Proceedings of the Standing Senate Committee on
Agriculture and Forestry

Issue No. 65 - Evidence - Meeting of May 9, 2019

OTTAWA, Thursday, May 9, 2019

The Standing Senate Committee on Agriculture and Forestry met this day at 8:02 a.m. to examine and report on issues relating to agriculture and forestry generally (topic: food literacy in Canada).

Senator Diane F. Griffin (Chair) in the chair.


The Chair: Welcome, everybody. I’m Senator Diane Griffin from Prince Edward Island and chair of the committee.

Today the committee is going to examine the matter of food literacy in Canada. Food literacy can be defined as an individual’s food-related knowledge, attitudes and skills.

In 2013, a Conference Board of Canada report presented the benefits that advanced public food policy and literacy, and I’ll quote from that now: “What individuals know about food, and whether they put that knowledge to use, influences the extent to which key food strategy objectives are achieved, particularly healthy food, food safety, household food security, and to some extent, environmental sustainability.”

Our committee has recognized that this is an important matter that needs to be discussed and this is the reason we’re all here this morning.

Before we hear from the witnesses, I’d like to start by asking the senators to introduce themselves. We’ll start with Senator Mercer.

Senator Mercer: Terry Mercer, Nova Scotia.

Senator R. Black: Robert Black, Ontario.

Senator Moodie: Rosemary Moodie, Ontario.

Senator Kutcher: Stan Kutcher, Nova Scotia.


Senator Miville-Dechêne: Julie Miville-Dechêne from Quebec.


Senator C. Deacon: Colin Deacon, Nova Scotia.

Senator Oh: Victor Oh, Ontario.

Senator Doyle: Norman Doyle, Newfoundland and Labrador.


Senator Dagenais: Jean-Guy Dagenais from Quebec.


The Chair: Thank you, folks.

For our panel we have here with us five persons. It’s a big panel, but we do have two hours. They will speak in this order.

We have Ms. Elsie Azevedo Perry, Public Health Nutritionist, Health Promotion Division, Haliburton, Kawartha, Pine Ridge District Health Unit. I’d love to see your business card. It’s a dilly. We also have Dr. Heather Thomas, Public Health Dietitian, Middlesex-London Health Unit; and Dr. Catherine Mah, Canada Research Chair in Promoting Healthy Populations and Associate Professor, Faculty of Health, Dalhousie University. With all those Nova Scotian senators here, they are going to have lots of questions for you.

Dr. Sharon Kirkpatrick is Associate Professor, School of Public Health and Health Systems, University of Waterloo; and from the Centre for Health, Science and Law, we have Mr. Bill Jeffery, Executive Director.

Thank you for accepting our invitation to appear. As you know, following your presentations there will be questions from the senators.

We will start off with Ms. Perry. The floor is yours.

Elsie Azevedo Perry, Public Health Nutritionist, Health Promotion Division, Haliburton, Kawartha, Pine Ridge District Health Unit, as an individual: Thank you, honourable members of the Standing Senate Committee on Agriculture and Forestry for this great opportunity to explore food literacy in Canada and how advancing it will benefit public health policy.

Dr. Heather Thomas and I are registered dietitians in public health in Ontario. We have spent the last few years conducting practice-based research on food literacy. We are part of a big team of 15 health units. We’re all registered dietitians working in public health. Sharon Kirkpatrick, who is also a witness here today, is our academic adviser on our team.

Food literacy is a novel concept with importance because our food environment has changed significantly over the last few decades. For example, there are more large-scale retail stores, more food is being sourced globally, we have a decline in skills of how food is prepared, and so on and so forth.

As a result, we have more low-cost, convenient processed foods that are higher in fat, sodium and sugar. Canadians, including our own children and youth, are not meeting dietary guidelines overall. These trends, over time, have contributed to the prevalence of diet-related diseases, such as obesity, heart disease, type 2 diabetes and some cancers. Additionally, food waste in Canada is estimated right now at 40 per cent, which you know increases emissions and does impact our environment.

Understanding those factors or determinants that influence healthy eating is essential to improve population health at both a program and policy level.

Our evidence-informed definition of food literacy is as follows: Food literacy is a set of interconnected attributes organized into five categories. First, food and nutrition knowledge; second, food skills, so basic skills to preparing cooked food; third, your self-efficacy and confidence, so the belief that you can buy or choose healthy food. This also includes our relationship with food, our food attitude. Fourth, food decisions, and fifth, there are these ecological or external environments. That includes your food system, cultural and tradition, and your determinants of health, such as income and housing.

As illustrated in the Food Literacy Framework provided to you, the concept of food literacy incorporates knowledge, skills and behaviours essential for the planning, managing, selecting, preparing, eating and enjoying food. It recognizes that it is difficult to detach relevant behaviours and skills from their contextual environment.

Food literacy also involves the confidence to apply your knowledge and skills in a very complex food environment and to analyze how food choice can influence personal health. Policy measures are needed to create a healthy food environment and to address the social determinants of health. Without these measures public food literacy, in our opinion, cannot advance.

We want to take you on a brief journey on how we derived our definition of food literacy. I’m going to hand it over to Dr. Thomas.

Heather Thomas, Public Health Dietitian, Middlesex-London Health Unit, as an individual: Between 2012 and 2014, we explored what food skills meant to high-risk youth, parents and young pregnant women. We conducted in-depth interviews with 85 different participants in a mix of rural, urban and northern Ontario communities. Findings highlighted that external or environmental factors impact healthy eating and food skills at the individual level, illustrating the need to move to a more comprehensive definition of food literacy.

For example, most participants did have some nutrition knowledge and were quite motivated to prepare healthy foods for themselves and their families, but identified several barriers, such as not having enough money to purchase food or ingredients, having insufficient cooking facilities or equipment, and not having the opportunities to learn more about food literacy applications.

We then wanted to measure food literacy to evaluate the outcomes of food literacy interventions in public health. In 2016, we conducted a very broad and comprehensive literature review to identify and summarize the attributes or characteristics of food literacy. We then confirmed these findings with front-line public health practitioners, academic experts and key stakeholders in public health.

We wanted to ensure that the attributes we found in the literature were identified, were valid, important and also relevant within the public health context. We derived a final list of 12 key attributes organized into five different categories as shown in the Food Literacy Framework you have.

In 2018, our team worked collaboratively with the University of Toronto and developed questions to measure each of those attributes, and we are currently validating the tool with this priority population.

From our perspective and practice-based research and expertise, there are several different public policy measures and resources that could advance food literacy.

For example, ensuring that healthy food is affordable and available is an important one to consider. With the current escalating gas prices and subsequently food prices, food literacy cannot be achieved at the individual level. Buying local produce will be nearly impossible for at least 10 to 13 per cent of our population, which is close to a million people who are food insecure, as well as many middle-class families too. Food pricing is an important factor in relation to food purchasing decisions. Consideration must be given to approaches that will increase equitable access to healthy foods.

Making stronger links to our local farmers and farmers’ markets will require education, along with funding and infrastructure, which is an opportunity for operators of municipally run facilities, schools, daycares and recreation centres to source more local foods that are healthy, as well as to change our current food system.

Advocating for programs and classes at elementary, alternative and secondary schools and community programs will also enhance food literacy. These food literacy programs should be hands on, practical, confidence-building and skill-related to better target our priority populations.

In general, there is a need for new or better healthy eating guidelines and food environments in settings such as municipally run facilities, recreation centres and schools in order to advance food literacy at the individual level.

These and other policy options are described in more detail in your brief. Thank you very much.

The Chair: Thank you. We will move on to Dr. Mah.

Catherine Mah, Canada Research Chair in Promoting Healthy Populations and Associate Professor, Faculty of Health, Dalhousie University, as an individual: Thank you, Madam Chair and honourable members, for the opportunity to speak with you today about food literacy in Canada.

I am the Canada Research Chair in Promoting Healthy Populations and an Associate Professor in the Faculty of Health at Dalhousie University. I started my health professional career as a physician, a community paediatrician, in Newfoundland and Labrador, and in Ontario, and I can tell you this: People don’t choose foods at the doctor’s office. They don’t make their choices after having reviewed all of the detailed evidence on the links between nutrients, food and health.

People choose foods in their communities. They choose at their school cafeterias. They decide what to eat while commuting to and from work. People choose foods based on what they know and what they like, yes, but these choices always happen in a social and economic context: household budgets, time constraints, preferences of their friends and families, and what’s readily available where they live, work, learn and play.

In my research I study the environmental and policy determinants of diet. Unhealthy diets are costing us in Canada. One in five deaths in Canada is due to diet-related diseases, including things like cardiovascular disease, type 2 diabetes and cancer. This burden is especially high in Atlantic Canada where I and many of the members of this committee live. This is a loss of life and human potential that is entirely preventable.

My team has worked with food businesses and public health providers in five Canadian provinces, in Japan and in Australia. I have a special interest in how grocery shopping affects our public health. Seventy cents of every food dollar spent in Canada is spent in a retail food store.

This brings me back to food literacy. Food literacy presents us with a number of policy opportunities, but only if we foster it as a collective attribute of our community food environments and our agri-food system.

The World Health Organization, in a 2013 report on health literacy, explained that modern societies face a literacy paradox. In a knowledge-based society, people need to make informed choices and use information more than ever before. But in many ways our capacity to make real choices in our everyday lives is increasingly complex and constrained.

Consolidation in the food sector means that fewer large companies have become de facto gatekeepers for our food decision-making. Households, especially working-age Canadians, are facing an unprecedented degree of economic uncertainty, and we are seeing this reflected in their food budgets.

From 2007 to 2012, in Canada, food prices rose faster than any other component of consumer spending in Canada. These pressures are especially acute for rural, remote, northern and underserved communities where economic factors, along with long-standing challenges in food distribution, amplify each other.

If the goal of food literacy is to create capabilities for people to choose a healthier diet, then every policy option that this committee considers towards improving food literacy needs to be paired with equal strategies to create a health-promoting food environment, including a diverse and resilient food supply.

Health promotion pioneer Nancy Milio in the 1980s said that we can make the healthy choice the easy choice through public policy. This committee can do one better. We can make the healthy choice the most rewarding choice throughout the agri-food sector.

Food is a shared jurisdiction, so this committee can promote what the World Cancer Research Fund and the United Nations has called policy coherence, so that good economic outcomes and good health outcomes go hand in hand and no region of Canada is left behind. The new Canada’s Food Guide is a superb, science-based roadmap on the dietary patterns that can best prevent disease and death. Now we need to ensure that Canada is also a global leader in agri-food policies that support healthy diets.

I would like to recommend four action areas: Number one, increasing household purchasing power; number two, investing in a diverse and resilient food supply; number three, strengthening the science on how food environments shape food literacy and choice; and number four, adapting public procurement policies to routinely promote healthy diets.

First, policies that increase household purchasing power, such as our seniors’ pensions, the Canada's Poverty Reduction Strategy, the Canada Child Benefit and ideas such as basic income can help to ensure that every household, no matter where they live, has a consistent and dignified baseline chance to make healthy food decisions. We refer to these as social policies, but economists also refer to them as consumption insurance.

Second, we need to ensure that new and smaller food businesses, including retail stores, have a level playing field and a decent chance to survive as a quality local food source and service provider anywhere in Canada. This includes administrative supports to smaller enterprises to access a diverse supplier base and a skilled workforce, including cooperative efforts; and incentives to take risks where returns on health can be demonstrated. We should also invest in training to improve business data management, data literacy and scientific literacy.

Third, and related, we need research funding and attention to maintaining high quality data sources to monitor the food environment, as well as how households manage their resources and their dietary choices in response to the evolving food environment and food system.

Fourth, we can use the power of the public purse to routinely promote healthy diets through our purchasing policies, including how we procure food for publicly funded institutions.

I would like to conclude with a recommendation that the committee also reinforce policy participation as part of food literacy. In classes with medical students and graduate students in health, one of the questions I ask quite early on is how many people have participated in or are aware that they have the chance to critically appraise policies and have their say on what Canadians are eating through government public consultations. Very few, and sometimes no students at all, raise their hands.

Food literacy should support the connection between the public, science and government so that diverse voices can be represented in a healthy food environment for all Canadians. Thank you.

Sharon Kirkpatrick, Associate Professor, School of Public Health and Health Systems, University of Waterloo, as an individual: Thank you, Madam Chair and honourable members of this committee, for this opportunity to talk with you today.

I am a registered dietitian and an associate professor in the School of Public Health and Health Systems at the University of Waterloo. My research focuses on what Canadians are eating and drinking, the influences on those eating patterns, and how we can change them to be more healthy. When we think about health, increasingly we’re thinking not just about ourselves, but also our planet. Dietary risk factors are among the top contributors to morbidity and mortality globally and here in Canada. According to the most recent analyses from the Global Burden of Disease Study published in The Lancet, the leading dietary risk factors in terms of disability and death include low intake of fruits, vegetables and whole grains, and high intake of sodium. These findings align with other comprehensive reviews of the evidence conducted by groups such as the World Cancer Research Fund.

The existing data show that Canadians’ dietary or eating patterns do not align well with recommendations for health. They are low in fruits, vegetables and whole grains, and high in sodium and sugars. We also know there is high intake of foods that might have negative implications for our environment, including animal-based proteins and packaged foods.

The available evidence heavily underscores the need for interventions to increase consumption of those foods and beverages that are currently under-consumed relative to recommendations, and decrease consumption of those foods and beverages currently overconsumed. This is where the idea of food literacy, and the concept of food literacy has really gained traction as a way to help Canadians gain the knowledge, skills and self-efficacy and confidence to navigate our current food environment to make choices that are healthy and sustainable.

In considering the role that food literacy may play, I’d like to add to my colleagues’ comments by thinking about the multidimensionality of our eating patterns.

From day to day and across the life cycle we consume many different foods and beverages, and each of these has its own profile in terms of nutrients and other dietary components, like phytochemicals that are found in fruits and vegetables. It’s increasingly recognized that it’s this mixture of foods, beverages and the nutrients they provide that work synergistically and possibly antagonistically to influence our health over the long term.

Additionally, we consume foods and beverages in particular combinations. For example, people who have access to and consume high levels of fruits and vegetables may also have access to whole grains. On the flip side, heavy reliance on packaged, processed foods may be associated with high intakes of sugars, sodium and fats.

As a result of this multidimensionality, when we alter particular components of our diet, other parts of our diet also change. For example, if we attempt to cut down on intake of sugary beverages, we may also change other beverages that we’re consuming, as well as our intake of sugary foods.

This multidimensionality of food also links to trade-offs between health and the environment. For example, we have ample evidence that consuming fish is recommended and is good for our health. However, we know that increasing accessibility to fish and seafood has negative implications for our environment.

The new Canada’s Food Guide, mentioned by my colleague, is very positive in terms of embracing this multidimensionality, providing a holistic overview of eating patterns that are consistent with health. Again, this is promising towards supporting a shift in our eating patterns and moving us to eating patterns that more consistent with health for both ourselves and our planet.

However, this guidance has been released into a landscape or a context that is quite reductionist in nature and that tends to focus on particular dietary components, such as sugars or fat. For example, messages related to reducing sugar intake within this reductionist context may result in individuals cutting out foods like fruits, which are a part of a healthy eating pattern, but are a natural source, of sugars.

On the other hand, uptake of messages related to consuming plant-based proteins more often could lead to an influx of packaged processed vegetarian items which have negative implications for our environment.

In addition to the changes to the food system and food environments already discussed today, enhancing food literacy among our population may help to shift this reductionist landscape so that guidance such as Canada’s Food Guide can be more effective.

For example, we heard about integration into the school curriculum, which could expose children to the food system at an early age, showing them how foods fit into this broader picture, and also teaching them about links between our eating patterns and the environment.

As we’ve already heard, food literacy efforts need to be comprehensive and multifaceted, and they need to reach across the life cycle and address different subpopulations within our country. This must be supported by continued and expanded investment in public health.

We’ve also heard about the importance of coupling strategies related to food literacy with those related to economics, security and purchasing power. We must also integrate environmental sustainability.

For example, through approaches such as whole-of-government and health in all policies, Dr. Mah referred to policy coherence. These types of strategies bring multiple relevant sectors, such as health, agricultural, transportation, environment and others, to the table to work together towards solutions to transform our food systems and what ends up on our plates.

Finally, I’ll echo Dr. Catherine Mah on the need to strengthen science ,as well as its translation to a range of stakeholders. In particular, I’ll highlight that we need comprehensive data not only on the food environment but also on what Canadians are actually eating. In the past 20 years we’ve had only two surveys that provide detail and comprehensive data on Canadians’ eating patterns, and those surveys actually exclude some important parts of our populations, including those living in the territories.

We need ongoing monitoring of dietary patterns that’s comprehensive in terms of covering our entire population. We also need further investment and research to better understand how our dietary patterns are contributing to climate change.

I think it’s a very exciting time in Canada in terms of our new food guide, the broader healthy eating strategy and other initiatives, including the attention of this committee to this issue.

Food literacy may be an integral ingredient as we move forward with these initiatives to try to change what ends up on Canadians’ plates. However, food literacy must be part of a comprehensive strategy that embraces the multi-dimensionality of eating patterns, that is multi-sectoral and that is supported by ongoing investments in public health and in science. Thank you.

The Chair: Thank you. Now a presentation from our final panellist, Mr. Jeffery.

Bill Jeffery, Executive Director, Centre for Health Science and Law: Thank you, Madam Chair. I don’t normally talk about our magazine, but because it’s so directly relevant to food literacy, I’ll tell you more about it.

The Centre for Health Science and Law publishes a consumer magazine called Food for Life Report. It’s advertisement-free and the publisher, my organization, does not accept funding from industry or government. We do that to maintain our independence and to assure our readers that the advice that we are giving is based on the best available evidence.

Thousands of Canadians are paid subscribers to Food for Life Report and all senators and members of Parliament get it delivered free, thanks to the free postage to Parliament Hill.

We’re still in the start-up phase, but our intention is to publish six times annually.

Food for Life Report conducts food product comparisons and features articles about nutrition-related topics. Our mission is to help make Canadians more savvy eaters, and industry and government more accountable.

Our most recent issue rated the advice in popular diet and nutrition books as well as Canada’s Food Guide, the old and new version, against Canadian estimates of the disease burden of various aspects of diet-related disease using the Global Burden of Disease Report that Sharon mentioned earlier.

This issue also features an article on the nutrition education of medical doctors, and a nutrition-conscious user’s guide to the menu at Tim Hortons.

Food for Life Report is a successor to the Canadian edition of a U.S. magazine called Nutrition Action Healthletter. I worked for the publisher of that organization for almost two decades, but that magazine was discontinued in 2016, largely because the U.S. publisher decided that nearly five-fold higher Canadian postage rates for non-profit magazines were making it prohibitively expensive to continue.

While the recent federal budget proposes to provide refundable tax credits to support for-profit and non-profit journalism, the tax credits are designed so far in a way that supports only general news publications and not specialty reports like ours.

Food literacy can be of minimal assistance, as several of the other panellists have mentioned, to children and adults who are surrounded by nutrient-poor foods, advertisements and labelling where they live, work and play, or whose financial means and cashflow undermine their ability to afford fresh fruits and vegetables, and other nutritious foods.

For 22 years I have advocated, along with many others, improvements to nutrition labelling; reductions in sodium and trans-fats in the food supply; shifting food taxes from nutritious foods to ones that promote poor health; restricting marketing directed at children, not just for food but all consumer products; conflict-of-interest safeguards in nutrition law-making and policy-making; and, last and I think most interestingly at least for members of the Senate, a national school food program which could include food literacy curriculum developed with Health Canada’s unique nutrition science expertise.

Recently my organization has also helped provide technical assistance on legal measures to restrict the promotion of breast milk substitutes in Sub-Saharan Africa as a technical consultant to UNICEF.

According to Canadian data from the Global Burden of Disease database, approximately 48,000 Canadians die annually from, in order of impact, too much sodium, approximately 12,000 deaths; too little fruits and vegetables, together, are approximately 12,000 deaths; too little whole grains, again, about 12,000 deaths; and too little nuts and seeds, about 10,000.

The point I would like to emphasize with this is, as you may know, Health Canada has embarked on a process to develop a front-of-package nutrition labelling scheme that would provide essentially warning labels to consumers about foods that are high in sodium, which certainly does make sense, but foods that are high in saturated fat and total sugars, which are only kind of indirectly related to the fifth- and ninth-highest risks. I worry a little bit that that kind of labelling scheme may actually contribute to more confusion about what a good diet is.

As an alternative to that, we have advocated, and in the magazine as well, food labels that feature a rating scheme that shows the overall healthfulness of food, basically by integrating information about all of these ingredients and nutrients of public health concern — fruits, vegetables, whole grains, free sugars, of course, and sodium — basically providing consumers with a single number.

The approach that Health Canada has taken in the past, and is proposing to take in the future, puts a heavy duty on consumers to be familiar with the nutrition science literature and to integrate information about the amounts of the various nutrients and ingredients in the food to come to a single number to make their decisions on. Of course, most consumers don’t do that. They use what are called in psychological literature heuristics. They take short-cuts. Sometimes they hyper-focus on a single nutrient like total fats or sugar, and sometimes they rely on the marketing messages that they often see on the front of the packages that are designed to sell the food and often don’t give a very balanced view of it.

In the current issue of Food for Life Report, as I said earlier, we did a review of dietary advice provided in nutrition books and also dietary advice provided by medical doctors, and we advocated a number of public policy measures to help ensure that Canadians get a more balanced view of nutrition science.

I would just like to add that during the course of this review it became evident that a lot of health practitioners are not just apparently providing advice that’s not supported by evidence but is dramatically contrary to the new version of Canada’s Food Guide, for instance. Health Canada traditionally does not publicly criticize those approaches and there has been a lot of attention in the media from a group of doctors that were trying to pressure Health Canada to, for instance, recommend the Keto diet in Canada’s Food Guide. I think officials from Health Canada would come to meetings like this and say that it is not consistent with the science, but they were not proactively going to The Globe & Mail and CBC to explain the differences that they have with the scientific rationales. I think that’s also contributing to a lower food literacy in the population. It is not just Gwyneth Paltrow, but sometimes, I think, inactivity on the part of Health Canada.

Thank you very much. Those are my submissions.

The Chair: Thank you. Excellent presentations, all. Two more senators have joined us, Senator Miville-Dechêne and Senator Wanda Thomas Bernard, another Nova Scotian, so we’re heavily weighted here for Nova Scotia today.

The people who have signed up to ask questions are Senators Kutcher, Mercer, Black, Doyle, Moody, Oh, Deacon, Bernard, Dagenais and Miville-Dechêne, and I will have a brilliant question at the end if somebody else has not asked it.

Senator Kutcher.

Senator Kutcher: Thank you, madam chair, and thank you very much for all your presentations. Are you ready for this? It was food for thought.

Hon. Senators: Hear, hear!

Senator Kutcher: I could not let that go by. Since I got to go first, I thought I had to put it in there.

I was impressed by both the breadth of what you shared with us, but also the depth in such a short time and in such an incredibly complicated area.

It strikes me that the whole area of food literacy is just starting to develop and that you are all practitioners at the cutting edge of what could actually make a huge difference for Canadians, not just consumers, but also for the agri-food industry.

One of the themes that kept coming through here, as I took this, was that consumers can often help guide innovation in the food industry — for example, the demand for better and more nutritious foods, or more foods grown locally — and, at the same time, by that informed decision-making, Canadians could actually improve their health status, and goodness knows, that needs improving. This has a wonderful bringing together of potential economic benefit, but also health benefits.

I just want to start at the beginning, and I have two very simple questions. Number one is, what is the baseline nutritional knowledge of Canadians, and does that vary by socio-economic class, the part of the country? Whatever variants there are, I’d just like to know.

The second question is, whatever that basic nutritional knowledge is, what are ways that even just that could be enhanced by the role of the federal government? Anybody who wants to venture.

Mr. Jeffery: I can take a stab at that. I think it is hard to kind of give you a pat answer to the question about what is the baseline of knowledge, partly because often the benchmark that good knowledge is measured against is things like, what are you doing to reduce sodium, saturated fat and total sugar in your diet, which, I think is clear, isn’t the whole picture. Health Canada kind of gives a fragmented view of what good nutrition knowledge is in measuring what people know, but certainly what could be done about it.

The true measure is how many people are dying from diet-related disease? I think that’s a significant part of it, although knowledge is not the only limiting factor there.

Health Canada has an important role to play in assisting provinces in developing nutrition curriculum for schools so that children understand about nutrition. They understand how to cook. A lot of knowledge about how to prepare food has been lost in recent years with the demise of home ec programs in schools.

As I said, I think a vital way of better communicating nutrition knowledge is having a coherent front-of-package nutrition labelling system. Coincidentally, Health Canada is actually hosting an international meeting here in Ottawa next week. Sixty countries will attend and 250 delegates will spend a whole day talking about different approaches to this. Health Canada is proposing something; it’s a keyhole system being used in Nordic countries. France has a new labelling scheme. Australia and New Zealand have a different approach, Healthy Stars.

I think this is a conversation that is happening globally about how to do this better. Health Canada has already kind of entrenched itself in a particular way of doing it, which I don’t think is all that great, but I think things will happen certainly around Canada in the future.

The Chair: Dr. Mah, go ahead.

Ms. Mah: I have two brief pieces of evidence that might be useful for you on these questions. Number one, I am part of a research group out of the University of Toronto called PROOF that looks at policy options to address food insecurity.

My colleague, Valerie Tarasuk, and her students looked at food skills among groups and compared food-insecure populations versus food-secure populations using the Canadian Community Health Survey data. They found, actually, that levels of food skills between food-insecure and food-secure households were actually quite comparable. In fact, they found that some aspects of planning food and using a budget were much higher in food-insecure populations.

For example, 85 per cent of food-insecure households reported doing their shopping using a budget, as compared to 43 per cent of food-secure households. So, there’s an interaction between the education factors and the economic factors that is always at play.

The second piece of evidence is in the food environments literature. Researchers are increasingly doing things like changing pricing, promotions and placement of food inside retail grocery stores, to see if they can change people’s purchasing habits. What these show — and there has been systematic reviews of the literature — is that anything that is related to education alone is not usually effective. It always needs to be combined with promotion, a whole kind of promotional program around the food, and often training for the store operators and employees themselves, so that they are familiar with it as well, as in addition to price.

It is these multifactor interventions that are especially important.

Ms. Azevedo Perry: I will jump in and speak more to the second question, because I don’t think we have as much data in terms of nutrition knowledge and that which we do is self-report. We find that Canadians tend to over-report and say that they have knowledge, but we know at an anecdotal ground level that is not always necessarily true.

When we did our research with our high-risk youth, young parents and pregnant women, we were actually surprised they were knowledgeable about nutrition. They knew fruits and veggies were healthy.

The issue is, as my colleague just said, that you can have all the knowledge — and this is where food literacy is so great — but you have to look at all the other pieces.

We found that a lot of the high-risk youth and young parents didn’t have the skills to prepare food. As already been mentioned, those skills are being lost. In the past, it was a generational thing. These skills were passed from grandparents or parents to the next generation. That’s not happening. Our population told us that hands-on learning was so vital and, in doing that, you can provide the knowledge.

I would like to couple that with when looking at that holistic framework of food literacy, one of the things the federal government can do is make sure that we are providing the knowledge at a school level. There’s great evidence to show that when you have fruit-and-veggie programs at the school level, kids are going to eat more fruits and veggies. We have that literature. That would be providing that funding so that schools can have a great salad bar and can have those fruit-and-veggie programs.

I would like to see mom-and-pop kinds of small business be integrated back into the schools and taking the profit out of the schools. However, we need that funding and we need that support at the school level, as one of the examples that I think the federal government can do, along with the knowledge. We need those other support pieces.

Ms. Kirkpatrick: I would echo some of the comments in terms of Canadians having some baseline understanding of what constitutes a healthy diet. However, it’s being able to apply those concepts. Again, we’ve mentioned that our new food guide looks very promising in terms of embracing a more holistic approach, but we have yet to see how Canadians are able to uptake those messages.

For our prior food guide, we do know that many Canadians are familiar with it. They can think of the rainbow format. However, when you talk about things like servings, they don’t necessarily know what that means. Is the serving the amount I actually put on my plate? What does that mean? Messages like moderation and energy balance, those sorts of things are where we tend to lose consumers.

In terms of promoting that knowledge, we also have to think about the potential for unintended effects. Where we have things like front-of-pack labels and other forms of labelling, we actually can widen disparities between socio-economic groups if some groups are better able to act upon that knowledge than others. That is where the types of strategies need to be part of a multi-faceted approach, the kinds of things we’ve already been talking about, to make sure all Canadians have access to healthy foods and are able to choose those if they so desire.

The front-of-pack label is a real tricky one in terms of how you try to convey the overall quality of a product. If you think of menu labelling, where we have calories listed at fast food outlets and that kind of thing, that can lead consumers down the path of focusing on things like calorie-counting, at the expense of thinking of the overall quality of the diet.

I think we’re sort of making it sound like this really overwhelmingly complicated and in some ways it is, but I think we need to start somewhere. We already have a great start with Canada’s Food Guide. As my colleagues have mentioned, we do have evidence of other things we could be doing to build on that start and to make this more feasible.

Senator Mercer: Thank you all for being here. A very interesting discussion. I’m sitting here trying to figure out if I am food-literate or illiterate. I am the principal grocery shopper in my family and, when I’m home, I’m the principal cook in my family. It’s by desire, not by necessity. It’s something I enjoy doing.

The new Canada’s Food Guide, while it’s important and the knowledge is important, I think the government stumbled on the introduction of the food guide. Those of us who were paying attention to the old food guide are confused now because some things that we were told were healthy and that we could be using more of, or less of, didn’t make the cut for this new food guide. It has changed direction. I’m not suggesting that it’s wrong, but I’m suggesting that there is a whole education piece and that perhaps we are all food-illiterate right now until we catch up to what the new food guide is actually telling us.

I want to ask a practical question. As I go into the grocery store in Halifax to buy my groceries, I am bombarded with advertising from all of the manufacturers and by the owner of the store to encourage me to buy certain products at certain prices.

I do read food labels, and I think that’s one of the biggest things that I think we can do, encourage people to read labels.

I eat all of my meals with the salt police, my wife and my son. Trying to find the salt shaker on the table is a difficult thing in my house. Because I have high blood pressure, they’ve determined that the salt shaker should be left in the cupboard.

Anyway, what’s the initiative for a food retailer to highlight healthy foods as opposed to the high profits?

Ms. Mah: Yes, I can lead off. As a first comment, I just wanted to mention the sodium. So the first thing that you notice when you walk into a grocery store is what? That smell of the bread and that happens to be the biggest food group source of sodium in our diet. Not the table salt.

The second thing that I wanted to say about our retail stores is that we are working with some really innovative retailers who are looking at prioritizing nutrition and how they can accomplish these economic and health aims all at once.

We are currently working in a partnership with a retail chain in remote Indigenous Australia. This retailer group started out as a small set of co-op stores back in the 1970s, and they have now grown to become one of the largest Indigenous employers in Australia. They run and manage retail stores in those remote communities.

Slowly, over time, they have built a store environment where things like fruits and vegetables are prioritized and promoted. They work with nutrition researchers so that they actually share their sales data with us and we can look at how are consumers responding to changes in the store environment.

Those kinds of partnerships between retailers and researchers, and really looking at the data and how people respond, I think, are quite important.

Mr. Jeffery: I mentioned this front-of-package labelling idea that would kind of give a more comprehensive perspective on how nutritious a food is. Just by way of example, you might see broccoli is 100 out of 100, and grape juice would be minus 10 or something like that. I think that would help people see that those are radically different products. They used to be regarded as just different kinds of fruits and vegetables and all good for you.

I offer this observation recognizing that I don’t think the federal government has that much authority over practices of retail grocery stores. However, one thing we have noticed, in trying to encompass the price of foods into our product comparisons, is that most retail stores — and you may never notice this because you’re not broke — but if you look at the fine print on shelf tags, you can see that a lot of the stores provide the price per 100-grams, but it is in much smaller print size and if the product goes on sale, they don’t recalculate it. If that information was more prominent, it might make it easier for people who are trying to eat nutritiously on a budget make those kinds of decisions.

This may be thinking too far into the future, but if you could combine those two things — the front-of-package score and the price per 100 grams — so people could pick the most nutritious food that are least expensive, I think it could be a really interesting and good incentive. I think oatmeal would rate very well, because it’s relatively inexpensive, and a lot of dried beans would also be very inexpensive.

There are a lot of misconceptions out there about whether it is cheaper to eat nutritiously or cheaper to eat junk food. I think there is a more complicated story that could be more usefully understood if the information were better.

Ms. Kirkpatrick: I would just add that I think this is an area very ripe for innovation and, again, for investment in science. Sometimes, speaking of misconceptions, there are misconceptions about the negative impacts that changing promotion and placement will have. In a school, for example, there are concerns that taking sugary beverages out of the vending machine will reduce sales, but studies have shown that it actually doesn’t. So there strategies that can be beneficial both for health, and for the environment and the economy.

Ms. Azevedo Perry: I would just like to add this: Let’s not forget that 10 per cent to 13 per cent of our Canadian population will not be able to afford our fruits and veggies. We know, without a doubt, that Canadians, our children, our youth, are not getting enough of this important food. We need to think about that.

We can have the knowledge; we can have the messaging — that’s all important — but when it comes to food literacy, you have to look at it holistically. What are those income policy measures that we can implement as the Canadian government to ensure that those priority populations — those folks who can’t afford fruits and veggies — can afford it. Whether it is subsidizing, I don’t know, but we need some good policy measures there.

Senator Mercer: How do we engage the consumer in the production of the food? As you know there are a number of Nova Scotians around the table today, and they’ve all heard of Hope Blooms, which is an inner-city gardening venture by some young people. Young people have actually commercialized a number of their products out of their community garden into salad dressings and the products are being retailed by the largest food retailer in Atlantic Canada. The money then goes to pay for their post-secondary education, if they participate. But it’s the participation that’s important in the education.

One of the things we have not talked about here a lot is using dietary selection and the food literacy education as a teaching tool. You don’t have to scare the kids that it is going to be a boring cooking class, or a boring class to talk about food literacy, but there is one common thread in all the food you prepare. You need mathematics. Maybe we need to retool our mathematics class and instead of talking about non-food things in our little puzzles that we give each other at schools, food should be the focal point of that in measurements. It could be everything from addition to subtraction, to multiplication, because it is a useful tool. Guess what, the kids would never notice that you were doing this.

Yes, Ms. Thomas.

Ms. Thomas: I agree with that. Kids need to know how to read recipes. It’s not just numeracy, it’s also literacy. You need to know how to read recipes. If you’re doubling it, there comes the numeracy. I think that food literacy opportunities within an education environment, whether it’s an elementary school, secondary school, or after-school programs in the community, is a great way to level the playing field for individuals.

I work a lot with at-risk youth in residential care, in group homes, kids that are involved in Children’s Aid Society, and these kids are very marginalized already. To bring them into a kitchen to teach them how to cook is a very rewarding experience for them, and that’s where we do education.

I’m a dietitian, but I’m teaching them how to double one-quarter of a cup. So there is an opportunity in different ways, if it is not actually in the school, for other community dietitians, social workers, et cetera, to work with kids that are higher risk, as well, to learn important life skills. They’re not learning it at home, especially these very marginalized or priority populations, and they’re not learning it in school. So maybe there’s an opportunity to really advocate for bringing it back into the school environment for kids who are attending traditional schools.

Mr. Jeffery: I think it’s an interesting question. We would like more students to read our magazine and to learn the things that we’ve been learning about the food supply. We often make the case not just about numeracy, but also that food is integrally involved in history, biology and chemistry. There are so many subjects where a better understanding of different aspects of food would benefit children.

My sense is that there is no group out there developing curriculum in this way. There have been a couple of attempts in the past that didn’t go anywhere because funding didn’t come through or whatever.

As I said earlier, Health Canada is kind of the recognized expert on nutrition science. That’s why Health Canada develops the food guide. That’s why they acquired all this expertise with food labelling. However, they don’t have any responsibilities for curriculum development. If we want to progress with this, and if there is eventually a national school food program, it will have to have nutrition criteria for doling out the funds, because I don’t think anybody wants schools to buy poutine with it.

There’s going to be a role there. Certainly there could be a role for Health Canada in creating a curriculum that would work collaboratively. Often schools teach nutrition science and then serve the poutine in the cafeteria, which is not really conducive to good outcomes.

Ms. Kirkpatrick: I think this goes back to the policy coherence and whole-of-government approaches we were talking about earlier and really speaks to the need for integration at the federal-provincial-municipal levels as well.

I also think about the post-secondary level. You brought up that these programs are then supporting their post-secondary education. At the moment, our post-secondary students are also a very high-risk, vulnerable group in terms of their levels of food literacy, as well as food insecurity.

We are seeing alarming rates of food insecurity among post-secondary students. In some cases they are coming with relatively little exposure to the food system, aside from eating, but they don’t have a lot of experience necessarily purchasing or preparing foods. They may live in residence where they are served foods and then they go off to live on their own and they don’t have the skills and the knowledge to, again, purchase and prepare foods. Plus, they are faced, potentially, with food insecurity. Again, this really underscores the need to cover across the life cycle and across different population subgroups.

The Chair: Thank you, Senator Mercer. Senator Black.

Senator R. Black: Thanks very much, chair. Recent initiatives - the new Canada’s Food Guide; Bill S-228, regarding direct marketing to children; — front-of-package labelling that is being talked about; the healthy eating strategy — all of these initiatives aim at encouraging healthier eating, no question about that. They focus on high levels of sodium, sugar, saturated fat and some of the foods that are grown to produce foods like milk, bread and things like that are most important to our agricultural industry.

The livelihoods of thousands of individuals across this country depend on growing, producing milk and grain, beef, pork, et cetera, and yet now we’re being told — and we were told by Health Canada back on December 6 — that milk would be considered unhealthy and bread would be considered unhealthy, because of the fat and the salt content.

What do you say to primary producers who are growing those products today? What do we say as the Agriculture and Forestry Committee when those folks come to us and ask, “What the heck?”

Ms. Kirkpatrick: I can’t speak for Health Canada, but my understanding of their guidance is not that certain foods are unhealthy or healthy, and this goes back to the multidimensionality of eating patterns.

We’ve heard in the past this idea that all foods can fit. Certainly we know there are foods in our food supply that really do not confer any benefit, but I don’t think that pertains to milk or bread, and those are included as part of the plate that you see through Canada’s Food Guide.

Senator R. Black: I’ll just interrupt and say that milk is not quite visible on the new plate. It could be white water; it could be yogurt; it may be milk.

Ms. Kirkpatrick: Yes, again, I can’t speak for Health Canada, but I do know from conversations I’ve had, that their rationale for including the glass of water was to emphasize water as the drink of choice, because we know that consumption of sugary beverages is high. Again, it’s getting back to multidimensionality and it’s a displacement sort of idea. However, of course, nutrients like calcium and vitamin D are very important and dairy is an excellent source of those.

I think this is part of what we’re talking about here in terms of food literacy, helping us to understand how different foods can be part of a healthy and sustainable pattern and not necessarily excluding certain things.

When we think about a food like bread, we might want to look at reformulation options. As Dr. Mah mentioned, breads are among the top contributors to sodium intake not because breads are particularly high in sodium, but because we consume large volumes of them. So reformulation to reduce those sodium levels, to the extent they do exist, can be helpful. That doesn’t mean cut out all breads. Of course, breads and whole grains provide important nutrients as well.

I think it’s not so much an exclusion/inclusion sort of idea, but a reconceptualization to move us away from that reductionist place we’ve gotten to and to consider how things work together and how we can balance all these different considerations.

Mr. Jeffery: If I were speaking to these producers, I would underscore that there are 37 million Canadians that eat a lot of food, and that’s going to continue in the future. Every day people eat food. No one’s advocating that people stop eating food or they eat 50 per cent less, or anything like that.

But if the definition of what is healthy is whether it’s grown or manufactured in Canada, then we have a problem. We have an analytical problem. Not all food is healthy and food that’s manufactured in Canada isn’t necessarily healthier than food that is manufactured in every other country.

The food guide was, at our persistent encouragement, and lots of others were advocating this too, and the press was, the previous food guide and the ones prior to that were all developed basically in collaboration with industry, in my view. I think if you have a food guide that’s developed in collaboration with industry and the idea is to just encourage consumption of Canadian foods, then don’t have the pretense of saying that it’s based on science and that it’s designed to make people healthier, because it plainly isn’t.

With regard to dairy products, I rely to a great extent on this Global Burden of Disease project, and there is a small benefit to consuming low-fat dairy, no question about that. It’s a great source of calcium and vitamin D. That doesn’t apply to cheese, and it doesn’t apply to yogurt with a bunch of sugar added to it or jam that’s stirred in.

I think that we have to kind of insist that nutrition science is based on evidence and that not all foods are equally healthy. If companies or farmers that are producing foods that are unhealthy change that and start producing foods that are more nutritious, then they’ve got all the support in the world from me.

I think it’s a bit more difficult with primary producers, because they make things that are taken by the food manufacturers and combined with a bunch of junk.

As Deborah Gray — I can’t remember the name of the former Reform Party MP — said, take canola oil and then partially hydrogenate it, it becomes trans fat and can you blame the canola farmers for that? No.

Ms. Mah: I want to reinforce what my colleagues have previously said. I really do feel that the current food guide provides more choices, not fewer choices.

What’s exciting is that it gives a new gap for the study that this committee is doing to connect the dots between consumers and producers and to say, “Oh, within this more open-ended set of nutrition choices that you have now, you could choose these foods.”

The Chair: Ms. Perry, and then Dr. Thomas will have the last word on this question.

Ms. Azevedo Perry: I want to assure you, as a registered dietitian working in public health, we’ve had many calls from daycares, schools, population, and I can tell you right now we are not saying not to have milk. Milk is nutritious, as Mr. Jeffery said. It is nutritious. Whole grains are important. It’s the emphasis and there are opportunities, as Dr. Mah said, to work more with our producers, maybe do some reformulation, and I think making that connection to the food system to our agriculture and our producers.

I think there’s opportunity to provide some incentives, especially for schools and daycares, municipally run facilities. I don’t think that opportunity is as big right now to connect with the local food producers. How do you do that logistically? How can these facilities do that? I think there are opportunities here to promote our local foods, our healthy local foods, our fruits and veggies, and our milk.

Ms. Thomas: I was going to say, similar to Elsie, that when we help people in the community to interpret messages of the food guide, we certainly indicate and draw their attention to the fact that you don’t have to eliminate those meats, dairy and bread products. We include them in the diet.

The great thing about the new food guide is that on the back side, it has those food literacy messages about cooking your food more often, enjoying your food and eating with others. It’s a great opportunity to share with community members and groups to enhance their own food literacy with others.

Senator R. Black: I will choose to reiterate again that on December 6, when I posed the question to officials here, I mentioned bread, milk, yogurt and cheese. I said, “Would you agree with me that those would all be considered unhealthy going forward?” The answer was, “Unfortunately, yes.” This is with respect to Bill S-228, the bill around marketing to children, and the fact that those products have high fats, high salts, and high sugars.

That’s disconcerting for my colleagues in the agricultural sector. That’s not a question; that’s a comment.

The Chair: That’s a comment.

I think Mr. Jeffery wants to comment on the comment.

Mr. Jeffery: I wasn’t here on December 5, but my understanding of the nutrition criteria that Health Canada is considering is that if it’s whole-grain bread, it certainly wouldn’t be considered non-nutritious. Low-fat milk would not be. If it’s high-fat milk or cream, that would be a problem. Likewise, for cheese. Cheese is very high in saturated fat and sodium. There’s nothing one can really say to discount that. Those are nutrients that have an adverse effect on health outcomes and perhaps, more importantly, cheese doesn’t have a health-protective effect like whole grains and fruits and vegetables do, so it’s categorically different.

Senator Doyle: One of our notes estimates that there would be about a $550-million cost to the food industry for new food labelling, which would be a one-time cost and it would take about five years, I believe, to bring it into effect. Is that a reasonable period of time to bring these new food labels around?

I was wondering, how do our proposed labelling regulations compare to major trading partners? Is there international co-operation or coordination on the food labelling thing?

Mr. Jeffery: This figure, $500 million, I’ve been around for 20 years through several revisions to the food regulations, nutrition labelling regulations, and it’s typical for label changes to cost around that amount of money. But keep in mind that every year, Canadians spend about $100 billion on food and that kind of cost for label changes is trivial compared to the overall price of food. It’s so low in comparison of the amount that people spend on food that it’s not considered price inflationary.

With regard to your question about collaboration or international co-operation, the Canadian government is the host and chair of the Codex Committee on Food Labelling, which will be meeting in Ottawa next week from Monday to Friday. One of the agenda items is front-of-package nutrition labelling. There’s a proposal that my international group made, along with New Zealand and Costa Rica in 2016, to initiate this conversation.

The Codex Alimentarius Commission is a joint commission of the Food and Agriculture Organization and the World Health Organization that sets international standards for trade and food. Codex’s role is to set these standards to essentially authorize national governments around the world to take the measures that are recommended by Codex and, if they exceed those standards in some way by providing too much public health protection, then they are subject to a trade challenge. They’d have to provide further scientific evidence to demonstrate that what they’re doing makes sense and is not overly restrictive of trade.

Senator Doyle: Have the Americans taken any great initiatives in that regard to change labelling and to bring it more up to date as to what people should be eating that conforms with their food guide and that kind of thing?

Mr. Jeffery: The U.S. Food and Drug Administration recently made some regulatory changes similar to the ones that we have made for back-of-pack nutritional labelling, in terms of increasing the prominence and font size of certain nutrients. They are not doing anything on front-of-package labelling, to my knowledge. They were petitioned to do something 13 years ago and haven’t acted on it.

What was previously called the U.S. Institute of Medicine published a pair of reports in 2010 and 2011 outlining the evidence base for front-of-package nutritional labelling, but the government hasn’t acted on that yet.

They will be participating in this meeting next week.

Ms. Kirkpatrick: I would just add that I think there is sharing of information and lessons learned across countries. We have similar nutrition fact panels on the back of our packaging, and there are lessons learned, such as, when the U.S. added trans fat to their labels, my understanding is manufacturers then hastened their removal of trans fats from products. So nutrition labelling can have benefits not only for consumers making informed choices, but it also can prompt reformulation and that sort of thing. Labels aren’t identical, but they are similar.

As far as front of pack goes, from a researcher perspective, there’s a lot of focus on what’s happening internationally, the research that has been done and what we think that benefits might be in terms of consumers and the food supply.

Ms. Mah: I just wanted to comment that this committee can be attentive to disparities across the food sector, in terms of businesses of different size and how the new regulations will affect them.

For example, smaller businesses tend to have less capacity and that can be something this committee is attentive to. For example, we held a workshop on healthy stores and how to use nutrition inside stores. There was actually a convenience store owner from Avondale that came to our workshop.

Senator Doyle: The community that I was born in.

Ms. Mah: You probably know the store.

I asked, “How do you have three hours to come to talk to us about nutrition?” I was actually surprised because he was the owner. And he said, “Because I see this as a competitive advantage. This is some other information that I can gather.”

Where we can actually support smaller businesses to comply with new regulations or give them an extra help to do so, I think that’s really important.

Senator Doyle: Good.

When you’re considering Canada’s Food Guide, is any special consideration given to Indigenous people and how their diet would fit into the whole thing? I’m thinking of how certain foods play a big part of how they live. Seal meat, for instance, plays a major part in the diet of the Inuit. Is seal meat, for instance, considered the same as beef when you’re considering the food guide? Does it fall into the category of fish?

Even when you’re talking about moose meat and wildlife generally, caribou and that kind of thing, would that be part of your consideration in the food guide with respect to the Indigenous population?

Ms. Kirkpatrick: Yes, it is included. To my understanding, Arctic char appears within the foods that are on the plate itself.

The food guide is accompanied by dietary guidelines that are intended more so for health professionals and policy-makers. Within that document, there is a review of evidence related to the fact that consumption of traditional foods, like seal and game, is associated with diet quality among Indigenous populations. There is a discussion of food literacy, but also other mechanisms that might be needed to improve accessibility to traditional food.

My understanding is that Health Canada is still to come forward with some other resources and strategies related to that population, including Nutrition North, which relates to accessibility.

Senator Doyle: I have 100 more questions, but I’ll leave it there.

Senator Moodie: Thank you for being here today. As recently as January of this year, I was one of those academic paediatricians who faced some of the challenges that we’re talking about today and who actually has done some research in the area of breastfeeding on food insecurity.

We have to focus on providing anticipatory guidance to parents and teaching trainees as well — you made mention of that — on how to do this. We focus on the early start and transitions of food from breastfeeding or early feeding to food options. What we find not infrequently is that parents often find this transition a big challenge. In the particular area where we have done some work in low-income, high-risk regions in Toronto, a lot of families really are challenged by this transition. They seek information everywhere, most often from the Internet where they gain poor, confusing and conflicting information, or straight out misinformation.

I’ve not done a study on this, but we’re hearing more and more that they find Canada’s Food Guide somewhat difficult to interpret and to apply, particularly in areas of cost. How do we afford this dish of fresh fruit and vegetables? It’s not something we can afford.

Also, I think they are finding it difficult to understand the specifics of the guide, translating it into their own cultural needs and overcoming their language barriers. A lot of these families are of low income and they are newcomers to Canada. They face language and economic barriers.

You spoke about the need to translate science and learning uncomplicated, easily understood information for users. That’s important. How can we tailor this information and engage families to improve food literacy, especially for low-income families, and especially for newcomers to Canada who face language barriers, cultural barriers and are accustomed to different foods? How do we make this information more available to parents and buyers — the people who actually control, in this early stage, what is bought and what is needed?

I do agree we need to educate our children, but there is this transitional people period where we need to help folks understand. How will you engage this group?

Ms. Azevedo Perry: When we did our research in 2013, our target was youth but also young parents, high-risk young parents and young pregnant females. We did all those interviews in Ontario and one of the clear findings from that was the importance of hands-on learning. Going back to what Dr. Thomas said, having those programs in the community is so important. Hands-on learning and practical learning that builds these skills is so important.

They told us, “Don’t give us a recipe.” Some of these folks with the language barriers are newcomers. It’s hard. They don’t understand. They don’t have the numeracy and the literacy skills, so that hands-on learning is so vital in that.

Again, going back to that comprehensiveness of food literacy and looking at those environmental pieces, income is also important. What are those policy measures we need to help these folks, the newcomers, our low-income folks, to access more of those healthy foods practically?

Senator Moodie: One of the additional challenges is the relative loss of generational learning in this population. There is no grandma to tell us what to do here.

Ms. Azevedo Perry: We did our study and we asked the question, of those who had good food literacy skills, how did they get it.

Of course, the primary source was parents and grandparents. For those who had those skills and maybe didn’t get it from a parent or grandparent, it was schools, if they had that opportunity, or an after-school program. Hence, one of our key recommendations is to continue to support and fund some of these community after-school programs. It’s so vital.

Ms. Thomas: Building upon what Elsie said, certainly the federal government has done a great job with the program of the Canada Prenatal Nutrition Program. This prenatal program targets higher-risk moms in the community who traditionally would not go to a typical prenatal program on their own or with their partner.

In my community in Middlesex, London, we have a number of different CPNP programs that target a variety of different populations. We have ones for newcomers and we have ones for young moms, and across the different types of populations. It does meet those specific cultural needs. It does help moms and families translate moving from breast milk or formula into those more family foods, and we give them the opportunity to practise their food skills in those programming areas as well.

While it might not always address their specific economic needs, it does address food literacy needs and that opportunity to teach them that translation and to family meals.

Mr. Jeffery: We don’t do a lot of program development in our organization, but it strikes me that the concern that you raise, namely, is learning about healthy diet something that could be addressed in the same way that it could be better addressed in schools. In particular, a lot of refugees, when they come to Canada — and certainly lots of immigrants — participate in settlement programs. Often they are learning English or French as a second language.

As we said earlier in relation to the public school curriculum, food is a very relatable subject that you could use to teach all kinds of things. You could use it to teach English or French as a second language. It would just be the topic. You would have a few sessions on nutritious food and cooking, and so forth, and you’re learning English or French at the same time.

With regard to the concern about low-income Canadians, we have long advocated that the GST/HST rules be changed to avoid applying taxes to nutritious foods and shift those taxes to non-nutritious foods. There are a bunch of bizarre rules in the tax system that, for instance, apply taxes to club soda and salads if they’re prepared at the grocery store. All that has to be done is for it to be cut with a knife, and then it becomes taxable at typically 13 per cent.

We estimate the federal and provincial governments collect about $7 billion a year from taxing food. A lot of it is from restaurant sales with no regard to the nutritional quality of those foods. If you don’t want to stand in the way of people eating nutritious foods, then don’t tax nutritious foods.

The second and often overlooked point is that — and I think largely because decision makers are relatively well off and don’t use this — relatively low-income people are eligible for a GST/HST low-income tax credit. It’s calculated on the basis of their income and the idea is to reduce the financial burden of having to pay this consumption tax. The amount of that refundable tax credit could be increased as high as the federal government wanted and it could be used as a tool for almost eliminating poverty.

I think that’s something that could be looked at more to deal with those two problems.

Senator Moodie: The focus I’m trying to get at is how we get this information to the people who need it? A lot of the avenues and the vehicles are not hitting them at home when they are doing the transitions, when they are trying to introduce their newborn to solid foods — “What do I use?” That’s a very typical scenario. They’re doing it in a different language, and culturally they’re not sure about these foods.

Ms. Kirkpatrick: My colleagues have already nicely made the points I was thinking of in terms of complementary strategies.

One thing I would say, though, is that we are excited about the food guide. It’s part of our national identity. We have had one since 1942, but the food guide can’t do it all. It is the backbone for nutrition policy, but we’ve seen criticisms in the media about the disconnects between the food guide and food security or insecurity. But the food guide can’t solve the economic drivers that underline food insecurity. Again, that goes back to the need for a broader, comprehensive approach.

Mr. Jeffery: Sorry, I wasn’t clear that you were focused mainly on the breastfeeding issue, because we’ve been advising UNICEF on this in Sub-Saharan Africa. I would make this one observation: The Canadian federal government is of two minds on breastfeeding. Health officials go to meetings in Geneva at the World Health Organization every year and support resolutions to strengthen the International Code of Marketing of Breast-milk Substitutes. We’ve been downgraded, according to UNICEF, in terms of observing those principles at home.

There are very few restrictions on the extent to which formula companies can market their products. I was at a meeting yesterday hosted by Health Canada’s Health Products and Food Branch, where they talked about giving formula companies new opportunities for doing research on breast milk substitutes in Canada.

So, some coherence would be welcome.

The Chair: I remind people that we have less than half an hour to go, and we still have a number of senators who want to ask questions.

Senator Oh: Thank you, panel, for so much information; now, I am confused. First, I think we might ask the panel to decide a menu for the senators. We are eating so unhealthy between meetings and more meetings.

Senator Doyle: That’s true.

Senator Oh: So I think it is important.

Whatever you recommend, you are going to shape new food manufacturing and that has impacts on economics. It is better to shape stuff from children and up, to groove them into a better, healthy lifestyle. We are over the hill now.

Senator Doyle: You guys are, yes. You are all over the hill.

Senator Oh: With the new lifestyle — we call it the fast way of living: too much pre-cooked food, too much manufactured food. It’s out of the freezer, take it out, throw it in the microwave, watch TV, do computer work while eating that.

How do we shape them to be better and healthy, and go back more to grandmother’s time of cooking healthy food?

Senator Doyle: That’s a good question.

The Chair: Who would like to lead off on that? Mr. Jeffery, we will start with you and go across.

Mr. Jeffery: I will talk until they can think of a better answer.

It is important not to be too nostalgic about the past. The people who lived in my grandmother’s time lived 10 years less than most people now. It was a different system of health care. There was a lot of bacon consumed then. It was around her time when white flour became the new thing.

In my organization, we don’t make recommendations about telling people what to do when they are home, watching TV or whatever. It is about making these small nudges in public policy to ensure they have the best information, that medical doctors are adequately trained to give them good advice, that taxes are not standing in the way and that food companies, especially with children, can’t mislead them with self-serving marketing messages. It is all about the little nudges, I would say.

Technically the food guide has not come out yet; it’s just a snapshot — a little two-page thing. It is supposed to be released later this year. We have repeatedly urged Health Canada to put in some of the risk information so that people know that if everyone stopped consuming soft drinks, that would prevent 2,000 deaths, but if everyone started consuming whole grains, that would prevent 12,000 deaths. I don’t think many Canadians know that. To me, it looks like a failure of the federal government to be more informative, frankly.

Ms. Kirkpatrick: I have a brief comment. You make a good point of starting with children. We are talking about a culture shift. I also agree with some of the precautions in terms of being nostalgic about the past.

We are probably not going to change the fast-paced nature of our world, but maybe there are ways to connect children to food, so they grow up knowing a different way of eating than we do.

One of my former advisors had a go-to saying: Eating should not be like pulling up to the gas station and filling up. To go back to the food guide, food is about more than just the foods we eat.

Ms. Mah: My comment is about the link between literacy and the settings in which you are enacting that literacy. Food literacy is fairly new, but when health literacy — I don’t need to speak about health literacy, because there are other experts in the room — but the idea is that it goes hand-in-hand with all of the settings in which you are spending your time, whether it is in front of the phone or in the workplace. If we can actually find a way to promote healthy eating in all of the settings where people are spending their time, then that makes it easier for people to use that information wherever they happen to be at that moment. Often, it is in their car or sitting in front of their desk at the office.

That’s why I also recommended things like looking at public procurement strategies. We already spend our public money ordering food for meetings or in public institutions, such as hospitals. Those places where we are already spending public dollars should be places that promote healthy diets.

Ms. Azevedo Perry: To add to that, consider recreation. How many of you have children or grandchildren playing hockey? Go to a recreation centre. What do you have there? Hot dogs and fries. It is just appalling.

As a dietitian, we need a healthy setting. Our children and youth are trying to get healthy by being physically active. Wouldn’t it be great if we had the policies and funding there that kids, youth and families could go to these places and have a salad or a smoothie — something healthy. It would be yummy and yet be affordable. If you are a family of five going to a place, it has to be affordable.

It’s about taking out business from these places and putting in some measures where people can go to these places — schools, daycares, rec centres, hospitals — and afford to buy healthy food that is yummy. That would be awesome.

Ms. Thomas: It is looking at health in every policy. Whether it is in the school environment, workplaces or hospitals, health should be top of mind when it comes to policy development.

Senator Oh: Canadians are so good at research. Just a few weeks ago, I was in California. I saw a medical report magazine that said that a Canadian company in Vancouver has done research on having two cups of coffee every day — you remember your friends for life because you don’t get Alzheimer’s disease.

Ms. Azevedo Perry: I can’t drink coffee.

Senator C. Deacon: I am a fan of this field. In charitable work that I was involved in, I helped to do a lot in Halifax. Supportive Housing for Young Mothers, SHYM, focused on food initiatives for them. Hope Blooms, our charity was the first investor in that. The Dartmouth North Community Food Centre had some great initiatives that really focused on the sorts of things you are talking about.

As a country, though, I think we have failed miserably in this field that we know more and more about. My mom was a nutritionist and got her degree in the 1940s. Our obesity rates have doubled since the 1970s. That’s a good measure of how well we adhere to the sorts of principles you are talking about. We have to do something quite different, as far as I am concerned.

I am very concerned, honestly, listening to the anti-profit sentiment at this table. It really worries me, because I’m a believer in harnessing vested interests. Dr. Mah, I was pleased to hear your note of the group in Australia and also a Flynn’s Store in Newfoundland.

We have to find a way to partner the knowledge that you have with for-profit entities in this country to mobilize that knowledge in an effective manner. If we take an us-and-them perspective, you will continue to fail in mobilizing that knowledge. I have to tell you, that, for me, has been troubling to hear at this table.

It has not been decided whether we will take on this topic as a committee because there will be a new committee after Parliament comes back and they may or may not be interested in that. I think we need to put forward suggestions. I would like to give you examples of partnerships you have established that have successfully mobilized knowledge in a way that is scalable and sustainable.

There has been no mention of technology and the opportunities to use technology very effectively in our mobile devices to make better decisions and to better enable people. There has been a discussion about curriculum and I think there is some great work we could do there.

I would like to talk about ways you have partnered as individuals to make sure your knowledge is applied in a way that’s sustainable and scalable.

Ms. Mah: I will reiterate the example of the current trial we are working on in Australia. This is a partnership. This is a retailer-led nutrition intervention that is intended to help reduce exposures to sugary beverages and foods inside the store, and to work in partnership with nutrition researchers to analyze the data in a way that’s meaningful so we know something about diet and purchasing afterwards, and we also know something about the revenue impact.

This type of retail environment research is being done increasingly. I am happy to send you piles of articles and a systematic review that we are working on about this.

We are just about finished our systematic review. There are 100 papers that we found in our study about retail food-environment interventions that have accumulated this evidence to date on how we can work inside retail store settings to improve diet.

Senator C. Deacon: I am more interested in how that research is being used to ensure there are changes in families and communities, and that there is profit being achieved by the stores in doing so. We have to get to the application of that knowledge, not just the collection and discovery of that knowledge, but the application of it for success. I’m really interested in hearing examples of that from you.

Mr. Jeffery: I’m not sure this is what you want to hear, but we publish a magazine and our mantra is that we don’t take advertising from industry or government funding. That’s to establish our independence.

I would say to you that, in the magazine publishing industry and magazines that publish information about diet and nutrition, the norm is partnership. The norm is writing an article about diet strategies and taking funding from the pharmaceutical industry. That’s the norm.

In the approach we have advocated, we don’t go around to the other magazines and tell them to stop taking ads. For most, it would reduce their income by 80 per cent. We advocate that governments set up conflict-of-interest safeguards to protect the integrity of the public policy-making process, which I think is a legitimate thing to do. I’m not opposed to companies making profits and we have never advocated for nationalized food production or anything like that. We expect that all foods will be made by the private sector.

It is tough, you know. We don’t make enough fruits and vegetables in Canada for everybody to meet their dietary requirements. We have to import a lot. I honestly don’t know if that’s because food companies and farmers would prefer to produce other types of more profitable products, or if they feel like that’s just where demand is. To me there is a role for some institutions standing apart.

Senator C. Deacon: So you found no groups that you could partner with to mobilize your knowledge directly?

Mr. Jeffery: As I said, if you mean by partnership and sharing resources with food companies, we simply could not do that. We would have to basically change the organization, because we have these conflict-of-interest safeguards.

As I said, I’m not opposed to companies making profits from selling nutritious foods, but it is problematic when companies make profits from selling non-nutritious foods and then insert themselves in the policy-making process to ensure they can keep doing that without corrective advertising or different kinds of labelling.

Ms. Mah: Where I’m seeing that evidence closing the loop in the literature and in life is in municipalities. Municipalities are taking on the connection between economic development initiatives that also incorporate health initiatives. You gave some examples in Nova Scotia. We can point to those in other cities worldwide. That’s where municipal investment is also important.

Senator Bernard: Thank you all for your presentations this morning and your responses to questions from my colleagues. It has been quite interesting.

I have a number of questions, but in the interest of time I won’t be able to ask them all. Let me ask my best.

The first is for Ms. Perry. In response to another question, you said that 10 per cent to 13 per cent of Canadians cannot afford fresh fruit and vegetables. Is that data disaggregated? Do we have a demographic breakdown of who is in that 10 per cent to 13 per cent? Are there specific recommendations policy that you would have to address the needs of said population?

Ms. Azevedo Perry: I will let Sharon or Dr. Mah respond. That data is coming from a group called PROOF, which has done this research with Valerie Tarasuk. They can better respond to that.

Ms. Mah: I will start and let Dr. Kirkpatrick continue.

The burden of food insecurity or having inadequate economic resources to access foods, including healthy foods, is different in different populations. We know that respondents who report being black or Indigenous in the Canadian Community Health Survey are much more likely to report being food insecure in their households, as opposed to Canadians who report as white.

Senator Bernard: Thank you. I would be interested in seeing more information from those studies, if that’s possible.

I was pleased to hear each of you touch on the issue of poverty and the impact of income or lack of income on food literacy, food security or insecurity, and health outcomes.

One of the things that some of us have been looking at is the whole issue of basic income. How might basic income influence some of these structural issues with food literacy and access to food?

Ms. Mah: I will cite one piece of evidence. We know there is very good research about the transition to receiving seniors’ pensions. That receipt of essentially what would be a basic income for seniors can reduce food insecurity by as much as half.

Ms. Kirkpatrick: We have quite extensive data on food insecurity in Canada. There have been a few longitudinal studies conducted in the U.S. that look at trajectories of food insecurity and one in Canada, as well. We know it is the influx of income that makes the difference, like getting a new job or a basic income. Food insecurity exists on a continuum and, as we have said, can impact the ability to afford things like fruits and vegetables. It starts impacting quality of foods all the way to quite severe quantitative deprivation and it has long-term implications for health, including mental health. Basic income could make a real difference.


Senator Dagenais: My thanks to our guests. My first question goes to Ms. Mah. Yesterday, I was with some poultry producers in Quebec and they told me that they now have a special label indicating that Quebec and Canadian chickens are better because they are raised without hormones. How effective is the labelling of processed products with consumers? Does the labelling we currently use contain all the information? What steps should we take for the labelling to be more effective?


Ms. Mah: A colleague with Statistics Canada, Dr. Moubarac, is doing a detailed study of foods according to processing level and what Canadians are consuming. Stay tuned for the results of their research, which I just saw an initial presentation of last week. This will be very helpful to you.

Mr. Jeffery: A lot of the information that appears on food labels is there voluntarily. It is information that companies are permitted to put on it by regulations but not required to.

I guess the public health concern with information that appears on food labels is that it promotes one aspect of the food but not all the aspects of the food. So, while it may be good that chicken is raised without hormones, it is still a chicken. It doesn’t have a disease-protective effect like fruits, vegetables, legumes, nuts and whole grains do.

The former head of the Canadian Food Inspection Agency, who has been for many years now a consultant to the food industry, said something a few years ago that was published in a trade journal that I thought was very illuminating. He said that Canadian law forbids companies from lying on food labels, but it allows them to bullshit as much as they want.

I think that’s a big part of the problem. Companies have a lot of latitude to say things that hyper-focus people on one aspect of the food but don’t give an overall picture that’s balanced and based on all the relevant information.

Ms. Kirkpatrick: I will add briefly that, similar to food literacy, the focus on the processing level is an emerging area. Brazil’s dietary guidelines, which came out a few years ago and gained worldwide attention, focused on the level of processing and showed examples of corn and the different processing levels as a way to help their population choose the more whole options.

The NOVA system for looking at processing was developed in Brazil and is used by the work that Dr. Mah mentioned.

Additionally, there is one randomized control trial that I know of that looked at processing impacts and outcomes. I think it was weight-related and suggested that perhaps the processing level might be more important than macronutrient composition in terms of fat, carbohydrates and protein. However, that’s one study and this is an area we’ll pay more attention to.

We’ve been looking at the latest national survey data and dietary intake data at key sources of things like energy, sugar and saturated fats, and mixed dishes containing red meats come out as an important source, but that’s a heterogenous category with lots of different variations in terms of processing. That would be an area where it would be informative to take that idea further.


Senator Dagenais: Going back to the labelling, according to the government, the changes could cost about $500 million. That is a lot of money, even for certain companies. I understand that, in your opinion, Mr. Jeffery, the new labelling requirements are not necessarily justified. As you said, you can put what you like on those labels.


Mr. Jeffery: Yes, $500 million is a lot of money and my view is always that if regulations are going to require companies to spend that kind of money to change labels, then the label changes should be very protective of health. My feeling is that they are not as protective of health as Health Canada is describing.

But I hasten to add that if you imagine walking down the cereal aisle in the grocery store, you see all kinds of claims about products being high in vitamin C and all these micronutrients on boxes of Froot Loops and other foods that are not nutritious at all. They are net negative nutrition. They are maybe less nutritious than the box they come in and that’s problematic.

If companies are required to put a high-in-sugar warning label on a product like that, that’s useful counter-information that people could take into consideration. Currently, they can put all kinds of pictures of cartoons on the front and all these micronutrient claims, which are mostly meaningless from a public health standpoint. If they are required to put this warning label on, I think it would be beneficial.

I feel that it is not the optimum approach to labelling and there will be another approach in the next 10 years or so.

Ms. Kirkpatrick: To mention an example that you might be interested in, I believe it is Chile that has gone to plain packaging.

Mr. Jeffery: On tobacco?

Ms. Kirkpatrick: No, on food. What’s the cereal with Tony the Tiger? I shouldn’t say that out loud. Corn Flakes or Frosted Flakes can no longer have that kind of advertising. That’s an example where it has gone quite a bit farther than in Canada.


Senator Miville-Dechêne: I am going to continue along the same lines as my colleague, Senator Dagenais. I am interested in this topic, because there have been a lot of articles in the Quebec press about the origin of ingredients in food products manufactured in Canada. As you know, you can just say “made in Canada”, even if you don’t know where all the ingredients come from. We have learned, for example, that the chicken in Saint-Hubert’s chicken pies comes from Thailand, and the apples to make apple juice come from China. As nutrition experts, is it your opinion that those details should be indicated on the label? You said that a lot of details need to be put on the labels. Is that one of the things that it is important to know? As we know, regulations are not always —


Is it a concern to you? Should it be on the label?


A little earlier, Senator Dagenais was talking about chicken, but there are places where the rules of hygiene may or may not be as strict. I would like to hear what you have to say about that. Mr. Jeffery, do you want to start?


Mr. Jeffery: Country-of-origin labelling is a matter discussed at that committee I mentioned earlier, the Codex Committee on Food Labelling, on at least two occasions in the past 20 years at length, and there were different opinions from around the world when it comes to mandatory country-of-origin labelling. Many countries felt that that would put their products at a financial disadvantage in the global market, so there was never agreement. The United States requires country-of-origin labelling on meat still, I think, because they want to promote buy American.

Senator Miville-Dechêne: I’m talking about processed foods.

Mr. Jeffery: I think to a great extent country-of-origin labelling can promote kind of prejudices about food. Food shouldn’t be sold in our country if it’s not safe. I worry a little bit about people looking at a label and seeing it comes from Mexico and thinking, “I’m not going to consume that because it’s probably going to make me sick,” which, I think, is an unfair prejudice.

Concerning the made-in-Canada type of labelling that is an example of what Senator Dagenais was talking about earlier, there are compositional requirements for stating that it’s made in Canada, but there are no restrictions on 100,000 different ways of saying something similar, like made with Canadian ingredients, which could be 20 per cent Canadian ingredients.

The Canadian Food Inspection Agency permits these kinds of misleading claims routinely, even though misleading labelling is prohibited by the Food and Drugs Act. I guess they feel that they can’t enforce those regulations unless there’s a very specific requirement.

Senator Miville-Dechêne: If you can’t enforce it, why not label it? Because the choice will be a consumer choice.

Mr. Jeffery: You mean if there were mandatory labelling?

Senator Miville-Dechêne: No, like with chicken pie. If you say chicken comes from Thailand, the consumer will decide if he wants a chicken pie where the chicken comes from Thailand.

Mr. Jeffery: Right. I’m just trying to emphasize that we don’t really have any mandatory requirements for country-of-origin labelling.

Senator Miville-Dechêne: What’s your opinion on that?

Mr. Jeffery: I guess, as I said, my opinion is that the current rules that allow companies to make almost country-of-origin labelling claims are so loose that they can make misleading statements currently.

There are concerns about products being shipped from long distances and the environmental impact, which are entirely legitimate, but that’s not necessarily effectively addressed by country-of-origin labelling, because that’s not the only source of environmental sustainability problems. Beef, for instance, is a major source of greenhouse gas emissions, but lots of it comes from the cows down the street kind of thing.

It’s a bit complicated.

Ms. Kirkpatrick: I was going to make a similar point in terms of the environmental sustainability. I think if we’re going to go that route, you need to provide consumers with the tools to use that information effectively. Again, with local, it could be more environmentally sustainable to ship a low carbon footprint food from across the country than it is to consume one that is produced locally. Again, that doesn’t mean that we’re cutting out certain foods. We want to balance these considerations.

I think it’s another piece of information that could be confusing for consumers without this broader framework that we’ve been talking about.

The Chair: I’ve reduced my brilliant questions to one. It’s quick and it’s for Dr. Thomas.

In the research that you have done, did you find that there was any difference between people in rural Canada versus urban Canada when it came to food literacy?

Ms. Thomas: No.

The Chair: That’s interesting. Okay.

Ms. Thomas: Food literacy can impact people who have varying incomes. It can impact people who are geographically located in different areas. For the young professional, for example, they might have a lot of food literacy, but they don’t have the time to prepare those meals. For young families who are living in poverty, they may have a ton of food literacy and great skills, but they don’t have the income to purchase the foods and they don’t have workable stoves in the apartments that they’re living in, and they don’t have all the equipment or utensils that they require. It kind of crosses the entire life span and even economically.

My dad is 84 years old and recently has had to learn how to cook high-protein, high-calorie foods for my step-mom who is suffering from cancer. He makes these custards from scratch. I’m in awe of that. He made beans on toast maybe when we were kids, but that’s about it. So food literacy for him has really —

The Chair: It has been a sharp learning could have been.

Ms. Thomas: Very sharp. So it just depends. There are so many people who are impacted by it.

The Chair: Catherine Mah, you give me the body language that you have a quick comment to make before I bang the gavel.

Ms. Mah: About 10 years ago a previous iteration of this committee did a comprehensive report on rural poverty in Canada. I would encourage us to think in a similar comprehensive way about rural food literacy.

The Chair: Thank you. I want to thank our panel. As you can see, we could easily have gone on a lot longer. We’ll see where this leads. As was already mentioned, there will be a new agricultural and forestry, and maybe whatever, committee appointed whenever the new Parliament convenes. We’ll see how that pans out. Of course, we’re all going to volunteer to be on the committee, right?

Some Hon. Senators: Of course.

The Chair: With that, I’m thanking you and I’m also adjourning the meeting.

(The committee adjourned.)