Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 32 - Evidence - April 23, 2015
OTTAWA, Thursday, April 23, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:29 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, Chair of the committee, from Nova Scotia. I'd like to have my colleagues introduce themselves, starting on my right.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Enverga: Tobias Enverga from Ontario.
Senator Tannas: Scott Tannas from Alberta.
Senator Nancy Ruth: Nancy Ruth from Toronto.
Senator Frum: Linda Frum, Toronto.
Senator Raine: Nancy Greene Raine from B.C.
[Translation]
Senator Chaput: Maria Chaput from Manitoba.
[English]
Senator Eggleton: Art Eggleton from Toronto and deputy chair of the committee.
The Chair: Thank you, colleagues. We are here today continuing our study to examine and report on the increasing incidence of obesity in Canada, the causes, consequences and the way forward.
I am delighted to welcome today as our witness group from the Assembly of First Nations, Peter Dinsdale, Chief Executive Officer, and it's my understanding he will make the presentation and his colleagues, who I will acknowledge now, will be prepared to answer questions as we go forward. We have Katie-Sue Derejko, Senior Policy Analyst, Public Health; Jennifer Robinson, Senior Policy Analyst; and Brigitte Parent, Policy Analyst.
Thank you all for being here. Welcome to our committee. I am pleased to turn it over to Mr. Dinsdale.
Peter Dinsdale, Chief Executive Officer, Assembly of First Nations: Good morning and meegwetch.
My name is Peter Dinsdale, I'm from Curve Lake First Nation in Ontario, and it is my honour to appear here before you. I want to acknowledge that we are on the unceded ground of the Algonquin people and thank them for allowing us to gather in their territory.
It's my pleasure to appear before you to speak on the increasing incidence of obesity in Canada, the causes, consequences and the way forward for First Nations peoples and communities. The AFN considers engagement with government on the increasing incidence of obesity in Canada from a First Nations' perspective to be a top priority.
First I would like to speak to the United Nations Declaration on the Rights of Indigenous Peoples, Article 23, that says that indigenous peoples have the right to be actively involved in the development and determining health, housing and other economic and social programs affecting them and, as far as possible, to administer such programs through their own institutions.
Second, it has long been a goal of the Assembly of First Nations to close the gap in health outcomes between First Nations and the general Canadian population.
This objective, we're pleased to see, is shared by Health Canada, as demonstrated by the express mandate to address health barriers, disease threats, and attain levels comparable to health levels of other Canadians.
While we clearly share similar objectives, the fact remains that First Nations people continue to suffer disproportionately with poor health, both mentally and physically.
Third, any consideration of the government's role in examining and reporting on the increasing incidence of obesity in Canada has to begin with an understanding of colonialism and its effects on the First Nations and our interactions with the government and related institutions which continue to wreak havoc on the health and well-being of First Nations.
In Canada this history includes legislation like the Indian Act, the creation of the reserve system, legal status, residential schools, the sixties scoop, inadequate services to those living on reserves, systemic racism and the lack of understanding or consideration of the effects of these experiences.
Furthermore, when discussing the health and well-being of First Nations people, it is critical to acknowledge and understand the important connection between the social determinants of health such as physical, social and environmental conditions as they relate specifically to racism, discrimination, colonization, marginalization and even oppression.
Though a social determinants of health approach is necessary to policy discussions and to the government's role in addressing the increasing incidence of obesity amongst First Nations, it is not sufficient on its own and must be implemented in accordance with the values, attitudes and aspirations of First Nations peoples.
While studies in Canada point to rising obesity rates and Canadians who are overweight in general, for First Nations the proportion of adults who are overweight or obese has been disturbingly higher than the general Canadian population.
Complementary to First Nations traditions, current research indicates that obesity prevention needs to begin prenatally, in utero, after a child is born and continue throughout the school years.
Rates of high birth weight among First Nations are much higher than those of the general Canadian population. High birth weight infants are more likely to be overweight or at risk of being overweight. Alarmingly, First Nations children have consistently higher rates of being overweight and obese than the general overall Canadian population. The most recent regional health survey revealed that almost three out five First Nations children are obese, yet 87 per cent of their parents and/or guardians see themselves as being in excellent health. It has become far too common in our communities and it is becoming accepted.
Yet again, the social determinants of health are significant determinants in influencing these factors, along with profound, rapid lifestyle changes brought on by colonization. Physical activity is also known to have several benefits, including lowering the risk of some cancers, cardiovascular disease and diabetes. Physical activity has also been identified as a predictor of obesity in youth and with the likelihood of being obese greater in people who are physically inactive.
First Nations have expressed that participation in recreation and sports activities is impacted by many of the social determinants of health, including the availability of or access to recreation facilities, the cost of participating in sports, a lack of physical activity opportunities both at school — should there be a school in their community — or in the community overall and competing sedentary activities such as television and computer use.
Traditionally First Nations led active, robust lifestyles by hunting, fishing and gathering foods, medicines, cooking, preparing and participating in traditional games and competitions such as lacrosse, dancing and canoeing.
Today boys and girls are less engaged in these traditional activities due to multiple factors of colonization and contemporary western influences.
Here are few examples highlighting the complex reality of obesity among First Nations and justifications as to why our collective efforts with government in addressing the obesity crisis in First Nations must be addressed now.
For one, the critical lack of food security and access to healthy, affordable foods for many First Nation communities is simply unacceptable. Exorbitant food costs continue to be documented in the media, yet efforts to date have not resulted in reduced costs for many struggling First Nation consumers.
In remote and Northern communities the high cost, poor quality, lack of variety and availability of perishable foods are additional barriers to purchasing fresh foods as part of a healthy diet. Added to this predicament is the reality that too many of our communities do not have clean potable water and are turning to unhealthy alternatives, resorting to soda and sugar-heavy drinks, adding to the growing obesity crisis.
There continues to be an alarming increase in obesity-related disorders. These include but are not limited to Type 2 diabetes, cancers and cardiopulmonary disease.
There is a no more telling effect of the obesity epidemic than the astronomical rates of diabetes. Although it is difficult to pinpoint a specific cause to any given individual, it is well understood that obesity is the most important modifiable risk factor contributing to the development of the disease.
Diabetes has become a disabling and deadly disease with First Nations affected at a rate of three to five times that of the general Canadian population. There are increasing rates of comorbidities associated with obesity, specifically Type 2 diabetes, and these diabetes patients are known to require frequent foot care, which is seriously underfunded.
There is strong evidence that obesity causes cancer. No doubt we are witnessing increasing rates of cancer in First Nation communities and the health care system and the Non-Insured Health Benefits system and First Nation community health budges are ill-equipped to handle the health care and transportation costs related to treatment, especially in remote and isolated communities.
Chronic illnesses related to obesity costs everyone. Transportation costs, treatment costs, medical devices, supplies, medications, child and elder care costs, would be astronomical with the rising cardiovascular rates as well as cancer and diabetes rates.
There is no denying the link between obesity and the mental wellness of First Nations peoples. Studies have found depression to correlate with the onset of obesity and obesity to predict the onset of depression. Food is an addiction and comfort like any other food, and a lack of mental health and addiction programs and supports can contribute to escalating weights.
As part of this picture, home and community care nurses in First Nation communities are reporting having greater difficulty lifting and moving heavier patients, and some home community care nurses report that NIHB equipment is of poorer quality and thus inadequate walkers and wheelchairs are unable to sustain heavier weights, and this comes with associated liabilities for both patients and health care providers. For this and many more reasons, we continue to engage with the government about improving access to NIHB services, in particular, the AFN joint review process with Health Canada that began last fall and will continue into the fall of 2016.
First Nations are the youngest, fastest growing population in Canada. This works in all of our interests. Strong and healthy First Nations make for a stronger and healthier Canada. As a result, there is an urgent need to support First Nations in addressing the obesity epidemic. And obesity-related comorbidities observe, in particular, the need for health prevention and promotion of partnerships in healthy lifestyles. Developing partnerships with community organizations can address barriers to food security, sports and recreation needs. Developing organizations such as ONEXONE and the Breakfast Club Canada are generously active in First Nations communities trying to make short-term gains by supplying meals, whether breakfast or lunch. However, these programs are not sustainable over the long term and require government intervention.
It must be clear that programs and services designed without the involvement of First Nations will not work for us. In fact, First Nations' control of the management of health programs and services must be a priority for the federal government.
In closing, the AFN makes the following recommendations: We continue to call for sustainable long-term funding to ensure that the solutions to the increasing incidence of obesity for First Nations are community-driven and have meaningful results that will enable First Nations families to heal from the impacts of colonization and the devastating effects of residential schools, systemic poverty and have our communities move forward toward a path of physical and mental wellness — its path to healing.
Furthermore, our communities require supports and investments in prevention through community-based programs that educate parents about healthy lifestyle choices and healthy weights, and intergenerational community-based programs that reconnect young parents with family and reconnect community and culture to promote breastfeeding and child-rearing practices. Sustainable and sufficient investments must be made across a broad range of social and health services, including basic infrastructure needs for First Nations, such as housing, safe work and play environments, recreation facilities, water, and mental health supports.
We welcome continued engagement and encourage continued collaborative efforts to address the increasing incidence of obesity in Canada, the root causes, the consequences of inaction and apathy and the way forward in a manner whereby First Nations communities can adapt, reform and realign wellness programs and services according to First Nation priorities.
I look forward to your questions.
Senator Eggleton: Thank you very much for being here. As you pointed out, the issues of obesity and resulting health concerns are being felt by First Nations communities to a much greater degree than in the rest of the community. A lot of it has to do with the social determinants of health — a wide range of things that we have heard about on many other occasions in many discussions about health care in Canada. These issues continue to plague First Nations communities.
First, I'll ask you about a reference to something I hadn't seen before: What is the Sixties Scoop?
Mr. Dinsdale: You're familiar with residential schools. The Sixties Scoop was when child welfare agencies removed children.
Senator Eggleton: I thought as much, but I hadn't heard the phrase before.
Let me ask you about the food situation. The government decided in 2011 to launch Nutrition North Canada to replace the food mail program. I don't know whether that program is pertinent to other remote locations in the country, although the issue of remote locations is not only a northern problem. Has that particular program improved the amount of food, in particular nourishing food, at a reasonable price for the consumer? Is that working or only partly working or not working at all?
Katie-Sue Derejko, Senior Policy Analyst, Public Health, Assembly of First Nations: When Nutrition North Canada replaced the food mail program, one of the issues was that some First Nations communities lost their eligibility. They were eligible when it was food mail but when it became Nutrition North Canada, they lost eligibility due to the way that Aboriginal Affairs changed the criteria.
That was one of the first issues that we had when it changed to Nutrition North Canada. The recent report from the Office of the Auditor General indicates that the issue now is that they can't prove that the subsidies are actually reaching the consumers. The accountability mechanisms weren't put in place. The subsidy now goes to the retailer, but the retailer isn't required to show its profit margin so there is no way we can prove that the subsidy is reaching communities. That's another issue. Since the release of the report, Aboriginal Affairs has said that they will address this issue. We can't say if Nutrition North is helping communities at all.
What we hear from communities is that the cost of food is still quite high under Nutrition North. The list of what's subsidized isn't always what the community needs and wants. Still, there are a lot of things not on there, which make the cost of living high. Some foods might be subsidized but if your overall costs for other products to live, then you're still going to need to cut your budget at some point and food is often something that still gets cut.
Senator Eggleton: What about the remote communities that may not be part of the North? Perhaps it depends on where they draw the line on what they consider to be the North or maybe they do provide this to other remote communities. Can you comment?
Ms. Derejko: Do you mean other remote communities that aren't First Nation?
Senator Eggleton: Yes.
Ms. Derejko: I would assume they provide to them but I can't say for certain. I don't know what their opinion is of the program.
Senator Eggleton: Some were disqualified. What was the basis for that?
Ms. Derejko: I'm not exactly sure what the algorithm is to figure out what is "qualified." It had to do with the fuel subsidy. I could get back to you on how that changed.
Senator Eggleton: Okay.
We are focusing on — and the chair keeps mentioning it when he introduces the subject — the increasing incidence. Are these things just long term? For example, over the last 30 years there has been a substantial increase, but is it the same for First Nations communities or has this matter of obesity been going on a lot longer than that, this question of obesity?
Mr. Dinsdale: It has been going on longer than that, generally, if you track the move from settlements to reserve communities, depending on what part of the country you're from, in the late 1800s. It certainly caused tremendous lifestyle changes overnight. That's the colonization impact. There are also the general Western impacts of television and video games, creating different priorities and a way to escape. That impacts communities as well. We can get tracks on the spikes versus the trends, but the trends have been going the same way.
Senator Eggleton: You mentioned that Breakfast Club Canada has been generously active in First Nations communities with breakfast programs for kids going to school. You say these programs are not sustainable over the long term and require government intervention. Can you expand?
Mr. Dinsdale: Generally, all of these breakfast programs are goodwill and service clubs. As long as those relationships remain intact, that may be the only meal those kids get during a day. Government intervention requires it to be sustained long term as priorities change. Obviously, there's a risk of those programs not continuing.
The Chair: To clarify your response to Senator Eggleton with regard to the First North Division, it wasn't only geographic, there were some other factors involved in the selection of communities transferred or not transferred.
Ms. Derejko: Yes.
The Chair: It was not simply geographic.
Ms. Derejko: Yes, that's my understanding.
The Chair: We would like to know if it's a clear point, if you could.
Senator Seidman: I wanted to pursue the food issue put forward to you in Nutrition North, but in a more general way. There is no question that diet is related to health. There is no question, Mr. Dinsdale, as you said in your presentation, that exorbitant food costs continue to be documented in the media. I myself was kind of taken aback to hear that lettuce costs $12 or some such thing in the North. It's hard to deal with that and then to try to understand how we can do better than that so that First Nations people have access to healthy food that's affordable. You also talked about prevention and community-based programs. Trying to link these things — prevention, better health, better diets — how do you see your way through that? What suggestions do you have to offer?
Mr. Dinsdale: In some respects, when I consider my family in Ottawa, I have two young boys, a ten-year-old and an eight-year-old, and, as they've grown up, they've played hockey in arenas throughout this town. I have the means to buy their registration and equipment. They're in basketball. One wants to take karate. They play outside. I take them fishing, and they actually come out hunting with me as well. We do all these things. If I was living in a remote community, what would the same paradigm be for my kids? By the way, they also have iPads and spend far too much time on them and watching TV. If I was living in a remote community, what's my access now? They may not have a rink or school so they could play basketball. They may not have any indoor facilities or organized sports league. Now my kids are outside running around playing, which is fantastic, but they'll do that as much as they will and then retreat to the other trappings we have, with the same satellite dish and same devices available to them. A lot of it is infrastructure. Far too often I'm sure we come to these committees and ask for more money, and it's one of those things that's an ongoing refrain, but there is a real question here. Imagine your children or your grandchildren being raised in those communities. What would you expect the services to be available for them?
Part of the issue, and this is bigger than your study on obesity, and I apologize, is that it's part of the fiscal relationship with this country. First Nations are funded through contribution agreements in the exact same way festivals in each of your communities are funded, the exact same funding mechanism, with no ability for long-term financing of facilities. Public-private partnerships require certain contributions and expectations in the long-term, so we're left with year-to-year agreements. There are agreements to build schools and facilities, and they come and go, but the ability for these communities to plan long-term and develop the infrastructure we're talking about which supports healthy lifestyles is lacking.
We have other policy challenges, like the Nutrition North program. I have seen studies where alcohol in some regions costs the exact same amount in an urban area versus up in a rural area. It's beyond me why we can get whisky to communities at the same price as the South but we can't get lettuce. That's an important question to think about. What policies do we have in place and how are these things measured? It's a kind of a meandering answer to you, but the challenge isn't just one thing. It's this broader systemic piece we live in. A big portion of it is the focus you're providing, which is appreciated, but it's also a coordinated action across the board.
Senator Seidman: The First Nations regional health survey, 2008-10, indicated that over half of First Nations households are food insecure, meaning that they struggle or are unable to provide sufficient food for the household, and 17 per cent of adults surveyed reported being hungry or skipping meals on a somewhat regular basis. The incidence of food insecurity is higher in large communities, similar to the incidence of obesity. Could you explain why you think food insecurity is more prevalent in urban and rural communities than in remote communities?
Jennifer Robinson, Senior Policy Analyst, Assembly of First Nations: Essentially, in urban communities, First Nations families struggle just like other families struggle with food insecurity, mostly because First Nations living in urban centres are living below the poverty line. It kind of stems back to what Peter was discussing about the socioeconomic factors. We can't put a policy in place that combats poverty specifically, but we can put policies in place that help First Nations people access education and school and help the infrastructure in urban centres so that First Nations feel comfortable living and working in those centres.
At the end of the day, if they are food insecure and missing a meal for their children or insecure because they don't have the money at the end of the month to buy milk or the essentials they need, as Peter mentioned, it's boiling down to the fact that First Nations still live below the poverty line more than other Canadians.
Mr. Dinsdale: In a previous life, I worked for the friendship centres. I was their executive director for seven years, and in that context we did all kinds of studies around urban Aboriginal people's access to services delivery in communities, and far too often mainstream services were seen as not available to First Nations people, whether they felt it was racism, whether they felt they were filled up with other clients or they didn't serve the cultural needs, they wouldn't go. So while poverty is a huge issue everywhere, the access to services is seen by the consumer to be minimized for Aboriginal people because of their access to them, so coordination of urban programs is an important element of addressing the poverty and food insecurity that they face.
Senator Tannas: Thank you very much for your presentation and for being here today. I'm on the committee just for today, so I may show some ignorance of other testimony. I'm wondering, in your studies and assembly of statistics, if there is anything of significance when you look at obesity and diabetes on an off-reserve, remote versus less remote, or wealthy and prosperous versus struggling communities? Is there any kind of differential, or is it all the same?
Mr. Dinsdale: I'm not aware of any significant differentials. I think it's a common experience, regrettably, and I think the sources are the same.
Senator Tannas: So there are no differences, or we know of no differences? No studies have been done in this?
Brigitte Parent, Policy Analyst, Assembly of First Nations: Certainly there are studies that have been done to indicate correlation between socioeconomic status and the incidence and prevalence of preventable chronic diseases. In terms of diabetes, for instance, if you're not able to afford to participate in recreational activities or afford to have your children participate in recreational activities, they're not necessarily going to be as active. If you have communities that don't have the infrastructure and they don't have the programs in place and you don't have the finances to become involved in these activities, then you're going to have risk factors to developing chronic diseases such as inactivity and sedentary lifestyles. Certainly there are correlations between socioeconomic status and health status, but in terms of remote versus urban communities, I'm not sure that there have been studies to show a correlation or a comparison between First Nations in remote versus First Nations in urban settings, and obesity.
Mr. Dinsdale: The other challenge when people quote stats that 50 per cent of First Nations people live in urban areas or depending on the jurisdiction different numbers, it's not a static number. People come to communities for work and they go back. They have at best a difficult housing situation with multiple people, so it's not a static population. You can't coordinate and say for the past 10 years, people only living in urban areas have this health status versus people only living in remote communities. The population is very active in terms of moving around their traditional homelands.
Senator Tannas: I think it would be worthwhile to search for some answers. I was lucky enough to go with Aboriginal Affairs on a tour of a number of reserves, both close to urban and quite remote, and found hockey rinks in all them, indoor hockey rinks, which I was impressed with. I think that's great.
Before we write all that off, I'm thinking back to Michelle Obama and her initiatives around encouraging people to take the resources in their communities and use them. Has that been a position of AFN or an initiative of leadership to say: Let's focus on this?
Mr. Dinsdale: Yeah, we have initiatives, such as indigenACTION where Waneek Horn Miller, a former Olympian, is a champion for us. B.C. has the Beefy Chiefs Challenge where overweight chiefs are doing their part to demonstrate leadership.
We haven't had a Prime Minister's wife take this on for First Nations in particular. We have our own leadership, as the States had previous leadership on this for sure.
I don't have it in front of me now, but that one study where three to five times childhood obesity — First Nations parents view their kids as healthy. We have an internal dialogue. I'm not ignoring that, but again back to our experience as parents and grandparents, you want your kids to have access to the best opportunities. You have seen those communities and they have more tools than others but it is not the common experience, I would say, across the country.
Senator Enverga: Thank you for the great presentation. There are many Northern communities in remote regions or maybe areas where there is not enough access to nutritious foods, like traditional foods, like caribou, Arctic char or fish. I'm lucky to be in one of those communities where we were able to taste those great foods. I really liked it.
Now, I know that trapping and hunting has declined about 31 per cent, generally. Can you discuss the role that traditional foods play with respect to the health and weight of First Nations people?
Mr. Dinsdale: It plays a tremendous role for sure. Far too often our children are not hunting or fishing nowadays. I think there are lots of reasons for that.
I would say there's a huge risk — I'm not trying to be political about this — but some of the environmental regime changes are going to make land management and wildlife management more difficult. There are issues with various mining, pipeline and other activities which do impact traditional migratory paths. There are pollution issues. Those are all real issues that we face in communities. Questions around traditional foods, did you —
Ms. Robinson: I can answer a little bit about that. It stems from having our land base. When you have your land base and traditional activities like hunting, fishing, being able to trap and spend actual time to do it as well, you end up making your traditional soups. We have evidence that the soups that we have made in the past, based on our way of life, included all the vitamins that we would have needed to sustain ourselves. It would have been a sustainable lifestyle as well. Health would have been a by-product of how we lived.
That's something to keep in mind. I work on mental wellness and addictions at the AFN and a lot of our programming is based on culture and making it so that entire communities can participate in their culture. What stems from that is a sense of well-being, hope, meaning and belonging. Those four components are part of the First Nations Mental Wellness Continuum Framework. That allows us to look at the broader social determinants of health that we mentioned are necessary to be able to go back to how we want to focus on our culture, to attain the same history that we have had with our food and with the way we can hunt, fish and do that.
One of the main focuses in suicide prevention is bringing back the culture. Many First Nations, when given the opportunity, decide for ourselves that we want to have canoe journeys. They're extremely physical. They involve a lot of tradition and ceremony. There are certain foods that some cultures have restricted that you can only eat during these journeys, which all have an impact on different parts of their health. It has an impact on physical, mental, emotional and spiritual health. That's how our culture is connected to how we determine how we are going to nourish ourselves in those areas.
Senator Enverga: Let's go back to the Nutrition North. Is this program structured to promote those kinds of food? I would love to have those Arctic char again and those berries. Is there a way to promote it within the First Nations? Those are really great foods.
Ms. Derejko: One of the calls we hear from a lot of communities is they would like to see subsidies for hunting equipment and things that help them get out on the land. Those tools are hard to access and they're quite expensive. That limits their ability to be on the land. There have been calls for those types of things to be added, like fishing lines and snowmobile parts, which help them to get on the land. They are difficult to get and expensive, so it impacts their ability to hunt, fish and trap, if those could be subsidized through something such as Nutrition North.
Senator Stewart Olsen: I would ask you to recognize that this committee is looking at a pan-Canadian problem. It is not just Aboriginals. We're all Canadians.
I would love to hear from all of you. You mentioned your soup. I know having been down to the reserve in Cape Breton that they have a lot of traditional food and they have it in their rec centres and whatever. These are very healthy for people. Rather than trying to do things in silos, I would like us all to work together on this because I think we are not going to solve our obesity problem by going back. We have to move forward. You should share those recipes for the traditional soups, honestly. More kids should be out on the land learning the traditional ways of First Nations.
We should develop sharing programs. Have you ever given some kind of consideration to that? I come from a poor community in New Brunswick. A lot of our kids are overweight; a lot of our adults are overweight. I have lived in the North, and I just think, if we all work together on something like this, I would rather use some of the traditional native suggestions because I think they are really healthy.
What would you think about something like that, about a sharing?
Mr. Dinsdale: I want to address this — maybe some of the foundations of the question about a pan-Canadian strategy and that being the approach. If we all had the same basis to build from then I would agree with you 100 per cent. It's like saying we have a pan-Canadian approach to our economy and a low unemployment rate, so we're all working together —
Senator Stewart Olsen: I don't want to —
Mr. Dinsdale: If I could finish.
Senator Stewart Olsen: I'm sorry —
The Chair: Would you let him respond?
Senator Stewart Olsen: I will and then I will respond.
Mr. Dinsdale: Part of the challenge that we have seen is that pan-Canadian strategies, generally, bypass First Nations for a lot of systemic reasons. We don't have the access to the exact same resources to build upon these strategies in other communities.
While I certainly appreciate the desire to move in that manner, there are systemic barriers that need to be addressed, like access to facilities and remoteness and these kinds of things. When a First Nation is set up, it will be there for the most part in perpetuity. When non-native communities are developed in northern Ontario, the mining communities, they have evaporated. They have left. There's no economy there, they've gone up and moved as a result. First Nations can't do that. The community itself can't move when it is not deemed to be beneficial to be there, to be economically sustainable. They don't have that ability. The federal government's additions to reserve process don't allow us to move from northern Ontario and buy land from somewhere else. It is simply not allowed. They are stuck there.
I don't think it's fair to say that a community that lives in poverty in one section of the country has the same challenges and barriers as remote First Nations communities. It absolutely doesn't. That community can't move or is unable to move.
Senator Stewart Olsen: If I may, I don't think that's what I said.
Mr. Dinsdale: Okay.
Senator Stewart Olsen: I said there are the same problems in all communities, and I think we have to get past — this is a severe health issue for all Canadians.
Mr. Dinsdale: Sure.
Senator Stewart Olsen: What we're looking for here are ways to mitigate this. I would like to learn from traditional First Nations what has been done or what could be done because there may be something for us to learn for everyone from this. That's more what I'm saying. There are lots of remote communities. I'm not ever suggesting that these things are not difficult. Life is hard in the North. Life is hard in isolated communities. I know that. We are not just talking about isolated communities. As Senator Tannas was saying, we're talking about urban communities; we are talking about everybody here. Most of us, I would say, have struggled with weight and with weight issues.
It is not just that kind of problem. From the Mi'kmaw people in New Brunswick, I have a feeling that there are other ways to look at all of this if we only could get our heads around it all. I would like to explore that a little bit with you all, if we could.
The Chair: Before you do that, I will try to put this in context. Mr. Dinsdale, I think you made an absolutely important observation with regard to aspects that impact native communities, particularly reserve communities across the land.
I'm going to try to focus the senator's question in an area where I think we could possibly move on this, namely the possibility that there are nutritional food preparations from traditional communities that could have value to Canadian society as a whole and possibly other communities within the Canadian society could contribute to this.
To give you a perspective from a different country, Argentina has recently developed a program whereby they have made photographs of five breakfasts based on foods used in the rural regions, and so on. It is not a wealthy country in the context of the general world situation. They have simply made photographs of those and distributed them as examples of healthy breakfasts to the country as a whole.
If I can try to move the senator's question to one that we might be able to make some progress on here —
Senator Stewart Olsen: Actually, he said it much better than I did. That's what I'm looking for, namely that kind of cooperation and —
The Chair: — might there be areas where you have identified, based on tradition and experience, foods that could be tremendously healthy that you could share with the broader Canadian community and perhaps identify in the broader community examples we can trade?
Ms. Robinson: Although you have reframed your question to be more about the positives and what we can do moving forward and in informing each other on how to do it, we still can't forget what Peter said about the differences, so I won't. Ninety-three First Nations communities right now in this country don't have potable water. Asking them to make a soup or even our own people to make a soup with water that they can't drink is going to be a bit difficult.
With the pan-Canadian approach there are things that we will have to do together, but, at the same time, there are a lot of things that First Nations are going to have to do individually, right?
Senator Stewart Olsen: Yes.
Ms. Robinson: In general, when we talk about obesity in the world, we talk about strategies that are multijurisdictional, different levels of government. Reducing salt in the general population is something that has been proven time and time again to help with cardiovascular disease. How are you going to address that specifically with different populations?
At the same time, there is a lot of opportunity in First Nations addictions. There is a culture as intervention program that is happening out of the University of Saskatchewan. They do what you said, which is creating recipe cards with healthy foods that are nutritious and people are able to access them.
Senator Stewart Olsen: So best practices?
Ms. Robinson: We have a lot of best practices we can share and we can probably add to a submission for that.
Senator Stewart Olsen: I would love to see that.
Mr. Dinsdale: We're seeing the treatment, not necessarily the prevention. In the treatment, we're seeing better coordination of our traditional medicines and approaches and Western medicines and approaches. Diabetes has a number of traditional medicines that are utilized in the work that's done.
Senator Stewart Olsen: I know, yes.
Mr. Dinsdale: I haven't seen the kind of sharing of lifestyle recipes. It is fresh fish, raspberries and blueberries that are already out there, wild game and root vegetables. It is all out there.
In terms of preparation, there could be conversations. We are seeing movement in the delivery of health services and that's an important component of it as well.
Senator Stewart Olsen: It is healthy to encourage people to do things like this and to encourage everyone. You have spruce teas and all kinds of things.
The Chair: I think we have the picture, senator. We can move on, perhaps.
[Translation]
Senator Chaput: Clearly, we need a strategy to fight against obesity. There are world strategies and a national strategy, but we need a strategy that takes into consideration the specific needs of the communities, which do not all have the same reality, which do not all have access to the same things, the same opportunities, the same tools, or tools adapted to their reality.
My question is for Mr. Dinsdale, but the other witnesses may comment as well. When you answered Senator Seidman's question, you spoke about infrastructures. If I have understood correctly, when First Nations have infrastructure needs and have to request financial assistance, do they apply using the same program that is used for funding festivals, for instance? Have I understood that correctly? If there are infrastructure needs in your remote regions, which program helps these regions obtain the infrastructure? Because young people need help to fight against obesity. It gives them access and an equal opportunity. What is the problem with the infrastructure?
[English]
Mr. Dinsdale: It is a huge issue. I don't want to name a community program incorrectly, but there are school-building programs to which you can apply at Aboriginal Affairs. They have a waiting list, so many get funding. When I was referring to the contribution agreements, it was more the delivery of the educational services overall and how they would plan.
If you think of a fiscal framework context, how does Ottawa get funded? How do the various institutions in a municipality get funded? The infrastructure funding that has been announced in the last couple of federal budgets is not accessible to First Nations. They're funded through different streams. It is a tremendous barrier.
I think there has to be a balanced approach between First Nations' abilities as governments to provide for their people. We have a bit of an issue. We have unfinished work in our federation — I know it's not your mandate; I apologize for continuing to go to this. The constitutional conferences ended with section 35 which didn't resolve which order of government First Nations are. It really is unfinished work in this country.
The issue is that they're treated less as municipalities in a financial framework, yet they provide provincial and sometimes federal services in their communities. That makes it really problematic for the governance side. The ability to develop and pay for their infrastructure with appropriate programming and fiscal framework doesn't currently exist. That's unfinished work we have to do.
[Translation]
Senator Chaput: In your opinion, how many communities in your remote regions have very little access to appropriate infrastructure? What is the impact of this lack of access? How many children and young people in these remote communities are affected?
[English]
Mr. Dinsdale: This is a very important question to get right. I would like to provide a brief that provides both water and wastewater in communities. That is, how many have potable water, how many have appropriate systems in their communities and schools in their communities so you have the proper answer.
I have a sense, but I don't want to give a wrong number for your study. I would appreciate that opportunity.
The Chair: You can address that through the clerk.
Senator Chaput: Thank you.
Senator Raine: It is good to have you here. We all recognize that the challenges facing Canadians in general are multiplied with the First Nations because of unique circumstances.
I want to change the subject a bit. I know that refined sugar was not part of the traditional diet of Aboriginal people in Canada, although, certainly, they understood all about maple syrup and, thanks to them, it was given to the rest of the world. But, with the introduction of refined sugar and not only sugar but also alcohol, there have been a lot of real challenges.
I want to ask if you have any information on two different things. First, has there been any research done on genetic factors that may be specific to Aboriginal people in terms of their metabolism of sugar? Second, and I guess this would be to Ms. Robinson, is sugar addiction recognized as an addiction? Are there any programs to deal with the addiction to sugar, which, I think, is understood now?
Ms. Robinson: I'm not sure there has been a lot of research on genetic factors. I know that there has been some work in B.C., in particular, with First Nation communities that have adopted a traditional diet and they have been able to see in their communities that people have attained healthy weights again.
There are not specifically studies that are published in journals, but there are communities that are involved in those specific types of community-based programs, where they decide together to adopt a more traditional lifestyle in terms of eating.
What that includes, of course, is berries — when berries are in season. Not taking berries, adding sugar and making them into jam and eating it throughout the year. If it's in season, they will eat them. If it's not, if they have a way of preserving it from how they used to do it in the past, they will.
In terms of addiction to sugar, the way that we approach mental wellness and addictions from a First Nation perspective, especially in treatment centres, is that they do have a nutritionist who looks at the food and the nutritional content. So we're very careful in our treatment centres with what kind of food we are going to serve clients, and part of their education is how to eat a healthy diet that is lower in refined sugar.
We have it as part of our prevention and part of a healthy lifestyle. It is not necessarily a sugar addiction that we're calling it.
Senator Raine: Do we need to do research on genetic factors with regard to some of these diseases?
Mr. Dinsdale: Intellectually, it would be interesting. Right now, the biggest barrier is obesity rates. We know that through the consumption of what they're eating. As with all Canadians, it is the primary issue.
Brigitte, I don't know if you are trying to get in, I apologize. In my view, it's studies of best practices and moving people to healthy lifestyles, such as Ms. Robinson was saying. From a programmatic perspective, what is most important is the outcome.
Senator Raine: It strikes me that we tend to import Southern or urban values and concepts to small communities and remote communities. Having a rink in a community is nice to have a big indoor space where you can be active and play, but having a hockey rink and wanting to have hockey teams doesn't work because you don't have the population base necessarily to have a team sport.
I have been very impressed in my visits to First Nations with the rise in dancing and drumming and traditional movement.
Mr. Dinsdale: Yes.
Senator Raine: If we're looking at infrastructure, maybe we need to build infrastructure that is useful in that context, as opposed to trying to copy what is in the South.
Mr. Dinsdale: I appreciate the observation.
Senator Raine: Mind you, we do know the story of Carey Price, and he's a proven example of a young man who grew up in a very remote community and who is now the best goalie, arguably, in the world. So we want everybody to be able have their dreams.
Mr. Dinsdale: Regrettably, he won't get through round one, but I think that's a different committee.
As to the recreation facilities, the point there is that it wouldn't be used just for hockey. I think it was colloquially phrased. I think powwows and drumming and all kinds of activities, traditional games like handball that communities have always done in the North, all would take place in those facilities. It is important to have a place to go to.
Senator Nancy Ruth: I'm pleased to hear that last interchange because it really reflects on what I was going to ask. This morning on the CBC, they reported that the British Medical Association was saying that the main cause of obesity is not the issue of exercise, it is the amount of sugar intake. That is what has to be cut down, and exercise may have very little to do with reducing obesity.
As to the sports facility, the handball and so on, I was concerned about the hockey thing because a lot of girls don't play hockey, nor are they interested in hockey. At least I never was. Are there gender-specific exercises when you build these recreational complexes? How is it girls don't get left out? That's my question.
Mr. Dinsdale: First, it is an incredibly important issue to pay attention to because I think early on, far too often, the boys would drum and the girls would watch them. They would sing behind them. They wouldn't dance. There are, of course, very specific, in a traditional context, dances for men and women, jingle dress dancing and other dancing that women specifically participate in. It is incredibly important to have focused on, from a recreation programming standpoint, specific opportunities for women and girls to decide which programs they want to do in those facilities.
We have seen, for basketball and volleyball, women's leagues solely. I think there are a number of traditional gender activities that take place as well around that. I think all are important indicators for sure.
Senator Nancy Ruth: Is hunting and fishing mainly a guy's thing or is it mixed now?
Mr. Dinsdale: I would say it is mixed. I think more men seem to do it, for sure, but it is certainly mixed.
Senator Frum: I read the same study as Senator Nancy Ruth, and I was thinking about that as well this morning in that context. Really, the problem is about food and less about physical activity and problems with access to food in remote communities are clear and obvious. That's the hard one.
In terms of the physical component because it is also related to mental health, which is then related to how you approach food — so it is all part of a circle — I did have the same thought about this as Senator Raine. Hockey is a notoriously expensive sport. It is our favourite sport, but it is the most expensive sport. You take hockey out of it and so many recreational activities for children are, in fact, very inexpensive. You mentioned Karate. What do you need for Karate? A white suit. You don't even need that. Soccer is very inexpensive. Baseball is inexpensive.
Mr. Dinsdale: For sure.
Senator Frum: Dancing, drumming. My question is about the school curriculum on First Nations and incorporating more physical activity into the school curriculum and making it more compulsory. Is that an angle that you look at?
Mr. Dinsdale: Education is a bit sensitive for us, as I hope you can appreciate, but we certainly have examples of school boards restructuring their school year so that the entire community goes out for a goose hunt in the fall or in the spring.
We have the traditional activities. We have traditional foods. The community comes together. We have culture. We have seen school boards absolutely accommodate that within First Nation-designed school boards. Physical activity and recreation built into it is a bigger issue for all educational facilities. They understand how much people move, how much better that is for children in the program.
I think it's acknowledged, but it is an interesting wrinkle that First Nations will open up those kinds of camps, hunting and fishing as communities.
Senator Frum: Forgive my ignorance here, but, in terms of the control over the curriculum, maybe some communities require more school intervention for compulsory physical education.
Mr. Dinsdale: One of the challenges is the hodgepodge across the country now. They are all provincial curricula for the most part, and they get adapted different ways. I don't think there is a standard right now.
One of the things that needs to be done is developing those infrastructures — developing First Nations school boards, the First Nation curriculum, which includes language and culture and these kinds of recreation components that you are talking about.
In the east, we're seeing in the Mi'kmaq Education Agreement some examples of taking control of their education curriculums, and there are interesting things happening in B.C. right now. I think there are pockets of hope. I don't think it's systemic at any point right now.
Senator Raine: This would be a follow-up. I know there is a school program in British Columbia where the principal of the school got involved. It's a school that serves Native and non-Native students. They have the children coming to school an hour early and doing physical activity an hour before school, and it serves a lot of good purposes. There is a program called SPARK that is involved in that.
When it gets down to it, as we're all realizing, it's calories out and calories in. On the "calories in" side, you said you can't understand why whisky costs the same in the North but lettuce doesn't. I understand why that is, and that is that whisky comes in a container and can be shipped up when it's effective to do so, inexpensive. It will sit there and last forever until somebody buys it.
Mr. Dinsdale: But you still have to ship it, senator.
Senator Raine: You have to ship it, but lettuce is perishable. It needs refrigeration. It needs a lot of extra things. I'm hoping that we move towards traditional foods and non-perishable foods that are healthy. Beans in a can are healthy and not expensive. I don't think we can expect Southern-restaurant-type food in the North.
Mr. Dinsdale: I think you're absolutely right, for the most part. If you go for a 5-K run, you burn 300 calories. Then you have an energy bar and a Gatorade and you take 450 calories in. You're not helping yourself. You may have a better cardiovascular system, but you're still taking in too much sugar and you're going to gain weight.
That being said, you can be a vegan and eat Doritos and have Coke all day. You can moderate yourself so you have 2,100 calories or whatever your caloric intake limit is. You're still going to be sick. It is calories in, calories out. It's also the quality, which you were referring to. In First Nation communities, the more we have traditional foods, as you suggest, that's exactly what we need.
Senator Enverga: I've seen a lot of food guides. Are there any food guides available using our traditional food, like instead of bread we use corn or something like that? Is there anything like that right now?
Mr. Dinsdale: I've seen community examples of eating healthy. I don't think Canada's Food Guide is all that appropriate in the North, as an example, because of the kinds of foods they eat. I haven't seen a systemic effort, but I've certainly seen community efforts describing traditional foods and the balance there.
Senator Enverga: Would you suggest that it would be better or it would be good if we could have a traditional food guide, using traditional food?
Mr. Dinsdale: Absolutely. It may be one of these things where all paths lead to Rome. Yes, that would be an effective way for some communities. As long as people are eating healthy, nutritious foods and in the right portions, I think we will get there as well, absolutely.
Senator Eggleton: I want to come back to how obesity affects health. You've pointed out that you have astronomical rates of diabetes and that obesity is the most important modifiable risk factor contributing to the development of diabetes.
The Canadian Medical Association says that of the health care costs in this country, half of them are related to what they call the social determinants of health. In other words, the health care system we have is only about 25 per cent of the cost of health in this country.
This is a big factor, and you've pointed out that the need for clean, potable water, for decent housing and recreational facilities and all the other things are part of that challenge, in addition to foods.
Could you comment on that? Do you agree with the Canadian Medical Association that the biggest single determinants of health in this country are the social determinants of health?
Mr. Dinsdale: They're so pervasive that it's hard not to agree. We see that as a policy lens that we try to apply to our work, which is why we brought those other elements into this presentation here today. I don't know if anyone wants to elaborate.
Ms. Derejko: I think it's definitely the case, and it's the case across the world and it's the case that's recognized by the WHO. I think what we're seeing in other countries is what the WHO has termed a "health in all policies approach," which means that all sectors of government come together and look at their policies and how these policies will impact health outcomes. The costs are being associated to the health system, but that's not necessarily the cause at the start. Finland is probably one of the best examples so far of how they have actually implemented this kind of "health in all policy" lens, and I think it's an interesting thing that Canada should look at.
The Chair: Mr. Dinsdale, you and your colleagues have displayed a tremendous understanding of the complexity of the world in which we all operate, and particularly as it impacts the world you're most clearly focused on. I would like to come to two or three observations based on comments you have made.
I am going to close it off, Senator Raine. If you have a question, please ask it now and then I'll continue.
Senator Raine: I wanted to get further information on the IndigenACTION program and how that is having an impact on lifestyle for children.
Mr. Dinsdale: I don't want to overhype it. It's something we're doing internally at our assemblies and things we're trying to do together. We work with Nike and with Tim Hortons in terms of awareness. We did research with youth around the country around getting active and getting moving. There is a big conversation in this country around physical activity and recreation and sports, and the question is: How do we get people moving? What policies are in place? Frankly, provincially, there are not usually physical activity policies. If there are, they're certainly not First Nation or Aboriginal-specific policies to get kids moving in certain areas.
Part of this is a policy dialogue we're trying to engage in. The most recent manifestation of IndigenACTION is at our assemblies, where we're trying to show leadership with youth and with others in engaging in fun runs. Woneek Horn-Miller puts us through painful exercises and things of that nature, so we're trying to demonstrate behaviours in that manner.
The Chair: I think we've certainly had some talk about the issue of physical activity, but in the testimony before this committee and the evidence that is available to us, it's very clear that physical activity is an important thing in life in general but not necessarily the key cause of the increasing incidences of obesity, and it's not a panacea that will solve all of these issues. When we're dealing with obesity, we're dealing with society as a whole, not just certain subsets of society in this regard. I think you've given us very pragmatic responses on the questions in this area.
I was struck by one of the issues you talked about as a difficulty in terms of First Nations within the context of the Canadian overall scene. All we have to do is think about 10 provinces and one federal government and then think about the challenges that are faced in the Native communities. It's easy for us if we just think about the provinces and the difficulties of getting agreements on the issues that we all face in this regard.
I was also struck by your comment about parental observation of the children. I grew up in a rural area and what you said brought back vivid memories of being in homes and family situations in which children were urged to eat up and to look healthy by eating more. When children looked to be substantial, they looked to be substantially healthy in the context. I'm not making any larger comment, but I can relate personally to the observation that you made, and it is one that is pervasive in society as well.
I did want to follow up on Senator Tannas' question and put the question to you slightly differently. In terms of the Native communities, can you think of any examples of a community that stands out in your mind or experience with regard to the overall issues of health and obesity in the context of our study? Is there any example where you could say, "If we could all be like X, maybe we could be. . ." but is there an example that stands out for you?
Mr. Dinsdale: I wish it was that simple because I'd move there.
Certainly, we see trends. This whole movement about First Nations and Aboriginal people in Canada reclaiming traditional identities manifests itself in different ways. People talk about Idle No More, and I think it's a manifestation of a broader rise in consciousness, as there has been a push back to traditional ways of being. Sometimes it's called "decolonization" and sometimes it's called "de-entrenchment." How do we de-entrench some of these behaviours? Think of our diet. How do we de-entrench how we eat all the time and bring back traditional ways of eating? We're seeing that movement, and it's incredibly healthy.
It has to do with drugs and alcohol, which is a separate issue. But in terms of traditional behaviour, those aren't done. And that's an important development. It doesn't always correlate to healthy foods. And I appreciate the focus on the consumption side. More broadly, we're seeing a rise — in part because of the media — in interest in sports of all kinds. Soccer in B.C. is tremendously large in First Nation communities as is basketball. And we talk about other sports, such as hockey. Certainly, communities put an emphasis on these things, which is incredibly healthy. As well, traditional dancing and things of that nature are exploding. That's a broader trend. I don't think it's isolated in one community. It's an encouraging trend.
The Chair: It's an excellent response because, in fact, it's sort of what I expected because that's what we see. We see trends and changes and things moving in some direction. There are examples we can use and maybe apply. If there were a magic bullet, it would be nice to identify it. But in its absence we will have to find our overall solutions.
I want to express my appreciation on behalf of the committee for your appearance before us today and the manner in which you have explored the issues with us. I declare the meeting adjourned.
(The committee adjourned.)