Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 26 - Evidence - June 8, 2017
OTTAWA, Thursday, June 8, 2017
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:30 a.m. to continue its study of Bill S-228, An Act to amend the Food and Drugs Act (prohibiting food and beverage marketing directed at children)
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
My name is Kelvin Ogilvie from Nova Scotia, chair of the committee. I am going to invite my colleagues to introduce themselves.
Senator Seidman: Judith Seidman, Montreal, Quebec.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Raine: Nancy Greene Raine from B.C.
[Translation]
Senator Cormier: René Cormier from New Brunswick.
Senator Petitclerc: Chantal Petitclerc from Quebec.
[English]
Senator Hartling: Nancy Hartling, New Brunswick.
Senator Neufeld: Richard Neufeld, British Columbia.
Senator Dean: Tony Dean, Ontario.
Senator Frum: Linda Frum, Ontario.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
The Chair: I remind us that we are here dealing with Bill S-228, An Act to amend the Food and Drugs Act prohibiting food and beverage marketing directed at children.
Colleagues, you have one of the presentations that has been provided in both languages. The other two are available only in one language. If you wish a copy, you have to request it. I'm not authorized to distribute it unless they are in both official languages.
With that, I will call the witnesses in the order that they appear on the agenda, since I had no violent request to go first. In that case, I will call upon Dr. Tom Warshawski, President and Chief Executive Officer, Childhood Obesity Foundation.
Dr. Tom Warshawski, President and Chief Executive Officer, Childhood Obesity Foundation: Thank you for inviting me to appear before the Senate today.
The Childhood Obesity Foundation is extremely pleased to see Bill S-228 before the Senate, as we feel that it is essential that children and youth be protected from being persuaded to consume food and beverages that undermine their health, often lead to chronic disease and may even shorten their lives.
I will comment on two proposed amendments to the bill. The COF understands that the Senate will be asked to amend Bill S-228 to focus solely on unhealthy food and beverages as opposed to all food and beverages. While we believe that restricting the marketing of all food and beverages is cheaper, less bureaucratic and more effective than creating a system to classify the healthfulness of foods, we acknowledge government concerns that a broad prohibition would possibly not survive a court challenge.
The proposed amendment is acceptable as long as the nutrient profiling system is robust and based on the advice of independent food and nutrition scientists. Our nutrient profile method must be free from food industry influence. We will be carefully monitoring the development of the regulations, and they will be critical.
However, I want to speak more to the proposed amendment to expand protection to children and youth aged 16 years and younger. This is in keeping with the World Health Organization's recommendations and with legislation currently in place in the United Kingdom.
Teens are particularly vulnerable to marketing when compared to adults, and these susceptibilities are cleverly exploited by the food and beverage industry. I will use the beverage industry as an example.
The best data we have on resources spent on food marketing is U.S. data from 2006. That year, the soft drink industry spent $550 million on marketing to children 17 years and younger, and 85 per cent of this was spent on teens. We can expect smaller totals in Canada but similar percentages. We know that this money is well spent and that marketing works.
The average Canadian teen consumes over 500 mils of sugary drinks per day, over half a litre. That is double that of adults. This intake significantly exceeds the maximum daily intake of sugar recommended by the World Health Organization and the Heart and Stroke Foundation.
Marketing to teens is very effective, very lucrative but also very unethical. Teens are vulnerable and lack the full reasoning powers of adults. The unique vulnerability of the adolescent brain is reflected in our laws. Unsupervised driving is prohibited until the age of 16 to 17; sexual consent is recognized as being at the age of 16 to 18 years; voting privileges are granted at the age of 18; alcohol consumption is not permitted until the age of 18 or 19 and tobacco purchases are not permitted until the age of 18 and 19.
Teens may possess the capacity to do complex mathematics, remember statistics and craft clever stories. They are intelligent, but they tend to have significantly different priorities than adults. This renders them uniquely vulnerable to sophisticated marketing, certainly more vulnerable than adults, and in some ways more vulnerable than younger children.
We now know that the hormonal changes of puberty exert profound influence on the human brain. The brain is the organ of thought, and the prefrontal cortex, this part in the front of the brain, is the area thought to be most involved in exerting executive control. It regulates attention, inhibits impulses and anticipates the consequences of actions. The prefrontal cortex actually develops in a slow linear fashion over time and is not fully formed until the mid to late twenties.
The orderly progression of reasoning capacity that accompanies prefrontal cortex maturation seems to be overwhelmed by the sex hormones that trigger puberty, testosterone and estrogen. The surge in these hormones causes changes in both the function and structure of the brain. The ventral striatum becomes more dominant, resulting in stronger reward-seeking tendencies as well as a preference for immediate gratification. Risks tend to be discounted. This predisposition is greater in adolescents than in younger children and greater than in adults.
The energy drink Red Bull is well aware of this, and their marketing usually features teens or young adults engaged in pointless death-defying stunts. The teenage brain that fails to recognize the imminent danger of going over a huge jump in a ski-doo and doing a double flip is usually not receptive to warnings that sugary drinks increase the long-term risks of obesity, type 2 diabetes and heart disease.
Adolescence is also marked by a unique susceptibility to peer influence. This is likely linked to hormonal mediated structural changes in the social brain network. Teens shift their social affiliation from parents to peers, and they value the opinion of teens more than adults. The need to be accepted by peers and to avoid social rejection is a strong driver of adolescent behaviour. Self-image is strongly affected by peer evaluations. Savvy soda marketers recognize the power of peer influence on teens and craft their marketing accordingly.
The teenage brain is also notable for the strong effects emotion have on decision-making. We know that during adolescence the amygdala, a deep brain centre influential in emotional processing, enlarges and its connections with the cortex of the brain become denser. These anatomic changes correlate with a heightened sensitivity to emotions when making decisions. This appears to diminish into adulthood. The influence of emotional arousal on the teenage brain is recognized by marketers, and products are frequently portrayed in a positive emotive scenario. A major soft drink manufacturer promises happiness in a can.
In summary, with the hormonal changes of puberty, there are significant structural changes in areas such as the prefrontal cortex, the ventral striatum and the amygdala. These changes coincide with important changes in brain function. In many ways, these changes temporarily reverse the age-related, orderly progression of reasoning ability and judgment that accompanies maturation of the prefrontal cortex.
Teens are not simply inexperienced adults. Youth have a tendency to seek immediate gratification, to take excessive risks and to be inordinately influenced by peer pressure and emotions. The human brain does not acquire adult-like decision-making capacity until the mid to late twenties. Teens simply can't be told to reason better. Society needs to protect them until their judgment improves with neuro-maturation.
The Stop Marketing to Kids Coalition recommends that the Senate extend protection from the marketing of unhealthy food and beverages to all children and youth aged 16 years and under. While this age cut-off does not extend protection until all teens complete puberty, it does provide important protection to the majority while they are in their most vulnerable stage of development. The proposed amendment is consistent with generally held societal expectations of the cognitive skills of teens and with evidence-based policy.
Thank you.
The Chair: Thank you very much. I am now going to invite Manuel Arango, Director, Health Policy and Advocacy, Heart and Stroke Foundation of Canada.
Manuel Arango, Director, Health Policy and Advocacy, Heart and Stroke Foundation of Canada: Good morning, Mr. Chair and senators. Our team had the distinct pleasure to meet with many of you in the last few weeks to discuss our support for enhancing Bill S-228. We congratulate Senator Nancy Greene Raine for this initiative. We also congratulate this committee for its report on obesity, which is an important platform and springboard for this bill.
Your committee has been hearing from many of our allied coalition partners and experts on this subject. Our common agreement is that Bill S-228 represents an important step to address the health of our children and to address the serious shortcomings of voluntary initiatives to reduce marketing of food and beverages to kids. Bill S-228's mandatory approach is essential to improve the health and wellness of Canadian kids. This was a point that made very clearly by Dr. Monique Potvin Kent yesterday at this committee.
As co-chair of the Stop Marketing to Kids Coalition, Heart and Stroke has conducted some detailed public opinion research and found that Canadians are very concerned about this issue. Almost 80 per cent of Canadians support a legislative intervention, and they also feel that parents are at a great disadvantage when trying to instill healthy eating habits among their kids, especially in light of the billions of dollars that industry pours into marketing of food and beverages across North America. In the U.S. alone, it was $1.6 billion back in 2008.
Mandatory legislation will mean a fair fight for everyone — kids, parents and the food industry — but we need to ensure that this legislation levels the playing field and that it is comprehensive and appropriately robust.
Today, Dr. Warshawski spoke to you about the importance of ensuring that vulnerable kids are protected by raising the age limit in this legislation to 16 and under. We trust this is a consideration you will review closely when discussing proposed amendments.
I also understand that this committee will be asked to make a couple of other key amendments, including changing the approach from restrictions of all food and beverages to a focus solely on unhealthy food and beverages and removing specifics related to the types of marketing mediums that should be restricted. If the committee and the Senate proceed down this road, it is critical to ensure that there are high-level commitments in this bill that will ensure two things: one, the development and adoption of a robust, evidence-based nutrient profiling system rooted in public health best practices and informed by independent public health experts; and two, keeping the door open to a broad range of marketing restrictions at the point when regulations are examined.
I would like to focus the remainder of my time on this latter point. Our concern is that as the specific marketing mediums are removed from this bill, we could end up without any guarantee that the final regulations will address the full panoply of marketing. If we do not do this, we could end up with a scenario very similar to what happened in the United Kingdom. The first version of the regulations in the United Kingdom only covered TV and radio. The result was that the industry simply poured all of their marketing dollars into online and digital marketing, completely nullifying the TV and radio restrictions. We don't want to repeat this mistake in Canada. Fortunately, the government in the U.K. is now addressing this deficiency and broadening the regulations to cover a wider range of marketing mediums, including digital and social media.
Yesterday, Dr. Monique Potvin Kent spoke to this committee about the digital marketing environment. We know that information technology changes rapidly and kids use new platforms and mediums daily. In fact, did you know that Facebook actually isn't cool anymore with teenagers and youth? Kids and youth now prefer Instagram and Snapchat, so we need to ensure that this legislation is broad enough to cover new and emerging social media and digital mediums.
Beyond the new apps and platforms that kids use, their built environment is increasingly a space in which advertisers can engage them. Advertisements in public schools and recreation centres, mascots at festivals, product placements in grocery stores or entertainment programs, cartoon characters on food product packaging, sponsorship of community events, as well as coupons and promotions connected to clubs and sporting events are all ways in which marketers reach our kids.
To this end, Heart and Stroke recommends that Bill S-228 include in its preamble a high-level commitment to a wide definition of marketing and a broad array of marketing restrictions. The bill must allow for the potential inclusion of mediums such as product packaging, digital media, marketing in child-centred settings, et cetera. If this doesn't happen, we could end up with regulations that will only cover TV and radio, and we know from the U.K. experience that this is completely insufficient and ineffective.
In conclusion, Heart and Stroke applauds the Senate of Canada, this committee and Senator Nancy Greene Raine for the recognition that marketing is a problem. Please consider making Bill S-228 a piece of legislation that truly protects our kids by being broad enough to cover what kids do and see and what marketers conceive and design. Let's get it right at the very beginning so that we can ensure that the kids will be all right.
Thank you. I look forward to your questions.
The Chair: Thank you very much. Now I will invite Russell Williams, who is the Vice President of Government Relations and Public Policy with Diabetes Canada, to make a presentation.
Russell Williams, Vice President of Government Relations and Public Policy, Diabetes Canada: Thank you, senators, for the opportunity to speak to you on Bill S-228.
If I can take one minute, senators, I want to congratulate you for the incredible leadership on public policy over the years. I wanted to just recognize you and also recognize the committee for great studies and helping public policy debates. Thank you.
Diabetes Canada is very proud to represent the estimated 11 million people living with diabetes and pre-diabetes. We are committed to helping those at risk of diabetes to avoid developing this condition wherever possible. That is why Diabetes Canada and the Stop Marketing to Kids Coalition are in support of Bill S-228.
[Translation]
I repeat that Diabetes Canada and the Stop Marketing to Kids Coalition support Bill S-228. I also want to congratulate Senator Raine for her leadership on the issue.
[English]
The existing voluntary measures have proven insufficient, and we need legislation that requires mandatory restrictions on marketing to kids, essentially levelling the playing field for kids and for the industry. It's important to act on the legislation now.
[Translation]
As a society, we should be worried about what's happening to children and youth. We're going through a serious crisis that continues to be neglected by governments, businesses and individuals. The crisis is childhood overweight and obesity. The obesity rate for children and youth in Canada has practically tripled in the past 30 years. Currently, 30 per cent of children are overweight or obese, so three out of ten children.
[English]
These rates have contributed to the development of type 2 diabetes in children, a disease previously associated with adults and never seen in young people. Many children have high blood pressure or high cholesterol. They are on an unhealthy trajectory for their future. Overweight and obese youth are more likely to become overweight and obese adults. These children face a far bleaker outlook than adults living with type 2 diabetes because they live with the disease longer.
An important factor linked to childhood obesity is food and beverage marketing to children and youth. Marketing to kids is no longer simply ads that feature characters promoting products during Saturday morning cartoons. Sophisticated marketing campaigns that exist on television, online, social media, in schools and recreation centres make it hard for children and youth to not be exposed daily or even hourly in all places where they live, learn, eat and play, as my other colleagues have already mentioned.
We know that taste preferences and eating habits of children become the diabetic habits of adults. Youth, on average, drink over half a litre of sugary drinks each day, which could contain up to 16 teaspoons or 64 grams of sugar. The link between obesity and the increased consumption of sugar-sweetened drinks is particularly disturbing. It is estimated that sugary drinks may be responsible for as much as one pound per month of weight gain in youth.
The eating habits and physical activity levels for children and youth are impacted and influenced by many different reasons. Thus, I can assure you there is no one-step solution. We are not here to say this is going to solve all the problems, but we are here to say that it is an important and essential step forward and it's a step in the right direction.
Canada's obesity problem is complex. Many people oversimplify it: eat less and move more. The reality is that we need multiple interventions that address the complexity of the problem. This includes education, food skills, better food labelling and addressing access to healthy foods. A comprehensive approach needs to recognize that not only individuals but governments have a role to play. Public policy matters.
[Translation]
Quebec has limited marketing directed at children since 1980. The childhood overweight and obesity rate in the province is currently lower, and the fruit and vegetable consumption rate is higher. We know the rules limiting marketing directed at children are successful and cost-effective. The restriction of food advertising directed at children is one of the most cost-effective measures the government can take.
[English]
A few key points that I would like to leave you with: Our call for restrictions is being made because industry measures on this to self-regulate have not worked in this case, and further action is now needed to deal with the health crisis that we all know is occurring with Canadian youth and children.
It is my understanding that you may be considering amendments to the bill, including changing the approach from restrictions on all food/beverages to focus on solely unhealthy food and beverages. If you do, it is critical that there is an adoption of a robust nutrient profiling system based on the best public health practices, and this has to be linked with this amendment.
Also, we strongly support the restrictions applying to advertising targeted to 16 years and older. As a father who brought up two young men, I would argue for 18, but that's another issue. I look around the table, and maybe we need some input from some of these young people to help us figure this out. They were talking about their understanding of media is probably better than ours.
Thank you for this opportunity to make remarks from our coalition, from Diabetes Canada. What's at risk is young people and obesity and the future generations. If we don't tackle this, they could be unnecessarily harmed by the marketing of food and beverages to them.
The Chair: Thank you all. I would remind honourable senators to direct your question in the first instance to one of the witnesses. If witnesses will signal to me that you also want to come in on the question, then everyone will have a chance to answer, but please direct your question in the first instance.
Senator Raine: Thank you very much, all of you, for being here today. I'd like to thank especially Dr. Tom Warshawski who has taken time from his pediatric practice to be here and also has been working diligently on this file for more than 10 years, maybe 15 years.
I'm pleased to be getting a lot of support from the public on the bill, and I know that there are still questions out there from some of my colleagues. I will leave it to them to ask those questions.
To Dr. Warshawski, when you look at the bill, if we move the age limit up to 16, what impact will that have on the total spectrum of children who have poor eating habits because of advertising? Your evidence was pretty compelling about the sugar-sweetened drinks, but other products will be captured in this as well.
Dr. Warshawski: Yes, all products that we regard as being detrimental will be captured. Sugary drinks are the most heavily advertised component to kids. I would add to Russell's comments about the link between sugary drink consumption and type 2 diabetes is extremely strong, and not just in relation to overweight and obesity; it's an independent risk factor. No matter what your weight is, when you drink this stuff in high quantities, maybe the fructose component, but we're not sure why, is actually toxic to the pancreas. This is a bad product; there is no doubt about it.
If we elevate the level of restriction to age 16 years and younger, we really afford way more protection to teens. Currently, the bulk of sugary drink advertising is directed to teens, but that also has a spillover effect to younger kids. When my daughter was a preteen, she always wanted to be a teen. When she sees 16-year-olds doing something and she's 10, that's what she wants to do. If you want to protect the 13 and under, you have to expand this up to age 16, 17.
That's an indirect answer to your question, which is about will it be broader. It will have to be broader, including fast food, for instance. There is a way to get into fast food restaurants, in and out and eat reasonably well, but you have to be very careful. It's not the sort of portions that are advertised. Advertising is very counterproductive to healthy eating at these sort of places.
The snack products that are heavily advertised, they are very clever. Doritos has a marvellous campaign, and it's amazing how they link it with Halloween. It's a viral marketing campaign that kids just find deliciously thrilling to watch. Of course it sells more products. They know it sells more products. They're extremely sophisticated in the way they get out there.
I got into this game, as you said, a long time ago because when I started in pediatrics I was counselling families and kids on how to lose weight. Everything you say in the office is a drop in the bucket about sugary drinks, chips and the other stuff when they're inundated with marketing. It's way more sophisticated, way better than my droning on about facts in the office. They leave the office thinking, "I have to stop,'' and then they are inundated with marketing. It rapidly overwhelms everything you've said.
The clinical stuff is important, but we have to move upstream. That is why this bill is so very important.
Senator Raine: Thank you.
Senator Eggleton: Thank you for your submissions. We are grappling with this idea of changing all food and beverages advertising to unhealthy food and using a nutrient profiling system.
Dr. Warshawski, your understanding is it's legally probably easier to protect in a challenge, and yet the Quebec system, which is the broader system, has been upheld as a result of a Supreme Court decision. Sometimes when you ask different lawyers, you get different opinions, but you must have some reason to believe that it's probably safer to go with this nutrient profiling system. Without giving away all the legal knowledge that you may have acquired in consultations on this, can you talk more about the nutrient profiling system versus the blanket idea?
Dr. Warshawski: As you know, the Stop Marketing to Kids Coalition got together and had several consensus- building meetings, and we landed on the consensus that we should restrict the marketing of all foods and beverages. It's simpler, cleaner and doesn't involve the extra cost of developing a nutrient profile method.
We then sought some legal advice from actually an ex-Supreme Court justice, along with others. Again, I'm a doctor, not a lawyer, but doctors think we know everything. Part of what they do is something called the aims test, which is that the measure has to be the least restrictive measure. In fact, we don't care if they market baby carrots and cauliflower and broccoli to kids. We'd applaud that; it's just not done. I don't think it will ever be done.
Restricting all foods and beverages is a lot easier, but it's not as precise because what we're really after is the unhealthy stuff. They said that won't survive a legal challenge.
Uncharacteristically, I've listened to others and think that we'll have to probably take the best legal advice. We don't want this to go through the Senate, go through the house and then run aground on a Supreme Court challenge. That's where I've grudgingly gotten to. I'm sure others can speak to this.
Mr. Williams: From an industry perspective, consistency across the country might be quite helpful. There have been compromises, et cetera, and we're all interested in taking a step forward. That's why I think we're living with compromises.
To your point, if it can work in Quebec, it should be able to work in the rest of the country.
Mr. Arango: With respect to the legality and the constitutionality of the different approaches, one point that I would make with respect to the Quebec model is that they have a Consumer Protection Act, and all the provinces generally have this. So they have within their purview, within those acts, to be able to address all commercial marketing. At the federal level, that's not really the case.
My colleague Bill Jeffrey, who presented yesterday, would argue you could go through the Competition Act. However, when we're going through the Food and Drugs Act, it's tougher to do the all-food approach.
With respect to nutrient profiling, Health Canada is beginning that work through their front-of-package labelling initiative. We are confident that if that process is used, we could use what we learn from it, as well as learnings from other international experts, to come up with a very good nutrient profiling system.
Senator Eggleton: Good answer, thank you. Mr. Williams, I think you all mentioned the need to get into controlling this on social media and digital aspects of the system and not just the standard television broadcasting kind of medium. You mentioned schools in your remarks. In what way is this happening in schools?
Mr. Williams: There's a lot of presence of the industry in our schools and in our recreation centres. As the education system is looking for support and funding, there are partnerships being created. There's an omnipresence of this kind of marketing in every aspect of life. As the doctor said, we can go through stats in our offices, but through partnerships, a young person is exposed throughout the day in schools and recreation facilities in a lot of municipalities.
Senator Eggleton: By partnerships, do you mean food machines or something like that?
Mr. Williams: There are food machines, et cetera, but also during the school day, young people are also exposed to a lot of various advertising possibilities. But, yes, there are partnerships, and sometimes very good partnerships with industry in recreation facilities and in our schools. But what we're concerned about is that we don't want specific marketing for young people to be associated with that.
Mr. Arango: With respect to what municipalities are doing in recreation centres and in schools, many municipalities have sole-source contracts with beverage companies, for example, and they do not allow for the municipality to add a surcharge to the sugary drink. In Kingston, they are going to be doing that. They are trying to add a 25 per cent surcharge to the drinks they sell in their recreation centres. At Heart and Stroke, we would prefer that these drinks that appeal to kids be banned in recreation centres frequented by kids, but a surcharge is a good next step.With these sole- source contracts, that's an important limitation that they put on municipalities. That's something we think needs to be addressed at the municipal level.
Senator Stewart Olsen: Thank you all for your presentations. I see where you're going with what you're saying, but I'm trying to get my head around exactly how this can happen. It sounds very good, but if you think about it, it's a vast undertaking that will involve enormous amounts of expenditure and work. There is nothing that I can find that says where the onus is going to be placed. If you're found to be advertising, who's at fault? Is it the company? Is it the medium that carries the ad? Is it the person who sells the poster space? Is it the Internet, or is it right back to the ad companies? This whole thing wraps into how it can be accomplished.
I hear what you're saying about marketing to teens, but I really think, as you said, that preteens look at teens, teens actually look at young adults, and that's where the marketing comes from. I don't think they aim it directly at teens anymore, because all teens think they're young adults.
I look at all this and I think it sounds wonderful, but I don't know how we can do it. Can you briefly comment on that, Dr. Warshawski?
Dr. Warshawski: Sure. I think it's quite doable. This isn't getting a man on Mars. There's precedent. England does it. They look at under the age of 16. It's broadcast media only, so radio and TV, and it misses the Internet.
Senator Stewart Olsen: That's what I mean.
Dr. Warshawski: However, we still know the majority is coming through TV. It's still a very powerful medium. That in itself is an accomplishment.
With respect to the Internet, we're not talking about driving these companies into the deep dark Internet, like a whack-a-mole thing where you can't find them. It's in their best interest to be found. They want to be easily discovered. They entice kids with advergaming on the Pepsi and Coke websites. These things are very public and they want it to be public.
I'm a big believer in the 80 per cent solution. We're not going to get 100 per cent coverage but we can get 80 per cent. The precedent is there. The mechanisms are there in the U.K. Quebec has it as well for defining child-directed advertising, as do other countries. I've not tried to look at the specifics of these policies, but that doesn't seem to be something that England has stepped away from and said, "We can't do this.'' They've said, "Okay, we've done this, but let's do a bit more.''
Senator Stewart Olsen: But it's limited.
Dr. Warshawski: Currently, but they're going to expand it to the Internet. Again, if we can get 80 per cent of these major sites, they want you to come to the Coke site. They're not going to try to hide it someplace else, because most people aren't going to find it. That's still actually a victory for us. There will always be some stuff out there and they'll always be trying to game the system, but we can do so much better than we're doing now. Those are my two cents.
Mr. Arango: Certainly, the undertaking is not small. We agree with that. But the burden is certainly not small either, as was indicated in the Senate report on obesity.
Senator Stewart Olsen: There's no question.
Mr. Arango: The cost of high levels of obesity and diet-related disease is $26 billion a year. That was calculated by Health Canada in 2015. That's no chopped liver.
With respect to regulations, I think that's where we'll deal with the enforcement mechanism. If you look at what was done in Quebec, they relied on a public complaints mechanism, which was very efficient. That can be done to some extent here, and that would simplify things.
Just to underscore it, again, it has been done elsewhere. In the U.K., as Dr. Warshawski and I mentioned, they are expanding to digital and social media. They're in the process of doing that, so it's definitely possible. Unlike Dr. Warshawski, I prefer the 90 per cent solution versus the 80 per cent solution.
Mr. Williams: I'm going for 95.
It don't be easy but, as you said, it's worth it. Nobody is denying the issue. I was going to mention the public complaints process in Quebec, but there are other precedents. Tobacco legislation wasn't easy to bring in. When I was a Quebec politician, we actively moved around prohibiting marketing to kids about Loto Québec. It wasn't easy, but it's done. Is it perfect? I don't know what the percentage is, but it's made huge progress.
I actually do think that, once we create the legislative and regulatory framework, the law will enable the policymakers to get with some of those advertising companies that understand this kind of stuff and help us think through this issue. I can't tell you how to handle social media; I barely understand it, but I know we have to go there. It's a fair question.
As you've already said, the numbers are clear enough that we absolutely have to do that and we have to do it now. There are international precedents, but here at home Quebec and other jurisdictions are looking at this question. I think we can learn how to do it.
Senator Stewart Olsen: Thank you.
Senator Seidman: Thank you very much for your presentations.
Dr. Warshawski, if I might address you, I recognize the important value of making every attempt we can to protect the health of young people in this country. There's no question about that in my mind. But I must say that I tend to have a preference for Quebec's legislation because I think it's far simpler to enforce. I also believe it has proven in the courts that it is resistant. So it has a precedent already.
With that preface, I'm trying to understand how we can distinguish between advertising meant for, say, 18-year-olds as opposed to advertising meant for 16-year-olds, because that's what this legislation is going to impose. Please help me.
Dr. Warshawski: I don't know if it's still on the Internet but, just last summer, I went on to the Sprite website. They had a big campaign called Obey You, and they had these ads all over the stores. It was obviously a teen quenching his thirst with a nice, juicy bottle of Sprite. You go onto the website and they're quite proud of the fact that this is aimed at teens, teaching teens to have their own voice, speak for themselves. They're not talking to preteens, and they're bold about this. There are legions of examples like this where they are aimed at teens.
Again, whether it's 80, 95, whatever, we can crop back a lot of this stuff. I agree that people tend to age up, but they don't age up that much. The teenage years are very much, in our society, held up in high esteem and coddled, if I want to say anything different. There is a targeted group that way. I think we will be able to identify a certain segment of this. Some of it is the 20-year-old that they sort of want to be; we'll miss that for sure. It's going to be hard to crop that back, but there are obvious examples, such as candy bar advertisers, the Doritos campaign I talked about, which are quite clearly aimed at teens and school-aged people. We can crop back a lot of this stuff.
Mr. Arango: I have a quick comment, Senator Seidman. At the end of the day, for health groups, we have a preference. Certainly we thought, from a feasibility point of view, the all food and beverage approach would be best. But at the end of the day, if the government decided to proceed with a Quebec-style approach where all foods are unhealthy, as long as it was done well, I think groups would rally behind the government.
I would just point out one factor that Dr. Monique Potvin Kent mentioned yesterday. There is an important loophole that we have to keep in mind with respect to the Quebec legislation. It allows for the promotion of unhealthy foods and beverages to kids if it's targeted towards adults. Dr. Monique Potvin Kent mentioned that yesterday. If it's an adult eating a Big Mac with the McDonald's logo behind them, that's allowed. That's an important loophole. That would be addressed through an unhealthy food and beverage approach, as well as with an all food and beverage approach.
Senator Seidman: Could I just follow that point up, if I might? I don't really understand that point because, with McDonald's, you can't bar a trademark because you think the food is unhealthy, so McDonald's is advertising healthy food these days. And so is Tim Hortons and any other company you come across, because they recognize the value in healthy diets and the focus in our society today on healthy diets. I'm trying to understand now the loophole that you're pointing to.
Mr. Arango: Sure. There are two components to that. The trademark or the logo in the background is one other issue that I admit is a little more complicated, the issue of restricting brands. My main point there is that if the marketing of the unhealthy food and beverage during children's programming is targeted to an adult — if it's an adult eating the Big Mac as opposed to a kid — then it's allowed. That's an important loophole because then the kids will see the marketing of this unhealthy food and beverage, the adult eating the Big Mac, and that's going to appeal to some extent. Obviously it will appeal more to them if it's directed to them, if it's a kid and there are cartoon characters used, et cetera. That's the nature of the loophole.With respect to restricting brands, that's a little more of a complicated story, I will admit.
Senator Seidman: I still don't understand it.
The Chair: You're still not getting to the crux of her question. The issue is that currently, we're aware that major labels are developing products that would pass the nutritional requirement for a healthy food. The issue the senator is raising is that if this simply prevents unhealthy food advertising during that time and it shows a healthy food with the major brand mark clearly described, how is that a step forward?
Mr. Arango: First of all, promotion of healthier food is actually going to be a good thing. That's a harm reduction principle. But I admit that promoting the logo of a company that produces mostly unhealthy foods is not necessarily a good thing either. Perhaps there could be a way to restrict the promotion of certain brand logos if a certain percentage of their product line is unhealthy, but that said, I do acknowledge that it's going to be tougher. When it comes to corporate logos, it's a tad bit tougher.
Senator Seidman: Just one other item: you said that this legislation would cover the loophole of an adult in the ad. I'm not sure I understand that either. Are you saying that this legislation wouldn't even permit advertisements to adults using an adult in the ad?
Mr. Arango: I don't know what's going to happen at the regulatory phase or with respect to the amendments of this bill, but if it's focused on not marketing unhealthy foods and beverages to kids, then theoretically there should be no marketing of unhealthy foods and beverages during children's programming. Even if it's an adult eating a Big Mac, that, in theory, should not be allowed by a bill such as Bill S-228 once it's amended.
Senator Seidman: That would be in the regs about time?
Mr. Arango: Exactly.
Senator Seidman: Okay. Thanks.
The Chair: We'll have to get into a certain aspect here, but I'm going to leave it for a while.
Senator Dean: Thank you all very much for the work that you have done and that you continue to do, and for assisting us today.
Mr. Arango, you just mentioned risk of harm. This is about regulating to respond to a known risk of harms, a context in which the potentially regulated community is large, sophisticated, well funded and, as I understand it, working with leading-edge tools drawn from behavioural psychology to great success. We've tried a voluntary approach. I've seen this curve before. There was a responsibility on those who argued for a voluntary approach to make that work, and I understand that that hasn't happened. Things have stayed the same or may have gotten a little bit worse. So here we are talking about regulation.
I take from your evidence today, and from what we heard yesterday, that you are thinking upstream and you're also thinking downstream about the ability and the likelihood that these are actors who will adapt to whatever legislation and regulatory regime is developed. You've started to get ahead of that in talking about the importance of age 16 and the nutrient approach.
As we think about what I'm going to call in the world of regulation conscious or wilful avoidance, what other things can we do to either create regulatory tools that are adaptive to adaptation, that are flexible enough to deal with wilful avoidance? You've mentioned the need for a comprehensive approach. I'd ask this question: Could advocates of harm reduction exploit the tools and processes from behavioural psychology as successfully as the targets of this regulation have done?
I want to follow the chair's advice. Mr. Arango, I'd point the questions at you and ask you to respond.
Mr. Arango: For sure. One point is that we absolutely have to be comprehensive in our approach. It's not just marketing to kids. That's really important. Marketing has a huge impact. Many other things need to be done as well.
Could we use learnings from marketing to inform other interventions? Absolutely. I would say even right now with respect to the front-of-pack labelling consultations, I think there will have to be an analysis in terms of what types of warning labels are put on front-of-pack and how they look, their shape, et cetera. We have to use the learnings from marketing to inform what's the best warning label we can put on the front of packs. That's very important to do. The second point is comprehensiveness, and front-of-pack labelling is extremely important, with warning labels on the front of these packages.
Price and subsidies are huge. Diabetes Canada and many other organizations have been calling for a levy on sugary drinks. That could have a huge impact. Putting subsidies on healthy food is another one. In the United States, they have a subsidy program for low-income people to support healthy eating. That's something, perhaps, we should consider here in Canada. Things like zoning restrictions to prevent food deserts and food swamps are also very important.
Access, affordability, marketing and price are all things we have to do. A comprehensive approach is what works, and that's we've learned from tobacco — you do the comprehensive approach. Look at what happened with prevalence rates. They went from 65 per cent back in the 1960s down to around 50 per cent today. That addressed price, marketing and everything.
Senator Neufeld: Thank you very much, gentlemen, for being here. I thank Nancy for bringing this issue forward.
I agree. At least we get some, and I don't know what the percentage is. I'm not looking hard at that.
I just wonder how difficult it's going to be to determine by regulation what unhealthy food and beverages are. I can't imagine that's going to be an easy process. Maybe it will be an easy process. I haven't had a lot to do with regulation in my life. I think it's going to be a little difficult.
I want to deviate to another thing. When you talk about 500 millilitres of sugary drinks per day, that's amazing. Why wouldn't we actually take sugar — we know it to be bad — and salt and some of the other things and limit how much sugar you can have in a drink? You just say: This is how much sugar you can have in anything, not just a drink, but in anything. This is how much salt. I only use those two because I have been told that those are some of the worst and the most prevalent in our food chain.
Dr. Warshawski, maybe you could just tell me a bit about whether that would be a lot more difficult than trying to determine what unhealthy food and beverages are.
Dr. Warshawski: Well, I guess they're closely linked. In terms of setting a limit on saturated fat, salt and sugar, it's based upon some scientific data that there's an unhealthy threshold. The science around the thresholds is developing. I think we have pretty good evidence around salt because it's more measurable.
There is a lot of noise around dietary saturated fat, and lots of confusion in the public, but we know that dietary saturated fat is certainly worse than a low-fat diet or a polyunsaturated fat diet, but it's probably better than trans fats and simple grains. It's a little murkier there.
With sugar, the evidence is quite clear that a high dose is deleterious. We haven't worked out the safe threshold yet. It's kind of complicated because sugar is glucose and fructose combined. Glucose can promote weight gain, but fructose seems to be the real bad actor in this combination. We're not sure what the safe threshold is. We know the current amounts are certainly unsafe.
So then you say: Limit the amount in a drink. You can limit concentration, but what about the 2-litre or 4-litre sizes, the big gulps? So the concentration is limited but you get high volume. It becomes a lot more complicated than that.
I'm not a regulatory expert. There are some tools that we know can alter behaviour. Humans are price sensitive; we know that from tobacco. That was important. Humans are, to some extent, education-sensitive, so have the warnings, decrease the promotion but also increase the negative social marketing so people are aware of the negative effects of sugar. We're just grading the awareness of sugar, and we're learning about salt in high-fat foods.
I'm after what works. Education is necessary but probably not sufficient. Some regulation is necessary, but then it becomes about how burdensome it is, how much you can micromanage everybody versus using tools that work. We know prices work, and, to a lesser extent, education works. You run into trouble when you say that this is the limit on salt or sugar because you can limit concentrations but probably not volumes, so your total dose still gets excessive. So that's my answer.
Mr. Williams: Let me just add to it. Some jurisdictions have been looking at that approach, and it is difficult but it also loses impact with the purchaser. In fact, price point can make a huge difference. I know this is not the subject of this committee hearing, but that's why we're quite the advocates of a tax on sugar-sweetened beverages. It was proven to be effective. It has been shown that consumption is going down. Mexico and France are looking at it. It's not only in lower income cohorts; it's actually starting to show effect on higher income cohorts probably — I'm now speculating — because of increased awareness. People are starting to talk about it, maybe complaining about it and dealing with it.
The added benefit is it is also a revenue generation so that public institutions and governments could actually do some of the programs that the other speakers were talking about. I never thought I'd be advocating for increased taxes on anything, but on this I think it's proven as delivering what we need it to do.
If I could just add to the comprehensive list the other speakers have talked about, in our education system we should maybe spend more time and energy on nutrition. I know the education system is under huge pressure to deliver on a lot of other areas, but it seems this is wanting in a number of areas in Canada.
Mr. Arango: Just to echo the comments about a levy, that's a great opportunity. Hopefully, that can be studied at this committee one day.
With respect to mandatory limits, whether for saturated fat, sugar or salt, perhaps that is the next issue we should tackle in the future. I would say it's not an off-the-wall suggestion because we do have a precedent and it's being examined right now. The government is proposing a prohibition on partially hydrogenated oils that are used to make artificial trans fats. Those will be not just limited but effectively eliminated from the food supply within one year after it comes into effect, which will probably be very soon, once the consultation period is over. It is possible. It's going to be done with trans fats. Perhaps we need to move forward and address saturated fats, sugar and salt in the way you've suggested in the future.
The Chair: I think I'd like to enter at this point. We did a study called Obesity in Canada and the very issues you're discussing today are covered in there. In fact, there isn't a mystery today in terms of the role of fat, protein, carbohydrates and others. It is much better understood today. In fact, part of the obesity problem is because of the complete misunderstanding and diet issues over a long period of time. We have made a number of recommendations in these areas, including when recognized as a trans fat, it has to be removed. That's the reason for hydrogenated oil because it's in the hydrogenation process that fats go through an isomeric transformation into these two forms. Those kinds of things are known and identified, and they have to be, as some of you have been saying, part of a complete solution. What is being proposed here is one aspect of a larger solution, and we've got to keep that in mind in this. So far, most have been indicating that they think it is a good part of a larger solution. For the more complete package, I urge you to read again a document that sets it out.
[Translation]
Senator Mégie: Thank you for your presentations. It was very interesting. I'm happy to see that, after Quebec implemented the legislation, the rate of overweight children dropped. However, I've noticed that, when obesity specialists talk to us about the matter, they show a symbolic slide illustrating an obese mother, an obese father, an obese child, and the pet dog, which is also obese.
When analyzing the data to show the impact of the legislation, how will you remove the parental habits bias? In the case of children aged 3 to 16, the parents make their meals or bring them to a restaurant. Have you considered this factor, and have you already included it in your results for Quebec?
[English]
The Chair: We'll go to Dr. Warshawski first, and then others can come in if they wish.
Dr. Warshawski: I have to apologize. I missed the first part because I was twiddling my dial and got the French instead of the English translation. The question is around the role of family culture and perhaps, to a lesser extent, the role of genetics. They're all bound up together, but family culture certainly does not exist in isolation. If it did, parents wouldn't support the ban on the marketing of healthy food and beverages to kids.
We know that parents are also very influenced by advertising, and ads that show kids delighting in candy, treats, chips and pop — who doesn't want to have their kids be delighted, especially if you're busy, working or you're feeling a bit guilty?
If you look at statistics for parents, something like 15 per cent have income insecurity, 15 to 20 per cent are single- parent families, 10 per cent have literacy issues, 10 per cent have mental health issues and 5 per cent have substance abuse issues. We're not talking about a mom and dad going to the grocery together, hand in hand, fully prepared to be strong and not buy those kids those Dunkaroos. We're talking about the usual parent who is in a hurry, trying to get through the day, and the kids are there with "I want the Lucky Charms! I want the Lucky Charms!'' We know there is pester power. After six or eight times the kid says it, "Okay, have the Lucky Charms.''
How can it hurt? It doesn't hurt; they don't drop down dead. The cumulative effect of this stuff is where the problem is. Thirty years ago, when your 14-year-old wanted a pack of smokes, you bought it for them because everyone was smoking, so it must be okay. Now we know that the cumulative effects are bad. Similarly, the cumulative effects of Lucky Charms for breakfast every day, washed down with a Coke, which sounds egregious but happens in this country, will be seen in 5, 10 or 15 years. It's very hard for parents to battle the here-and-now "I want, I want, I want.'' We know actually that adolescents drive a lot of purchasing in the family. Kids do, as well. We're just not aware of how bad it can be in the long term.
Family culture is important, absolutely. I see it in Quebec in B.C. B.C. has lots of health nuts. In my practice, I have two groups: one is ultra-healthy, strong, not buying their kids this junk; and I have another group that are tired, worn out, exhausted and buying this stuff. They have eaten it all their lives. They struggle with weight issues themselves. They feel guilty. There is a whole bunch of stuff that comes in. When I get in my ivory tower and tell them, "Don't do this,'' it doesn't work very often.
Mr. Arango: To add to that point, I totally agree: Family culture does not live in isolation from the environment. The environment shapes and influences family culture over the years.
For example, as mentioned, pester power has a huge influence on parents. That changes the family culture. As well, there was a study done recently that found that parents remembered very fondly certain cartoon characters from the food industry, such as Tony the Tiger, Toucan Sam, et cetera. That stayed with them 40 to 50 years later. That influences family culture. Let's not forget: Kids who are marketed to become parents eventually. That influences the family culture.
I agree 100 per cent that it's not in isolation. The environment influences family culture. Marketing influences family culture.
[Translation]
Senator Mégie: How will you include it in your study on the impact of the legislation? Are you able to evaluate the parental attitude bias?
Mr. Williams: I'll check with our researchers who work with the governments, and I'll send the response to the committee later. However, I fully agree with your point. The family environment has an essential impact. As we move forward with implementing the legislation, I hope it will be accompanied by an education program and a family support program.
I remember Chapleau's cartoon in La Presse, where the characters said, "Why did we encourage our children to eat vegetables? It's too expensive.'' Therefore, we need a support program and an education program.
I'll check how the government evaluated this factor, since I'm not a researcher. I'll send you the information later.
Senator Mégie: Thank you.
[English]
Mr. Arango: It will be incumbent upon the federal government to have a very good monitoring and evaluation mechanism, including consistent ways of measuring obesity and other nutrient-related diseases, pre and post.
At the same time, as they do that and as was discussed yesterday, we have to understand that it's very difficult to precisely determine how a particular intervention can be causal on another outcome because there are so many other factors coming into play: price, education, food literacy, et cetera.
That said, we expect that the federal government would try to implement a mechanism like this.
Dr. Warshawski: Briefly, I would say it would be impossible to tease out the role of culture right now. However, a lot of our work is based on a logical inference. The companies have real-time data. They expend money in marketing and their analytics on purchases go up, so they continue in this.It's a logical assumption that if marketing decreases, so will purchases. They know this because when they have campaigns and the campaigns end, the flare in sales goes down again. So if they decrease marketing, there will likely be decreased purchases and therefore decreased consumption. That's the logical chain.
Senator Frum: I have great sympathy for what you and Senator Raine are trying to accomplish here.
Could you explain the nutrient profiling system, based on the Quebec experience? I'm thinking specifically of something like fruit juices. We know they have more sugar in many cases than soft drinks. In Quebec, are fruit juices captured by the prohibition? I'm also thinking about things like crackers, which may have a low sugar content but are empty calories and have no nutritional value at all. Do they get captured by the profile system? Can you help us understand how the right foods would get captured?
To Senator Dean's point about industry adaptation, you can imagine easily that whatever the bar is, industry will find a way to nudge up to that bar. Then you have these foods that straddle, like yogurt and granola bars, that appear healthy or can be made to seem healthy.
Mr. Arango: In Quebec, they don't use a nutrient-profiling system because it's a restriction on all commercial marketing to kids. If fruit juice is being targeted to a child during children's programming, it's restricted. If it's targeted to an adult, and it's an adult drinking the orange juice, then it's allowed. That's how that's done. It's not done through a nutrient-profiling system. That is what is going to be proposed, I believe, through this bill — eventually.
Just to comment with respect to fruit juice, because I can't help myself on that one: How is fruit juice produced? The juice is squeezed from fruits and vegetables. It is then superheated to get rid of bacteria. What you're left with is sugar water. Then it's fortified with vitamins and nutrients. It's almost like fortifying pop. Basically, it's the same thing. We do know that the calories in fruit juice are metabolized in the same way as pop. It's just really unhealthy. Yesterday, there was an article that came out in the United States saying that diabetes specialists are pushing for the exclusion of fruit juice from their nutrition programs for low-income people and making recommendations in that respect.
The Chair: We call it a pop without the fizz, and we castigate Health Canada for using a picture of a fruit juice pack on some of their so-called nutrition guides for Canadians.
Dr. Warshawski: Senator Frum, your question was specifically around nutrient profile methods and how you actually capture this stuff. We've learned from the British experience. What they did was kind of a complicated plus and minus. If something had lots of sugar, it lost points, but if it threw some fibre in there, it gained points. Protein gained points and that sort of ratio. Under that old system, cereal that was 20 per cent sugar by volume could be classified as healthy.
Learning from that, there have been at least three different nutrient profile methods that have come forth, two by the World Health Organization and one by the Pan American Health Organization. I don't know if Mary L'Abbe spoke to this yesterday. What they do is a more, I think, scientifically sound basis, where, if you exceed thresholds in any one of three major criteria, saturated fats, sugar or salt, you're unhealthy.
Fruit juices, as Mandy said, when you actually look at the chemical constituents, are just free sugar in water, with some vitamins spilled in. It is unhealthy, so it shouldn't be marketed.
Robust, useful nutrient profile methods are certainly possible, based on sound scientific evidence. That's where you need independent experts to advise, though.
The Chair: I think, Dr. Warshawski, that we need to be little careful of the use of the fat term because it is part of a balanced diet.
Dr. Warshawski: Saturated fats.
The Chair: Balance is an overall issue with regard to diet, so it's critical. That's where we went after Health Canada on their nutrition guide because, from our point of view, it was unbalanced in terms of the overall issue, but your point is taken.
Senator Petitclerc: Thank you for your presentations. My question will be short because it was answered a few minutes ago. I was interested — and Senator Mégie asked the question — in the influence of the parents. The reason I wanted to question that is because I remember, in second reading, there were a few questions on: Isn't it the job of the parents? Why would we do that when it's their job, and not even a "job?'' We heard people saying that it's an opportunity for teaching your kids. This was my question, but I think that's been covered.
The more I listen to you, the more I feel that the Quebec approach covering everything makes so much more sense and is less challenging. That's my impression.
Just a very small question: When we talk about nutrients and labelling, they can be separate. Do you know what I mean? One does not impede the other. Both can have value. Even if we were to go with a bill that covers all food, it doesn't mean that having those nutrient evaluations and labelling and correct front labelling can't be separate as we think about many ways to attack the same problem.
Dr. Warshawski: I agree that they are complementary. Education and information are necessary, but not sufficient. You need to back that up.
The Quebec legislation has merit in all sorts of ways, but then you delve into a whole different rationale for that prohibition. It was in the late 1970s, when people felt very strongly about a commercial-free childhood and not being exploited. It goes for all marketing — Barbies. I could argue as a pediatrician that highly sexualized toy advertising to kids is not a good thing. Similarly, it also applies to jeans. It applies to shirts. Then you get skates and bicycles. Then it gets awfully broad. I'm always wary of trying to boil the ocean. I like to say, "I know this is bad. It's obviously bad. Let's start with this, and we can move incrementally.'' I'm kind of okay with that if we have a social licence for it. I don't think we're anywhere near that. That's my two cents.
Senator Hartling: Thank you very much for your very interesting presentations. It's a very interesting topic that impacts all of us.
I understand very well the issue of obesity in children leading to chronic illness. One thing I'm concerned about — and maybe you might have some examples — is that it also impacts the children's mental health. Can you talk a bit about that? I'm not sure who wants to answer that.
Dr. Warshawski: Probably 90 per cent of my practice now is mental health related. We understand more and more about the critical role of nutrition. It's something the Greeks were telling us: "Healthy mind, healthy body.'' Our grandmother told us this, and we kind of discounted it. It actually affects us in so many ways it is unbelievable. The latest area of endeavour is around the role of nutrition, our gut bacteria and the role that our gut bacteria have in our mental function in terms of anxiety, depression, the role of gut bacteria in heart disease.When we eat junk, crap, it changes our gut bacteria in very profound ways and has this sort of long-term impact, but it's an emerging area.
The other thing that's more robust is the evidence around food dyes and food preservatives with acting up behaviour in kids. I was told in my pediatric residency 30 years ago that that was nonsense and doesn't make a difference. We have a boy who went absolutely crazy every time he had candy canes at Christmas. It was just nuts. Now, there are robust, double-blind, placebo-controlled trials that tell us what parents have told us for the last three decades or so, that, for some kids, food dyes and food preservatives trigger behavioural problems, ADHD. We don't know the data around depression, but there is data around depression and diet in adults. So, likely, it happens in kids as well. Absolutely, garbage in affects us all the time.
The Chair: Just before going to the second round, I want to come to a point that I meant to make in one of my earlier interventions. Among the various issues that we identified in our report, and one of the issues raised here by the committee members, are the things that can actually work. Two of you, at least, have mentioned taxation on sugar. That was one of our strong recommendations in our report.Now there is increasing evidence, even in the year since our report, of studies in countries that have brought in a sugar tax of the clear impact it has on the consumption, which deals with the issue that Dr. Warshawski pointed out in terms of the volume of consumption that can occur. Governments can't legislate everything, but they can use tax as an effective measure, at times, in some of these issues. I wanted to pick up on the observation the two of you made with regard to a sugar tax and to note that it is also one of our strong suggestions as part of a complete approach to dealing with these issues.
Senator Raine: It's been very interesting. I have a couple of things I'd like to get your comments on. One is that, in my conversations with people from Quebec, they welcome the overarching ability to have federal legislation that will strengthen their regime. My first question would be: Will you be encouraging other provinces to put in place similar regulations at the provincial level with regard to consumer protection laws?
Perhaps more importantly, you all represent advocacy groups for health promotion. Is your organization prepared to be vigilant in the development of the regulations that would go along with this bill?
Mr. Arango: With respect to the provinces and even municipalities, we are encouraging them to move ahead. For example, at the municipal level, Ottawa is considering restrictions on marketing to kids of unhealthy food and beverages in municipal settings under their purview. One advantage of having municipalities and provinces act is that it can encourage the federal government as well to move forward more quickly. Another advantage is that once the federal government comes out with restrictions, there might be some loopholes, and provinces can come in and, through their Consumer Protection Act, strengthen those loopholes. We've seen that with tobacco in the past. Provinces and municipalities acted quickly at first, came out of the gate, and then the federal government came in and addressed them in different ways. It's a combination of both, and we are encouraging provinces and municipalities to act.
With respect to vigilance at the regulatory phase, yes, we are absolutely going to be focused on being vigilant. We do know that that is going to be a critical period, and due diligence is going to be required for sure.
Mr. Williams: I've always believed that the municipal level of government can be a very strong social change agent in this country, so collaboration with the provincial government. Frankly, I'm not looking for symmetry across this country. Each region is different. However, momentum from the provincial government levels will be crucial to make this happen.
In terms of vigilance, you can count on us for sure, and everybody else, to be working on it, but you raise a good point. We are going to learn together. We've already had a few other questions. There are a lot of people that will adapt and adjust and change, and what we've thought about maybe we would be outsmarted or it evolves. I would recommend some public vigilance. I would recommend review processes that we can take stock of what changes we made. If it needs adaptation and adjustment in regulations because of new technologies and marketing, et cetera, we should empower the legislators to make some adjustments with the review process. We'll work on our advocacy.
When I've looked at other legislation that's gone through, to have a review process built in so that there are accountabilities is often a very effective model because we may not get it all right the first time. With good intentions, we may think we've done the best, or we have made compromises saying that this is the best consensus and there is buy-in if we go to — I won't give the examples of our consensus — and so be it.
This is moving quickly. Your report has highlighted the huge crisis in front of us. If we take a step forward now, I would like us to equip ourselves so that in two, three or four years, we can take the next step together.
Dr. Warshawski: Yes to vigilance.
I'm not sure, Senator Raine, whether you are wondering if our organization would also support a ban on all commercial marketing as is done in Quebec. I would say from the Childhood Obesity Foundation perspective, we're a narrow-range organization, so we wouldn't be advocating all marketing. It may be something that the Canadian Paediatric Society would be active in, but not our organization.
The Chair: The question that I want to be sure we are clear on surrounds the Quebec legislation and its success in withstanding a challenge. The Quebec legislation is a small part of a much larger act — isn't that correct? — the Consumer Protection Act. I'm assuming, because Quebec was able to develop a Consumer Protection Act that covers a range of things, that that was a major factor in its withstanding a court challenge. I assume that, since Quebec was able to withstand judicial challenges, it is because it adopted a legislation that covers several aspects.
Mr. Arango: I'd have to ask you to repeat it.
The Chair: Quebec's law dealing with advertising to children has withstood a challenge. Is that because it is a part of a larger act, the Consumer Protection Act, which gives it the armour to withstand an individual challenge?
Mr. Arango: Unfortunately, I'm not a legal expert.
The Chair: I don't expect you to be. I want to know whether any of you knew whether that's the basis or not.
Mr. Arango: I would recommend you to our colleague Jacob Shelley from the University of Western Ontario, who has done lots of research in that area, and he has done research on that challenge.
The Chair: I don't want the details. You don't know the answer. If that's the answer, that's the answer I want. We have heard in two meetings now witnesses suggest that a ban at the federal level will not withstand a challenge. There has to be a different act and a different way in which it's couched.
I want to come back to the importance of us moving forward in these various areas. It's important for us to remember we're dealing with children. Why is it that we're dealing with children? The issue is that that is the stage at which habits are formed, and they lead to lifetime developments.
In the case of obesity, we now know there is a scientific basis by which enhanced weight becomes a factor in maintaining enhanced weight and even moving forward. Preventing overweight and obesity in youth is a major factor in a lifelong healthy approach, and it impacts the health of Canadians in ways represented by at least one of you here today in terms of the Diabetes Canada area and, of course, Dr. Warshawski, covers all the areas in which these happen in youth and lead to lifelong issues.
Obesity is a major factor, and we've heard some figures with regard to the overwhelming cost to society just in medical expense terms of the issues, let alone in quality of life. The investments and strategies to deal with this, at the youthful stage of life, have to pay off big dividends in the quality of life of adult Canadians and costs to society in terms of health care.
We want to say to you, as a committee, that we greatly appreciate your being here today and the experiences that you bring from the hands-on knowledge you have, either directly or through your organizations. We hope ultimately that Canada will have a package of measures that collectively have a huge impact in this critical area.
I will once more commend to you and to our viewing audience our report on obesity.
Dr. Warshawski: I can make one statement and also recommend another report. Your report was seminal; it's so important. It got the ball rolling. I say as a Senate booster that this bill is a good example of how the two houses work together, and getting meaningful bill that originates in the Senate and then is endorsed by the house demonstrates how important this body is. Kudos to this body and to Senator Greene.
In terms of reports, this one alludes to many of the things you just talked about. It just came out from the University of Waterloo, Amanda Jones and David Hammond and others, the Health and Economic Impact of a Tax on Sugary Drinks basically enumerates and quantifies cases of diabetes and heart disease, cost to the system and lives saved by the intervention recommended in your report, so this is a great adjunct to your report. If anyone needs a copy, Senator Raine can contact our group and I can have that forwarded to you.
The Chair: Thank you very much. We hope we're successful at our end first. We won't make any projections as to what the house may do. However, we do have an example that has come back to us, and that is our report on dementia. The House of Commons has just passed the bill, and it's in our chamber now. We hope to get it passed and to Royal Assent before we rise. It would be the exact model that you're referring to, Dr. Warshawski.
Once again, I thank you for being here.
(The committee adjourned.)