Health — Issue No. 3 — Thursday, April 27, 2006 (HTML)

2006 Legislative Session: Second Session, 38th Parliament
SELECT STANDING COMMITTEE ON HEALTH
MINUTES AND HANSARD

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH



CONTENTS

		Page

Work of the Committee		15

Presentations		15
	M. Golbey
	B. Mackie
	R. Hulyk
	D. Mackay
	D. LeFrank

Chair:	* Ralph Sultan (West Vancouver–Capilano L)
Deputy Chair:	* David Cubberley (Saanich South NDP)
Members:	* Dave S. Hayer (Surrey-Tynehead L) * Daniel Jarvis (North Vancouver–Seymour L) * John Nuraney (Burnaby-Willingdon L) * Valerie Roddick (Delta South L) * Katherine Whittred (North Vancouver–Lonsdale L) Katrine Conroy (West Kootenay–Boundary NDP) * Michael Sather (Maple Ridge–Pitt Meadows NDP) * Charlie Wyse (Cariboo South NDP) * denotes member present


Witnesses:	Dr. Michael Golbey (President, B.C. Medical Association) Rob Hulyk (B.C. Medical Association) Deborah LeFrank (District of Saanich) Diane Mackay (Insurance Corporation of B.C.) Dr. Bill Mackie (B.C. Medical Association)

R. Sultan (Chair): Good morning. Welcome to the Select Standing Committee on Health of the British Columbia Legislature.

Today's meeting is a public meeting. It will be recorded and transcribed by Hansard Services, the very competent staff behind the smoked glass behind me. A copy of the transcript, along with the minutes of this meeting, will be printed and made available on the committee's website at www.leg.bc.ca/cmt.

In addition to the meeting transcript, a live audio webcast of this meeting is also produced and available on the committee's website so that interested listeners can hear the proceedings as they occur. An archived copy of the audio broadcast will also be retained on the committee's website.

In case you didn't quite catch the nuance, we are on air over the Internet. Welcome, world. I'm sure they're listening with great interest in all the continents of the planet.

R. Sultan (Chair): I would also like to begin by reminding ourselves and, in particular, our expert witnesses this morning of the terms of reference of this committee. We have been empowered by the Legislative Assembly to conduct inquiries and to make recommendations with respect to critically important health issues confronting British Columbians. In particular, we have the mandate that we are now attempting to fulfil to examine, inquire into and make recommendations with respect to finding effective strategies to change behaviour and encourage children and youth to adopt lifelong health habits that will improve their health and curb the growing rate of obesity, to achieve the great goal of leading the way in North America in healthy living and physical fitness.

In order to do that, we are conducting consultations such as this morning's. We are also being asked to report on the recommendations of our member Valerie Roddick's committee in the previous Legislature, and their report in 2004 titled the Path to Health and Wellness: Making British Columbians Healthier by 2010.

We are also asked to conduct research into other successful childhood health and wellness promotion campaigns. Jonathan, our faithful researcher over on my left, is exploring research material in that regard, and we depend on expert witnesses as well.

We are asked to undertake discussions on how to promote childhood health and wellness, including the appropriate use of incentives and disincentives — my goodness, are we talking about special taxes here? — to help influence behaviour, particularly as it relates to healthy nutrition and physical activity. Finally, as we are doing this morning, undertake discussion with experts and, if necessary, undertake research into the factors contributing to unhealthy eating and physical inactivity in our youth today.

Because many of the consequences of obesity are hardly a medical mystery, I presume — we'll ask our experts their opinion on that — it occurred to some of us that one of the most important dimensions of this committee's work would be to publicize and try and better educate British Columbians about the problem, and to try and induce behavioral change among the public at large. In that regard, this committee is in the process of recruiting a media adviser to help it publicize among the general public important findings with respect to the causes and cures of childhood obesity.

I wanted to inform the committee — they already know, but to put on the record — that I have recused myself from the process of searching for, evaluating and retaining a media adviser for this committee. The reason is that there's a reasonable probability that one or perhaps even more persons or organizations seeking this assignment are well known to me or even associates in another life.

Accordingly, I've asked our Deputy Chair, David Cubberley, to work with committee member Val Roddick and with Committee Clerk Kate Ryan-Lloyd to assess such applicants as may come forward and to present their recommendations to the committee as a whole. I shall not be knowledgable or involved in any of that.

David may wish to give us a brief report, without mentioning anything that would embarrass me, on the progress of his subcommittee.

D. Cubberley (Deputy Chair): The briefest of brief reports. We have advertised for interested applicants. We have received applications and have done an initial review of them. We have developed a short list that we will be pursuing in the near future with the hope to make a recommendation to the committee for approval shortly. How's that for brevity?

On to our testimony. I would remind all of us, including the witnesses, that the format is, hopefully, a 30-minute presentation. We've allowed 30 minutes for testimony and 15 minutes for questions from the committee.

Our first distinguished expert witnesses come to us from the B.C. Medical Association. They are the very first, and perhaps appropriately so, witnesses to appear before this committee — as the association of all the medical practitioners in the province, I think appropriately so. One presumes they see the problem we're trying to address first hand every day in their practices.

I will just read their names for the record: Dr. Michael Golbey, president; Dr. Bill Mackie, chair of the Council on Health Promotion; and Rob Hulyk, senior public affairs specialist with the BCMA. I would perhaps ask each of them to just give another very brief bio so we can get to know you a little bit better, before you proceed.

M. Golbey: Good morning, everybody. We certainly do appreciate the opportunity to be able to pre-

sent to you today. It's an extremely important topic, one we take very seriously.

I'm Dr. Michael Golbey, and I'm president of the B.C. Medical Association. In my real life I'm a family physician in Kelowna. I've been there for the last 23 years. At the moment I spend half my time in Vancouver working for the doctors of B.C. and for our patients within the BCMA.

To my right is Dr. Bill Mackie, who is chair, as you heard, of the BCMA Council on Health Promotion. To my left is Rob Hulyk, senior public affairs specialist for the BCMA.

You wanted to hear what we do in our real lives. Bill, perhaps you'd like to do that right now.

B. Mackie: My name is Bill Mackie. I've been involved with health promotion as well as being a full-time family doctor for most of 30 years. I also do sports medicine and look after athletic injuries and help people in their training programs.

My previous experiences here at the Legislature have been involved in promoting and legislating mandatory bicycle helmet use to prevent injuries. We saw that as a big spike in recreational deaths and injury. I am a dad of a number of young kids who perform in sports. I go to meetings, and people say, "Oh, you're Gail's dad," or Charlotte's dad or Owen's dad. That's a brief introduction of what I do.

R. Hulyk: I've been with the BCMA for ten years. I've been on the public affairs side for five, and in my five previous years I was a policy analyst. One of the things about Dr. Mackie…. He's too modest, so I'm going to say it for him. He was also a member of the 1972 Canadian Olympic team as a competitor, not a physician.

M. Golbey: I don't aspire to any of those things, but I did do the Sun Run 10K in under an hour. I was very pleased with that, and the weather was great.

I would like to begin by providing some brief context on the issue of childhood obesity. Secondly, Dr. Mackie will briefly summarize the BCMA Council on Health Promotion's campaign on childhood obesity. Our purpose is to highlight the successes from that campaign, which we have seen and we believe can be expanded on. Thirdly, we're going to provide three recommendations for your consideration.

We're here today because obesity is now well recognized as a major public health concern. Indeed, the World Health Organization released its Global Strategy on Diet, Physical Activity and Health in 2004. Yet today our major challenge is in moving from analyzing this issue to action.

Controlling obesity amongst children and adults comes down to the simple fact that people need to eat healthier food and get more exercise. There's no miracle solution. Changing people's attitudes will take a cultural shift that will take efforts on several fronts. We're competing against a generation of attitudes and marketing, and change won't happen overnight.

Consider, if you will, that if we were doing this presentation 25 years ago, there might have been an ashtray sitting right here in front of me. So things can change. To translate that into today's terms, it is usually cheaper today to buy a bottle of pop than to buy the same size bottle of water. We currently lack measurable indicators and accurate data. We're going to be talking about this a little later on.

Right now I'd like to pass the floor to Dr. Mackie to discuss the BCMA's health promotion work on childhood obesity.

In 2004, following its successful health promotion campaign on seniors health and dementia, the BCMA Council on Health Promotion identified childhood obesity as our next public health campaign, which we called Eat Well, Play Well, Stay Well. Our goal was to provide parents and families with information they could use to make healthy choices.

The council formed a steering committee made up of representatives from practising GPs, pediatricians, the Ministry of Health, the Ministry of Education, the B.C. Recreation and Parks Association and the Heart and Stroke Foundation. This slide illustrates the different initiatives we have produced through this project.

Now I'd like to tell you what worked. In November 2004 the BCMA published two patient pamphlets entitled Eating Well on a Budget and Helping Your Overweight Child. We have copies for the committee for you to review at your leisure.

The BCMA distributed 200,000 copies of each pamphlet to physicians offices around the province. Eating Well on a Budget is amongst the most popular BCMA pamphlets requested by physicians in pamphlet reorders, and the on-line version of the pamphlet is one of the top ten hits on the public area of our website. No pun intended, but there is definitely a hunger amongst British Columbians for this kind of objective and unbiased information.

The Eat Well, Play Well, Stay Well project kicked off in February 2005 with the issue of the first eight news releases on topics such as healthy eating, physical activity and chronic disease prevention. Considering that these were not hard news items, we were pleased to receive generous media coverage on these topics. For example, we did a release noting that children should not be on fad diets. We received national news coverage on this.

It is always a challenge to compete for news coverage on health promotion. However, we again found an appetite for information among the media where they could provide useful information for their audiences.

During September 2005 a BCMA health promotion message ran on the side of one-litre Dairyland milk cartons. Distribution covered much of the province through major chain stores and local grocers. This proved to be a low-cost vehicle for promoting our message and assisted in driving traffic to our website. The provincial childhood obesity forum, held in March 2005, also cited this as a useful partnership on child-

The physician presentation program is the largest component of the project. The program provides a 20-minute PowerPoint presentation for physicians to give at school parent advisory committee meetings in their own community and to answer questions. The presentation addresses issues such as diet, exercise and meal planning, long-term health benefits and costs, with the overall focus that they undertake these plans as a family.

In its brief lifetime we have accumulated over 150 physician volunteers and given over 40 presentations around the province. We are working collaboratively with the Confederation of Parent Advisory Councils and Action Schools B.C. to provide this program. Feedback from parents and schools has been extremely positive, and physicians have enjoyed themselves immensely. We will leave a copy of this presentation for your review.

The BCMA would like to make three recommendations for your committee to consider in your deliberations. I'll outline them briefly and then go through them in some more detail.

The first recommendation. We believe the province needs to create a child health registry to support monitoring, research and evaluation. Secondly, we believe we need to promote and support obesity prevention and treatment in primary care, and by primary care I mean more than just in physicians' offices. Thirdly, the BCMA believes that to effect real change, we need to implement nutrition and physical activity standards across the province. Now, I know the word "standards" makes some people nervous, so we will expand on that shortly.

When looking at the issues of childhood obesity, I find some similarities to the challenges we faced on tracking wait times in British Columbia over ten years ago. Today there's actually very little information available on the general health of B.C.'s school children. When you look at the data we have, it's often based on small samples or on groupings of children and/or schools.

There are limits to what you can do or evaluate using this information. When planning programs designed to change behaviour, you must have a means of evaluating how you are doing. You must also be able to conduct comparisons amongst different regions or communities. We do not have this information now, and if we are going to effectively plan and evaluate how our initiatives are doing, we do need this information.

Let me put this into some context. We've all heard the Premier state repeatedly that everybody needs to eat their veggies — right? We've got to eat five servings of fruit and vegetables per day. As a physician, I can tell you he's absolutely right, and I hope he keeps saying it. But how do we measure this? We are also seeing exercise programs changing in our schools. But how do we know which ones are making a difference, and how do you compare the different programs with each other?

What we are recommending is the creation of a provincewide child health registry. By registry I mean the collection of very basic data pertaining to health — for example, height, weight, waist-to-hip ratio, etc. We're not advocating for any kind of comprehensive database. We believe this information should be collected, and it should be collected twice a year, probably in September and again in May. To be worthwhile, this registry should be implemented in as many schools in the province as possible.

I certainly recognize there are issues of privacy and consent involved, so in order for this to be successful, it will require the following factors. All the information collected will need to be anonymous. Participation will need to be voluntary and with the informed consent of parents. We also need to provide, both to parents and to the school kids, clear information on why this is being done. The information needs to be conducted in private by health professionals, such as a community health nurse.

Our second recommendation involves the support and promotion of obesity prevention and treatment in primary care. We raise this issue because there are two developments that simply did not exist eight months ago. The first one is that in September of 2005 the Ministry of Health and the BCMA released their obesity clinical guidelines; I have this here. This guideline provides standard tools for assessment and monitoring of obesity. It also includes a patient guide for people to take home. If you haven't seen this document, I do encourage you to look at it.

Secondly, as you all know, the BCMA and the provincial government reached a tentative agreement a few weeks ago. One of the things I think both sides were excited about were the opportunities on prevention and chronic disease management that arise from this agreement. The votes are being counted one week from today. If ratified, this agreement will provide funding for prevention as well as giving physicians the opportunity to partner with other professionals such as dietitians and nurses in providing counselling to their patients. A year ago and prior to this agreement this simply was not possible.

Our third recommendation calls for the province to implement nutrition and activity standards across the province. The elements of these standards are not new, but we are calling for them to be implemented in all schools — the sooner, the better. We are pleased that some schools are already doing some of these things.

First, remove all pop and candy from schools, and replace them with healthy alternatives. We should also consider expanding this recommendation to any public building. We recognize that up until now this has been a school district choice, but frankly, we believe this is important enough for government to take a provincewide approach.

Secondly, implement daily physical activity programs in schools. By daily activity we mean 30 minutes of activity. These activities must be flexible and adaptable enough to allow everyone a chance to participate. We are hoping that over the next two years we could see over 80 percent of B.C.'s school children have access to at least 30 minutes of activity per day.

Thirdly, provide families and parents with healthy meal, snack and portion planners throughout their schools. This should be updated and repeated each year.

Thank you for listening to us, ladies and gentlemen of the committee. That concludes our presentation, and we would be delighted to answer any questions that you may have.

R. Sultan (Chair): Thank you, Dr. Golbey, and thank you, Dr. Mackie. Indeed, you've presented some very interesting and easily understood recommendations. I'm sure the committee has some questions.

J. Nuraney: Excellent presentation. Right on the button. As you also know, this society now is moving towards being a very lazy society, and computers are primarily responsible for making us just sit on our chairs and watch the screen.

I was wondering whether you have thought of bringing home to the children themselves how to reduce weight. For example, if they follow a certain diet for, say, 15 or 21 or 30 days, they can reduce weight directly — some kind of a message that goes directly to them to say that if you just avoided Coca-Cola for a week, you would lose two pounds.

Those are messages that really hit home, rather than giving a dietitian and providing services of a dietitian. We are just too lazy to do that, to be quite honest, so we have got to bring these things home.

My second question is…. For the parents to understand the relationship between obesity and the disease that can follow in their children…. That is a scary note that immediately catches parents' attention: if they are not careful, this may result in their children.

Those two very critical messages, I would have thought, would play some part. I just wanted your thoughts on that.

M. Golbey: Thank you. If I can address your second question first — absolutely. The whole point of this campaign and preventing obesity is to look after their health in the future. I think that message is getting through, but we have to keep going with that message.

Your first one about diet for kids — absolutely. But that's only a small part of it. We have to get kids — and their parents — when they're very young to understand that a diet of Coca-Cola and French fries and chips and computers is not a healthy way to live, and it's going to lead to problems down the road. Certainly, I accept what you say. Stop drinking Coke for a couple of weeks, and you'll lose a couple of pounds. But it's got to be way more than that. It's got to be a complete lifestyle change for kids.

I'm sure Bill will agree with me here. What we're seeing in our offices every day, even though we don't have the measurements yet, is chubby kids, and we never used to see that. We just never did. They come into the office now. The fashions are…. You know, they're wearing short things, and their bellies are sticking out, and it's awful. It is an incredible change in the 20 years that I've been in practice.

I think back to when I grew up in London. When it was vacation time, I got kicked out of the house in the morning, and I was told to come back at lunchtime. I spent my whole morning running around the streets. After lunch I was sent out again, and I came back when it was dark.

Things have changed. It's not safe to do that anymore. You can't do that with your kids. Plus, there are computers and TVs, so life has changed, which is why we have to do this now and we didn't have to do it previously. It's a whole lifestyle thing. It's a change of attitude.

B. Mackie: They were insightful questions. The whole issue of changing diet is something that we hope to integrate into the school system, and have schools promote healthy living. It's not simply a matter of removing some things and having a few pounds of weight loss. That's a start, but like Dr. Golbey said, it's part of a larger issue.

The other thing is activity. It's much safer now, actually, than it was. The safety statistics are much improved as far as abduction and injury to children, but we're so inundated by media that we hear about something like this that happens in the southwestern U.S. or somewhere else. The statistics prove that it is much safer now as far as abductions. With those abductions, it's usually somebody that the person knows — a disenfranchised family member or something like that. It actually is much safer now for children to engage in activity.

Again, referring back to the past, you know, playing on things that were unsafe when I was a kid…. That's changed now. There are restrictions on parks and activity centres. Areas of play are much safer for children. We could probably encourage parents in our province to give children a little bit more free reign to play.

The amount of activity that is needed to keep children healthy is equivalent to two hours of play twice a week, which is…. If the kids have a chance to get out and play, they tend to do that. Interestingly enough, the same thing applies to adults. If you put adults outside, they end up being active as well.

R. Hulyk: I just wanted to pass on…. When you're pursuing your activities, you have to remember to target the parents as well as the children. You can't just target the children exclusively, as parents are ones who are going to be dictating and setting behaviour examples for their children.

M. Sather: Mike, I really agree with your presentation. The issue of pop and candy in schools…. I think it's long overdue that we need to get rid of those deleterious substances from the schools. Of course, if you have discussions with the schools, they will talk about funding issues and how that is the reason they have those in there. So it's sort of a bigger issue for them too. But as you say, some have made that step, and that's very positive.

I think that the 30 minutes of daily exercise is really good. I wondered if you've had any discussions with schools now or if you are aware of what kind of programming they have now. I'm not entirely, in terms of the amount of exercise that the kids are getting in school now….

One other thing I wanted to ask about was nutrition. Of course, that's a big issue. We know about a number of kids who are coming to school without breakfast or without lunches and so on. Have you had any…? What are your thoughts about anything that we can do towards improving nutrition for kids, whether it's a meal program or whatever it might be?

Have you had those discussions with any educators? In fact, I know you've mentioned something about education in here, but I'm not clear how much communication you've had so far with educators in schools about the program.

B. Mackie: Thank you. Let me just go over that. There were a few questions there.

B. Mackie: The one about contact with educators. I've been quite involved with a group called Directorate of Agencies for School Health in the past. They were a support group for health programs in schools. I was actually the president one year. They have a lot of information. They go by the initials DASH — Directorate of Agencies for School Health — and I would say that's where a lot of information can be gained on school nutrition programs.

The question about providing meals in schools. Last summer I was in Finland, and they have a tradition of providing meals in schools. They did that postwar, because there were concerns with malnutrition and starvation. They've continued them since then, and they've continued them through a period of time when some areas in Finland had the highest cholesterol and cardiovascular death rates in the world. Because they'd been providing them all along, they were able to modify them then.

There is a place in some jurisdictions for that. Again, our program is calling in the families to provide the right thing as well. It's a family issue.

M. Sather: Yeah — if you were aware of how much activity kids are getting in school now.

B. Mackie: Well, I was actually on the planning group for Action Schools B.C., so it started as a volunteer pilot program in about 300 schools around the province. It's mainly aimed at grade four, I believe, and it has increased to about 700 or 800 schools. I haven't been on it since I've had other responsibilities, but I think it has expanded in the breadth of grades as well But it started out as grade four.

What it is, is a jumping activity games program where children are being continually kept active, which is very good. It's not like physical education where they're learning skills and games and activities that will give them skills that they can take away from school.

R. Sultan (Chair): Could I perhaps interrupt, Michael? We have a long list of other questioners, if you don't mind me breaking in.

D. Hayer: Good morning. Thank you very much. Excellent presentation. It was very informative.

I have a couple of questions. First, would you sort of make a recommendation saying we should try to make this compulsory for schools to have 30 minutes of physical activity or some sort of exercise program? The second thing about that: have you talked to some of the teachers to see how they feel about it, as well as the principals and superintendents?

The next question is the creation of a child health registry. Have you looked at what type of cost we're looking for roughly, and have you talked to the Ministry of Education or Ministry of Health or somebody regarding this?

B. Mackie: Anything that has compulsory before it strikes a little bit of heavy-handedness. Having some choice is important, but it may be a pressured choice. Changing it to more of an opportunity than a requirement is probably a better way to look at it, but the answer to the question is yes. It should be compulsory in some way. The Canadian Heart and Stroke Foundation is recommending that children have a half-hour of

physical activity every day. The American Cancer Society is recommending that individuals, children and adults, have an hour of physical activity every day. So we can go down that list and say: "How much do we want to make compulsory, and how much is reasonable?"

There's an excellent publication that came out from Britain called Raising the Bar. It talks about physical activity for children in schools and how to introduce children from programs in the schools to after-school sports and activities, providing physical activity opportunities for in-patients in hospital and having that be continued as they migrate out of hospital into the community. It's just an excellent publication. It was commissioned by Tony Blair. Sebastion Coe was one of the co-authors, and there was an expert group that put it together. It came out just a couple of months ago, so it's very recent. It's called Raising the Bar.

M. Golbey: And on the cost of the registry, we don't have figures for it, but it's not going to be a major cost. Certainly, one of the costs that we absolutely have to build into this is evaluation, because we need to know if these programs are going to work. But the potential savings are huge. We're looking at savings of a billion dollars a year or more in health costs — fairly quickly, I would think. The return on investment is absolutely huge.

R. Hulyk: Just to quantify on that. The World Health Organization estimates that about 5 percent of health care costs in developed countries is a direct result of obesity, and you can look that up on their report. You extrapolate that to our health care system, so those are the kind of numbers that we're talking about.

D. Hayer: Have you talked to the teachers or the superintendents and principals about that for the second part and the Ministries of Education and Health and both of these programs?

B. Mackie: Well, through the years I've had dialogue with Deputy Ministers of Education and attempted to increase the physical activity that children are doing in school, so there's been an ongoing dialogue in that regard.

The last thing. As far as curriculum changes, we were told after one of our meetings that children could have up to 10 percent of their curriculum time being designated as physical education. This was before Action Schools. One of the school principals who led a group and I met just over here. We left feeling quite good about there being up to 10 percent of curriculum time being devoted to physical education, but the "up to" was the problem in the details. A lot of schools didn't approach 10 percent.

D. Cubberley (Deputy Chair): Just on the question of trying to find sources or ways of stimulating daily physical activity, I understand that one of the main challenges from the point of view of actually creating habits and positive behavioral change is to find forms of behaviour that are easily incorporated into daily life, so that they're not add-on activities. I was pleased to see in your slide that the one of the…. You both said that it needed to be done in a manner that was flexible, and you used walking groups as an example.

I'd like to get a little bit further comment on that and want to frame it around…. Have you considered the opportunities outside of physical education classes to begin to stimulate this level of activity? Have you thought about the journey to and from school as a possible source of physical activity?

M. Golbey: As we mentioned, it's not just in schools exactly. This has to be a community-wide exercise that involves kids, families, parents, grandparents — whoever — walking to school. I used to; everybody used to.

M. Golbey: Everybody used to. And why not? Of course, whatever opportunity we have to encourage people to be more active. As Bill said, it doesn't take a whole lot of exercise to make a huge difference.

When I was in school, one of the things you weren't allowed to do was run. Do you remember that? You weren't allowed to run in the corridors. I never see kids running anymore. The way we look at things, the way we were brought up has changed, so we need to see change in the way we do things. Yeah, walk to school — what a fantastic idea. It's not very expensive, is it?

D. Cubberley (Deputy Chair): If I could ask one other quick question. You were talking about the new agreement and the potential for primary care to be oriented more towards prevention. Has any consideration been given to developing a template for an exercise prescription that doctors could issue as a response to physical inactivity, obesity, diabetes, other kinds of things? Doctors would actually prescribe physical activity and lead people towards a simple form of activity such as walking.

M. Golbey: Yeah, absolutely. It's actually mentioned in this guideline. It's something we've been doing, really, for a long time, but it's been as an add-on. We often haven't had the time to do it properly, but as you mentioned, with our new agreement and some funding available for this sort of thing — absolutely — prescriptions for exercise are a good idea.

D. Cubberley (Deputy Chair): Would there then be some scope for reaching out to doctors to bring the idea home and to…?

B. Mackie: As you mentioned, simple things like walking are probably where the greatest impact can be achieved. Having easy access to walking trails and things that are convenient…. In West Vancouver the seawall walk along there is used day and night. It's incredible.

B. Mackie: Yeah. There are places to stop and sit if you feel tired, so people who are getting back into walking can do that. There are washrooms, which are often very important for people to feel comfortable doing these things.

Excellent walking trails are found in various communities around the province. They're not well publicized. I've had this thought that some photos of these in nice weather conditions should appear in malls. I would much rather see signs on the highways indicating where there were walking trails than where there were wineries. I think those are some things we can do that will have a positive effect.

D. Jarvis: I don't want to become the devil's advocate here, but the parents that I talk to…. I live on the North Shore as well, and I have children and grandchildren. I'll tell you, the parents are exhausted taking their kids from one sport to the next sport and on and on continually. Between school and organized sports outside, I think the kids are actually, on the whole, pretty active.

The part where I agree with Dr. Golbey is that they don't have enough time on their own, playing in the bush and doing what they should be doing. At the seawall in North Vancouver on a nice day…. We should be encouraging going out on rainy days, because on nice days it's like Coney Island down there, and there are no children — all adults.

I think that one of the problems — and I'm wondering how you're going to feel about it — is the fact that the dress and attitude and the size of young girls and everything, with anorexia and bulimia in the play so much now…. It's not necessarily there every day, living around them. I mean, it's what they're seeing on TV and periodical magazines and copying all the stars and all the rest of it in their clothing and dress and wanting to be thin. So I wondered what you thought of that.

Then, on the registry — quickly, I'll get on this…. We used to have, not necessarily a registry, but a chart as to your weight and size and all the rest of it in comparison. Are you thinking of something along that line? I'm wondering if we still have one in doctors' offices, because I've never noticed one — where we used to compare children. I remember the doctor saying: "Well, don't worry about him or her, because those are eastern figures, not western figures." I'll throw those out to you and see what comments you have.

M. Golbey: Your first comment about being sensitive to the other side of this equation, which is anorexia and that sort of thing…. Obviously, that's very important. We can't take a bunch of overweight girls and convince them that that's awful and they all become anorexic. We have to be very, very sensitive and very careful about how we do this and what the norm is. The norm is not the skinny people you see on TV. It's extremely important that we're very careful how we do it.

The charts that you're talking about absolutely do still exist, and we still use them. They're a little out of date, and they're being revised and reviewed to be more appropriate for the times and the place that we live in. But that's not the registry, though. The registry would actually collect the data. We would be able to look at the overall data and see how we're improving things and how we're getting back to what we believe should be the norm.

D. Jarvis: Is there a difference between the east and the west — like there used to be, supposedly?

M. Golbey: Yeah, there are differences between communities across Canada, between countries, obviously between the Far East and North America. Everybody has different sizes, different shapes and different norms.

Those graphs and charts are becoming more available. You may have seen recently that even the standard North American one is being changed for babies and young children to take account of the fact that more are being breast-fed now. The old ones were based on bottle-fed babies, so changes are occurring.

R. Hulyk: Just to expand on the registry a little bit. What we're asking for is a collection of anonymous data from all the schools in the province. We're not calling for individual…. How much does child A, by their name…? What's their height and weight? We're asking in a school of 500 kids, where there are 300 boys and 200 girls: what is the average height and weight? You can use that to make comparisons between schools, between age cohorts, between regions.

We don't collect that information currently because, frankly, you don't often see a child in a physician's office in a year. You sometimes won't see them for a time, and that data isn't typically collected; whereas in a school is the best opportunity to get this data. We're not looking for individualized data on individual children. We're looking for aggregate data across schools and across communities so that you can use that basic information to conduct research, monitoring and evaluation of programs.

We're running a little bit over time. We have three final questioners. I'd ask them to each ask one short

question and to keep the responses equally brief. We will start with Val and then go to Charlie, and then Katherine Whittred will be our final questioner.

V. Roddick: As parliamentary secretary for Agriculture Planning, when you're working together…. Obviously, you've worked with Education. In the agriculture sector I find one of the biggest challenges today is that no one knows where their food comes from — at all. Most children think milk comes in a carton on their supermarket shelves or neatly packaged. They don't equate it with a cow. To get people back and joined with their food, have you been working at all with the actual — well, not necessarily the farmer — as to where the food comes from…?

I know there are a few separate people trying to do this on their own, like John Bishop at Bishop's on Fourth. Actually, in my riding Gerald Worobetz, who's the chef for Tsawwassen high school, is trying to take his students out to see where their food comes from. Is that something you as doctors can work together on with Education and Agriculture to get the word out?

B. Mackie: There are meetings being held at PHSA, which I think is the Provincial Health Services Authority. John Millar has pulled together a group, some of whom are in agriculture. Some are dietitians, some are doctors, and some are provincial health authority members. There are programs in the school now where they bring in local fruit and vegetables, and the school students have access to that and the health information that goes along with it. There are some interesting and informative things happening in that area. I think they should be expanded.

V. Roddick: I'm just saying: do you think there is a possibility that the BCMA and the Ministry of Agriculture and the Ministry of Education could all work together?

V. Roddick: What I'm seeing is that they're starting to work in silos. What we really need to do is work together to get this on the road.

B. Mackie: In our BCMA journal, we put out an article in the letters-to-the-editor section explaining about this program so that doctors in the far-flung communities in our province knew that it was happening and that there were programs like that — the distribution of fresh fruits and vegetables.

C. Wyse: To begin with, I would like to commend your organization for having initiated activities around this area, right upfront. Because I've been asked to be brief, I'm going to assume that somebody has data on the number of children who don't have access, actually, to the food necessary for a healthy diet.

Education systems often are looked at as being a source of data, as a vehicle to promote and provide exercise opportunities and so on. Have you given any thought to these schools likewise being a vehicle for distribution of healthy food to children — those that aren't able to afford such?

M. Golbey: I think that's an extremely good point. That goes back to what Dr. Mackie was saying about Finland and school meals in Britain. There's a good example of what one person can do in Britain — that fellow, the Naked Chef, Jamie whatever his name is. He's changing single-handedly the food that the kids eat in schools in Britain, from unhealthy food to healthy food.

Absolutely. We have to work at every possible level, and that certainly is one level where we do need to work.

One of my little pet peeves is around marketing and targeting of kids in terms of product. I am of the opinion that probably most people know the right things to eat. They just get carried away with the available choices.

One or two examples are those little cheese packs that you see kids have. These are marketed in stores. I see parents pack them in their kid's pouch for their snack when they're having their break from their skating lesson or whatever. I see these so-called health bars, and if you actually read the nutritional data, they've got 25 grams of fat in them for crying out loud. People are fooled into thinking: "Hey, we're really giving our child a healthy snack."

My question is this. Have you considered coming to us as government and saying that we should be putting some sort of measure on this food to say: "Great big poison. Do not give this to your kids for a healthy snack"? I really do think that many, many people are simply being conned into giving kids unhealthy foods, thinking: "This is a really good thing I'm doing."

M. Golbey: I couldn't agree more. If you actually start reading labels, it's astonishing what's in some of this stuff. To answer your question, we would love to come and talk to you and work together to make sure that foods are labelled: "Poisonous for your kids. Do not feed." Absolutely.

R. Sultan (Chair): Unfortunately, this very interesting dialogue must come to an end. We have another series of expert witnesses. I'd remind our committee members that the House is in session at ten o'clock, and this room is needed at ten o'clock.

I would like to thank the British Columbia Medical Association for sending their representatives to speak to us today on this important subject — in particular to Dr. Golbey, Dr. Mackie and Mr. Hulyk. Thank you so much for your testimony today.

R. Sultan (Chair): I'll call the meeting back to order, ask members to take their seats and once again resume the meeting of the Select Standing Committee on Health of the British Columbia Legislature. I will not repeat the preamble that we submitted our first expert witnesses to, but I will advise that we have one half-hour, slightly less time than originally planned, to hear from our next two witnesses. I would suggest they may wish to speak for 15 or 20 minutes, depending on the length of their presentation. Then we'd have ten minutes for questions and answers.

I would turn the meeting over to Deputy Chair David Cubberley, who will introduce our next two witnesses.

D. Cubberley (Deputy Chair): I'd like to introduce the committee to Diane Mackay and Deborah LeFrank who are with the safer school travel program, which is with ICBC.

Diane has been involved since the program's inception in 1999. She implemented a pilot project at Royal Oak Middle School in my home municipality of Saanich. Since then she has been involved in spreading that program across British Columbia, having developed a template for how it could work. She's the provincial coordinator with ICBC and responsible for training and managing safer city coordinators in the implementation of that program at sites across B.C.

Deborah LeFrank has been involved with the program since 2004. She's a landscape architect well known in the community as a trails advocate. She's brought planning and active-living skills together with community-building skills in her role. She's the Saanich safer city coordinator, and her focus has been on developing best walking route maps and safer school travel plans to many of the schools in both the Saanich and Greater Victoria school districts.

D. Mackay: Good morning to everybody. Thank you for this opportunity to present the safer school travel program to your committee.

In our presentation today we're just going to include a brief background summary of the program and details of the process and the implementation of the program. Then we'd like to leave you with a few ideas of future opportunities for adapting and applying the concepts and ideas of safer school travel to other areas.

Safer school travel is a component of the larger safer city program. Safer city was developed by ICBC and is a partnership or collaboration between a city, the police and ICBC. It aims at making road safety a priority. It leverages and integrates the three Es of education, enforcement and engineering into one framework to maximize the effectiveness of those key resources in a community.

There are eight communities that are safer cities in B.C. Those are Kamloops, Abbotsford, Chilliwack, Maple Ridge, the township and the city of Langley, Nanaimo and Saanich.

In every safer city there is a safer city coordinator who coordinates all the activities in that community for safer city, and 2006 is a transition year for safer city. ICBC has participated in the development of the program in all the cities. But by the end of this year all the cities will be in a position to take over ownership of their own projects. This includes funding of the safer city coordinator and the operating budget, which up to now has been cost-shared between ICBC and the cities.

Where does safer school travel fit in, and what is safer school travel? Safer school travel is a web-based program. It was developed to assist parents or school communities in developing safer school travel plans. It's a step-by-step guided process, and it is very much based on the three-Es approach — engineering, enforcement and education — so identifying all the issues in the walk cycle limits of a school and coming up with solutions from the three-Es approach. The goal in safer city is that all elementary and middle schools within the safer cities will have safer school travel plans.

I'm aware that the committee is probably keen to hear about how programs are actually being implemented, how they've been successful and how they're making a difference. I'm going to hand it over to Deborah, who has that experience from working in Saanich as the safer city coordinator. She is going to give you some practical examples of how the program works and how it is in action.

Thank you very much for this opportunity to talk to you about this program. I came to this program…. Just a little bit of background on myself. I'm a practising landscape architect, but I found this program for my son's school, and I was so excited about it that I decided to take a bit of a leave from my own practice and take a contract on with ICBC and the district of Saanich in order to take this program into a bigger way.

I think it's an incredibly positive program. The thing that I really like about it is the community planning, the community-building, the integration of daily activity of fitness. What it gets the kids to do is get out of their cars and get to school using their own legs, whether that's biking or walking. I think that's just really positive. Again, from the landscape architectural perspective, it's connecting to nature on your way to school, and that's just a really positive thing, in my opinion.

The program is very grass-roots. It's very much a step-by-step program that the parents do. I help them through it, and I help them connect with stakeholders. In order to make the program successful, you have to have that connection and that buy-in or that commitment from those stakeholders, such as engineering and planning, parks departments at municipalities and at the school district level.

We have had that buy-in from them because it's very process-oriented. People who work in those kinds of situations understand that there is a need for a step-by-step process, and that's what this brings to this. It helps them with what I call the "nag line" — you know, every parent phoning up and saying: "Well, you didn't put a crosswalk in at my street, and I think you should." It helps to formalize that process so you can prioritize it and identify what those critical things are that need to be in place in order to make it safer for the kids to get to school.

One of the first things that we do with the schools is send out a survey and ask the parents and the students how they get to school in good weather or in bad weather. They actually map how they get to school, on a map that's part of the survey. We also ask them some questions. "Do you have some ideas about…? What are problems, what are issues that you have? What are concerns that you have? Do you have some ideas of what would make that better? If you are driving to school, what do you need to have in place in order to maybe switch that mode of travel?"

Those surveys provide us with a great deal of data. We take that data, and we start to summarize it. I would say that really, some of the most common comments in the surveys are things like: "Well, I'm running late in the morning, so I'm driving my kid to school." You know, that's…. Who's not running late sometimes? Also: "I'm on my way to work, so I drop them off." But there are also a lot of comments about: "You know, that crosswalk at such-and-such a street — if it was enhanced in some way, that would help." "The sidewalks are not connected in my neighbourhood," or "There are no sidewalks in my neighbourhood." Bike lanes, bike racks — those kinds of things are really common comments in those surveys.

When we start this program, one of the things that I'm sure you're really well aware of is that we can talk to the kids about trying to be healthier, but — it's a trickle-down thing — we have to educate the parents as well. That's one of the really positive parts about the program being very much a parent-driven program: you're educating them from the first meeting on. It's very much a part of the whole program.

Once we have all this data and we summarize it, we define what is realistic, what's achievable. What are the things that we can really do something about? We take that information to the stakeholders. We have meetings with them. We come up with solutions that, again, support the three Es. We look at what kinds of strategies can be put in place.

We work towards achieving two main things in terms of tangible documents. I know that in your package you have a condensed version of the Rogers School report. This is the full report here. What it does is identify short- and long-term goals, defined with the individual issues that have come out. It looks at, again, the engineering, the education and the enforcement strategies.

We also work towards producing the best walking routes map. In your package, I've provided you with a copy of the Rogers one and, also, with a couple of copies of some of the other schools we've been involved with. I haven't given you maps from every school. That seemed like a bit too much paper.

The final report identifies these different strategies, and again, it comes down to a couple of different things. I'm just going to use the Rogers School as an example. One of the education strategies that came out was that they reignited their Walking Wednesday program. That's a program that Way To Go, another supporting education program for getting kids to use alternative modes…. That program helps them to encourage the students. They've reignited that program and have started doing that.

They also looked at working with their school liaison police officer to introduce a program in the classroom that talked about what kinds of things they needed to look for as they were walking to school — so looking at the education of the kids. We also looked at some small infrastructure things. We got an enhanced crosswalk. We got some curve bulges to reduce the width that the crossing was. We've put a gate in at the back of the school. They spent about $20,000.

Now I just want to give you a little snapshot, because fortunately, the school that I'm talking about, Rogers, was able to do some re-evaluation for me yesterday on very short notice.

When they did this program in May 2004, they had 54 percent of the student population coming by car, and they had 46 percent of the students walking or biking. Yesterday, when they did that count again, they had 38 percent of the students coming by car and 62 percent walking or biking. That's a 16-percent increase over a two-year period. I think that's incredible success.

This real, tangible kind of number that we can look at…. We saw what we needed to put into place. We prioritized it. We listened to the parents, we listened to the staff, and we put in place what needed to be there. There are still some long-term goals that require capital funding that are going to need to be in place in order to continue to encourage that.

Some of those longer-term capital goals also layer with community values, because we worked with the community association as well. I guess that's one of the things that we thought…. In terms of some of the future opportunities for consideration, one is to continue to do some evaluation on some of the schools, to look at what kinds of things we can have in terms of real accountability of numbers and whatnot.

One thought was also to perhaps follow 20 or 30 students whose schools are in this program over this four-year period to 2010, to be able to try and…. It was interesting to hear the last speaker talking about trying to get some data on students and using…. Maybe there's a way of pairing some of this information and, also, of looking at potentially some of the infrastructure things and looking at an opportunity to find ways of using components of that.

Actually, I'm just going to stop for a second, because I know that Diane's going to talk a little bit more

D. Mackay: As I mentioned, this is a transition year for the safer city program, and so that's for the safer school travel program as well. In terms of evaluation, we've heard loud and clear from all of our eight safer cities that they wish to continue with the ideas and the concepts of the safer school travel program. They will all carry on with it and take ownership of it in those eight communities.

Also, we have in Richmond, just to give you an example of what's happened there…. Richmond, which is not one of the cities within the safer city program, had the same issues. How do they deal with road safety issues? How do they promote walking and biking to school?

What they did is look at the safer school travel model, as well Way To Go — which, as Deborah has mentioned, is another ICBC Autoplan broker-funded program that just promotes walking. It's the education aspect of promoting walking and biking to school.

They looked at safer school travel, they looked at Way To Go, and they came up with their own model. They have developed their own model that is unique to Richmond but, again, based on the ideas and the concepts of this program.

For us, that's a sort of validation that what we're doing is right and of those ideas and concepts.

D. LeFrank: I think that one of the things that inspired Richmond and has inspired some of the other municipalities to get involved is trying to prioritize for their infrastructure projects. I'm sure you've all had some experience at the municipal level. The competition for those dollars is fierce, quite frankly. I guess one of things that we felt was maybe an opportunity was to potentially have some provincial partnership where you could have this program expanded and have a way of evaluating what kind of criteria needs to be in place and have some small projects funded, so that you could spend $20,000 and make a huge difference and get a 16-percent increase in walking to school with a relatively small amount of investment.

Things like those flashing solar beacons. I think you see them around here quite often now in Greater Victoria. It's $11,000 to put those in. They make a huge difference. Parents feel so much more comfortable sending their kids to school on their own or walking with them, because it's safer. Cars can see them. As soon as they start sending their kids to school, then of course there are fewer cars on the road, so then there's less traffic, and so then it's safer for the kids as well. It's a real trickle-down community-building sort of thing.

There's an opportunity, I think, to look at trying to figure out a way to evaluate projects. Certainly, that's a small project — $11,000. In some cases there are larger projects.

I know that for Rogers School, one of the things they identified is a connection of sidewalk. Of course, it's a sidewalk that needs to be put in place where there are hydro poles that are conflicting, a ditch that's conflicting. It's probably the most expensive kind of situation for putting in a sidewalk where there wasn't one in place. I think it's about a $150,000 ticket. It would make a big difference to the community, but those kinds of things are very hard when there's so much competition for that infrastructure.

R. Sultan (Chair): Could I ask the witnesses to maybe wrap up so we'll have some time for questions.

D. Mackay: Just to carry on from Deborah's thought, then, to wrap this up: the United States, in August of 2005, introduced a federal program — a safer-routes-to-school program. They are going to be spending $612 million over the next five years, because they have realized the value of getting children out of cars and walking.

Similar to what Deborah is saying here, part of the funding goes towards a safe-routes-to-school coordinator, who is in every state. We've seen that a really valuable part of this program is the coordinators in those regions, who can motivate and get the parents going on this program and keep it all together. They also have this pot of federal money where the states can apply for two kinds of funding. One is for infrastructure to make those connections, to make the change, to make it safer. Also, the other grants are for education and promotion of walking and biking to school.

If I can just read it to you, the one goal of their program is to make biking and walking to school a safer and more appealing transportation alternative, thereby encouraging a healthy and active lifestyle from an early age — seeing that all those concepts are wrapped up into that program. There is more information in the package we've given you, if you wanted to look at that.

D. LeFrank: Today we've told you about the safer school travel program, and we've told you about that detailed process. We've talked to you about some of those opportunities. When I saw the title of the 2004 report, I couldn't help myself.

I just would like to encourage you, if you have an opportunity, to leave a legacy, to take that path to health and wellness and pave it, because that's what the kids really need to get to school.

I know there are lots of programs, and certainly, we've given you some paper, but rather than leaving a trail of paper, maybe leave a real trail behind.

R. Sultan (Chair): Thank you very much. We do have many questions, I'm sure.

We have Mr. Hayer and then Mr. Nuraney, and then I'm thinking maybe Mr. Cubberley has some questions as well.

D. Hayer: Good morning. Thank you very much. An excellent presentation. Very informative.

You said that eight schools.… Is Surrey school district involved at all? If they're not involved, do you know how the different school districts get involved?

It seems, in your presentation, that you need a very small amount of money. How much time do they need to be involved with it — school trustees, city councillors, as well the parents, ICBC and yourself?

D. Mackay: Surrey is not involved. As I said, this program is part of the bigger safer city program from ICBC. We have only had it in the eight communities. Currently we are not expanding the program. We're just doing a review and an evaluation.

You know, the main emphasis of ICBC is crash reduction — reduction of crashes and serious injury. What ICBC has to do now is to just step back from the bigger safer city program. We're doing an evaluation to see if we are really making a difference and what that is looking like. At this point, from our point of view, there's no way of bringing those schools into the current program as it is.

Cost-wise and time-wise, Deborah would be able to tell you a little bit more. It's parent volunteers who are doing it. The engineers and the school districts do attend the stakeholder meetings. Every school would have one or two stakeholder meetings. They go to those, which last a couple of hours each.

The costs. As I say, there are infrastructure costs, if there's anything, but otherwise, the actual program, to be….

D. Hayer: Just for the students' point of view, Surrey has probably more students than all the eight districts combined.

R. Sultan (Chair): We will ask our questioners to ask one question and our answerers to be very brief in the time remaining.

J. Nuraney: One of my questions is answered, because I come from Burnaby and I had the same question that Dave had. I'll perhaps speak to you at a later time to see how we can get involved.

Secondly, the results are very positive in terms of percentages of children who are now walking, I think. Having an architect on the team…. You can see the print marks on the brochures. Excellent work, I would say.

My quick question: the drop-off and pickup centres that you have away from the school to encourage them to walk — are there supervisors there to make sure that they're safe?

D. LeFrank: No. It's still the responsibility of the parent to get the kids to school. As we like to say, that's an opportunity for you to park one or two blocks away and talk as you walk up to the school. There's no supervision at that point.

Sometimes parents will develop a walking school bus program. I don't know if you've heard of that before, where kids are picked up along a walking route. Typically, with a walking school bus, it's not that they're driving to a point and then walking from there. It's usually that you're walking from your home and kids are getting picked up along the way.

I'm from an area that's much more rural in nature. I'd like to take advantage of your presence here. Is consideration given to this type of a program for those areas of the province that have much more of a rural aspect to them? For example, the school would have, let's say, a balance in population of those who are riding on school buses over long distances versus your walking catchment area.

D. Mackay: Actually, when I piloted the program, one of the schools was in Kamloops, which was Heffley Creek. I don't know if you know that that is quite a rural area. What we did there is developed safe routes to the school bus stops. We looked at the routes to the school bus stops, and those were some of the issues that came up.

This process — the ideas and the concepts — can definitely be adapted to different situations, and it has been shown that that works.

M. Sather: Although we know that assaults on children on the way to school are very rare events, is this a barrier that you find very often — that people don't want to get involved for that reason?

D. Mackay: It depends on the areas, as well, that we're in. I know that in certain of our cities that has been a bigger problem than in others. Again, what we do then is get in the RCMP or the local police to do a presentation. Again, it's an education thing. Ninety percent of their abductions and assaults are actually from people they know.

Some of the issues that come up might be bullying. You then are made aware of that, and you can take it to the administrators of the school. They can do an education program. They're made aware of it, and they can deal with it. So it does bring up other issues, but I think that's where your education comes in.

Well, unfortunately, we have run out of time, but I think we've had ample discussion of a fascinating approach and one that I think is commendable.

On behalf of the committee, I would like to thank ICBC for making Diane Mackay, the provincial coordinator of the safer city program, available for her testimony this morning and the district of Saanich for making available Deborah LeFrank, the Saanich safer city coordinator, for showing us the way to get our kids out of the cars and walking to school — a wonderful objective.

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REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH