Health Committee on Oct. 19th, 2011

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

Thank you, Madam Chair.

I would also like to thank all the witnesses who made a presentation.

My first question is for everyone, more or less, since you all said that nutrition, diet and lifestyle are solutions for preventing the chronic diseases we are talking about. Some witnesses talked about agriculture. I think it was Mr. Sharma in particular.

Have you contacted people who work in the agri-food sector across Canada? If not, what has been done? Will you be developing processes, initiatives and programs as suggestions for the government? What can the government do to encourage all that?

I have other questions, but I will let you answer this question first.

[Manuel Arango, Director, Health Policy, Heart and Stroke Foundation of Canada]

Thank you very much. That's an excellent question.

Our recommendation with respect to agricultural policy came out of a huge scoping review that was commissioned about a year and a half ago, and it made this important recommendation. We are in the process of reaching out to the agricultural community.

What we do know is that often we have subsidies for corn and soybean production, which end up creating cheap supplies of fat and sugar. That fat and sugar is afterwards used in processed foods, and it makes the processed foods much cheaper than vegetables and fruits. This results in a bit of a perverse situation. What we need to do is ensure that fruit and vegetables are cheaper. We need a similar type of subsidy on fruit and vegetable production. Another example, as well, would be subsidies to farmers, to be able to transport fruit and vegetables to and from their markets.

Very generally speaking, we need the government to use a health filter or a health lens when they look at agricultural policy. We will be reaching out to Agriculture Canada and other organizations to work on this, but very generally speaking, we do need subsidies for fruit and vegetable production. That will make a difference, because, as Dr. Sharma mentioned, seniors are often on limited budgets and that will help with aging and chronic disease.

[The Chair, Conservative, Joy Smith]

Does anyone else have a comment on this?

Ms. Leo.

[Aileen Leo]

We haven't had any direct contact with agricultural producers. On occasion we will work with food producers in certain joint ventures, but we are concerned by the fact, as Dr. Sharma has mentioned, that fruit and vegetables are often prohibitively expensive, particularly in rural, remote, and northern areas of Canada.

We are concerned by the end of the food mail program and the substitute program that was put in its place, because often the subsidies are not passed on to consumers directly. They reside with the distributor. Given rates of aboriginal diabetes, that is a particular concern for us, because it's estimated that aboriginal diabetes rates are three to five times the rates of those found among the general population.

We need to provide affordable, inexpensive, healthy, nutritious food for all Canadians. That includes people who live on reserve, aboriginal Canadians who live off reserve, and also people on low incomes. I don't think it's any surprise that the consumption of soft drinks has gone up quite precipitously, when you consider that soft drinks are often much less expensive than milk. What message does that send to young people, in terms of what drinks they should be consuming?

While we haven't had those conversations directly, we would certainly be in favour of exploring measures to make healthy, nutritious food more affordable and less expensive, because it's well known that up to 50% of type 2 diabetes cases could be avoided with healthier eating and increased physical activity.

[Jessica Hill]

Madam Chair, perhaps I could make a comment.

[The Chair, Conservative, Joy Smith]

Yes, please go ahead, Ms. Hill.

[Jessica Hill]

We have a few resources and activities that address healthy eating. First of all, we have a public policy directory on our portal, on cancerview.ca, that actually captures public policies that are effectively supporting prevention. One of the resources on that is a resource called Addressing Healthy Eating and Active Living: A Community Level Policy Scan. The public policy directory also captures policies at the federal, provincial, and municipal level, and updates it on a regular basis. As municipalities or communities are looking for what they might do in the way of improving their policy directions, they can look at this and they will actually see a resource that's available. It reduces a lot of time for organizations and communities that want to improve their public policies at those levels.

One of our coalitions, Coaltions Linking Action and Science for Prevention, is looking at healthy communities and how to support communities to address the full range of policies—physical activity and nutrition, healthy eating—together in their communities and advancing those directions in their communities. It's more of an integrated approach, where nutrition is looked at as one of the key factors, with physical activity, to move forward.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Hill.

And thank you, Ms. Quach. Your time is up.

Now, with the permission of the committee, I want to welcome Mr. Wilson.

I've had days like this too, when I just couldn't get there at the right time.

We have begun our first round of questions. With the permission of the committee, could we just pause right now and give seven minutes to Mr. Wilson? Is that okay with the committee?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

All right, we'll pause and go and go back to our presenters.

Mr. Wilson, you have seven minutes. Welcome.

[Christopher Wilson, Director, Public Affairs and Advocacy, National Office, Canadian Lung Association]

Thank you very much.

I apologize for being late. I was at the Minister of Finance's office and I couldn't tear myself away.

[The Chair, Conservative, Joy Smith]

Oh, we know that Minister of Finance. We'll talk to him later.

[Christopher Wilson]

I certainly don't mean I was seeing him personally, as you well know.

[The Chair, Conservative, Joy Smith]

Thank you.

[Christopher Wilson]

Okay, well, thank you.

I'm Christopher Wilson. I'm the director of public affairs and advocacy with the Canadian Lung Association.

With me is Rosario Holmes, who is an asthma and chronic obstrucive pulmonary disease educator.

I'm going to give you the short version.

The story of lung disease in Canada is really a bad-news and good-news story, if I can put it that way. The bad news is that over six million Canadians suffer from some form of respiratory illness, be it asthma, chronic obstructive pulmonary disease, COPD—it used to be known as chronic bronchitis and emphysema—lung cancer, sleep apnea, or cystic fibrosis.

Lung diseases are not curable. Without good management, they can be extremely debilitating and very expensive to treat. Together, lung illnesses have the highest repeat hospitalization rates and the second-highest acute in-patient treatment costs. To make matters worse, lung diseases are widely undiagnosed and untreated, including an estimated 50% of COPD cases and an astounding 85% of sleep apnea cases. Sleep apnea, for everybody, is a condition in which breathing is obstructed during sleep and it results in chronic fatigue and a host of health problems.

Undiagnosed diseases are poorly managed and they lead to periods of crisis and overall deteriorating health, resulting in high rates of emergency treatment and hospitalization. Thus, respiratory illnesses put a very heavy burden on the health of Canadians and our economy. It's conservatively estimated that between direct-care costs and the costs of disability, lung diseases currently cost $15 billion a year, and in 20 years will cost over $27 billion. This is just for chronic lung disease.

Respiratory illnesses have an especially heavy impact on older people. Prevalency rates for COPD among people aged 65 to 74 are almost triple those for 35- to 44-year-olds. COPD hospitalization and mortality rates rise steeply beyond age 65. Over 60% of asthma deaths in Canada occur in people over age 65. Lung cancer is rarely diagnosed in people younger than 40, and 80% of lung cancer cases occur in people over the age of 60.

Now, it's important to emphasize that older people are also disproportionately affected by some of the key risk factors for lung disease, including smoking, occupational exposures to harmful chemicals, as well as outdoor and indoor air pollution. It's important to remember that the awareness of these risks was much lower when the older generation was growing up, and therefore prevention wasn't practised and people were exposed more often and more severely.

Also important to note, as I'm sure you've heard, is that people with respiratory illnesses, like other chronic diseases, also frequently have more than one chronic disease. They are co-morbidities, which often end up being the cause of death. COPD patients, for instance, frequently die of heart attacks. Lung diseases in the elderly also increase the risk of hospitalization and death from infectious diseases such as influenza and pneumonia, so COPD has been diagnosed as a co-morbidity factor in over 50% of all deaths attributed to influenza in Canada.

Finally, I'll note that elders in first nations, Métis, and Inuit communities are at especially high risk for lung disease as a result of high smoking rates and overcrowded living conditions. As a result, the statistics are very high. The rates of COPD for off-reserve aboriginal people are nearly twice those for average Canadians. Women in Inuit communities have a COPD death rate that is ten times that for other Canadian women. Lung cancer rates for Inuit men and women are the highest in the world, and these rates are rising.

The story here is that in the absence of concerted action, the prevalence of lung disease will only get worse as our population ages in the coming years. The Conference Board of Canada has estimated that the number of people living with various lung diseases will increase by between 33% and 41% over the next 30 years. Seniors will make up most of this increase. Meeting the needs of these Canadians will put enormous pressure on our health care system. It is estimated that by 2020 there will be a 35% respirologists shortage, just as an example.

Fortunately, this is not all gloom and doom. There is good news here and there is real hope. There is hope for the following reasons. First, most lung disease is preventable. Reducing exposure to tobacco smoke, industrial pollutants, indoor air contaminants, and so forth will dramatically cut the incidence of new lung disease. Continued action in these areas will pay off even for people who are approaching their senior years.

Second, many respiratory illnesses can be effectively managed to reduce their severity and significantly improve health outcomes. There is a best practice emerging in Quebec that through patient self-management has cut costs by 38% and disease exacerbations by 45%.

Third, earlier diagnosis of respiratory illness will cut rates of untreated and poorly managed disease. Remember that the rates of undiagnosed disease for some of the most debilitating lung diseases are very high.

Taken together, the gaps in the prevention, diagnosis, and treatment of lung disease present a serious challenge, but they also afford a major opportunity. This is one disease area where we can have a big impact in the short term as well as in the long term through strategic investments.

To achieve the goal of concerted, coordinated action, the lung health community has partnered with the Government of Canada in the national lung health framework, which has developed an action plan for improving lung health, with a focus on improving prevention, diagnosis, and treatment. In its first stage, the framework did a strategic assessment of the state of awareness of lung disease. In the next phase, we are looking to have targeted actions with a high impact on reducing lung disease.

We have three recommendations. The first is to continue support for action on tobacco control and smoking cessation. We believe that the federal tobacco control strategy is important. Second is continued action on air quality. Third, we suggest renewing the national lung health framework.

Thanks.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Wilson. Thank you for giving the presentation.

We are going to resume our questions and answers.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair.

I want to thank the witnesses for being here today and for participating in our study. I think this is probably one of the most important studies we've ever done. We've had statistics in front of us. The cost to Canada for chronic diseases is $190 billion per year, so your input is really important.

I want to ask my first question to the Canadian Partnership Against Cancer, because you brought up something that I found very interesting. You talked about healthy communities. This past week we were back in the constituency and I attended a luncheon that was put on by a group in Oshawa. They're starting something called “victory gardens”, which used to be grown back in the war, and what they are doing is very cost-effective. We hear about the cost of fruits and vegetables. Well, they are growing their own. It was an excellent luncheon. It was all locally prepared food.

I am wondering what roadblocks are in the way of developing healthy communities. I look at my communities, and I see we are designing communities that have subdivisions where people need to hop in their cars to drive to get their cigarettes and Doritos and bring them back home. I wonder if you could comment a bit more on the concept of healthy communities and partnering with municipal designs. Is there any way you could see the federal government helping in that evolution?

[Jessica Hill]

Thank you for the question, Dr. Carrie.

Actually, one of our coalitions is called Healthy Canada by Design. Peel Public Health is leading that work with other coalition partners. It's very much looking at municipal planning and how we can encourage the planning practices by municipalities to consider what's needed to support both physical activity as well as other aspects of healthy living. They are seeing some real changes in the uptake of their planning practices, not just in Peel, but also in other areas of the country, by supporting this activity.

That's one dimension of it. The other is that there has been work led very much by the Heart and Stroke Foundation in northern communities around the concept of gardens and opportunities to create access to healthy food sources that are much more community-based, and really encouraging community ownership of that idea.

So there are many dimensions that can be tackled in terms of supporting healthy communities.

We have another coalition that's looking at helping kids get physically active. In particular, we have one with first nations communities in Saskatchewan and Manitoba, where we are piloting chronic disease prevention education, with first nations communities by first nations communities. Again there are many levels on which I think you need to engage the community so that nutrition and healthy eating and physical activity are addressed collectively.

Certainly the partnership, through its coalitions, takes a very broad perspective about supporting prevention activities and really looking at those risk factors and how we can accelerate action. So we're going to be looking to how we can support further the Peel Public Health and communities by design to be adopted across the country.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I think it would be great if we could raise awareness on that issue, because what I'm hearing from all of the witnesses here--personal responsibility, proper food, exercise, a lot of common-sense things--will help us all as a country avoid a lot of these chronic diseases.

One of the statistics you brought up was disturbing. You mentioned that between 2007 and 2031 it's expected that new cancer cases will increase by 71%. I was wondering why you see such an increase. Is it earlier diagnosis? What types of cancer do you see increasing over the next few years?

[Jessica Hill]

The growth is related to the aging of the population in part, so some of it is unavoidable by virtue of the fact that we are getting older and our bodies are breaking down. However, there are important things we can do--for example, to screen early for the cancers. Colorectal screening is a perfect example of that. In addition, looking at healthier lifestyles and adopting healthier behaviours mitigates risk.

There are so many contributing factors to the increasing rate of cancers. There are definitely lifestyle factors. We also know that infectious agents are a contributor--HPV. There was recently an article saying that there may be bacterial aspects in colorectal cancer.

I think we're unpacking a very complex set of diseases; therefore, action on the prevention side and on the screening side is probably the most important area where we can have an impact.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

I want to ask a question to the Heart and Stroke Foundation--

[The Chair, Conservative, Joy Smith]

Just one moment, Dr. Carrie. If you don't mind, Mr. Arango would like to comment.

[Manuel Arango]

Yes, thank you.

I wanted to add a little more information with respect to Dr. Carrie's question on community design.

First I want to acknowledge and congratulate the Canadian Partnership Against Cancer for their coalitions program, which they fund to the tune of $17 million annually. We are involved, as Ms. Hill said, in a few of their projects. One of them is with respect to community design.

The member asked what the federal government can do. There are several problems with communities that can sometimes make them unhealthy. There's the fact that they don't have a mixed design, and what I mean by that is they don't have stores near communities. Rather than having to get in your car to drive downtown to buy something, if you have stores, mixed communities, near your neighbourhood, it makes a big difference if they can be walked to.

As well, not having enough sidewalks and cycling paths, walking trails, etc., can make a big difference. We mentioned the need for an investment in an active transportation fund, an infrastructure fund. That would support more sidewalks, walking paths, cycling paths, etc., where they're needed.

Finally, one other piece is further investment in public transit. It might not strike you right away what the relationship is, but on average, in communities where public transit is accessible the typical commuter walks 20 to 30 minutes to get to the public transit, so that increases physical activity. It reduces air pollution, which also is an inhibitor of physical activity. So public transit should also be considered.

Thank you.

[The Chair, Conservative, Joy Smith]

Mr. Carrie, my apologies, but the time is up.

Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you, Madam Chair.

I'm sorry I'm late. I apologize to everyone. I had another meeting that I couldn't cancel.

Obviously, some of the things you've talked about are on prevention. The tobacco strategy is a big part of it, especially with regard to lung disease. I want to know what you feel about the current commitment to the tobacco strategy. Do you feel that a one-year extension is sufficient, or do you feel there should be a permanent strategy to look at smoking cessation in a real way and in a practical way?

I think it's a large part of cancers and chronic lung disease. It doesn't really matter if you can walk 30 minutes to transit if you have COPD. Those are some of the things we need to talk about.

What are the practical ways in which the federal government can play a role in preventing the chronic diseases you talked about, such as cancer and lung disease? I think you talked about Quebec best practices. What things do you think one can do to help manage people with chronic diseases so that quality of life is assured? They could actually stay out of hospital and be able to decrease medications. All of those quality-of-life issues could be attended to, of course, with the cost of hospitalization being one of them. What are the ways in which you feel the federal government can play a role in moving that agenda forward?

One thing is good management. I know the provinces are responsible for delivering health care, but the 2004 accord talked about jurisdictional flexibility and federal-provincial cooperation in moving this agenda forward. What do you feel are the practical core things that one can do as a federal government?