Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 28 - Evidence - February 26, 2015
OTTAWA, Thursday, February 26, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:27 a.m. to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I will ask my colleagues to introduce themselves, starting on my right.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Stewart Olsen: Carolyn Stewart Olsen from New Brunswick.
Senator Enverga: Tobias Enverga, Ontario.
Senator Frum: Linda Frum, Ontario.
Senator Merchant: Pana Merchant, Saskatchewan.
Senator Moore: Wilfred Moore from Nova Scotia.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of this committee.
The Chair: Thank you, colleagues. We are continuing our study to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
I want to welcome our witnesses today. Since there is no preference, I'm going to call them in the order that they are listed on the agenda. Following your presentations, I will open the floor up to questions from the committee members.
I will begin with Clifford Maynes, Executive Director of Green Communities Canada, Canada Walks.
Clifford Maynes, Executive Director, Green Communities Canada, Canada Walks: Thank you very much, Mr. Chair, and greetings to you and committee members. Thank you for an opportunity to address you on an important matter.
Our message to you is simple: Walking is the wonder drug of the 21st century, the penicillin of the obesity epidemic. No other intervention has the potential at a population scale to have a greater or more lasting impact on obesity and inactivity. No other intervention is so affordable with so many wonderful co-benefits.
If walking were a pill, we'd be scrambling to give everyone a prescription. It would be on Oprah. We urge this committee to identify walking as a priority response to obesity and to support actions to restore the culture of everyday walking in this country. I'll take a few minutes to explain.
By way of introduction, Green Communities Canada, founded in 1995, is a national organization that promotes positive action with benefits for the economy, environment, infrastructure and health. Our innovative programs address priorities like energy efficiency, private well stewardship, restoration of the urban water cycle and much more.
Walking has been a major focus for us since the mid-1990s, driven by the vision and persistence of Jacky Kennedy, Director of our Canada Walks division. Canada Walks is the only national entity devoted almost exclusively to walking. With our partners, we have been leaders in reversing decades of neglect and putting walking on the map.
Our vision is a nation where everyone can walk enjoyably, easily and safely to school, work, play, shopping and transit. This is about everyday utilitarian walking, not just recreation.
Our work raises awareness, inspires and celebrates success, builds skills and knowledge and brings together a multitude of partners from many sectors with one common purpose: to create a culture of walking in Ontario and Canada.
Over the past two decades, we have introduced and supported Active & Safe Routes to School across Canada, which led to the development of a Canadian School Travel Planning model, which has been widely implemented in every province and territory. STP is a comprehensive community-based approach that places its focus on children's mobility, using the daily school journey to develop and implement strategies to encourage active school travel.
We brought the international Walk21 conference to Canada for the first time in Toronto, 2007.
We also won the Guinness World Record for the largest number of people walking one kilometre at the same time. Over 200,000 met the qualification, and we still hold that record. Canada is still the world leader.
We delivered walkability workshops to 50-plus communities across the country.
We launched the WALK Friendly Communities designation program, which recognizes and rewards genuine progress towards improved walkability. We have eight designations to date in Ontario and plan to go Canada wide.
We provide countless resources and maintain a high-profile online presence. Some links are in the material I've given you.
We believe walking must be at the heart of Canada's obesity strategy, and here's why. Walking is already the most popular activity among Canadian adults, and that gives us something to build on. Almost everyone can walk anywhere, anytime. It's free and there is no need for club membership or expensive equipment. Walking can be integrated into our everyday lives, which makes it a persistent habit from youth to old age. Walking is the perfect starter activity and foundation for a sedentary population and a "gateway drug'' to more demanding activities.
The documented health benefits of regular walking — a half hour of vigorous walking per day for adults and an hour for youth — are awe-inspiring. Walking burns more fat than jogging; it improves heart health and blood pressure; reduces glaucoma risks; limits colon cancer; halves the odds of catching a cold; halves Alzheimer's incidence over five years; helps to cut significantly new cases of diabetes in half, manages existing cases, and, in some cases, even reverses them. Regular walking also makes us happier, improves mental fitness, including school performance, and even helps with sexual dysfunction.
Finally, walking helps to stave off age-related disability by maintaining muscle strength, balance and healthy bones, something for all of us to think about as we head towards our seventies and eighties, the dangerous decades. Regular walking is a proven and effective preventive measure for maintaining mobility and independence.
How will we get Canadians walking? Part of the answer will be a broad-based communications campaign, something like "Get Healthy, Get Happy, Get Walking.'' Health care professionals need to understand the benefits and prescribe the walking life. Communities need to promote walking through festivals, street closings and campaigns. Youth need to develop a lifelong walking habit through effective school travel planning, instead of getting hooked on motorized transportation by well-meaning adults.
But more is needed. Over the past decades, communities have been designed and built to make cars happy, which means that walking has been engineered out of our lives. This is what the late Ontario Chief Medical Officer of Health Sheela Basrur called an "obesogenic environment.''
Communities need to become more walk-friendly, places where everyday walking is safe, convenient, attractive and comfortable. Communities need features like lively and pleasing streets, connected walking routes, convenient crossings, pedestrian safety measures and enforcements, such as the lower speed limits that are being introduced in residential areas, and mixed use development so that destinations are accessible by foot.
Experience shows that walkability initiatives can quickly begin to attract growing pedestrian traffic. Walkability works.
Walkable neighbourhoods are healthier neighbourhoods, as documented by the diabetes research by Toronto's St. Michael's Hospital. Walkable neighbourhoods are safer and more socially cohesive, the air quality is improved and transit works better because every transit ride begins and ends with a walk.
Finally, walkability is linked to higher real estate values and retail sales, which is a real driver, and workplaces in walkable neighbourhoods are better able to attract the employees they seek — like Coke moving its head office to downtown Toronto because they felt they would be in a better position to attract the kind of people they wanted working for them than they could in a suburban industrial park.
In conclusion, walking is the wonder drug of the 21st century with a long list of benefits. Walking is a lifelong activity that most of us can weave into the fabric of our everyday lives. Income is not a barrier. Further, we know how to create sustained improvements in walking rates by creating walk-friendly communities with health, social, environmental and economic dividends.
We therefore urge this committee to incorporate the following into its findings: Walking and walkability should be a top priority for Canada's national obesity strategy, with an ambitious national target such as a doubling the routine walking by 2025. This should be incorporated into the action plan associated with the National Health and Fitness Day.
Federal funds should be invested in walking infrastructure, and a possible hook for this would be to celebrate Canada's one hundred fiftieth birthday in 2017. We are all in favour of the TransCanada trail, but here we're talking about streets in communities and routine utilitarian walking.
As well, the federal government should support a high-profile campaign and participate in a pan-Canadian collaborative to implement a Canadian walking strategy.
On this last point we were inspired by the example of the Every Body Walk! campaign in the U.S., coordinated by America Walks. Canada needs an effective multi-partner collaborative voice like Every Body Walk! to issue a call to action and accelerate progress.
Walking has legs. Now is the time to seize the opportunity to pick up the pace. Now is the time to make a "walkolution.'' We urge you to help us make it happen.
The Chair: I will now turn to YMCA Canada. Scott Haldane is President and CEO, and Jennie Petersen is General Manager, Wellness Program, YMCA Calgary.
[Translation]
Scott Haldane, President and CEO, YMCA Canada: Thank you, honourable senators. Good morning. I am the President and CEO of YMCA Canada.
[English]
I am here with my colleague Jennie Petersen, General Manager of Wellness Programs at YMCA Calgary. On behalf of all the YMCAs in Canada, we would like to thank you for this opportunity to share our learning and experience in tackling obesity by connecting Canadians of all ages to healthier lifestyles and the means to maintain them in their communities.
[Translation]
Let me tell you a few words about the history of the YMCA in Canada. The YMCA was established over 160 years ago as a charity dedicated to the health of both individuals and communities. We are now part of a vast international network, firmly rooted in our own country and in some 119 countries in the world.
[English]
Today, there are 45 YMCAs and 5 YMCA/YWCAs in Canada that engage 28,000 volunteers and 22,000 staff members in offering programs and services to over 2 million Canadians annually in more than 1,000 locations across Canada, both within and beyond YMCA facilities.
While our buildings — our 125 health and fitness centres, for example — are used to deliver vital YMCA services to individuals and families, they also become the place where communities gather, where relationships are forged and where Canadians become stronger together. It is a growing national network of centres of community.
We support personal development in what we call spirit, mind and body through health and wellness programs, fitness and aquatics, child care — we're the largest provider of child care in Canada — camps, housing, education and training, employment services, immigrant services, youth programming, leadership development opportunities and many more.
Many of our associations also deliver programs to prevent and manage a wide range of chronic diseases like cancer, diabetes, hypertension, osteoporosis and pulmonary diseases, many of these in partnership with the health care system.
While many organizations are working on these issues, few if any offer such a comprehensive range of community- based health and wellness programs on a national scale for individuals at all ages and stages of life, regardless of their ability to pay. Our focus on inclusiveness and accessibility, for example, enabled over 270,000 Canadians last year to receive free or discounted access to our services, a value about $36 million, through YMCA financial assistance programs.
Rather than repeating information you may have heard from others who have testified before you, I would like to highlight three key aspects of the YMCA's work to promote healthy weights and address obesity. These are evidence- based practices that we believe model the way forward for our efforts as a country to tackle this increasingly critical and costly health issue.
The first is that we have a growing focus at the YMCA on teaching physical literacy and healthy nutrition, beginning at a very young age — we think that is where the biggest impact can be made — as a means of building self- awareness and self-confidence with movement and healthy eating, creating advocates within the family context when kids get home to their own families.
Second is our emphasis on understanding the broader determinants of health as a means of addressing the full range of factors that influence an individual's ability to achieve and maintain a healthy weight and healthy lifestyle. We can't underestimate the importance of things like income, equality, access to food, and so on, as part of this equation.
The third is our emphasis on building the social and community supports that are critical to sustaining behaviour change over the long term, which is a key piece of the complex health and wellness puzzle that focuses the efforts of our staff and volunteers on encouraging Canadians to get fit together. In other words, the whole idea of people coming together creates the support system that makes the other changes possible.
To echo the words of some who have testified before us, obesity is a complex issue. Like other complex social issues, obesity is best tackled on many levels simultaneously — what we think of as spirit, mind and body — through a concerted and coordinated effort that addresses multiple dimensions of the problem and draws on partnerships and collaborative approaches at the community level.
I will turn it over to Jennie to give you examples.
Jennie Petersen, General Manager, Wellness Program, YMCA Calgary, YMCA Canada: Let me spend a few moments to illustrate the three points Mr. Haldane made. The first point is empowering children and adults through physical literacy and healthy nutrition practices.
We know from our research that people of all ages are increasingly looking to the YMCA as a provider of reliable information about healthy lifestyles. While we are providing more information, we are also actively working to increase physical literacy and enhanced nutritional education through our programs as a key to engaging individuals and communities in their own health.
Physical literacy can be described as the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life. This work needs to begin very early as many of the physical and psychological complications and co-morbidities of obesity begin during childhood.
At our YMCAs in Calgary and Edmonton we are integrating the concept of physical literacy into our day camps, after school programs, early childhood programs and even our adult programs as a strategy in supporting our communities to be active for life, a key outcome of the Canadian Sport for Life model.
In British Columbia, our YMCAs are working in collaboration with the provincial government to deliver the evidence-based U.K. program MEND — Mind, Exercise, Nutrition, Do It! — for 7- to 13-year-olds with unhealthy weights.
The second point is looking beyond a person's obesity to understand the broader range of factors that shape unhealthy behaviour. We know from research and practice that the major determinants of health interact in complex ways, so we work to address this complexity by offering an array of wraparound programs and services that address the whole person in the context of his or her broader community for greater impact. We also rely on our partnerships at the national, provincial and community levels, often playing the role of integrator in collaborative interventions.
An example of collaborative work we are involved with includes our South Health Campus YMCA located in the Wellness Centre at the new South Health Campus hospital in Calgary. There are many examples where we see hospital programs delivered in the YMCA across Canada, but this is the first model to integrate a YMCA into a hospital setting. A key strategic goal of the South Health Campus YMCA and Wellness Centre is to improve decision making and active participation in the health of our community members, patients and staff working at the hospital.
The third point is building staying power by connecting individuals to their community. The biggest problem with weight loss programs is keeping the weight off over the long term. We know that staying on a path to healthier behaviour relies on a complex interaction of the individual and their community supports, from their relationships with YMCA staff and volunteers, to those with an individual's peer group, to connections that are built, to other partners and community resources.
We are becoming increasingly intentional about this work with participants by providing staff training programs focused on the theories of behaviour change; conducting evaluation work that has highlighted the crucial record of building meaningful relationships in supporting our participants; providing our YMCA Calgary Grade 6 membership program with the Calgary Flames Foundation, an initiative and program that many of the Ys across Canada are also doing; and the YMCA of Northern Alberta's partnership with Prescription to Get Active aimed at sedentary adults, a finalist in the national Play Exchange Challenge.
As you will have noted if you had a chance to watch the CBC special, the social dimension of the activity is very important in keeping participants on track with their objectives. I would be pleased to provide additional information about any of this work in the question period.
Mr. Haldane: In addition to the significant social return on investment that accrues from the work the YMCA is doing to help Canadians improve their health, education and employment prospects, our networked community hubs offer our government partners a national community-based platform and testing ground for policy and program innovation. We welcome opportunities to build on this relationship in working with all governments and community partners to tackle the growing incidence of obesity and chronic disease by promoting healthy lifestyles and communities in Canada.
[Translation]
Thank you for giving us the opportunity to share with you the YMCA's concerns and recommendations. We are now ready to respond to any questions and comments you may have. Thank you.
[English]
The Chair: Thank you all very much.
I will now turn to my colleagues. We will begin with Senator Eggleton.
Senator Eggleton: Thank you for your presentations.
We talk sometimes about calories in, calories out and the balance between the two. Yesterday we had the "calories in'' people from the industry, and we have the "calories out'' people here today. You change our focus a little bit to the exercise aspect of things.
Mr. Maynes, we hear from the medical profession, from a lot of people, that walking is a great thing. My wife and I enjoy doing a lot of walking as well. I commend you on your efforts to promote this.
Frankly, I haven't heard much about your organization. We used to have this endeavour called ParticipACTION. It had a big national profile for a number of years, but you don't hear much about it anymore. Are you aspiring to get up to that level of public knowledge of your endeavours? Are you just a small organization?
Mr. Maynes: We're a mid-sized organization. We are a membership organization. Our members are community non-profits, so we are very much about community-based delivery of programs. It's pretty difficult for anybody to achieve that kind of national status at this point with the availability of revenues and resources out there.
We have always worked with many different organizations. The health organizations are important. The insurance people are concerned, of course, because of what it's doing to their health insurance costs. We do presentations at the business improvement area conferences because these folks are very interested now in what the impact on their sales is of creating more walkable retail districts, and it's big. That's the way we primarily function, through partnerships and alliances.
Senator Eggleton: Do you target people who might be obese or overweight or organizations that deal with those kinds of difficulties, people who have those kinds of difficulties? Do you focus on that or is it just general?
Mr. Maynes: Yes, it's about increasing walking as a routine, everyday activity for everyone. As I indicated, the benefits are far beyond the benefits in reducing obesity and so on. We take this kind of holistic approach. We put together all the motivations from all the different players and maybe we'll get some action.
Senator Eggleton: Certainly, the YMCA has a terrific reputation for all of the various areas you talked about in your presentation here today. You are dealing with this in the exercise or physical sense as well as nutrition, because it is something that involves both what you eat and how you then exercise.
Let me ask you about one federal program we have had around for a little bit. The federal government in 2006 introduced the Children's Fitness Tax Credit. It's a non-refundable tax credit. I emphasize "non-refundable'' because it means that people that are low-income, where there is a fair degree of obesity, are not able to benefit from this program at all. I'd like you to tell me how you think people have been benefiting from this. Do you have any information about how they have benefited from that tax credit?
Mr. Haldane: Michael Weil, who was my predecessor as the CEO of YMCA Canada, served on the panel that Minister Kellie Leitch chaired on the fitness tax credit, so we were intimately involved in that process. We're obviously very supportive of the recommendation. It's like a tax receipt for a charitable donation, very important and motivates people, but it's not enough in and of itself to stimulate that. I would say the same thing about the fitness — and now including arts — tax credit. It's very helpful. It encourages people and is one more incentive, but on its own I don't think it's going to make the difference in terms of acting against obesity.
Every little bit helps, but if we suggest that the fitness tax credit is going to change this epidemic, I think we're fooling ourselves. I don't have the data on its use. Certainly, we experience with our members that they are motivated by this.
We are working on something else with Air Miles for Social Change, and now with a collaboration of loyalty programs to actually test whether incentives will drive behaviour change.
Canada has the highest rate of use of loyalty cards. I always joke that my wife has them all in her purse. We use them more than anybody else and we know that they drive consumer behaviour. We are starting to recognize it could also drive lifestyle behaviour. We've have been working again with Air Miles for Social Change. We've done a pilot project in four of our YMCAs, and we have seen a difference in frequency of use and deciding to put kids into recreation programs because you're going to get Air Miles points. It sounds funny, but it's a different way of looking at this — not just the public awareness and promotion, but actually incenting people to choose the right lifestyle.
I think that, coupled with a tax incentive, can start to perhaps affect people's behaviour in a different way.
Senator Eggleton: You're not aware of any assessment or evaluation that has been done of that program?
Mr. Haldane: We haven't done any assessment at our end. I imagine the government has done some sort of tracking. I guess CRA would know.
Senator Eggleton: It should know how many people.
Let me ask any of you about the federal role in terms of dealing with children, particularly the education system, which is a provincial responsibility. There is a lot they can do in terms of promotion of more active lifestyles, including physical education classes. Do you see any federal role in any of these programs? What do you think the federal government could do to be helping, since a lot of this is either provincial or local responsibilities? Communities are where the action is needed. How can the federal government be of some help?
Mr. Haldane: One of the biggest messages I would like to give you is this very challenging situation where we spend something like 96.5 per cent of our health care dollar on curing disease or intervening with people who are already sick. We know, especially in something like obesity, that it's all about prevention and getting in at the upstream, at the youngest age possible.
In the scheme of things, the Public Health Agency of Canada has a role that can really emphasize to a much greater extent the preventive end. Where can the federal government intervene? It's difficult to intervene at the health care end because it's certainly a provincial jurisdiction, but on the preventive end the federal government can intervene. We have such an extraordinary imbalance of resource involvement that it's no wonder we are not getting ahead of the chronic disease issue; we're not spending any money on it.
I'll give you an example. For the last decade the U.S. YMCA has had very strong evidence that the National Diabetes Prevention Program actually has a greater efficacy than any pharmaceutical intervention. It has been written up in The New England Journal of Medicine. PHAC has come to us and said they want to replicate that YMCA program in Canada. Obviously, in the U.S. they have a whole different set of incentives. They can use the private insurance industry to incent people to go on the program. We've been trying to get that up.
The challenge the Public Health Agency gave us, and we are pleased to be working with them, is that they are going to give us half the money we need to do this program and we need to go out and raise the other half. We said fine. By the way, that's the way I think some people are defining social finances; we'll give you half the money instead of all the money.
We've been trying to fundraise. We're trying to get $10 million together. It's been hard slogging, to be frank, to replicate a national diabetes program that has proven in the U.S. as effective, rather than saying, "This is an investment we should make, so let's put the money into it.''
As a not-for-profit organization, we're left trying to raise money in a very competitive marketplace to invest in a prevention program for diabetes, which the federal government, frankly, should be putting significant dollars into.
I think righting this imbalance in terms of focusing on treatment to focusing on prevention is a place where the federal government can intervene.
Mr. Maynes: Certainly, the requirement for matching funding that was referenced here has been a serious barrier for us as well. The matching funding has to come from non-governmental sources, and it's not that easy to develop those kinds of relationships at scale.
In terms of the federal government's role, the very fact that this committee is meeting on this topic I think reflects an acknowledgment that it's a national issue, a national crisis, and the federal government does have a very important leadership role to play within a collaborative context.
Part of what we've asked for here is a call to action and the establishment of national targets for increased walking. We also need to see support for ensuring that the entire network of health care providers understands the importance of this and is on board. Also, support for the excellent tools out there, like the WALK Friendly Community designation and the Healthy Development Index that are helping municipalities take action to transform their communities from places where it's kind of unpleasant, unsafe and inconvenient to walk to places where people really want to walk and feel happy doing it.
We know how to do it, but there needs to be support. We're really talking about turning around a Titanic or a Queen Mary that has been going in one direction for a number of decades. We see a lot of momentum to turn it around, but we think the federal government needs to be a serious part of that push.
Senator Seidman: There is no question that what you're telling us is quite intuitive, but you both used the word "evidence'' many times. Of course, if you want people to put their money where their mouth is, so to speak, they need evidence. Drugs that are developed usually go to clinical trials, a clear way to test the fact that they work or not.
What is the scientific evidence that walking or doing any form of physical activity alone — we're not talk about healthy living now, but doing any kind of physical activity alone — will have a direct impact on cardiovascular disease, whatever disease we might like to list here?
Ms. Petersen: You're asking about the evidence for the benefit of physical activity, especially as it relates to different chronic conditions? A wealth of evidence exists. In the physiological context there are a number of different benefits that physical activity has, on whether it is improved heart health to improved learning, when you're talking about —
The Chair: If I could interrupt, I think the senator is asking what the source of the evidence is for that. You've all indicated what you think are the impacts. The senator was specifically asking what the basic evidence is to draw that conclusion.
Senator Seidman: Right. For example, are there clinical trials that test a particular physical activity and its direct impact on heart patients? I'm being very general now as opposed to getting down to the nitty-gritty. What is the actual evidence that you speak of? You used the word "evidence,'' but what is the basis?
Ms. Petersen: Especially in physical activity research, looking for evidence, we're talking sometimes about community-intervention-level research and evaluation programs. That's a bit different than when we think of the randomized controlled trials; so definitely there's a wealth of evidence from RCTs that demonstrates the impacts on different benefits of physical activity.
But from a community intervention perspective, a number of studies out there that indicate the benefits of different interventions at the community level that are multipronged, have multiple levels involved and use more of a holistic or a wrap-around approach to supporting people with behaviour change. There are a number of different community interventions that would have evidence behind it.
Mr. Haldane: I'll mention two specific studies that have been done. The first one was the one I briefly mentioned before in the U.S. The YMCA entered a partnership with the University of Pittsburgh with the Centers for Disease Control in Atlanta. There were a number of reputable partners.
They did a controlled study on the effect of people entering a YMCA program which was basically 16 weeks of intervention, both nutrition and exercise, plus a social support group, and then following up to a year of less intensive support. I don't know the details on the name of the drug, but they compared that to the leading drug for diabetes prevention. These were pre-diabetic people. It was demonstrated that the YMCA program was significantly less expensive and significantly more effective in terms of losing weight and keeping the weight off.
The YMCA has now expanded that program over the last decade. It's delivered now in 300 YMCAs in the U.S. The numbers have not been quite as strong, as the program has scaled. It has not had the same level of effectiveness. That's probably predictable because you don't have as much focus, and it's more difficult to maintain the standard at that level, but it's significantly stronger than the drug.
Another example of research that we've done was with McMaster University's System-Linked Research Unit. It wasn't specifically on obesity, but it was actually testing the effectiveness of various forms of intervention for sole- support mothers on social assistance. The incidence of obesity and other health-related issues amongst that cohort is greater than the general population. That's based on the research on the social determinants of health.
What we found was respite programs taking the children of those moms and putting them in recreation programs that include healthy living, physical activity and so on, is both more frequently used by the mother, but also within one year double the number of mothers got off social assistance when their children were put in recreation programs than if they were just left to fend for themselves. That's not directly related to obesity, but it is related to getting kids into these programs that help them learn about nutrition.
The challenge has been that while the investment is made by one level of government, the benefits accrue to another level of government. We've been having a hard time getting the various jurisdictions to come together to say, "This is a no-brainer; we should make this investment.''
There are some examples. These programs continue to this day in the Sarnia-Lambton area, the Niagara area and the Halton area of Ontario. The Y plays a broker role where we have the social services department give us the names of the mothers who are interested in participating, and we broker the placement of their children in various recreation programs. That has an effect on their ability to live a healthy lifestyle.
That's the type of research we've been engaged in, and certainly we can provide some direct information about those studies.
The Chair: Thank you, Mr. Haldane. If you would provide that to the clerk, that would be great.
Mr. Maynes: I've certainly seen many studies. I cited the work done by the St. Michael's Hospital in Toronto, which measured the walkability of various neighbourhoods in Toronto and other factors like income. They found, first of all, a correlation between walkability and the amount that people actually walk, but they also found a very significant correlation with the incidence of diabetes. That would be one particular study.
Just this morning, I happened upon a 70-page evidence review by Toronto Public Health called Healthy Streets. They just adopted it at their January meeting. I haven't had a chance to review it yet, but it contains many references. So I would forward that and other information.
A number of the facts that I was quoting come from the Every Body Walk! campaign in the U.S., which is supported by the largest HMO, Kaiser Permanente. The Chair of Kaiser Permanente, George Halvorson, emphatically declared, "The only way we can overcome the chronic disease epidemic is to walk.'' That's the conclusion they have come to. They decided that this is where they need to put their efforts for both health promotion reasons and ultimately their bottom line.
Senator Seidman: That is really helpful, Mr. Haldane, especially in the studies you put forward to us because I'm asking for an evidence base that demonstrates not a correlation but a causal link between physical activity and disease outcomes.
Given your work with the YMCA and with children, are you aware of any studies that involve children in particular, the use of the school system and the kinds of things that one looks for in trying to develop policies?
Mr. Haldane: I would like to get back to the committee, if I could, on some of the specific research.
We're not a research organization; we're a program delivery organization. We recognize that it's not just anecdotes that we can share, although they're important; it's also the research evidence. We're trying to figure out how we actually afford, as a program delivery organization and a charitable organization, to research what we're doing? One of the things is we need to have research that proves the point, and then make sure that we demonstrate we're replicating those variables within the programs we're delivering so you don't research every program at the same level.
Secondly, we're trying to build research into the delivery of the program. In fact, we do a before and an after test. When someone registers for the program, and there's certain information we can collect and certain information we can't. With regard to what has changed between the beginning of the program and the end of the program, the YMCA in Kitchener-Waterloo is doing some interesting research that's being recognized that way.
One further point, if I might: The debate about whether in fact it's physical activity or whether it's healthy nutrition, as I read the proceedings of the committee coming into here, that's a big part of what people are saying. There's this little fight going on between the people who really think it should be about nutrition and the people who really think it should be about physical activity. My own view is that that gets us absolutely nowhere because it's both. It's about people's whole lives. Especially for children, not only is it good for obesity prevention, but it's good for just having a better life if you're active and also eat well. We don't distinguish between those and get involved in the debate about whether it's one or the other. We believe they're part of a healthy lifestyle, and we incorporate both of those into our programs.
Senator Seidman: That is really good. Thank you.
The Chair: Colleagues, if you can focus your questions and if the witnesses will not repeat any answers they have given previously but refer to it and move on, I will restrict the time to ensure that every senator has a chance to ask a question.
Senator Stewart Olsen: I'm from New Brunswick, and we live in a rural community. You mentioned the streets and that program, but I want to know specifically, do you have programs that could be accessed for use in rural communities?
Mr. Haldane: The YMCA is primarily an urban organization.
Senator Stewart Olsen: Yes, I know.
Mr. Haldane: For our whole history, we have struggled with how to serve rural communities.
I would mention two things. One is we've developed a model for partnering with very small communities, sometimes populations of only about a thousand, where we have kind of a hub environment. So if the municipality, for example, is creating a small centre, the YMCA becomes the operator of that centre. We provide our value-added programs, leadership development and other kinds of programs within that centre.
The Sarnia-Lambton YMCA has experimented with this in a number of rural communities there, and it's working quite well.
In your own province, the Moncton YMCA has an outreach program now in Campbellton. I don't know if Campbellton is rural or not, but it's more remote. So we're working on that kind of small centre approach, making it more sustainable by linking it to a larger centre nearby.
The second thing is that we have done some work in First Nations communities, and one of our volunteers right now is actually running an organization called Spirit Runner. This gentleman is actually a grandfather who will ride his bicycle this summer from the farthest north settlement in Canada to Point Pelee, which is the farthest south, to raise money for awareness around the importance of recreation for children and youth. He has an app called Spirit Runner, which in a very culturally sensitive way encourages First Nations young people to get more physically active.
So there are ways in which we can, through technology and through some creative ways of delivering our programs, be more active in a rural context.
Senator Stewart Olsen: That's what I am looking for. Thank you.
Mr. Maynes: A number of the communities that have participated to date in our WALK Friendly Community designation process are what you would call rural communities, quite small ones. We have adapted materials to fit the conditions in those smaller communities. It definitely has implications in communities of all sizes.
Senator Stewart Olsen: Can those be accessed on your website, or does someone have to correspondence with you directly?
Mr. Maynes: I'm not sure whether the materials that specifically identify how to implement this in smaller communities are on our website, but I would be happy to pass those along through the committee.
Senator Stewart Olsen: Thank you very much.
The Chair: To remind you, please correspond through the clerk with regard to anything that you can think of following this meeting that would be helpful based on the questions.
Senator Merchant: Thank you to all of you. Thank you for the work that you do.
This is a study about obesity and the obesity epidemic, so I will try to concentrate on that for now, if you don't mind. I'm wondering how we can engage Canadians to understand that this is a problem that we have to tackle.
I was in a car in Vancouver a few months ago, and the driver was complaining about the bicycle lanes because they have designated part of the street — and this is happening in other cities — just for bicycles. He was lamenting the fact that now traffic cannot move freely around downtown Vancouver anymore. So obviously there's a disengaging factor there.
In your programming, like the YMCA, for instance, do you target obese people? I know you're working with youth, which is a very good thing because you are educating people, but it's more difficult to inspire people who have a problem getting engaged in these activities. It is difficult for them to visualize the benefits. What got them in the situation in the first place was perhaps activity or poor choices in nutrition like, I don't know, only being able to afford to eat certain foods or the convenience of picking up ready-made foods. How do you engage that segment to become interested in improving their situation? I think saying that you might develop diabetes in 30 years does not deal with the problem. They can't visualize that; it's not going to happen to them.
The Chair: The central question is: Do you have things that focus specifically on the diabetes issue?
Senator Merchant: On the obesity issue. Not just diabetes, but I'm saying —
The Chair: Thank you, senator. I apologize. The obesity issue, yes.
Mr. Haldane: I'll kick it off. Jennie might want to add something.
You've identified a very challenging issue. Once somebody is diagnosed with a chronic disease, such as when a doctor says, "You have diabetes,'' then the incentive is greater because you know you have a problem and you need to address it. Even then, it doesn't always work.
What we're trying to do is intervene at the pre-diabetic stage, when people have all the risks but don't actually have the diagnosis. That's very difficult. We're looking at a number of different ways to achieve that goal, mostly through partners. We've been talking to the drugstores, the neighbourhood pharmacies. I don't know if you have heard from them, but we've been working with them. In fact, the pharmacies will do pre-screening using the CANRISK tool, which is a Government of Canada tool, and have people then sent with a prescription, basically, to the YMCA.
The program we mentioned that was a finalist in The Play Exchange, CBC's initiative, is a good example of that. The YMCAs in northern Alberta have partnered with the primary care network in Alberta, with Alberta Health and others, to actually have a prescription for health. Research from New Zealand has shown that a written prescription is significantly more effective than simply verbal advice. So if somebody says, "You should really go to the Y,'' that is different from having a prescription written by a doctor saying, "Take this to your YMCA.''
What they have done in Alberta is you take that prescription and you get a free membership. It's not just the Y; all not-for-profit recreation centres in northern Alberta are part of this network. So we're seeing people pick up this brand new program. It took a long time to get everybody organized, but two months in, they have had 175 redemptions, and 25 per cent of them have extended it beyond the initial period; in other words, they've taken their own money and said, "I had the introduction, now I want to keep going and have reported significant weight loss as well.''
People don't know they need the help, so like all of us, they just say, "I'm not going to bother with it.'' We need something that's creative.
The incentives around the Air Miles rewards are the other way we're thinking about this.
You really have to get creative because it's hard. We get the people who are already fit and the people who are worried because they already have a disease. It's the people in the middle who really are a challenge.
Mr. Maynes: Our work on creating walk-friendly communities doesn't focus on people who are obese as such. It focuses on everybody in transforming behaviour at a population level. That includes obesity prevention.
We see walking as being very well-suited as a routine activity for people who are overweight and obese. I don't know if you have seen the film Fat, Sick & Nearly Dead. There's a morbidly obese truck driver. At first the film seems like an infomercial for veggie juicers, but fairly quickly the emphasis changes to focus on activity. This man, initially all can he do is walk. That's basically all he can do. Eventually he ends up working for the Y.
Mr. Haldane: We didn't talk about this!
Mr. Maynes: He ends up working for the Y because he's a poster child for transformation. He loses half his weight, from over 400 to 200 pounds.
The point here is we think that walking has a very central role in obesity prevention and treatment.
Senator Frum: I want to thank all the witnesses for the excellent work you're doing. This is very positive testimony.
Mr. Maynes, I want to ask you about something you said because it touched on a personal obsession of mine. You spoke about helping children develop walking habits rather than getting hooked on motorized transportation by well- meaning adults.
My question is about your organization's interaction with schools, because I know from my own personal experience, I allowed my children to walk to school from when they were in Grade 3. Rather than being seen as a good mother, it was quite the contrary. My peers thought that I was completely reckless and negligent, and I had to sign waivers at both my kids' schools saying I took on the responsibility for what might happen to them if they walked home from school. So there was a very clear disincentive from the school to allow this behaviour. That culture is out there, that walking is dangerous. Does your organization try and tackle that?
Mr. Maynes: Yes, that's a major aspect. First, we support you in redefining what it means to be a good mother.
But, yes, when Jacky Kennedy started off in 1996 with three schools in Toronto, it was bringing the whole idea of walking to the school bus, walking Wednesdays, International Walk to School Day and that sort of thing. It was very much program oriented. All of that activity is still ongoing in many schools across Ontario, and it has spread across the country.
A few years ago she said that what we really need to do is to institutionalize this and change the culture, as you said. So she adapted to the Canadian context an approach called School Travel Planning that engages the entire school community. So you have parents, the school itself, the municipality, et cetera, because partly it's about overcoming barriers. There might be safety barriers along the way, having safer crossings for kids who are going to be walking on their own. It's about establishing ongoing programs, like the Walking School Bus.
The Ministry of Education in Ontario has provided some funding for us to demonstrate how that could roll out on a community-wide basis. We have a very active program in Ottawa that is supported by the Ottawa Student Transportation Authority, the corporation that handles school busing. Our model at this point is that Ontario is heading towards spending a billion dollars a year busing kids. The organization that is busing kids should also be involved in helping to coordinate these comprehensive, multiparty planning processes to implement and maximize active school travel.
There are lots of details we can talk about, but that is one of the major areas where we have worked in every province and territory across the country. We had a very large project that was funded by the Public Health Agency of Canada to do that.
Senator Frum: This is not related, but you said something that I thought was almost too good to be true. You said that walking burns more fat than jogging. As a walker I thought that sounded great, but that also doesn't sound right.
Mr. Maynes: That's an example of information that comes from the Every Body Walk! campaign in the U.S., which is Kaiser Permanente. Their lead doctor on this is Dr. Bob Sallis. I would have to dig up the actual evidence and provide that to you.
Senator Frum: Ms. Petersen, I was intrigued by the program you described at the South Health Campus in Calgary, placing the YMCA at the hospital. Does that program target certain types of patients? Who is it for? Who are you targeting?
Ms. Petersen: First of all, South Health Campus is a new hospital that has a different philosophy around how it works. They've tried to focus the concept on a more upstream and preventive focus. Having the YMCA in the hospital is a big reason why.
In terms of who it targets, a number of different patient groups come through the doors there. The South Health Campus hospital opened up a couple of years ago, in September 2012. They have been working with patient groups and started up different programming since those days, but it is early days for them.
One group we've been working a lot with is the mental health and addictions group. We certainly have seen other patient groups coming through, cardiovascular patients, even new moms and whatnot coming through the doors too. But the group we've been working the most with is the mental health and addictions patients. We set up referral programming with them where we would work with the practitioners to bring their patients into the YMCA and give them a chance to participate in different programming and services so that they have exposure to wellness opportunities before they leave the hospital.
That's really crucial, especially that transfer of relationship that the practitioners would have, having them come down to the Y and introduce them to our staff, and our staff have a chance to work with them at the Y. That's really important. It's very intimidating, as a person who is new to exercise or maybe has a health condition, to go into a facility and try to use some equipment or go on a climbing wall or go into a class. So that's important work we've started up there.
We now have a program that is very similar for a prescription to get active, where there's a free membership for patients at the hospital during their stay. We also can provide financial assistance after they leave.
Senator Frum: That sounds like wonderful and important work, but it's not aimed at people who have weight- related issues, per se.
Ms. Petersen: That particular one isn't, but there are other programs and pieces of work that I know are being developed to work with different groups, especially having different weight conditions.
I know there is a clinic on site where we've started some work with people who have metabolic conditions such as diabetes and different conditions that might also be related to weight issues. One of our staff is going into their meetings and delivering presentations and talking to their patients who are in line for maybe surgery or have been or are receiving treatment. It's an actual outpatient clinic. We're also offering them a chance to come into the Y as well and use the different programs and services. That's a fairly new one.
We've also been doing some work with the primary care networks in Calgary in particular to set up another referral system for them to come in, and that would be an opportunity, especially for people who have overweight or obesity issues.
Mr. Haldane: Very quickly, just one other example of this is actually the hospital programs in the Hamilton Mountain YMCA, where in fact we have programs for obese patients and other patients with chronic diseases. They're actually happening in the Y, and if you went there you couldn't tell the difference between Y staff and hospital staff and between patients and YMCA members. It's a completely seamless, integrated environment that is working very well.
Senator Enverga: Thank you for your presentations. We've heard so much about fitness and how it helps and what are we going to do with it. The fact is that sometimes it's the person. It's hard to push people to do it, especially living in Toronto where you are driving most of the time and you're sitting doing nothing, and at the same time you run to your work and then you sit again.
When I was taking my graduate courses, every few hours an aerobics instructor would come into the building and say we had to exercise and that we had to do this. She would put on loud music and everybody just did whatever she told us to do for maybe 15 minutes.
In this regard, do you think it would be good if we make it mandatory for offices — like maybe the Senate — to implement this kind of thing: Let's take a break after about every hour, every couple of hours or so, and do some mandatory exercise for everybody?
The Chair: So the question is "mandatory.''
Mr. Haldane: I think mandatory anything is pretty difficult to accomplish. I suppose we have mandatory income taxes, but there are not many other things that work that well. Certainly behavioural change doesn't. I think primarily it's going to be making it easy and connecting the dots for people. My sense is that incentives will be effective.
Specifically to your example, I think employers are starting to be very concerned about the impact on productivity of the chronic diseases that their employees are experiencing, so I think getting into the workplace is going to be a big part of the solution here. But how to do it, whether it's mandatory, I think that will be difficult.
The Chair: Mr. Maynes, on the mandatory aspect.
Mr. Maynes: We're not about mandatory anything. We're about creating conditions where it's the natural thing to do.
Senator Enverga: I was hoping that it might be mandatory. If you could perhaps talk to corporate executives, saying this will help productivity and help reduce absenteeism, that would be great.
The Chair: We've given you that challenge, to go to corporate Canada.
Senator Wallace: Mr. Haldane, I think of the YMCA. Back in my youth, growing up, it was a big part of my life. The activity, the camaraderie with others, the sports — it was fun. I have very positive memories of it.
As you are probably well aware, there is a new YMCA. I live in the greater Saint John area of New Brunswick, and there is a new Y that is all but completed, a $25 million project. I congratulate you for that. That's a welcome addition to the community.
Mr. Haldane: Thank you.
Senator Wallace: The role of the Y has changed from when I was a child, and now you provide a lot of these other services, including immigrant settlement services. There is a host of them. Going back to the role of the Y when I was young, which was to provide activity and camaraderie and to get young people to be active, do you keep an analysis or statistics for both young people and adults to see what the trend is at your YMCAs? For example, I know there are a lot of other activities at the Y, but just looking at physical activities that are encouraged and promoted by the Y, do you keep any statistics on the participation rates for youth and adults?
Mr. Haldane: Yes, we do. We track the level of participation. We are a charitable organization, but we have a very market-driven role because many people choose to go to the Y and pay for our services. When you're in that kind of environment, the market speaks. If people don't want what you're offering, they'll go somewhere else or they'll stop coming. We have a pretty clear idea of the ebbs and flows, trends and interests, and so on.
There is no question that the rising use of screen technology has had an impact on the activity levels of the young people who would traditionally come to the Y and hang out on Saturday mornings and be actively involved. The temptation of spending time in front of their computer screen — I guess not so much in front of the television screen, because it's all recorded now, but certainly in front of the computer screen — is a big competitor for the Y, if I can put it that way, bigger than other people offering similar services. Frankly, it is just that distraction.
We have had to do things like youth zones in our Ys. Most of our Ys now have a youth zone that uses technology, but active technology. I don't do these things myself, but the Dance Dance machines and other kinds of active technology are now in our YMCAs because we also believe that a big part of the support system is doing these things together — not just in your own home but to actually go to the Y. We try to have active video games, if you will, so that kids can have what they're used to and what they think is cool, but in a setting where they will get those supports and have fun with others. So we do track that.
Some of the traditional things that we have done for a very long time: We invented basketball, and basketball is still a huge draw, especially in urban settings. Some of those trends don't change. In fact, basketball is probably more popular than it's ever been before. It's not organized leagues as much as it's just pickup games, in a safe place. That's the other key part of this. We provide, not just in YMCA facilities but with other partners, safe places for kids to go.
We are very excited about the new Saint John Y, by the way.
Senator Wallace: You did hook me on basketball in my youth; no question.
If you do keep that information, is that something you could make available to us? With youth and adults at various ages, is participation in physical activity on the increase, decrease or is it static?
The Chair: Mr. Haldane, the incidence of obesity has been fairly dramatic in terms of increase over the last 30 years, so perhaps if you can show any statistical change in the directions that the senator is asking over that period of time, or any fraction of it that you actually have the records for.
Mr. Haldane: Yes, we'll get some information for you. I think the evidence is that actually physical activity is decreasing at a very significant rate.
The Chair: We will wait to get the actual statistics.
Ms. Petersen: One other comment to your question. I wanted to add that one of the programs that I mentioned earlier is around the Grade 6 membership. I wanted to bring that up, because participation rates at that age tend to shift in terms of where kids would go into certain activities. At that age, they tend to go into a more sport-specific route or they don't stay involved, as they do not want to participate in that structured type of recreational activity. So we have implemented the Grade 6 Initiative as an important time point in children's lives to help address that, trying to provide those youth zones or special Friday night activities for them, or very specific activities for their age, 11 and 12.
Senator Nancy Ruth: I want to follow up on that — 11, 12 and earlier. There are a lot of studies on how young girls tend to drop out of sports when they reach puberty or prior to puberty. What kind of gender-segregated data do you do in your evaluations, and how do you set your programming to counter this phenomenon within Canada?
Ms. Petersen: That's a great question. I have a really good stat: For girls who do not participate in sport before the age of 10, only 10 per cent of them will continue on to become active by the time they're 25 years old. So it's a significant issue. I would say there are definitely differences in terms of what different genders would get involved with in sport, and I think, as a culture, we certainly encourage boys to be more involved in sport than girls.
We have programming in the Okanagan where there is a program specifically for girls. We have tried to focus it just for them to make it a little bit more comfortable. That's a really important thing, especially for girls of that age, 11 and 12, to have a comfortable environment in order for them to want to be active.
Senator Nancy Ruth: What about the rest of the Ys in the rest of Canada? Part of the question I'm asking too: What has been the impact of the YWs in many places having to close and be absorbed by your organization? How has the gender division been accepted or integrated? What have you done with all that?
Mr. Haldane: I think a particular focus on girls and young women is important, because there are significant gender differences. In the YMCA, we tend to provide programs in an integrated environment of both genders. There are examples, like the Okanagan and others, where they are having more of a specific focus, and certainly the YWCA would have a very specific focus.
For your information, the YWCA is a separate organization from the YMCA. Just to be clear, some of the YMCA/ YWCAs have disaffiliated from the YWCA and become YMCAs, simply because it's difficult to keep the focused perspective on women and girls alive in an organization that has a broad mandate. That's a decision they have made. The YWCA has a particular focus on women and girls. I think it's important because there are differences in lifestyle factors, behaviours and so on.
Senator Nancy Ruth: Is that not integrated into your programs?
Mr. Haldane: The YWCA programs?
Senator Nancy Ruth: It's not the YWCA; it's the general data that exists in the academy around these issues for young girls.
Mr. Haldane: Generally, our role is to deliver programs in an integrated environment. We do have some Ys that have chosen to do this work in their own communities, in partnership with others, but it isn't, by and large, a role that we play. The YWCA would play that role to a greater extent.
The Chair: I'm assuming, Mr. Maynes, that yours are non-gender specific.
Mr. Maynes: Non-gender specific. I would have to check to see if there is any research on that, but I doubt there's any difference in walking rates.
The Chair: I thought it would be obvious in your case, but thank you for confirming that.
Senator Moore: I want to thank the witnesses for being here.
Mr. Haldane, you said that the YMCA is the largest provider of childcare in Canada. How many children do you look after on a daily basis?
Mr. Haldane: I used to be the CEO of the YMCA of Greater Toronto, so my numbers on the YMCA of Greater Toronto are a little bit more accurate, but Toronto Y has approximately 250 licensed childcare centres. Overall in Canada, I think it's about 900 or so licensed childcare centres. That would represent something in the neighbourhood of 75,000 children.
To be specific, we're the largest provider of non-profit, licensed childcare. I don't think there's larger profit, so I could probably remove the word non-profit and still be accurate.
Senator Moore: You mentioned three key aspects of your work to promote healthy weights and address obesity. One of them is your growing focus on teaching physical literacy, beginning with the very young. What does the YMCA do daily in terms of trying to teach youth? At what age do you start, and what is the involvement or the buy-in of the parents, which I think would be critical?
Mr. Haldane: We start with children when they're weeks old. So we have programs for our infants in our child care centres, and then we go right through to young adults. We cover that whole age range.
We have a curriculum called YMCA Playing to Learn, which is a play-based curriculum that has our YMCA childcare teachers looking for learning opportunities within the activity of children, which is play. The children will be playing in a variety of ways, using a variety of supports, and the teacher will be looking for an opportunity to talk about nutrition, about physical activity and so on. It's completely integrated into the day-to-day experience of being in a YMCA childcare centre.
We do a number of programs, as we mentioned earlier, like the MEND program, the CATCH program. These are programs that incorporate physical activity and nutrition into after-school programs. What we hear anecdotally is that the child becomes an advocate within their own family. So it's just like seatbelt laws and smoking laws. The child gets exposed to this. When they get home, they're sitting at the dinner table and — you've experienced this — the child will say, "You know, mom, this isn't healthy and we should be eating something different.'' We create an advocate within the family coming from the child, which is pretty powerful. As any of us who are parents know, if the child tells you something at the dinner table, you have to pay attention because now they're giving you the good example. We hear that when the kids have the experiences in our childcare programs, they actually go home and start to influence their families in a very positive way.
Senator Moore: Do the instructors pass on materials to the parents? When the parents come and pick up the child at the end of the day, is there something you can take home to reinforce what the child experienced during his or her time at the Y?
Mr. Haldane: One of the big parts of the YMCA Playing to Learn curriculum — by the way, play-based learning for preschoolers is now very common in the education system, and we've been doing this for over 25 years — is a major strategy around communicating with parents. The single biggest criticism that anyone doing work with children gets is from parents who say, "I never know what they're doing.'' You ask your kid, and they say, "Nothing.'' We actually have a very robust and deliberate strategy to communicate with parents so that every single day our teachers write a note to the parent saying, "This is what your child learned today, and this is how they learned it because we use play to do that.'' The nutrition focus and the physical activity focus that they experience during the day would form part of the teacher's report back to the parents every day. When they read what their kid did that day, they'll see that they were exposed to nutrition, healthy living, healthy activities and so on.
Senator Moore: How long has the Y been doing this physical literacy program?
Ms. Petersen: I can add to that.
Senator Moore: You mentioned something about 25 years, but I don't think you meant that.
Mr. Haldane: We've been in childcare for 25 years.
Ms. Petersen: The work we've been doing with physical literacy probably started about three or four years back, and the Edmonton YMCAs have probably been one of the groups that have been spearheading this. They started off with integrating physical literacy into their day camps. The concept of physical literacy is in line with the idea behind literacy, learning how to read, so there are key movement skills that you learn that are crucial for you to become an active adult down the road. By using that concept, the purpose is to make our programs a bit more intentional around giving kids those really important skills. It's not just physical skills. It's also the affective or emotional side where we want kids to enjoy movement and be motivated to become involved in physical activities. That is the purpose behind physical literacy. It's a very intentional approach to teaching people how to move.
In the Edmonton Y, they started off with summer day camps, and they have moved into the other aspects of children's programming. We're now going to be doing something similar in Calgary.
The Chair: Mr. Haldane, I wish you could influence the school system. I understand it's very difficult for parents to get an annual report that accurately reflects what's been going on. I'll leave that alone.
Senator Raine: Thank you all for being here. It is very positive what you're doing, and we thank you for that.
I have a couple of questions. I want to follow up on prescription for exercise. Are Canadian doctors being trained to prescribe exercise? If they haven't been trained in the past, how do you see this happening in the future? Obviously, if a doctor is not confident to prescribe specific exercise, then why would they do it? I'm very aware that a lot of post- degree education in our country is underwritten by pharmaceutical companies. My question would be: Who should pay for the training of the doctors to prescribe medicine?
My second question is related more toward Canada Walks. Do you have any information on the gadgets and the Fitbits and the various walking pedometer devices? Does that help to motivate people to set personal goals for their walking?
Mr. Haldane: I'll answer the first and the third. I'm not quite sure about the second one. That's a toughie.
Influencing doctors to be actively involved in influencing their patients to move forward on lifestyle changes, as opposed to prescribing medicine, is tough. We met with the Canadian Medical Association and asked them if they could help us with it, particularly related to pre-diabetics and having them referred to the Y. They said, "We can't really influence our doctors.'' I thought it was interesting that the CMA doesn't feel that they can do that either. So it is a tough one.
What they have done in Edmonton is engage the primary health networks. So the family doctors and other health care providers are actually partners in this. The education of doctors around the importance of doing this and the effect of a prescription versus just saying, "You should get more active,'' is part of the education that's going on.
I don't think it's happening in the formal education system. I don't think it's something that doctors are necessarily prepared to do or trained to do. I think that once we get these kinds of networks going, that the possibility does occur.
On the third question you asked on the gadgets — I know Mr. Maynes may have a response to this as well — this incentives program with the loyalty companies that we've been talking about will be gadget-based. So it will be a system connected to whatever phone you happen to use, and you can actually record your good behaviours on that. You will also select where you want your points to go. If you're an Air Miles collector versus an Optimum collector, you can say you want Air Miles.
Whatever is included in that, if you record that you've done that, then you can actually get the points assigned to that. We are working with a coalition of organizations to figure out how to use a gadget-based incentive program to influence healthy behaviours.
Mr. Maynes: On the issue of incorporating physical activity into the medical system, Kaiser Permanente, which has 9.1 million members in the U.S., has made physical activity one of the vital signs that health care professionals need to chart and act on, along with weight, family health and blood pressure. There's an example of it being integrated, albeit through a private health care provider.
We're all in favour of Fitbit and step-counting devices and they're very valuable. The point we'd like to make, though, is you need to change the environment so that people want to walk. Then step counters and promotional programs and street festivals and any other number of other things that might be done become additional incentives to do it. But if it really is not pleasant or safe to walk in your community, I don't think a technological solution will make the difference.
I really encourage this committee to think of the need to create the foundation for a lifestyle on the part of everybody that will prevent obesity and help to reduce it where it exists.
Ms. Petersen: I'd like to add to the question that you had around the referral. With our experience, one of the things we have found that's really important with the referral is having that relationship transferred down from the Alberta health care provider to the YMCA side or the recreation facility that might be receiving the referral. It is difficult to come in and just send people to a facility through giving them a piece of paper. However, that does really support that verbal recommendation from a physician. I know we've seen physicians within the health care environment such as a recreational therapist who really focuses on supporting that person with the wellness opportunities they might be interested in. That's one thing.
In relation to your other question around the use of gadgets, some of the different programs we have in our facilities include a program called "Fit Links'' and it's an electronic tracking system. Our experience is that there are certain types of people who really like it and are really attracted to the gadgets and others just don't care about that. That's not the way they work. I think it's a bit of a personality piece, too, and sometimes one size doesn't fit everyone. However, you might hit some people with it though. That's been our experience.
Senator Raine: My observation has been that young mothers are actively involved in looking for the best opportunities for their children. At a certain time in life women say, "I've got to do something,'' and they tend to get out and do certain kinds of things like walking, but I suspect that men choose other kinds of activities. Do you find there is a difference between what attracts adult women to activity versus men?
Ms. Petersen: In our facilities especially, group fitness classes have a much higher percentage of women participating in those than men. You would see more men maybe on the weight floor or in different other types of activities. I think it really highlights the importance of social support for those women. They like to be around their friends and participate together. That's a very important point that you're making with that question.
Senator Raine: Do we risk losing the men if we focus too much on group fitness? Are men more attracted to team sports, for instance, and adult leagues?
Mr. Haldane: We try not to lose anyone, so we try to offer a wide range of programs to meet a wide range of people's interests. It's not just gender-based. Different people are attracted to different things, so we try to have something for everyone to the extent possible.
Men tend to be more focused on individual sports and perhaps pick-up sports.
The other piece of it is many people in their own way are attracted to doing these things. A lot of the people we deal with are attracted to the social part. The physical activity and the social really go together, especially in terms of maintaining the lifestyle or maintaining the weight loss; the social network is really key. Sometimes that's in a group fitness class and sometimes just in the change room afterwards where you have your friends who use the same locker every single day.
Senator Seidman: Mr. Haldane, you have 75,000 children in preschool programs, if I understood correctly what you said.
Mr. Haldane: I'm going to check my numbers, but I think it's roughly correct.
Senator Seidman: You have a huge cohort; you could do a wonderful study.
Mr. Haldane: If we get someone to pay for it, we'd be glad to do the study.
Senator Seidman: I will leave that for now.
You may have already elaborated on this, but in case you haven't, I'll give you the opportunity. You say the YMCAs are working in collaboration in B.C. to deliver an evidence-based U.K. program called MEND, which is Mind, Exercise, Nutrition, Do It! which does combine more than just physical activity. It's a healthy-living program specifically for 7- to 13-year-olds with unhealthy weights. Could you give us more information on what exactly that program involves and what success it may or may not be having?
Ms. Petersen: I probably can't speak to the totality of the success part. I think they have seen great successes with their children and youth in the program and it's obviously grown as a result. The program is targeted at children who are in the eighty-fifth percentile of their weight category. They're overweight and obese, so it's very targeted. They bring in parents and caregivers to join them in education sessions together and they educate them on physical activity and healthy eating together. It's a more holistic approach of trying to target the parent and the child, especially for children who are struggling with their weight.
Mr. Haldane: We'll get some additional information through the clerk on that program.
One of the benefits of being in an organization that is in 119 countries is that we are constantly sharing best practices across the world. We have a number of examples like this where we've taken a program that's worked somewhere, and so there will be some U.K. evidence on this as well. I'll provide that to the committee.
Senator Seidman: That would be appreciated. Thank you.
Senator Merchant: Early on in the presentations I believe one of you mentioned a critical age or a dangerous age, people in their sixties and seventies. We have concentrated a lot on the activities in engaging young children early on so that they develop lifestyle patterns. Can you tell us what is happening with people when they get to their sixties or seventies? I have noticed that in Regina, for instance, some of the malls have walking programs for people who have retired and have a little extra time and incentive to get out because they're not going to work anymore. They need the social interaction and they walk in malls.
Can you tell us what happens to people when they get to their sixties and seventies? Are they still physically engaged, or what do you do to facilitate people to participate in your programs? I'm not sure if the Y has programs or the walking group has programs.
Mr. Maynes: I was actually talking about people in their seventies and eighties. The research shows that if you have been and continue to be walking on a regular basis that the incidence of age-related disability is greatly decreased. And if you do suffer a fall or something that disables you for a time, you're much more likely to rebound. That's not necessarily obesity related, but it's definitely a huge health care cost and a huge personal cost for people who lose their independence and become immobilized. It's probably a very strong indicator for other health problems arising very quickly.
This is seen in people who are healthy in their older years; they've undoubtedly spent many decades involved in routine physical activity, very often walking.
Mr. Haldane: Again, we tend to offer our programs in an integrated environment, so we have some programs that are focused specifically on older adults. Based on demographic trends, we think that we'll probably be doing more of this in the future, but it's all within an environment where people of all ages participate together.
In terms of older adults, one thing I would mention that really works is the social network. It is extremely important. Along with perhaps less physical activity due too just aging and not being as engaged in the community, we also see social isolation being a significant factor for older adults. The incentive to get involved is not the physical activity so much, it's actually being with other people, and not only people of their own age but with people of a variety of ages. You just feel like you're part of the community and connected to it. It's almost like the physical activity is what you do when you're in that environment. I think that's a big factor.
Ms. Petersen: I could add examples of other programs. We have a program called Healthy Living especially for people who have chronic conditions, so it tends to be older people who come into the program. They come in and exercise together and they even have social activities that surround it. We have even seen some of them being trained in delivering the classes because their experience and support as a volunteer is crucial in inspiring other people of the same age to be active.
The Chair: This has been a fascinating discussion and you've covered an awful lot of really important aspects of the whole issue of exercise relative to social development behaviour. I particularly like the approaches that you've all described; that is, you're looking at, first of all, the community as a whole, and then the individual as a whole individual, as opposed to focusing on a specific disease.
I'm only going to make a couple of specific comments. I was fascinated with the first examples that I saw in the public literature on the use of prescribing physical activity by physicians. An initial study had shown — it wasn't a true clinical trial in the sense that Senator Seidman has been asking about — the follow-up of a group of people for whom exercise had been prescribed because of high blood pressure and a number of related issues. It showed a significant change in the physical characteristics that can be monitored, which followed a certain period of time.
Also, as you've indicated, having been given a prescription to a particular physical activity centre or other centres like that — I'm not going to refer to the YMCA — there is a willingness to follow through with that. I thought it was an excellent concept. I can see why physicians would readily do that because it takes no time to write the prescription. They're good at that, but for individual family doctors to take the actual time to prescribe a holistic approach to life is a whole different ballgame. It was a good concept and I think the evidence will grow quickly along the lines you've indicated.
I've been very interested in your answers on the issue of exercise and the gender-related issues. I have worked out all my life, usually around the university. I'm not going to make any observations about what I have seen, but there are clear gender differences in the behaviour of people in facilities such as that. They are probably all equally successful in terms of outcomes, but they are definitely different in how they approach these kinds of centres.
I've noticed a real impact in exactly the way you've described social activities, and I'll refer to my home university, Acadia University. It has a number of programs for people who have been identified with — let's take a typical one — heart disease. If someone has a heart attack, a program is delivered to follow up in these areas. The neat thing about that is it becomes a club. They don't like it when the university is closed for holidays and whatever else. They get so attached to it that they want to go.
The thing that I find interesting is that because it is a specific medical condition, they tend to follow it very carefully. The reality is that many of the people that might have been prescribed that because they were overweight to obese — some of those characteristics tend to go a little bit together — because it's done this way, they're active. They're out there and they're doing it. It's a very good program.
I don't want to get into a long discussion on this, Mr. Haldane, but would you have a quick observation?
Mr. Haldane: The YMCA in Burlington was the first community-based post-cardiac program, which started in 1966. I met a gentleman in the late 1990s. I said, "When did you have heart attack?'' and he said in 1967. He was still coming to the program every day because he was in the club.
The Chair: Very successful. On the basis of experience, I want to say to both groups, to Mr. Maynes and to you folks, that I relate very much to what you have said here today. I think you are doing things that are of enormous benefit to us as a society. I applaud what you're doing. The directions and changes to the YMCA are evident in communities where you operate.
Mr. Maynes, your program is obviously an excellent one. Issues have been raised by my colleagues, such as the difficulty people have in finding places to walk. This is a northern country. Even if there are sidewalks, they were not always safe for people of all ages. If there are challenges for society as a whole, there are certainly challenges for senior citizens to gain easy access to walking, something many of them are still capable of doing, but it's gaining access to a location where that can occur.
I live in rural Nova Scotia. It's much more difficult, as both groups have indicated, for people in rural areas to find opportunities to pursue these things. However, if you find a group of like-minded people and if they have a little bit of club activity in this area, that tends to keep people going.
I have enjoyed your presentations and answers to our questions. I want to thank my colleagues for the questions that they've put to you that have helped you elaborate on these issues and the potential benefits.
(The committee adjourned.)