:
Welcome, ladies and gentlemen, to the Standing Committee on Health, meeting number 51, pursuant to Standing Order 108(2), a study on healthy living.
Welcome, witnesses. Today we have with us the Canadian Cancer Society, Heather Chappell, director, cancer control policy; and Rob Cunningham, senior policy analyst.
We have the Canadian Chiropractic Association, Dr. Eleanor White, president, and Dr. John Tucker, director, government and interprofessional relations.
From the Canadian Restaurant and Foodservices Association, we have Garth Whyte, president and chief executive officer, and Joyce Reynolds, executive vice-president of government affairs.
We have NUTRIUM, Stéphanie Côté, dietitian, public nutrition and communication/media.
And by video conference from Vancouver, British Columbia, we have BC Healthy Living Alliance, Barbara Kaminsky, chair, and Mary Collins, director of the secretariat.
We will open with five-minute remarks from each organization. We will begin with the Canadian Cancer Society.
Good afternoon, Mr. Chair and committee members. On behalf of the Canadian Cancer Society, I would like to thank you for inviting us to share with you our perspective on healthy living.
The Canadian Cancer Society is a community-based organization with 1,200 staff and 170,000 volunteers. We work in and support communities across the country at the local, provincial, and federal levels. And we fight cancer by doing everything we can to prevent cancer; by funding research to outsmart cancer; by empowering, informing, and supporting Canadians living with cancer; by advocating for public policies to improve the health of Canadians; and by rallying Canadians to get involved in the fight against cancer. We have been a leader in fighting cancer for almost 75 years.
Healthy living is a broad issue that includes a number of lifestyle factors impacting overall well-being and disease development. I'm going to focus my comments specifically on healthy body weights and physical activity, and my colleague will focus his comments on tobacco.
Currently in Canada, we know that 61% of adults and 26% of children are overweight or obese. In looking at the physical activity numbers, most recently, just in the last month, we found that 15% of adults and 7% of children are meeting the physical activity guidelines. Even more startling is that half the children are not even reaching five minutes a week of vigorous activity.
With regard to this impact on cancer, we know that up to 35% of all cancers can be prevented by being active, eating well, and maintaining a healthy body weight. That means in the year 2010 there were an estimated 60,000 Canadians diagnosed with cancer as a result of these lifestyle factors. More specifically, looking at two more common cancers, 45% of colorectal cancers diagnosed and 26% of colorectal cancer deaths are linked to these risk factors, and 38% of breast cancers diagnosed and 19% of breast cancer deaths are linked to these risk factors. After smoking, unhealthy body weight is the next largest risk factor for cancer development.
Obesity is a complex issue that encompasses social, economic, physiological, environmental, and political factors. It's not equally distributed across communities in Canada. Rather, it's more concentrated in communities that are economically, politically, and socially disadvantaged.
A strategy is needed with sustained political commitment and multisectoral collaboration. This cannot be done by a single organization, sector, or government alone. Policy actions can impact obesity in a number of ways. The first is by shaping the environment so that healthy choices are easy choices for Canadians. This can include food access, security and labelling, built environments for supporting physical activity, as well as tackling some of the broader socio-economic disparities. Second, they can directly influence behaviour. This can include public awareness so that individuals and communities know the magnitude of the problem and the solutions that can help combat it. And third is by supporting health services and clinical interventions for those who are already overweight or obese.
:
Regarding tobacco control, I'd like to begin by expressing support and congratulations for two very important measures that have been brought forward: Bill on flavoured tobacco and the new, enhanced picture warnings for cigarette packages. Both of these measures show world leadership. The Minister of Health, all political parties, and members of this committee deserve praise and thanks.
For this committee's current study on healthy living, and as part of achieving broader healthy living objectives, I simply want to underline the ongoing crucial importance of tobacco control.
Tobacco remains the leading preventable cause of disease and death in Canada.
Le tabac tue. Tobacco kills 37,000 each year.
We've made clear progress in reducing smoking, but an enormous amount of work remains to be done. Fully 18% of Canadians and 13% of youth aged 15 to 19 were current smokers in 2009.
The 10-year-old tobacco control strategy announced in 2001 expires very soon, March 31, 2011. It is essential that this strategy be continued. We need, as always, an approach to tobacco control that is comprehensive in nature. Within Health Canada's comprehensive strategy, the programming component is vital. The minister has referred to $15.7 million in funded cessation, youth prevention, and other initiatives. These should continue; we cannot let up. And new initiatives must be pursued, such as the very commendable social media campaign that will be linked to package warnings. Ensuring that the federal strategy is continued without any gap would ensure that the preparatory work for the social media campaign as well as many other initiatives would be carried out in full without interruption.
Given high aboriginal smoking rates, including 59% for first nations individuals on reserves, additional aboriginal initiatives of course are needed.
In closing, tobacco control remains pivotal for what we will achieve in the years ahead in terms of overall healthy living for Canadians.
[Translation]
Thank you for the opportunity to appear before you today.
The Canadian Chiropractic Association appreciates the opportunity to appear before the committee. Healthy living is fundamental to our profession.
The promotion of a healthy lifestyle is an important objective of chiropractic care. As primary contact health care providers, the chiropractic profession supports public health promotion and prevention strategies that encourage physical and mental health well-being, such as programs that address smoking cessation, obesity, physical activity, and nutrition.
Historically, at its core the chiropractic profession has embraced its role as health promoters and champions in healthy living. By engaging patients as active partners in managing their own health outcomes, chiropractors aim to improve overall function and well-being. Consequently, the adoption of healthy living approaches by patients helps them achieve greater capacity. The average chiropractor spends a considerable amount of time recognizing and managing capacity issues at their early stages. As chiropractors, we can assist our overworked fellow health care providers in acute care by providing health and prevention in the framework of our patient plan of management.
The CCA's initiatives are founded on chiropractic's strength to implement such strategies. Our recent programs have included Fit-in 15, which encourages Canadians of every age and fitness level to devote 15 minutes a day to a physical activity. Recognizing the aging population, the CCA has also developed Best Foot Forward, which is a program targeted for seniors to reduce falls and their associated negative outcomes. An initiative of the CCA and its provincial divisions in conjunction with Chatelaine magazine has produced the Chatelaine back health promotion, both in print and online. In addition, our provincial divisions have also developed a number of creative public health initiatives, including Alberta's bad back campaign, British Columbia's WorkSafe, Ontario's Lift Light, Shovel Right, Quebec's Santémania, Newfoundland's Straighten Up, and so forth.
Canadian chiropractors are involved on a daily basis in widespread activities to promote healthy living to our patients and Canadians in general.
Our efforts do not stand alone, but rather are implemented in a collaborative framework with other health care professions that encourages the creation of public policies that reflect our vision of health promotion in Canada. The CCA has partnered with the Canadian Coalition for Public Health in the 21st Century, ThinkFirst, Osteoporosis Canada, etc., on a number of innovative projects. Moreover, the chiropractic profession has fostered and supported team-based clinical affiliations, notably at the National Spine Care program in Calgary, St. Michael's Hospital in Toronto, Mount Carmel Clinic in Winnipeg, and the Rosedale Medical Clinic in Hamilton. Patients benefit when health care providers are grouped together to offer the best practices available. These examples have clearly demonstrated the increase in patient satisfaction and savings in care when providers collaborate synergistically.
Moreover, our commitment to health equality has inspired the CCA, in association with local governments and communities, to support the provision of chiropractic services to Nunavut residents in an effort to move their health status closer to that of the general Canadian population. The proposed project, entirely funded by the CCA, will benefit the residents of Nunavut by offering an alternative, hands-on form of health care and treatment for neuromusculoskeletal complaints. As an example of our potential community engagement in Nunavut, the CCA was recently approached by ThinkFirst, a non-profit organization dedicated to the prevention of brain and spinal cord injuries, to collaborate on the implementation of injury prevention strategies for elementary-aged children in the north. Planning is well under way on this initiative.
The CCA also supports such advances as HealthForceOntario, allocating funds for health promotion for physicians within a primary contact care setting. The Ontario Ministry of Health and Long-Term Care aims to support a model of care that encompasses health promotion and disease prevention as well as treatment and disease management. In addition, the system accommodates a wide range of practice models, specifically team-based and interdisciplinary practices. We commend the Public Health Agency of Canada's recent release of Canada's new physical activity guidelines and the revised Canada food guide.
Such a paradigm shift towards health promotion must stem from efforts from all sectors, including regional, provincial-territorial, and federal governments, complemented by public and non-profit sectors.
The CCA recognizes that good health requires more than good health care and supports national public policies and initiatives that address the socio-economic determinants of health, such as early childhood development, poverty, education, and safe and affordable communities.
As Canadians, we must unite to support projects and enterprises that encourage health and well-being. Such an agenda should not be limited to population-based public health programs but extend also to individualized rewards for good choices through an array of governmental incentives. Notwithstanding, the provincial-territorial and federal governments must put forth incentives that aim to address the needs of patients, practitioners, and health care collaborative teams. Direct reinforcement for positive behaviour, in the form, for example, of the proposed adult fitness tax credit, would encourage Canadians to increase their level of physical activity. The children's fitness tax credit has also demonstrated the economic sensitivity of Canadians toward financial incentives.
Economic Benefits of an Adult Fitness Tax Credit, a study conducted by the Centre for Spatial Economics on behalf of the Fitness Industry Council of Canada, concluded that it would only take three years for health care cost savings to be observed that were due to the increase in physical activity within the population. The amount of total savings resulting from improving a population's general health would far outweigh any loss in net personal tax incurred by the government.
Essentially, the CCA's mission is to help Canadians live healthier lives by informing the public about the benefits of chiropractic care, facilitating chiropractic research, and advocating for health care system reform, ensuring quality health care for all Canadians. Consequently, the CCA believes in a vision of every Canadian having full and equitable access to chiropractic care. Similarly, every Canadian should have access to the same opportunities to make positive behavioural choices that will allow them to be healthier individuals and in turn be exemplary role models for their families and communities.
Thank you.
We want to thank the committee on health for inviting the Canadian Restaurant and Foodservices Association to speak on healthy living. We're a non-partisan national organization that has more than 30,000 members representing restaurants across the country.
You should have before you a package of information that Joyce and I will be presenting during our presentation.
There's a saying in our business: “If you're not at the table, you're on the menu.” With an important issue such as healthy living, it's essential that the restaurant sector be included at the healthy living policy table. Our key message is that we should be seen as an important part of the healthy living solution, not as part of the problem.
Healthy living is a major imperative for CRFA and its members. Last year, we developed a healthy living vision with 10 principles, which was endorsed by our board and our membership across the country. It is included in your package. Recently, we've been working with several provinces, including Ontario and B.C., in this area. We've also been involved in national strategy sessions with key senior representatives from the agriculture, health, and food sectors. And over the past several years we've worked closely with the federal government, and specifically Health Canada, on such key issues as sodium, trans fat, and nutritional information in our establishments.
In March, the Canadian Restaurant and Foodservices Association is participating in a nutrition disclosure think tank with Health Canada and other leaders in this area, and we want to bring some of that information to the table today.
I'm going to ask Joyce, my colleague, to speak specifically on those areas.
I'm going to focus on nutrition disclosure in restaurants, since it dominated one of your previous sessions. We do appreciate the opportunity to clarify the industry's position on this very important subject.
First, you should be aware that CRFA is in discussions with Health Canada and individual provinces about a national policy framework for nutrition disclosure. Included in your package are the guiding principles informing these discussions. One of the challenges for both government and industry is ensuring that this initiative will have the desired impact on the food choices and ultimately on the health of Canadians.
A recent witness acknowledged that “The evidence that menu labelling will influence people's eating habits is not conclusive”, but went on to say that “most recent studies have found significant, though modest, effects”. I haven't seen any studies that have found significant effects. I can cite many studies that have found weak, inconsistent, or no effects. Most recent studies, based on real-world experience, not hypothetical, show no impacts.
A study in the current issue of the American Journal of Preventive Medicine tracked purchasing behaviour at a fast food chain before and after calorie posting was regulated, comparing sales between a chain establishment within and adjacent to the regulated jurisdiction over a 13-month period. It found that the regulation had no impact. Trends in transactions and calories per transaction did not vary between the control and intervention locations after the law was enacted. A study released just this week in the International Journal of Obesity came to the same conclusions.
Because the evidence to date is inconclusive, Health Canada is planning a think tank on nutrition disclosure at the end of March that will bring together academics, NGOs, industry, and governments. One of the objectives is to identify research gaps, needs, and opportunities.
From the industry's perspective, the objectives of a nutrition disclosure policy framework are, first, to provide consumers with meaningful nutrition information so they are able to make informed choices that reflect their individual dietary and lifestyle needs; second, to help consumers make healthier food choices that will improve their health.
Building on CRFA's voluntary nutrition information program, a national nutrition disclosure framework would include the consistent, prominent, and visible display of nutrition information for standardized menu items in store, prior to point of sale. The manner in which this information is displayed may vary, depending on the individual restaurant's unique environment, but must meet the test of being visibly prominent and available at point of sale.
Some examples of how restaurants may prominently display nutrition information include: wall poster, menu insert, brochure stand, computer kiosk, etc. Technology is changing the face of society and the way we interact and consume information. Nutrition information is no exception. Many CRFA members are developing new electronic applications so that customers can view nutritionals simply by pointing their BlackBerry or their iPhone at the menu or menu board. This is already operational in some chain restaurants in Canada.
So CRFA is opposed to the oversimplified provision of single-nutrient information, such as the posting of calories, for several reasons.
The first reason is the difficulty of presenting the information in a way that is meaningful to consumers. Restaurants offer menu choices in multiple varieties, flavours, and options for customization. This makes it impossible to fit nutrition information on menus and menu boards in a way that is accurate, complete, legible, and enforceable. A sandwich, a pizza slice, a burger can vary in caloric content by a margin of 50%. Customers may have thousands of options that aren't listed on the menu, and this is the reason so many chain restaurants use nutrition calculators on their websites. Jurisdictions in the U.S. that have mandated calorie posting allow broad ranges of calories on their menus that aren't permitted in Canada.
Second is the singular focus on calories, rather than on nutrition and balance. This approach delivers a mixed message to consumers. For example, a small serving of milk will show more calories than a small soft drink; a yogurt with granola will show more calories than a bag of chips; a flax seed bagel will show more calories than a cookie. And it should be noted that Weight Watchers, which has helped millions of people throughout the world lose weight, uses a point system based on fat, carbohydrates, fibre, and protein—not calories.
Third is the shifting public policy concern about posting information on menus.
Over the years, the industry has been faced with public policy initiatives requiring posting on menus and menu boards of specific allergens, fat, trans fats, calories, and, most recently, sodium. Recognizing the normal shifts in public health concerns, we are amenable to a policy that highlights specific nutrient information on calories and sodium in our nutritional information in an effort to draw particular attention to them at this time. The industry is concerned about the precedent of requiring specific information per menu item on menus and menu boards.
To conclude, CRFA is interested in working with government on a made-for-Canada national policy framework that will ensure that Canadians have meaningful information for making healthy choices when they visit their favourite chain restaurants.
In the interests of time, I'm going to provide clarification on our positions on trans fats and sodium during the Q and A.
:
Good afternoon, my name is Stéphanie Côté, and I am from the nutrition reference centre at the Université de Montréal. Our mission is to educate and inform the public to help people make informed nutrition decisions. Ours is a positive approach that takes enjoyment into account.
I want to talk to you today about diet. And I want to speak to you as eaters, because we all eat, and so diet affects us all, to some degree or another. But we have a problem when consumers think they need a degree in nutrition in order to eat well. Sometimes it feels like you need a degree just to read a nutrition label, especially when faced with an enormous amount of nutrition information, which often does more to confuse than inform.
Nutrition-related communication is an essential tool for prevention. Appropriate and well-directed communication can build nutrition skills, food skills, cooking skills and even parenting skills. But that is not currently the case.
I want to share with you two key communication concerns when it comes to food choices and nutrition.
The first is confusion, due in part to the overabundance of nutrition-related information. There are numerous forums that deal with diet and nutrition, and much of the information and advice comes from unreliable sources and non-experts. Furthermore, the way that reporters and people in the media handle that information is also questionable. Many of the claims that appear on food products only add to the confusion, not to mention the private logos that companies put on many of their own products.
The second concern is the anxiety generated by some of the communications out there. The current approach to nutrition is likely to cause feelings of stress and guilt, especially since products are lumped into two very distinct categories: foods that are good for you and foods that are bad for you. What's more, the approach is often expressed in terms of right and wrong, which can backfire when you are trying to get people to eat healthily. For the past few years, we have been hearing about orthorexia, a fixation with healthy or righteous eating, a relatively new disorder.
I have three major recommendations to address these concerns.
The first has to do with segmentation. Segmenting messages is paramount in order to better engage with the various target groups. Canada's is a very diverse population, and communications need to reflect that. It would be worthwhile to focus efforts on enhancing our knowledge of the various segments of the population, so as to tailor not just the messages, but also the way they are communicated. Numerous factors affect people's needs, receptiveness and understanding with respect to the message being communicated, including literacy, education, ethnic background, language, socio-economic conditions and family. We should not limit our communication to groups who are already interested; it is equally important to target all groups.
My second recommendation is to create an accessible no-charge service, which could take the form of a call centre or an electronic service, where members of the public could, at their convenience, ask nutritionists questions about nutrition, diet or food preparation. This type of initiative would use oral communication and therefore help to target groups with lower levels of literacy. Furthermore, it would also serve as a reliable source of information. People would not have to wonder whether the information came from a credible source, given that they would be speaking with trained nutritionists. Both Ontario and British Columbia currently provide such a service.
And last but not least, my third recommendation has to do with educating children. Teaching children from an early age about foods, healthy eating principles and basic food preparation is key. And obviously, it is important to continue with that education as children get older, to instil in them the knowledge essential to developing healthy eating skills.
Taste-based education is another approach worth exploring. Experts in Europe are particularly interested in the effectiveness of that approach versus one based solely on nutrition. It involves developing a child's joy of eating, helping foster a stronger appreciation of food and possibly healthier eating habits and portion control, which would solve two problems at once.
In conclusion, I would remind you that eating is a natural act. Mealtime should be an enjoyable time. But unfortunately, for many Canadians, the simple act of eating involves constant calculations and stress.
Clearly, our current approach to communication is not working. Not only must we come up with better ways to communicate with a diverse population, but we must also measure the effectiveness of those communication methods.
I want to thank you for the opportunity to be here today. I also want to thank you for your consideration.
:
Good afternoon, Mr. Chair and committee members.
On behalf of the BC Healthy Living Alliance, we would like to thank you for the opportunity to share our experience and views on what can be done to promote healthy living in Canada.
By way of information, BCHLA is an alliance of nine provincial organizations that have been working together since 2003 to address the common risk factors and health inequities that contribute significantly to chronic disease.
While our work has focused specifically on British Columbia, our experience in overseeing $25 million worth of initiatives to address these risk factors and our involvement in policies to reduce health inequities have provided us with a wealth of knowledge that we believe has applicability to Canada as a whole. We have provided copies of a number of our reports to the committee. We hope you'll have an opportunity to peruse them in more detail.
In the limited time available today, we would like to highlight three main areas.
First, to effectively change social norms related to healthy living, we need a holistic and comprehensive approach. We call it a “whole of society” approach. No one sector can do it alone. To see real results, we need to align our priorities and work on a common agenda.
Within governments at all levels there also needs to be a “whole of government” approach. Whether to redress the underlying social and economic determinants of health or to enact specific policies or actions, the health ministry alone cannot do it all. We need accountability requirements for all departments to address the health and health equity impacts of their policies and programs. We also need a commitment from the Prime Minister, premiers, and mayors to put this issue at the top of their agendas. Only in this way will we move towards a healthier Canada, which will also be a wealthier and more productive Canada.
Second, as you well know, whether you will be healthy or not, in many cases, depends less on the health care system and more on your economic and social circumstances. Without focusing on these determinants of health, including income security, food security, housing, early childhood development, and a healthy built environment, among others, we will never really redress the health inequities that continue to plague us or the ever-increasing levels of chronic disease, with the attendant costs for the health care system, currently estimated at $93 billion a year.
Finally, we need to focus on specific policies and actions that can assist Canadians in changing behaviours and in engaging in healthier lifestyles. We would like to share with you some specific examples of where we believe the federal government can play an important role in making this shift.
:
We'd like to focus our suggestions on the issue that is of growing concern in Canada and elsewhere and that you've been hearing about at the committee, the increasing levels of unhealthy weights among both adults and children.
As you've heard from others, currently a quarter of 2- to 17-year-olds in Canada are overweight or obese, and it is estimated that 70% of 35- to 44-year-olds will be in this category in 20 years if nothing changes.
Although the problem is complex, there is a fairly broad consensus on some of the actions necessary to curb it. To make progress on this issue, we need to start shifting the physical and socio-cultural environments that shape our consumption and activity patterns. In our experience, this requires a combination of carrots and sticks—regulation and taxation as well as health-promoting actions that focus on access, education, and skills development required for Canadians to engage in healthy living.
A priority is to ensure Canadians have nutritious food and the ability to make good choices about what we eat. Children in particular need healthy food in order to achieve optimal development, to succeed in school, and to develop lifelong healthy habits.
The federal government can play an important role by restricting the marketing to children of unhealthy foods and beverages. We would suggest to include banning television advertising of unhealthy foods and beverages during programs viewed by children age 12 and under; banning or restricting unhealthy food at grocery store checkouts; banning the use of celebrities or cartoon characters to promote products to children; and banning sponsorship or marketing of unhealthy foods and beverages within school settings. If this can be achieved in cooperation with industry, that would be great. But if not, we would recommend a strong regulatory regime be introduced at the federal level, much as was done for tobacco.
Information is key to decision-making, and in order to make healthy choices, consumers need to have clear information about what they are purchasing. We recommend strengthening the requirements for clear and consistent front-of-package labelling of the contents of packaged foods, providing appropriate information on sugar, fat, and sodium, and clearly relating these to servings. As well, we need to gradually reduce the acceptable levels of sodium and sugars in many of our foods.
While we are pleased that some industry groups have made a start in this direction, there is still much work to be done.
We have been particularly concerned with the overconsumption of sugar-sweetened beverages among young people. One of BCHLA's initiatives, Sip Smart! BC, enabled more than 6,000 school children in British Columbia to learn about the sugar content of what they were drinking and encouraged them and their families to make more appropriate choices. This program is now being expanded to other jurisdictions across Canada with the support of the Childhood Obesity Foundation, CDPAC, and a CLASP grant.
Education is important, but in this case easy access is also a concern. When sugary drinks are often the cheapest and most convenient option, it is no wonder they have been consistently linked with overweight children. Taxation is never a popular choice, but with respect to the challenges we are facing with childhood obesity, we believe an increased tax applied to non-nutrient foods and beverages could limit overconsumption in the same way that tobacco taxes have reduced smoking rates.
Of course, physical activity must play a larger part in the lives of our children and adults. Through the tax system and in other ways, governments can play an important role in supporting measures to promote and facilitate families of all income levels to be able to engage in physical activity. In particular, we suggest the federal government should support other levels of government in ensuring that there is the appropriate physical recreational infrastructure to meet the physical activity needs into the next generation.
Finally, we would like to congratulate Health Canada on its recent health promotion campaign to raise awareness of the links between sugar-sweetened beverages and childhood obesity. But much more needs to be done. We urge the federal government to take a leadership role in working with the provinces and territories, the private sector, and the not-for-profit sector in a joined-up approach to promote, support, and inspire the next generation of Canadians to live not only long lives but healthy ones as well.
:
Sure, I'd be happy to answer that question.
We were represented on the group. We understood when we joined the group that the mandate was to develop a sodium reduction strategy, which is what the group did. It was a huge undertaking. It took up a huge amount of the time of the representative from our association. We weren't expecting.... We thought that after the report was delivered, that was going to be it.
I was very concerned. In fact, I wrote a letter to the editor about the Carly Weeks' article in the Globe and Mail that insinuated that the brakes have been put on the sodium reduction strategy with the dissolution of the task force.
I had all kinds of calls from my members asking what was going on, and I said that nothing had changed. We're still implementing the strategy. Nothing has changed in terms of the implementation of the strategy. The FRAC committee is now the advisory body.
There were also suggestions in the paper that it was dominated by industry. Two out of the nineteen members of the FRAC are from industry.
I think members of this committee need to be reassured that the sodium working group strategy is moving ahead. There is a huge amount of effort going into implementing that strategy.
:
Thank you very much, Mr. Chair.
I must say, I'm really pleased to see members from my own profession here today.
I'd like to start off with a question to the Chiropractic Association.
One of the things I really enjoy about this study is I'm hearing words that 25 years ago you didn't hear that often unless you were a chiropractor, words like wellness, prevention, holistic, comprehensive approaches focusing on lifestyle, and health promotion. It seems these are the catchwords and phrases that we hear all around this table, especially during this study.
There are a lot of changes, a lot of different demands, a lot of financial challenges to our health system in general. How does the profession see its involvement evolving as changes forced by the public occur in health care? How do you see the profession working with the overall health system?
:
Thank you for the question.
You're absolutely right, chiropractors historically have spoken to wellness. It was not always initially well received, and they moved towards more specific roles as a “back doc”. However, now we're hearing our own words echoed back to us and are being asked what we know about it.
I think the role chiropractors initially and historically have played partially depends on the fact of where we enter a treatment regime. If you consider a patient's actions, when they have any particular failing that leads to a loss of capacity or function, they will make a decision about how they want to deal with it. Typically, a patient who is used to chiropractic care will come to a chiropractor before they go to their medical doctor. If the problem is not severe, this will be a very normal response. Then the chiropractor quite often may say this is not doing well; we need further diagnostic testing. It might progress to something for which you involve other practitioners.
Chiropractors are very often and for some segments of the population the only first contact. We all have patients who don't go to medical doctors—not that we advocate that; it's their choice. So we see patients at the initial stages of many problems.
We also see them in chronic situations. The area in which we see this role expanding is really all to do with access, and as the chiropractic profession expands its scope, access is dependent upon access to educational opportunities and to clinical opportunities. Chiropractors at the moment are still somewhat outside the tent. You don't see a chiropractor when you're in the hospital; you see a chiropractor independently. It's private funding in most of the provinces—in all but one. So there are problems of access.
There are educational opportunities that need to be capitalized on. We have chiropractors all across the country who are involved in very specialized projects, who pre-screen for orthopedic situations, who are doing marvellous research. We have 10 and almost now 12 research chairs across the country dealing in various aspects of health and wellness. These need to be developed and expanded. We might look across the pond to Denmark, Norway, and Sweden, where chiropractors and medical doctors go to school together until their fourth year, when they split up. They work together in hospitals and state clinics. They're reimbursed by the state, fully or partially, and very often moneys go directly to research.
Right now, in Denmark, there is a 9% clawback from the pay of the chiropractor; if they're employed in a state clinic, 9% of the payment from the state goes to a research fund for each profession. At the moment, that's generating $3 million Canadian in Denmark for chiropractic research. They're in the boat of looking for researchers. We in Canada fund our chiropractic research from the chiropractors' pockets alone, and we are looking for money—and we have piles of researchers.
So I think there are benefits in those examples to the whole field.
British Columbia's contingent made a very good point regarding collaborative care. It was also voiced by the cancer society. The chiropractic contingent, dealing primarily with neuromusculoskeletal, is a very important part of caloric consumption. Whereas you're looking after what's going in, we're hoping to help with what's going out. The utilization of our foodstuffs and how we act in our fun, in our leisure, in our jobs is very important, and chiropractors improve the capacity of an individual to function more fully.
:
Okay. Well, thank you very much for that.
For my second question I'd like to go to the restaurant association. I took some of the previous testimony we've had here as your being slammed a little bit.
Given my profession, I actually have to go to a number of different restaurants. I always look around and look at different menus, and some of them have caloric counts on them or have various little “heart healthy” emblems.
In some of the things that have been brought forward—you mention things such as calories versus nutritional content—I can see that your association.... And I want to thank you for contributing to everything the government is doing—you mentioned the sodium group. But when I go to restaurants, quite often I see salt and pepper shakers right there. If their food doesn't taste good or isn't flavoured well, what do people typically do, if they have salt and pepper on the table?
:
Thanks very much, Mr. Chair.
And thanks very much to each of our presenters here today. I certainly have enjoyed hearing what you've had to say, and it's been a good addition to the study we're doing, so we appreciate that.
Just carrying on a little bit further with the sodium issue, I'll ask the Restaurant and Foodservices Association a question on your booklet “How to Reduce Sodium in Menu Items”. On page 18, at the bottom, you have the chart, which says “Frequency of Adding Salt at the Table”. Where it says “Never”, then 2,927 milligrams per day would be the average intake. If you do add it at the table “Very Often”, it's only 3,396. And I'm saying “only” to express a difference between them; I'm not saying that to mean it's not very much.
So most of our sodium intake, then, is coming from other things occurring, either when it's cooked or in the food, not when we put it on freely at the table. Is that correct?
:
In your package is “Where Canadians Source Their Meals”. There you see 10% of the meals are purchased at restaurants. If this committee thinks they're going to solve the sodium problem through restaurants only, you have a big challenge, number one. The salt shaker example is talking about how do we educate Canadians, period. And I totally agree with the Healthy Living Alliance from B.C. We need a comprehensive look at all these things, from the manufacturing of food to all the different...the whole level, the whole food chain. I think we really have to look at this.
Secondly, about taxing of food, we already do. Whenever you do it, you have to be careful what you do. You should ask why is milk consumption flat and declining? Why is that happening? The committee should look into that, because we certainly talk a lot about it in the agriculture committee, because of supply management and what the cost of milk is and dairy products. Look into that.
We certainly talk about, when we go to Finance, taxing the food...on HST and food exemption in stores versus in our establishments. That's another taxing policy that's currently in place that has shifted eating habits. There are all sorts of things. So please be careful when you pick one over another. Look at it from a holistic point of view. Just look at commercials, like delivery. Look at those things and the different policies that have been put in place that have changed consumption patterns.
:
I can speak best to Ontario because that's where I'm from, and before being with the Canadian Chiropractic Association, I was with the Ontario one, so I was involved with it somewhat.
At the moment, in Ontario, musculoskeletal is not represented on family health teams. You don't have physios or chiros being included in the set-up. You have podiatrists, midwives, naturopaths, you name it, but not MSK. It's interesting that the World Health Organization will be launching it's non-communicable diseases initiative in the coming year, where they have found that, lo and behold, a large part of disability is not coming from infectious disease, but it's coming from chronic MSK disability.
There needs to be a greater inference and a greater importance put on the treatment of MSK, and it should be included in the teams as a whole. At the moment, it is still separate. We are involved in some pockets, and we have had to pay our way in and pay our own staff. We put people in. We do it as a research project. We're in St. Michael's. There's going to be a second, larger, institute in St. Michael's.
:
Thank you very much, Mr. Chair.
Welcome everyone.
First, I have a question for you, Ms. Côté, since you are an expert in nutrition as well as communication. What I find disturbing is the realization that, in the immediate term, we may have actually had very little impact when it comes to changing our environment and the foods we consume.
One of your three recommendations deals with prevention measures for children. And that is certainly important in changing our eating habits. Something else that concerns me are low-income families and families with low-level reading skills. You also mentioned that earlier. There is, of course, a tendency to buy products whose prices are significantly reduced, and these families will often opt for a litre of Coke over a litre of milk, because the pop costs them a bit less to put on the table.
Do you think we should focus more on prevention strategies for children by teaching them about foods that are good for them? You mentioned enjoyment. Would reintroducing the joy of eating also have a positive impact on them?
I'm about to suggest something that may give you some ideas. I'm going to ask you all a question, and I hope you keep the answer short.
We tax the bejabbers out of tobacco and what do we get? We get a huge black market so that kids can buy cigarettes almost in the schoolyard for less than 5¢ a piece. I'm all for taxation of tobacco, but we have to get the right level.
Most of the first nations territories, and in the territories I worked in along James Bay and Hudson Bay, don't permit alcohol. What do they do? They sniff gas and stuff. I'm not against taxing all those other things, but I am about trying to find solutions.
We can tax the bejabbers out of salt and sugar and all those other things, and we talk about taxes, but I don't care what government or where, if they put too much tax on, they're out and somebody else comes in.
I have a novel idea to help raise money for the Cancer Society and to help promote good ideas, and the Canadian Chiropractic Association might have the answer for me. When I go shopping for a mattress, I see on the mattress that it might be approved by the Canadian Chiropractic Association. Am I right that you wouldn't permit that logo to go on there unless you stood behind the product?
:
Yes, they do, but I don't know if they get any money from it.
I know my wife looks for certain products that are approved by the Canadian Dermatology Association. Here's a novel idea for the Canadian Cancer Society to raise money for the thing they do best.
I get involved in the Relay for Life, and I'm sure many other MPs here do because we've all been touched by the scourge of that dastardly disease, cancer.
Here's how you can raise some money. I'm sure the restaurant people and the folks who make the other products.... Instead of big government forcing themselves into the lives of people, maybe the Canadian Cancer Society can look at the vast array of food products, and perhaps someone who owns a very profitable restaurant would invite you to come in and take a look at their menu, or ask you for a menu that the Canadian Cancer Society believes is a healthy way to eat that doesn't contain within that product something that is, in your view, carcinogenic.
Do you think that's a good idea, Ms. Chappell?
:
I have less than two minutes.
I think the Canadian Cancer Society and the organizations around cancer have a pantheon of medical doctors and research scientists. It probably wouldn't need a lot of work to find a few. You just need to start with a few, and the money you would get would help you do more research into more products so you could put your logo on them, like the Dental Association and the Chiropractic Association and the dermatologists.
If I remember Madame Côté's response to one of the questions, she talked about logos on products. When I go into a grocery store, especially if my wife is with me, and I reach for a can of soup, my hand gets pushed over to the lower-sodium soup. Heart Healthy means different things to different people, but if I were to go into a restaurant that had a little logo from the Canadian Cancer Society, you can believe I would choose that, and I would bet if you asked every MP around here, he or she would probably choose a product that had a Canadian Cancer Society logo. When you say something is good, it's good. Nobody's going to argue with you.
Thank you to all the witnesses for your attendance here today.
I have a couple of questions for the Canadian Cancer Society regarding the warnings and some of the changes to advertising on cigarette packages.
First, I want to congratulate you on your dedicated effort to increase the size of the warning labels on cigarette packages.
I come from Alberta. I don't smoke, but I understand that cigarette packages are not on display. They are behind the counter.
I have two questions. Number one, how many provinces have rules in place for keeping cigarette packages actually out of view? Number two, for provinces like mine that do have those rules and regulations in place, what effect do you think these increased warning labels will have, since the cigarette packages are actually out of the view of potential customers?
:
Well, I think if that's all that's there, they'll adjust.
I want to do a very quick follow-up, because Mr. Norlock actually mentioned something a while ago about the sodium-free soup that his wife would bring his hand down to. I'm just trying to get some sense, because if you—
A voice: [Inaudible—Editor].
Mrs. Carol Hughes: Well, that's a decision you need to make.
However, first nations people and people in poverty can't go and buy that can of soup because it's too damn expensive. It's much more expensive than the regular can of soup.
I'm just wondering, because this is a big issue. And we hear this over and over again, that the choice is out there. For some people it's not a choice because they just don't have the money to pay that extra dollar.
:
Well, I was going to say that I agree with Madame Beaudin's point, in that we should talk about the good things as well as the bad things. Our industry is the R and D for healthy food. Sushi wasn't developed in a grocery store. We come out with a chef's survey of hot trends, what up-and-coming chefs are using: locally sourced foods, sustainability, organics, gluten-free food. There's a ton of things that our industry brings first, before the consumer even thinks of it. We're doing that.
We've also done public opinion surveying of why the consumer goes to our restaurants. One is that they see it as an indulgence. This is the challenge we all have. It's not because you're going out. The biggest issue is it's an indulgence—I want to go with my family, I want to go with my friends, I'm going to a restaurant to celebrate. So that's part of our challenge.
But if you can make it interesting and exciting and fun, you can get people to eat. Come to our trade show that's happening March 5, 6, and 7. Come and see all the young chefs, and just the activity that's there, the healthy food that's being provided and all the different things that are there. How do we leverage that?
I'm on the board of the Association of Canadian Community Colleges. One of their fastest-growing areas—and in Quebec, in the CEGEP, pick every one of your provinces—are the culinary schools. I hope you report on that, because a lot of the R and D and exciting stuff that is happening is coming from our industry.
Mrs. Tilly O'Neill-Gordon: Thank you.
:
Do we have time for a little one?
Thanks, Tilly.
Garth, I was wondering if you could comment, because I'm really concerned about the mom-and-pop restaurants. You mentioned being very careful before you put taxes up, because quite often governments do that, and they have a certain intent, but there may be some unforeseen consequences to that. I also have a concern. I think it was said as well that when you start labelling foods as good and bad, you're kind of moralizing.
Traditionally, there's been a large group of new Canadians who start off their career in Canada as restauranteurs, and they introduce us to new and wonderful foods that when I was a kid I never had the opportunity to try. I like them, and I go out of my way to go to these small restaurants. I was wondering if you could give us an idea of what unforeseen consequences might occur if government throws this policy in without even thinking about it.
:
Thank you very much, Mr. Chair.
Ms. Reynolds, you just said that there are costs associated with transforming the food supply. You just identified the problem for low-income families, and that is especially troubling because these are the families where food choices and obesity are very much an issue. Of course, everything will cost money, but why is that so bad if it results in better food choices and healthier eating habits? It is disappointing to see that the situation is worse today than it was in my parents' day. Our kids are more overweight than ever. I am glad that we have taken some action in Quebec at least and that we are now seeing the benefits of that on our children, in terms of obesity rates.
As far as salt shakers go, the solution is simple: why not just take them off restaurant tables? In France, you have to ask for butter because they do not put it on the table as we do here. That would be a very easy and, I would imagine, a fairly inexpensive fix. Why not just take salt shakers off restaurant tables? If people want salt, they can ask for it.