Evidence of meeting #60 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was amendment.
A recording is available from Parliament.
1:10 p.m.
Liberal
The Chair Liberal Sean Casey
Do you want to respond to that?
Were you looking for a response, Mrs. Goodridge?
1:10 p.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
I don't really know if what I was saying is.... I don't think there was actually a question in there.
1:10 p.m.
Liberal
The Chair Liberal Sean Casey
Okay. Thank you for that intervention.
Are there any further interventions? If not, are we now ready for the question on amendment G-3?
(Amendment agreed to [See Minutes of Proceedings])
That brings us to CPC-4. Do we have a mover for CPC-4?
Mr. Jeneroux.
1:10 p.m.
Conservative
Matt Jeneroux Conservative Edmonton Riverbend, AB
Mr. Chair, I will move CPC-4. I move that Bill C-252, in clause 4, be amended by adding after line 22 on page 4 the following:
(2) The review shall also examine whether, since their coming into force, sections 7.1 and 7.2 have been effective having regard to rates of obesity, high cholesterol, diabetes, sleep apnea, mental health issues, cancer and high blood pressure in children.
Essentially, Mr. Chair, this is getting at the metrics and results of this bill.
Thank you.
1:10 p.m.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Jeneroux.
Is there any discussion with respect to CPC-4?
Mr. Jowhari, the floor is yours.
1:10 p.m.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Fundamentally, I don't have any issue. I always support having measures so that we can effectively look at the end result. However, I'd like to hear from our witnesses on whether they have any concerns around specifically mentioning these indicators.
1:10 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
As with everyone else, of course, any time there's new legislation and regulations put in place we want to make sure that we have a review process and measurable outcomes we can look at. In the longer term, absolutely, things like obesity, hypertension and chronic disease are things that we would want to monitor. However, five years, which is when the parliamentary review process would kick in, is actually too short a time to look at those sorts of trends. Those trends are things that evolve over a much longer time period.
In other jurisdictions where they put restrictions like this in place, they have measured outcomes, such as the numbers or the amount of advertising directed at these groups. Again, to substantially see a change in obesity rates, chronic disease or something like cancer, which is also a risk factor for exposure to these products, those latency periods for something like cancer are much longer. It would be impractical to be able to see those sorts of changes in a five-year period.
1:10 p.m.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
On a point of clarification, I know that it says they “have been effective having regard to rates”. Rather than look at the rates, I'm wondering if there is a way in which we could effectively look at the trend and say, for instance, that the benchmark right now is at x%, and over the last five years we've seen a 2% downward trend, rather than saying, our our target is 2% from 10%, and, therefore, this bill hasn't met its....
Would wording like that make a difference?
1:10 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
It would still be challenging. Again, all those things that we're looking at in that list are multifactorial. There are lots of different things that can affect them. Those trends will continue and they'll move on.
The question would be.... For this intervention, which we would measure from the time that it would be put in place to five years after, you have time for implementation and those things to take effect and then be able to see those trends in children. It would be really difficult to then be able to make a link from this intervention to that outcome in this time period. You could see trends, as I said, but again, it's more likely that those trends would be affected by other factors rather than this specific intervention.
Again, that's why it's focused on the bill itself and the parliamentary review of these measures and the effectiveness of these measures. It's just not practical to be able to see that effect in this short period of time.
1:15 p.m.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you.
I'm a Tim Hortons double-double guy. What I am understanding from what you're telling me is that, by the time we pass this bill, develop the regulations, implement the regulations and put the monitoring in place, we may well be in the second or third year of the bill. Whatever remains for us to monitor, it's not going to be long enough, within that five years when the first review comes, to show us the true effect of the bill. Am I right to understand that?
1:15 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
It's that, and I would even go a step further and say that, if we are putting aside the implementation time and magically putting all of these interventions in tomorrow and starting to measure from that time period, even if we did that in five years, given the types of outcomes from a public health perspective, it would be really challenging to be able to demonstrate that in that period of time.
1:15 p.m.
Liberal
1:15 p.m.
Conservative
Laila Goodridge Conservative Fort McMurray—Cold Lake, AB
Thank you, Mr. Chair.
In hearing that argument, I understand and I think that is valid for the very first piece. However, if you don't start, you'll never get the trend. Therefore, if you don't measure it, it often doesn't get done.
I would argue that argument actually makes it more important that we have this amendment accepted, because this will establish a baseline of where we're at, so that, five, 10 or 15 years from now, we can see how effective it is in certain spaces and places, and whether this perhaps needs to be tweaked. If we don't set the baseline of what we're going to consider.... Whether this is successful or not, that review is going to be one that doesn't actually have any metrics as to how to judge success.
I'm going to try to urge all of my colleagues to vote in favour of this, so we can set that benchmark and those guidelines and so we can find those trends. Without this, there is no capacity within the bill, as it's currently written, to have that trend space.
1:15 p.m.
Conservative
Cathay Wagantall Conservative Yorkton—Melville, SK
Thank you very much, Mr. Chair.
I would concur with my colleague on that. My thinking is the same. You want to set a benchmark as early as you can, regardless of.... I understand there's the need for implementation. I think it would be great to ensure this takes place in a speedy fashion.
I can certainly attest to the fact that—and I do believe—the impact of these foods on our children is significant. I am of a generation with children and grandchildren. My children made decisions around a number of products. It did not take long, at all, to begin to see a significant change in their children's sleep patterns, exercise and a lot of health issues.
I would absolutely agree that we need to move forward with this.
1:15 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you for your comments, Doctor.
Do we have parameters, at this present time, on these levels at all?
1:15 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
Yes, there are a number of avenues we use to collect that data, the children's health survey being one of them. All of these parameters—illnesses, health outcomes, obesity, etc.—are being measured.
I think the issue here is specifically saying that a review of the bill and the parameters, in this short period of time, for these types of things, would not be effective. I think we absolutely agree 100% that these measures, in and of themselves, are very important—that there should be ongoing measurement—but wiring in measures that can't be effectively put in place, or are not meaningful for these interventions, is a bit of a challenge.
However, 100%, on all of the other food and nutrition files we have, this is an ongoing issue we are continuing to monitor—both health outcomes and dietary patterns in all age groups, including children.
1:15 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
We have those parameters today.
Don't get me wrong. I recognize that the reality is that we need longitudinal studies to determine the validity of any of the research we do. Oftentimes, the problem we have today is that people don't understand we need these longitudinal studies. It's like when we looked at issues such as polio and the reality of the value of the polio vaccination. It took 10 years before we actually knew how valuable that was.
The reality, here, is that we're talking five years and making decisions on advertising. We're assuming that advertising is the only parameter impacting over these five years, when there are so many other variables that could be impacting that person. We're making an assumption—this legislation is making an assumption—that it's the advertising causing the changes, when it could be so many things.
When we don't have that value.... By knowing the fact that we look at children with diabetes and we recognize that a 15-year-old is tested for diabetes, and then, we find out, through steps being taken, over those five years, that, perhaps, their diabetic issue has gone down.... They're not necessarily taking the metformin they need to take, their diet has changed or their cholesterol level has changed—it's gone up or down. Those are parameters that I think, if you don't have those values in that time frame.... Yes, five years is a short term and you need the long term, but it is a step for people to recognize, “Here we are. We can see the trends that are happening.”
Would you not agree we need those trends and should be pointing them out?
1:20 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
One thousand per cent I agree that we need to have those trends, and I could not agree with you more with respect to the importance of monitoring those and that this is one factor. We have a healthy living strategy. We have a healthy eating strategy. Absolutely even dietary preferences and scope are...it's multifactorial.
I think the issue on the amendment specifically is the wording that talks about seeing if proposed sections 7.1 and 7.2 “have been effective having regard to” these rates. What we're saying is that in this time period there is no way to be making that determination that this intervention specifically could show effectiveness on those rates because of, as you said, the nature of these diseases or how long these take to develop. It gets even more complicated in children, because children zero to 13 are not one homogeneous group. They each have different developmental stages. They have different parameters. When you're studying that, those groups are even smaller, so then it gets down to statistics. How much would you have to see in this group to be able to demonstrate that there's a difference? That's the thing.
I don't at all want to give the impression that we do not want to be doing all the monitoring in terms of children's health. That's absolutely the case. It's just the ability of this provision to show the effectiveness of this intervention is not possible in this time frame.
1:20 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
You're suggesting—I'm sorry if I'm misinterpreting you here—that we're looking at epidemiologists and biostatisticians making decisions or taking those parameters or not being able to take that information. Is that correct?
March 30th, 2023 / 1:20 p.m.
Chief Medical Adviser and Senior Medical Adviser, Health Products and Food Branch, Department of Health
Is there clarity in terms of which decisions you're asking about?
