FEWO Committee Report
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Dear Mrs. Leblanc:
I am pleased to respond on behalf of the Government of Canada to the Fourth Report of the Standing Committee on the Status of Women entitled Eating Disorders among Girls and Women in Canada, tabled in the House of Commons on November 17, 2014.
On behalf of the Government of Canada, I wish to thank the Committee members for this extensive and valuable study. The Government of Canada recognizes the devastating impacts of eating disorders, particularly on women and girls. Preventing eating disorders begins with improving mental health. Recognizing that health care delivery is the primary responsibility of provinces and territories, our Government has announced a long-term arrangement that will see transfers reach historic levels of over $40 billion by the end of the decade. In supporting jurisdictions in determining how to best address serious mental illnesses, such as eating disorders, the Government of Canada collaborates with provinces, territories and stakeholders to address this issue of grave concern in a manner consistent with the federal role.
To articulate the Government’s activities related to the challenges identified by the Committee, this response is organized along four themes: development of a federal framework; treatment and access to care; research and surveillance; and awareness and education. The Government established the Mental Health Commission of Canada (MHCC) to provide leadership and coordination in improving the mental health of Canadians and Canada’s response to mental illness. The MHCC provides a foundation for collaboration that supports mental health broadly and in doing so supports our objectives in preventing eating disorders. In addition, the Government has recently taken action to improve the nutrition labels on packaged foods. Following a commitment in the 2013 Speech from the Throne, the Government consulted with consumers on ways to improve the presentation of nutrition information on prepackaged foods. The Nutrition Facts table enables consumers to choose and compare products and make informed, healthier food choices. Health Canada is reviewing and incorporating all the feedback received as the Government of Canada moves forward to update the nutrition labelling requirements.
The Report’s recommendation in this area relates to considering the development of a federal framework to collect from, and provide to, all provinces and territories (PTs) information, statistics, and best practices, and to raise awareness about the prevalence of eating disorders in Canada. As the Committee noted, there are a number of obstacles that make it difficult for individuals with eating disorders, their families, health care professionals and others to recognize, receive or provide diagnosis, seek treatment and access other forms of support for these conditions.
As eating disorders are a form of mental illness, they are included in this Government’s comprehensive approach to addressing mental health and mental illness. The Government of Canada works with partners, including PTs, to leverage lessons learned, evidence and data to improve the mental well-being of Canadians by promoting activities that protect our mental health (e.g., building resilience, coping skills and social connections) and that reduce factors that put our mental health at risk (e.g., drug abuse and exposure to family violence and child abuse.) As a result, Canadians may be better able to cope with and manage the pressures that may contribute to a mental illness such as an eating disorder.
In 2007, the Government of Canada announced $130 million over 10 years to establish the MHCC to address gaps and challenges, and to help create the awareness and partnerships needed to improve the mental health of all Canadians. This investment, along with our support for research on eating disorders and mental health, is the appropriate role for the federal government to play. This Government remains committed to working with partners to tackle the challenges of mental health and mental illness, including eating disorders, in a coordinated and collaborative manner.
Treatment and Access to Care
The Committee’s Report highlights a number of challenges and barriers for those suffering from eating disorders to access treatment and care, particularly those from remote, rural or marginalized populations. While PTs are responsible for the organization and delivery of healthcare services in Canada, our Government will continue to collaborate with PTs and stakeholders to increase access to services in underserved areas and align medical education with Canadians’ needs. For example, through the Family Medicine Residencies Initiative, $39.5 million in federal funding, over six years, is supporting family medicine residency positions and advanced training in rural and remote communities across the country. In addition, a further $9 million per year in Canada Student Loan relief is available to new family physicians, medical residents, nurses and nurse practitioners who choose to practice in rural and underserved communities across Canada. These investments help to attract more medical professionals to Canada’s smaller communities and improve access to health care services for people who live beyond large urban areas.
The Government of Canada invests in mental health activities consistent with the federal role. Promoting mental health and well-being is about enhancing the capacity of communities and individuals to take control over their lives and improve their mental health. It is about increasing their resilience to respond to future adversity. Federal programs focus on populations at higher risk. For example, the Public Health Agency of Canada invests over $112 million annually in community-based health promotion activities for at-risk children and their families – including promoting mental health, nutrition and healthy eating – to support a healthy start in life.
The Government of Canada also funds First Nations and Inuit communities to support culturally appropriate health programs and services, including initiatives focused on healthy living and improved mental health. This work to improve health outcomes of Aboriginal peoples is a shared undertaking among federal, provincial and territorial governments, as well as Aboriginal partners. Health Canada’s role involves supplementing and supporting provincial and territorial health services to provide culturally appropriate health programs and services that work to strengthen health outcomes for First Nations and Inuit. This includes promoting mental health and supporting mental illness treatment and addictions services, healthy behaviours and healthy eating.
The Government of Canada also supports PTs in their delivery of health care through the Canadian Institutes of Health Research (CIHR). CIHR leads Canada’s Strategy for Patient-Oriented Research (SPOR) which is a coalition of federal, provincial and territorial partners. The first Network under SPOR, ACCESS Canada, is in the area of youth and adolescent mental health, and aims to improve health outcomes for adolescents and youth by transforming the way mental health care is provided in Canada. This Network represents an investment of $25 million over five years shared equally between CIHR and the Graham Boeckh Foundation.
These approaches are also aligned with the recommendations of Changing Directions, Changing Lives, Canada’s national mental health strategy, released by the MHCC in May 2012. The MHCC continues to work with partners to support uptake of the Strategy, promote best practices, explore opportunities to improve mental health and wellbeing, and tackle mental illnesses, including eating disorders.
Research and Surveillance
The Committee’s Report underscores the importance of strong research and surveillance in preventing and assisting those living with eating disorders. The Government of Canada recognizes the importance of these activities and undertakes significant work in this area. For example, several Institutes of CIHR support research related to eating disorders. The majority of CIHR’s funding is allotted through investigator-driven funding opportunities, where researchers identify key research topics and submit proposals for funding. CIHR would welcome additional applications from researchers studying eating disorders, including the effect of these emerging treatments on eating disorders.
From 2006/07 to 2013/14, CIHR invested approximately $480 million towards mental health research, including approximately $6 million targeted to eating disorders research. This investment includes: long-term trends in relapse and recovery in women with anorexia; research on the treatment of eating disorders; methods for screening for eating disorders among children and youth; the connections between substance abuse and eating disorders; the genetic determinants of low body weight in anorexia nervosa; the manner in which relationships with fathers affect the development of eating disorders among young people; the growing number of boys and men affected by these conditions; and the effectiveness of treatment interventions for women with binge eating disorder. For example, one research project implemented and evaluated an evidence-based eating disorders training program tailored for health care professionals working in primary care to help ensure that these professionals have the expertise to appropriately assess and treat eating disorders. Another research project assessed the usefulness of a new instrument to screen for eating disorders among youth in order to provide easier access to eating disorder treatment for individuals who might not have sought care on their own. CIHR has also funded research related to the effects of deep brain stimulation and transcranial magnetic stimulation on mental health problems such as depression and schizophrenia.
The Government of Canada also supports surveillance of eating disorders and other mental health illnesses. As the Committee noted, the Canadian Institute for Health Information (CIHI) collects health and health care information from PTs, including information on eating disorders. The Government welcomes CIHI’s work with jurisdictions to increase information on the coverage of eating disorder services across Canada in CIHI’s databases and their work with partners to develop information systems for primary care and community services. Statistics Canada collects mortality data by cause including eating disorders, which is also publicly available. In addition, the Public Health Agency of Canada supports the Health Behaviour in School-aged Children Study, which reports on body image perception among children. The Agency will be collaborating with the Hospital for Sick Children and the Children's Hospital of Eastern Ontario over the next year to analyze existing data to understand the status of eating disorders in Canada and to report on the prevalence, co-morbid conditions and risk factors of eating disorders.
The Government of Canada supports various research programs, such as the Networks of Centres of Excellence (NCE) program, which is administered jointly by the three federal granting agencies – CIHR, the Natural Sciences and Engineering Research Council, and the Social Sciences and Humanities Research Council. The NCE program supports nation-wide, multidisciplinary and multisectoral partnerships to connect excellent research with industrial know-how and strategic investment. The rigorous and highly competitive NCE program selection process functions through a peer-review assessment, a strategic review and recommendation by a selection committee, and finally a funding decision by the NCE Steering Committee. Application opportunities are posted on the NCE website at nce-rce.gc.ca.
In addition, the Government invests approximately $265 million per year through the Canada Research Chair program, to attract and retain some of the world’s most accomplished and promising minds. Approximately 2,000 Canada Research Chairs are awarded through a rigorous peer review process that includes evaluation by external experts, assessment by the review panel, strategic review by the selection board and final approval by the steering committee. This includes the Canada Research Chair in Personality and Health, Dr. Gordon Flett, who is exploring the relationship between perfectionism and psychological disorders, including eating disorders and postpartum depression.
Awareness and Education
The Committee’s Report underscores the importance of awareness and education in addressing eating disorders in Canada. As the Committee noted, advertising to children and promoting education and awareness around eating disorders and the challenges those suffering from them face are critical. In all provinces and territories, except Quebec, industry self-regulation guides the use of various marketing methods. In Quebec, commercial advertising directed at children under 13 years of age is prohibited, subject to some exceptions provided for in regulations. The Government of Canada takes issues related to education and awareness raising around mental health, including eating disorders, seriously and works to ensure its activities reinforce positive health messaging and minimize possible negative impacts.
This Government raises awareness about mental health and mental illness, including eating disorders, through its support of the MHCC. The MHCC is a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues. The MHCC focuses on a broad range of initiatives including developing and promoting a national mental health strategy, knowledge exchange and reducing the stigma associated with mental illness, including eating disorders. For example, through the MHCC’s Mental Health First Aid training program, individuals are trained to provide initial support for someone who may be developing a mental health problem or is experiencing a mental health crisis, including an eating disorder.
Private sector initiatives, such as Bell Canada’s Let’s Talk campaign, are complementing these efforts to reduce stigma associated with mental illness so that Canadians seek the help they need. The Government has brought international attention to public education through our role at the World Health Assembly.
Health Canada’s healthy eating initiatives are purposefully planned and delivered to minimize health risks, such as eating disorders. Every effort is made to provide consumers with positive nutrition messages that focus on health and well-being, and not on weight, as weight preoccupation is a hallmark of eating disorders.
Eating Well with Canada’s Food Guide is likely the most well-known national nutrition resource developed by Health Canada. The Food Guide promotes a pattern of eating that will meet nutrient needs, promote health, and minimize the risk of nutrition-related chronic diseases. In the development stages of Canada’s Food Guide, energy balance was a key consideration in food intake patterns.
In defining normal weights, the Government of Canada follows the best evidence and internationally recognized standards. Health Canada’s Canadian Guidelines for Body Weight Classification in Adults (2003) uses the body mass index and waist circumference to assess weight in adults over 18 years of age. This classification system is aligned with the World Health Organization’s (WHO) recommendations widely adopted internationally. For individuals, this classification is only one component of a more comprehensive health assessment needed to clarify health risk. For monitoring and assessing the weight of infants and children, the Government of Canada recommends the use of growth charts developed by the WHO. These are also promoted for use in Canada by Dietitians of Canada, the Canadian Paediatric Society, the College of Family Physicians of Canada, and Community Health Nurses of Canada.
The Government of Canada is committed to working with provincial and territorial partners in promoting healthy weights in children through Curbing Childhood Obesity: A federal, provincial and territorial framework for action to promote healthy weights. Priorities identified in this framework include increasing the availability and accessibility of nutritious foods.
Through the Canadian Best Practices Portal, the Government provides access to the latest data, resources and evidence that can help inform health promotion and chronic disease prevention efforts. This Portal provides a consolidated one-stop shop that links to resources and solutions to plan programs for promoting health and preventing diseases for populations and communities. The Government also shares reliable, easy-to-understand health promotion information, including mental health promotion, to the public through the Healthy Canadians website. To help raise awareness of eating disorders and contribute to prevention efforts, the Government of Canada will specifically include eating disorders in these resources for Canadians.
In closing, I would again like to thank the Committee for its important work. This report is both timely and highly relevant and it has helped to shed light on the challenges facing us all in preventing and combatting eating disorders among women and girls. I trust this response articulates the Government’s commitment to continue supporting important initiatives to help address these devastating illnesses.
The Hon. Rona Ambrose, P.C., M.P.