:
Thank you very much, and let me thank you for the kind invitation to be here.
We've been following the deliberations of this committee with great interest. It's truly a privilege to be invited back and to be able to share with you some of the issues around process and evidence in developing a food guide.
I'd like to start by introducing my colleagues. There's a coterie of us from Health Canada. I'll start with Janet Pronk, the acting director, policy and standard setting. It is within the policy and standard setting group that Canada's Food Guide is evolving, and Janet has a lot of involvement in this particular initiative.
Chantal Martineau, who is actually the lead on the food guide development itself, sends her regrets. She's at the Montreal meetings, les journées annuelles de santé publique, that are going on currently.
Also with me is Danielle Brulé, who is the director of research, monitoring and evaluation, and who has played a very significant leadership role in the science that's underpinning Canada's Food Guide. Also here is Elaine De Grandpré, who is a nutritionist in our dissemination and outreach area. She has taken on the significant challenge of ensuring that the messaging and packaging of the food guide itself in terms of delivering appropriate messages to Canadians is done well and that it is understood.
As well, we have Lori Doran, who is the acting director of the chronic disease and injury prevention group within the first nations and Inuit health branch of Health Canada is here. She will share some insights on that particular initiative, in which I know the committee has an interest.
My hope today is to engage in a discussion and to allow you an opportunity to ask questions. I'm going to run through a bit of a presentation, because I think it's important that we all start with the same understanding of what has been done to date.
You've heard a lot about the food guide. You've had a lot of people share their perspective on the food guide with you. I'd like to start by making sure everyone understands that the only food guide that people have seen is the food guide that was put out last November for consultation. It was in fact put out precisely for the reason that we wanted to get people's input to enable us to put out the best tool we could.
My plan here is to provide an overview of process, of the evidence used to guide this development, to discuss obesity in relationship to the food guide, and look at the next steps. But we are mainly here to provide an opportunity for your questions and discussions.
Canada's Food Guide actually is designed to promote a pattern of eating that will meet nutrient needs, promote health, and minimize the risk of nutrition-related chronic diseases. We consider it to be a very important and significant evidence-based policy vehicle. It is taken with great seriousness by those of us in the department and others across Canada. Canada's Food Guide is not only used to try to explain to Canadians what healthy eating means, it also underpins policies and programs that are used by provincial, regional, and local governments.
The evidence base that underpins this work has been significant. We have updated nutrient standards, the dietary reference intakes, which are a set of nutrient standards that have been executed by the National Academy of Sciences' Institute of Medicine in the U.S.
I think it's important that you understand that up until the mid-1990s it was in fact Health Canada, along with expert advisory committees, that actually reviewed science, looked at where the evidence had moved, and put out the Canadian dietary standard. The name was changed to nutrition recommendations over time. But it was in fact Health Canada.
In the mid-1990s, with the recognition that the complexity of the science that underpins nutrition was now sufficiently complex, and because there was a need to call on the best science and the best scientists that we could access, it moved to a more North American platform. We've been working with the Institute of Medicine ever since.
Through a review of literature and synthesis of what's known, eight reports have come from eight nutrient panels. It's all with the goal of taking the best that nutrient science has and putting forward a statement of nutrient standards about how much of each nutrient is needed. For those nutrients that we know play a role in chronic disease, such as fat, trans fats, saturated fat, the goal is to establish acceptable macronutrient ranges.
Beyond that, because much of the evidence that underpins diet and health is not simply on a nutrient basis but on a food basis, we've undertaken a review of foods and chronic disease and looked at that evidence. That's a very significant undertaking, and not one for which we're resourced to execute in terms of manpower or time. We called on work that has already been done. We looked at the WHO-FAO joint report on diet and nutrition in the prevention of chronic diseases, as well as the work done by the dietary guidelines advisory committee in 2004.
The goal there was to look at what we knew from the literature about foods and food patterns and health outcomes, and make sure we captured and reflected that in Canada's Food Guide as best we could. For example, we know that fruits and vegetables provide protection against forms of cancer and cardiovascular disease. You don't want to generate a food guide based on a nutrient platform and miss the very important relationship with food and food patterns. So that work was also part of our evidence base.
On the environmental context, we know that Canada is a different place from it was 30 years ago. There are socio-demographic and cultural changes to the profile of who we are. There has been significant evolution in the foods in the marketplace, and we needed to make sure we captured and understood what was going on in the environments in which Canadians are eating.
We also undertook a significant review of the 1992 food guide. Canadians and the stakeholders who were involved in the review identified strengths of the 1992 food guide, including flexibility, simplicity, visual appeal, and high recognition, but they also identified significant challenges in understanding and using it.
The challenges that were identified included confusion about serving sizes, serving ranges, and the use of terms such as moderation. We were told they didn't understand what that meant. There was the perception that the graphics themselves were out of date. We had clumped together in 1992 something we called “other foods”. They included what I'll call non-nutritious, high-sugar/salt snack foods, water, and essential oils, with the one overriding direction: moderation. We were quite appropriately challenged on why we would be encouraging Canadians to moderate their intake of water, and at the same time use one message for this entire group of foods. So several problems were identified, and all of those challenges have informed the food guide revision.
We initiated the revision in 2004 and put together a range of advisory committees to help us with the task. We already had a dietary reference intake expert advisory committee that had been put in place to take the science of the Institute of Medicine's nutrient standards and help us interpret and implement that into a range of guidance for Canadians. They were called upon to really help us with what that work suggested to us in terms of a dietary pattern. I'll touch on the process shortly.
There was an interdepartmental working group established. We called on the various branches in the health portfolio, as well as CIHR and our colleagues in the Public Health Agency of Canada. We also involved INAC, the Agriculture and Agri-Food group, and Canadian Heritage to help us with the multicultural challenges. Its mandate was to give a broader Government of Canada view to this issue.
We then established a food guide advisory committee. We put it together to bring into the loop a range of different stakeholder perspectives on dietary guidance. We tried not to line ourselves up with people who looked at the world the way we did as a department of health. Rather, we considered a range of perspectives. We wanted to hear first-hand from stakeholders outside the process. The membership included knowledgeable individuals who provided advice from a range of perspectives, including public health, industry, education, health policy, nutrition, disease prevention, and communication. At the same time, we tried to ensure that we captured both national, provincial, and local perspectives.
I'll now turn to the food guide content.
Through our process, which involved several advisory groups and consultation, we came up with a pattern of eating that would provide age- and sex-specific guidance on amounts and types of food. This was in response to the criticism we encountered when we reviewed the 1992 food guide. People said we had such large ranges that they had no idea how much they needed to eat. We wanted to ensure that people didn't think they needed to eat more than they did. The recommendations were age- and sex-specific based on specific nutrient requirements. The pattern reflects the food supply available to Canadians and their eating habits. If you were to go to, say, Thailand, or to other countries, you would see a different pattern. All food guides, regardless of where they're issued, look at the food supply, the kinds of things that people eat, and include it in their dietary pattern. So if you were putting a food guide together in Singapore, for instance, bread wouldn't be part of it, because bread is not a staple there.
In developing the food guide pattern for each of 16 age and sex groups, 15 diets were generated, following what the pattern laid out in amounts and type of food. Distributions were assessed in terms of nutrient adequacy. This led us to develop more specific messages to make sure we were getting adequate advice, and that we didn't favour Canadians consuming too much energy, too little folic acid, or not enough fibre. We examined all these parameters in the 500 diets for each age and sex group. And we took one extra step: we made sure that if we were assessing a dietary pattern for children we actually used popular children's food choices. We derived the data from our provincial surveys, which have been going on for the last decade.
Once we got the pattern, once we packaged the pattern so as to ensure that we had adequate direction in communication, we went out to consultation. Our consultations started back in January 2004 with a meeting in which we brought together stakeholders from all aspects of food guidance to discuss what we had found in the review. We all agreed it was time to go into a revision. In May 2005, we crossed the country, holding 13 regional meetings in the provinces and up in Yellowknife. In these meetings, we shared the direction we were taking and allowed stakeholders to tell us if they thought we were headed in the right direction. We didn't just show them what the food guide was going to look like. We told them that our plan was to have something in hard copy but to put a lot of emphasis on the Internet, to have educator-communicator material, and to include something special for Inuit first nations.
What we heard back from this process was that it's good to really enhance the web, for instance; we think that's going to have lots of use for schools and for many people, but you must ensure that you have hard copy, because that's very much the piece that is used in teaching situations across the country.
In November 2005, we actually launched our national consultation activities. That was done with online as well as regional meetings. The online consultation was in fact designed to enable people right across Canada to provide input to us in a relatively easy manor.
However, with that online consultation came constraints. One of the criticisms I think you've heard is that there was little focus on the actual pattern and more focus on the packaging of the pattern. That was, indeed, a constraint that emerged out of the online approach to this consultation. And part of that was due to our wanting and needing to take the consultation down a pathway that asked specific questions but at the same time provided Canadians an opportunity to say to us, “We think you've missed it. We think there's a problem with what you've done.” So there was a question, and it was how we ended the entire consultation: “Do you have anything else you wish to say to Health Canada about the Food Guide?”
In fact, over 6,000 Canadians participated in the online consultation, and from that we learned a great deal. At the same time, we went into focus testing because we wanted to ensure that the piece that we had put together was able to be used by Canadians, and we garnered input from that. Overall, the feedback was positive, but it was also very positive from our perspective in indicating where people thought we hadn't been direct enough, we hadn't gone far enough, we had put in too much information. It brought a wealth of information to us that we're using right now as we take this food guide through to the end product.
The outcome of the pattern and the processes we're using is to ensure we have a pattern that, when followed, will provide the nutrients that are required for health. We know that it meets the nutrient requirements of Canadians, except for Canadians over 50, where there's a need for extra vitamin D, but we also want to make sure we're consistent with evidence that exists that associates the food pattern with reduced risk of a range of diseases, such as diabetes type 2, diabetes, obesity, cancer, and cardiovascular disease.
There is a tailored aboriginal food guide being developed. It's being tailored for aboriginal people and is inclusive of first nations, Inuit, and Métis. It recognizes the importance of traditional foods as well as non-traditional or store food. There has been broad support from national aboriginal organizations, from nutrition educators and health services providers, for the need and the importance of having something that's tailored to this target group.
My colleague Lori Doran, of the first nations and Inuit health branch, with her team, is leading this work. They have the expertise within the department in terms of first nations people. They have a nine-member advisory group. A needs assessment was undertaken with people who work with first nations, Inuit, and Métis. It was conducted in October 2005. There's a consultation under way now, or just completing, and there are focus group tests that are planned for November and December of this year. Their product is following slightly behind the main food guide, and Lori is here with information should you have more specific questions on that particular initiative.
In terms of overweight and obesity, we're very concerned. Part of what has driven us throughout the entire process is making sure we come up with guidance to Canadians, recognizing that they live in an environment where overweight is a significant health issue and, generally, overweight and obesity are of great concern to Canadians themselves. We and you, more than anyone, potentially recognize that obesity is a very complex issue.
We recognize there's a need for a comprehensive strategy. We looked internationally to the global strategy on diet, physical activity, and health that WHO developed. We were in fact very involved with the development of that particular strategy. Nationally, there has been the development of a pan-Canadian healthy living strategy.
It's only to anchor the fact that we recognize obesity is not something that a food guide is going to fix. It's not something that a food guide in and of itself will solve. But at the very least, we need to expect that the food guide will be a policy piece that provides Canadians with the kind of guidance they need in order to meet their food supply and enjoy their food in a knowledgeable manner.
This means we have to help Canadians understand that the food guide pattern that will emerge will in fact contain very basic foods. It means we're talking about breads and cereals, not croissants and muffins. There's very little room for extras in this pattern, such as cakes, pastries, french fries, ice cream, and alcohol. It requires different choices to be made.
On our next step in this process, we're looking to release a planned suite of products early in 2007. There will be a hard-copy consumer piece. There will be extensive web-based material for consumers. It will be an extension of what's in the actual policy piece, the consumer hard copy. But we'll also go further to try to enable Canadians to do some tailoring for themselves.
My example of this is that if you look at the age and sex specifics with which Canada's Food Guide will come out, we know we're giving a range of ages that starts at the age of four and goes up to over the age of 70. We know there's a certain amount of confusion in looking for your sex and age and coming down to the number of food guide servings that you would choose.
We're making a web-based platform where you can actually go to the Internet to put in your age, your sex, and the physical activities you enjoy, and you'll then have a printed copy of something you can put on your refrigerator as an adjunct to the hard-copy piece. There will be communicator-educator material as well.
We look at this whole suite of products as being step one on a pathway that we'll be able to add to as we start to be able to identify with increasingly specific evidence where we see the need to support Canadians with more information.
, that's my presentation. We welcome your questions.
:
Thank you very much, Mr. Chair.
I'm going to start with a brief preamble and leave a couple of minutes for answers.
First of all, I'd like to thank all the witnesses for coming here to this committee. I'd like to congratulate you and thank you for the great work that you do on this file. This is a mammoth task, and I don't think anyone around this table thinks this is easy. We're simply trying to make some suggestions that will improve the health outcomes of Canadians.
I'll ask my questions all at once and then give you a chance to respond, Ms. Bush, or whoever chooses to respond.
Is this a fait acompli? Are you here today and saying that basically it's a done deal, the thing is put together, it's basically ready to go to printing; that this is all very interesting, but the new food guide is put together and ready to go?
I'm going to back up a bit, Mr. Chair, and say to Ms. Brulé that her comment that you can't blame obesity on the pyramid is certainly a point well taken.
If it's not a fait accompli, I'd urge you to make it as easy as possible. That's been my comment as the food guide has been brought up. Hopefully this is a user-friendly food guide.
My next question is, could you expand upon how you're going to get the message out? I heard you say something about something for the fridge, which is very fitting. Maybe it could be a pared-down highlights card of the consumer hard copy. Let's be honest, no one is going to read the consumer hard copy if it's any more than four pages long. I would ultimately like to see a laminated card that's double-sided, flashy, and delivers all the messages. That may not be possible, but a highlighted card that could be distributed in a general practitioner's office would be excellent.
How are you going to get the message out? That's my question. I'd urge a massive television campaign, and I think you'd have great success in disseminating the message through that medium.
My final question would be, have you considered having recipe books that comply with the Canada's Food Guide recommendations? Have Canadians submit recipes that might comply. There could be endless recipes, and people could just click on the web or buy it. Now, that's something I'd buy, a recipe book that would comply, but I'm not going to buy the consumer hard copy and go through all the different servings and portions.
Those are my questions. First, is it is fait accompli? Second, how will you get the message out? Are you considering these helpful ways of getting that message out?
Thank you.