Health Committee on Feb. 14th, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 54 of the House of Commons Standing Committee on Health.

Today we meet for two hours with witnesses on our study of children's health.

Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022.

We do have one witness online. For our witness online, you have the choice at the bottom of your screen of either floor, English, or French. I'll give a reminder that screen shots or pictures of your screen are not permitted. The proceedings will be made available via the House of Commons website. In accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

I will now welcome the witnesses who are with us this afternoon.

From the Canadian Tire Jumpstart Charities, we have Dr. Marco Di Buono, president; from the Childhood Obesity Foundation, we have Dr. Tom Warshawski, chair, who is with us via video conference; from the Coalition for Healthy School Food, we have Carolyn Webb, coordinator, knowledge mobilization; and from ParticipACTION, we have Elio Antunes, president and chief executive officer.

Thank you all for taking the time to be with us today.

Each witness will have up to five minutes for an opening statement.

We'll begin with Dr. Di Buono. Welcome to the committee. You have the floor.

[Dr. Marco Di Buono, President, Canadian Tire Jumpstart Charities]

Thank you, Mr. Chair.

Canadian Tire Jumpstart Charities is a national charity committed to ensuring Canadian kids have equal access to sport and recreation. Operating through 289 distinct community chapters from coast to coast, Jumpstart creates opportunities for kids in financial need to participate in sport and play, empowering them to achieve their full potential.

Backed by a national network of supporters, and thanks to the support of the Canadian Tire Corporation, which covers all of Jumpstart's general and administrative expenses, Jumpstart has been able to disburse upwards of $300 million to help more than three million Canadian children get in the game since 2005.

We welcome the opportunity to meet with the members of this committee and to underscore the importance of equitable access to sport and play in Canada for the health of young Canadians. We know all members of this committee share Canadian Tire Jumpstart’s belief in the power of sport to provide better health and social outcomes for children and youth of all backgrounds and abilities.

Jumpstart harnesses the power of sport and play as a tool for social change and the advancement of children's health. It's one that can be intentionally used to achieve very specific outcomes related to improving child and youth development, the benefits of which include social and emotional well-being, academic performance and participation, reduced youth offending, and improved physical and mental health.

The role of sport in these dimensions of youth development has been well documented in scientific literature, and underscores how critical sport and physical activity are in supporting the healthy development of children.

However, significant barriers exist for marginalized youth to access these benefits. They include the increasing cost of participation, systemic racism, shortfalls in safe sport opportunities, and lack of inclusive programming, to name a few.

When the COVID-19 pandemic stripped away access to sport for Canadian youth and put the country's community sport and recreation organizations at risk, the vital importance of access to sport became clear to everyone. Canadian Tire Jumpstart's 2022 “The State of Sport in Canada” report revealed that in the first nine months of the pandemic alone, 1.5 million children living in low-income households lost over 277 million hours of sport participation, largely due to programs being closed or running at reduced capacity.

The loss of access to sport and physical activity had, and continues to have, real consequences on Canadian youth. For example, our recent research found that half of parents who said their children played fewer sports also expressed concern about their children's deteriorating mental health. Forty-six per cent of all parents said their children were feeling isolated, experiencing a sense of loss or anxiety, or lacking fitness. Half of all adolescent girls in Canada were not currently participating in sport, a disproportionate number compared to their male counterparts. Sport organizations reported that delivering programs amidst COVID-19 recovery was still daunting, with 91% concerned about their ability to provide the same level of service to their communities as prior to the pandemic, and 82% were still concerned about their ability to run programs in the future.

There has never been a more important time for the federal government to invest in sport, play and recreation. We know that implementing a sport for development approach can reap significant social and economic returns, while improving the health and well-being of children and youth of all ages and abilities.

Additionally, national leadership in sport for youth development will foster greater collaboration within government and stimulate cross-sectoral engagement in communities across the country, resulting in an enhanced impact and improved outcomes for youth across Canada.

Sport Canada's Community Sport for All initiative was a very important first step in recognizing the true value of sport. Early drafts of the federal government's new Canadian sport policy also signal a shift wherein sport is used primarily to achieve health outcomes and podium finishes become one of the many by-products.

However, to leverage the many health and social benefits of sport, we must encourage national leaders to join us and invest in the future of all children.

On behalf of the thousands of community-based sport and recreation organizations supporting millions of Canadian children across Canada, we encourage this committee to call on the federal government to further invest in equitable and safe community sport and play as a means of achieving health and well-being for our youth.

Thank you.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Di Buono.

Welcome to the committee. You have the floor.

[Dr. Tom Warshawski, Chair, Childhood Obesity Foundation]

Thank you and good morning.

One of the most significant risks to the health of Canadians and to the viability of our health care system is the current prevalence of unhealthy weights in children and youth. Over 30% of our children are either overweight or obese, and because of the lifestyle habits ingrained in childhood, the situation worsens with age.

Currently, over 60% of Canadian adults have unhealthy weights, putting them at increased risk for heart disease, type 2 diabetes, hypertension, stroke and cancer. On average, obese adults die seven years earlier than healthy-weight peers. Obesity is thought to cost Canada's health care system over $7 billion per year.

The root of this epidemic begins with the unhealthy dietary habits learned in childhood and, to a lesser extent, low levels of physical activity. The COVID pandemic worsened the situation. Sales of unhealthy food increased. Children spent more time on screens, which commonly market unhealthy foods and beverages to children, and youth spent less time being physically active. While Canadian data is sparse, American studies indicate that children demonstrated an increased weight gain velocity during the COVID pandemic.

Having overweight core obesity is detrimental to the health of children and youth. It is associated with increased rates of depression and anxiety, secondary to weight stigma; increased rates of hypertension and metabolic syndrome in adolescence; increased rates of chronic disease in adulthood; and increased costs to the health care system. Each teen who remains obese into adulthood triggers an additional cost of $25,000.

Obesity worsens health disparities. It disproportionately affects indigenous communities, as 87% of first nations women will develop type 2 diabetes due to unhealthy weights, versus an incidence of type 2 diabetes of 46% in non-first nations women.

Obesity hits lower-income Canadians harder. Obesity rates are 28% in the lowest-income quintile versus 24% in the highest. It impacts rural communities more than urban, with obesity rates of 31% in rural areas versus 25% in urban.

Canada needs to take steps to both prevent and treat unhealthy weights in children and youth. However, treatments are expensive and hard to access, and are primarily under provincial jurisdiction. The federal government should focus on effective prevention steps, which are under federal jurisdiction.

The Childhood Obesity Foundation supports the call for the federal government to finalize front-of-pack nutrition labelling and for the implementation of a national school nutrition program. However, the most pressing need, and to some extent the obvious low-hanging fruit, is for government to introduce regulations to restrict the marketing of unhealthy foods and beverages to children.

The remainder of my presentation will highlight the rationale for this important step, which is explained in more detail in the brief submitted to HESA by the Stop Marketing to Kids Coalition.

Ninety per cent of the foods and beverages marketed to children promote unhealthy weight gain. In adults, consumption of these products is associated with ill health regardless of weight status. Persuading children to consume food that will ultimately damage their health is unethical. Most children under the age of five years cannot distinguish ads from content. Most under the age of 12 years do not understand the persuasive intent of advertising.

Unfortunately, marketing works. It influences kids' food preferences and food choices. That's why the food and beverage industry spends over $1 billion per year in Canada in marketing to kids. As a result, over 60% of the calories children consume are from ultra-processed, unhealthy foods. Parents are being outgunned by big food and beverage, who are spending massive amounts to produce sophisticated marketing that is flooding the airwaves and the Internet.

Many parents, if not most, are ill-equipped to compete: 10% have mental health issues; 10% live in poverty; 15% have poor literacy skills; 15% are single parents; and 17% are immigrants, a percentage that is growing each year. Recent immigrants are particularly vulnerable as they strive to embrace Canadian culture.

Parents are asking for help. The overwhelming majority want government to help them keep their kids healthy by enacting restrictions on the marketing of unhealthy foods and beverages to their children.

Voluntary codes are not effective. For the past 10 years, industry has set its own standards in self-regulated marketing. In June 2021 the industry revised its voluntary code. Although the nutritional criteria are robust, the rules of application have significant loopholes, rendering substantially less protection than the regulatory regimen currently in place in Quebec. The new rules would not even prevent child-directed marketing for such products as Lucky Charms. The fox should not be trusted to guard the henhouse.

Canada's healthy eating strategy, under its objective to protect vulnerable populations, includes restricting marketing and advertising of beverages high in salt, sugars and saturated fats to children. This commitment was included in the government's 2015 and 2021 election platforms, the 2019 federal budget, and four health minister mandate letters.

Health Canada has draft regulations that are poised for implementation. We strongly recommend that they be introduced in Canada Gazette, part 1, by the fall of 2023, as per Health Canada's forward regulatory plan. Government need not and should not wait for the private member's bill, Bill C-252, to wind its way through Parliament. Implementing a regulatory framework to restrict the marketing of unhealthy foods and beverages will positively impact the health of our children and must not be delayed.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Warshawski.

Next, from the Coalition for Healthy School Food, is Carolyn Webb.

Welcome to the committee, Ms. Webb. You have the floor.

[Carolyn Webb, Knowledge Mobilization Coordinator, Coalition for Healthy School Food]

Thank you, Mr. Chair and committee members, for inviting me to speak on children's health.

The Coalition for Healthy School Food is made up of more than 240 non-profit member organizations and over 120 endorsers from all provinces and territories.

We're advocating federal funding for a national school food program because schools are ideal places for children and youth to access healthy food and to develop eating habits and skills that will last a lifetime.

I know that our members have spoken with some of the members of this committee, and we've appreciated your engagement and support.

Across the country, approximately two-thirds of schools do not have a school meal program. We know that many children in Canada, for a variety of reasons, are not able to access healthy foods and that the diet quality of children across the entire socio-economic spectrum is poor.

Studies show that kids aged nine to 13 get up to 60% of their calories from ultra-processed foods, which is more than that of any other age group. Unfortunately, when children are hungry or undernourished during the school day, their energy level, memory, problem-solving skills, creativity, concentration and mental health suffer.

When school food programs are offered and strong nutritional guidelines are in place, they increase children's consumption of vegetables, fruits and other healthy foods. This has widespread benefits for their physical health, mental health, future eating habits, behaviour and school performance. These programs can also take pressure off the family budget and help level the playing field.

As quoted by the World Food Programme in its “State of School Feeding Worldwide 2020” report, “All the evidence shows that school meals programmes, along with other social protection initiatives, are one of the smartest long-term investments any government can make.”

Canada is the only G7 member and one of the only industrialized countries without a national school food program. Across the country, programs reach somewhere between 20% and 40% of children across the spectrum of urban, rural and remote locations, thanks to investments from the provinces and territories, some municipalities and communities, and other contributions. While many programs exist, most struggle with limited funding, rising food costs and other pressures.

The coalition is very pleased that the development of a national school nutritious meal program and policy have been included in federal mandate letters. This followed the commitment of funding for school food in both the Liberal and NDP election platforms. We hope that all parties will support the inclusion of funding in budget 2023 as a critical step that can move us towards a Canada where every child in every part of the country has access to healthy food at school every day. Specifically, we recommend the development of a program that serves food based on Canada's 2019 food guide, so that children and youth develop the taste receptivity for nutritious foods, gain food literacy and develop habits for a lifetime of healthy eating by living the food guide in practice.

A national program should provide universal access to students. This means that where a program is in place, all students in the school would have access to it. We would like to see that the food served, grown and learned about reflects the diverse cultures and traditions of students at the school.

A national program should not market products to kids. This would align with the recommendations made by the Stop Marketing to Kids Coalition and the Minister of Health's mandate to put “restrictions on the commercial marketing of food and beverages to children.” We strongly support these restrictions.

Food is a powerful connector. A strong program would enable connections between students and members of the broader community and create opportunities for students to eat together, to connect with caring adults, to build resilience and to feel that they belong. A well-designed program would also include opportunities for students to plan, budget for, purchase, grow, harvest and prepare food.

In addition to funding for a broad program, we're also asking the government to enter into discussions with indigenous leaders to negotiate agreements for the creation and/or enhancement of permanent, independent, distinctions-based first nations, Métis and Inuit school meal programs.

As students spend a minimum of 50% of their waking hours on most days in schools, these settings present an unparalleled opportunity to support the health and well-being of nearly every child in the country.

School food programs can positively impact dietary quality, mental health and feelings of connection and belonging. They can improve academic skills and help students acquire personal skills that contribute to long-term success.

We urge your committee to take a strong stand on the importance of a Canada-wide school food program and to support an investment in school food in budget 2023 as a means to support the health and well-being of all children in Canada.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Webb.

Finally, from Participaction, we have Mr. Antunes, the president and CEO,.

You have the floor, sir. Welcome to the committee.

[Elio Antunes, President and Chief Executive Officer, ParticipACTION]

Good morning, Mr. Chair and honourable members of the committee.

Thank you for the invitation to speak to you today about the impacts of the COVID-19 pandemic on the health of children and youth in this country and, more specifically, the critical role of physical activity.

Imagine if we had available to us a magic pill that, if taken daily, could help kids be healthier, happier, more resilient, perform better in school and even provide them with a stronger sense of connection with their friends and family. As national leaders, would we not do everything possible to ensure that every child in this country had access to their daily dose?

Fortunately, such a pill does exist. It's called physical activity, and the dose is 60 minutes a day, every day.

Physical activity is critical to kids' health and well-being, because the benefits are so numerous. There are physical benefits, like decreased risk for type 2 diabetes and cardiovascular disease. There are mental benefits, like improved academic performance and decreased symptoms of anxiety and depression. There are social benefits, like increased self-confidence and self-esteem, and a greater sense of developing and maintaining peer relationships.

Unfortunately, only 28% of kids in Canada are meeting national physical activity guidelines of 60 minutes per day. Only 28% are getting their daily dose. Even more alarming is that this is a drop of 11% from prepandemic levels, and kids from equity-deserving groups had even larger decreases, placing them at greater risk of poor health outcomes.

We are only just beginning to understand how the closures, lockdowns and isolation experienced during the height of the pandemic impacted the lives of children and youth, including their physical activity levels and mental health. The pandemic caused a sudden and drastic shift in the ways kids could access physical activity opportunities.

Playing with friends, in-person physical education classes, sports competitions and community programming all came to a halt. Kids were doing less and being more sedentary, and the pivot to virtual learning and calls to stay home transformed kids' screens from an indulgence into a necessity for education and socializing. Only 18% of children and youth are meeting the screen time recommendations of no more than two hours of recreational screen time per day. This is particularly troubling, as increased screen time among kids has been associated with depression, anxiety, hyperactivity and irritability.

We should be extremely concerned not only about the impact COVID has had on kids' physical activity today but about the long-term public health consequences if we don't take action now. Now's the time to establish cost-effective policies and approaches that will improve physical activity levels and contribute to healthy bodies and healthy minds.

It's not an easy task. I spent my entire career in health promotion and I fully understand that the roots of our physical inactivity crisis are complex and require a comprehensive and multi-faceted approach.

A lot has changed over a short period of time. Most of us grew up running freely in our neighbourhoods until the street lights came on, playing street hockey with friends and walking or biking to school. Today, we see how the conveniences associated with our modern lifestyle have led to physical activity being socially engineered out of our lives. That's why Canada has to view physical activity as a necessity of life and one of the most important things we can do for our overall health and well-being. It must be an accepted and expected part of our social norms that everyone can enjoy, regardless of age, ability, ethnicity, income, shape or size. We must work collaboratively to impact change. No single institution or organization can tackle this issue alone.

Organizations like Participaction can provide essential leadership and coordination, and raise awareness of the importance of physical activity.

The federal government should invest in developing and implementing strategies and policies for physical activity that draw from the pan-Canadian framework “A Common Vision for increasing physical activity” and continue to support initiatives such as Community Sport for All, which aims to reach and engage those who face social inequities in attempting to get active.

Provincial and municipal governments should prioritize strategies to shift intentions and perceptions about physical activity. This includes infrastructure and social marketing to support families in adopting active transportation practices, and addressing bylaws that promote and encourage outdoor play.

Schools must prioritize physical education as a fun, inclusive and welcoming subject that develops physical literacy, and treat it as being as important as other core subjects.

Manufacturers of digital devices can disclose on product labels the potential harms associated with excessive use.

Social media platforms could promote active breaks from screen use.

Communities can create accessible environments, such as parks, trails and playgrounds that support physical activity alongside affordable and inclusive programs that encourage families to get active.

Of course, parents are an essential piece of the puzzle, as they are the single biggest influence on the physical activity of children and youth. We must look at strategies that also support their own physical activity.

The World Health Organization recently stated, “There are few areas in public health - such as physical activity - where evidence on required action is so convincing, cost effective and practical.”

We have an incredibly powerful intervention, a magic pill sitting right in front of us. Let's move into action and ensure that kids get their daily dose of physical activity for better health and well-being.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Antunes.

We're going to begin now with rounds of questions starting with the Conservatives. We have Mr. Jeneroux for six minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

Thank you, witnesses, for taking the time out of your busy schedules to join us here today.

I think I have a question for everyone, but we'll start with you first, Mr. Di Buono.

I thought it was a rather alarming stat. You indicated that half of all adolescent girls are not participating in sport. Does that increase as they get older? I'm thinking of our younger kids. I think of my two adolescent daughters. They're teenagers now. They're not participating in sport, but earlier they were in soccer and some other sports. Is it as they get older...?

I guess I'm looking for some of the reasons and causes for that.

[Dr. Marco Di Buono]

It's an excellent question.

There is absolutely a disproportionate drop-off that occurs as girls enter their teenage years. Approximately one in every two girls tends to drop out of sport between the age of 12 and the time they would graduate from high school, in comparison to one in every three boys in that same time period. That's the latest data we have from Canadian Women & Sport.

They have articulated several reasons for that, in their own voice, as to why they would drop off, but it comes down to not having spaces and places that are welcoming for their particular social, emotional and physical needs. Quite frankly, there is a dearth of programming that still exists across the country that is designed specifically to create those safe spaces for girls and young women.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Spaces and places—are you talking about the physical infrastructure? There's a boys' hockey team, but there's not a girls' hockey team? Is that the type of—

[Dr. Marco Di Buono]

It's a mix of all those things. Representation matters very much for girls and young women, so having coaches and youth activity leaders who reflect their needs and understand their needs....

They don't have to be women, but at least be mindful of the challenges that girls and young women are facing as they progress into their adolescent years. It's having spaces that are more accommodating for girls, and not just the boys' change room for the one girl on the hockey team, as an example.

It is a combination of the physical infrastructure and other amenities and services that surround the delivery of sport and physical activity for girls and young women.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

It sounds like a lot of a culture approach here in Canada. Are we seeing that elsewhere too? Is that unique to Canada?

I guess where I'm going with that is whether a certain amount of funding suddenly helps all this, or whether something broader at play should be considered.

[Dr. Marco Di Buono]

It's certainly not unique to Canada. What we have working to our benefit right now is that there is some very targeted funding from Sport Canada, the Ministry of Women and Gender Equity and Health Canada that is helping to overcome some of these challenges, but there is much work that needs to be done there, and particularly further upstream, so that we can ensure that young girls who are participating in sport, physical activity and recreation know there is a safe path for them to progress as they move into their preteen and teenage years and into adulthood.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Has there been an impact since the pandemic? Have we seen an even further decrease?

[Dr. Marco Di Buono]

Yes, absolutely.

There was a disproportionate effect on girls and young women relative to their male counterparts during and after COVID-19 for a number of reasons.

First, boys' sports and programs were prioritized when the money and the resources got tight. Second, there were many dynamics within the home environment that prioritized access for boys and adolescent males over their female counterparts as the pandemic progressed.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Okay.

I'm going to move on to you, Ms. Webb, from the Coalition for Healthy School Food.

You talked largely about schools. I have a little guy in a day care. There's no food funding for that. Is that part of your request?

[Carolyn Webb]

Our specific request is for schools from K to 12. We have been speaking with some of the folks working on the child care accords regarding food in the child care setting, but that's not a part of our specific request. It's really limited to the elementary and high school settings.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Do you know the number? You said that two-thirds aren't funded by the school food program. Do you know the percentage in day cares?

[Carolyn Webb]

No, I don't know the details for day cares. I do know that many day cares do have food.... I think day cares often have a component of food as part of their day care service, but our work is not focused on that.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

I'm using to the wrong day care, then, because there's no food at my program.

On January 25 there was a Globe and Mail article on this topic. They suggested that the rise in food prices may be affecting child nutrition. In light of the budget and the budget request, to what extent do you think food prices are affecting nutrition for kids?

[Carolyn Webb]

I will speak again to the school food program setting. Thank you for the question. It's such a relevant question.

We have spoken with many of our members across the country and we hear that everyone is struggling with the rise in food prices. There are many media reports covering the situation across the country. What we've heard is that many programs, depending on the circumstances, have had to cut food groups from their meals and snacks. Some have had to cut the quality of food. Many are going to have to serve food less often during the week, or they will have to close earlier. Many could extend their funding until May or June, but this year many are going to have to end their programs come April. It's impacting them in a variety of different ways.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Webb.

Next up is Mr. van Koeverden, please, for six minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Chair.

Thanks to all of the witnesses for being here and for also joining us online. This is a super-important topic of conversation, and we're really grateful for all of your expertise.

I'm going to focus the first half of my questions on childhood obesity and the role that poverty and the lack of physical activity interventions play in contributing to childhood obesity.

We know that kids in the United States suffer disproportionately from obesity and fewer opportunities to be physically active and healthy. We've heard—as recently as this morning, actually, in a CBC article—of some of the really aggressive things the United States is considering around reducing childhood obesity with health care interventions like drugs and surgery for little kids.

Can anybody speak to the opportunity of investing more money and resources into kids in their early days, perhaps through their daily lives at school, or other opportunities to be physically active and have access to healthier food so that we wouldn't have to intervene in a kid's life with a health care intervention like bariatric surgery or drugs in order to deal with something that is so preventable?