[Recorded by Electronic Apparatus]
Thursday, May 30, 1996
.0905 
[Translation]
The Vice-Chair (Mrs. Picard): I would like to welcome Ms Diane Daghofer and Ms Debra Reid from the National Institute of Nutrition.
We are going to ask you to make a brief presentation so that we may have time afterward to ask you some relevant questions.
Ms Diane Daghofer (Member, National Institute of Nutrition): Good morning. Thank you for having given us the opportunity of appearing before your committee this morning.
[English]
I would like to start with a brief explanation of who the National Institute of Nutrition is and some of our accomplishments in the area of childhood nutrition. I will then hand the podium over to my colleague, Dr. Debra Reid, who will address the areas we see as being most pressing in this area.
First of all, who is the the National Institute of Nutrition? NIN is a national non-profit organization formed in 1983 to advance the knowledge and practice of nutrition. We have established a strong reputation as an objective and credible voice for nutrition and a catalyst for change. We are a leader in promoting nutrition research and education in Canada, and work to influence public policy in nutrition for the benefit of all Canadians.
NIN successfully formed a unique partnership with governments, industry, health professionals, and universities to accomplish our goals on a cooperative and collaborative basis. We are governed by a board of trustees representing a wide range of expertise in all regions of Canada. We are funded primarily through private sources, with funding for specific projects partially provided by government departments, particularly Health Canada and Agriculture and Agri-Food Canada.
NIN has worked in areas of nutrition spanning the life cycle, but as your focus is primarily on children from zero to six years of age, I will limit my remarks to accomplishments in those areas.
NIN believes the key influence for nutritional health for young children is the family, in its many forms, with child care organizations also playing a role. Given that most of Canada's children are cared for in home settings, the focus on the family also captures many caregivers. If a healthy lifestyle and healthy attitude toward food are established at a young age it can play a pivotal role in avoiding many of the food-related illnesses of later life. Eating disorders, chronic diseases such as heart disease and cancer, and obesity have strong links to nutrition. And healthy eating habits, as I said, are established very early.
In reference to the framework for population health, which I'm sure you are all familiar with, most of NIN's work in the last 12 years has dealt with the foundations for action, although some of our activities are also in the other two areas. In the area of individual factors, we have carried out several public awareness programs to reach individuals and families to improve their knowledge and skills regarding nutrition and to help shape their attitudes toward healthy eating.
We are currently developing a communication program focused on the total diet, which is aimed at empowering consumers to realize that good nutrition, based on including all foods in a balanced diet, is an attainable goal.
As far as collective factors go, most of NIN's work is done in conjunction with members of the food and pharmaceutical industries, health professionals and groups such as the Canadian Pediatric Society, and government policy makers, either actively or in an advisory role.
As I said, most of our work has been in the area of foundations for action. In the area of research, NIN's consumer research provides input into individual health practices and coping skills with regard to food and nutrition. We also maintain a fellowship program to support post-doctoral researchers at medical schools across Canada.
NIN reaches the Canadian nutrition network through a number of means: publications, conferences, and symposia. In 1989 we worked with a network of federal, provincial, and territorial groups on nutrition to develop Canadian guidelines on promoting nutritional health during the pre-school years. That was distributed to health and child care professionals across Canada. Since then, our quarterly publication Rapport has focused on children's issues. You have copies of those issues in your packages, along with Healthy Bites and the NIN Review, which is also focused on several areas specific to children.
In the area of public policy, the major public policy effort we have been involved in in the last five years is the development of Nutrition for Health - An Agenda for Action. We are pleased to have been instrumental in initiating the formation of the joint steering committee to oversee the project and to have been an active member in its development. We are even more pleased to see the commitment Health Canada displayed in ensuring the action plan was developed through thorough consultation and rigorous discussion with all stakeholders.
.0910
In that plan NIN believes we now have the foundation, the framework, to address many of the issues most important to the health of our children. NIN is committed to following the four action areas identified in the plan: to reinforce healthy eating practices; to support nutritionally vulnerable populations; to continue to enhance the availability of foods that support healthy eating; and to support nutrition research. Many of our past programs have supported and certainly all our future programs will support this framework.
I'd like now to introduce Dr. Debra Reid to address the key issues of childhood nutrition, as we see them. Dr. Reid directs NIN's research programs and also works as a public health nutritionist in the parent-child health program at the Regional Municipality of Ottawa-Carleton.
Dr. Debra Reid (Member, National Institute on Nutrition): Thank you, Diane. Good morning to all the hon. members of the Standing Committee on Health.
[Translation]
Good morning, madam Chair. I am happy to be a member of this dynamic duo that is opening this morning's discussions on children and nutrition.
[English]
To begin, I want to congratulate and applaud the committee for its focus on health and on health for young children. As a society and as leaders of this society, I think it's wonderful to see we not only enable families to care for their children, but we also accept the responsibility as a whole to help foster and create an environment in which children are valued and indeed nurtured.
I was thinking a bit about an analogue for this morning. No doubt you've thought it through yourselves. Driving by all my little plum and cherry trees in flower this morning, it really brought home that as the twig is bent, so grows the tree. I think we have an opportunity to foster during the early developmental years children who will certainly be on the best road.
As we watch our children grow almost before our eyes, we realize this so-called long-term investment in health grows to maturity quite fast and to voting age quite fast as well.
Your focus on nutrition for our young treasures is also be applauded.
[Translation]
Of course, as a dietician, my interest in nutrition is no secret.
[English]
I'm sure others have also repeated the importance of food and nutritional support for early growth and appropriate development in the early years. To paraphrase another group's words, the health and well-being of individuals and the prosperity of the nation require a well-nourished population. That voice comes from your federally led joint steering committee, responsible for the development of a national nutrition plan for Canada.
[Translation]
We just barely managed to obtain copies of this document yesterday by performing administrative acrobatics,
[English]
and it's my pleasure to share it with you this morning.
This is a wonderful document and it's been a wonderful process, which has been a model and an example of collaboration and consultation. It's an enviable model, as I saw only last week while I was attending a conference in Alberta with my colleagues from the United States, who are still struggling to come up with their national plan of action.
This document has been endorsed by both the Minister of Health - a fellow Cape Bretoner, I might add - and the Minister of Agriculture and Agri-Food Canada. To have two ministers endorsing the publication apparently is a bit of a political coup. It was developed with broad-based participation from various sectors, provinces, and non-government organizations and with community consultation. Using this document as a framework I would like to shape some of my comments, drawing attention to some of the critical issues facing the nutritional health of young children.
This agenda for action describes in a nutshell - pardon the nutritional pun - the current situation regarding nutrition and the factors contributing to the food choices that impact on nutritional health. If you can have a look at page 4, in the left-hand corner we see in their discussion and description of the national plan that already they have highlighted at least four issues that directly impact on and are drawn from this young age group.
.0915
Point four says the prevalence of obesity in children has increased in the past decade from 14% to 24% among girls and from 18% to 26% among boys.
The next point relating to your target group, breast-feeding initiation and continuation rates - these rates vary widely across Canada from an average of 75% initiation and only 30% continuation for four and six months.
Again, further down the line, the rate of low birth weight in Canada is 5.7%, which varies greatly in certain sub-populations, particularly those in the inner cities, where low birthweights are as high as 10%, rates comparable with some developing countries in the Third World.
I guess the fourth point that we see as pivotal and underlying in addressing young children's nutrition is that there are approximately 460 food banks helping over two million Canadians, including almost a million children.
Where should our efforts be directed to impact on children's nutritional health? The agenda for action, beginning on page 12, cites four key strategic directions. Each of these directions presents key actions that can address the determinants identified in the framework for population health. This is the framework that you can no doubt recite forwards and backwards and at dinner parties in front of your family.
This framework for population health provides strategic directions and presents opportunities to address the nutritional health of babies and young children - our treasures.
If we have a look at number one, reinforce healthy eating practices, national nutrition policies do indeed provide the foundation for healthy eating prograMs Health Canada has recently released a supplement to Canada's guidelines for healthy eating, a focus on pre-schoolers that addresses nutrition for the two to five age group. We are also eagerly awaiting the revisions on infant feeding guidelines and guidelines for nutrition during pregnancy. So these important federally led documents are indeed a key component.
Looking at the key action areas, I draw your attention particularly to actions number one and seven: to work to include and maintain nutrition services as part of comprehensive health services in both existing and evolving community-based settings, to enable communities to support the families and create the environment, to protect and promote breast feeding, and to improve access to community-based breast-feeding support groups.
The second strategic direction, support nutritionally -
[Translation]
The Vice-Chair (Mrs. Picard): We had set aside ten minutes only for your presentation, and I would ask you to conclude quickly so that we can ask you a few questions.
Dr. Reid: Very well. Here are the four strategic directions:
[English]
reinforce healthy eating practices, support nutritionally vulnerable populations, continue to enhance the availability of foods that support healthy eating, and support nutrition research.
In closing, NIN urges you to integrate the appropriate action from nutrition for health and agenda for action into your committee's recommendations. This plan of action was designed for this very occasion to encourage partnership, widespread adoption, and diversity as Canada builds strong and healthy children.
[Translation]
Mr. Dubé (Lévis): You were in full flight, there; I was trying to see where you were headed. I find all of this very interesting, and, in any case, we will have the document to consult.
I have two questions. The first question that comes to mind - please forgive me for not having had the time to examine your documents in-depth - is to ask you who should implement this and what role you see the federal and provincial governments playing, in light of the fact that according to the Constitution, health is a matter of provincial jurisdiction. Have you considered what role each level should play, as well as what role the other partners should play? The question is short, but the reply could be long.
.0920
[English]
Dr. Reid: When it comes to implementation and to buy-in, I believe they have chosen their words well in calling it An Agenda for Action. This was a process that was federally led, based mostly on the promises and the commitment we had made to the international community, as you can read in the preamble. I think we have responsibilities that can be led on the national front, but there are also opportunities for partnership, for sharing, for encouraging diversity and for actually enabling all of the players, be it federal, provincial or non-governmental organizations, to work together in partnerships to enhance their respective communities.
For example, I think the federal government itself can implement and begin, perhaps with regard to An Agenda for Action, on their own policy avenues to make sure that nutrition is part of all initiatives touching young children over which they have jurisdiction and have undertaken responsibilities - activities and surveys, for example, done with Statistics Canada. Perhaps they should all have a nutrition component that would help in the monitoring of a nationwide situation.
So there are many avenues for support on the basis of a national foundation of information and a national avenue for gathering information and monitoring.
Ms Daghofer: I would agree. I think the federal government has a strong role to play in terms of information-gathering and dissemination, not necessarily by itself but perhaps in directing those programs through NGOs such as NIN, which has a history of being able to do that type of research and that type of public awareness.
The plan clearly identifies roles for all levels, from the community level to the federal government, to participate in this process. Certainly in areas such as income security, which is an important area for ensuring the appropriate nutrition, it obviously is a federal jurisdiction. I think in reading the document it will be fairly clear in what areas the federal government can take a leading role, as I said, either in their own right or through organizations like NIN.
[Translation]
Dr. Reid: In fact, it is throwing the ball into everyone's court rather than shouldering its own responsibilities.
[English]
The Vice-Chair (Mrs. Picard): Mr. Szabo.
Mr. Szabo (Mississauga South): Thank you for your presentation. I'm glad we continue to have lots of information, but I have to tell you, I'm very frustrated in this process - not just you; this is not you. It seems all of the educators and all of the people working on this, everybody, knows everything they should know. But you know who doesn't know? Canadians, ordinary Canadians, down at the bottom.
I'm trying to figure out, if nutrition is a key element in terms of healthy starts and long-term positive outcomes, how much research and how much studying we have to know about what is good, basic nutrition. The idea is, where are we today, where would we like to be and how do we get from here to there?
I can tell you, preparing guidelines and monitoring and research and all this is wonderful - as long as everybody who gets one of these reads it and hears about the macro things. What we're hoping to hear, I suppose, eventually, is where are the micros? Where are the little things? Can we go to neighbourhoods across the country and ask what they know about nutrition? You know what they should know. How do we make those people know what you know?
.0925
The idea here is that we think healthy children translates into a lot of benefits: lower health care costs, lower social costs, lower criminal justice costs, lower number of high school drop-outs, lower family violence, better family values, better social values. Nutrition is an element of that. This is preventative strategies for good health. I don't think you can just say nutrition is good. What can we do, or what can you do here? If we were going to produce a document, can you tell us how we could help Canadians know what's important, why it's important and what they can do? We have to get down to the micros.
We just got this today, and I can't read it now. These are lovely, but - and this is a big but here - the communications are going to whom? They're going to people just like you in other agencies, who love to read about this stuff, but I don't see anything in here going to an ordinary Canadian who may be at risk because of lack of knowledge of good nutrition.
So the idea is, what can you tell this committee about microstrategies? Give me one concrete recommendation about what we could say to Canadians that would advance the issue of nutrition for Canadians.
Ms Daghofer: I think this is an area in which I certainly share your frustration, but it's something NIN has been working very hard at, particularly over the last 18 months. In our history we certainly have focused more on the research side, on establishing a reputation with health professionals. We're a small NGO, and our work has been through people, through other health professionals, who will go to the public.
There is a piece in there called Healthy Bites, designed specifically to go to the average Canadian. In the last 18 months we have started to shift our focus. We've done a lot of research in the area you're talking about, what we can tell Canadians to make a difference in their nutrition. We've identified four main barriers to nutrition as Canadians see them. There's a lot of confusion out there. People are getting lots of messages from lots of different areas about what good nutrition is all about. Some of them are very sound, but some of them, unfortunately, are fringe groups with their own agenda not necessarily aimed towards nutritional health. So confusion is a big issue.
Canadians believe eating well costs more than not eating well. It's a misconception. They feel it takes more time and effort to prepare a nutritious meal than to pick up a convenience food. They don't see a bag of frozen vegetables as a convenience food, which it certainly can be. The fourth area we've seen as being a concern, again, is tied to the whole issue of convenience and time.
Mr. Szabo: Okay. That's a situation that exists. That's the problem. You know where you want to be. Now, what are you recommending, using what strategy? It is a leaflet? Is it something through the schools? Is it speaking everywhere you can get out to? I mean, you have to have an action plan. We're not looking for producing a report that says ``Here are the probleMs The End.'' We want to see something that says what are the problems, what are the consequences of those problems, here is where we'd like to be, and here are the specific strategies.
I hope your group is going to be able to go away and think about it. You people have a lot of knowledge and a lot of information, but there's somebody else out there who probably knows how can we can best get to where we want to go in terms of communication strategies.
Ms Daghofer: If I can continue, we have done a lot more than just think about it. In fact, we're making a presentation tomorrow to twelve of the major food manufacturers in Canada, presenting a plan to them to deal with public education. It includes television advertising as well as a newsletter that would be distributed free through the retailers, through grocery stores, to address those specific areas that we understand are barriers to good nutrition and to move ahead on this, to start to educate Canadians. Certainly we're only one group, and we can't do it by ourselves, but as you can see, we're well on the way to raising the funds to be able to do that.
[Translation]
Mr. Dubé: In order to find out more, I consulted Appendix 3 in your action plan where you refer to some background documents. I noticed two paragraphs in particular: the fifth, where you mentioned the document Food Quality and Safety programs in Canada, a review of federal food regulatory programs, and the sixth, where you refer to the Review of National Programs, a review of canadian programs relative to three ICN themes.
.0930
Do you think those two documents could be made available to the members of the committee?
Dr. Reid: I think those documents can be had through Health Canada, probably from Mr. Aiston, the Director General of the international affairs branch.
Mr. Dubé: Mr. Chairman, may we ask the clerk to obtain those documents for us?
Dr. Reid: It is a collaborative process.
[English]
led by the federal government. NIN was a key partner in its development. That's why we're so happy to share it with you and to draw it to your attention this morning, because we believe it's a foundation for action.
[Translation]
The Vice-Chair (Mrs. Picard): Are there any other questions? Ladies, thank you for your presentation and also for the brand new document that has just been issued. It seems very interesting and we are going to examine it.
Thank you for coming to meet with us here, and I wish you the best of luck.
We are going to break for a few minutes.
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.0936
The Vice-Chair (Mrs. Picard): Good day.
We are now going to hear Ms Gilmore and Ms Shea, who represent the Public Health Office of the city of Toronto. We ask that you make a ten minute presentation, approximately, so that we can then have the time to ask you some relevant questions.
You have the floor.
[English]
Ms Julia Shea (Director, Public Health, Nursing and Education Services, Department of Public Health, City of Toronto): Thank you. We appreciate the opportunity to address you today on behalf of the City of Toronto's Department of Public Health.
Current fiscal restraints faced by all levels of government present us all with real challenges to the achievement of commitments made to Canada's children. These include: the 1989 all-party resolution by the House of Commons to eliminate child poverty by the year 2000; the affirmation of the 1990 United Nations World Summit on Children, which espoused the principle that children have the first call on all nations' resources in bad times as well as good; and this government's proposal to establish, through the social assistance review process, income security for children.
I would like to commend this committee's decision to study and consult regarding children's health and to develop specific recommendations to the federal government. I believe through this process the fundamental principles to which we have committed ourselves will be maintained and acted upon, and we will stay the course notwithstanding the turbulence of deficit reductions.
I will speak about what I think is our shared vision of health equity for Canada's children, one in which all children realize their right and entitlement to such things as access to adequate nutrition, housing and essential services, affection, care and support, freedom from family and societal violence, and access to a full range of educational challenges and opportunities.
I want to speak about Toronto's public health enthusiasm and support regarding the Health Canada programs that we believe are moving towards the realization of that vision, but I also need to raise our concern about our federal social policy directions that appear to move to deepen child poverty, erode crucial services for families with young children and perhaps even undermine the health of Canada's children.
Child health has been a long-standing public health priority. Our mandate in the Department of Public Health, and indeed through public health departments throughout this province, is to prevent disease and to protect and promote community health. We see infancy and early childhood as crucial starting points, because we know assisting in the development of healthy children establishes the foundation for a healthy community. If we fail to identify problems or enhance capacities of children and their families during this early period, it will become much more difficult and costly to respond later.
Public health departments are comprised of multidisciplinary staff that includes public health nurses, nutritionists, dietitians, community development and lay workers, physicians and dental staff. We work to support child health in our community in a variety of ways, including nutrition and parent support programs, parent education, oral health services, immunization, case and policy advocacy and community organizing.
An important part of our program work in children's health involves collaboration with Health Canada through the Brighter Futures initiatives, such as the Nobody's Perfect parenting program, the community action program for children, Canada's prenatal nutrition program, the national breastfeeding program and the healthy babies program.
The efficacy of these programs is strongly supported by our department staff and by the community members who participate in them. They have been effective in reaching parents and children, both pre- and post-natally and throughout the pre-school years, and are helping to provide some of the key requirements to improved children's health in our community, such as access to nutritious food, prenatal and parent support, parent relief, parenting and health education, and the development of community networks.
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Unfortunately, the success of these programs is shadowed by the impact of enormous reductions to federal-provincial social transfers. With the elimination of the Canada Assistance Plan in April 1996, and the introduction of the Canada health and social transfer, transfers to the provinces for health and social services will be cut by 25%, or approximately $7.4 billion, over the next two years.
In Ontario, it is expected that this loss will be approximately $900 million in 1996-97, and up to $3 million in 1998-99. This can only mean further reductions to social programs in Ontario, which have already been drastically reduced within our last year.
The situation for low-income families with children in Toronto regarding access to the basic prerequisites of health has worsened dramatically in the past year. In October 1995, when Ontario cut social-assistance spending by 21.6%, about one in three children under the age of 18 were on social assistance. A third of these children were under the age of five. Currently, 30% of Toronto's children live on social assistance, and thousands more live in households on minimum-wage incomes. Thus, more than a third of Toronto's children live in poverty, which comes to approximately 35,000.
The Toronto Board of Health has been aware that families living on social assistance have been unable to obtain the basic prerequisites for health even before recent cuts. We believe that current social service reductions will further undermine the health of Toronto's most vulnerable, children. The reduction in the social service assistance rates have left families with incomes more than 40% below the Statistics Canada low-income cut-off.
In addition, the Province of Ontario has had to make significant funding cuts to social service programs that support and give relief to low-income communities. Thus, services are being reduced and, in some cases, eliminated precisely when they are perhaps most needed. The cumulative impact of these cutbacks on families with children living in poverty has deepened material deprivation and has created a sense of hopelessness.
Over the past seven months, our department has been involved in projects that are beginning to track the health impact of cuts to social assistance and community-support services. These involvements include partnerships in a community-based, participatory research project, a Metro Toronto interagency coalition, research projects supported by the University of Toronto's urban health and life research unit, and in the gathering of information from community experiences of our front-line staff.
Although these projects are all in their preliminary stages, we are beginning to obtain some concrete information regarding difficulties faced by low-income families with children. According to information from the Metro Toronto hostel services, children are the fastest-growing group of the new homeless. Mother-led families relying on shelters were up 53% in November 1995, compared to November 1994, while couples with children increased 27%. In January 1996, landlord eviction applications to the sheriff's office were recorded to be 25% higher than that of the previous year.
[Translation]
The Vice-Chair (Mrs. Picard): Ms Shea, is Ms Gilmore also supposed to speak?
[English]
Ms Shea: No, we were just going to answer questions together.
[Translation]
The Vice-Chair (Mrs. Picard): Could you conclude rapidly?
[English]
Ms Shea: In the same period, the number of families with children who have been involved with Children's Aid and have had to share accommodation has doubled. This is a situation that raises concerns around housing adequacy and overcrowding for children. The Ontario child health study has found that the lack of space at home may be responsible for slowing down intellectual and physical motor development, and has been shown to be a factor in poor school attendance.
Today, federal and provincial governments in Canada and throughout the western world are tackling staggering public deficits and trying to improve the fiscal bottom line. We will make a costly mistake if we concentrate on short-term fiscal solutions, which may have unintended outcomes of undermining and reducing child health. Governments must respond to the identification of these pitfalls and develop strategies that mitigate against the negative impacts of fiscal restraint upon children.
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We are aware that proposals for a social investment fund to address the specific economic needs of families with children are being put forward by a number of groups, such as Campaign 2000, an advocacy group, the Canadian Institute for Child Health, and most recently Premier Romanow of Saskatchewan has announced that he will introduce a similar proposal at the upcoming first ministers conference.
We urge your committee to recommend that the federal government explore and implement a strategy perhaps of this nature. Such a strategy would include enforceable national standards that would ensure that all Canadian children have the opportunity for health.
Thank you.
We're prepared to answer questions about our specific programming. We weren't aware, when we did our presentation, that we should do that right off. We just did an overview.
The Vice-Chair (Mrs. Picard): Mr. Szabo.
Mr. Szabo: I just have a couple of quick questions. Can you tell the committee what your present understanding is of what constitutes poverty or child poverty?
Ms Joanne Gilmore (Parent and Child Health Consultant, Public Health Office, City of Toronto): What constitutes poverty?
Mr. Szabo: Yes, you talked about it. There's an increase of child poverty. There must be a -
Ms Gilmore: We're looking at the low-income cut-offs that Statistics Canada reports.
Mr. Szabo: What are they?
Ms Gilmore: I don't have that off the top of my head. I'm sorry.
Mr. Szabo: Okay, do you have any idea about the condition of families, specifically in terms of family breakdown, such as divorce rates and separations? What percentage does that represent of the people we're talking about in Toronto?
Ms Gilmore: I don't have those figures off the top of my head. I'm sorry.
Mr. Szabo: Okay, I raised it because I did a phone-in show in Calgary and an expert came on and asked me questions about that. I had a proposal for assisting families.
They said that 50% of families in our cities are divorced, so what are you going to do for us? The issue was that if you have a family making collectively say $35,000, $40,000 a year, which represents a pretty average range, and that family breaks down, then by definition, according to Statistics Canada, all of those family members are now living in poverty. The only reason is that now they have a second residence to pay for, which I would think most people in this room couldn't afford in their present economic circumstances.
Family breakdown, family divorces and this kind of thing are probably one of the greatest causes of child poverty.
Ms Shea: You're quite right.
Mr. Szabo: I hope that as you continue to advocate on behalf of children who are unfortunately in this situation in which the family has deteriorated and broken down, which is a very high proportion of families, you deal with some initiatives that will promote healthier families, which is really a good prevention. Those are some of the things we're looking for. I'm sure that your organization has information on that.
I hope there's some way you could tell us in your experience how many.... You talked about mother-led families. I know about that, having been on the Peel Regional Housing Authority. Half of the public housing units were mother-led families. The question is, why? It's not single mothers; it's mother-led families. They don't happen from the start. They're a consequence of something else. I hope the focus is somewhere....
Let's not throw money at problems after we've got the probleMs The word in our study here is ``prevention''. We're trying to look at the genesis of some of these probleMs I think this family breakdown issue is a critical one. I'm sure you've got information about it.
Ms Gilmore: Unfortunately, I don't have the actual statistics with me. I don't carry that stuff around in my head, but you're right. But it's not just a total family breakdown that causes the single-led families; there are two components. You're right that there's a large component of families who divorce, and therefore you have the mother-led family, which leads into poverty. You've also got those single women, usually teenagers, who also become pregnant whereby there never was a marriage to start with.
When you talk about prevention, how far back do we go? Which came first, the chicken or the egg? Even speaking about this point, we with the City of Toronto spend a lot of time in the schools working with.... You can talk about puberty education and getting the children when they're young. As for this decision-making, you just don't go in and talk about the parts of the body and here's how you're going to change and watch for this and that. You have to talk about how to make healthy decisions in making decisions about relationships, and what constitutes a healthy relationship.
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Those are the kinds of things we're trying to do to help with preventing family breakdowns. We also try to start as young as possible to look at that sexuality education. Again, it's the decision-making of teenagers as to when they're going to start having intercourse, how they're going to protect themselves, and getting them to think about protection, which is an issue.
You also have to look at this. There seems to be a trend that single mothers tend to breed single mothers. Children who are brought up in a home living in poverty with a single mother living on social assistance have that as a role model.
There are so many cultural aspects to the whole situation that you just don't want to take the kids at 12 and start working with them. Let's see if we can go back further, to maybe when those children are young. We can work with the mothers to help build up their self-esteem and make them feel better about themselves in their roles as mothers and help them stimulate their children. But also, they can look at what their life is all about.
Through some of those programs, we are seeing some successes with getting mothers who, once they start feeling better about themselves, feel more a part of the community and that they can achieve something. Then their outlook will change, so perhaps we can get them back into the workforce and contributing.
Is that what you had in mind?
Mr. Szabo: That's great.
The Vice-Chair (Mrs. Picard): Mr. Volpe.
Mr. Volpe (Eglinton - Lawrence): Thank you, Madam Chair.
I didn't want to deprive the other colleagues around the table of the opportunity to ask some more questions, because I think in the responses of the last moment or two Madam Gilmore was getting a little bit closer to what this committee wanted to hear.
A thought crossed my mind when I was hearing Madam Shea giving us an indication of the current situation. I guess, almost sarcastically, I wondered if there was a graph, somewhere along the line in your studies, that preceded the fiscal rearrangements initiated by the federal government that indicated a Utopian point at which everything was okay.
Ms Shea: I doubt it, but it's a good question.
Mr. Volpe: I thought it would be worth asking, because since the fiscal rearrangements were initiated a couple of years ago, there are a whole series of other statistics that you've given me that suggest there's a cause-and-effect relationship between what happened with past budgets and poverty in the field, at least in Toronto. So there must also be other statistics that indicate that things were, to use a hackneyed old phrase, just hunky-dory before that.
Ms Shea: I didn't really look into it. I doubt that there's anything available, but I do appreciate what you're saying.
Ms Gilmore: To say everything was hunky-dory, I don't know whether there ever really was a time, but certainly look at things that are getting worse. The Daily Bread Food Bank indicates that between 1995 and 1996, among the families coming to the food bank, there was a 68% increase in the number of children being serviced. When you look at that, it's significant.
Mr. Volpe: It's significant, but I'm not sure that you're going to get the answer here today about why it's significant.
That food bank started its operations when Toronto was going through probably its most glorious prosperity in the history of the country. I think the going rates there for employment were just sky-high. There was in fact, underemployment. Anybody who wanted a job could have got one. I'm not misspeaking myself. I think you're aware of what I'm saying. In the mid-1980s, if you wanted a job in Toronto, you could have picked one, changed it, and got another one before the afternoon was out.
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So I'm not sure that the cause-and-effect relationship you want to impress upon me is one that's universally acceptable.
Ms Gilmore: But you're talking about the 1980s. Maybe that's -
Mr. Volpe: Yes, but you brought up the food bank and that food bank opened up -
Ms Gilmore: I was talking about the changes in the last year.
Mr. Volpe: It opened up right in the middle of this boom situation. You're suggesting, at least to me, that there is a cause-and-effect relationship when money is flowing. I recall the days when money was flowing in gushes. That was exactly when what is now an institution opened up and started doing business.
Ms Shea: At the time it was to be nothing but an emergency response.
Mr. Volpe: It was an emergency in the middle of prosperity. So is more money the answer?
Ms Shea: Not necessarily.
Ms Gilmore: It can't be just money. We need to build all those other supports for our families. We've had some successes with prograMs
Do you want me to tell you about some of the programs working with prospective parents? Some of the programs we are particularly proud of in the city are our Healthiest Babies Possible programs, our Healthy Beginnings programs and our Parents Helping Parents program.
The Healthiest Babies Possible program has been around for quite a while and we've evaluated the program. It is a home visiting program for high-risk pregnant women. We are not just talking about nutrition here, but about giving them other supports and education. We know if you are intervening and giving one-to-one support and education in a holistic approach, you can affect low birthweight. We've seen a significant difference and improvements in what's going on.
Healthy Beginnings was a program we started in collaboration with food banks to look at pregnant women and address more of their needs. This program is now being duplicated under the perinatal nutrition and support prograMs Our Parents Helping Parents program, where we've taken lay workers and trained them -
[Translation]
The Vice-Chair (Mrs. Picard): Please be brief as other members of the committee would like to ask questions.
[English]
Ms Gilmore: Okay. If you would like me to be finished, sure.
[Translation]
The Vice-Chair (Mrs. Picard): Mr. Dubé.
Mr. Dubé: Thank you for having explained Toronto's particular situation to us.
Since I sat on the Standing Committee on Human Resources Development I have a fairly good idea of the changes wrought by the Canadian Social Transfer.
Let me tell you straight away that I don't necessarily share Mr. Volpe's opinion on that. We have different political perspectives.
You are from the City of Toronto Department of Public Health. Aside from the federal programs, such as Health Canada Program, there are also Ontario government programs and services. In Toronto, you administer provincial and federal programs, or do you have your own programs?
In your opinion, do the services provided by the three level of government overlap in the area we are discussing today, the health of children? Do we need to do some housekeeping in all of that? Is everything fine in that regard, or is it just a lack of money?
[English]
Ms Shea: Maybe I could begin.
I don't believe it's perfect, but I wouldn't say there is overlap. We are actually mandated by the Province of Ontario under the Health Protection and Promotion Act to provide services to our community, which for us is the city of Toronto. It's the same for all 43 health units in the province of Ontario.
We do, however, participate by choice in some federal programs such as Nobody's Perfect and occasionally we may have a program of our own. For example, public health units in the city of Toronto are conjointly funded by the province and the corporation of the City of Toronto. We get 60% of our funding from the province to carry out the mandated programs and 40% of our funding from the corporation of the City of Toronto.
This is a little bit different in the rest of the province, but they are all conjointly funded. I wouldn't say it's perfect, but I also wouldn't say there is overlap. Would you say there is overlap, Joanne?
Ms Gilmore: No, I don't see that.
Ms Shea: It actually works quite well. It gives us some freedom to take on programs like Nobody's Perfect and utilize them in our communities. We then find people in the community to carry on. This has actually been one of our very successful prograMs But there are also some provincial programs we carry out just because of the nature of the mandatory guidelines.
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[Translation]
Mr. Dubé: The federal government has made cuts through the Canadian health and social transfer, and we all know the position of the new Ontario government on downsizing prograMs Has the City of Toronto taken similar steps with regard to the 40% it is responsible for?
[English]
Ms Shea: Yes. Actually, we've lost staff. We've already experienced what people call streamlining. What we've lost is the ability to service with the same number of persons at all levels of staff, including senior management and front-line staff. What we have to do is find ways to deliver services with fewer people by priorizing in a different way. We have to, in a sense, work smarter with less, the same as everyone else is trying to do.
The Vice-Chair (Mrs. Picard): Mr. Scott.
Mr. Scott (Fredericton - York - Sunbury): Thank you very much, Madam Chair.
To react to the discussion between the witnesses and Mr. Volpe about all the jobs and money gushing around Toronto, it's sort of a maritimer's dream come true, really.
Mr. Volpe: You're living it now. We lived it ten years ago.
Mr. Scott: You talk pretty much in a macro way. But I could see the angst and the bewilderment that the government is dealing with so many of the reductions in spending and dealing with a problem that seems inconsistent with our actions in some fashion, I think. I can see this and I share a lot of it myself.
Having said that, though, I think we have to recognize there seems to be something happening in society that is greater than us. It has to do with some resistance to the public offering up the resources necessary to make these programs go. All over the place, people are talking about reducing taxes and reducing the revenues available to governments to make these programs happen. I think as responsible leaders in the country, we do not necessarily have to buy into it, but we have to recognize it's there. I think we all have this obligation.
One of the solutions to what is happening is to analyse what we do so we can find out in communities why people are not as supportive of those things as they should be, if you follow me. We need to make the direct connection so back home where I come from people understand when they tell me they want their taxes cut what that means. It means some program they probably enjoy is going to go.
One of the things I think we need to do is to increase Canadians' confidence that these things are done well. You don't have to give anybody the benefit of the doubt. But there are some of us trying to figure out a way to make these things work well so we can then tell our communities we deliver these programs with some efficiency. Then they will be more prepared to give us the money necessary to make these programs go.
I just say this to offset some of your angst about why we are doing what we're doing in the face of other things we're also doing. I think there is something helpful about this. There are those people who believe that in the past we have not solved problems by throwing cheques at them. But neither do I think we're going to solve problems by tearing up the cheques. We have to figure out some way to fix it.
Anyway, my question is a very simple one. Are you aware of any research assessing the various systems for delivery of the resources that would be available to deal with the very specific problem we're trying to attend to? I think we all know that somehow carrots are better than Smarties. I think we know all the things we need to know. The information exists. It's not in the hands of the people who should get it. How do we get it into the right hands so better decisions are made on the ground? Whether it has to do with food, sexual activity or whatever, is there any research that deals with this social marketing challenge?
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Ms Gilmore: Well, there is no research that has ever analysed every single thing and tried to pull it together. We know multiple strategies tend to work. You can't just take a single strategy. For instance, you have children who are below the weight they should be. Just giving them some food and proper nutrition will help them a little bit, and just giving them psycho-social stimulation will help a little bit. If you put it all together, then you have a lot.
So I think there is enough research that talks about multiple strategies. I think even the population health framework looks at some overall strategies and some targeted strategies for specific populations. I guess you're asking a $64 million question.
Mr. Scott: Well, it's probably worth $32 million now.
Ms Shea: I don't think there is anything comprehensive at this point in time. If there is, we don't know it.
Mr. Scott: Thank you.
[Translation]
The Vice-Chair (Mrs. Picard): We don't have time for any more questions. Thank you for coming to meet with us. I do apologize for having had to interrupt your presentation; it was very interesting, but we have a very heavy schedule.
I wish you the best of luck in all of your undertakings and in the work you do with the poor. The services you provide to that most disadvantaged group is admirable. Thank you very much; have a nice day.
Our next group of witnesses is from the Toronto Coalition on Perinatal Nutrition.
Good morning, ladies. Members of the committee, may I introduce Ms Sonja Nerad, program co-ordinator, Healthy Beginnings, and Ms Maureen McDonald, program co-ordinator, Parkdale Parents' Primary Prevention Project.
Ladies, may we ask you to make a presentation of approximately ten minutes, in order to allow us to ask a few relevant questions afterwards. You will have a half hour altogether to tell us what you wanted us to know about the health of children.
[English]
Ms Sonja Nerad (Program Coordinator, Healthy Beginnings, City of Toronto Coalition of Perinatal Nutrition and Support Programs): Good morning, honourable members of the committee. My name is Sonja Nerad and I'm the coordinator of Healthy Beginnings/Stop 103. With me today is Maureen McDonald. She is the coordinator of the Parkdale Parents Primary Prevention Project, also located in Toronto.
Today, however, we are representing the City of Toronto Coalition of Perinatal Nutrition and Support Programs, which was formed in June 1994. The coalition consists of seven prenatal nutrition and support prograMs The aim of these programs is to optimize the prenatal and postnatal health and well-being of mothers and babies born in the city.
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Our goals are to advocate on behalf of programs for pregnant women living in high-risk circumstances; to encourage collaboration and to secure funding for programs; to identify gaps and establish programs in order to promote comprehensive coverage in Toronto, while avoiding duplication; to facilitate ongoing evaluation of programs and promote a coordinated evaluation effort; to share information, strategies and resources.
Ms Maureen McDonald (Program Co-ordinator, Parkdale Parents' Primary Prevention Project, Toronto Coalition on Peri-natal Nutrition): In Canada, approximately 5.5% of all births are low birthweight births. In Toronto, the low birthweight rate jumps to 6.1%.
We know that it costs a tremendous amount of money to care for the immediate needs of these babies. It costs approximately $1,500 per day, and with an average stay in hospital of 40 days, the cost can rise as high as $60,000 per infant.
There are a number of factors that increase the risk of a woman delivering a low birthweight baby. These may include poverty, poor nutrition before and during pregnancy, single parenting, teenage parenting, poor or no prenatal care, living with a violent partner, stress, smoking, drug and/or alcohol use and workplace stress.
Approximately 75% of newborn deaths and illnesses occur in low birthweight babies. Prevention of low birth weight will save innocent babies serious health problems and even save them from death, while saving the health care system and taxpayers the cost of the immediate care required by these infants.
In addition to the lifetime of costs to the health care system, there are the emotional and psychological costs associated with the ongoing investment required by families with low birthweight babies. Studies have shown that the most important element to healthy child development is a supportive and caring family.
When a new mom is lacking self-esteem and confidence in herself, she may not be able to provide the nurturing relationship particularly required by a child at this crucial point in its life. In turn, this will ultimately have an impact on the relationship between mother and child, possibly for the child's lifetime. For this reason, it is essential that the Canada nutrition programs are comprehensive in nature and extend beyond the six months' post-natal period in order to support parents in their child's early childhood development.
Canada's prenatal nutrition programs and community action programs for children are not only a wise investment, they are an investment in Canada's future. At STOP 103, for instance, which receives 15% of its budget from the CPNP, the low birthweight rate in 1995 was 4.7%, well below the national rate. The rate in the community where STOP 103 is located was 6.7%.
The effectiveness of these programs is evident when one views the data. A comprehensive perinatal nutrition and support program costs approximately $60,000 per year. If each program prevents low birth weight for just one baby, the program will ultimately pay for itself.
The core elements of these programs happen during informal drop-ins and our aim is to reach as many high-risk pregnant women as possible. Therefore, extended family members, older siblings and friends and children are welcome.
We have volunteers who are specifically recruited to meet the language needs of our participants. All programs in the city are community collaboratives and are delivered by a multi-disciplinary team of staff, including nurses, dietitians, social workers, home visitors, early childhood educators and community workers. The result is a more holistic response to the complex, multifaceted issues these high-risk pregnant women face.
Programs provide crisis counselling as well as informal one-on-one support and group support. They also offer informal education sessions, and some offer more formalized prenatal classes. Ongoing information and education is available from staff in the form of videos, classes and written resources in a variety of different languages.
These programs are non-judgmental, participant responsive, and accessible to a diverse population of Toronto. To ensure that they remain responsive, program participants are involved in program direction through their advisory boards. As most programs are collaborative and partnering agencies work closely together, referrals are used to ensure that women do not fall through the cracks should they continue to require support throughout their child's early childhood development.
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For example, in the program in Parkdale, its local parent-child resource centre is a partner in the project. This is a resource to families throughout their child's early childhood development and pre-school years. The Toronto Department of Public Health has nurses and a program called Parents Helping Parents to follow up on new mothers who are identified as high risk, thus providing intense one-to-one case management to more vulnerable families.
Women don't get lost in the system. Follow up is possible and women can continue to be supported in making positive life choices for themselves and throughout their child's pre-school years. We provide both formal and informal childcare to ensure accessibility. Women are involved in a variety of activities while they are at the drop-in, such as knitting, sewing and cooking demonstrations, in order to get to know each other better.
Ms Nerad: Canada's pre-natal nutrition programs provide funds for nutrition supplements for the City of Toronto perinatal prograMs This is in response to numerous studies that have documented the correlation between healthy nutritional status and healthy pregnancy outcomes.
These funds allow programs to provide women with milk and orange juice each week. This, however, is not enough to significantly change a woman's diet. If a woman has other children she'll feed them first and herself and her unborn child second. Therefore, grocery support is additionally supplemented by food hampers from local food banks.
Historically, the quality of food bank supplements has been dependent on food drives, but for a couple of months in the late summer and late winter the supply of food was steady and of relative nutritional value. However, since the cuts to social assistance in Ontario in October the number of people using food banks has risen by 50%, while the supply of food solicited has remained constant. Therefore, grocery support for pregnant women is rapidly shrinking.
The programs also offer information and instruction on preparing low-cost meals and on the nutritional content of food. Nutritious snacks are also offered at the drop-in. However, recently staff have noticed that the snack is becoming breakfast and lunch for many of our program participants.
From our experience, women learn from each other, and, therefore, programs encourage role modelling, mutual aid and support. We also encourage peer leadership, particularly in areas such as breastfeeding and parent-child bonding.
Evaluation is also very important. This allows us to assess the programs and ensure they are responding to the changing needs of families within our communities. In addition to participant consultations, the staff gather each week to review the program happenings and to adjust for future programming.
Most programs offer practical needs support such as clothing and infant's equipment. When women return post-natally, they have a picture taken to keep for memories.
Ms McDonald: The federal government can play a key role in the healthy development of young children by continuing and increasing its support for prenatal nutrition and support prograMs The following themes have been highlighted throughout this presentation in the brief you will receive.
Canada's prenatal nutrition programs and community action programs for children are not only a wise investment, they are an investment in Canada's children and in its future.
The federal government needs to provide stable core funding for comprehensive perinatal nutrition and support prograMs They have been proven effective in reducing low birthweight rates in high-risk communities. A comprehensive program costs approximately $60,000 per year. If each program prevents just one low birthweight baby, the program will essentially pay for itself.
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The full cost of nutrition supplements needs to be recognized. Much of the food offered at the programs is provided in kind by charitable organizations.
[Translation]
The Vice-Chair (Mrs. Picard): I must ask you to wrap up, if you please.
[English]
Ms McDonald: Okay.
With the increasing demand on the charitable food system, sufficient nutritional support for pregnant women is depleting rapidly. The federal government can also take a lead role in educating the general public about the importance of perinatal health, particularly amongst high-risk women.
We would like to thank you for listening to our presentation. I would like to leave you with one final note, that it does take a whole village to raise a child - but not through bread alone.
[Translation]
The Vice-Chair (Mrs. Picard): Thank you. Mr. Dubé.
Mr. Dubé: I must congratulate you on the work you do. The slides help us to understand. I would like to know where the funding for your program comes from. You said that you would like the federal government to maintain a certain level of funding. Do you receive direct funding from the federal government for that program?
[English]
Ms McDonald: Yes. Health Canada's community action program for children, CAPC, funds programs throughout Canada. My project in particular is funded through that stream of funding. We do have one component, our prenatal program, and we also have other programs that extend beyond the prenatal period. The Canada prenatal nutrition programs are funded through Health Canada.
[Translation]
Mr. Dubé: Are you subsidized by the provincial government or by the City of Toronto?
[English]
Ms McDonald: No, we are subsidized only through provincial and municipal funds through in-kind funding and support through our partnering agencies. So for programs we have two public health nurses and a public health dietitian come in each week, and that's provided in kind. We also have in-kind space available to us, and we don't pay for administrative support.
Ms Nerad: Just to enhance what Maureen has said, her program is funded by the community action program for children and has the prenatal component. Many of the other prenatal nutritional support programs in Toronto are funded through the Canada prenatal nutrition project, which is a much smaller funding base, and therefore the programs do not have the extensive post-natal supports the Parkdale project offers.
I'm in a position where, as was mentioned, about 15% of the project is funded through Health Canada. The rest of the funds are raised locally.
[Translation]
Mr. Dubé: And the rest?
[English]
Ms Nerad: The rest of the funds are raised locally through the agency that sponsors the program. Of course, the program is very unstable, because we're never sure whether we're going to have funds to continue coordination of the project.
The Vice-Chair (Mrs. Picard): Mr. Szabo.
Mr. Szabo: That was an interesting presentation.
Are you familiar with FAS?
Ms McDonald: Is that fetal alcohol syndrome?
Mr. Szabo: Yes.
Ms McDonald: Yes, I am.
Mr. Szabo: Then you probably know that it results in retardation of growth and as a result of that probably has to do something with low birthweight babies. Can you give us an idea of, among all the people you look at, what percentage of children are in fact FAS/FAE?
Ms McDonald: In terms of within our programs, in actual fact, of the babies that have been born so far we do ask the question of women whether or not they use any types of drugs or alcohol. If they do, they're referred to a more specific program that deals specifically with pregnant women and that can help them more effectively.
We're in the process of a two-year evaluation being required of us by Health Canada, to follow through on these types of questions and to be able to see the results within two years. So right now I'm not able to give you those results.
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Mr. Szabo: Do you have any idea whether it happens a lot?
Ms McDonald: No, I would say it's not.... Many of the women in our programs, because Toronto is such a diverse community, are from a variety of various cultural backgrounds. As a result, alcohol may not even be part of their lifestyle. So though we ask this question and then follow through if we do have an answer of yes - we do help them more effectively - I would say it's a very small percentage right now.
Mr. Szabo: We've done some work on a subcommittee of this health committee. I guess the interesting thing about FAS is that it does not require substantial use of alcohol. It's something that can be caused by casual use at special occasions, and depending on other circumstances, maybe you've played roulette and you've lost.
Is it your plan to pursue this? Since one of the major effects of FAS/FAE is growth retardation, which I guess necessarily makes it involved in low-birthweight issues, is it going to be part of your mandate to deal with the education, or advocate on behalf of higher education?
Ms McDonald: In fact, we do already deal with this issue if the women perhaps identify this as a difficulty. One of the issues within our community itself is not alcohol but in fact the use of other illegal drugs such as heroin and crack.
Actually, one of our sponsoring agencies is a larger hospital. They're starting up a methadone program for pregnant women, which will provide them with ongoing support throughout their pregnancies. There are also excellent comprehensive programs within the city of Toronto. One is called Breaking the Cycle, which is in fact the community action program for children. That itself addresses these issues.
Mr. Szabo: One last question. Do you have any idea how much it costs, I guess for everything, when you have a low-birthweight baby? How much does it cost Canadians?
Ms McDonald: If the baby were to require 40 days of health care, it would be $60,000.
Mr. Szabo: Thank you.
[Translation]
The Vice-Chair (Mrs. Picard): Are there any more questions? I want to congratulate you for the excellent work you do in your community, with these women who are in need of your services. I know that you have to give a lot of your time when you work in community prograMs Often, also, remuneration is not the highest. We know that programs such as these are subsidized and those who work in them are the ones who take the brunt of that. You must feel rewarded when women come back to see you and tell you that they have given birth to perfectly healthy children. I congratulate you and encourage you to continue your excellent work. Thank you.
[English]
Ms McDonald: Thank you very much.
[Translation]
The Vice-Chair (Mrs. Picard): We are going to break for a few minutes.
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The Vice-Chair (Mrs. Picard): We shall resume our work. We will have the pleasure now of hearing our last group of witnesses, from the Montreal Diet Dispensary, Ms Louise Desaulniers, President, and Ms Marie-Paule Duquette, Executive Director.
Ladies, please limit your presentation to about ten minutes so that we may ask you some relevant questions afterwards.
I remind you that we must free up this meeting room at 11 o'clock. Ladies, you have the floor.
Ms Louise Desaulniers (President, Montreal Diet Dispensary): I thank the members of the committee for having invited us.
First, a few words about the mission of the Montreal Diet Dispensary, which has been in existence now for 116 years. The specific mission of the Dispensary is to promote health in the community, particularly the health of high-risk pregnant women.
I'm going to ask our Executive Director to present a much more concrete picture of our activities to you.
Ms Marie-Paule Duquette (Executive Director, Montreal Diet Dispensary): On the transparency, you can see the Dispensary building. We see more than 2,600 disadvantaged pregnant women at the Dispensary each year.
The statistics concerning the poverty of those women are easy to interpret. Indeed, 97% of them have an insufficient income and 10% have no source of income at all. Between 10 and 14% of the mothers to be who are referred to us don't have a cent to eat or pay the rent. Thirty percent of them have less than nine years of formal education, 10% are teenagers of 12 to 17 years of age, many are young women who have had health problems, and about 30% have health probleMs
If we want to make a significant impact on the health of children, preventing low birthweight is where to start. One out of 17 babies born in Canada weighs less than 2,500 grams at birth, or less than 5.5 pounds.
We also know that among these low birthweight babies, one out of six weighs less than 1,500 grams and runs a very high risk of having physical and mental handicaps, as well as other probleMs Furthermore, these babies are a heavy financial burden on society.
We know that the low birthweight rate in Canada has remained around the 6% level over the past ten years while it is at 4% in some of the other developed countries.
We know that
[English]
the low birthweight baby is a heavy burden on the health care system.
[Translation]
Compared to normal size babies, the low birthweight child is three times more likely to have mental retardation, cerebral palsy or a learning disability. Those children are more sickly, and they are seven times more likely to experience physical abuse or neglect in childhood, putting them at risk of criminal behaviour later.
You are probably all familiar with Child at risk, on which the Senate had done close and careful work.
Low birthweight children are more likely to be affected by health disorders such as high blood pressure, cardiovascular diseases, diabetes, etc. in adulthood.
No one is left unaffected by the problem of babies born too small or too soon; the parents, the grand-parents and all of society, because they are very, very costly.
Every year, over $130 million are allotted to the care of low weight babies in Canada, as shown by the cost benefits' studies carried out by the Dispensary. Those figures are based on our cost benefits' studies.
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Poverty stands out as a leading cause among the factors associated with low birthweight. It is really the primary factor. It covers a number of other factors. At the present time, the low birthweight rate among disadvantaged women is somewhere between 10 and 16%, while it is at the 4 to 5% level among non disadvantaged women.
According to Dr. Kramer, 75% of low birth weight is related to factors such as low caloric intake, low pre-pregnancy weight i.e. the thinness of the mother. Low birthweight babies also are borne by person of small stature, who have had a poor obstetrical history, have had previous low birthweight babies, and who smoke. Those conditions apply to most of the women we see at the Dispensary.
When clients are referred to us, we take a nutritional history and our statistics show that 56% of these women are undernourished in that they do not ingest sufficient protein to meet their own nutritional needs and those of their unborn child.
In 16% of cases, those women were underweight prior to pregnancy and in 28% of cases, they have not gained enough weight at 20 weeks at pregnancy. Also, in 30% of cases, they have given birth previously to a low birthweight baby, and 15% of them smoke. The women who smoke are generally of Canadian origin, and they are young adolescents.
The Montreal Dispensary carried out a survey on rent levels to see what percentage of their income families had to spend on rent. They spend 46% of their total income on rent, thus leaving practically no money for food.
On the next slide, you can see that when families must spend 46% of their income on accommodation, they only have 10% left for food. That is why we are seeing food banks proliferate. These women are really malnourished.
Finally, we know that a mother to be who begins her pregnancy with a nutritional deficit will have to make very important nutritional adjustments to ensure a child's optimal development. Our studies show that intervention can reduce the incidence of low weight babies from 50 to 75%, and 55% of the very low birthweight babies, those who weigh less than 1,500 grams, can have their weight increased.
We did a study on the children of a woman who had a first pregnancy without being followed by the Dispensary, and a second pregnancy with the help of the Dispensary. Babies who had profited from our help weighed 107 grams more, and the incidence of low birthweight babies had been reduced by 52%.
Some clients arrive at the Dispensary late in their pregnancy, and others arrive earlier. Thus, very often, we don't have the time we need to intervene. If the client can have four contacts with the dietician, we increase the weight of the baby by 200 grams and we reduce the incidence of low birthrate weight babies by 78%. The women who were malnourished at the outset and whose protein intake was insufficient gave birth, after our intervention, to babies who weighed 275 grams more than their previous baby, who had not been treated. We saw a reduction of 67% in the low birth rate weight. As I said earlier, 56% of the mothers are undernourished when they come to see us the first time.
We also try to determine whether our intervention had the same impact on teenagers. We noted that we managed to reduce the incidence of very low birthweight babies by 47%. Our intervention also had an impact on premature birth.
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This table relates to twin births. These are two populations that are at very high risk of giving birth to low birthweight babies. Through our intervention, we reduce the incidence of low birthweight babies in these two groups: adolescents, and mothers who give birth to twins, and the reduction was very significant. Only very rarely have studies shown such a decrease so early.
How do we achieve that? We have set up a very efficient way of targeting the very high-risk clients and determining which ones need extra nutrition. We have established what we call an Income Adequacy Table. When the client comes to see us, we determine whether her income is sufficient to ensure the proper nutrition and the risk she presents.
At the Dispensary, we see over 3,000 mothers who need our services. This year, we managed to help 2,600 financially thanks to our subsistence budgets. We establish what the minimum cost is to remain healthy. Less than that and the family members' health is prejudiced. Ninety-eight per cent of our clients do not have that minimum. To get by with that minimum, you need a university diploma to manage your money.
The income adequacy table allows us to determine who can receive the food supplements.
The Vice-Chair (Mrs. Picard): I'd ask you to wrap it up briefly.
Ms Duquette: We provide nutritional supplements to our mothers. We make nutritional adjustments for those mothers and provide them with supplements, a litre of milk and vitamins. Also, it's through understanding that we can stimulate the mother-infant bonding. We encourage breast-feeding. One thing is important: achieving a 50% reduction in low birth weight. In our cost benefit studies, we have determined that for each dollar invested, eight dollars are saved.
We recently received a $70,000 grant from CPNP. We were able to take care of 293 mothers 200 of whom gave birth before March 31. So the cost is $350 per pregnancy. Those $70,000 allowed us to help the government save over half a million dollars. In addition, 94% of our mothers were breastfeeding and are still breastfeeding their babies. We give them support that's very profitable for the future.
If such programs existed all across Canada, the $165 million now being spent could be decreased. Each year, we could easily realize savings of $65 million through our action with mothers during their pregnancy.
Ms Desaulniers: There's a dietician in the team who, thanks to the Risk Scoring Grid can offer adequate nutritional involvement which, over a very short period of time, gives results at birth. We recommend that the services of a dietician trained with this system be included in the projects funded by the CPNP.
Taking into account everything Ms Duquette has already said - I won't insist on the efficiency and the minimal cost of $350 per pregnancy including all costs - we recommend that a greater proportion of funding be granted to agencies making use of a method similar to ours or trained in the use of this method which would allow them to attain the same rate of efficiency as ours. When you want to attain a rate of 4 or 5% LBW babies means that have been proved efficient should be used. The Dispensary has been doing this for over 50 years.
The Canadian program, through its subsidies, has allowed us to offer other dieticians in Quebec and Canada, we hope, to follow a four-week training program at the Dispensary to implement this system that gives results. We strongly recommend you grant us funds to continue to do so and encourage community organizations to use this system.
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The present prime minister came to launch his program at the Dispensary and, based on the experience and results of the Dispensary, expressed the wish this system be used everywhere in Canada. We would also wish to see training of the People helping pregnant women.
We established a screening system to evaluate those who really are at risk nutritionally speaking. As Marie-Paule was saying, the studies are very eloquent. Extra nutrition at that point has very marked effects on the baby's health and contributes to decreasing future health care costs.
The expertise of the dispensary is even imitated by the famous WIC program in the US which only attains a 25% decrease because they do not follow our system perfectly. When it is properly followed and we have the opportunity to train people with the system, we get extraordinarily results. We help all of society, and that includes its pocketbook, improve its health.
Those are our recommendations. Thank you for listening.
The Vice-Chair (Mrs. Picard): Mr. Dubé.
Mr. Dubé: You have been around since 1879. You told us mainly about your program, but you also told us about a soup kitchen you organize.
Ms Desaulniers: At the outset, the dispensary was a soup kitchen. At that time, we responded to all the needs of the community and senior citizens. However, in the 1950's, we saw that pregnant women represented the highest nutritional risk.
We have been developing our expertise for 40 years. We deal with pregnant women on a priority and even on an exclusive basis because demand is so much greater today and our expertise is in that area. It is recognized worldwide.
Mr. Dubé: These are day patients.
Ms Desaulniers: The dispensary is a house. It extends a very warm welcome.
Mr. Dubé: They don't live there.
Ms Duquette: They come every two weeks on appointment. I have talked about the intervenor, but at the dispensary, there are also a dozen paid people and 120 volunteers. On top of that, we have volunteers who get the food for our kitchens. That food is given to the mothers who really need it. Fifteen percent of our mothers don't have a single penny and have neither welfare nor unemployment insurance. They have nothing. So we have to find a way to feed them. We offer them a litre of milk and an egg supplement every day. Sometimes we offer what we have in our kitchens and we call upon other members in the community to help them.
I'm thinking of a young pregnant mother who was sponsored by her husband; she's now trying to obtain termination of the sponsorship. We discussed this with her lawyer recently. He says that she lost her request for sponsorship and that there'll be another year's wait before she gets any money. She hasn't paid her rent since December. So she was kicked out. She was out on the street and pregnant. That still happens, here in Quebec.
Mr. Dubé: You're not only funded through the program. Could you give us an idea of your sources of income, in percentages?
Ms Duquette: This year, the UnitedWay has given us 50% of our budget; 20% comes from the Quebec Health Department and 3 or 4% from the federal government through the Canadian Prenatal Nutrition Program; and about 30% comes from fundraisers organized by our board members.
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The Vice-Chair (Mrs. Picard): Any further questions? Ladies, I thank you for having come here and told us how the Montreal Diet Dispensary looks after the health of pregnant women, women who are in need, women who are amongst our most disadvantaged. I would encourage you to continue your great work.
Your presentation and comments will be very useful in helping us include in our report the necessary recommendations to the department. I found it very interesting because you showed us very revealing figures concerning the care you provide. Thank you very much.
Mr. Dubé: Could you make your study on accommodation available to the committee?
Ms Duquette: Yes. I could also leave you our annual reports. I'd also like to leave with you the summary report of what we did last year with the $70,000 grant and the funds we got for training.
Mr. Dubé: You are among the witnesses who have scientifically shown that their system had a specific impact.
The Vice-Chair (Mrs. Picard): I've just been asked if you could provide us with your transparencies or copies of them.
Ms Duquette: Yes.
The Vice-Chair (Mrs. Picard): That would be fine.
Ms Duquette: I also brought along a little folder explaining how a dietician spends her mornings. It's to give you an idea of our clients and, especially, their poverty. We have groups of mothers meeting. We promote breastfeeding. Some mothers help other mothers who are breastfeeding. We also have volunteers who deal with food and clothing for the children. We take all the children's clothing we can get. At the end of the day, we're quite proud of our babies.
The Vice-Chair (Mrs. Picard): Congratulations!
The meeting stands adjourned.