Health Committee on Feb. 14th, 2023

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you.

With about two minutes and some seconds left, I'd like to go to Ms. Webb.

In the written submission to the committee, under the section entitled “A National School Nutritious Meal Program for Canada”, you highlighted that two ministers have been mandated to develop a national school nutrition meal program. In your preamble to the recommendation, you talked about “investing in a cost-shared universal healthy school food program”, and then you made a request of about $1 billion over five years, which is about $200 million per year.

The recommendations you made were very interesting. There were seven recommendations specifically. With whatever time I have left, would you like to take that opportunity to quickly go through those seven recommendations and get them verbally on the record, as well as in writing?

The floor is yours, Ms. Webb.

[Carolyn Webb]

Thank you very much.

Where do I start?

The coalition has eight guiding principles that we've asked a national school food program to follow.

A program should be health-promoting, in line with Canada's food guide. It should be universal and accessible to all students.

I'm not sure if these are the specific recommendations you're touching on.

There's a cost-share aspect. Many provinces and territories already fund these programs, so let's bring it all together so that we can have a well-funded program that can meet the needs of students.

We're also encouraging programs to be flexible so that they can meet needs and build on what already exists in communities. So much is happening, but it would be a shame to impose a one-size-fits-all aspect.

We're asking for programs in indigenous communities to be controlled by indigenous communities, and for those to be sustainably well funded.

We're also asking for programs to consider school food targets, because there are so many economic benefits that can come from local procurement.

There are so many opportunities for food literacy. Following the food guide and engaging students in developing some of those food skills can last a lifetime. They can really impact families. Kids can bring home those food skills and ask to cook foods they've experienced in the programs, and also learn budgeting skills.

We're also asking for programs to have strong evaluation programs, to not market to children, and to have conflict-of-interest standards.

Thank you for the opportunity to expand.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Webb.

The floor is open to Mr. Garon for two and a half minutes.

[Jean-Denis Garon, Bloc, Mirabel, QC]

My question is for Mr. Antunes.

I find that not much is said about the municipalities. It is very much the cities and municipalities that have the responsibility to develop sports infrastructure and, above all, to ensure that these infrastructures are accessible free of charge to everyone, to families, as a public good. Ottawa has a lot of infrastructure funding programs where money is budgeted and not spent and where negotiation is difficult with the provinces, etc.

Would you support more funding for this type of municipal infrastructure, which makes sport accessible to families?

[Elio Antunes]

Absolutely.

In delivering sport and physical activity, all three levels of government need to work in collaboration. The federal government has a strong leadership role to play. However, yes, a lot of the programs and facilities are certainly controlled by municipalities.

A number of infrastructure granting programs have been provided to municipalities. I would say, however, that this doesn't go far enough. For instance, we just invested in significant active transportation infrastructure. That money went directly to local municipalities to create trails and bike lanes. The challenge is that if we don't support that with strong social marketing and communications to change social norms around active transportation, that infrastructure will get built but not used. We need to build infrastructure, but we also need to get people using it.

That's where I think the federal government could play a strong role in support of what the municipalities are doing.

[Jean-Denis Garon, Bloc, Mirabel, QC]

Ms. Webb, I have read your brief, in which you ask for an additional $200 million for infrastructure, among other things.

Your brief also says that the funds would go directly to schools and organizations or provinces. In fact, in Quebec, a public school cannot receive funds directly from the federal government. It is illegal.

I love your mission. I think what you do is important. Given the context of institutional constraints, I would like to know what approaches you have made and what relationships you have developed with the Quebec government so that we can move towards a national Quebec policy in this area. Indeed, less than two years ago, the House of Commons recognized the Quebec nation.

[Carolyn Webb]

Thank you for your question. I will answer in English.

You touched on a couple of points. I'll speak to the infrastructure funding.

We have asked for funding for infrastructure because many schools are not built with kitchens or with facilities for growing food. We've said a possible grant or infrastructure funding from other places to support schools could be quite important. You can do some simple retrofits, in some cases, that would enable a lot more cooking. You can't prepare whole, healthy food in a school if you don't have a space to chop vegetables and whatnot. That is a big piece. It could be given directly to organizations through grants such as the local food infrastructure fund or through other mechanisms.

I believe your other question was about how we've worked with the Quebec government.

The Collectif is a chapter of the coalition at the Quebec level. They have been in discussion with the provincial government about accepting federal funds as well as about developing and supporting the programs that exist in the province.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Webb.

Go ahead, Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Webb, I believe in the last federal election both the Liberals and the NDP made an election pledge of spending $1 billion over four or five years to establish a school nutrition program.

We're on the verge of making a budget for 2023. Do you have any indication that the current Liberal government is going to honour that promise?

[Carolyn Webb]

As you said, the NDP committed $1 billion over four years and the Liberal government committed $1 billion over five years. In the discussions we've had, folks keep saying they're committed to this issue and are very keen. I wish we had a crystal ball, but we're just fighting hard. We're speaking with anyone we can, but we don't—

[Don Davies, NDP, Vancouver Kingsway, BC]

You haven't seen any of that money yet.

[Carolyn Webb]

We haven't seen the money. We haven't had any firm commitment.

As I said, we're speaking to whomever we can and hoping that it can flow soon. Programs really need these funds.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Warshawski, you made comments in your opening remarks about childhood obesity costing us $7 billion a year.

I hate to put this in economic terms, because these are our Canadian children, and one would think that making sure we're taking steps to keep them healthy would obviously be the top consideration. I'm just wondering, in terms of our health care system, which has been under such pressure lately, if we were to implement a lot of these obesity-fighting measures—stop the marketing to children and provide better physical activity and better nutrition, etc.—what the economic impact of that would be, say, a generation down the road.

[Dr. Tom Warshawski]

Thanks for the question.

It is conjecture; however, the University of Waterloo did a study looking at the financial benefits of implementing a tax on sugar-sweetened beverages. I don't have the study in front of me, but it seems to me it was close to roughly $1 billion per year over 25 years in health care cost savings because of the role of excess sugar in the diet.

The benefits will be there, absolutely. The cost-benefit analysis is pretty clear that there certainly are benefits in reducing the incidence of childhood overweight and obesity as well as from improving nutrition as physical activity.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

Mr. Antunes, it seems to me that if we were serious about this as a country, we would make sure that in every school in this country there would be 60 minutes of physical activity every day for every child from six to 18.

I know that's provincial jurisdiction, but is that something we should be doing as a country?

[Elio Antunes]

Yes. Absolutely.

Schools need to implement quality daily physical education. We need to value physical education and physical activity like we do math, science and all of the other core subjects. Absolutely.

I would suggest, though, that we have to support schools in the community to ensure that their programs are accessible for kids in their communities as well. We have to ensure that the families in their homes also value physical activity so that wherever the child is—at school, in the community or in the home—they're supported with those values of physical activity being important to their overall health and well-being.

Certainly, schools have a significant role to play.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Antunes.

Go ahead, Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

I apologize, Dr. Warshawski. I came in when you were speaking originally.

I'm wondering what exactly you were saying around food literacy and children. I'm not exactly sure what you said. Was it that it's not helpful or it's not proven to be beneficial? Perhaps you could comment on that.

[Dr. Tom Warshawski]

That's correct.

There are a number of jurisdictions that looked at improving food literacy and the impact of those didactic sessions on behaviour. I would say that they're not non-existent, but they're dwarfed by the power of marketing that kids are subjected to.

The budget for marketing unhealthy foods and beverages to kids is over $1 billion per year. It uses sophisticated marketing spokespersons, sportspeople, cartoon characters. It's pervasive. It's all the way through the Internet and social media. There are billions of views per year in social media. It's a cannon compared to the popgun of media literacy.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

That doesn't mean it doesn't work. It perhaps means there aren't enough resources.

To me, the obvious question would be what the result would be if we don't actually teach children food literacy in the vernacular—what they should eat and what they shouldn't—how are they ever going to make good choices? I guess that's part of the issue.

[Dr. Tom Warshawski]

It should be taught; however, I don't think we should rely upon that to have a substantive change in eating patterns for children.

Part of it is the neurobiology of kids, their neurocognitive perceptions. The organ of thought of the brain area—the prefrontal cortex—doesn't fully develop until age 20 to 25. In children, especially under 12, it's relatively underdeveloped.

We also talked about the role of emotion and the role of memory in children.

Yes, I think it's important to give consistent messaging around appropriate food choices; however, it's not a reliable tool to substantively change their nutrition patterns.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much for that, Dr. Warshawski.

Clearly, though, we need a multitude of tools, because we are not winning at the current time. This significant issue is continuing to get worse.

In the United States, the American Academy of Pediatrics has taken a very different view on childhood obesity and the treatment thereof in advocating things like bariatric surgery and the use of medications in children over 12. Could you comment a bit on that and how it might fit into a Canadian model, if it does at all?

[Dr. Tom Warshawski]

When you look at the key action statement around the AAP recommendations, you see that they don't differ significantly from what's been recommended in Canada. They talk about monitoring and detecting early departure from healthy weight trajectories, and when that's detected, they have a conversation about fundamental behavioural changes. That's nutrition. That's physical activity. It's looking at stigma. It's looking at mental health. Those are the bedrock foundations.

They also talk about—and I don't want to go into too much doctor jargon here—looking for comorbidities, about looking for things like hypertension, high blood lipids, sleep apnea and that sort of thing. Those are common both north and south of the border.

What's getting a lot of publicity are the recommendations around pharmacological interventions and also around bariatric surgery. My own perspective on this—and I think the Canadian practice guidelines will also reflect this—is that those are important steps for adolescents who are really suffering from, say, type 2 diabetes, hypertension, metabolic syndrome and those sorts of things. That is kind of a last-ditch effort.

With the promising advent of the GLP analogues—Wegovy, Ozempic and that sort of thing—to me that would be an opportunity for health care providers to intervene not with an irrevocable step like bariatric surgery but with pharmacology. However, that's down the road.

As I did mention earlier in my comments, the unique aspect of Canada compared to the U.S. is that we do have a chance for some significant regulatory intervention on a national level. Restricting the marketing of unhealthy foods and beverages to kids would help diminish the consumption of these products, which are strongly linked with overweight and obesity. Taxing sugar or sweetened beverages can be done on a national level. We have a progressive mindset here. Physical activity can be increased on a national level as well.

I think there are things that we can do upstream, hopefully, to decrease the need for something as drastic as bariatric surgery.