Health — Issue No. 5 — Thursday, May 4, 2006 (HTML)

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

9. The Committee adjourned to the call of the Chair at 9:58 a.m.

Ralph Sultan, MLA
Chair

Kate Ryan-Lloyd
Clerk Assistant and
Committee Clerk

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH

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. Penny Ballem (Deputy Minister of Health) Ann Britton (Ministry of Agriculture and Lands) Brent Warner (Ministry of Agriculture and Lands)

R. Sultan (Chair): Good morning. I will call the meeting of the Select Standing Committee on Health to order. We have a very important list of witnesses today, with Dr. Penny Ballem, the Deputy Minister of Health, and presentations by the Ministry of Agriculture and Lands. Before we get into our hearings, we have another important business item to address, which is the selection of a media consultant.

As I had previously indicated to the committee and for the record, I have excused myself from participating in these proceedings and will do so now. I turn the meeting over to our Deputy Chair, David Cubberley, who has some matters he wishes to present to the committee. So I will leave the room. Thank you.

D. Cubberley (Deputy Chair): We'll give the Chair a moment to leave the room.

K. Ryan-Lloyd (Clerk Assistant and Committee Clerk): We need a motion to go in camera.

R. Sultan (Chair): I would like to call the meeting to order. This is another meeting of the Select Standing Committee on Health of the British Columbia Legislature, which is holding a series of hearings from expert witnesses and others on the assigned topic of childhood obesity.

Before we begin, I wanted to remind everybody that today's meeting is a public meeting recorded and transcribed by Hansard Services. A copy of this transcript, along with the minutes of this meeting, will be printed and will be made available on the committees website at www.leg.bc.ca.

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

Finally, as we are all aware, the proceedings are being broadcast live through the services of the World Wide Web to every corner of the globe. I'm sure persons in Kazakhstan are waiting with bated breath for our proceedings to begin.

The panel appearing before us this morning is particularly important, being led off by Dr. Penny Ballem, who is the Deputy Minister of Health. I will ask Penny in a moment to just give a brief biographical sketch for the information of our listeners, but I would mention that I came in early to do a little bit of research on the responsibilities of the person who is arguably the de facto CEO of just about the largest enterprise in this province.

The Health Ministry, which Dr. Ballem is responsible for in virtually all respects, is about twice as big as the telephone company, about twice as big as the Pattison Group worldwide, about three times the size of Canfor or Teck Cominco or B.C. Hydro. This is a huge enterprise, with huge challenges. I think it's a tribute to the importance of the subject of childhood obesity that Dr. Penny Ballem would take time from those responsibilities to come and appear before us this morning, for which we are very grateful.

I would turn it over to Penny. Perhaps you could begin and just tell us who you are, Penny.

P. Ballem: Thank you very much, member, and to the committee. I very much appreciate the opportunity, actually, to come and talk to you.

Who am I? Well, I originally trained as a physician. I'm a hematologist, which is a kind of specialist internist that you probably don't ever want to see in your life. We're on the sort of high-acuity end of things. Because hematology is an interesting art, most of us have always had an administrative job in our careers. So from the very start of my career 30 years ago, I've worked as a health administrator as well as a clinician.

I'm a Quebecker originally. I moved to British Columbia in the early '70s, went to medical school here, got my specialty training here, went to Seattle to the University of Washington and came back. I've worked at St. Paul's, the Cancer Agency, VGH, Children's Hospital. I was one of the founding executive of B.C. Women's Hospital when the Salvation Army moved away from the governance of the Grace. I also worked many years for the Red Cross blood transfusion service as the deputy medical director.

I'm a clinical professor in the faculty of medicine at UBC, and I've been in this job for five years in August. I just have to say to the committee it's the most amazing privilege to have a chance to be a deputy minister in the Health Ministry. It's one of the most intellectually and physically challenging jobs I've ever had. When you see the importance of health care to the people of this province, in the country, and generally around the world, to be able to serve in a place and actually have a chance to try and make a difference is the reason I'm still here five years later.

I'm very happy to have a chance to talk to you about this very, very important topic. Just as you described, Chair, the Health Ministry is enormous. The money we use, which is the money of the taxpayers of British Columbia, is huge.

Issues like obesity. We have a real vested interest in helping society, the public, the private sector, communities, government and individuals actually under-

stand the threat and the risk this is to them individually, but also to the whole sustainability of any kind of health care system — to actually cope with the downstream impacts of obesity.

I congratulate the committee on this topic. I think it's critically important, and governments around the world — both the developing world and what we consider the western world — are actually struggling with this issue because it's basically epidemic at this point.

R. Sultan (Chair): We hope that we can continue to capture your participation until about 9:20 a.m., including a little bit of time for questions.

You're going to hear from the provincial health officer, if you haven't already, but I'll very quickly, just from our perspective, give you a sense of the problem. I'm sorry I don't have copies of this presentation for you to be following through with me, but they will be arriving any minute now.

The problem is evident. I mean, we have all read in the newspapers and lay literature about the high rates of obesity among children and youth in this country. Basically, obesity comes from a very simple formula: too many calories in and not enough calories burned off. It's very, very simple.

The thing that is going to be challenging to us is that, in fact, it's not that our kids are becoming less and less physically active. Actually, the trend is up; it's not hugely up. But they're bringing into their bodies way more calories than they're burning off. As they eat more, the amount of physical activity they have to do has to go up and up and up. So the equation is way out of balance. Basically, it's physical inactivity and poor eating habits. Going after those two things is the solution.

Then you have, at an individual level, genetic factors and the ability of individuals to make different choices in their lives, particularly children. They're very dependent on their social support networks, their family environment and their peer environment to help them make those choices. So the social issues — what they read in magazines; what they see on TV, on their computers and on the Internet; peer pressure — all have an impact on the choices that kids make in terms of physical activity and eating.

There are cultural issues. We know that if we track our immigrant population in this country, we see how they lived in their countries of origin and what they ate. When they come here, they often pick some of the least healthy parts of all of those things. So they continue what in mainland China perhaps is a pretty high-carbohydrate diet, but where they're walking more and where they don't have the transportation and the lifestyle that they have here. When you combine those eating habits — which were how they grew up — with a much more sedentary lifestyle in North America, you can just see the balance starting to get out of whack.

We know that people on the lower economic scale have a higher incidence of obesity. The incidence of smoking in lower socioeconomic groups is higher. Poverty as a determinant of health, we know, is a very significant driver of poor health. What we see is that not only do people have more morbidity and disease, but you can see that their lifestyle choices tend to be less healthy when they're in a lower economic group.

Our strategy for the government…. I say that very carefully, because ActNow B.C. is the platform that the government is now using to try and address the prevention of chronic disease. The common risk factors across about 60 percent to 70 percent of the disease we treat in our health care system are driven by these five risk factors: physical inactivity, poor nutrition, overweight and obesity, tobacco and — in the area of alcohol, particularly — around unhealthy choices in pregnancy.

We have done something quite remarkable in British Columbia, which is gaining the attention of the World Health Organization and the United Nations. Instead of saying, "We're going to have a diabetes strategy, and we're going to have a stroke strategy and a heart disease strategy on the prevention side," we have said: "These are the key risk factors that make a huge difference."

We have actually managed — and I'll show you a little bit more detail — to bring together the big disease groups and other key organizations and sectors to say: "Let's focus on the risk factors versus the end-stage disease." Then we get, for those of us who love Scrabble, a triple word score. You are able to focus and consolidate resources so you get more value. You have everyone focused on a small number of things. It's very clear; it's easy to understand. You impact heart disease, stroke, respiratory disease, diabetes, kidney disease — all the things that downstream are the impact of all of these things coming together and causing vascular problems, thickening of the arteries and lungs that don't work very well.

It's a very focused prevention strategy, and all the government and their related sectors have to be involved. These are the targets for ActNow B.C., and we have focused them on the 2010 date. The Olympics are a huge platform for the world and the country and British Columbia, obviously, to galvanize and mobilize around physical activity. We've actually set a goal that we'll be the healthiest population to ever host an Olympics.

That sounds a bit folksy, but in fact the IOC takes those things very, very seriously, and they're very interested in tracking very closely how we intend to get there. They want to know, because they want to share with the rest of the world what our indicators are going to be and how we would describe the healthiest population. I think we sometimes underestimate the power of reaching out and making a stretch commitment like that, and how you could actually get more mobilization towards these important health targets when you do that.

Our targets are based on our risk factors: increasing the percentage of people who eat at least five servings of fruits and vegetables, which is the key amount; increasing the percentage of people who are physically active by 20 percent; reducing the number of B.C. adults who are overweight or obese by 20 percent; reducing tobacco use by 10 percent. We know we're already a leader in tobacco use, but it still costs us a lot of money every year, and we need to continue to push it down.

Then because British Columbia has really had a focus on the downstream effects of alcohol used in pregnancy, we have specifically focused in our alcohol risk factor for now on alcohol use in pregnancy in order to try and prevent the spectrum of FAS, which continues to be an issue for us in this country.

Some people are mobilized by seeing people with conditions and having people in their families suffer with diabetes. Others are mobilized by the business case. I'm not really fussy about what gets to you and galvanizes you, so I'm a big believer in telling you the whole story of all the different reasons why you should be concerned about this. But the cost of actually not addressing this and moving upstream, as we call it, to get into prevention and healthy-living choices is very, very significant.

These estimates are big numbers, and they come from theoretical models of understanding the burden of disease, the length of time it takes to have target-organ damage for different things, and what it costs every year to take care of, say, a diabetic, somebody who's had a stroke or whatever. One could argue with the methodology, but our health economists around the world do this kind of modelling.

The best data we have is that with physical inactivity, if we don't start doing something about it, the impact of not having people physically active enough will cost us somewhere in the range of $570 million a year. The impact of having the percentage of the population who are overweight and obese is somewhere between $700 million and $850 million per year. Tobacco use is still huge, and some of that is damage that we're having to take care of from the '50s and '60s. That's $1.2 billion a year.

What we know is that with healthy diets, we can reduce deaths from cardiovascular disease and stroke by 20 percent; from cancer and diabetes by 30 percent.

If you look at FASD, three in every thousand children are born with FASD in B.C. each year. Now there are approximately 40,000 children born in the province. If you do the math — it's 40 times 3 — that's 120 kids with FASD.

The cost of a child growing up into a young adult with FAS or FASD is about $1.4 million over a lifetime. That's because these individuals — whether they're kids, teens or full adults — get into health problems. They tend to develop addictions, they have socially destructive behaviours if they don't get properly treated, and they end up in our corrections system. The broad social cost of managing that is very, very expensive. If you start to do the math for 120 kids a year, it's very worthwhile to focus on this.

Our strategy through ActNow to address obesity basically goes directly to what I said to you. It's all about increasing physical activity, healthy eating and being conscious of the balance between burning off calories, which is what you do through physical activity, and eating healthily in adequate amounts but not overeating. That's where you get that balance.

We put breast-feeding in there because the literature and the science are becoming clear that breast-fed babies tend to have a lower incidence of obesity. We know that formula-fed babies don't have the same what we call satiety reflex, in that they tend to take in more calories. There are more wasted calories in cows' formula milk than there is in human breast milk, and so breast-feeding is a good thing to do for many, many reasons. We've been through waves where it wasn't the thing to do. My mother gave it up because that was the thing to do. Formula was the big secret. I would have been much smarter, probably, if she'd breast-fed me. I had that out with her a long time ago. We work hard on moving that agenda along, as well, for lots of different reasons.

ActNow. The thing that's different about it, besides the fact that it focuses on risk factors versus diseases, is that we have positioned this as a cross-government platform. That's to send the message that healthy life choices come through the education system, through housing, through how we engage our communities. There are people who are building highways, roads and bridges. There are lots of things they can do to promote people walking along those highways and byways or crossing those bridges on their bikes. We're trying to stimulate the whole of the government and their related sectors through the ministries to think about these things.

We've developed, as I'll show you, an amazing number of partnerships. Every ministry has to come forward with what their contributions to the ActNow goals and targets are going to be. We have programs now where they're coming to us and where we're trying to be the coach. ActNow is delivered right from the very top of the government, from the Premier's office. The Ministry of Health is the coach, because we're the ones that really have the vested interest in this.

We're trying to help people develop some ideas. If you're running the justice system, how can our deputy minister of Attorney General make a contribution to ActNow? Interestingly, tobacco control — tobacco programs in our justice system and jails — is one good way that he and the Deputy Solicitor General can work together.

It's interesting that when you talk to people in their different sectors, they start to get excited. We've had an amazing response across government for this. We're encouraging them to go out to their sectors and work with them, so we'll see. We have a growing number of non-government organizations, industry associations, businesses, communities and municipalities which are very, very committed to working with us on this.

At this point now, we have 70 partners that are already visibly engaged with resources and activities as aligned with the ActNow targets and risk factors. One of the most significant things that we were able to do…. I really want to credit Andy Hazlewood, who's the ADM in my ministry for population health and wellness. Many of you know that he has worked in this government for many, many years and is a tremendously accomplished civil servant. He worked with some of the toughest disease-based NGOs around cancer, heart and stroke, B.C. Lung, the BCMA and the diabetes society — I'm going to forget some, but those big NGOs that raise money for their particular disease.

He convinced them to come together, to bring their tremendous network of volunteers and resources and, instead of just driving their disease, to say: "Let's all go upstream and focus on these risk factors, because that's where we can get the best value for a lot of the work you want to do in prevention and promotion." They've agreed to do that.

That has given us access through the Healthy Living Alliance to nearly 45,000 volunteers and 4,300 direct members of those organizations. We've also brought communities, the Parks and Recreation Association and UBCM into that coalition. They're partners because, as you know, you can't have healthy families unless their communities support them. At the local level, people are thinking about this and, everywhere they go, trying to think about how they can make their communities more supportive for healthy living choices.

We've contributed $25 million to the Healthy Living Alliance for them to use over the coming years with us to try and stimulate programs that are going to reach out across this province. With the big focus on healthy eating and physical activity, it's designed to have a big direct impact on obesity.

Other key partners are 2010 Legacies Now, which as you know is the legacy organization for the Olympics. They have many, many community connections and connections in sport and recreation, as well as in arts and literacy and volunteers. They provide us with an instant network of connections to get people on board.

I mentioned B.C. Parks and Recreation. This is the first time they've ever been invited to participate in a health agenda. They are absolutely thrilled. They run all our community centres, and they program. If you're living in your community and you think, "Maybe I'd like to take an exercise class after work is finished or on the weekends," that's where most people go. They go to their local community centre. So we're working with them with how they can help educate; how they can make them more accessible; what they are doing about target groups like kids and youth and seniors, who actually want to get into this; and how they are using their resources and programming to make this more fun, more accessible, and to ramp things up.

UBCM has been very, very interested in this, and so we work closely. We actually now have 183 active communities in the province which are working with materials that we've developed with UBCM and are starting to learn how, at the very local level, they can make decisions or policies and put in place programs, if they can, to stimulate activity towards these risk factors.

The ministry itself put $15 million, as well, into a cross-government fund. What we said to all the different ministries is: "We'll share 50-50. You come forward." We have an ADM committee that looks at all kinds of ideas coming forward. The ADMs are from all across government. They scrutinize these ideas and make decisions on how we're going to allocate these resources. It's had a tremendously positive effect, helping line ministries, the dirt ministries and other places where they would never think of themselves as on the health agenda or able to make a contribution. They've come up, as I'll show you, with some terrific ideas.

This is just graphic that some people…. I'm more of a picture person. I think what this shows is that the ActNow concept comes right from the top. We have all the line ministries. Then we have the sectors that relate to those ministries at the bottom. We're seeing that they're very interested in these, because they have their own vested interests. Most businesses, as an example, pay extended health benefits. We know those go up. As people get diabetes and heart disease, they pay for more drugs. They pay for physiotherapy. They pay for all kinds…. So everybody can find a reason why they want to get on board with this.

In terms of youth and obesity, in British Columbia the Ministries of both Health and Education help — and I find this amazing — to drive the first joint consortium on school health that has ever existed in this country. It's a partnership between the Ministries of Education and Health across the country. I have to tell you that I did find that a bit astounding, but it's a fact. We've brought Health Canada into that. There is, as you know, no reflecting federal ministry for education. That's one of the issues.

We've now formed this joint consortium. We will have the first conference in two weeks' time. I can't remember whether it's in Vancouver or Victoria. I think it's Victoria. People are coming from all around the world to talk about school health and how you can improve programming to address obesity in kids and physical activity. We've got the whole country — the deputies coming and various experts in their ministries as well as visitors and experts from academia, recreation and all over the place.

The principle being, as you know, that school is a terrific place, where we've done a good job educating kids about smoking. We need to put in place programs and activities to help them understand that they, too, can be in control of physical activity and healthy eating — and how we wrap them around with things like Action Schools to help them to have fun and make better decisions.

So this is data. In ActNow we're actually using existing data sets. In some cases we're purchasing from places like Stats Canada a deeper cut of surveys that they do routinely, and we've actually asked them to do

it more frequently. They're quite interested in this. Stats Canada, you know, is a terrific place if you can get them aligned and moving along with your needs. They've been very interested and very cooperative, so we're going to have better data in British Columbia than we've ever had tracking things like the prevalence of acceptable levels of physical activity. Acceptable means a level that's actually going to have an impact on preventing obesity and being overweight.

This is worrying. As you can see, as I said, we're actually increasing the prevalence of acceptable physical activity across our population up to 2002-2003, but still only 30-plus percent, 32 percent, are actually doing enough physical activity to make a difference. Even though British Columbia has the highest level of physical activity among its population, it has to be sufficient to make a difference.

I'm going to show you a few examples of actual programming that we're doing around this. I think most of you may have heard of Action Schools B.C. It is moving out across the province in the primary schools and now the middle schools. It's one of the most popular programs I've ever seen cut across the education system. It's best practice. It's precedent-setting, because experts at UBC — Dr. Heather McKay and her team — actually did the hard science around looking at the menu of things that schools and parents and kids can choose to do in Action Schools and what actual impact they have on physiology, biology, cardiovascular fitness, weight and bone health. They actually did measurements across a large cohort of children in this province.

We know that this program is not just fun. It's got a high uptake and great feedback, and it actually makes a difference. If you look at a lot of these programs across the world, most of them measure: is it fun? Does it get good uptake, and do people have a good time? But there are none that have actually done the biological science to say: does it actually make a difference to the physiology?

We have the active communities program that I already mentioned — 183 communities already on board. That means they've got a committee. They're doing planning. Their city council is committed to working on the issues around physical activity.

The LEAP program is resourced through the Ministry of Education and MCFD, I believe. That is a program that's basically being developed now. It is to actually take little children — babies through to little toddlers, so before they get to school — and help their parents and child care workers and caregivers to actually understand: how do you help kids with how to move their bodies, and how do you stimulate them to be physically active? Lots of parents get nervous, especially with their first kids, so this is going to help them feel really comfortable helping their children feel very comfortable with their bodies.

I was never terribly coordinated as a kid, and kicking a ball and throwing a ball took me a lot longer to learn how to do. I had a daughter who was exactly the same. It takes a concentrated effort to help a kid who doesn't come by that naturally to do those things and make them feel comfortable in their own skin doing those. So that's what this is all about.

Here we're getting into some things that are coming from other ministries. Adventure Smart is the ministry…. Sorry, I don't have my notes right with me, but I believe that's the Ministry of Environment and the parks groups — get outdoors in the B.C. parks, pick your trail.

Those are all things that they're doing to try and focus on not just having good parks but actually having programs put into those recreation resources we have in this province to help people engage and feel excited. For instance, on pick your trail it's: how do you help people pick a trail where they're not going to be completely overwhelmed? In this province when most trails go straight up, it's actually a problem.

Fit for work, fit for life. We've got firefighters who are working in partnership with us around the province promoting firefighters as role models for school children. Because you have to be fit to be a firefighter, they actually inspire kids — you know, hoping they're going to end up being a firefighter. At the end of the day, it sends the right message.

We're very much focused on aboriginal youth, working with the New Relationship being the platform that has brought forward many, many communities that want to work with our health authorities and recreation leaders. We have a number of things that we're doing to help aboriginal youth basically become leaders in helping their communities around aquatics, outdoors and recreation — things like scuba diving for our bands on the coast. There are lots of things that they can get interested in.

We have aboriginal youth first municipal aquatics program, which is actually providing opportunities for aboriginal youth to train as swim instructors and lifeguards.

Now, this is a technical slide, moving on to healthy eating. Back to the physical activity, there are many, many other programs happening at a community level that have been stimulated by this work. I would really bore you if I made a long list of them. One of the ones, though, that I did want to mention is the Chill program, which won some awards last year. That is focused on aboriginal youth. Its run by Legacies Now, and it is taking street kids from the downtown east side up on Grouse Mountain for a six-week snowboard course. It's really remarkable. The results already for two years of this program are that kids' lives are turning around because, for the first time, they're having an opportunity to get out and be on a snowboard on Grouse Mountain, if you can imagine.

Now Prince George has picked it up. They're using it for their street youth as well. This is something that the community recognizes. It got, I think, one of the Vancouver awards. Now it's spreading around other communities that think: "Well, this is something we could do." The ski resort gives the tickets for these kids. It's easy to do, and one of the sport suppliers supplies the snowboards. Grouse Mountain throws in the in-

structor…. I hope it's Grouse and not Cypress, but one of our local mountains in Vancouver. The point is that the whole community is making a contribution, and that's how you move these things.

This is healthy eating. It's hard to see, but if you look at the blue columns on the slide, that's the number of children who are at an appropriate weight. The yellow bar is who's overweight and obese. If you're eating five-plus fruits and vegetables a day — on the right-hand side — you have the highest level of normal weight youth and the lowest level of overweight and obesity. All this slide tells you is that along with physical activity, it's important to eat fruits and vegetables and to have a diet that not only has a balanced number of calories but actually has the right content in terms of fruits and vegetables, which are key for us in terms of overall health.

This is a tough thing to drive, frankly. Food is around us; it's everywhere. We're just bombarded every day with ideas of how to make choices that aren't particularly healthy. We have a school fruit and vegetable snack program that's being driven through the ministry responsible for the agricultural sector. They're actually working with our agricultural sector and our retail food industry to provide fruit and vegetable snacks for kids in elementary schools.

The Action Schools program has a healthy eating component as well. As you know, we have guidelines for food and beverage sales in schools that are moving into place. We've done lots of work for the vending industry around how they can make better choices in those vending machines around our schools.

The community food action initiative is running through the health authorities, and they're doing it in partnership with all kinds of private sector businesses and NGOs. The purpose of that is to make sure there's access to affordable, healthy foods across all communities, particularly emphasizing people with low incomes. That's stimulating community gardening programs and all kinds of examples and pilots that have been around and shown good success. Now our health authorities and our medical health officers are pushing that in a very systematic way across the province.

Partners in Healthy Eating. Our agricultural colleagues are working with the food industry — an alliance of growers, fishers, processors, distributors and restaurants — to really promote awareness of healthy foods. The more you go around the province into restaurants, you're starting to see menus where you can actually see what the healthier choices are. That really has an impact on people, and it actually stimulates the restaurant, as well, to look at their menu and say: "Okay, how many of our choices would be considered healthy?" That speaks to the healthy restaurant program as well.

Shapedown B.C. For those of you who have had any kids in your families or extended network of friends, this is a wonderful community-based program which works well for kids, children and adolescents who are struggling with being overweight. There's a magic formula in it. They find it's a safe environment, and they feel very supported. For any of you who've had a teen that is on the heavy side, they are tortured by their peers.

Programming for them is not that easy, and you can lecture them and educate them. Frankly, it doesn't make a difference. You have to find the key to what kind of programming they will go to, because it works for them. This is a very successful one. We're trying to find prototypes that work and then move them around and help our health authorities, school sectors, communities and recreational facilities understand that these work well. Then we have the challenge of making it adaptable to the different ethnic communities that we're serving.

Specialization in the early years. This is an undergraduate course that promotes the importance of physical activity and nutrition. These are the kinds of things we're doing in the higher education system to help our future teachers, physical activity trainers and the like to understand the science behind physical activity and nutrition.

Growing healthy kids one snack at a time. We're providing refrigerators for 900 B.C. schools which otherwise couldn't afford them to actually store healthy stuff, because the vending machines often have limitations depending upon whether they're refrigerated. They may not be able to have healthy snacks, which require a four-degree limit. So these are the kinds of things in school districts where the socioeconomic conditions and the fundraisers may not be as onto these things. We're trying to make these choices easy.

Another program is First Nations Community Food Systems for Healthy Living project. We've provided some funding to the Obesity Foundation, and that's to allow them to move ahead. There was a big forum on obesity in March 2005 with experts from the medical community and other areas. They put forward lots of good recommendations, and we're trying to move those forward.

I've already spoken about the importance of aboriginal health and especially obesity in the aboriginal community. It's a big problem. There are cultural issues, all kinds of biologic and genetic issues and many different contributors to that. Tobacco is also an issue, and we implemented the first aboriginal tobacco program in the country. That's moving out, with the help of our ministry and health authorities, across 85 different communities. We've expanded that program because it was very successful, and it was considered by the aboriginal community to be very culturally appropriate. So having found that entry point to be successful, we're now building on that to take in healthy eating and physical activity.

These are some of the different communities and types of things that we're working with, as you can see. We're in the Fraser Valley, Agassiz, Prince Rupert and Comox, so these things are happening around the province. As you know, there are many, many small aboriginal communities, both on and off reserve, that

we need to work at. It takes time, and it takes committed people who have the skill sets to build these relationships. So the school-based healthy lifestyles education program, Stop the Pop community-based programming, healthy lifestyles, personal training specialist certificate….

These are things that we're building off a menu of best practice. We're adapting them and partnering with aboriginal communities so they get to choose, and they find the things that they think are going to be a good priority for their community and then move it ahead with our support.

As you can see, ActNow as a platform to try and bring attention to this issue of youth and childhood obesity. We have a lot going on, and that's just a fraction of what our partners and networks are doing. Physical activity and healthy eating are the two main focuses. We are launching a website for ActNow in May 2006 that will allow people to garner lots of information.

We are going to launch a social marketing campaign. The first part will be focused on physical activity, and that will be in May 2006 — this month. The healthy eating will launch in the fall. We are developing a passport to health and building on experiences from the U.K. You know, we're trying to come at it from every different aspect of galvanizing the public, using the best health promotion techniques.

In summary, obesity is a very serious problem. It has tripled in the 12-to-17-year-old age group in the last 25 years. Canada was a leader in health promotion right back to the 1970s with the federal government's Ottawa framework, which is world-renowned for teaching us how to move an agenda that is about health promotion.

We know that it has to be multi-pronged. It has to mobilize communities and individuals and families. That's the science behind how we're trying to move this along. In what I think is a very, very short period of time we have an amazing number of strategic partnerships. We're working off the tremendous advantage of being the host to an Olympics, which is an incredible event that the whole world watches. We just need to use that as much as we can to help move this ahead.

I think we feel that we're on the right track. We're very interested in your feedback to us and any suggestions you may have. We're really delighted and feel very fortunate that you're focusing on this important issue. It only helps us. As the Deputy Minister of Health, everything you can do to help promote awareness about obesity and being overweight in children and youth is just going to help us in the long run and help us move this very important agenda along. Thank you.

R. Sultan (Chair): Thank you, Dr. Ballem, for an impressive — awe-inspiring, in fact — presentation in terms of the ambition of your program and the scope. Certainly, it befits an enterprise of your scale and the magnitude of the challenge.

J. Nuraney: Dr. Ballem, as usual, I'm not really surprised with your expertise and the hard work that you've demonstrated through your presentation.

My only question is that I have not seen in your presentation any connection or linkages with ethnic communities. You have ministerial programs, but under the Attorney General, who now heads multiculturalism, I did not see any linkages at all. That to me would be very critical in terms of new immigrants and a different lifestyle, which needs to be brought into ActNow B.C.

P. Ballem: Yes, it's a very, very important point. Maybe I can say a couple of things. We actually have had a physician in from Kelowna, Dr. Gary Randhawa, who has been working with us over the last six months. He has, as you may know, tremendous connections with the South Asian community. He's got a great interest in this and has been working with us around that ethnic community in starting to understand the breadth of programming we have, helping us work out how we're going to make sure our agenda is inclusive and culturally appropriate for different ethnic groups.

The Chinese community is another big, big community in our province. We have a number of things that we've worked on over the years in some of our institutions. But that's another group where, if you know you're going after eating and physical activity, you have to understand the approach to those things, community by community, and adjust your programming — add new ways of doing it. I think we are well on to the aboriginal community, and they've taught us a fair amount about how to do that ethnic connection and programming.

It's a big issue for us. I see that as something that…. You know our Action Schools? We have found that in areas of the province where there is…. For instance, Richmond was one of the first places that Action Schools was, and that's where we studied a lot of the children. What we know about that program in the education system is that kids from all different ethnic backgrounds seem to really love it and find ways that they can be involved and that work for them. We're trying to use some of what we learned there to move through and address the wide array of diverse communities that we have. It's a very important point.

There are lots of things going on, but perhaps the next time I come to the committee we can maybe focus on that more specifically.

D. Jarvis: Thank you, Dr. Ballem, for a very complete report, as was mentioned. I always wondered why I was in this job, and now I know it was my mother's fault. I've not smoked for 20 years now, but I'd smoked for 30 years before that. As soon as I stopped smoking, I started gaining excessive weight. My daughter, who's in the health care industry, said that I would probably die of a lung-related disease, anyways, even though I've stopped smoking for 20 years.

I can see young girls, and I hear stories of young girls, that control their weight by smoking, so smoking is, I guess, one of the biggest, highest risks we have for everything — health care and at least the specifically…. The low-income are using it more and more. The resource communities, we hear, are smoking more than, say, in the urban areas.

Your raising-awareness campaign is really very good and complete and all the rest of it, but I'm just wondering if, perhaps, we're not hard enough in our demonstrations to our young in the schools. Either we have a complete prohibition for, say, under-18s to smoke or whatever it may be, like alcohol — I've mentioned that before too; you've heard me talk about it — or we get hard by going in with bottles of formaldehyde with cancerous lungs in them to show every kid, so they know exactly what it is. We don't seem to be slowing it down enough, although I understand we're better off than any other province. But where does it start? With the family? Are kids watching their family smoke, or are the kids learning it in the schools?

P. Ballem: I think those are important questions, but first maybe I could address your own smoking history. Perry Kendall will perhaps show you the slide. If he doesn't have it in his deck, I'll ask him to put it in. There's a very clear slide that shows if you stop smoking, your risk just comes down over the years. So I want you to know that it was well worthwhile to stop it. Your risk of dying from a lung disease is much, much lower than it would have been if you'd carried on, so refer your daughter to me.

The second thing. Around youth, it's clear that in British Columbia we've reduced our smoking rate. It's the lowest in the world, with the exception of Utah. The tobacco control program that was started in the mid-1990s and that has been carried on for nearly the last nearly ten years has been recognized worldwide. We are leaders.

Andy Hazelwood is part of the World Health Organization tobacco treaty panel. British Columbia has a very, very strong reputation. We are flatlined at this point in terms of continuing to bring smoking rates down. That's, in part, because we're into the hard stuff now. As you say, we have to very specifically target people living in rural communities because they have way higher smoking rates. The data's very clear, and they have associated morbidity with that. We're finding that's the best way for them to start to understand why they might want to do something about it. The community has to kind of get mobilized.

In terms of children, young girls absolutely use smoking to manage their diet and their eating. Lorraine Greaves, at the B.C. Women's Centre of Excellence in Women's Health is the international leader on this. She's written a very, very interesting book about why women and young girls choose to smoke. It brings a whole different paradigm around how we women think about these things and how we use tobacco in our lives — very different from men, interestingly enough.

We're developing better ideas about how to target young teen girls, in particular, and try and…. You've got to come at it, because you have to realize why they're doing it; then, how could you get around it to help them stop?

Targeting teens and teen girls is very important. Our programs for teenagers are all peer-reviewed and focus-tested intensely with kids to make sure that they work for them. What we learned over the years is that bringing in the lung didn't…. Actually, they were like: "Oh, cool."

But there are other ways that they've told us, like: "If you do this kind of thing, that works for us. We'd pay attention to that." Andy could probably be a better person to tell you the details.

The Kick the Nic program. And we have a magazine that we publish for our schools that's very effective. The kids really get excited with it. As an adult, I looked at it and thought: ooh. But it's terrific, and it works. We're really trying to target it in a way that's based on the evidence from children and youth about what would make an impact on them and help them make better choices. Targeting is very, very important.

We are working with the Cancer Society and B.C. Lung, who have lots of terrific ideas. They do all kinds of polling of the public, so they can bring us information about how the public feels. We need to use our partners to help move this agenda and ratchet us down to that next level. That, in the end, pays off hugely for our province.

When I look at the incidence of cardiac disease that gets treated on a per-capita basis in this province versus Ontario, it's dramatic. That's big dramatic. Big dollars that we save by…. And a lot of that is attributable to tobacco prevention.

First of all, Dr. Gary Randhawa. I know him really well, and he is well-connected and well-respected in the South Asian community and holds many health forums throughout British Columbia. So it's good to see that he's helping you work with the community.

The second part is that you talked about babies and toddlers. When newborns are born, is there some book that is given to the parents? I often hear: "When you buy something in the store for $10, there's an instruction guide on how it works, yet many times with kids there's not enough instruction coming on how to raise them, how to look after them."

D. Hayer: Now, is it the HealthGuide, which you have in many different languages now? Or is there something else that you provide?

As well, do you work with restaurants and fast-food places to see how they can start looking at serving better food, including our restaurant at the Leg. here? I

know they're providing better food. Do you talk to them to see if they can even make it better than that? And associations of the restaurants, not regular restaurants, and also to fast-food places, so they can all work together as partnerships….

P. Ballem: Well, a few things. We have Baby's Best Chance, which is a publication that's been given to every new mother in this province for a number of years. It has just had a recent update, I think, in the last year. Experts from, actually, all over British Columbia, and in some cases outside of our province, contribute to that. It's a tremendous resource. Having been a new mother many years ago and not having an extended family, I would have loved to have had something like that. Yes, we do have that.

The NurseLine is very active, and as you know, we have many, many HealthGuide facts, and they have all kinds of support 24-7 that they provide to families and new mothers and expectant mothers. What we know about the stats from the NurseLine is that it is largely women that use it. We know that women are the managers of their families' health care for the most part. They pursue information wherever they can get it. Our use of the NurseLine is going up all the time.

In terms of partnerships with the food industry, we have a number of partnerships. I've had a number of meetings with private businesses like Coca-Cola. I know that Legacies Now…. McDonald's is a big partner in the Olympics, as you know. We are having a dialogue with the fast-food industry, and I think that if you've tracked the menus of a number of these outlets, you'll see that they're trying to have healthier choices available.

I think the awareness of the risk of not eating in a healthy way and being exposed to unhealthy foods that our culture in North America, for whatever reason, seems to emphasize…. The awareness and the risk to the public at large is increasing. I see movement is happening that was never there for a long time, and that's what part of this is all about. When we bring the broader retail food industry together with the fast-food industry, then that starts to make a dialogue even more possible.

I think that's part of the social context that we all live in and that our teens, in particular, are influenced by. It's hard work, but I believe progress can be made. We need to use the lens of the Olympics on British Columbia to help be a stimulus for more action, faster, on those fronts.

We're going to try and squeeze in every committee member who wishes to…. Every single member of the committee wants to ask a question, so we'll try and squeeze that in if we can all be brief with our questions.

I'd also like to insert a question from a committee member who's not here today, Valerie Roddick. She apologizes for having been occupied with the agriculture planning committee, which she chairs. Val observes in the note she passed to me that Agriculture, Education and Health have virtually the same goals for the province. Her question is: would it be possible for the different committees and ministries to work collaboratively to enable the various active programs and current reports in the making to attain success? She says: "We need to be united and focused."

P. Ballem: Yes. I think we covered that ground in the presentation. We very much need to work with those ministries and others. Andy Hazelwood chairs an ADM committee that's responsible for moving those sort of cross-sectoral ideas and relationships along.

That's what our seed funding is all about. We have a big budget. We've committed, out of our budget, some money to help stimulate those different ministries to get creative and think about this in a way that they've never done before. I think it's working already.

K. Conroy: One of the interesting things is when you were talking about early childhood. The only program that really focused on that was the LEAP program.

K. Conroy: Is there any way to look at providing funding for early childhood programs in the same way you're doing for school programs? That's really where it starts — with kids that are ages zero to five. It starts around three, when they start healthy eating and living.

K. Conroy: The other question is around youth and programs for young moms. A lot of the programs that are funded are grants.

K. Conroy: They're not sustaining funding, and with very minimal sustaining funding, those programs could provide substantial programming to the kids in the community. They do amazing work with very little money, so a little bit of funding in that direction would be very, very effectively used. I'm just wondering if there's any potential for funding to move in that direction for programs like early childhood education and the youth programs.

P. Ballem: Right. I'll just start with the preschool. You're absolutely right. What's interesting is that when we looked into what programs worked for very young kids and their parent or their caregivers, there's just virtually no evidence.

The LEAP program is going to be precedent-setting because it's the first time we've actually tried to gather up whatever evidence there is and create a program that we can then evaluate and see if it actually works. LEAP is the start into an area where there's very little going on. There's some stuff in Australia, a little bit in

We're taking that, and we're going to start with LEAP. The Ministry of Education is very interested in that, as is Minister Reid and the Ministry of Children and Families. We're going to start that, get some data and then see how we can move that out if it works.

In terms of young mothers, I think you've identified a very important group. Those young, teen mothers are at risk for all kinds of things — tobacco, low–birth weight babies, alcohol use and other substance use in pregnancies. We've done a lot of work with B.C. Women's in the past few years trying to sort through how to identify those upstream and how to take care of them around the time that they're pregnant and their kids are being born. As you probably know, there are some excellent programs with the Y and other places in the school system keeping those kids active and in school and continuing on with their education as well.

Those are areas as well where, when we look at targeting…. We do want to target. I have no specific commitments at this time. That's what the Healthy Living Alliance will be looking at. "Okay, we've got $25 million now. Where are the key areas, if we target, where we're going to get a lot of value for that investment?" Those things are very important and there will be targeted groups that we'll be looking at as we work with them around how we're going to commit those funds.

R. Sultan (Chair): Thank you Dr. Ballem. We have three final questioners that I would like to squeeze in if they keep their questions brief and the responses equally brief.

K. Whittred: Two things. One is: amongst all of the stuff you've talked about, has there been consideration given to asking ministries to apply an activity lens to programs? Not just ministries — I'm thinking specifically of schools. For example, when a school timetable…. One of the things schools have done is reduced lunch hour. The effect that has is that it cuts out intramural programs. If you were required to apply an activity lens, that would add another dimension to making that decision. I mention that just as something that might be applied with a number of these organizations, much in the way you do a gender lens.

P. Ballem: Yes. I think Action Schools is very much that. One of the things that the committee might consider is to have Bryna Kopelow or Heather McKay, who developed and drive this program to come and talk to you. It's an amazing program. Those are just the kinds of…. I don't know specifically whether that's one, but it's that menu of things that schools can choose from and that they can integrate into these programs to drive a school to greater physical activity levels. We can certainly bring that back, member.

D. Cubberley (Deputy Chair): Actually, I have a comment that has a question embedded in it.

What we're embarked on comes down to efforts to try to change patterns of behaviour. I was interested in your presentation because we have…. I'm pleased to see we're targeting populations within the overall population. We're trying to aim our activity at groups rather than the whole population, and we're targeting venues — the school being a privileged venue for the kind of activity. Both of these, I think, are steps in the direction of effecting behavioural change. I didn't get a strong sense of our targeting activities. What I'm seeing is that there's a lot of talk about promoting physical activity.

My comment is based on my own experience with people who want to try to market active transportation, which is one of these bundling concepts. It's virtually impossible to market it, because it's an abstraction. You can't organize a social marketing program that will get people to become more engaged with active transportation by marketing active transportation. It's way away from where the decision is going to be made in a person's life.

I guess what I want to say is there was an indication that ActNow was going to go into social marketing of physical activity. So it's entering into that field. I think there's got to be more focus on what the engagement mechanism is. Number one: what the activity is that's under promotion, and that it's only one activity that's promoted in a venue at one time rather than a bundle of activities — rather than a menu saying: "Be physically active; pick one." It's actual activities. Part of that has to recognize that change is a process, not an event, that there are stages of change and that the program itself has got to relate to a trigger of some kind that effects movement along that continuum of change.

Within that, I want to say on that slide around Action Schools where there were actions that were being talked about within the school, things that might be promoted, I didn't see any mention of the journey to and from school, which is a daily activity that potentially involves physical exercise. I didn't see any mention at any point of walking as a privileged activity or an activity that might be identified as within the reach of individuals without involving participation in a team sport, going to a specific venue or another level of organization but is something that can take place within daily life.

I also didn't see a really strong linkage to any infrastructure that enables physical activity. Now, there was some mention of parks, playing fields, one mention of trails but not around the infrastructure available at schools and, in particular, the infrastructure that links to the journey to and from school. I mention those things because I think that when we solve this problem, we're going to have to select the specific activity, and we're going to have to become good at promoting those and opening them up in a way that engages individuals more directly.

P. Ballem: Those are all excellent points, member. I think a basic principle of how we're trying to do this is

the assumption that a family isn't going to want to spend any more on doing this. We have to make it in the context of their lives and in the context of their socioeconomic circumstances. You pointed out a number of things.

Action Schools. I could give you a lot more information, because it's an amazing program. It might be worthwhile for the committee to hear more detail, because it does absolutely encompass those things that you described — no question about it. You're absolutely right. This program has to be pragmatic, or it won't work. It's got to be doable, and it's got to be…. If you live in a suburb or if you can't even, you know, get on a bus to go anywhere, you have to be able to do it.

I don't want to give away our social marketing campaign, and I'm not an expert in social marketing, but basically, it's the incremental steps. We have to let people know that they don't have to go out and be some big hero, doing 25 hours of physical activity a day, in order to make progress. So I think our whole approach will be incremental. Just like every cigarette that you don't smoke counts, so everything you do, every set of stairs you go up, actually starts to make a difference.

That's the way, if you go to the science of health promotion, you have to do it, so I really appreciate your points. As more comes available and as we have a website and we can actually show people some of these things, a lot of what you said, member, is an absolute feature of what we're trying to do — very practical.

R. Sultan (Chair): Thank you. We have time for one more brief question from our last questioner, Michael Sather.

M. Sather: I'll be very quick. Every presentation we've had deals a lot with the nutritional aspect for children and kids not getting adequate nutrition, particularly at the low-income levels. I'm just wondering, given that kids whose families are on income assistance are certainly amongst those who are getting inadequate nutrition, are you having those discussions with that ministry about the problem vis-à-vis nutrition and obesity? Do you talk to them about increasing the rates for income assistance?

P. Ballem: First of all, there's some very good data in this province. We do the nutritional survey. I've forgotten what the organization is called, but it's the nutritionists organization we work with around the food basket and what it costs and what the relationship of that is to families and families' incomes. It's very much hooked up with the Ministry of Income Assistance, working hard with them and with our community food programs, to try and sort through how to find that balance. So it is possible for families to actually get a healthy basket of food and live up to the recommendations of what we believe is the healthy eating, minimal approach for kids.

I think first nations communities are another area where we're trying to do a lot of creative work. They have big problems. Not only do they have socioeconomic issues, but even getting food to them that's fresh and that counts in the healthy basket is quite difficult for some of the isolated communities. It's a big issue.

We're working very closely with the ministry, and the deputy of MEIA is very committed to this. I hope we'll see an array of different solutions for how we're going to try and improve the access of our lower-income folks in this province to a healthy basket of food.

R. Sultan (Chair): Thank you, Dr. Penny Ballem, and thank you again for taking time away from the onerous responsibilities you have in running the $12 billion enterprise — about the largest we have in British Columbia — to address the committee. The information and recommendations you're making will be taken very, very seriously indeed.

I might also mention before we close this particular phase of the morning that we had a previous report of this select standing committee in 2004, titled the Path to Health and Wellness, and Dr. Ballem's ministry has prepared a response to the 29 different recommendations. We may invite her or one of her representatives to come back and address the response of the ministry to the 29 recommendations that were made. We put you on notice for that pending invitation.

This concludes Dr. Ballem's presentation. I think we will take a two-minute recess.

Again, this is the Select Standing Committee on Health, examining the very important public health issue of childhood obesity. Our presenters and expert witnesses for this phase of the morning are Brent Warner, who's an industry specialist in agritourism and direct marketing with the Ministry of Agriculture and Lands of the British Columbia government and Ann Britton, program coordinator with the B.C. school fruit and vegetable snack program of the ministry.

I would ask our expert witnesses to perhaps begin by just explaining who they are and then plunge right into their presentations. We would hope that prior to ten o'clock we would have some time for questions and answers. We are on a fairly strict deadline in the sense that this room is occupied by others at ten o'clock. The bells ring, and everybody gets up and leaves. So we'll put you on notice.

A. Britton: Thank you. Good morning, Mr. Chair and members. We'll try and keep it snappy and brief.

I was really glad to see that Dr. Ballem was here ahead of time talking about fruits and vegetables. We brought you a basket. I want you to know that it cost

We're going to very quickly tag-team a presentation, give you some information about our program. We've left you lovely gift bags that have program information and some great aprons that you can barbecue your veggies in.

B. Warner: I'm with the Ministry of Agriculture and have been a horticulturist with the ministry for almost 30 years, working in the front line with the farm community. I would just like to say that this is probably the most exciting program in agriculture in North America at the moment.

We're quickly going to give you a history of how the program began. I'll do that end of it, and then Ann Britton, who is actually with the B.C. Agriculture in the Classroom Foundation — she is the coordinator of this program — will finish up with the details of the program. And yes, we will get through this in time for questions.

You've heard from Dr. Ballem about the health crisis. You've heard previous speakers talk about this, so we're not going to spend a lot of time on introducing this. But obviously, there is a huge issue. It's not an issue just in British Columbia. The World Health Organization has pointed this out.

You will have this package, and you can read some of these quotes. If you don't have them, we have made the front page of every magazine in the world in regards to the crisis of obesity in North America.

The reality of that translates into huge costs for government, for citizens. We're just starting to see this translate into our children, with numbers coming out from Newfoundland in 2003.

Up to 80 percent of obese children become obese adults. The ramifications for our health systems worldwide are crippling, to say the least. This is not just news out there; it's news right here. This is in our own local papers. One in three children born in 2003 in this province is at risk for type 2 diabetes, which used to be called late-onset diabetes. I'm sure you've heard that. And 80 percent of this type 2 is directly related to obesity, which is directly related to what our children are eating and the lack of what they're doing.

These are the real costs that we're facing here in B.C. right now. Things such as diabetes are $10,000 per child and up a year to treat without complications. That does not include diabetes dialysis treatment, which could go as high as $44,000. Talking to doctors in the medical community in Vancouver, we are now looking at children having the potential of having their liver transplanted because of what they're eating. We're now up to 350 of those procedures a year in this country.

Some of you have probably studied this slide. Our own treasury analysts look at the B.C. budget, and with increasing health care costs, it's driving the budget essentially to only health care and education by 2017. This is the slide that really has got people thinking: how do we do things differently? So differently is where we're headed.

The obesity task force. Some quotes. I think the bottom one is the one that is very, very important. "The epidemic of pediatric obesity may become the most important and devastating public health challenge of the 21st century."

Your own select standing committee prior. Ms. Roddick, who I spoke to, did report on this. I'll leave the top two quotes. I think the new one that you should be aware of. As of July last year "the Canadian community health survey found that children and adolescents who reported eating fruit and vegetables five or more times a day were substantially less likely to be overweight…." That was just pointed out to you by Dr. Ballem.

That is a very interesting lead into where we're going. Some 61 percent of our children do not eat the recommended five to ten servings of fruit and vegetables. Basically, what are we going to do about that, and how? The Premier made the announcement last year that how we were going to address this was as part of the ActNow program and that we were going to initiate a look at a made-in-B.C., fruit-and-vegetables, in-our-schools snack program.

This is an amazing partnership, one that has not happened before, where you have the Ministry of Agriculture, the Ministry of Health and the Ministry of Education working together to try and make change, working with a private foundation, the British Columbia Ag in the Classroom Foundation, who have Ann Britton as their coordinator. She's here today to actually explain the program. But I would like to point out, specifically, how much of a change this is to have these three ministries directly focused on this problem.

We did not invent the school fruit-and-vegetable type of programs. We built this program as a B.C. version of a program in the U.K., the national school fruit scheme. There's also a similar, but obviously very different, program running in some of the states south of us. They are expanding that program every year. They are looking at our program. Everybody's looking at everybody else's program to see what the best one is. We didn't invent this, but we have certainly tailored it to be totally different than anybody else's.

A. Britton: The good news is that the one we've created in B.C. is, in fact, the best model. We've been asked to go and speak to the U.S. in June to talk about how we came to create this. We're the most cost-efficient model, and we're also the most foodsafe model that there is in the world.

We came to that because we pulled together some really amazing people as an advisory committee. We have experts from all three of our ministries who sit on our board, also from the Centre for Disease Control. We have community nutritionists, we have retailers and we have educators, and we have agriculture and industry involved. We've also done extensive consultation with agriculture, with teachers, with principals,

with PACs and with students to determine the best way to go about delivering this.

The pilot began this school year. We worked on it prior to the year to develop the entire program. In September we started delivering, two times a week, fresh fruits and vegetables, B.C.-grown, to ten pilot schools. We have two schools in each of our health authority regions currently running. We did that because we really wanted to make sure that we could hammer out distribution costs, which are a significant cost for this program — again, in all five health authority regions.

Our goals are very, very clear. Our number one goal is to increase the consumption of fruits and vegetables by our B.C. kids. But not any fruits and vegetables, because healthy communities come from a number of ways, and a very important thing that we need to remember is that we want to support B.C.-grown product. So that's our focus.

We want to also increase students' knowledge that we do grow fruit and vegetables here. I can tell you from our early evaluation that over 30 percent of our children in B.C. didn't know that we grow apples. That's a scary fact.

We also want them to know that fruits and vegetables are really important foods for their health. We're using the pilot costs and systems and hoping to be able to expand the program next school year.

Essentially, what happens is that the B.C. Agriculture in the Classroom Foundation is contracted to B.C. Ministry of Agriculture and Lands to run this pilot program. We have created contracts, then, with growers throughout B.C. to source our product. From there, we're working with Save-On Foods, as a major retailer, to order that produce and deliver it, primarily to the regions where our schools are. The produce is then picked up by a secondary foodsafe organization and delivered directly to the school, and it's ready to eat.

One of the issues we have in this province is that many — most, in fact — of our elementary schools do not have foodsafe kitchens, so product has to be delivered ready to eat — washed already and packaged. Not necessarily packaged, but sealed — whether it's an apple box or a container.

Inside the schools, we have been paying for an in-school coordinator, which in most instances is an existing staff member, a TA or a library person. They are all FoodSafe certified, so they receive the product at the front door. We've given each of the schools classroom bins, and the product is then divided up, individually, into classroom bins to meet each classroom's need and delivered to that classroom. This is an in-class activity. It's not a recess or a lunch activity. We provide enough product not only for all of the students but, also, for all of the teachers and staff in the school, because we know that role-modelling is vitally important.

We have a whole different selection of products that we offer to our kids. We brought you a sample of some of what we're doing, and we hope to expand next year to include blueberries and grapes as well.

We've created a lot of information materials on where product is grown, how it's grown, and provided that to teachers and the students and parents. I've given you a copy of some of that in your bags. It's also available on line if you're interested in looking it up.

B. Warner: Why we chose this model is because B.C. agriculture is very regional. There are crops grown in certain areas and only in those areas — i.e., kiwi fruit, the picture there. It's only grown on the southern tip of Vancouver Island. We can move that around the province and expose all our children to that and give them a healthy diet.

A. Britton: I think the most important thing you need to know, apart from the fact that we actually are delivering fresh fruits and vegetables into the hands of children for less than you would pay in a grocery store, is that the uptake has been phenomenal. We note at least an 85-percent uptake of fruits and vegetables. There are some comments up there about what the kids are saying, and I think they're included in your handouts as well.

We know that they've got crunching contests going on in schools. They've got jokes. They've got all kinds of things, and we're changing the school environment.

We are doing a complete evaluation of this program, working with the University of Victoria. Preliminary findings have been hugely positive, and we should have a full report out by early summer this year.

The other big thing is that we have evoked change in the school. We've changed the school culture. Instead of having doughnut and chip days, now on the days that we're not delivering, they're actually bringing in fruits and vegetables. That's what kids are instead bringing as healthy snacks.

One of my favourite comments was that plums are better than candy. Kids that have never even tried plums before are now actually buying them and taking them as a snack. So we are changing things in the school.

We've also created great role modelling. I know that we've been contacted by preschools and day cares, asking us for this model so that they can actually use it in their own centres.

Right now we have over 120 unsolicited schools on a wait-list. I'm pummelled with them every day: "When can we get in? How can we participate?" We do have an expansion proposal model that is with all three ministries right now, and we're working with retailers across B.C. to tie this into the retail outlets and market it not only in the schools but also to tie it in, so that we have a B.C. apple week or a B.C. cucumber week, so the product is available for those kids when they're shopping with their parents, as well, to purchase.

As Penny mentioned very quickly, there is a partnership that we formed with the B.C. Dairy Foundation to put fridges into schools to help facilitate encouraging more consumption of both dairy and fruit and veggies.

B. Warner: One of the reasons for that is that most of our schools are not capable of handling either milk

or fruit and vegetables, because they simply don't have the refrigeration infrastructure in the schools to do that. This program will allow them to participate in both programs.

The other thing you have to be really cognizant of is that this program will change the B.C. agriculture industry dramatically. It will invigorate this industry. It will make people, as Ann said, aware of it. Just to put some numbers out there that you can think about. Fully implemented by 2009, we will consume a million pieces of B.C. fresh fruit and vegetables in our 1,200 schools. On the apple week, that would translate to ten acres of B.C. apples — one ten-acre orchard being consumed a week, without any of the spinoff value as to education of kids. Not only are they becoming healthy; they're becoming aware of the agriculture system, which is hugely important for rural British Columbia.

We are also inventing new products in B.C. We have a company in Kelowna that has invented packaged fruit — apples, pears…. We're working with grapes. All this product can now go into the vending machines — the change to healthy vending machines. So the program is stimulating real innovation here.

A. Britton: What we need to expand, obviously, is continued support from this government. The Premier has come out and been very, very supportive of this program from the inception. Continued funding or expanded funding to expand out and also some realistic expansion time lines…. Certainly the goal was to have all schools in B.C. — all elementary schools and middle schools — involved in the program by the Olympics.

I'll wrap it up there, because I think it's probably more important that we can answer some questions if you have them.

B. Warner: We're done. We wanted to save time for questions. Thank you very much.

D. Hayer: A very good presentation, a very detailed presentation. We try to encourage everybody to eat more fruits and vegetables. Is there a way of keeping track of these fruits and vegetables — how they're grown — so they don't have some chemicals and other stuff that we might not realize right now, then later on we find out we encouraged people to eat fruits and vegetables? We're talking about organic food versus the non-organic. To make sure there's nothing coming up…. Then later on we're find it ends up costing us a lot more — maybe not now, maybe ten or 20 years from now.

B. Warner: This product is all coming off of HACCP-certified lines. It's produced in probably some of the best conditions in the world. We are also supplying organic product two weeks of the year — possibly four, possibly six. We are actually scrambling to get as much organic product into the stream as we can get. I think the key is what Ann said. We know right when this product is handed to the child that it's been in a HACCP food chain right from the orchard or the vineyard or the vegetable field. It's gone through every single process of a foodsafe system. It is, from my lifetime in this industry, the safest food in the world that we are giving our children.

M. Sather: Sounds like a really good program. I particularly like your focus on eating locally. That's a very important part of the whole process. The problem is that in many communities in B.C. — such as Maple Ridge, where I live — there's tremendous pressure from development on the agricultural land base. We've almost got these two streams running at cross-purposes in some ways. What do you folks do or what can you do within your ministry to work on that issue: the preservation of farm land? Without that, the "eat locally" program is out the window.

B. Warner: I think we're doing all kinds of things. We certainly have a very strong land reserve — probably the ideal situation in North America as far as the strength of our land preservation of ALR land.

From my perspective, if you want to say "farmland," you have to say "farmers." You have to make it so a person, a young person, can get into farming and make a living. That's what saves farmland.

This program saves farmers. It creates an economic income for them. It makes them part of the community. It makes kids aware of how important farming is. This will save farmers; this will save farmland. This is the most exciting program in North America, as Ann said. Everybody wants to know how we're doing this. To have your people in Maple Ridge aware that there are strawberry farms where they can go, that there are strawberries in their stores that were produced within five minutes of their house is hugely important.

I think we're tackling this on many fronts, but this is a new front: to have this partnership between Agriculture, Health and Education to talk about farming. We will do exactly what you would like.

A. Britton: I think the other thing to quickly note is that the B.C. Agriculture in the Classroom Foundation is existing in probably 500 of our elementary schools now. They do a tremendous job of teaching teachers about agriculture so that they can pass that information along to their students as well.

K. Conroy: We raise purebred polled Hereford beef breeding stock, and I'm really always happy to see the accent on agriculture, especially in the classroom. I know our granddaughter was home recently. We were slaughtering, and she realized that the animal in the field was really the beef in the freezer. She explained that to her friends in kindergarten here in Victoria.

Some of them were quite dismayed by that, but she said: "No, it doesn't come from Safeway."

So it's working, and I know the fruits and vegetables are working too, because when I asked her what she wanted for a treat the other night, she said: "Flowers." You can't eat flowers. She said: "No, these." And she wanted broccoli, so it is working. It's a great program. I love the program where you're bringing the agriculture in the classroom, where you're actually bringing animals to the classroom. That's a great program.

K. Conroy: Do you have a list of the schools that are actually benefiting throughout the health authorities?

A. Britton: I don't think I provided you one, but I'd be happy to pass it along to you.

Is there much waste? What happens to it at the end of the day? Do the kids get to take it home? What is the plan for expansion? Is it going to happen soon? Is it in this year's budget?

A. Britton: Well, okay. Good questions. With waste, we have very little waste in the school. We always deliver more product because we don't break cases because of the HACCP food chain. So if you have a school with 80, like our Slocan school for instance, they're going to get 125 apples, because that's just the virtue of how the product comes.

Any leftover product — each school has it's own decision-making process in that. In some instances where there are needier schools, they know who the kids are that are in need, and they package stuff up and send it home with them. Some of them use it for sports teams. Some of them just save it for the next day. I mean, apples are good overnight. It's not an issue, so we have very little waste.

As far as the budget goes, again, we have an expansion proposal that we've put on the desks for all three ministries. We're hoping that we're going to have funding. I would suggest that that would be up to people in this House as well, though.

B. Warner: To follow up on that, we are gearing up to expand in blocks that we can handle of 100 to 200 schools in a systematic approach to get us to 2009. You can't simply go from ten schools to 1,200, so we need to develop this systematically. Ann and I have put the proposal at the deputy minister level of all the ministries, and they're working forward.

R. Sultan (Chair): If the Chair may be permitted a question. Comparing, say, the distribution of chocolate bars through vending machines in the schools to the alternative of distributing, say, apples through vending machines in the schools, on a commercial basis, can you be competitive?

B. Warner: I think what you're going to see, as well, is that the whole vending machine world is changing. In this province they have to come in, within the next few years, with healthy vending machines.

Healthy vending machines are going to look a lot different. They're going to have refrigeration available so that the interesting products that you talked about there, developed by our friends Russ and Tony up in Kelowna…. The bagged apples are packed in ascorbic acid. Slices last 21 days in refrigeration. So a refrigerated machine can put that type of product in there — totally cost-competitive with a bag of chips or your chocolate bar. This product is competitive.

A. Britton: I think the other important thing to note…. I know that everybody is concerned about the loss of revenue for the schools. We've seen, in the Kelowna area, the switchover to healthy choices in vending machines. While there was about a two-month flux, they're actually making more money in revenue now than they were before.

We don't sell cigarettes in schools. Why are we selling unhealthy things that are creating a problem that is just as devastating?

R. Sultan (Chair): Unfortunately, our morning session has run out of time. I'm sure we could explore this very mouth-watering topic with Brent Warner and Ann Britton further. I'm going to look for an apple before I go into the House.

We want to thank you very much for a most creative program and one that I think has huge potential to transform our food distribution system. Thank you for appearing this morning before the Select Standing Committee on Health.

Hansard Services publishes transcripts both in print and on the Internet.
Chamber debates are broadcast on television and webcast on the Internet.
Question Period podcasts are available on the Internet.



CONTENTS

		Page

Presentations		45
	P. Ballem
	A. Britton
	B. Warner

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH