done any studies to determine whether this affects girls or boys more. Where is it most effective?
Ph. D. Student, University of Saskatchewan, As an Individual
Actually, we did a study comparing girls and boys, but presently we are more focused on eating. We want to understand what has meaning for the boys and what has meaning for the girls. I want to work based on what is meaningful to somebody. It's not a case of using force; we don't want to change people using force. We want to motivate along the lines of what has meaning for you.
We found that what matters to girls is different from what matters to guys. Particularly, a girl is more interested in her physical lappearance, so if you tell her that something is going to make her look look ugly and become unattractive, this, as superficial as it might sound, is the main thing they care about. They don't really care about getting a disease sometime in the future, or the probability of getting diabetes or something; those things don't have meaning.
You just have to find what the main thing is that has meaning for the person. To a guy, for instance, having a disease probably makes a difference--
February 9th, 2012 / 9:55 a.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Ms. Orji; I'm going to have to cut you off. You've gone over, but it's very interesting. Thank you.
We'll now go to Mr. Gill.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
Thank you, Madam Chair.
I also want to thank the witnesses for being here and for the wonderful presentations.
My first question is for the Canadian Association of Occupational Therapists. Could you please discuss your organization's initiatives? Have you developed any in terms of aiming at obesity?
Also, in your experience, how much time is spent by occupational therapists on obesity-related issues, and has this amount increased in recent years? Where do you see the trend going?
Occupational Therapist, Liaison with the Canadian Obesity Network, Canadian Association of Occupational Therapists
Thank you.
It's a great question I'm very passionate about.
About 15 years ago, I was the first occupational therapist in Canada to officially work in the area of obesity management. Since that time I've been able to mentor a number of emerging therapists who are now taking on the role. It is an emerging area. It's a very natural fit and it doesn't require us to do any additional training. We have the skills and the knowledge; what was lacking was the integration of those skills in the area of obesity prevention, management, and treatment.
I've done a lot of work with the association in developing education at conferences. Our association has a position statement that helps to guide practice. I'm currently editing a textbook that will be available across North America for occupational therapists and students to be able to use around occupation and obesity. It will have a management, prevention, and treatment focus. We currently have leaders in the area of obesity in Alberta, and there is a bariatric strategy through Alberta health services. One of the leaders in that field is actually an occupational therapist, who is responsible for a health network out there and is taking on the responsibility of training other therapists to work in that area.
I'm involved in interprofessional education that's available to all health science students. It is focused on rehabilitation and it's available to students across Canada. It's out of the University of Alberta and out of McMaster University. Our numbers are small, but as a profession we're small.
I can't specifically tell you about proportions, because when we identify our area of practice, obesity would be embedded within acute care, community care, long-term care, and primary care, but we are exposed on a daily basis to working with individuals who have obesity and we are high profile in the area of obesity. I am on a high level with the Canadian Obesity Network, representing the occupational therapists of Canada, and I lead several projects through them and put that occupational therapy lens on everything we do. Although we're small, we are very active in promoting what we do in that area.
Dr. Claudia von Zweck Executive Director, Canadian Association of Occupational Therapists
I can add that although a number of occupational therapists in Canada may not specialize in the area of obesity management, the mandate of our profession is to help people to do the occupations that are important to them every day and allow them to engage in things that are going to help them to be active in their environment. What we've heard from other witnesses today is the importance of looking at the barriers individuals face, helping them to address those barriers, and finding the most successful solutions, which are the solutions that address individual needs. That's where occupational therapists are working with individuals, groups, and populations in order to allow them to engage in those occupations and have that healthy lifestyle. Although it's not always necessarily geared towards obesity, it's geared towards active living, which feeds into the whole issue.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
Thank you.
My next question is for Rita.
Rita, are you able to discuss with us some of the challenges you may be facing in developing this application for computers or smart phones? How do you intend to market this application to the general public?
Conservative
The Chair Conservative Joy Smith
I'm sorry, but we only have about 30 seconds, Rita. That doesn't give you much time.
Ph. D. Student, University of Saskatchewan, As an Individual
Some of the challenges concern how to project the future outcome of the behaviour, to make the person actually.... If you're going to take a stairway instead of taking the elevator, in one month what is going to be the impact on your life? What motivates people is outcome. In behaviour change, you don't see the immediate outcome. If you're able to show somebody what is going to happen in one month's time—that is, how is your behaviour right now going to convert into an outcome in one month—it is going to be a big motivator. One of the challenges we are facing right now is how to actually do this in terms of healthy eating, which is kind of complicated.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you, Madam Chair.
Rita, earlier you spoke regarding the difference between boys and girls. I want you to please finish what you were saying. You were about to start on what boys want.
Ph. D. Student, University of Saskatchewan, As an Individual
Okay. As I was saying, girls are really more interested in....
For example, suppose I have some girl who is a smoker. She smokes and she doesn't have a reason for doing that. When I went to talk to her, I said, “Why do you smoke?” She said, “It's fun, and I just want to do it”. I said, “You might get some disease and die”. She said, “That's nothing new. Something's going to kill you anyway”, so that didn't work. The next time I told her, “You know what? You're going to get cancer of the mouth, and guess what? Women who get that are going to be unattractive, and nobody will kiss you again”.
That was the main thing. It worked. She refused to leave my room because she wanted to know more. She asked me what it looks like. She set out all the pictures to see what cancer of the mouth looks like, and she said, “That is really horrible. Rita, this is horrible. I would prefer to die”. I said, “No, you're not going to die. You're going to live with this for a while”.
It was interesting that this was actually what worked for her. For the next month she didn't smoke, but the downside is that she's also afraid of gaining weight, because at times when you change one behaviour, another one comes in. She's obsessed about adding some weight, so her fear was that if she stopped smoking, she was going to add weight. I said, “There's another way you can manage that”.
What I'm trying to say, in a sense, is that finding out what motivates people is actually the key to behavioural change. When I found out girls are more interested in their physical looks, I wanted to show them how they were going to look in a month's time if they continued eating burgers on a daily basis.
Ph. D. Student, University of Saskatchewan, As an Individual
From the model we have, boys care more about disease, but they also care about looking healthy. Most boys of a young age care about their attractiveness, but to boys attractiveness doesn't mean weight; it means the body's appearance, the general body build. Therefore, if I want to motivate a guy, I might not just focus on the weight; I might focus on the general appearance, the body build and stuff like that. That is what drives the boys.
What we're going to build for them is like this. If you want to build them up, you might want to create a model that makes them want to build their muscles. We want to tailor it to people's health needs, and for boys, that means creating a model that makes them choose building muscles. For somebody who wants to look good--and most of the guys want to build their bodies and build muscles--if you get an opportunity to channel someone into that aspect, they are so enthusiastic about it.
That's one of the things we're doing.
NDP
Dany Morin NDP Chicoutimi—Le Fjord, QC
Thank you very much.
My next question is for Martin Cooke.
A little earlier, your colleague and you were talking about long-term investment in prevention programs aimed at aboriginal populations. Can you give us more information about the current situation? You are not the first representatives of agencies talking to us about the lack of reliability regarding investment in programs designed to prevent disease and promote health. Tell us more about your current needs and what you are asking the Canadian government for to ensure the continuity of these good programs, be they pilot projects or very useful projects for aboriginal communities.
Research Partner, Associate Professor, University of Waterloo, University of Western Ontario
I'm not sure. I don't know that we have any expectations of government in this respect. What we're trying to do is show that we have a model that we think can improve how systems work; I guess we would hope that this model would be replicated. We recognize that local contexts are always very different and that they matter, and that the collaborations and everything else will be different. However, we hope that some element of the model of the process, through breaking down barriers and improving collaboration among all partners and all elements of this complex public health system, can improve the health of indigenous children in our communities. It's the idea that this might be a model that can be used in other areas.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Dr. Morin; we're about there.
My colleagues have graciously allowed me a question, so thank you.
I'm very interested, Ms. Orji, in what you have to say and in your research. I like what you have to say about motivation, because I think that whether we are young or old, that's what makes us do what we're supposed to do.
There is a disconnect between the younger generation and the older generation. Our demographics are showing that most of the population in our country are going to be of the older generation in a couple of years; that is, there will be more of the older generation than there will be young people. That's the first time this has ever happened in Canada.
You talked about social media. Have you thought about how you would make the older generation aware of social media, about how they can apply it and how they can make it easy for them? I worked with a group of seniors and introduced them to the computer and a few things like that; once they got going, there was no stopping them. Some of these seniors really need to be motivated to do physical activity; in fact, this morning I was learning how to swim. I never swam in my life. I did six laps this morning, and my hair looks like it.
Could you give us some input into that area?
Ph. D. Student, University of Saskatchewan, As an Individual
Our study showed that a good number of the older generation are not so effective at the use of computers, but when it comes to mobile phone use, they are almost at par with the younger generation. Most of the apps and interventions we're going to be designing are going to be running on phones. They can be used by anybody, older people and younger people alike. That's why we feel that applications for mobile phones are the in thing. They are the way forward, because mobile phones go with people wherever they go. They're something anybody can use.
The key here is that you don't have to learn it and you don't need to buy anything extra. You just have it with you. When something extra needs to be attached to the cellphone or the person, it adds another difficulty to the behaviour you want to promote. However, if I'm able to get it into the phone you're already using, then if you know how to dial a number, you can use the application. We're actually targeting the whole group, both the old and young generations.
That's why I said that mobile phones are going to be the future. They're going to be the in thing that everybody can use. You don't need any extra thing. You don't need to learn. There's almost zero learning curve involved.
Conservative
The Chair Conservative Joy Smith
I'll carry this a little further. You know that, and now we know it because you've come to committee, but how would you let the public out there know? There might be a suggestion that you could you give that information to each of the MPs or people like that, and they could put it into the ten percenters and spread the good word around, because physical activity is the key to managing chronic disease. We've heard that over and over again in our committee. It might be something to consider looking at for your research, because it would narrow the gap.
What do you think about that?
Ph. D. Student, University of Saskatchewan, As an Individual
It's a good thing. I think part of what we're doing today is getting it to the public. Then we've got a couple of publications we're going to be having outside, although I wouldn't believe everybody will have access to them. We also hope to make it as public as we can by attending forums and showing the results of what we've done. We hope to design some things, evaluate them, produce the outcome, and get it outside as a publication for other people to read. By doing that, we hope to create an awareness of the added capability that mobile phones and some other applications have in changing people's lives, and more specifically obesity.