Health Committee on May 28th, 2018

[Ben Lobb, Conservative, Huron—Bruce, ON]

If you look strictly at the process of having pilot projects and building out from those—I know you're not starting from scratch—there has to be tremendous opportunity just from that. I understand the limitations on services, definitely from that standpoint, but to have a focus group of people that you can work on each and every day must pose a great opportunity for that community, I would think.

[Roslynn Baird]

Well, in my 20 years of working in indigenous diabetes, I haven't noticed a lot of surveillance data to draw upon, especially not in Ontario. I think there's a lot of work to be done.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Regarding technology, I had a meeting not too long ago with an upstart health technology company. Some of the work they do involves monitoring people who have chronic disease. The work they do is primarily in rural and northern communities, and then also in the southern states.

Understanding the limitations with Wi-Fi and networks and everything else, I think I read that this is a $1.8-billion issue worldwide every single year with diabetes. There are apps for this and apps for that, and I'm wondering why large technology companies, and even small technology companies, haven't taken to health technology the way in which it seems they have in entertainment and every other thing.

[Roslynn Baird]

That's a good question. We have been approached by people who do have ideas around apps. We do have a gestational diabetes program where we would be looking to support women through their pregnancies using an app.

There are a lot of ideas coming to our program now that we're looking into and bringing back to the communities for their input. It is something that's being brought to our attention. We're being asked to look at apps for wound care. It would include taking those apps into northern communities, and having even lay diabetes workers using the apps to send information about the wound. There would be more of a circle of care when there isn't a wound care professional in that community, or even a doctor, for example.

So we're on the verge of looking at those types of technologies, but no, they're not available.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I think I saw the app you're talking about. It can even detect, when a guy gets out of bed, if he hasn't taken his medication or if he's had something to eat and everything else. I think that's a tremendous—

[Dr. Mélanie Henderson]

Can I add something to that? From a pediatric and adolescent standpoint, apps are wonderful if people are motivated to use them. While children are very clicked in to the Internet and stuff, they're not particularly interested in using health care apps, from my experience. They're of interest, and I think we need to continue to develop these, but I think we also need to find ways to make them interesting for children and adolescents. We need to be sensitized to the fact that just because we adults think it's a fantastic idea, they might not actually embark on using them in an effective way, if you know what I mean.

[The Vice-Chair, Conservative, Marilyn Gladu]

Absolutely.

[Dr. Mélanie Henderson]

They'll use Instagram well, though.

[The Vice-Chair, Conservative, Marilyn Gladu]

We'll now go to Mr. Davies for seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you to the witnesses for being here.

Ms. Baird, I'd like to begin with you. It seems pretty clear to me that one of the driving forces behind type 2 diabetes is obesity, as we know, and that speaks to the food we eat. I think the phrase you used in your recommendation was “food sovereignty”. I am making the assumption from your testimony and others' that having access to fresh, healthy food is a particular challenge in indigenous communities across this country, and maybe even in urban areas.

What does food sovereignty look like to you, and how do we get there?

[Roslynn Baird]

I guess I could use some examples and observations from when we travel into northern communities. We take our foot care program into some very remote places. We do a full day of treatment and care, and with that, traditionally we provide food. People come into the programming and we share food together. We use food as a teaching tool.

We've gone into northern communities where we can't find food to provide for these healthy sessions where we're trying to educate by using food as a tool. In the northern stores the food is just not affordable. The items that are affordable, such as pop and chips, are not healthy. We try to advocate for things like drinking water instead of pop. We've learned, as southern educators going into northern communities, that this doesn't work either. They have been on boil water advisories, as they have in Six Nations, which is very close to Toronto.

Sovereignty is having control over your food, knowing where your food comes from, having accessibility to the food, going back to having rights to harvest your own food, having clean fish, and having clean water. It's just the availability of food itself. To me, the feeling that it will always be accessible for future generations is sovereignty.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you give us a sense of whether we are or are not making progress? It's 2018. Are we making progress in that area? Are there programs being delivered as we speak here today that are addressing those issues in a significant manner, to make a real dent in food sovereignty for indigenous people?

[Dr. Agnes Coutinho]

Having travelled to some northern communities first-hand, I can say that the intent is there. There are programs to teach individuals and families about healthy living. However, it's very difficult for individuals to leave, for example, a workshop on healthy living and healthy eating, and go to the grocery store where a quarter of a watermelon is almost $16, two apples are $4, but an extra large chocolate bar is 99¢.

Paired with the programming that I think is already there, and if resources are provided to be able to deliver these as needed, I think that the other side of it has to be policy that will impact what is available and at what cost because it's very difficult to tell somebody to eat healthy, but give them no access to those healthy foods.

[Don Davies, NDP, Vancouver Kingsway, BC]

I think, Dr. Coutinho, that these were your words.

If not, maybe they were yours, Ms. Baird.

You called diabetes “a systemic disease at pandemic levels”. That's a pretty jarring description of where we're at in 2018.

We just had some senior federal civil servants here. I was asking them about the degree of progress that we've made since the 2013 Auditor General's report, which I will say is scathing. It's just an across-the-board comprehensive indictment of the failure of the diabetes program at Health Canada at that time.

At that time in 2013, the AG's report called for Health Canada to commit to properly measuring outcomes of the aboriginal diabetes initiative. Health Canada agreed to enhance performance measures to assess the impact of the ADI, to use those enhanced performance measures to assess and advance the diabetes activities funded, and to provide increased support to regions to use data for health status reporting. In response to that report, Health Canada committed to doing all of that by the end of 2013.

Have you seen major changes or progress in the past five years since those better performance measures and enhanced programming commitments were made by Health Canada?

[Roslynn Baird]

In the indigenous communities, I would have to say that, no, I haven't seen that.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Coutinho, do you have an opinion?

[Dr. Agnes Coutinho]

I think that there are changes in discussions and approach. The fact that this is the first time that we're sitting at this table to represent the National Aboriginal Diabetes Association shows changes, but I think there's always room to improve.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Dr. Henderson, I think educating people about what we eat is a very major part of this. Do you support front-of-package labelling so that consumers can directly see how much sugar, how many calories, and how much sodium are in the foods they are purchasing?

[Dr. Mélanie Henderson]

I do. I think there have been a lot of studies showing that certain methods used have been efficacious in reducing the consumption of certain deleterious foods. I think that is a definite step to reducing the consumption of foods that are probably very poor for health overall.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have any opinion as a pediatrician on the marketing to children of foods that are not healthy for them? Is there any research that you're aware of that indicates whether that's effective or not?

[Dr. Mélanie Henderson]

There is some research to support the fact that banning marketing or ads, like television commercials, to children does decrease the desire for or the use of certain products. In Quebec, for example, there are some strong policies that restrict marketing to children.

I think that is a very excellent question because has anybody in the room has ever seen an ad for healthy fruits and vegetables? We never see that, but we see tons of fast food, hamburgers, and stuff. It has really shown that when you watch television, your food choices are affected by that. You go for calorie-dense foods that are usually high in fat and high in sugar.

I think it would benefit both children and adults alike.

[The Vice-Chair, Conservative, Marilyn Gladu]

All right, that's your time.

Mr. Ayoub, you have seven minutes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Madam Chair.

Dr. Henderson, there are two types of diabetes among youth, type 1 diabetes and type 2 diabetes. When a child receives a type 1 diabetes diagnosis, he will have to live with that and deal with it for all of his life.

Is the situation the same in the case of type 2 diabetes for a young person or an adult?

[Dr. Melanie Henderson]

Indeed, type 1 diabetes is considered a lifelong auto-immune disease. However, type 2 diabetes is generally a progressive disease. When the patient reaches the point where he needs treatment to maintain normal blood sugar levels, then it is really lifelong. We need to act upstream to prevent the development of type 2 diabetes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I see.

There is much talk about lifestyle habits, available food, its sale, and people say that it has to be accessible to young people, particularly these days. Adults make choices but youngsters may not do so quite as much. Adults or parents are generally the ones who feed the children.

Regarding what is found on convenience store shelves, there was another study recently about sweet alcoholic drinks. I don't want to talk about alcohol as such, but about the sweet drinks, their availability and the way in which they are presented and marketed.

How do you feel about the fact that juices are included in the Canada Food Guide, whereas many feel that they should be removed, although there are good and bad sugars. As a specialist, what is your opinion?