Thank you very much, Vice-Chair and members of the committee.
I'm very pleased to be here today along with colleagues from the health portfolio. With me is Kathy Langlois from the first nations and Inuit health branch; Diane Finegood from CIHR, the Canadian Institutes of Health Research; Claude Rocan, director general of the Centre for Health Promotion; and Janet Pronk from the health products and food branch, director in the office of nutrition policy and promotion. I am director general in the health promotion and chronic disease prevention branch in the Public Health Agency of Canada.
As I mentioned, I am very pleased to be here to discuss the government's response to the parliamentary standing committee's report on childhood obesity, “Healthy Weights for Healthy Kids”.
Your report provides an important assessment of the issue in Canada. It identifies many of the key determinants that contribute to excessive weight gain in children and youth, and highlights the implications of obesity for the health and well-being of young Canadians and, indeed, for the long-term welfare of Canada.
Through its analysis, the committee makes it clear that childhood obesity is a serious public health issue with links to a range of chronic diseases as well as premature death. Moreover, it effectively illustrates that halting further increases to Canada's overweight and obesity rates is a shared responsibility. It rests not only with the health system, including public health and health care actors, but jointly with players from across many sectors. As such, you call upon the Government of Canada, specifically the health portfolio, to provide leadership in raising awareness about the complexity of the issue of childhood obesity and in coordinating the efforts of diverse sectors, particularly those under federal jurisdiction.
In its response, the government highlights a range of key initiatives and actions already in place to address the problem of childhood obesity. These were organized under the six recognized core federal responsibilities in public heath, including leadership, coordination, and strategic policy, among others that you are familiar with.
While I will not go through the entire range of initiatives detailed in the response, I would like to draw your attention this morning to the following policy measures and initiatives that have been introduced by the government in recent months to help children and families live active healthy lives, namely: the children's fitness tax credit; the funding of the new ParticipACTION campaign; the revised Canada's Food Guide, including a tailored version for first nations, Inuit, and Métis; Canada's physical activity guides for children and youth; as well as funding for the initiatives of nine non-governmental organizations through the Public Health Agency's physical activity and healthy eating contribution program that specifically target children and their environments. These initiatives will help to reduce barriers and increase access to convenient, safe, and affordable opportunities to integrate physical activity and healthy eating into daily living.
The government's response recognizes the importance of information and evidence in helping to monitor the health of the population and evaluate policy objectives and interventions. To this end, investments have been made to support activities that enhance the health portfolio surveillance and research capacity, including the Canadian Community Health Survey, the Canadian Health Measures Survey, the Health Behaviours in School-aged Children Survey, and the Non-Communicable Disease Surveillance Infobase, as well as funding strategic university-based research across the country through the Canadian Institutes of Health Research.
As pointed out in the committee's report, the sharing of information on specific initiatives, including established best practices as well as promising practices, helps accelerate effective program uptake across the country. To this end, the government has established initiatives and mechanisms to share information with key stakeholders, including the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention, the Canadian Task Force on Preventive Health Care, and the National Collaborating Centre for Aboriginal Health.
In addition, the federal-provincial-territorial public health network provides an effective infrastructure that allows the two levels of government to share information and best practices and collaborate on public health issues such as childhood obesity. For example, in September of this year, the deputy ministers of health from all jurisdictions held a retreat that dealt with this issue in order to share successful approaches and identify ways of tackling the problem of unhealthy weights.
We understand that children living in lower socio-economic conditions are more likely to be obese than those living in families with higher education and income levels, and those living in rural or remote communities are also more likely to lack access to quality services for health promotion and related health interventions. The government response therefore notes key investments in several community-based programs, such as the community action program for children and the Canada prenatal nutrition program. These programs mitigate and improve the life circumstances of these children, as well as provide families, communities, and health professionals with access to the information and support they need to make healthier choices in the areas of physical activity and food selection.
The committee also draws attention to the issue of obesity and the overall poor health of aboriginal populations, which results from a complex array of historical, economic, and societal factors. The government response highlights the programs, services, and initiatives that respond to the unique circumstances of first nations, Inuit, and Métis peoples. These include, for example, continued investments in the maternal and child health program, aboriginal head start, the Canada prenatal nutrition program, the aboriginal diabetes initiative, as well as other key initiatives such as the food mail program.
Further, new data is being gather through the first nations regional health survey. The next cycle of this survey will go into the field early in 2008 and it will collect important information on food security, physical activity, height, and weight. Collectively, the policies, programs, and initiatives, as outlined in the government response, provide an important foundation upon which to continue to build and inform our current and future actions, not only with respect to children but in all segments of the Canadian population.
In moving forward, we are taking an approach to overweight and obesity with an increased emphasis on the complex interplay of underlying factors and environmental conditions that influence the choices and behaviours of Canadians. We also recognize, similar to the approach taken to achieve the success demonstrated on tobacco control and smoking cessation, that counteracting obesity will require long-term, multi-sectoral efforts involving many of the key partners and stakeholders highlighted in your report.
The Government of Canada is just one player among many that must be engaged on childhood obesity. We are, however, in a position to provide a key leadership and coordination role, based on the foundation of work to date and our public health and related expertise. In this regard, we appreciate the need to work collaboratively within the health portfolio and, in turn, to engage all federal departments and agencies that can support efforts to enhance existing and potentially new policies, programs, and services.
I would like to highlight to the committee that we have created a new directorate within the Public Health Agency of Canada. This new capacity will advance action on the social determinants of health--those determinants that are fundamental to addressing overweight and obesity--and coordinate efforts to address this area as a core priority.
I am also pleased to report that since the tabling of the government response in August, we have continued to advance and build on the initiatives outlined in the response.
As you know, in June of this year, the announced that Health Canada adopted the recommendations of the Trans Fat Task Force and called upon the food industry to reduce the levels of trans fats in foods within two years. The minister also announced that if significant progress is not made in the next two years, Health Canada will develop regulations to ensure that the recommended levels are met. Health Canada is closely monitoring industry actions in this area via a trans fat monitoring program and will inform Canadian consumers of industry progress approximately every six months through the Health Canada website.
We recognize the importance of providing nutrition and healthy eating information to help support healthy food choices in an environment saturated by food industry marketing messages and confusing information. To help address this, the government is a partner in organizing a national policy consensus conference on the impact of marketing on the unhealthy weights of Canadian children and youth, scheduled to take place in Ottawa in March 2008. The results of the conference will be used by the government to address concerns about marketing to children.
In its report, the committee provided recommendations on front-of-package labelling. This issue is now being considered as part of Health Canada's public consultation on a modernized framework for health claims for foods, given that front-of-package labelling can be seen as a form of implied health claim. A discussion document on health claims has been developed, and face-to-face consultations will take place in six cities across Canada early next year.
Feedback from stakeholders as well as consumer research on this topic will guide the final proposed framework. This information will also be used as the basis for future targeted consultations on the issue of front-of-package labelling alone. Moreover, a healthy eating campaign, to be launched in the winter of 2008, will promote healthy eating concepts and encourage the effective use of nutrition information on food labels to enhance the ability of Canadians to make healthy food choices. This campaign builds on the TV ad campaign launched last winter, which promoted the revised Canada's Food Guide.
In addition, we have taken further actions consistent with the overall direction of the committee's report and recommendations. For example, to help foster the conditions that facilitate lifelong active living, we will be supporting implementation of the World Health Organization's age-friendly cities initiative in several communities across Canada.
One important focus of the project is changing the physical environment in communities, including the built environment, as a key factor that influences opportunities and/or creates barriers to physical activity participation. In addition, there is growing awareness of the impact of trade, particularly in regard to agricultural commodities and the increased availability of packaged foods as a possible factor in the escalating prevalence of obesity.
To further our understanding of these global trade dynamics and their impacts on children and families, the health portfolio partnered with the World Health Organization to host an expert forum in Montreal this past November. Specifically, the purpose of the forum was to synthesize current knowledge and identify opportunities to promote and develop sustainable and healthy policies and actions on the part of industries, governments, and other stakeholders.
In a similar vein, the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes will in the new year bring together representatives from the food industry, health sector, ethics, marketing, and agriculture policy to build trust and work collaboratively to reduce obesity and identify potential solutions. As the committee and the government have clearly recognized, obesity, including childhood obesity, is a complex issue. Therefore, it is important to develop innovative approaches and a stronger base of Canadian evidence to address the drivers of this issue and ensure that we systematically learn from these.
To support this need, the Public Health Agency of Canada has created an innovations and learning strategy. This strategy will provide funding support to design and test inter-sectoral initiatives applicable to the underlying causes of overweight and obesity. For its part, the CIHR Institute of Nutrition, Metabolism and Diabetes has undertaken significant new work to improve the knowledge base in the area of childhood obesity. For example, in partnership with the Heart and Stroke Foundation, CIHR recently funded initiatives in the area of the built environment and obesity, including studies focused on the features of the built environment in residential neighbourhoods that influence excess weight in a group of children at risk for obesity, and a longitudinal study of environmental determinants of overweight among children.
In addition, the Canadian Institutes of Health Research have created a new type of funding opportunity that supports intervention research, including the study of programs, events, or policies initiated by others. For example, CIHR has funded two studies to assess the impact of the relaunching of ParticipACTION. This new approach demonstrates how the government is efficiently linking research investments to help evaluate the effectiveness of new policies and programs. The range of initiatives currently under way by the health portfolio and in collaboration with other stakeholders illustrates how we are continuing to take action and build the partnerships that are needed to address the causes of childhood overweight and obesity in Canada.
To conclude, the standing committee has been instrumental in helping to underscore the serious nature of the issue of childhood obesity in Canada, as well as the need to act. The government concurs with the committee that childhood obesity, and indeed obesity in general, requires continued attention by governments and other stakeholders. The foundation that has been created through existing and new initiatives and partnerships, as described in the government response and further clarified today in my remarks, positions the government to effectively move forward to address this very serious societal issue.
Thank you for the opportunity to highlight our continued and expanded work in this area.
I thank all of you for coming.
First, thank you for updating us on the deputy ministers retreat, which I think is a positive step. I think the fact that there will be a national consensus conference on the marketing pieces is progress.
However, I don't think I speak just for myself in saying that the government response was pretty thin gruel in terms of saying anything we didn't already know from the hearings themselves. I think the government's response is supposed to say what you're going to do about the committee's concerns, not what you've already done. I think we have to get out of the habit of the government response to a committee report being just a reiteration of what we already heard at the hearings and a laundry list of things you're dabbling in at the moment. We know about ParticipACTION. We know about the tax credit. We know about these things. We want to know what you are you going to do, based on the concerns raised by the committee, that is different from what we have already heard at the hearings.
In the ongoing quest by this government.... I have to say that when I arrived here 10 years ago, the women's health strategy was a laundry list of what we were dabbling in at the time. It was not a real strategy in terms of what would be done, by when, and how, with targets and methodologies for doing things, whether it was Caesarean section rates or whatever. So here, I have to say, I was pretty disappointed that the response was very much a regurgitation of what we'd already heard.
Things like, we “will have to partner with”, and in terms of setting measurable targets, “Beginning in 2007, progress towards these targets” set for adults “will be reported through”.... Well, it's already the end of 2007, and I don't actually see that happening.
On the social marketing campaign, it's December, and we've not seen anything. On trans fats, we don't have a clue what's holding people up in terms of what it was very clear had to be done, and we're back to the government response being that industry will be “encouraged to voluntarily reduce”.
That's not what we wanted. We wanted to know, because of the real importance in our country of canola oil, whether the fooling around should make it 2% or 3%, because of what is naturally occurring. We wanted to know when we are going to actually have trans fats banned at a realistic rate for our country.
I'm a bit dismayed that there's not anything in here, other than a couple of the things I just talked about, that actually says yes, we'll do the trans fats; yes, we will set some targets; yes, we will respect the direction of this committee in terms of doing new things. What we as a committee may find we have to do is re-table this report and ask for a better response. This is just the same old, same old, and it's disappointing.
I would like to know the things you think you have done since you saw this report that actually show that you've heard the committee and that you're taking this issue seriously. It's not that you weren't taking the issues seriously before, but what have the wishes of Parliament done to catalyze funding, catalyze commitments, or catalyze anything?
Even in terms of research, I guess I'm still very upset about the lack of funding to CIHR and the fact of the difference between investigator-driven research and what it says in our recommendation about ensuring a research focus on quality physical activity. How do we sort out what we really know needs to be done now in this country?
I was pleased to see that the CIHR is doing some research on which interventions work and which don't. I myself would love to see a research project on the frigging food guide as to whether it's ever changed anybody's behaviour in this country. In terms of just redoing the same old, same old, it looks like the same thing that was hanging on my bulletin board when I was in grade 7.
I would like to know what's new, that you're proud of, since this committee tabled this report.
Thank you. I'd be very happy and actually proud to also respond in terms of the work we have been doing within the base of our programming in first nations and Inuit health branch.
I've done a quick calculation. We spend about $150 million annually in four programs alone that are aimed, in large part, at the issue of childhood obesity. Those programs have already been named by my colleague, Mr. Ball: the aboriginal diabetes initiative, the aboriginal head start program, the Canada prenatal nutrition program, and our new maternal child health program.
Some things are new since the report was drafted. We continue to invest within that base of funding. We have put in place 63 new maternal child health community projects, and we are expecting an additional eight by the end of this fiscal year. That program is meant to connect mothers on reserve with the supports needed to improve parenting skills and to also address the needs of their children.
As well, our aboriginal diabetes initiative is now rolling out in terms of putting into place community-based diabetes prevention workers. We've been working in three regions of the country. We trained 46 community workers last year, and we have recruited an additional 86 to train this fiscal year. Our goal is to have 300 to 400 trained community workers on reserve who basically will be community mobilizers. They will be out there mobilizing the community around healthy eating, physical activity, and bringing activities to the community.
Also, in our aboriginal diabetes program we have just awarded 16 new diabetes prevention projects that are for the off-reserve population. And that's on top of an existing 32. We're spending about $1.9 million on those 16 projects this year.
I'll give you a few examples of what they are. In the Ooknakane Friendship Centre in B.C., there'll be a breakfast for learning program. Again, it's for off-reserve aboriginal kids. The Dauphin Friendship Centre will see school youth engagement in healthy food choices and physical activity. In the Ki-Low-Na Friendship Society we'll see food programs directed to youth and elders, making that linkage that is so important for cultural continuity.
Those are some of the main things we're doing. I have some other items, but it gives you a sense of it, I think.
I'll defer to my colleague.
Thank you, Mr. Chairman.
Like Ms. Wasylycia-Leis, I am new to the committee. Obviously this is a very important topic, and I congratulate the committee for the work it has done. Mr. Ball has given an excellent summary on the response. I think, Ms. Bennett, the government is doing an outstanding job.
I have a couple of questions, though many of the questions have already been asked in this area, and that has to do with your comments about the whole issue of obesity, or the topic that has been raised on “Healthy Weights For Healthy Kids”. I think you used the words, “it's a shared responsibility”.
I'd like you to elaborate a little more on that. I look, for example, at the province of Ontario--and I realize what I'm about to say is a provincial issue--where many of the school boards, for the food that's served in the schools, have changed their philosophy about what they're serving. In other words, it's better-quality food. They simply said they weren't going to serve certain foods, which I think is a good thing.
We've talked about advertising. I think all that's very good. We have regulations about advertising for liquor and cigarettes, and there's nothing wrong with putting restrictions on advertising for certain types of food. There's nothing wrong with that, because clearly we have a social problem. I appreciate what you are saying about where the government is going.
Canada's Food Guide is a good thing. I made sure that all the schools in my riding received copies of that document. The problem is, how do you get people to read the darned things? How do you get people to respond? How do you educate mom and dad? We seem to be getting into the schools, but how do you educate mom and dad?
I guess I'm returning to my initial comment about your response of a shared responsibility. I appreciate that you have conferences and consultations planned, and all those are excellent. We have to talk about it. You can't simply snap your fingers and solve this problem that has been building up for years, whether it's food packaging, advertising, or kids playing on computers and watching television, etc. As the papers indicate, it's a very complex issue.
I'd like you to elaborate, or perhaps your colleagues can elaborate, more specifically on the shared responsibility that we have as a federal government with provincial governments, municipal governments, school boards, moms and dads, etc.
Mr. Chairman, as a visitor to this committee, I want to say it's very gratifying to see the tremendous interest you have in the audience here today. If they stay for the next meeting, they may find it almost as interesting as this one, so I hope they will stick around.
said he wasn't being critical. I think that was an understatement, if you'll forgive me. I want to urge my colleagues opposite to assist their ministers, not by throwing lob balls and easy questions, but by holding the departments to account.
Having been a minister, I appreciated the work of committees when they uncovered things I didn't know about, when they provided ideas that were useful, and when they held us to account. That's a very useful role for members on all sides of the committee.
What's disturbing about a response you gave earlier, Mr. Ball, was that you looked to the chairman to confirm it was true that the role of the agency in responding to a report from a committee is simply to say, here's what we're currently doing. It seem to me that the work of a committee ought to be as a catalyst. The work of parliamentarians in this regard--listening to witnesses, providing analysis, and providing arguments--ought to be as a catalyst for an agency or a department, to look into what it's doing to look for better ways of doing things.
In this regard, let me turn to recommendation 12, which called upon the agency to “work to facilitate, in collaboration with the Joint Consortium for School Health, appropriate healthy food and physical activity standards and programs in schools”.
This is a consortium that works with deputy ministers. I'd like to know what's happening with it. The answer simply refers to “working collaboratively with the World Health Organization to develop an international school policy framework”, etc. It doesn't really give any answer to suggest there's any effort going into this work across federal-provincial governments.
I'd like to know when the last meeting of this consortium was and what it's doing.
I guess data's my business.
Yes, absolutely, and I think the members have articulated very clearly the data gap or the knowledge gap. Sometimes we have knowledge about what the problem is, but we don't actually have knowledge about what works and what the solutions are.
In reference to the previous comments about front-of-pack labelling, we have very little information about what kind of front-of-pack labelling would actually stimulate consumers to make the healthy choice. In fact, CIHR has funded a researcher here at Carleton who has done some very interesting work looking at packaging for children's foods and has also done focus groups with kids to find out what they think when they see front-of-pack labels that talk about goodness for this reason or that reason.
Most kids don't take those seriously. When they see fun foods, which is the way most food is marketed to kids, then they think it's fun and not good for you, but that's what they want. When it looks serious, then they don't want it. So we're beginning to uncover what those relationships are.
In terms of aboriginal health and aboriginal health issues, this is a really critical area where there's a data gap. And there are different kinds of data: there's data about how big the problem is, but more importantly there's data about what would work and what the solutions are.
I wanted to make the comment that community-based research, wherein you work with the community to understand the changes that they want to put in place, tends to lead to a more effective solution orientation. We are partnered with first nations and Inuit health branch on our new program, which allows us to try to understand what works, for whom, and under what circumstances.
The issue of ParticipACTION was brought up. The government funded ParticipACTION because brand recognition was high. Unfortunately, for the last time that ParticipACTION was funded, we don't really know whether it had an impact on health. CIHR put in place a program and funded two research groups to help us understand what the impacts are this time of ParticipACTION.
A critical component of it is that we're responsive in a very timely fashion to fund those projects. Our system wasn't set up that way. We've now changed it to create a program that is responsive, and the two research groups that are working on ParticipACTION were actually in the field before ParticipACTION was launched this fall.