Health Committee on May 27th, 2019

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

Yes, I know. It's most interesting. Of course every sport in Canada has a national organization of some sort, and I've met with the umbrella group that represents them all. They do wonderful work in promoting their sport to the communities and to individuals to get them involved. Obviously they want more people involved in whatever sport they participate in, and you don't even have to look at sport. I don't want to just think of sport. There are many physical activities, such as dance, of course. We have to look at a broader range of things, but any help we can give to organizations to self-promote will be beneficial as well.

Some kids are better at different sports than others, of course, but I think there's a sport out there for every kid. It's just that they may not have been introduced to it yet, so if there's something like a “Try a Sport Day” whereby a child could try 30 sports in one afternoon just to get a taste of them, I think we should look at it.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

That's a good idea.

How much more time do I have, Chair? It's one minute? Good.

With respect to self-esteem, I was one of those kids who was always the last one picked for any team sport at school because I was gangly and growing at a rapid pace. Nowadays educators try to make sure to protect kids' self-esteem. Everybody who participates in track and field gets a ribbon, and that sort of thing. Do you think we need to take measures to address those kinds of situations, because there are still kids who may not be the favourites?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

I think in order for a sport to have a positive impact on children, they need to feel good about participating in it. It maybe doesn't faze some children if they're picked last, but every child is different, right?

I think anything we can do to promote self-esteem, self-confidence and confidence in general in a child.... At the end of the sport, the activity or the recreational activity they undertake, they should feel better about themselves and not worse. Otherwise, it just defeats the purpose. There's a lot of study on this aspect and there are experts much smarter than I am on it, but a child ought to feel good after participating in physical activity; otherwise, we're failing and the process is failing.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good. Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

Ms. Quach, welcome to the committee.

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

Thank you, Mr. Chair.

I want to thank Mr. Peterson. No one opposes virtue and everyone agrees that young people need to move more.

The last Parliament conducted several studies on physical activity among young people. Canadian Heritage carried out studies on girls, women and sport, and another study on Indigenous people and sport. There were also studies on processed products and the lack of physical activity among young people.

I wonder how this motion is different and how it makes a constructive contribution to the discussion of the existing reports and recommendations. Did you find the recommendations unsatisfactory? Did the groups that you spoke to say that the common vision was incomplete or insufficient?

Why did you decide to introduce this motion and study it in only two meetings? In two meetings, how will this motion add to what has already been done?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

I appreciate that question.

I know that your colleague Mr. Davies raised it in the House, but this motion is very distinct from Common Vision in a number of ways.

The Common Vision initiative does great work, and it's fantastic. I read it in its entirety and referenced it in both of my speeches and I also asked a Library of Parliament analyst to do a little report for me on the distinctions and what's missing, and there are a number of things missing.

First of all, if you talk to stakeholders about Common Vision, most people think it's a positive step and most people agree it's great work, but some of the recommendations are not as precise, concise or concrete as they could be. It's almost more a statement of principles than it is of concrete measures, and it's much, much broader than my study.

My study focuses on promoting physical activity in young Canadians. Common Vision is about all Canadians and focuses on a number on things, including the physical benefits of it as well. There's a little bit on the mental health benefits, but more on the physical benefits and how to get not only youth but adults and older Canadians involved as well.

My motion is much more precise, in that it focuses on youth, and not just because of the physical benefits, but specifically, I think, on the mental health benefits. Bullying is on the rise in young people. Children need to be more resilient to bullying, and the evidence shows that physically active youth are more resilient to bullying. They're able to cope with bullying, and they are less likely to be bullies because they appreciate the team spirit. They've been in environments where they're not the most important person out there and where sports creates this sort of ecosystem in which you rely on others. The science behind it indicates that.

This is not to disparage, dismiss or discount Common Vision at all. In fact, I think Common Vision should inform some of the recommendations that we make today. I'll leave my copy if the analysts don't have one, but it's easily accessible. You can look at that and then at the Participaction report card that came out, almost all the same time, incidentally. Participaction was one of the groups involved with Common Vision. There's some overlap because of that, of course.

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

What concrete measures does your motion specifically address?

Basically, you talked about some good initiatives, such as building schools within a four-kilometre radius, based on the Japanese model, and making sure that there are parks. However, these measures often fall under provincial or even municipal jurisdiction.

How can the federal government take action in this area without encroaching on provincial or municipal jurisdictions, other than through funding?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

It's the same way it can in anything.

Another incidental difference, and you'll be interested, is that Quebec is not part of Common Vision, so whatever recommendations come out of this committee will equally apply to Quebec, whereas Common Vision doesn't. Quebec didn't participate in Common Vision. It's unique.

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

Do you know why?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

I think that was its own choice. I know that there's a footnote at the beginning that says that “Although Quebec is not opposed to the principles underlying [this] Vision, it has its own programs,” etc. It opted out.

It's important for Quebeckers and your constituents, then, to have some sort of federal role in what ought to be done. I think the federal government....

You're right. I mean, some of this is provincial and municipal jurisdiction, and we don't want to step on anyone's toes, but if that limited us, the federal government would have very little work to do in any sphere. Any stakeholder you speak to across Canada thinks there's a role for the federal government to play, and they don't think that we've played it.

The report—

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

Can you provide concrete examples? I agree with you, but what initiatives do you want the federal government to implement?

[Kyle Peterson, Liberal, Newmarket—Aurora, ON]

I want the federal government.... I mean, I don't want to propose to make recommendations, but I would recommend that funding be set up and that money be spent on these recommendations. Common Vision is great because it brought together. every sport minister across the country, except for Quebec's. Why can't we do that quarterly and report to see what's being done? Why can't they have to report to Parliament on what best practices are working? Why can't we make sure that there's funding for sports organizations, recreational organizations and community organizations that ensure that more children are involved in sports? We should fund research that shows why physical activity helps the mental health of young people. None of that is being done right now, and it's a shame, because everyone is so close to knowing that this an important thing to do.

The other thing is that they can break down silos and just share information. There are so many good groups doing so much good work, and a lot of them don't even know what the other groups are doing. Even if the federal government played nothing else but some role to connect all those groups together, I think we'd be better off now than we were six months ago or 12 months ago. There's much work to be done, and I'm not one who necessarily subscribes to the notion that “Oh, that's provincial jurisdiction, and the federal government shouldn't do it”, because it's not getting done. We need to step up.

If I were a provincial member of a provincial parliament, I'd probably be doing the same thing and saying, “Let's do something.” However, we're all federal members of Parliament right now. The job's not getting done. It's incumbent on us to do what we can, I think, to help that job get done.

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

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you, Mr. Peterson, for bringing this to us and for helping us to understand some of the challenges.

We're going to suspend for a minute while we invite the Public Health Agency of Canada to come up and get seated in place. We'll just suspend for a moment.

Thanks very much, Mr. Peterson.

[The Chair, Liberal, Bill Casey]

Thanks very much everybody for coming together so quickly.

We welcome now the Public Health Agency for another half-hour session. We have Ms. Gerry Gallagher, executive director, centre for chronic disease prevention and health equity; and Mr. Andrew MacKenzie, director of the behaviours, environments and lifespan division, centre for surveillance and applied research.

You have 10 minutes to open, but if you were to tighten that up a little bit, we'd have more time for questions.

Go ahead. You do have 10 minutes.

[Gerry Gallagher, Executive Director, Centre for Chronic Disease Prevention and Health Equity, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada]

Good afternoon, everyone.

Thank you for the opportunity to be here. It's a real pleasure. I'll be giving remarks on behalf of Andrew and myself, but we'll both be available for questions afterwards.

We're pleased to be here to address the committee regarding the Public Health Agency of Canada's role in improving the level of fitness and physical activity of Canadian youth.

As you know, the vast majority of Canadians do not get enough physical activity. At least eight out of 10 adults and six out of 10 children and youth do not meet the recommended guidelines for physical activity. We also know that there are sharp differences by gender for the five- to 17-year-old age group: Only one in four girls meets the physical activity guidelines, compared to almost two in four among boys.

Regular physical activity in childhood contributes to physical and mental health, as was mentioned earlier. We also know that it reduces the risk and/or delays the onset of chronic diseases later in life. These include type 2 diabetes, cardiovascular disease and many forms of cancer.

Physical activity also provides benefits for the social development of youth, including self-confidence, academic performance and resilience.

Now here's a little bit about our role at the Public Health Agency of Canada.

Our role at the Public Health Agency of Canada is to help all Canadians be more physically active in safe and responsible environments. To that end, we obtain surveillance data to better understand the patterns and trends related to chronic disease, including the factors that put us at risk and those that protect our health. We gather, generate and share evidence to inform and guide stakeholder policies and programs. We design, test and scale-up interventions to promote healthy living and prevent chronic disease.

We do this in collaboration with partners inside and outside the health sector, because everyone must play a role in this field.

Here is a bit more about facts, specific activities and surveillance.

The agency measures and reports regularly on the levels of physical activity, sedentary behaviour and sleep among Canadians aged five and over. We also examine patterns of physical activity where different groups of Canadians live, learn, play and work. This information from the chronic disease surveillance system and the pan-Canadian health inequalities reporting initiative is available in an online interactive platform.

Through funding and scientific support, we also support the Canadian Society for Exercise Physiology , which you'll hear from after the break, in developing the 24-hour movement guidelines for both the early years and for children and youth. These were developed in collaboration with other national and international stakeholders and researchers.

These evidence-based guidelines are used by parents, health and education professionals, clinicians, policy-makers and others to inform surveillance, and more importantly interventions, with youth across the country.

The guidelines are promoted through a fun and interactive tool called “Build Your Best Day,” which encourages young Canadians to be more physically active.

Importantly, the guidelines hear from a variety of different means—sport and other forms of daily physical activity—in this notion of building your best day.

As far as key initiatives are concerned, the Public Health Agency of Canada is working in innovative ways and with a variety of partners to increase the reach and impact of our grants and contributions investments, focusing on measurable results for Canadians who are least active.

The agency has invested $112 million and leveraged $92 million in non-governmental funding through a program entitled “promoting healthy living and preventing chronic diseases through multi-sector partnerships”. This program funds projects that create supportive social and physical environments and address common risk factors for major chronic diseases, focusing again on physical inactivity and sedentary behaviour, unhealthy eating, and tobacco use. These are commonly referred to as the common risk factors for chronic diseases.

One example is that the agency invested $5 million over five years on a physical activity project entitled “build our kids' success”, or BOKS for short. It happens before school, and it's a physical activity program for elementary school children to help boost their physical and mental health. We had more than 1,300 schools register for the program, and 58,000 students participated in all provinces and territories, so it's scaled up over time.

Our evaluation results are demonstrating that children take an average of 30% more steps on these BOKS days than on other programmatic days. Interestingly, what we heard from school administrators was a reported reduction in negative behaviours in the school, which they definitely credit to the program. That means children are better able to focus and have a readiness and eagerness to start their day, and there are other benefits for specific students who may have had problems in the classroom prior to the program.

Importantly, budget 2018 also pledged $25 million over five years to support Participaction. We'll be hearing from colleagues from Participaction shortly. That is administered through the Public Health Agency of Canada. The focus there is to increase participation in daily physical activity among Canadians through the “let's get moving” initiative. This investment aims to change social norms through long-term multisectoral partnerships and coordinated public education, as well as engagement to get Canadians to move more and sit less, more often.

Earlier, we talked about collaboration between the federal, provincial and territorial governments. Since physical activity is a shared responsibility, the federal Minister of Health works closely with other federal ministers and with provincial and territorial ministers responsible for health, sport, physical activity and recreation through intergovernmental mechanisms.

“A Common Vision for Increasing Physical Activity and Reducing Sedentary Living in Canada: Let's Get Moving” was released in June 2018. Federal, provincial and territorial governments, as well as a wide range of other organizations and partners, developed this collaborative policy framework. It was intended as a mobilizing vision to support all Canadians and communities to move more and sit less through the different assets that different types of partners can bring to the table to advance this important challenge.

Internationally, Canada's efforts related to physical activity are very much in line with, and contribute to, current international policy directions, because we are not the only country facing this challenge. Canada ratified the United Nations Convention on the Rights of the Child and is taking action to implement it . This includes the right to play and the right to recreation and the right to the best health possible.

In May 2018, during the 71st World Health Assembly, Canada endorsed the global action plan on physical activity 2018-2030.

This past September, Canada adopted the declaration at the third United Nations general assembly high-level meeting on non-communicable diseases. This term is used interchangeably with chronic diseases, which I referred to earlier. This declaration is a blueprint to accelerate action on non-communicable diseases to prevent and control them—because in many cases we know what to do to prevent major chronic diseases—and to advance our commitments to the 2030 sustainable development goals. Physical activity is a key element in advancing these commitments.

Finally, I just wanted to say thank you to the committee for inviting us to speak about the contributions of the Public Health Agency of Canada on this important issue.

Through data, evidence, innovation and partnerships, we look forward to building on our efforts to help all Canadian youth move more and sit less where they live, learn, play and work.

Andrew and I will be pleased to answer any questions. Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much. You finished quickly. That's perfect.

We're going to start with Ms. Sidhu. You're going to split your time, I understand, with Ms. Damoff.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair. Thank you all for being here.

First of all, I want to thank my colleague for bringing Motion No. 206. I seconded it. I spoke on that. I'm chair of an all-party diabetes caucus. I know that obesity is a big risk factor for diseases, and I think we have a big burden on the health care system. Obesity rates are going higher and higher, as you know.

We need to do a lot more. As you said, this is a shared responsibility between provincial and federal levels.

What kinds of programs do you think can be set up so kids can do more physical activities? Do you think we should give incentives to recreational centres, so that when kids have time, they can go? I know school programs are great, but after school, what is there for them?

[Gerry Gallagher]

I can start with this, and again Common Vision outlines this quite nicely. There are quite a few different real and/or perceived barriers to physical activity for Canadian youth. It can be time; it can be money; it can be safety; it can be social norms; it can be bullying. A number of these other ones are outlined in Common Vision.

This is why the foundation is that different sectors have a role to play. Within a family environment, again, children often follow patterns that are typical for that particular family. I'll make an analogy with the food guide: the Canada food guide says it's not just what you eat, but even how you eat together as a family. We see similar patterns: families that move together tend to move together and eat together. Some of these notions are about how family environments have shifted, in many cases, over the last number of years, and how we can have supportive family environments.

Similarly, when you think about where youth live, learn, play and work, each of those environments has a set of actors, a set of different sectors that can influence how things unfold in those particular environments, through incentives in some cases, and in other cases through disincentives, I will say, for how things play out in those different settings.

That's why Common Vision outlines what different players can bring to the table. It was not intended as a specific implementation plan, but that work is under way now. As we speak, officials are working on the bones, the concrete steps about how we move forward, together with provincial-territorial governments and other sectors, to support that initiative.

What I would say is we have some very encouraging results from some of the work we have done in attempting to show what works and trying to scale that up.

I'll give another example, which is Trottibus, which was mentioned in the early remarks. We mounted a challenge a number of years ago that asked Canadians what they thought would work to increase physical activity for children and youth in Canada. The winning-prize dollar recipient, if you will, was Trottibus.

Trottibus is a walk-to-school program. It was an adaptation of what's been used in some other countries. It didn't have the features of the Japan model noted earlier, about regulating distance to school. Within a Canadian context, in Quebec winters, sometimes communities had new arrivals to Canada. In other cases there were linguistic barriers for some of those families and children. There were really interesting results in increasing physical activity levels for those children, but importantly, there were also other benefits in terms of fresh-air time, how to dress in the winter cold, how to practise sidewalk safety. Also, those communities, in some cases, then influenced the design of the areas around their schools so that they were safer—changing sidewalk access and arranging for less car traffic outside of the school so that the air quality outside the school was better.

We've seen some really interesting results. That was time-limited funding, but the results are quite promising, I would say, for potential applicability to other parts of the country.

Another example I'll use is APPLE Schools. In this particular one, it isn't a school-based setting. For many of us from our era, once we got to school, we stood in line and waited for class to start. If we'd been sitting on a bus or in a car all morning, to stand there for another 10 minutes to wait for a class to start is probably not the best start to the day. They've tried to change the social norms in the school setting, to say, “Here's the lineup, but what are you going to do on your spot?” You're actually lined up, but you're moving as you get ready to enter that school. It's really thinking about, within those different settings and the actors around, what can be done.

Perhaps I'll stop there. I have other examples I'd be pleased to raise if you'd like.

[Sonia Sidhu, Liberal, Brampton South, ON]

We'll now go over to Pam.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

I only have a couple of minutes left, and I have two questions, so I'm going to skip the one I mentioned to you.

Dr. Tam, our chief public health officer, did an amazing report called “Designing Healthy Living”. How was that, or was that, distributed to municipalities, and is there an opportunity to continue to push that report in municipalities? Those are the people who are actually doing the planning, and if we design communities to be livable, walkable and bikeable, then people will get out every day and use those facilities.

[Gerry Gallagher]

Absolutely.

I have the pleasure of supporting Dr. Tam as part of following up on her work on a healthy built environment. We've taken a very intentional approach in using that report to mobilize action, both across the federal family and with other levels within the country. In collaboration with the Canadian Institutes of Health Research and Infrastructure Canada, she convened 13 federal departments to talk about what each department could bring to the table to advance this issue.

There have been a number of collaborations to advance that work. We've also had her speak at the Federation of Canadian Municipalities and the Canadian Institute of Planners—some of these non-traditional tables where you typically don't see a chief medical officer talking.

[Pam Damoff, Liberal, Oakville North—Burlington, ON]

Was it given to the Federation of Canadian Municipalities to distribute to municipalities, or did it just get there and sit with them?

[Gerry Gallagher]

They have certainly been part of the discussions around the follow-up to that. They've also been instrumental in the development of Common Vision. I can follow up with the specifics.