HESA Committee Report
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Government Response to the Seventh Report of the Standing Committee on Health
Healthy Weights for Healthy Kids
Quantifying the problem
Aboriginal Children and Youth
Knowledge Development, Exchange and Dissemination
Community-Based Programming and Community Capacity Building
Monitoring and Evaluation
Impact of Obesity
The Report by the Standing Committee on Health, Healthy Weights for Healthy Kids, reflects a growing understanding of the impact and extent of unhealthy weights in the population. The negative impacts of unhealthy weights in childhood, in particular, on individuals, families, the health care system, the economy and society, are increasing.
Obesity exacerbates nearly all physical chronic conditions, significantly contributes to the incidence of chronic disease complications and can adversely affect mental health. The problem is compounded by the fact that health risks associated with obesity increase with the duration of obesity. The economic costs are significant; direct and indirect costs associated with obesity have been estimated at $4.3 billion in 2001.
As the Report highlights, obesity is a complex issue. We know that weight gain results from a chronic energy imbalance, but many factors, including social and economic status, education, genetics, social factors, the built environment, culture and media, have contributed to the rise in unhealthy weights in Canada. The large number of underlying factors at play points to the need for a government-wide effort, drawing upon various policy and regulatory mechanisms, resources and networks of relevant departments, institutes and agencies.
The particular vulnerability of children to environmental conditions over which they have little or no control has made this age group a particular concern. For example, food and computer game advertising and reduced physical activity opportunities and unhealthy food options at school play an important role. The home environment, too, has a significant influence over whether a child is at a healthy weight. Research has shown that: heavier mothers tend to have heavier babies, which, in turn, is associated with later obesity; children are more likely to be overweight or obese if they have overweight and obese parents; and over-nutrition at early life stages can have a lifelong effect on obesity . Efforts to address obesity among adults can therefore also help promote healthy weights among children. An additional challenge, as the Committee’s Report notes, is the gap between reality and parents’ perceptions of whether their child is overweight or obese. We also know that there is a tendency for obese children and the majority of obese youth to become obese adults.
Given the complexity of the underlying factors that contribute to unhealthy weights, it is critical that we continue to generate new knowledge, focus expertise and build capacity in the area of obesity research. The Government of Canada (GoC) continues to provide leadership to fill gaps in our knowledge about the causes of obesity, what interventions work, for whom and under what conditions. The Canadian Institutes of Health Research (CIHR), the Government of Canada's health research funding agency, supports the work of up to 10,000 researchers and trainees in universities, teaching hospitals, and research institutes across Canada. CIHR’s Institute of Nutrition, Metabolism and Diabetes (INMD) is the agency’s lead health research Institute for research related to healthy body weights and obesity.
In 2002 INMD identified "Obesity Research: Towards Healthy Body Weights for Canadians" as its primary strategic research focus. Through these INMD initiatives, scientists are now working across multiple disciplines to develop a keener understanding of the causes and consequences of obesity and identifying effective interventions. The results of this work will inform the activities of health professionals, policy makers, and the Canadian public in the prevention and treatment of obesity and the maintenance of healthy body weights.
Quantifying the problem
Until recently, there has been no relevant tracking of the prevalence of overweight and obese children, or the underlying behaviours that contribute to the problem. However, in 2004, the Government of Canada, through the Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition Focus, undertook a major initiative to gain an understanding of eating patterns, physical activity and overweight/obesity levels. This cycle of the CCHS is a particularly important source of information on children in Canada, as it measured heights and weights of children two years and older and fills a 35-year data gap on what Canadians are eating.
This survey marks a major achievement for the Government of Canada; analysis of CCHS data not only helps us understand the scope of the problem and provides a baseline from which to measure change, but will ultimately inform future policies and programs undertaken by the GoC, other levels of government and non-governmental organizations to address unhealthy weights.
Aboriginal Children and Youth
One major focus of the Committee’s Report is the need to address the specific circumstances facing Aboriginal children and youth. The Government of Canada’s role is to provide health services and programs, as well as social and other services, to First Nations people living on reserve and to Inuit living in Inuit communities. The federal government also supports the work of provinces and territories, as well as Aboriginal organizations on health promotion programming for First Nations, Inuit and Métis peoples, regardless of residence.
At the national level, the key partners – the federal government, provincial/territorial governments and National Aboriginal Organizations – work together to address sectoral and jurisdictional barriers in order to implement a coordinated system of services using flexible funding mechanisms. The GoC recently signed joint workplans with both the Assembly of First Nations and the Inuit Tapiriit Kanatami to further address the health needs of First Nations and Inuit in Canada and explore innovative approaches to meeting these needs. The GoC will continue to work respectfully and collaboratively with its partners, drawing upon and reinforcing basic democratic values such as transparency, accountability and responsibility in bringing clarity to the roles and responsibilities among all parties.
The response to each of the Report’s relevant recommendations provides details about the programs and services already in place for Aboriginal young people that are designed to help prevent unhealthy weights.
Another consistent theme throughout the recommendations in the Report is the need to work collaboratively with provinces and territories. In addition to the excellent work that many provinces and territories have undertaken independently, there are numerous examples of federal-provincial/territorial (FPT) collaboration on the promotion of healthy eating, physical activity and healthy weights. An important mechanism for intergovernmental collaboration is the Public Health Network Council. Through the Network’s Expert Groups on Population Health Promotion and Chronic Disease and Injury Prevention and Control, governments are able to share knowledge and expertise, and collaborate on shared priorities. Other examples of FPT collaboration are highlighted throughout this document.
B. CURRENT GOVERNMENT OF CANADA INITIATIVES TO PREVENT UNHEALTHY WEIGHTS
The answer to rising childhood obesity rates lies beyond the scope of influence of any individual Canadian, any government or any sector to address on its own. It also must be recognized that, like with anti-tobacco efforts in recent decades, preventing unhealthy weights is a long-term, multi-pronged initiative involving many sectors. Furthermore, as the Committee’s Report notes, multiple factors contribute to young people becoming overweight and obese, and these factors cannot all be changed immediately. While a lot of work needs to be done, not only at the federal level but across all sectors and jurisdictions, there is a solid platform on which to continue building our efforts.
The Government of Canada is well positioned through existing activities and partnerships to promote healthy eating, physical activity and healthy weights. The federal Healthy Living and Chronic Disease initiative focuses on the full spectrum of health promotion and chronic disease prevention. The Healthy Living component of this initiative emphasizes physical activity, healthy eating and their relationship to healthy weights. Some other recent examples of important initiatives include: the new Eating Well with Canada’s Food Guide, launched in February 2007 and for the first time including information specific to children over the age of two years, foods from different ethnic backgrounds, as well as a tailored guide for First Nations, Inuit and Métis; the Children’s Fitness Tax Credit, which encourages and supports parents in enrolling their children for physical activity and sports programs; and funding for a renewed ParticipACTION, which will be designed to motivate Canadians to get active.
Various mechanisms are used as levers to effect change, including policies, programs, legislation, regulation and taxation. The many programs and activities by which the Government of Canada contributes to addressing the issue of childhood obesity can be categorized by using six core public health functions: leadership, coordination and strategic policy development; knowledge development, exchange and dissemination; surveillance; community-based programming and community capacity building; public information; and monitoring and evaluation.
i) Leadership, Coordination and Strategic Policy Development
The Government of Canada (GoC) plays a stewardship role in public health, providing leadership and drawing in players from across many sectors. The GoC also works collectively across departments and with other stakeholders on federal legislation, regulation and taxation levers, and with provinces and territories to assess gaps and support action on the promotion of healthy eating, physical activity and healthy weights.
The Pan-Canadian Healthy Living Strategy (PCHLS) is a key example of the Government of Canada’s leadership and coordination function. The Public Health Agency of Canada, in partnership with Health Canada and the provinces and territories, engaged non-governmental, private and academic sectors in the development of the Strategy, which was approved by federal, provincial and territorial governments in October 2005. The PCHLS provides a forum for multiple players to work collaboratively in addressing common risk factors, with an emphasis on physical activity, healthy eating and their relationship to healthy weights. It is through this forum that FPT Ministers of Health/Health Promotion set targets for physical activity, healthy eating and healthy weights. (More information on these targets is provided in the response to recommendation 1 below.) Collaboration on physical activity policy and programs also takes place through the FPT forum on Sport, Physical Activity and Recreation. Similarly, the FPT Group on Nutrition provides a mechanism for collaboration on healthy eating policies and programs.
Other examples of initiatives under this function include the introduction of the Children’s Fitness Tax Credit, nutrition labelling regulations and the Joint Consortium for School Health, an FPT initiative designed to complement the Pan-Canadian Healthy Living Strategy and involving P/T ministries of health and of education, with PHAC.
ii) Knowledge Development, Exchange and Dissemination
The Government of Canada understands the value, and continues to be at the forefront, of developing research capacity, fostering knowledge exchange and the dissemination of information related to childhood obesity. Government of Canada decisions on how to address childhood obesity are guided by a variety of information sources including surveillance data, experimental and non-experimental scientific studies, expert opinion, epidemiological risk analysis and experience from clinical practices.
The Government of Canada undertakes a variety of activities under this function, including, for example, the CIHR’s Institute of Nutrition, Metabolism and Diabetes designation of obesity and healthy body weights as a strategic focus, with a particular focus on childhood obesity. Another important initiative is the Canadian Best Practices Portal, which is a centralized access point for exchanging evidence of effectiveness for best practices related to chronic disease prevention and healthy living. In addition, the Public Health Agency of Canada established six National Collaborating Centres to focus on knowledge translation in six priority areas of public health including the determinants of health, public policy and Aboriginal health.
Surveillance is critical to the success of any obesity prevention and management approach, as it helps decision makers understand the health of the population and measure progress towards reaching policy objectives. Surveillance of childhood obesity in the population – how many children are overweight or obese, their physical activity levels, eating patterns, attitudes about weight, and knowledge among parents about healthy eating – adds valuable information for planning and evaluation, as well as for setting targets and tracking changes over time.
The Government of Canada has led or participated in several important surveillance initiatives, including, as described in section A, the CCHS (Nutrition Focus), the Canadian Health Measures Survey, and the Health Behaviour in School-aged Children Survey. The CANPLAY program, a partnership between PHAC, provinces and territories and the Canadian Fitness and Lifestyle Research Institute, is the first Canadian large-scale representative nationally representative study measuring physical activity in children and youth. New data sources, such as public health units and family physicians’ offices are also being explored. In addition, the GoC participates on the Public Health Surveillance and Information Network, one of the expert groups of the Public Health Network. Surveillance activities are further described in the response to recommendation 1.
iv) Community-Based Programming and Community Capacity Building
Evidence suggests that integrated, community-level interventions that combine a range of approaches, with sufficient duration and time, are more successful than independent, unlinked initiatives. Integration offers the potential of being a more effective prevention strategy, and of focussing limited prevention resources.
The Health Portfolio funds a number of community-based programs to ensure that children have a healthy start in life. The Maternal Child Health Program provides home visits to First Nations families on reserve during pregnancy, infancy and early childhood. The home visits provide support, information and linkages to other services. The Aboriginal Head Start program (AHS) promotes the health and well-being of children, through a comprehensive program that includes components on health promotion, nutrition, parental involvement, Aboriginal culture and language, social support, and education. There are two components: AHS-Urban and Northern Communities targets First Nations, Inuit and Métis children from birth to six years old and their families living in urban and northern centres, and AHS-On-Reserve, which targets First Nations children on reserve. The Community Action Program for Children (CAPC) provides funding for organizations working with children up to the age of six who are at risk for social, emotional, health, development and learning problems, and their families.. The Canada Prenatal Nutrition Program works to improve the health of both infant and mother by supporting activities related to maternal nourishment, breastfeeding support and education and counselling on health and lifestyle issues. Healthy weight gain during pregnancy and breastfeeding are known to protect against obesity for mother and child later in life. CPNP has two components: one to serve First Nations women living on reserve and Inuit women living in Inuit communities, and one to serve high-risk pregnant women, including Aboriginal women who live off reserve or in urban settings. The Aboriginal Diabetes Initiative funds obesity-prevention projects for children, including healthy school policies that emphasize healthy snacks, and children’s camps that focus on preventing obesity through the promotion of healthy lifestyles. Many diabetes prevention projects target youth, and funding has been provided for research on healthy lifestyle interventions that specifically reach children. All of these programs aim to reduce health inequities by addressing the determinants of health.
The Healthy Living and Chronic Disease initiative supports other community-based programming. The Healthy Living Fund will support organizations at the national level, through the Physical Activity and Healthy Eating Contribution Program, and in the regions through agreements with the provinces and territories. The regional stream of the Fund will be administered in collaboration with provincial and territorial partners, who will jointly determine priorities and co-fund the organizations. The renewed Canadian Diabetes Strategy targets populations at high risk of developing diabetes as well as preventing complications among those with diabetes. The strategy addresses obesity as a risk factor for diabetes by encouraging those at risk to eat a healthy and balanced diet and to be physically active.
v) Public Information
Although it is necessary to promote and support environmental changes that increase opportunities for people to make healthy choices, individuals must also be given helpful, timely and reliable information about how to make these choices. The Health Portfolio’s expertise in developing social marketing campaigns is now being applied to several public information initiatives that target children and youth, parents and other intermediaries with healthy eating and physical activity messages. Ongoing activities of the GoC that also provide public information specific to healthy eating and physical activity include the revised Food Guide, the Physical Activity Guides for Children and Youth, and the Children’s Fitness Tax Credit promotional campaign, which includes a Web site promoting physical activity and healthy eating.
vi) Monitoring and Evaluation
By carrying out monitoring and evaluation activities on programs and policies related to obesity, such as the Children’s Fitness Tax Credit and Healthy Living and Chronic Disease initiative, the Government of Canada is able to strengthen the design and delivery of programs addressing childhood obesity. Monitoring and evaluation focus on the relevance and impact of activities and whether alternative programs are needed. These activities will build on current initiatives and the findings from previous evaluations (such as recent evaluation of the Canadian Diabetes Strategy), as well as lessons learned about the evaluation process itself.
The GoC also has an important role to play in analysing innovations and translating and disseminating this knowledge. For example, the Public Health Agency of Canada, acting as a World Health Organization National Collaborating Centre on Non-Communicable Disease Policy, has partnered with the Pan American Health Organization to establish a Policy Observatory on Non-Communicable Diseases. The Observatory will promote the systematic analysis of information on key policies, including their context formulation and implementation processes, any mitigating and constraining factors, as well as the real and potential impact of such policies.
The following section outlines the Government of Canada’s response to the Committee’s recommendations, including details of initiatives that address each recommendation.
Detailed Responses to the Recommendations
Recommendation 1 - The federal government:
- Establish targets to achieve healthy weights for children through physical activity and healthy food choices including:
- a halt to the rise in childhood obesity by 2010,
- a reduction in the rate of childhood obesity from 8% to at least 6% by 2020;
The Government of Canada considers the setting of targets an important consideration in efforts to address unhealthy weights among children. Until recently, there was a lack of data related to healthyJune 27, 2007 eating, physical activity and healthy weights, particularly among children. This meant that it has not been possible to identify meaningful targets for children. However, recent federal efforts have supported the development of surveillance tools and indicators, which could serve as a baseline from which to set targets. The Government of Canada will have to partner with other governments and organizations involved in promoting healthy weights prior to determining specific targets because these targets will have implications for their work and accountability.
Though targets have not yet been set for children, the Government of Canada has been involved in several target-setting exercises among adults. For example, in 2003, the Government of Canada, in partnership with provincial and territorial government departments responsible for sport, physical activity and recreation, set a target to increase physical activity among adults by 10 percentage points in every province and territory by 2010. Progress towards this target is being measured by the FPT Physical Activity and Sport Benchmarks/Monitoring Program undertaken by the Canadian Fitness and Lifestyle Research Institute (CFLRI). Data tools used in this program are correlated with the bi-annual data from the Canadian Community Health Survey (CCHS). In addition, in 2005, FPT Ministers of Health* set targets through the Pan-Canadian Healthy Living Strategy to increase by 20% the proportion of adults who are physically active (i.e. report at least 30 minutes of daily physical activity), make healthy food choices (e.g. report consuming fruits and vegetables at least five times per day) and are at a healthy or “normal” weight (i.e. having a Body Mass Index of between 18.5 and 24.9). Beginning in 2007, progress towards these targets will be reported through annual reports to the Council of the Public Health Network. The focus of the first annual report is to outline work to establish baseline data against which progress can be monitored in reaching these targets.
Surveillance and Monitoring of Children and Youth
Physical Activity: In order to address the lack of data on physical activity of Canadian children and youth, in 2005, FPT ministers responsible for sport, physical activity and recreation commissioned the CFLRI to develop and implement the Canadian Physical Activity Levels Among Youth (CANPLAY) study – the first nationally-representative study using pedometers to objectively measure physical activity in children and youth aged five to 19 years. The first round of data collection for the CANPLAY study (2005-2006) indicates that only 9% of Canadian children and youth meet the recommended guideline in Canada’s Physical Activity Guides for Children and Youth.
Healthy Eating: The FPT Group on Nutrition has agreed that a national-level target be established but that the specifics of the targets (i.e., amount of change) be established at the local level by regional health authorities. Setting a target for healthy eating is complicated by the challenge in determining appropriate indicators. Until now, frequency of fruit and vegetable consumption has been used as a nutrition indicator. The CCHS (Nutrition Focus) indicates that between 55% and 83% of children and youth aged 2 to 18 years do not meet the recommended number of Food Guide servings of vegetables and fruit that is specific to their age and gender group. The CCHS (Nutrition Focus) also provides national and provincial food consumption data and estimates of absolute intake for the first time in 35 years. With discussions underway to repeat CCHS (Nutrition Focus) in 2012, there is an opportunity to develop indicators that better reflect the complexity of healthy eating.
Healthy Weights: The CCHS (Nutrition Focus) measured the heights and weights of a representative sample of children and youth, aged 2 to 17. Eighteen percent (18%) of those in this age group were overweight and an additional 8% were obese – a combined prevalence of 26%. Although this was a one-time survey, as stated above, discussions are underway to repeat it in 2012. This would be particularly important for assessing progress with respect to childhood obesity, since regular cycles of the CCHS do not include children under 12.
• Implement, in collaboration with First Nations and Inuit, immediate measures to halt obesity among First Nations and Inuit children; and,
Health Canada is taking an active role in preventing obesity in First Nations and Inuit children, recognizing the need for an approach that deals with underlying risk factors. These include culturally-appropriate strategies to promote healthy choices around physical activity and food, and supporting policies that result in healthy foods being available at a reasonable cost, in addition to programming and services that deal with social determinants of health.
Health Canada supports a range of community-based health promotion and health protection services on reserves and in Inuit communities, as well as primary health care in remote and isolated First Nations communities. These programs and services, some of which are described below, are delivered at the national, regional, and community level and are managed in collaboration with First Nations and Inuit.
The Aboriginal Diabetes Initiative funds obesity-prevention projects for children, including the development of healthy school policies that emphasize healthy snacks and children's camps that focus on preventing obesity through promotion of healthy lifestyles. The program also addresses the prevention of diabetes during pregnancy, which lowers the risk of obesity for infants later in life.
The Aboriginal Head Start program, which has two components (On-Reserve and Urban and Northern Communities), targets children from birth to age six. The goal of the AHS is to support early child development strategies for optimal growth and development. As described in section B, this program is designed to promote the health and well-being of children, through a comprehensive program that includes components on health promotion, nutrition, parental involvement, culture and language, social support, and education.
The Canada Prenatal Nutrition Program and the new Maternal Child Health Program contribute to the prevention of childhood obesity in First Nations and Inuit communities by providing parents with the information, resources and support they need to care for their children and themselves. These programs also promote healthy weight gain during pregnancy, which can help to reduce childhood obesity.
A number of activities to improve food security (availability, quality, cost, accessibility of healthy market and traditional foods) in First Nations and Inuit communities are taking place through the above-mentioned programs. A framework for the implementation of effective food security interventions is also being developed in partnership with the Assembly of First Nations and Inuit Tapiriit Kanatami. A partnership with three major northern retailers, known as the Retail-Based Nutrition Interventions, is intended to increase the availability, accessibility and consumption of healthy store-bought foods in northern First Nations and Inuit communities. This joint venture will focus on improving operating conditions in stores and providing in-store information or education.
In addition, Canada's Food Guide has recently been tailored to the needs and considerations of First Nations, Inuit and Métis for the first time on a national level. This resource recognizes the importance of traditional and store-bought foods, and can be used to educate, set policies and provide guidance to ensure adequate nutrition and decrease the risk of unhealthy weight and diet-related disease.
• Report annually to Parliament on overall efforts to attain healthy weights for children and on the results achieved.
The Government of Canada recognizes that demonstrating program effectiveness is essential to enhancing progress. The implementation of the 2005 Management, Resources and Results Structure Policy will lead to the development of a common, government-wide approach to the collection, management and reporting of financial and non-financial performance information by federal departments. This mechanism provides the basis for Parliamentary Reports on Plans and Priorities and Departmental Performance Reports. Through these existing reporting mechanisms, Parliament will have the means to review the results of Government of Canada policies and programs related to the promotion of physical activity, healthy eating and healthy weights. Work on developing indicators and targets through which to monitor progress and evaluate programs and policies will be important in achieving this goal.
Implement a Comprehensive Public Awareness Campaign
Recommendation 2 -- The federal government:
- Establish a comprehensive public awareness campaign on healthy weights for children;
- Promote both quality physical activity and healthy food choices as key elements of the campaign;
- Employ all available media in all regions of the country;
- Develop and disseminate clear, easy to use, multilingual, culturally diverse educational tools for parents, children, teachers, health professionals, community planners, etc.; and
- Collaborate with provincial and territorial partners, national Aboriginal organizations and other stakeholders as appropriate.
The Government of Canada agrees that public awareness and education campaigns are important. However, they must be viewed as one strategy among a mix of integrated strategies that are needed to effect change at a population level. Recognizing that a number of studies have demonstrated low levels of health literacy, the GoC supports a number of key public information initiatives that promote both physical activity and healthy eating. These initiatives use various forms of media, often include an Aboriginal component and are developed with many partners, including the provinces and territories and Aboriginal organizations. Some of these initiatives are described below.
Public Awareness Campaigns
The Government of Canada announced funding for ParticipACTION to develop a new campaign in February 2007. The campaign aims to encourage Canadians to improve their health and quality of lives through physical activity and sport participation. ParticipACTION is partnering with media, business, labour, education, volunteer organizations, and physical activity and sport groups, and will support the efforts of national and provincial/territorial governments in building momentum towards a more active and healthy Canada.
During the 2007/08 fiscal year, a Social Marketing Campaign will be launched to promote existing and new physical activity and healthy eating tools including Canada’s Physical Activity Guides, Canada’s Food Guide and Web resources. The campaign will likely target certain segments of the population, through outreach, partnerships and information on the Web, to complement the broad reach and more general messaging of ParticipACTION.
The Government of Canada led an advertising campaign in February/March 2007 to promote the Children’s Fitness Tax Credit. The goal of the campaign was to encourage parents to engage their children in physical activity and sport.
The Government of Canada recently launched a national Healthy Pregnancy Campaign, including components for First Nations women on reserve and for Inuit women living in Inuit communities. The campaign includes key messages on healthy eating, physical activity and oral health as well as advice on avoiding alcohol, drugs and tobacco.
Food and Physical Activity Guides
These Guides are important education and policy tools that underpin health policies and standards and public information programs across the country. They are two of the most-requested Government of Canada documents.
Through a television advertisement, the Government of Canada is raising awareness and encouraging the use of Eating Well with Canada’s Food Guide, the new version of which was launched in February 2007. Close to 7 million copies of the Guide have been distributed since the launch. To address the challenge of preventing obesity, Canada’s Food Guide has tailored guidance on amounts of food; it also provides details on the types of foods to consume and limit, and includes daily physical activity as part of the guidance. The new Food Guide acknowledges the evolving cultural diversity of Canada by including a range of foods from different ethnic cuisines. Soon it will be possible to print the web-based tool “My Food Guide” (www.myfoodguide.ca) in a number of different languages. As mentioned earlier in the response, the Government of Canada has also developed a complementary tailored food guide for First Nations, Inuit and Métis.
Canada’s Physical Activity Guides for Children and Youth and supporting materials (including materials for parents and teachers) provide advice on how much activity is needed for optimal health benefits and how to start or increase physical activity. Health Canada is working on a tailored version of the Physical Activity Guide for First Nations, Inuit and Métis, as well as on a marketing plan to support the promotion, dissemination and effective use of this guide.
The Canadian Health Network (www.canadian-health-network.ca) web site brings together over 300 resources about healthy eating and over 200 resources about active living/physical activity for children, youth and their parents. Resources include Frequently Asked Questions, articles and practical tools such as games and quizzes. The resources, which are provided in collaboration with a network of over 1600 partners from the non-profit sector, are quality-assured and current. In 2006, CHN received 2.5 million unique visitors. Resources on children and on healthy eating are among the most popular. One example of CHN’s interactive resources is Healthy Lunches to Go, which provides strategies and recipes that can be used by children, youth, teachers and parents to encourage packing healthy lunches.
The healthycanadians.ca (www.healthycanadians.ca) web site provides a portal for information on health and lifestyle issues, and includes links to many of the initiatives described above.
The Health Portfolio’s community-based programs provide resources and public education activities to address physical activity and healthy food choices for a variety of target audiences, including parents, children and health professionals. These resources and activities are created in consultation with stakeholders and are culturally-appropriate. They are distributed through programs such as the Canada Prenatal Nutrition Program, Aboriginal Head Start, the Aboriginal Diabetes Initiative and Community Action Program for Children. These programs target children, women and families at higher risk for poor health outcomes. Each program employs a targeted approach, focussing on ways to reduce health inequities. Nutrition and healthy eating are particularly important components of the Aboriginal Head Start Program and the Canada Prenatal Nutrition Program.
SummerActive/WinterActive (www.summeractive.org/en) These initiatives are run in collaboration with provinces and territories, and promote physical activity, sport participation and healthy food choices. For several weeks in summer and winter, Canadians are encouraged to register their participation in community activities across Canada. The initiatives include tools, messaging and incentives aimed at various population groups, such as children, youth, seniors and Aboriginal peoples. The focus on Aboriginal peoples was developed in collaboration with the Assembly of First Nations and Inuit Tapiriit Kanatami.
The Government of Canada recently provided funding for the Canada Science and Technology Museum Corporation to develop the Food for Health Travelling Exhibit, which includes an educational program for school-aged children and an interactive Web site. The interactive museum exhibit, launched on March 9, 2007, communicates information on the relationship between food and health. The display includes an explanation of the new Food Guide and explains the impact of nutrients and other food components on health, as well as a hands-on demonstration of the balance between calories in food and energy expenditure.
Implement Mandatory Front of Package Labelling
Recommendation 3 -- The federal government:
- Implement a mandatory, standardized, simple, front-of-package labelling requirement on pre-packaged foods for easy identification of nutritional value;
- Apply a phased-in approach starting with foods advertised primarily to children; and
- Promote the new labelling requirement to parents through an aggressive media campaign.
The Government of Canada recognizes the importance of providing nutrition information to help Canadians make healthy food choices. As with other policy development activities, it would be necessary to review current evidence and consult with stakeholders to inform any potential new labelling policy. This would ensure that the policy meets important health objectives, results in useful information for consumers and will be feasible for industry.
Current nutrition labelling regulations, which came into effect in Canada in December 2005 are consistent with the World Health Organization’s Global Strategy on Diet, Physical Activity and Health, which highlighted nutrition labelling as a key activity for Member States. They require that calories and the content of 13 core nutrients be conveyed in a standardized format, known as the Nutrition Facts table, on most pre-packaged foods. The Regulations also contain definitions for 47 nutrient content claims (e.g. “trans-fat free”, “source of fibre”) and conditions for using five health claims that highlight the relationship between a given food and health. The Nutrition Facts table and several related public education activities provide information to help consumers make healthy food choices and reduce their risk of developing chronic diseases.
As noted in the report of the Standing Committee on Health, there has been a recent proliferation of competing front-of-package labelling practices; the lack of consistency in criteria and in the type of information provided by these different practices can lead to consumer confusion.
Health Canada’s public consultation on health claims for foods, which will be launched during the summer of 2007, will consider front-of-package labelling (including simplified nutrition labelling and healthy eating logos) as well as appropriate nutritional criteria for foods that carry health claims. Feedback from stakeholders and review of evidence will form the basis for future, targeted consultations on the issue of front-of-package labelling.
Evidence from studies of the impact on consumer behaviour as a result of current nutrition labelling regulations and the voluntary use of nutrient content claims will inform a decision about whether to adopt mandatory, standardized, simplified, front-of-package nutrition labelling.
The Canadian Food Inspection Agency (CFIA) is responsible for enforcing the regulations on mandatory nutrition labelling, nutrient content claims and diet-related health claims on food labels and advertisements. As part of their risk management compliance strategy, the CFIA has prioritized commodities that tend to have elevated levels of saturated fats, trans fat, sodium and added sugars (such as bakery goods, snack foods, juice and beverages, and confectionary foods), many of which are traditionally marketed to children. In order to promote compliance, the CFIA provides a number of tools to help industry implement the nutrition labelling requirements, including an updated Guide to Food Labelling and Advertising, the Nutrition Labelling Toolkit, the CFIA Compliance Test, and several information brochures.
Limit Trans Fats
Recommendation 4 -- The federal government:
- Establish regulations by 2008 that limit trans fat content in food as recommended by the Trans Fat Task Force, while not increasing saturated fat content.
All government departments concerned with this issue recognize that trans fats in foods are a health concern for Canadians. As described in the Committee’s Report, a multi-stakeholder task force released their report in June 2006. This report recommended a regulated approach to limiting trans fats in Canadian foods. Health Canada, in consultation with other government departments and agencies, have reviewed the recommendations from the Task Force.
As industry continues to demonstrate progress in reducing trans fat in the food supply, Health Canada proposes that industry be encouraged to voluntarily further reduce the level of trans fat in food products to the levels recommend by the Trans Fat Task Force. If continued progress is not demonstrated through ongoing monitoring studies, Health Canada would seek the authority to regulate the levels of trans fat in food.
Canada was the first country to introduce a mandatory nutrition label that included trans fat on the labels of prepackaged foods. It was envisioned that the provision of nutrition information, together with consumer education, would result in consumers making food choices aimed at decreasing their intake of trans fat. The requirement to declare trans fat content was also intended to act as an incentive for the food industry to decrease the trans fat content of foods. In fact, since the mid-1990s, the trans fat intake of Canadians has decreased from an average of 8.3 to 5 grams per person per day in 2005 — a level still higher than the current recommendations of the World Health Organization and the American Heart Association (2-2.7g).
The Canadian Food Inspection Agency’s inspection activities will include the fats and oils sector to ensure trans fat is listed correctly on labels. Inspection and enforcement activities will focus on food distributed at all levels of trade, including manufacturers, importers, retail, food service and institutions. Other sectors that are traditionally high in trans fats and saturated fats, and which are targeted towards children, such as the bakery goods, cereals, snack foods and confectionary sectors, are also part of current inspection activities.
Collect Data for Targets
Recommendation 5 -- The federal government:
- Collect data on a regular and continuous basis on healthy weights for children;
- Make data available on both physical activity levels and food choices;
- Provide data from a variety of biometric measurements, including body mass index, waist-to-hip ratio and abdominal circumference;
- Include data on diverse ethno-cultural and socio-economic groups, specifically including Inuit
- Collaborate with provincial and territorial partners, national Aboriginal organizations and other stakeholders as appropriate.
The Government of Canada recognizes the need for a comprehensive ongoing national surveillance system that includes food, nutrition, physical activity and related factors. Surveillance is a key knowledge and management tool for decision-makers to understand the health of the population and to measure progress in affecting health outcomes.
Several departments and agencies play a role in surveillance. The Public Health Agency of Canada carries out some surveillance activities related to diseases, injuries and other preventable health risks and their determinants, while Health Canada has the lead role in food and nutrition surveillance. CIHR provides funding to several researchers for the analysis of data generated by numerous surveillance efforts.
To fully understand the complexity of childhood obesity requires data on a multitude of elements, such as biometric measurements, food choices, physical activity levels and socioeconomic status. Although limited, there are some current sources of data on children, as described below.
One source is the Health Behaviour in School-Aged Children Survey (HBSC), a joint initiative with the World Health Organization (WHO), that collects data every four years from students in grades 6, 8 and 10 on health behaviours, including physical activity, eating patterns and body image. This initiative provides national estimates of health indicators and allows for comparisons to be made with the 40 other countries who participate.
As described previously, the Canadian Community Health Survey (Nutrition Focus) built on learnings from earlier food consumption surveys to gain a better understanding of food and nutrient intakes, food safety, nutritional status and nutrition-related health outcomes. The survey, conducted in 2004, is a particularly important source of information on prevalence of unhealthy weights among children in Canada, including data specific to Aboriginal children living off reserve. The Health Portfolio is now collaborating on the analysis of CCHS data to maximize the knowledge developed from this effort.
The Canadian Health Measures Survey (CHMS), currently underway, will capture a nationally-representative sample of 5000 Canadians between the ages of 6 and 79, including a sub-sample of 2000 children and youth ages 6 to 19 years. This survey includes a wide range of anthropometric measures (e.g., measured height and weight, waist circumference, skin folds), physical activity and fitness measures and biological markers of nutritional and disease status. Although it is still a one-time survey, there is considerable effort across federal departments to establish this as an ongoing state-of-the-art surveillance tool for Canada.
The Physical Activity and Sport Benchmarks/Monitoring Program is a partnership between PHAC, Sport Canada and the provincial and territorial government departments responsible for sport, physical activity and recreation. Governments mandated the Canadian Fitness and Lifestyle Research Institute to monitor and track physical activity levels and report annually on progress towards the FPT physical activity target. Under this program, CFLRI has also undertaken the Canadian Physical Activity Levels Among Youth (CANPLAY) study (described in detail in recommendation 1) to measure physical activity levels of children and youth.
Statistics Canada, Human Resources and Social Development Canada and Aboriginal advisors from across the country have developed and led the Aboriginal Children’s Survey to collect information on the development and well-being of First Nations, Inuit and Métis children under the age of six years. The first data collection for the survey of 18,000 children occurred between October 2006 and March 2007; results are expected in the fall of 2008. The survey targeted First Nations (status and non-status), Inuit and Métis children under the age of six years living in all 10 provinces (off reserve) and children under the age of six in the territories. The 2006 Aboriginal Peoples’ Survey, which is being funded by a coalition of federal departments, will similarly generate useful data relating to health outcomes and socio-economic determinants of health.
Health Canada collaborates with the Assembly of First Nations on the First Nations Longitudinal Regional Health Survey (RHS), which includes three survey instruments: adult (18+ years); adolescents (12-17 years); and children (0-11 years). The latest RHS (2002-03) collected data from 22,602 respondents in 238 communities across Canada, focussing on medical and non-medical determinants of health within a First Nations cultural perspective. The RHS includes information on weight and height, physical activity levels and food choices among First Nations children living on reserve. A pilot study, which includes a sample of 200 First Nations children on reserve, will include data on waist circumference, height and weight measurements, and direct measures of physical activity.
In order to further improve the availability of data on children, the Public Health Agency of Canada will be undertaking a number of new surveillance activities. Within the context of the Public Health Network, for example, an expert advisory group provides coordination and leadership in public health surveillance and information collection, analysis and dissemination. The Agency is also working with national experts (including provincial and territorial governments) and international experts on the development of a Sentinel Surveillance System to collect information from a sample of general practitioners across the country that would include physical measures of all their clients, including children. In addition, the Agency has undertaken collaborative pan-Canadian initiatives on the health of vulnerable populations, including immigrants, rural residents and women, to identify and study health disparities in Canada and to explore avenues for action. Information on children and youth is included in these studies. Work is also ongoing on the development of “data cube” software for Canada that will capture a broader range of summary-level statistical information available to the public via the Internet.
Collaborate on Knowledge Exchange
Recommendation 6 -- The federal government:
- Create a mechanism for knowledge exchange on healthy weights for children that:
- includes a focus on both physical activity and food choices
- disseminates ongoing and published research, results of evaluations, best practices, promising practices, unsuccessful practices, etc.
- collects and makes information available in diverse languages, reflective of multiple ethno-cultural demographic communities, including First Nations, Inuit and Métis; and
- Collaborate with provincial and territorial partners, national Aboriginal organizations and other stakeholders as appropriate.
In response to a growing interest in, and recognition of the federal role in leading knowledge development, translation and exchange, the Government of Canada has identified the need to establish and support mechanisms for knowledge exchange under both the Pan-Canadian Healthy Living Strategy and the federal Healthy Living and Chronic Disease initiative.
The Health Portfolio is undertaking knowledge exchange activities related to healthy living and chronic disease prevention. For example, CIHR has a mandate to translate new knowledge to facilitate the development of more effective health services and products and a strengthened Canadian health care system. The CIHR-INMD has led workshops, supported think tanks, built partnerships and funded research teams to translate knowledge and facilitate action in the field of childhood obesity.
The Public Health Agency of Canada led the development of the Canadian Best Practices Portal (http://www.cbpp-pcpe.phac-aspc.gc.ca), which is intended to increase the capacity of decision-makers to identify and implement evidence-based interventions. The Portal is a centralized access point for exchanging evidence of effectiveness for best practices. Nutrition, physical activity and obesity have been identified as priority areas for the Portal, which already includes best practice interventions and systematic reviews specifically on the issue of childhood obesity prevention. There are plans to further facilitate information exchange within the health sector, as well as other areas of work that impact health, such as transportation, social conditions and agriculture. The knowledge development and exchange activities under the Canadian Best Practices System also include the Canadian Task Force on Preventive Health Care, whose revitalization is currently being supported by the Public Health Agency of Canada. Comprised of university-based clinician-methodologists, the Task Force’s role is to review research and to make recommendations that will help primary health care professionals to choose effective and proven tests as well as appropriate counselling strategies. Collaboration with provincial and territorial governments, professional organizations and international organizations enhances the quality of this work and helps to improve uptake among health care practitioners.
The Non-Communicable Diseases (NCD) Surveillance Infobase (www.cvdinfobase.ca/surveillance) is a particularly important knowledge exchange tool, providing Web-accessible, user-friendly surveillance information, with data on mortality, morbidity and incidence, when available, on most cancers, cardiovascular and respiratory diseases, by province/territory and by regional health unit. Information on other determinants and demographics and related health care data are also currently available.
The Government of Canada also supports the Canadian Population Health Initiative, a part of the Canadian Institute for Health Information. The CPHI conducts and synthesizes data analyses on priority health issues, and disseminates its findings in a series of reports on Improving the Health of Canadians. Recent reports have focussed on the health of young Canadians (2005), healthy weights (2006) and health in urban places (2006).
The Centres of Excellence for Children’s Well-Being provide an established structure within which knowledge on healthy eating and physical activity can be exchanged and disseminated. Several Centres are engaging in knowledge translation activities: the Centre for Children and Adolescents with Special Needs has a task force on nutrition, health and development; the Centre for Youth Engagement has done work on healthy body images; and the Centre for Early Childhood Development has done extensive work on nutrition, and its encyclopaedia includes a chapter on nutrition and pregnancy. All Centres work on Aboriginal issues, and in some cases, publish resources in Aboriginal languages.
Other mechanisms are in place to develop, translate and exchange information specific to the health of First Nations, Inuit and Métis children. For example, Health Canada works with the National Aboriginal Health Organization’s Centres for First Nations, Inuit and Métis on such activities as public education, health promotion, report publication, research, and capacity building. Also, the Public Health Agency of Canada supports the National Collaborating Centre for Aboriginal Health as a national focal point for knowledge synthesis and translation related to this issue.
Increase Multi-Dimensional Research Capacity
Recommendation 7-- The federal government:
- Build research capacity across the broad range of health determinants related to healthy weights for children;
- Ensure a research focus on both quality physical activity and healthy food choices;
The Government of Canada acknowledges the need to continue building research capacity across the broad range of health determinants related to healthy weights for children, and has demonstrated its commitment to doing so under the Health Portfolio. The Canadian Institutes of Health Research (CIHR), through the Institute of Nutrition, Metabolism and Diabetes (INMD), play a leadership role in research related to healthy body weights and obesity. In 2002, following an extensive environmental scan and stakeholder consultation, INMD identified “obesity and healthy body weight” as its only strategic priority for research funding. In addition, the Public Health Agency of Canada, which has an important role to play in knowledge development and exchange, has identified obesity as a policy and programming priority. Health Canada also conducts and invests in research to support strategic, evidence-based decision making in the management of Canada’s food system and the promotion of nutrition, healthy eating and food safety in Canada.
CIHR-funded studies are already addressing the Health Committee’s call for research on health determinants related to childhood obesity, physical activity and healthy food choices. The primary objective of the INMD strategic priority has been to increase understanding of the measures, causes, prevention, treatment and consequences of obesity. As a result of this focus, there has been an estimated sixfold increase in obesity funding since 2000 and researcher capacity in the area of obesity and healthy body weights has increased approximately sevenfold. In total, CIHR has invested approximately $63M on obesity research (between 2001 and 2006), of which an estimated $10M was targeted to childhood obesity.
A supportive tool in the fight against childhood obesity will be the development of nationally-validated indicators for child and youth health. CIHR’s Institute of Human Development, Child and Youth Health launched an initiative with the National Child and Youth Health Coalition to develop these much-needed evidence-based indicators. Once developed, these indicators will: support greater consistency in the provision of health services for infants, children, youth and families across Canada; monitor and improve access to and quality of care within individual health care organizations and regional authorities; and inform and assist policy and decision makers in addressing future infant, child and youth health resource planning and allocation requirements.
Recognizing that determinants research by itself cannot fully provide the evidence needed to prevent or control childhood obesity, CIHR is seeking to build the evidence base on interventions in order to better understand what works, for whom and under what conditions. For example, the newly launched initiative on Intervention Research will support research and evaluation of programs, events and policy changes that have the potential to impact healthy living and chronic disease prevention. The knowledge gained by supporting both intervention and determinants research will help ensure that the policies and practices put in place to address childhood obesity are based on a more complete understanding of the issue.
As a result of the increasing prevalence of childhood obesity and the associated increase in the onset of chronic diseases in childhood and adolescence, more effective practical solutions that are thoroughly evaluated by researchers are needed. The scope of the childhood obesity problem has led CIHR and INMD to collaborate with the U.S. National Institutes of Health in funding a network of researchers focussed on the development of childhood obesity models to assist in predicting the impact of the rising prevalence and the cost-effectiveness of intervention solutions. Over the next three years, INMD intends to become even more strategic in the area of obesity and will focus on specific knowledge creation and translation challenges aimed at more effective practical solutions.
The Public Health Agency of Canada also plays a key role in targeted population and public health studies to support healthy living and chronic disease prevention by increasing knowledge on risk factors and health determinants. Through its grants and contributions, the Agency continues to provide funding to build capacity for studies on chronic disease burden, risk factors and determinants, and effective individual and population-level interventions, including those for vulnerable populations. The Agency is also actively conducting risk assessment and population health studies on obesity, physical activity and nutrition, mainly focussed on their associated risk of chronic disease as well as determinants (personal, social and environmental) that affect the prevalence of obesity and physical activity.
Other research efforts are also being undertaken by the Government of Canada. For example, the Government of Canada supports the World Health Organization Commission on Social Determinants of Health which will review the underlying factors associated with inequalities in health and make recommendations on how these can be addressed through policies and practices. In addition, in 2006, the Public Health Agency of Canada announced funding for six National Collaborating Centres for Public Health, including the National Collaborating Centre for Determinants of Health, whose focus is on knowledge synthesis and transfer in this area.
- Include, but do not limit research efforts to, federal departments and agencies such as the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Statistics Canada, Health Canada, Public Health Agency of Canada, Indian and Northern Affairs Canada; and CIHI
The Government of Canada agrees that it is important to include multiple departments and agencies whose policies and programs affect childhood obesity in research efforts. In addition, the GoC believes that other partners, both inside and outside Canada, should be engaged in research efforts.
The CIHR Act requires CIHR to engage individuals and organizations with complementary research interests, pursue opportunities and provide support for international collaboration and partnerships by Canadian scientists, and consult, collaborate and form partnerships with the provinces and individuals and organizations in or outside Canada that have an interest in issues pertaining to health or health research. As such, the Institutes develop partnerships relevant to their mandates with federal departments, health charities, associations, industry, provincial governments, health research agencies and international organizations. In fact, in 2005-06, CIHR was able to build partnerships with more than 150 different organizations committed to health research and improving the health of Canadians, which translated into $107M in additional funding for health research.
As partnering is a key component of CIHR’s mandate, it will continue to address the Health Committee’s recommendation to ensure that partnerships reach across the broad spectrum of stakeholders interested in the issue of unhealthy weights among children. Further, each Institute is guided by an Advisory Board that ensures that funded research is strategic, focussed and composed – elements to ensure findings are readily translated in practice. INMD also works in close collaboration with stakeholders on issues related to physical activity, nutrition, and obesity such as the Canadian Population Health Initiative at the Canadian Institute for Health Information and several federal departments.
Other Health Portfolio partners engage in research with organizations within and outside of government as well. The Public Health Agency of Canada, along with CIHR, is supporting the Canadian Society for Exercise Physiology to undertake and publish a scientific review of physical activity guidelines and measurement in Canada. This project will help to identify gaps and establish priorities for research, and help inform and equip other stakeholders develop better policies, programs and messages. Similarly, Health Canada is working with the US Institute of Medicine to support the advancement of the scientific underpinning (i.e. Dietary Reference Intakes) for the development of national dietary guidance.
The Health Portfolio is also engaged in initiatives to highlight research needs in the area of nutrition. For example, Health Canada supported and produced a journal supplement on the determinants of healthy eating that summarized the existing literature, identified gaps in knowledge and offered recommendations for research to enhance the evidence base. The development of the supplement encouraged innovative approaches in working across sectors and with other disciplines to strengthen our knowledge base.
Health Canada and CIHR are working closely with Statistics Canada to build capacity and research opportunities for using data from the Canadian Community Health Survey (Nutrition Focus). For example, the CIHR is funding an initiative to provide enhanced opportunities for expert analysis of CCHS data, including analysis of the social inequities on nutrition in children, the determinants of nutrient inadequacy, the relationship between dietary patterns and physical activity status in Canadian immigrants, nutrient and food intake of Canadian children in relation to chronic disease and the prevalence and correlates of food insecurity in Aboriginal peoples living off reserve. The CIHR is also collaborating with Health Canada on ongoing training and capacity building for the research community to use these data.
- Develop individual research components on the determinants of health for First Nations, Inuit and Métis children.
Given the specific determinants affecting First Nations, Inuit and Métis children, the Government of Canada agrees with the importance of researching specific determinants affecting this vulnerable population. In an effort to better understand how to respond to and support the serious health challenges of Canada’s Aboriginal populations, CIHR’s Institute of Aboriginal Peoples’ Health and its partners will continue to build and sustain research on determinants of health in First Nations, Inuit and Métis populations. CIHR continues to build research capacity in Aboriginal health, and has invested in research specific to healthy body weights and obesity in Aboriginal populations.
Through the development of Guidelines for Health Research Involving Aboriginal People, CIHR is enabling more and better research specific to Aboriginal children. As the Guidelines are designed to be a collaborative tool, it is anticipated that they will assist in developing research partnerships that will facilitate and encourage mutually-beneficial, culturally-sensitive research.
Health Canada is also undertaking research activities and collaborations that build evidence for policy and programming specific to the factors associated with healthy weights, effective interventions and the determinants of healthy eating in First Nations and Inuit. For example, a plan is being developed in partnership with CIHR and other academics to guide research and surveillance activities as part of the enhanced Aboriginal Diabetes Initiative. One of the National Collaborating Centres for Public Health established by the Public Health Agency of Canada in 2006 will facilitate knowledge translation on Aboriginal health.
Develop a Coordinating Mechanism
Recommendation 8-- The federal government:
- Identify immediately a lead department or agency for federal interdepartmental action on healthy weights for children;
- Include but do not limit action to the following departments: Health Canada, Public Health Agency of Canada; Canadian Institutes of Health Research; Finance Canada, Indian and Northern Affairs Canada, Sport Canada, Heritage Canada, Infrastructure Canada, Human Resources and Social Development Canada, the Canadian Food Inspection Agency, the Canadian Radio-television and Telecommunications Commission and Statistics Canada;
- Ensure that action encompasses a healthy eating and a physical activity focus
The Government of Canada agrees that childhood obesity is a complex issue whose underlying risk factors touch on the mandates of many different departments, and that there is a need for strong leadership. The Health Portfolio is the lead on efforts related to obesity, including childhood obesity. However, obesity touches on the mandates of many other federal departments and agencies, including Agriculture and Agri-Food Canada, Canada Revenue Agency, Canadian Food Inspection Agency, Canadian Radio-television and Telecommunications Commission, Finance Canada, Human Resources and Social Development Canada, Indian and Northern Affairs Canada, Infrastructure Canada, Sport Canada and Statistics Canada.
Through its strategic planning process, the Public Health Agency of Canada has identified obesity as a major public health challenge and a policy and programming priority for the Agency.
The Public Health Agency of Canada, working with its Health Portfolio Partners, Health Canada and the CIHR, developed the Healthy Living and Chronic Disease initiative, which provides federal leadership across a range of public health actions to promote the health of Canadians and reduce the impact of chronic diseases in Canada. Activities are already underway through this Strategy, and a coordinating mechanism is in place.
The Health Portfolio works with its federal partners on issues related to obesity through a number of existing mechanisms, such as:
- the Federal Coordination Committee for School Health, which coordinates the federal government role in the FPT Joint Consortium for School Health and the National School Health Conference;
- the Science and Policy Advisory Committee on Nutrition, which brings together the Canadian Food Inspection Agency (CFIA), PHAC, Health Canada (HC) and Agriculture and Agri-Food Canada to support the mandate of the HC/CFIA Committee on Food Safety and Nutrition and to provide horizontal linkages necessary for effective management of food safety and nutrition issues;
- regular consultative meetings among Statistics Canada, PHAC and Health Canada officials to discuss content for various CCHS surveys, providing an opportunity to suggest new themes and questions, as well as to review old questions to see if they are still appropriate; and
- an interdepartmental group consisting of PHAC, Environment Canada, Natural Resources Canada, Transport Canada, Infrastructure Canada, National Capital Commission, and Public Works and Government Services whose mandate is to guide and influence federal policy and program development related to sustainable urban transportation, of which active transportation is one priority;
- the Metropolis Project, a multi-departmental research project on immigrant well-being led by Citizenship and Immigration Canada, which includes health as a major focus; and
- the Interdepartmental Action Group on Healthy Living, which was formed during the development of the Pan-Canadian Healthy Living Strategy and includes members from numerous federal departments and agencies whose mandates touch on physical activity and healthy eating.
- Establish an ongoing mechanism for consultation with First Nations, Inuit and other national organizations.
The Government of Canada has worked to build an effective and coordinated system for First Nations and Inuit children and their families with strong linkages and partnerships. On December 7, 2006, the Minister of Health and the National Chief of the Assembly of First Nations (AFN) signed a joint workplan, developed by a Health Canada/AFN Task Group, with the aim to improve the effectiveness of First Nations health services over the short and long-term. This joint initiative provides a forum to explore and develop innovative approaches for concrete action to improve First Nations health. On April 18, 2007, the Minister of Health and President of the Inuit Tapiriit Kanatami (ITK) signed a joint workplan to guide a Health Canada/ITK Task Group, with the aim to jointly explore and develop approaches in areas of mutual interest for advancing Inuit health. The Task Group will identify areas of collaboration and consolidate efforts leading to initiatives to improve Inuit health status.
In addition to these workplans, the GoC has been working with provincial and territorial governments and Aboriginal people to close the gaps in health between First Nations people and Inuit and other Canadians. This work has included exploring trilateral agreements for the integration and improved coordination of health programs and services for Aboriginal peoples.
On November 27, 2006, the First Nations Health Plan Memorandum of Understanding (MOU) was signed by three parties: the First Nations Leadership Council, the Government of Canada and the Government of British Columbia. This tripartite MOU committed the parties to enter into negotiations to develop an initial tripartite ten-year health plan, including activities, priorities and potential funding implications, within six months of signing the tripartite MOU.
Control Children’s Food Advertising
Recommendation 9-- The federal government:
- Assess the effectiveness of self-regulation as well as the effectiveness of prohibition in the province of Quebec, in Sweden and in other jurisdictions;
- Report on the outcomes of these reviews within one year;
- Explore methods of regulating advertising to children on the internet; and
The Government of Canada understands the concerns related to marketing to children, and is undertaking efforts to further explore this issue. The Public Health Agency of Canada is currently examining the various methods used by marketers to reach children and the current situation in Canada. Different models for reducing the influence of marketing on children will be considered, including the consumer protection regulations in Quebec, prohibition on advertising (radio and TV) in Sweden and Norway, and new regulations in the United Kingdom limiting the promotion of food and beverages high in fat, sugar and salt to children. The feasibility and effectiveness of these approaches, as well as self-regulation in Canada (including the most recent initiatives described below) will be assessed. This work is being conducted in preparation for an upcoming public policy consensus conference on the Impact of Advertising and Marketing to Canadian Children and Youth.
The Canadian Radio-Television and Telecommunications Commission (CRTC) is the Government of Canada agency responsible for regulating broadcast advertising, which in general is heavily regulated at the federal and provincial levels. Broadcast advertising to children is regulated via the Broadcast Code for Advertising to Children, to which all broadcast licensees must adhere. The CRTC requires, as part of this license condition, that all ads be cleared prior to broadcast by an expert self-regulatory body – Advertising Standards Canada (ASC) – to ensure compliance with the Code. The CRTC directly limits advertising to children on channels targeted to children, and some of these services have no ads at all.
- Collaborate with the media industry, consumer organizations, academics and other stakeholders as appropriate.
The Government of Canada collaborates with media, consumer organizations, academics, the private sector and other stakeholders on the issue of nutrition labelling, nutrient content claims and advertising. For example, the Canadian Food Inspection Agency works with the food industry and ASC to ensure that advertisements for food meet the requirements of the Food and Drugs Act and Regulations, particularly with respect to nutrition labelling, nutrient content claims and health claims. Although targeted to high risk commodities and nutrients, CFIA’s compliance and enforcement activity promotes accurate and truthful advertising, including on the Internet. While not specifically targeted to children's food advertising, this work contributes to the accuracy of nutrient content claims and health claims on all foods.
The Government of Canada recognizes the role of the private sector in reaching children and youth, and believes that it is critical to involve this sector in promoting healthy weights. For example, the GoC is working with broadcast and advertising industries, who recently announced three initiatives to respond to public concern about childhood obesity:
- Long Live Kids: an education campaign using public service announcements targeted to children to promote healthy, active lifestyle choices;
- Canadian Children’s Food & Beverage Advertising Initiative: a commitment by 15 Canadian food and beverage companies to devote at least 50% of ads targeted to children under 12 toward the promotion of healthy dietary choices and/or active living messages (which will be formally audited and publicly reported by the ASC);
- Two new guidelines added to the Codes governing advertising to encourage responsible product use and appropriate food portions, effective September 2007.
Once it takes effect, the Canadian Children’s Food and Beverage Advertising Initiative will yield essential data from which to assess the effectiveness of the industry’s self-regulatory efforts.
Through its support of intervention research, CIHR has created a mechanism for engaging the research community in the research and evaluation of programs like Long Live Kids and Canadian Children’s Food & Beverage Advertising Initiative. CIHR also works with Concerned Children’s Advertisers and other industry stakeholders to foster networks between researchers and industry.
Increase Healthy Food Choices
Recommendation 10-- The federal government:
- Evaluate, with First Nations and Inuit, methods to provide their remote communities with access to nutritious food at a reasonable cost, including the Food Mail Program, the use of traditional foods, and various self-sustaining initiatives.
The Government of Canada has a number of initiatives that address healthy eating, access to food and the use of traditional foods, described below.
The Indian and Northern Affairs Canada (INAC) Food Mail Program pays part of the cost of shipping nutritious perishable food by air to isolated northern communities that are not accessible year-round by road, rail or marine service. This subsidy makes it possible for retailers in these communities to sell fresh food at lower prices. While the Food Mail Program is recognized as playing an important role in reducing the costs of healthy food in isolated northern communities, the government is reviewing the program to determine whether this is the most effective and efficient means of addressing the underlying issues of food costs and food security in isolated communities. This review will be based in part on evidence from pilot projects underway in three communities where the rate charged for shipping the most critical perishable foods was further reduced. INAC will also be launching a new price monitoring tool in the form of a Revised Northern Food Basket to assess and monitor the affordability of a healthy diet in eligible Food Mail communities and southern supply centres.
In northern communities, fresh affordable food from the south is a complement to traditional Aboriginal food. Recognizing the need to improve access to healthy food in isolated communities, the Government of Canada has recently designated Winnipeg as an additional entry point for food mail service to the Kivalliq region of Nunavut. This action will reduce food prices and improve food quality in this region, thereby helping to address nutrition and food security issues and promote healthier food choices.
The Government of Canada promotes the use of traditional foods through other ongoing activities, such as:
- Health Canada’s community-based programs for First Nations and Inuit, which promote the use of market and traditional foods through their resources and public education activities. Some programs also support access to food. For example, Canada Prenatal Nutrition Program-First Nations and Inuit Component supports access to healthy foods for pregnant and breastfeeding women.
- The Northern Contaminants Program, carried out together with northern Aboriginal organizations to study the implications to human health of contaminants found in certain traditional/country food, resulting in dietary advice to Northerners that reinforces the fact that, in most cases, the benefits of consuming country foods outweigh the risks. Specific health advice has been provided to women of child-bearing age and pregnant women to reduce the risks from contaminant exposure through the consumption of certain traditional foods.
- Eating Well with Canada’s Food Guide - First Nations, Inuit and Métis, which promotes traditional foods as well as store-bought foods commonly available even in isolated communities, such as frozen and canned vegetables and fruits.
- Environmental and traditional foods workshops, which facilitate information-sharing about the benefits of traditional foods, as well as possible risks from contaminants.
Other activities related to food security include: a Food Security Reference Group, which brings together First Nations, Inuit and federal government partners working on food security to share information, discuss strategies and opportunities, and set priorities for action towards improved food security for First Nations and Inuit; and a partnership with three major food retailers in Northern Canada, who have agreed to stock and promote foods that are generally lower cost, commonly available in rural and remote locations, shelf-stable, and familiar to community people.
Evaluate the Impact of Tax Credits
Recommendation 11-- The federal government:
- Establish immediately a reliable baseline with respect to the number of children who enrol in sports and physical activity
Baselines and benchmarks have been established for children and youth. Sport participation among children and youth is monitored annually via the Canadian Fitness and Lifestyle Research Institute’s Physical Activity Monitor and via Statistics Canada’s General Social Survey, most recently conducted in 2005. Sport Canada also maintains a database of registered members of national sport organizations.
- Report on the uptake of the Children’s Fitness Tax Credit within two years; and
- Evaluate the effectiveness of the Children’s Fitness Tax Credit within five years.
The Government of Canada has already committed to reviewing the effectiveness of the Children’s Fitness Tax Credit within the specified time, as recommended in the Report of the Expert Panel on the Children’s Fitness Tax Credit. The Canada Revenue Agency and the Department of Finance are collaborating with the Public Health Agency of Canada to monitor uptake of the Credit. For 2007, the first year of the credit, taxation statistics on the number of taxpayers claiming the Children’s Fitness Tax Credit and amount claimed will be available by the end of 2008.
Support Appropriate Food and Physical Activity in Schools
Recommendation 12-- The federal government:
- Work to facilitate, in collaboration with the Joint Consortium for School Health, appropriate healthy food and physical activity standards and programs in schools;
- Collaborate with the provincial and territorial partners, national Aboriginal organizations and other stakeholders as appropriate.
In May 2004, the World Health Assembly adopted the Global Strategy on Diet, Health and Physical Activity. One of the components is for Member States to develop and implement school policies and programs that promote healthy diets and increased levels of physical activity. The Health Portfolio is working collaboratively with the World Health Organization to develop an international school policy framework, focussing on the promotion of healthy eating and physical activity/education through environmental, behaviour and education changes. The framework will aim to provide guidance to Member States on how to develop and implement a sustainable national and/or sub-national school policy to promote and support healthy eating and physical activity.
The Government of Canada also works in partnership with provinces and territories through the Joint Consortium for School Health (JCSH) to enhance the capacity of the education and health sectors to promote the healthy development, including healthy eating and physical activity, of children and youth in the school setting. The key role of the JCSH is to act as a catalyst in strengthening cooperation among ministries, departments, agencies and others and in building the capacity of health and education systems to work together.
The work of the JCSH includes: coordination and support for provincial/territorial school health coordinators; publishing knowledge summaries and promising practices related to school health promotion; promoting local policy models; supporting active working groups on specific concerns such as nutrition, social behaviours of youth or on vulnerable groups such as Aboriginal students; facilitating the development of coordinated systems for reporting on the health and social behaviours of children and youth and on school policies and programs; publishing reports on emerging issues and trends; working with researchers and research agencies; and supporting inter-provincial and international exchanges of information.
- Provide appropriate healthy food and physical activity standards and programs in First Nations schools within federal jurisdiction.
Indian and Northern Affairs Canada (INAC) supports the development of healthy schools through its Education and Capital programs. Through its Education Program, INAC works with the provinces and First Nations organizations on regional priorities, which could include healthy children’s programming. One such example is New Paths for Education, which is designed to improve the school environment and class room instruction and strengthen overall school governance, and has been used at several schools for breakfast and lunch programs.
INAC’s Capital Facilities and Maintenance (CFM) program supports infrastructure investments in schools and recreational facilities. For school facilities, communities may use funds to build gymnasiums, sports fields and playgrounds, as specified in the departmental level of service standards for schools and school site development. Funds can also be used for the construction of community buildings, including recreational facilities and community halls like arenas, community recreational centres and indoor pools.
Through its community-based programs, described previously, Health Canada promotes healthy eating and participation in physical activity in First Nations schools. The Aboriginal Diabetes Initiative funds obesity-prevention projects for children, including healthy school policies which emphasize healthy snacks, and children's camps that focus on preventing obesity through the promotion of healthy lifestyles. Many diabetes prevention projects target youth, and funding has been provided for research on healthy lifestyle interventions that specifically reach children.
Enhance Community Infrastructure
Recommendation 13-- The federal government:
- Provide new and dedicated infrastructure funding to facilitate access to varied options for children with respect to quality physical activity and healthy food choices; and
- Collaborate with the provincial and territorial partners, national Aboriginal organizations and other stakeholders as appropriate.
The Government of Canada recognizes the importance of liveable communities and access to facilities in order to support Canadians in attaining healthy weights by promoting sport and physical activity participation. It also recognizes that the type of food available in grocery stores, schools, recreation and community centres should support healthy eating.
The Government of Canada invests in public infrastructure through various mechanisms, including the Municipal Rural Infrastructure Fund, the Canada Strategic Infrastructure Fund, the Gas Tax Fund, Public Transit Fund and the GST rebate, which respond to a broad range of quality-of-life objectives in communities. Access to healthy lifestyles for all citizens is promoted through investments in community infrastructure such as recreation and community centres, arenas, pools and active transportation paths, as well as larger-scale facilities for major amateur sports and athletic events. Budget 2007 confirms the GoC’s commitment to supporting communities by providing $33B under a new long-term Infrastructure Plan, for a total of $37B over seven years in new and continued infrastructure funding. Under the Infrastructure Plan, a new Building Canada Fund will support investments in small-scale municipal projects including recreational facilities.
Infrastructure investments are delivered in collaboration with provincial and territorial governments, First Nations and municipal governments. In full respect of jurisdiction, the Government of Canada will continue its collaboration with these stakeholders on infrastructure priorities.
The Government of Canada acknowledges the complexity of the issue of childhood obesity and agrees with the Committee that there is a significant amount of work to be done to improve the health of children and youth in Canada. The GoC has an important role to play, as outlined in this response, in providing leadership and coordination, improving surveillance, helping to build capacity in communities, continuing to support knowledge development and exchange, providing information to the public and monitoring and evaluating interventions and innovations. Work will continue to better understand the determinants of health, which will inform decisions on the best interventions and mechanisms to use to address these determinants.
The GoC is committed to collaboration with many stakeholders to promote healthy eating and physical activity and, thus, healthy weights. In order to effect change in obesity levels among children and youth, particularly in vulnerable populations such as First Nations and Inuit, the Government of Canada will continue to build upon the solid foundation of initiatives described in this response to better understand and address the challenges of unhealthy weights in children.
- Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol. 2004 Feb 29(1):90-115
- Law C, Power, C, Graham H, Merrick, D. Obesity and Health Inequalities. Obesity Reviews. 2007
Sentinel surveillance provides an alternative to population-based surveillance for the collection and
analysis of individual patient-related information. Active sentinel sites might be medical clinics, hospitals, health centres that cover certain populations at risk, or they could be networks of individual practitioners such as primary health care physicians.