[Recorded by Electronic Apparatus]
Thursday, April 18, 1996
.0905 
[Translation]
The Acting Chair (Mrs. Picard): Good morning, everyone.
The first thing to do is to adopt the proposed budget, which will then be submitted to the Standing Committee and the Liaison Committee. We have scheduled six meetings. The suggested expenditures are as follows: $12,000 for 15 witnesses, for an average of $800 per witness; $300 for coffee, at $50 per meeting; and $200 for courier services and miscellaneous expenses. The total proposed budget is $12,500. Who wants to move this motion?
[English]
Mr. Murphy (Annapolis Valley - Hants): I so move.
[Translation]
The motion is carried
The Acting Chair (Mrs. Picard): We will now ask our first witness, Mr. Szabo, to come to the table.
Mr. Paul Szabo, M.P. (Mississauga South): Good morning, Madam Chair.
The Acting Chair (Mrs. Picard): Mr. Szabo, you are the initiator of Bill C-222. You will have approximately ten minutes for your presentation, which will be followed by questions from members.
Mr. Szabo: Thank you, Madam.
[English]
Because of the time constraints I would like to give some point-form input to the committee to give you a flavour of what we're going to be into during the hearings on Bill C-222.
First of all, you should be aware that health warning labels on the containers of alcoholic beverages have been the law in the United States since 1989. Legislation was passed in 1987. It was first discussed in the United States in 1967. In Canada the first time the legislation came up was under Health Minister Marc Lalonde in 1976. A number of attempts have been made to get attention to this bill. This is the first time the bill has reached this stage in the legislative process.
I would like to read into the record the present warning that appears on the health warning labels in the United States:
- Government Warning: (1) According to the Surgeon General, women should not drink
alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of
alcoholic beverages impairs your ability to drive a car or operate machinery and may cause
health problems.
In the end, that is one of the reasons why labelling is going to be so important. Fetal alcohol syndrome occurs in one of five live births. That is more prevalent than Down's syndrome. It is probably one of the least known fetal diseases around. It accounts for one in five birth defects in Canada.
.0910
The law for warning labels on alcoholic beverages has also been in place in the Yukon and the Northwest Territories since 1991. I am sure you'll hear a lot more from the representatives of native physicians on the rationale or the genesis of that requirement in Canada in our northern territories.
The health minister appeared on Tuesday evening on the.AAS news to announce that he was supporting the principle of this legislation. He also indicated to the press that officials would be appearing before this committee to support Bill C-222.
In addition, I received a copy of a letter dated May 23, 1995, from Mr. Paul Ramsey, Minister of Health and the minister responsible for seniors from B.C. I would like to read the first part here.Mr. Ramsey was chairing a joint meeting of all the provincial ministers of health. This was to Minister Marleau. He said:
- I am writing to you in regards to the issue of Alcohol Warning Labels. This was a topic of
discussion at the Provincial/Territorial Ministers of Health meeting held in Vancouver, April
10-11, 1995. There was unanimous agreement that warning labels should be pursued by the
Federal Government.
The reason I have been so strongly supportive of this initiative has to do with the aspects that alcohol or abusive use of alcohol touches in our society. To give you an example, some 19,000 people die each year in Canada from alcohol-related impacts. In terms of additional health care costs, social program costs and lost productivity costs, it costs Canada at least $15 billion a year. Some 2,000 people have been killed in automobile accidents, 10,000 injured in one year, 40% of accidental falls, 30% of accidents due to fire, 30% of all suicides, 60% of all homicides, 50% of incidents of family violence, and one in six divorces - all are caused by direct or indirect alcohol consumption.
These are some of the reasons that have caught my attention and, I know, the attention of many members of Parliament. They are social ills. If alcohol were invented today it would not be a legal product under our current laws. It would require special consideration, either licensing or prescription or something. It is a poison; ethyl alcohol is a poison. Indeed you will find from some of the witnesses, particularly the Canadian Centre on Substance Abuse, that Canadians need these labels because they have a right to know that they are drinking poison. That is the issue. Anyone who has experienced the so-called hangover is experiencing the effect of toxicity or poison in the system. That's what a hangover is.
Madam Chair, the figures, the concern, the social problems, the ills, the cause of divorce, the attendant or indirect ripple effect of family breakdown as a result of alcohol, have many more costs about what happens when a family breaks down. If the cause is alcohol, should that cost a family breakdown and the additional social program costs...? There is also the impairment of the likelihood of positive outcomes for children now living in poverty because the family has broken down. There are so many issues that ripple away from the basic issue of responsible use of alcohol in our society and the fact that it is a dangerous substance.
The industry will come before this committee and they will talk about the good things about their product. They will tell you, among other things, that it's good for your health. They will tell you, as they told me, that if you put on a warning label you are going to scare pregnant women to the point where they will have spontaneous abortions. They will tell you that labels don't work. They will tell you we spend lots of money already, and if you put labels on, we are going to have to withdraw some of the other stuff we do.
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Well, Madam Chair, I can tell you that I'm going to work very hard to ensure that this bill passes and that we don't in fact have a withdrawal of efforts to educate the public about the dangers of irresponsible use of alcoholic products. We're going to have an increase.
The alcoholic beverage industry makes a very, very tidy profit on peddling poison to the public. Alcohol is the only consumer product in our society that can cause you harm and that does not have a warning label to alert the consumer of that fact. These particular initiatives - and I can tell you that there are people from right across Canada who have been working so very, very hard to educate the public on this - are ones that I'm disappointed in. I'm very disappointed with the industry - extremely disappointed.
With my first efforts, when I brought forward a private member's bill, I wasn't given the time of day. They told me I was talking stupid. I'm not talking stupid. Now that the bill has passed second reading, now that it's come... Madam Chair, the fear-mongering that they did in the first instance they're not repeating again. In fact, in their literature, which you have all received, they're saying that Bill C-22 is wrong. They're saying it's wrong. So the lines have been drawn.
But it was important, and members will know that I encourage a full and open dialogue on the subject matter to cover all the bases to make sure that no one could say this was not a fair representation of the facts. I encourage you, however, when the industry comes forward and tells you that in one company alone they'll have to replace all their bottles at a cost of $5 million because of this little label, to come back to them and say that they already add the label to that bottle when they export it to the United States. It is the law. Canadian producers must print the health warning label on the bottles when they are exported to the United States now.
In addition, when the United States, which has had this law since 1989, puts that bottle into the Canadian market, you will see that the label is gone. There is a contradiction here. They're already, on both sides, doing two things. We have some products with a label and some without, both in Canada and in the United States. There's a contradiction here. In fact, there are ways... I would just conclude with the hypothesis, I guess, at this point - because I cannot give substantive evidence at this point on the cost - that with the low cost and the very high and sustained public acceptance of warning labels with the majority believing in their effectiveness, this intervention would need to demonstrate only modest effectiveness for the benefits to outweigh any costs. I repeat: only modest effectiveness. The industry will say ``Prove it.'' I say to the industry, ``You prove to me that health warning labels do not work.''
Thank you.
[Translation]
The Acting Chair (Mrs. Picard): Are there any questions?
Mr. Hill.
[English]
Mr. Hill (Macleod): Thank you, Paul, for your intervention.
As you know, the issue is split between, on your labelling, fetal alcohol syndrome, which is affected by the warning to a pregnant mom, and an equipment and intoxication warning that relates to driving and other things. The problem I would like to place on the record is that many women who do drink when they're pregnant are not educated. They're poor and they're paying no attention to a label of this kind. I would like to place on the record my preference for a label that is a graphic and that shows in profile a pregnant woman, so that no one can misunderstand, with an X across that pregnant woman on the bottle. I would like to hear your comment on such a graphic label, rather than a worded label that can be overlooked by someone who is not articulate.
.0920
Mr. Szabo: I can concur with your sentiment; the issue of fetal alcohol syndrome and the attendant problems of alcohol consumption during pregnancy is my primary point of interest. The others certainly are very important and I think there's a lot of work going on there.
I think you will find that there is research, and others will probably be providing input to the committee about the form of labelling and all the studies that went into the U.S. experience, even the effect of whether the label is on the front, the back, or the side of the bottle, whether it's vertical, horizontal, read up, read down, whether there's a graphic, etc. They have definitely found evidence that the graphics work much better.
However, we live in a society of compromise, and I think you will find, from the research and the U.S. experience, that the accommodation by the industry was more forthcoming without a graphic. I think this is something that should be considered. However, they also said in the research that having a single consistent labelled message was preferable to having a rotating or multi-dimensional message. Keep it simple, keep it focused.
I would refer you to Denny Boyd, who's a columnist for The Vancouver Sun. I thought he did it extremely well. He described warning labels on alcohol containers as acting as a consumer lighthouse, sending out signals of impending danger. We don't have to read the labels.
We receive so many inputs in our lifetime about the importance of responsible use of products that we should not try to encapsulate them all in a small space. It should be simply the proxy for all the knowledge, all the education we have learned throughout our lifetimes. Therefore I would simply say that maybe we have to look at this as part of a bigger, broader solution that's going on and not as something in isolation.
I don't think it's fair to say that labels are a new thing and to ask whether they work or what the experience has been. The problem with that is that you can't prove it. The industry will say you can't prove it with scientific data. The reason you can't do that is that you cannot hold all other factors in the world constant and just change this one thing and then measure the impact. You don't know. If nothing happened in terms of the raw data, the research, that doesn't mean that the impact wasn't positive. All it means is that there may have been some offsetting negatives, the net result of which is no movement, but you could still argue that it was positive.
I think it would be a very theoretical argument to say you can prove anything. All I know is that in the United States, 87% of Americans surveyed supported the health warning labels on alcoholic beverages. In Canada the Addiction Research Foundation similarly did a survey and found that 82% of Canadians support this initiative. When Canadians feel that this is an important thing to do and an investment to make, I think that we as legislators have to listen.
Mr. Hill: I have a second question. You said that one in five birth defects are caused by fetal alcohol syndrome. Can you justify that statement for me, please?
Mr. Szabo: You want a source or a reference?
Mr. Hill: Yes.
Mr. Szabo: I'm going to leave that to the representatives from other agencies who are scheduled to appear before this committee. I have not personally done the research, so from my standpoint it would simply be hearsay. I've relied on others, but those others will now have an opportunity to speak on the public record and I think I'm going to allow them to do that.
The Acting Chair (Mrs. Picard): Mr. Volpe.
Mr. Volpe (Eglinton - Lawrence): Thank you, Madam Chair.
Paul, on the basic principle that what you say is acceptable and that the committee would go forward with it, I'm just wondering how you address the observation made by some that approximately 80% of the alcohol sold is sold in bars and restaurants, where people don't have a chance to see the labels. They're served from other containers. How would your proposal address that?
Mr. Szabo: A number of provinces have attempted to legislate warnings on the walls of the institutions. The initiative in the United States acknowledges the fact that there are many forms of delivering, but they require the label to appear only on the manufactured container. If you have a keg of beer, it will appear on the keg, but the consumer is not going to see it. It's certainly not going to be on the glass.
.0925
Having said that, the important thing here is that sooner or later you will see the label. If it is supplemented and coordinated with other efforts, it will have an ample opportunity to have an impact on the targeted audiences. In fact, research has shown - I know others will comment on this - in the United States that after about five years of experience, the recognition of the labels and the identification of them increased on a straight-line basis.
It continues to grow. It was slow at the beginning, but it has now shown a significant recognition factor. There have been some comments with regard to change in behaviour, etc. It's not enough. I don't think they have enough yet, but it's a start and it's positive. I don't believe that we shouldn't do something because it doesn't simply solve a problem in a short timeframe or isn't totally effective. It is a plus. It adds to the solution, and I think that's extremely important.
Mr. Volpe: Thank you.
The Acting Chair (Mrs. Picard): Mr. Murphy.
Mr. Murphy: I don't quibble at all with your introductory remarks and statistics and so on, but as for the labelling alone, you have said it's a beginning. Have you given thought to more of a matching scenario here, whereby along with the labelling, we would have much more aggressive educational programs out there in the community?
We know that many of the provinces in their taxation take some of that funding and put it toward treatment mostly, rather than education. It would seem to me - I don't even know if this is possible - that the industry and the provincial people who are taking the taxes in from liquor would combine to put educational material together for those people in the health industry.
I think we've made some gains on the cigarette side of things, but it's nowhere near enough, obviously. It seems to me that just the labelling is a start, but I certainly feel that it needs to be expanded. Whether that could be expanded in the context of what you're proposing is the question I ask of you.
Mr. Szabo: I agree with you 100%. One aspect of the research I have done in health generally is that about 75% of every dollar we spend today is spent on curative or remedial approaches, while only 25% is spent on the preventive side. That means, considering today's fiscal environment, that we have a health care strategy and philosophy that is not sustainable.
There has been a conscious effort within Health Canada and the health profession to look for preventive strategies and for more improved productivity of the health care dollar, as it were. There is no question that the provincial ministers of health and Health Canada have looked very rigorously at ways in which we can build on the preventive strategies. This is going to be an important part. I think that it has to be much more than labels.
You have raised the issue of the education side, which involves a number of jurisdictions. One of the things you'll note about the label I'm proposing is that it does not have any attribution to any party.
In the United States, it's a government warning from the Surgeon General. I am not able to put that in a bill and propose it to you, other than that you may want to consider asking Health Canada whether or not there is a possibility that they would attribute this statement to themselves. This would say that Health Canada advises or warns that... I think that gives it a lot more weight.
I cannot propose that. I cannot speak on their behalf. I would ask you to do that, though.
If that is not possible for other reasons, say to do with the controversy over tobacco packaging or labelling or warnings at this time, then I think it would be important for us to consider attributing it at least to the Parliament of Canada. It would say that the Parliament of Canada warns or advises that... This would give it some point of reference or attribution that would assist in giving the message.
.0930
Then it should be supported and encouraged not only by government agencies, but in the private sector and the medical profession, in order to build that educational strategy with a view to prevention, and not on a curative or remedial basis.
The Acting Chair (Mrs. Picard): Mr. Scott.
Mr. Scott (Fredericton - York - Sunbury): Merci beaucoup, madame la présidente.
Congratulations, Mr. Szabo, for bringing this along this far and as capably as you have.
I should point out that we're a lot kinder to you than I've seen you being to other witnesses.
Voices: Oh, oh.
Mr. Scott: Having gone through the exercise of the plain packaging of tobacco, one of the things that occurs to me that we might do better this time has to do with recognizing where we bring judgment and where we would seek outside judgment. This isn't specifically dealing with Dr. Hill's suggestion, but that prompted the question. It occurs to me that there are probably people who would bring sound advice as to the best way to advertise, or unadvertise, if that's the way you would characterize this.
In other words, rather than have us try to decide whether the best way to do this is through some graphic illustration, I'm sure there are people and research to do this. I would recommend that we find out who those people are and seek their advice so we're not sitting here trying to decide, from our limited experience in these kinds of things, which is better, graphic or verbal. I wouldn't have a clue which is better. I'm sure somebody does, but I don't. As we are in the preliminary stages of this exercise, it might be worthwhile to pursue to find out who it is.
The reason I bring it up now is because I know many people have written you and you've been in conversation with others, so perhaps you already know or people have come forward. Is that something you've explored?
Mr. Szabo: I have materials. I'm going to pass on to the committee anything I think is relevant to the questions you've raised or that may become relevant.
There are arguments on the table, though, because it was all considered with the U.S. experience back in 1987, when they dealt with the legislation in Congress. I think you'll also get this from some of the groups that are going to appear here, such as the Addiction Research Foundation, the Canadian Centre on Substance Abuse, and the B.C. Coalition for Warning Labels on Alcoholic Containers. They all have a tremendous resource of reference material on the rationale for doing this, that or the other thing. So I think we should draw on them as much as possible. I would concur.
I want to also share with you that I had made a suggestion to the industry at my last meeting, after we passed second reading. I felt that it was important for the industry to consider very seriously whether they should do this voluntarily, because they are very intimately knowledgeable about this. They fought the battle in the States. They have been continuing to fight the battle in Canada. We even had a committee of this Parliament, or the last Parliament, dealing with this fully and recommending the labels.
They initially told me that they would not do this voluntarily; we would have to legislate it. Once it passed second reading, they said - this was in February of this year - they could not do this voluntarily because if they put out a warning label on their product, that is an admission that they have a dangerous product and it would increase their exposure to legal liability.
However, I found this out just yesterday. I wasn't aware of it, but I am now. We should get this information. The Supreme Court of Canada in December 1995, in the decision Hollis v. Dow Corning in fact ruled that because a business had put a warning on their product to caution people on its use, this in fact mitigated their liability, not increased it.
The industry knew that. They told me something different. I will certainly want to follow up and find out why they would tell me one thing when in fact the Supreme Court of Canada said quite the opposite.
Mr. Scott: I would only say you are as tough a witness as you are an interrogator.
Thank you, Mr. Chair.
The Acting Chairman (Mr. Volpe): Okay, Mr. Scott. Any other supplementaries? Dr. Hill? No?
.0935
Mr. Szabo, thank you for appearing before the committee and sharing your testimony with us.
We now call on the representatives from the Canadian Medical Association and the Native Physicians Association of Canada. Thank you, gentlemen, for joining us.
We have Dr. Barry Adams from the health care and promotion committee of the Canadian Medical Association with us, along with Dr. David Walters, director for health care and promotion. We also have Dr. Vince Tookenay with us, who is the president of the Native Physicians Association of Canada. Did I say your name correctly?
Dr. Vince Tookenay (President, Native Physicians Association of Canada): Yes, that's correct.
The Acting Chairman (Mr. Volpe): Gentlemen, I think you've been apprised of the way we conduct our business here. You can use almost all of your time in giving the presentation or you can give us a short introduction and leave the rest of the time available for questions from members.
Dr. David Walters (Director, Health Care and Promotion, Canadian Medical Association): Thank you for the introduction. We're from the Canadian Medical Association and we at the CMA have had the pleasure of working with Dr. Tookenay from the Native Physicians Association of Canada. He has worked with CMA for the past couple of years on many projects on aboriginal women's health, and of course that includes the topic we're talking about today.
From the CMA perspective, as was pointed out by Mr. Szabo, we at our national association have also worked on the curative side for medical activity, and we have done much work on the disease prevention, health promotion and accident prevention sorts of policies as well. This is key to what we do at the CMA. We're not only interested in acute care or in curative medicine. This is very much the role of the association as well, and we're here today to explore this issue. Dr. Tookenay will do his presentation first and CMA comments will come after that.
The Acting Chairman (Mr. Volpe): All right, Dr. Tookenay, you're on.
Dr. Tookenay: First of all, I would like to thank the committee for inviting the Native Physicians Association to be part of this endeavour.
The Native Physicians Association in Canada does not have a specific policy regarding labels on alcohol containers. We just have not evolved to the level of specific policy statements. However, the Native Physicians Association is of the opinion that alcohol consumption is an individual responsibility and placing a warning label on an alcohol beverage container is alone not likely to prevent someone from using or abusing alcohol.
.0940
I have just a few background statements about that. By the time an individual sees a warning label on the container of alcohol that is about to be consumed, it may well be too late. In fact, in most cases the decision to drink has already been made before the bottle or glass has been purchased. In addition, at this time these individuals are likely to have many other external factors influencing their decision to consume the contents of the container at that particular time.
The Native Physicians Association would prefer to see a continuation and expansion of health promotion and abuse prevention initiatives, primarily those of an educational nature that focus on attempting to change attitudes and behaviours towards healthier lifestyles, to see these initiatives targeting specific segments of the population that are considered to be at a greater risk, and to see these initiatives incorporating private sector funding or private sector partnerships where possible.
The Native Physicians Association believes that there is a need to provide specific information in order to influence the attitudes and behaviours of high-risk populations such as the aboriginal population. To ensure that the message is received, there is a need for facilitating total community participation in the form of soliciting direction and ensuring that the community accepts the program format for the message. The message should be culturally relevant and appropriate.
One such example is the partnership between the Native Physicians Association and the Brewers' Association in developing and implementing the Native Physicians Association ``Caring Together'' project as part of the Brewers' Association of Canada responsible use program. I would like to take a few moments to present this initiative in a little more detail. However, before I do that, I would like to refer to some noteworthy statistics.
First, the aboriginal population is a relatively young population, with almost 40% of the population under the age of 14. This means that a significant portion of the aboriginal population will be entering childbearing age over the next ten years.
Second, the rate of infant mortality, although declining, is still 22 per 100,000 for the aboriginal people. That's roughly twice the Canadian rate.
Third, the estimated rate for substance abuse among aboriginal people, based on treatment centre admissions, is estimated to be somewhere between three to five times the Canadian average.
Finally, teenage pregnancies are estimated to be about three times the Canadian rate.
I think those statistics reflect the background of the Caring Together project, as we feel that those statistics are the realities of life and are not really a study of statistics or comparisons. The number merely reflects the human experience of caregivers serving aboriginal communities.
This experience prompted the native physicians to initiate the Caring Together project with funding support from the responsible use program of the Brewers' Association of Canada. The project, as the name readily implies, is about people caring together for each other. Caring Together was conceived by the Native Physicians Association as a health promotion initiative, developed by and for aboriginal people, and designed to emphasize the importance of care and responsible behaviour during pregnancy.
Also, by creating awareness of the physical and emotional realities of pregnancy, Caring Together can support other educational activities that endeavour to lower the incidence of teenage and unplanned pregnancies.
The Caring Together message was not developed in isolation. Aboriginal caregivers and laypeople were brought together in a series of focus groups in remote rural and urban communities to discuss prenatal health concerns and to recommend ways to inform aboriginal people about these issues. Their response was clear: traditional aboriginal values and customs that were once set aside can now help protect aboriginal children. The focus group believes that these ideas should be shared with all aboriginal people in a culturally meaningful and engaging manner.
I should note that the Native Physicians Association cannot speak for all aboriginal people and has no intention of doing so. However, it is noteworthy that during the Native Physicians Association consultation process and focus group exercises, there was no mention of warning labels as a deterrent for misuse or abuse by any of the participants, and that was over the last several years. I can't explain that statement, but there wasn't.
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Caring Together is the Native Physicians Association response to the needs identified by the focus group, and the Native Physicians Association has been guided by the thoughts of community participants throughout the project.
First, we developed two wall posters, a table display poster, and a handout of information cards that were available through the display poster. They were produced to create awareness of prenatal health issues and to share the Caring Together idea. These posters were distributed to aboriginal health care facilities, first nations people and native friendship centres across the country. A total of about 11,000 of these posters were sent out. They were also placed in several liquor stores and brewery outlets, primarily in the western provinces.
The message on the posters is a simple one. For the expectant mother it's ``Think of your health and lifestyle and be sure to seek the advice of a caregiver''. For the partner, family and friends it's ``You can influence for the better the health and well-being of the expectant mother and her unborn child''. The message from the Native Physicians Association of Canada recommends no alcohol be consumed during pregnancy.
Recently, on the last day of February this year, the Native Physicians Association released a production of the Caring Together video and a discussion guide. Through these products, the Native Physicians Association offers an information tool to caregivers that will help communities talk about prenatal health care and provide culturally affirming health knowledge to young prenatal women, their partners, families and friends.
Caring Together means sharing knowledge and creating awareness among aboriginal youth, so they will be better prepared to make informed decisions about health and lifestyles during pregnancy.
At this time I would like the committee to view a roughly two-and-a-half-minute abstract of the video.
[Video Presentation]
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Dr. Tookenay: The total length of the video is about 31 minutes. A copy will be left with the clerk, along with other reference material for this project.
I would like to thank the committee again for allowing us to participate.
Dr. Barry Adams (Member, Health Care and Promotion Committee, Canadian Medical Association): The Canadian Medical Association, unlike the Native Physicians Association, does have a position and a policy statement on alcohol beverage labelling. There have been several statements in the last few years about alcohol-related problems, and these have been included in your handout.
Since I've already distributed the brief, I won't say too much about what's in there so we'll have more time for questions after.
I would like to point out that the Canadian Medical Association regards alcohol use and the problems related to it as a major concern to Canadians. We feel a comprehensive program has to evolve to deal with this. It must be preventative and educational, as well as curative.
Alcohol is probably the most common drug of dependence used in North America. It is physically damaging - probably only secondary to tobacco - and we have used educational information and warnings in the tobacco field. There are many physical effects from alcohol use, both to the user and to the offspring of the user, and these have been well documented. There are many social issues related to alcohol use and abuse as well.
On the basis of all these issues that relate to patient and society health, the Canadian Medical Association recommends a very comprehensive program to encourage responsible alcohol use. This comprehensive program should include education to encourage, promote and maintain abstinence and low-risk drinking as part of a healthy lifestyle. Educational programs should be focused particularly at youth, as well as the general public, to make them aware of the personal and societal hazards of alcohol use.
As part of this broader education program, the CMA believes that labels on alcoholic beverages sold in Canada should contain warnings about the health and social consequences of the use of alcohol. These warnings could point out the risk to the drinker's physical health, the impairment of the drinker's ability to drive or operate machinery, the hazards of alcohol use during pregnancy, the addictive nature of alcohol and other associated risks. These warnings could be succinct. Help in comprising what they say could certainly be given to the industry.
Both in the tobacco area, where labelling has occurred, and in the United States, where labelling of alcoholic beverages has occurred, information has shown some decrease in the amount of drinking, and at least awareness by the public of the problems associated with it. Therefore, the Canadian Medical Association really encourages the speedy enactment of Bill C-222. We are on record, in our statement on fetal alcohol syndrome, as urging the Canadian governments to enact legislation requiring alcoholic beverages sold in Canada to be labelled with warnings of the hazards of consuming alcohol, especially during pregnancy.
We'll answer any questions. Perhaps Dr. Walters has something else to add.
Dr. Walters: I have a few additional comments.
.0955
The current situation is that a number of states and two territories in Canada have explored the use of labels on alcoholic beverages. In large part in the data we've seen it's very difficult to pin down actual proof of what change in behaviour this labelling by itself produces. However, there is some reasonable evidence that it can be at least very visible and very popular with the public. The public probably thinks it works. They're aware of it in situations where this has been tested.
In our minds it's something like the analogy of the tobacco warnings. Again, it was a tremendous battle to get these warnings even thought about. Then they were designed in small print, and it became the small print of warnings. Then we've escalated this to realize we need these to be visible and large-print warnings, taking up a sizeable message at every opportunity there is to see a label, to see an advertisement, etc. We've made tremendous progress on that, and that has been a battle of public health really for twenty or thirty years - in fact, thirty-five years - until we became aware of the major health hazards.
In the progression of what we do in public health in arguing for messages, I think this is a critical message. A warning of a hazard is a critical issue. It may seem as if this in and of itself not fully effective, and we don't pretend that it is, but a warning of a key preventable illness or disease, in this case, is absolutely fundamental. So it's not a light issue of whether this little piece of paper works or doesn't work. It's a fundamental issue, we believe, of public health ethical obligation.
As far as we can see, having looked at this, there is absolutely no reason not to do this. We have not found a good reason not to do this.
It's a universal message. It's the most common one everyone will see. It's an educational launching pad. Just this event, bringing this simple proposal forward, is one of those simple, cost-effective launching pads for major educational progress on the issue, and we think it could be universal. If you've come to a sharp curve in the road, why wouldn't we put up a sign saying there's a sharp curve in the road? Everybody accepts that. Every driver will see that. It's the same issue.
The cost of doing that is literally a drop in the barrel of beer or liquor. It's not something that can't be done. You have labels. You have labels with a lot of information. They put them on the front of bottles, on the back of bottles, on the side of packages, on the front of packages. All sorts of money is spent on this. A simple warning is probably a drop in the bucket.
Another issue we've talked about is whether it influences the individual as they look at the bottle. Do they look at the label? Is that too early or too late?
I think there's a whole group of people around the individual - it could be the family, it could be the friends, it could be and should be the partner - who also, seeing that warning, may say wait a minute here, is this the best thing to do, to encourage this? Perhaps, being reminded of this label, they can be influenced in the direction of the appropriate behaviour as well.
So there are a lot of reasons why labels could and should be a fundamental public health message on this issue. We would like to see this prevented, if at all possible.
[Translation]
The Acting Chair (Mrs. Picard): Are there any other questions?
Mr. Scott.
[English]
Mr. Scott: Thank you very much for the presentation.
I'm curious whether any consideration has been given - and I suspect you are the group or organization that might have done this... As we seem to be heading down the road of the government accepting some responsibility for bringing to the attention of the public the ill effects of consumption of tobacco, as we mentioned, and alcohol, has any research been done on the cross-consumption benefits? In other words, if we explore this mechanism to bring health problems related to the consumption of certain things to public attention, to some extent I suspect you're going to get to the point where your labelling itself will have a tendency to bring attention to the relative good and bad qualities of these things. Has anybody done anything about that as a benefit as well?
.1000
As compelling as your argument might be, that there simply seems to be no reason not to do this, the fact of the matter is, when you mention the sign of the curve in the road... I have a constituent who calls me regularly trying to get a curve sign taken down on the grounds that it's a distraction and people are going off the road.
Dr. Walters: It sounds like an unusual constituent.
Mr. Scott: All my constituents are unique.
The point I'm making simply is that because something seems to be so logical as to be compelling doesn't necessarily always lend itself to that. I'm curious if there isn't some argument that might be made for the fact that the cross-application of these labels in itself will bring some benefit.
Dr. Adams: There are several studies now in different states where there has been labelling on alcoholic beverages for some time, and they showed that the awareness of people did improve, but it took a few months after the actual labels went on before people said they noticed them. There has been a decrease in the amount of alcohol consumed in certain groups, and they attribute it to the labels.
As Mr. Szabo said earlier, you can't say it's definitely attributed to the labels, because you can't put everything else at a standstill. There are educational factors as well.
The other statements that have come out of the literature I've read is about the media input. Advertisers are talking about how the institution of the labels had an awful effect as well, in that it brought people's attention to the problem of alcohol and alcohol-related problems, so that even if people didn't read the label, the media attention that came about as the labels were added to the products did have a beneficial influence on changing their ideas and behaviour about alcohol.
Mr. Scott: Thank you, Madame la présidente.
The Acting Chair (Mrs. Picard): Mr. Szabo.
Mr. Szabo: Thank you very much, doctors.
The statement has been made that fetal alcohol syndrome is a 100% preventable disease. Would you agree with that?
Dr. Adams: Yes.
Mr. Szabo: Would you also agree that low levels of alcohol consumption can lead to, among other things, allergic reactions and adverse pregnancy outcomes?
Dr. Adams: I don't think anybody has stated - at least I have not read any scientific literature that states - at what level the fetus becomes involved. I guess allergic reactions to hops or other things could occur in a person taking alcoholic beverages, but again, I am not aware of scientific articles stating that.
Mr. Szabo: The medical profession probably should be on the record to comment on the susceptibility to problems during various stages of pregnancy. I don't want to lead you on this, but is there a period during the pregnancy...? And what is the medical profession doing or what can it do to assist women who are planning a family, etc., leading towards that preventive approach? What are we doing now?
Dr. Adams: This has to involve an entire group of people, not only physicians. Any person involved in the care and advice to a young mother has to be aware of advising them on the ideal way to conduct their life during that period prior to conception and during the pregnancy itself. The video pointed out a lot of these features. It ought not to be only during the monthly visit to the doctor that they get some positive reinforcement about healthy lifestyles - it has to be during the entire pregnancy.
The time for teratogenic effects on the fetus is in the early part of the pregnancy, but it has been shown that the effects of alcohol are a problem throughout the entire pregnancy as they relate to the fetal alcohol effects rather than to the total syndrome. This is the poor performance in school as the child goes on, and so on. These are thought to be possibly occurring in the later stages of pregnancy. Therefore the effects of alcohol in pregnancy are not only in the first three or four months, as with viral infections and some other things.
.1005
It's an educational problem. Most of our mothers now are attending prenatal classes. They are contemplating when they are going to have a child, so they ask questions before they become pregnant. Years ago you became pregnant and then you thought about what you were going to do.
The only population in which this doesn't occur is the young unwed mothers, but, again, educational programs in the schools are addressing these problems. But we have to make them aware all the time of the need for a healthy lifestyle, especially in the childbearing age.
Mr. Szabo: Finally, do you have any statistics on birth defects and what percentage of these are a result of alcohol consumption, either FAS or FA?
Dr. Adams: We can get the statistics. I looked through my document on the working group that I attended on fetal alcohol syndrome. It went into the prevention, but it did not specifically say that. A high number of abnormal children are born with fetal alcohol syndrome, but I can't tell you the exact percentage.
Mr. Murphy: Dr. Tookenay, you mentioned your Caring Together project. Did you say that the Brewers' Association and yourselves did a combined -
Dr. Tookenay: Yes, it's a partnership. It's part of the Brewers' Association responsible use program. We have a partnership. They serve as the funding group and we provide the information from the aboriginal community and develop the message and the materials for the aboriginal community, which really relates to the outline to which I referred. It's a continuation and an expansion of the health promotion initiative, suggesting that there is an identification of a target population with specific problems in a high-risk group and that these initiatives incorporate the private sector funding or private sector partnership. We've actually gone through that.
Mr. Murphy: What I'm getting at is that the Brewers' Association obviously weren't adhering to the message that your liability goes up if you admit there's something wrong with the use of alcohol. Either you twisted their arms or... How did they come on side?
Dr. Tookenay: As part of the partnership, we at the Native Physicians Association had indicated that our basic message is really that there should be no alcohol consumption during pregnancy. Starting from that point, we were able to work with the Brewers' Association to be able to develop focus groups to solicit the messages that the community wanted to hear, and also the vehicle that they would like to hear them in, so that the format is appropriate.
Mr. Murphy: It sounds to me as if you have a model there that is transferable and very usable. I think it's very useful. Thank you.
Mr. Hill: Dr. Tookenay, in my own experience from living near two big native reserves, one of the problems was the illiteracy of many of the women who came to me. That's why I struggle with the idea of a label that is complex.
Would you comment on the likelihood of a graphic having more impact on a native woman who has an alcohol problem and is contemplating pregnancy or is pregnant?
Dr. Tookenay: For the illiterate portion of the population, certainly a graphic without any writing would be helpful to get the message across. But I think a more effective approach would also be to supplement the label, if that's the approach, with a specific educational program that an organization such as the Native Physicians Association can develop. The message would be facilitated at the community level by health care providers in the community - and they would not necessarily be professional health care providers, they could be educators or community representatives - so that the female population and especially the at-risk population would be very aware of the potential negative outcomes of alcohol consumption during pregnancy.
.1010
Mr. Hill: One of the posters that I saw and that your association has been involved with did have a graphic on it, and the graphic was quite specific in this way. Obviously this must have been something you considered.
Dr. Tookenay: I don't think that was really our poster. There may be another poster, but I'm not sure of the graphic. The only graphics we really have on the posters that we have put out have been referencing logos, and that certainly wasn't... I have copies of them here. Perhaps you're thinking of something else.
Mr. Hill: Maybe I hooked you together with this particular...
Dr. Tookenay: I'm sure there are several aboriginal organizations that are involved in these initiatives, but not necessarily related to our project.
Mr. Hill: Would you say there is any safe amount that a woman should drink when she is pregnant?
Dr. Tookenay: My response to that is to not necessarily give you an absolute number. The problems associated with alcohol during pregnancy could be totally eliminated by eliminating drinking, and I think that's the only message that one can give. To say there is a certain amount of alcohol that's safe is not... I think the complexities of pregnancy and the complexities of fetal growth and development are not sufficiently studied to indicate any level of safety. So the message really is one of no alcohol.
Mr. Hill: So no drinking when pregnant. To my other confrères, I see a nod to that.
Dr. Tookenay: Yes.
The Acting Chair (Mrs. Picard): Mr. Volpe.
Mr. Volpe: Dr. Tookenay, I wondered whether I heard you correctly in your presentation. Did you say that 40% of the aboriginal population is under the age of 14?
Dr. Tookenay: That's correct.
Mr. Volpe: Once more?
Dr. Tookenay: That's right, which is indicative of the extent of the risk of that particular population.
Mr. Volpe: I agree there, it's indicative. The age of 14 just seems to be an extraordinarily young age.
Mr. Szabo: It's not an ancient population.
Mr. Volpe: So it would appear.
I have an example of a ``Caring Together'' label that you had. It makes two references to drinking: one is drinking, and the other one is not drinking. In your presentation, I thought I also heard you say you really didn't think that the kind of labelling that this legislation is suggesting would actually fulfil a function. You make some reference to it, but why wouldn't this go on - rather than saying ``drinking'', mention ``alcohol''? I realize some people think they are one and the same thing.
Dr. Tookenay: The message was derived from our focus groups, and this is the way the aboriginal community would prefer to hear it. It's not necessarily what the Natives Physicians Association would put out, but we do base all of our output on information from the focus groups, and that's the message that was...
Mr. Volpe: You just answered a question by my colleague opposite regarding the safe amount of alcohol. I wonder whether Dr. Adams might answer a similar question: Is there a level of consumption of alcohol among pregnant women that's...?
Dr. Adams: As I mentioned to Mr. Szabo, the scientific literature on this has not come up with any particular amount. But the consensus of the profession and others caring for pregnant women is that no alcohol during pregnancy is probably the best message to get across.
.1015
Mr. Volpe: I'm going to take a leaf out of Dr. Tookenay's response and float something by you, just for your reaction. Just a moment ago he said that the focus group from the aboriginal community suggested that they use the word ``drinking'' as opposed to ``alcohol'', because that's how the native community sees this issue. In your view, what do you hear when you hear the word ``alcohol''? Does that include wine?
Dr. Adams: Yes.
Mr. Volpe: You make no distinction for those cultures that use wine not as a drink you buy at a bar but as something you have with your meals?
Dr. Adams: When you talk about alcohol, you're talking about wine, beer, and spirits. The consensus is that any of these in any amount during pregnancy is not recommended. There's been no scientific evidence that says that if you have one drink the week before you know you're pregnant it's going to be detrimental, but the message you want is to try to get away from the feeling that a drink here and a drink there is okay. That's why you say no drink. There are no figures that say that one drink is detrimental or that two drinks are detrimental.
In fact, this was one of the problems at the workshop we had where we were coming up with a consensus statement. We brought together different groups from across Canada to look at fetal alcohol syndrome. The native positions were represented there, and we could not agree. Some people wanted it absolutely zero, and others said a drink here or there wouldn't hurt, but the consensus is that the message you want to get to pregnant or potentially pregnant women is that drinking anything during pregnancy is not recommended.
Mr. Volpe: It's a laudable approach. What I was aiming at is whether the premise for some of those studies or some of the conclusions was based on the fact that alcohol always means the consumption of spirits and always means a consumption that is associated with anything other than usual dietary practices.
Dr. Adams: I guess if it's your custom to have half an ounce of sherry or a tonic containing sherry before meals, then you consider that medicinal. I wouldn't know whether that makes that much difference. But again, if that were the usual policy of one of my patients, I would say maybe you should take a different vitamin preparation during pregnancy instead of the tonic with 14% sherry in it, or something like that.
Mr. Volpe: Or taking half a glass of vinegar in order to help break down the fibres as you eat your meals.
[Translation]
The Acting Chair (Mrs. Picard): I am sorry, Mr. Volpe, but there are only a few minutes left.
[English]
Mr. Scott: It occurs to me that we're talking about some kind of social marketing here, with behavioural change and so on. Have either of the organizations given any consideration to a very targeted approach? The bill in question refers to pregnancy and operation of machinery. My colleague has talked about a graphic that would only attend to half of that equation, at least so far as he's brought it forward.
Have either of your organizations taken a position that might be a more effective social marketing exercise to very specifically target pregnancy? I'm not gesturing an opinion, I'm just curious because all of the discussion up to this point has gone in that direction. I think the public seems more or less likely to know about operation of machinery, if only by virtue of the attention that's been brought to drunk driving. Have you a position on this?
.1020
Dr. Adams: I can't speak for the Native Physicians Association, but the Canadian Medical Association is on record as saying this is a comprehensive educational problem that has to be broad-based to affect all of the potential problems related to alcohol use. And fetal alcohol syndrome is only one of those. But we are on record as having concern about all alcohol-related illnesses.
Dr. Walters: I have a comment. I think maybe we're getting ahead of ourselves in respect to designing right here specific social marketing campaigns. However, from past experience, very often you see effective compaigns, perhaps sometimes on the opposite side. For instance, the tobacco industry is very heavily targeting youth with its Joe Camel type of ads. They know they are doing this, but they deny it.
In Canada, as Dr. Tookenay has pointed out, we've had some good projects with the industry itself promoting responsible behaviour. The industry knows a lot about and can rally a lot of forces, hopefully in the right direction, in terms of social marketing. I've been at combined meetings of the liquor organizations and the control organizations in Canada. They have some excellent campaigns directed at university youth, for instance, to moderate drinking and cut down on alcohol consumption. We know how this goes if we've been there. It has had a big effect. It is very visible and sends very powerful messages to the university community.
I think that sort of design thing can be a follow-up to this warning on labelling. I like the idea. Here's something new. It's a powerful message from government and it can get some of these engines going. I think if the industry, the profession, the social marketers and the educators can get together on this, it would be excellent.
[Translation]
The Acting Chair (Mrs. Picard): I want to thank our witnesses for their interesting presentation. The Committee will take into account your statements and we will send you our report.
We will have a five-minute break.
.1022
.1029
The Acting Chair (Mrs. Picard): We now have the pleasure to welcome representatives from the British Columbia Coalition for Warning Labels on Alcohol Containers. Good morning. You have ten minutes for your presentation.
[English]
Mr. Art Steinmann (Executive Director, Alcohol-Drug Education Service, British Columbia Coalition for Warning Labels on Alcohol Containers): Good morning. Thank you for the opportunity to be here today. My name is Art Steinmann and I am representing a coalition that our organization put together on this question.
I also bring greetings from Dr. Stan Wilbee, who is an active member of our coalition and would have been here today except he's in Croatia. He sends greetings to the committee and to the staff.
.1030
I'm speaking as executive director of the alcohol-drug education service, as a parent, as a teacher and as someone who has been involved in alcohol and drug education and prevention for about twenty years.
Our agency and I personally have overseen the development and implementation of many preventive education programs, print and video packages and training materials for children, parents, teachers, ethnic groups, police, women and others. Our interest in labels stems partly from the fact that education by itself is not going to address the whole problem, although I'm all for more education.
Some of the members of our coalition include the B.C. Association of Social Workers, the B.C. Automobile Association, the B.C. Council for the Family, the B.C. Epilepsy Society, the B.C. Federation of Foster Parent Associations, the B.C. Healthy Communities Network, the B.C. Home Economics Association, the B.C. Medical Association, the B.C. Nurses' Union, the B.C. Pharmacy Association, the B.C. Principals and Vice-Principals Association, and on and on. About eighty organizations are a part of this coalition and are supportive of our position statement on labels.
We have prepared a brief, which will be tabled. We'll make sure all of you have copies of it.
In it we refer to research. I'm not going to spend too much time on that, but I'll simply point out that here are some of the research articles we have on this topic and here is a binder of research abstracts. We've come up with about 140 articles that mention alcohol labels in some form, and that's just alcohol labels. There's also a large body of research on other forms of labels of other products.
Basically there is research to show that if labels are specific and credible, they do work. Interestingly, some of the U.S. research has found that homeless people, heavy drinkers and women do report reading the labels, do report retaining it, and actually report changes in behaviour as a result of labels. That is documented.
Also on the topic of research, I'd like to make the point that in our opinion we don't need more research. The time now has come to act. In Canada we were meant to do some pilot tests on warning labels some years ago, and that never happened. It never got off the ground for a number of reasons.
Right now Ontario is a control group for U.S.-based research, and I hope very soon the day will come when Ontario is not a control group because they have warning labels and can no longer be used in that fashion.
Alcohol causes massive costs to our society - about 19,000 deaths a year. If a 747 jet crashed every eight days all year-round with no survivors, that's how many people in Canada die each year related to alcohol. There are about fifty deaths a day - two deaths an hour. So while this committee is meeting, there are people who are suffering and will die as a result of the use of alcohol.
What I'm getting at is there's an ethical imperative here. We have to do everything we can to address this situation.
I'd also like to point out that in addition to the deaths, there are many injuries and many cases of fetal alcohol syndrome and fetal alcohol effects on people.
I'd also like to point out that binge drinking and periodic drinking cause tremendous problems. It's not just chronic alcoholism. There are teenagers who get pregnant because of one night when they had something to drink and made some poor decisions. There are teenagers who die on our highways, as we all know. There are people who incur very serious damage to their fetus because of one binge-drinking episode. So we're not just talking about the chronic, long-term alcoholic.
Labels are widely supported. Warning labels on alcohol are a popular notion, and I would suggest to you they're a winning ticket: 82% of Canadians support labels.
In 1988 all the ministers of health in Canada made a motion to then Minister Jake Epp to put warning labels on alcohol containers. They were all unanimously behind it. I would encourage you to check the minutes of the ministers of health meeting in Quebec City in 1988, because they should make reference to that. Unfortunately it never came to pass at that time.
The growth of the membership in our coalition has been impressive. We have been amazed at how many groups are supportive, interested and concerned about this topic. Also, our work was happening independent of Paul Szabo's work, and there are others across Canada who are working independently on this issue.
.1035
In the U.S. there's also broad support for labels. I believe it's plateaued at about 91% who support warning labels, and they've had them since 1989.
The Yukon got tired of waiting. It put its own label on - this little yellow label here. It has put that on at its cost, and it has added it after the product is already manufactured. That's how strongly it believes in this issue, and I think it's unfortunate that it has to take those steps. I hope that before long every product in Canada will have the label right on the bottle.
There are lots of other examples of warning labels on many, many products, and I could take a lot of time to show you the American labels. We've already talked about tobacco, but it's not just alcohol and tobacco. This is a warning label from a snow board. It's warning people about the hazards and how to use a snow board. There are products that are far less toxic than alcohol that have much heavier warnings, labels, and regulations than alcohol.
I also think it's dramatic to note that, as we sit today, governments, our own included, are considering banning cheese. I understand that in California 29 people have got ill, they believe because of cheese, and they're thinking of pulling that product off the shelf. One group is arguing that instead of doing that, put a label on it. I think the reason is that people know labels do work. People do read them.
So while we're thinking about banning cheese when we have not had one documented death in Canada, and we will have, just since we've been talking this morning, 50 deaths today, just in Canada, from alcohol alone, I think it's imperative that we do everything we can to address this.
I'd also like to comment that I doubt that the manufacturers of bleach and many, many other products were consulted or asked whether they would like a corrosive warning label on their products.
The alcohol industry has a place at these discussions. It needs to be involved. But I caution you not to put it in the driver's seat. It has a vested interest. From a health and social standpoint, you need to be consulting with people who can help you with those concerns, and I think it's too much to ask the liquor industry, whose goal is to sell more alcohol every day and every year, to enthusiastically get behind you and give you the type of wording and type of warning that you think is going to do the job.
In the last year for which we have statistics, 966 Canadians died an alcohol poisoning death - toxic alcohol. I don't have data that breaks that down, but based on my experience, I will submit to you that of those 966 deaths, the vast majority did not know that alcohol can kill you in one single session by drinking too much too fast. They didn't know it was toxic. I would also suggest to you that most of those deaths would likely be of young people. I base that on my experience in which I have had teachers phone me and say ``Art, guess what we did today. We just got back from the hospital. A grade eight kid is dead because they binged on alcohol and drank too much too quickly.''
We are not talking about some abstract concepts here. There are almost three people per day in Canada who die from poisoning themselves with alcohol. There are seniors who do not know that mixing alcohol with sedatives, barbiturates, and tranquillizers increases the effect fourfold, and they accidentally overdose and kill themselves.
I believe we are doing a tremendous disservice to kids in our culture to assume that somehow they'll pick up the notion that alcohol might be dangerous if you drink too much too fast. Kids today in our schools, thankfully, are trained to read labels. There are classes where they hold up samples of the different warning signs and what they mean. What that does is prepares kids to look for that and to expect that, and I would suggest to you that there's a whole culture coming through now who are trained to look for labels, and if we do not have warning labels on alcohol, it's suggesting to them that somehow it isn't dangerous.
What is the cost of one life? What is the cost of one kid? I'd also like to point out that it's entirely possible that one mother who has a fetal alcohol syndrome child and did not know that alcohol could cause that may not only sue the liquor industry, but also may attempt to sue the government. I think it would behove the government to try to head that off at the pass with alcohol warning labels.
.1040
I've said that I've been in alcohol education for 20 years. I'm trained as a teacher. I'm here to say that we need a multifaceted approach. Alcohol labels by themselves will not solve the problem, but neither will alcohol education by itself.
If you've had a chance to look into preventive alcohol strategies, there are four main ones: education; competence development, which is skill development, teaching people decision-making, refusal skills, how to handle social pressure; controls, which includes everything from taxes to availability to hours of sale, all of that; and environmental design, which is making an environment that's supportive of making healthy choices. We need strategies in all these areas.
Labels are popular and inexpensive. They could be implemented at no cost to the government and they could be done quickly. They serve as a continual and repeated reminder to people.
Labels are a population health approach. I urge you to be careful of your expectations of labels, even though there is some good evidence to show that they have effect. The main point I would like make is that it's an issue of consumer consistency, of marketplace consistency. We owe it to the consumer to put the information right on the product. Because it is a population approach it takes a broad approach, trying to reach the whole population. It does that over time.
We cannot assume that all people know about the hazards of alcohol. There's plenty of evidence to show otherwise. The knowledge out there is uneven. People are misinformed and there are myths. I get many calls from people who are surprised that after they've had a few hours of sleep they are still intoxicated. They don't understand that alcohol is metabolized at the rate of about one drink in one hour. Nothing you do - coffee, sleep, cold showers or anything else - changes that. This is basic information and we're losing many lives because that information is not common knowledge. There are young people coming through who don't know it, there are seniors, there are women. We need to get on with the job.
I'll come to a conclusion by referring to some of the comments. People will say that labels are -
[Translation]
The Acting Chair (Mrs. Picard): I would ask you to conclude. There is hardly any time left and we would like to ask questions.
[English]
Mr. Steinmann: All right. I'll just end by saying that this issue needs federal action. The provinces cannot act unless you act. It's not fair to expect the liquor industry to do something different for every province. I hope you will take this chance to act and that very soon we can see a reduction in the loss of lives.
I'd like Betty MacPhee to comment if she can.
Ms Betty MacPhee (B.C. Coalition for Warning Labels on Alcohol Containers): Thank you. I'm aware of the shortage of time, but I wanted to respond right off the bat to one of the comments about drinking during pregnancy, socially. As Dr. Chris Loock said to me, we need all the IQ points we can get. If the brain develops throughout pregnancy, it is a consideration.
Thank you very much for this opportunity. I am very nervous. My name is Betty MacPhee. I am a registered social worker and the manager of YWCA Crabtree Corner. I am also a member of the Canadian Centre on Substance Abuse, the FAS Advisory Board, and the B.C. FAS Resource Society.
I'm pleased to say that in 1995 Crabtree Corner received the medallion of distinction from the Canadian Centre on Substance Abuse for our community-based FAS work.
I'd like briefly to describe Crabtree Corner, where I work, to put my comments into context. I am aware of the shortage of time.
The families that come to Crabtree live in poverty; 80% are first nations women. Their housing consists of hotel rooms, rooming houses or shared apartments - all substandard housing. The third week of every welfare cheque month, the family runs out of money for food, diapers, formula and bus money. TB, hepatitis and HIV-AIDS are all daily realities, as are needles and condoms on the streets. The neighbourhood is both a vibrant community and a violent place to be bringing up children.
Each month we see approximately 115 individual children from the age of six weeks to their sixth birthday. A third of the children who attend our day care are children with special needs, due primarily to maternal use of alcohol and other drugs during the mother's pregnancy. This information has been documented and I can provide all of it.
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In our little postal code or census track, the studies showed that 46% of all the babies that were born had been exposed to maternal use of alcohol and drugs. This is a very high percentage. It's estimated now that each child during its lifetime will cost $1.5 million going through all the systems, which unfortunately often includes jail.
In 1992 I appeared before the standing committee on the subject of fetal alcohol syndrome. At that time I recommended a multi-strategy approach, which, I'm pleased to say... In reading the comments from December - and Madame Picard mentioned it a couple of times - I noticed some points about multi-strategy education: protocols for pregnant women; target of percentage of corporate and government revenue from alcohol sales to be designated towards FAS; mandated warning signs on all establishments; and finally, mandated warning labels on all alcohol containers. I think you have to have multiple strategies to attend to this, to begin educating the generations that are coming along. It does take, I think, a generation for change to start to happen.
In 1992 I stated:
- I have great difficulty understanding the reluctance of the alcohol industry to label their
products. ... Every woman has the right to be an informed consumer. Every woman should
know there is no known safe amount of alcohol to drink when you are pregnant.
- It seems ludicrous that alcohol beverages exported from B.C. and the rest of Canada to the
U.S.A. have had warning labels for two years, but the same bottles in our stores do not.
The Acting Chair (Mrs. Picard): Mrs. MacPhee, would you please conclude.
[English]
Ms MacPhee: Okay, I will conclude with my own personal story. This is difficult for me to read, but I would like your patience and the time. It will only take a minute.
I would like to tell you briefly of my own personal experience with FAS. In 1988, I began to come to the conclusion that my first-born child was fetal alcohol affected. I worked throughout my pregnancy, ending my workday with a commute to my middle-class home in the suburbs. During the meal preparation, I often would have a drink. I was vigilant about not taking any medication and had quit smoking prior to my pregnancy. During my pregnancy, I asked my doctor about alcohol. In 1968 and 1969, his knowledge was that a couple of drinks a day were fine.
My son Jeff was born on February 11, 1969, a healthy baby. He appeared bright; developmentally, he kept up with his peers. His attention span was very short, however, and he was a very busy child. I rejected the term ``hyperactive''. By the time he was three, he had had stitches three times. He was fearless and did not seem to learn from his falls.
In grade two Jeff was identified as learning disabled and he repeated that grade. The painful years of testing, learning assistance and special education classes began. During this time, I worked very hard to be an advocate for him in the school system, and I also tried to help him maintain his self-esteem. He told us when he was 16 that after watching a Public Broadcasting System program on learning disabilities, he sat and cried.
With much support, he completed high school at age 19. He began working in construction. His well-developed social skills, his charm and wit made hiring easy for him, plus he had a résumé at the ready that masked his grade four reading level. Stating that he wanted to build his own house some day, he worked his way through the sub-trades, but he was often plagued with on-the-job accidents. Again, I suspect a lack of judgment. He fell off roofs, he put a nail through his hand with a nail gun, objects landed in his eyes, etc. Through all this he maintained a cheerful attitude, often working twelve hours a day.
On July 5, 1990, Jeff attended a friend's party in the suburbs -
[Translation]
The Acting Chair (Mrs. Picard): Mrs. MacPhee, I understand that delivering this testimony is very emotional for you, but we have to leave the room soon and there won't be any time left for questions.
[English]
Ms MacPhee: Okay, but I want to finish this.
[Translation]
The Acting Chair (Mrs. Picard): You have half a minute. That's all I can give you.
.1050
[English]
Ms MacPhee: On July 5, 1990, Jeff attended a friend's party in the suburbs where he lived. During the evening he took four prescription pills that were being passed around. The other kids took two pills. Jeff didn't read the label because he couldn't read it. The pills were slow-acting morphine. He died of an accidental drug overdose. He was 21 years old.
I have shared this very private story to emphasize that this isn't an academic exercise for me. As a very conscious pregnant mother, I had the right to know that alcohol could damage my child. I believe Jeff's death was connected to his birth.
I urge you to use your position on this committee to advocate for the right of every parent to have the knowledge that when you are pregnant there is no safe amount of alcohol to consume.
Thank you.
[Translation]
The Acting Chair (Mrs. Picard): Are there any questions? Thank you, Mr. Steinmann and Mrs. MacPhee. I apologize for rushing you. We are not acting in bad faith, but unfortunately we have to go by our schedule and we have to leave the room in a few minutes. Thank you.
You have a question?
[English]
Mr. Szabo: I would like to thank you both very much for taking the time. I know how hard you've worked. You're in B.C. How many people in B.C. are involved in the FAS issue or movement in B.C.?
Ms MacPhee: There are 70 agencies on the warning label issue. I think we've worked very hard to put FAS on the map.
Mr. Szabo: And you have, very much so. How many people would those agencies touch? Does B.C. as a province know about FAS?
Ms MacPhee: Yes.
Mr. Szabo: Are you aware of the awareness level in other provinces on a comparative basis?
Ms MacPhee: Yes, I am. I think Ontario's starting to have better knowledge and programs. Saskatchewan has some. I was just in Edmonton, where they were beginning to introduce alcohol and other drugs in prenatal programs. Some of the eastern provinces haven't even named the issue.
Mr. Szabo: So we're just starting to deal with this problem in Canada.
Ms MacPhee: Yes, we are.
Mr. Szabo: Thank you so much for coming.
Ms MacPhee: Thank you.
The Acting Chair (Mrs. Picard): We are now adjourned.