Health — Issue No. 7 — Thursday, May 11, 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

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:	Sandy Clarke (City of Victoria) Lorna Curtis (Recreation Oak Bay) Jennie Edgecombe (CEO, YM/YWCA of Greater Victoria) Janice Macdonald (Dietitians of Canada — B.C. Region) Carol Tickner (Vancouver Island Health Authority)

R. Sultan (Chair): Good morning. This is a meeting of the Select Standing Committee on Health, of the British Columbia Legislature.

Once again, we hope to benefit — and I'm sure we will benefit — from expert testimony by persons deeply involved in one dimension or another of the mandate of this committee, which is to explore the causes and cures of childhood obesity in our society. This modest task has been assigned to the committee, which has already received quite a bit of information on the extent of what some have called an environmental disease. I would prefer the terminology "behavioral disease," but certainly it perhaps warrants the noun "disease" to describe a pending health care calamity.

This morning we are having experts on the topic of recreation. Let me remind you all that today's meeting is a public meeting which will be recorded and transcribed by Hansard Services, the competent staff behind the glass here. A copy of the transcript, along with the minutes of this meeting, will be printed and will be 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 is available on the committee's website live. So you're being broadcast all over the world as we speak. This will enable interested listeners to hear the proceedings as they occur. An archived copy of the audio broadcast will also be retained on the committee's website.

This morning we welcome three representatives of the intermunicipal recreation committee and Health and Recreation Alliance committee. They are Sandy Clarke, who is the manager of programs and services for the city of Victoria, recreation services; Lorna Curtis, who is manager of programs for Recreation Oak Bay; and Carol Tickner, who is community nutritionist with the Vancouver Island Health Authority.

We will turn the meeting over to you, with the reminder that we expect you to perhaps present for 25 minutes and then leave time for 15 minutes of questions. However, we really should try to wrap up at approximately 8:40. We're a little bit flexible on that.

Could I suggest that you lead off with just a very brief biography of who you are.

S. Clarke: Thank you, and good morning, Mr. Chair and members. Thank you for the opportunity to present this morning.

The panel this morning does include three of us, as you see. Lorna Curtis, manager of program services with Oak Bay, has been there for 25 years. Carol Tickner is the community nutritionist with the Vancouver Island Health Authority, prevention services. And I am manager of program services in recreation with the city of Victoria. I, too, have worked in the area of recreation for approximately 22 years.

Our intention this morning is to present on how we work together as municipal recreation departments with VIHA, what some of the specific initiatives are that we have developed and to leave you with some samples of the materials that we have prepared during these initiatives.

L. Curtis: Regional parks and recreation relationships. We have an intermunicipal committee in the region, and it has representatives from the following municipalities: Esquimalt; Oak Bay; Saanich; city of Victoria; Peninsula Recreation Commission, which represents North Saanich, Central Saanich and Sidney; West Shore parks and recreation, which represents Langford, Colwood, Metchosin, View Royal and the Highlands; and SEAPARC recreation, which represents Juan de Fuca electoral area and Sooke. Working together on regional initiatives and programs avoids duplication of services and is a more effective use of resources.

C. Tickner: I'm going to talk a little bit about the Health and Recreation Alliance. I am the community nutritionist with Vancouver Island Health Authority in a program called prevention services. I'm in the nutrition program of that.

I'm the chair of HARA. HARA is basically a group of people that came together because they were interested in doing something community-oriented that would prevent childhood obesity. It's made up of all the recreation centres in Victoria and some partners from the Vancouver Island Health Authority — including prevention services, the program I'm from; aboriginal health; and primary care programs. We also have some representation from the hospital and UVic occasionally.

The committee does its work based on a foundation from two forums that happened last year: the provincial and regional childhood obesity forums, one in Vancouver and one here, in Nanaimo. Those points will come up on the screen for you.

What happened at those forums? There was an opportunity to look at what the people who were involved in the community and involved in these initiatives thought were key strategies in reducing childhood obesity.

They were social marketing campaigns of key practical messages around healthy eating and physical activity. One of the things people were saying around that was that the messages needed to be consistent. They felt that promoting healthier neighbourhoods and communities was really important in reducing childhood obesity. The term you hear these days, "built environment," means making our environment such that it's easier for people to walk, and they don't have to get

in their car all the time to go places, and there's green space for playing, for children and that kind of thing.

To support enhanced comprehensive school health programs. I'm not sure if you've already heard about comprehensive school health programs, but any initiative that we've done through HARA — the all-youth HARA is the short form — we link back into the schools, so that whatever is happening in the community is also reflecting in the school, and hopefully, whatever is happening in terms of changing the school environment is supported in the community. We felt that making healthy weights and regular physical activity a part of a child's early developmental goals…. Our committee hasn't been focused so much on early childhood at this point.

Create an obesity assessment and treatment centre. Again, that's something that our committee has discussed, but we haven't done anything particular about it yet. We might do something in the future that may facilitate that happening.

Enhance local relationships between health, recreation and ministry. That is, you'll see on the next slide — we won't go there yet — our main mission for HARA: to be a portal for all initiatives that are health- and rec-based, so that we have a more consistent approach. We find that there are a lot of initiatives happening in the community that could confuse our target audience, so we're hoping to try to make more partnerships, have key messages and not be so diluted. Also, to do an inventory of services or other initiatives that are happening, so that everybody knows what everybody else is doing and we can work more closely together.

The next slide. As I just said, HARA's mission is to be the portal for all healthy eating and physical initiatives that involve health and recreation partnerships. Our hope is that this will improve the implementation of these kinds of initiatives and improve communication between these interested parties. The other main thing that HARA wants to do is to stay action-oriented. We always want to be working on some kind of community initiative. This is one that we've been working on lately, but we're working on what we're going to do next.

Other things that we've worked on while we've been doing Eat Well, Get Moving! which I'll talk about in a second, are the summer camp guidelines for food and beverages. You may have heard that there have been food and beverage guidelines implemented in schools. We're trying to follow suit in the rec centres and put guidelines in for summer camp. That's the little Eat Well, Get Moving! thing that I've given you — the guidelines that we're sending to parents around helping them to make healthy choices for their children at summer camp.

Another initiative we're talking about working on is called health olympics. It's be another community initiative that we are just starting to work on now.

I think I am up to talk about Eat Well, Get Moving! That's the pamphlet you have here. This is the main initiative that HARA has worked on over the last year. You'll find a little card inside, and if you open it up, you'll see a lot of running shoes or sneakers and a lot of tomatoes. The concept is that people can use this to track the number of minutes of physical activity they do and the number of servings of vegetables and fruit they eat.

The reason we focused on physical activity and increasing vegetables and fruits was because the research shows that those are the two most effective behaviour changes that people can make in order to affect their weight, to achieve and maintain a healthy weight. Increasing vegetables and fruit in your diet is one of the key things that you can do to maintain a healthy weight.

Basically, you take off a sneaker for every 15 minutes of activity you do and a tomato for every serving of vegetables and fruit you do. When you complete the card, you drop it in at one of the rec centres. There's a little drop box there. Frontrunners, as well, has a drop box.

There are prizes every month. You can participate as an individual, a family, a work group or as a class or a school. We have prizes for each category.

It's been most successful, I find, in the schools. The schools have really latched on to it, I think, because it's a really easy-to-implement program in schools, and teachers are…. It's a school mandate to try to do more of these types of things in schools, so it's an easy thing for them to implement. Is there anything else about that?

S. Clarke: While Eat Well, Get Moving! is one of the initiatives that we're most excited about around the issue of childhood obesity, regionally we also have many other initiatives. Their focus is primarily to increase activity levels.

We wanted to highlight our LIFE program, which stands for Leisure Involvement for Everyone. In the municipal recreation world, that is our leisure access program. It's targeted towards low-income families who wouldn't be able to participate otherwise. We're most excited about this program because it went regional in the year 2000, so regardless of the municipality you live in, you know that the program is available to you.

It has two components to it. It has a 52-time punch card, which gives people access to 52 drop-in admissions at any regional recreation centre, regardless of the municipality that you live in, so it crosses boundaries. The second piece of the program is that it provides credits or coupons to allow for discounted or free admission to program registration. That is the municipal LIFE program.

L. Curtis: Canadian Tire Jumpstart program. This is a new initiative in the last year. It is totally funded by Canadian Tire. The goal of this program is to give children between the ages of six and 18 years of age who are economically disadvantaged the opportunity to participate in a lifetime activity such as swimming, soccer, tennis, skating, etc.

Canadian Tire allocates funds to the municipalities three times per year through our intermunicipal committee. Through that we've been able to fund school swim programs, such as in the city of Victoria. They have a grade four swim program for one of their schools, and they're able to participate for free.

S. Clarke: KidSport. Again, all of this leads you to understand, hopefully, that we are dedicated to linking with other organizations to maximize their message and to help the community understand that there are funding opportunities available to get people involved in activity.

KidSport is an organization committed to providing funds for children to participate in community sports programs. They provide a grant of $150 per child at least once a year, and often more frequently, based on funds available. The community recreation centres provide the applications, make the community aware of the program and act as links back to KidSport.

L. Curtis: Coast Capital Savings free swims. Intermunicipally we applied for a grant a few years ago, and the Coast Capital Foundation sponsors free swims in the region. They give us funding to provide a free swim — 36 free swims per year. Almost once a week, somewhere in the region, there is a free swim.

Loonie-toonie activities are…. Most recreation centres have to provide some low-cost activities for teens, for youth and for older adults — swimming, skating, fitness — and they're all at various times throughout the week.

S. Clarke: Finally, one of our most recent initiatives that we've developed is our two-for-one pass, which we've given you a sample of. The intent of the two-for-one is that it would cross boundaries. We're trying not to make it just for one specific municipality.

We're going to target this product to the schools. We frequently get asked by schools to provide passes. We want to make that link with school children and introduce them to activities that are available at their community and recreation centres.

We will be distributing these in certain initiatives. We used them for Move for Health Day yesterday. With the schools, we'll use them again during International Walk to School Day in October, and we'll continue to look for other opportunities to use them, as our partnerships with the school districts increase. Those are, collectively, some of the initiatives that we have put together to highlight the issue of physical activity and healthy eating and, also, to help make those more accessible.

We wanted to just briefly give you an overview of some of the programs that exist in the municipal recreation departments in the various ages. What we would say about these is we consider many of these programs, in my mind, core services that we hope all children have a chance to be exposed to, to introduce them to the options that exist for them and to get active and stay active for a lifetime, particularly something like swimming lessons. We hope every child has an opportunity to have swimming lessons and become competent and safe around the water.

We're just listing some of what we call our core services, and ones that, as I say, we hope all children will have a chance to be exposed to. We are also looking at new programs. We just have a few programs that we wanted to highlight, as well, and those are new programs that we're currently developing as our partnership with VIHA continues to grow. Those are cooking programs. We've highlighted those under the youth area. These are in development, and they're called young chefs and cooking fun for families. Carol is going to expand a little bit on what those could look like as another partnership program that we're working on.

C. Tickner: Recreation departments have been expressing a fair amount of interest in developing cooking programs that would be available either free or at a low price for youth, and possibly even families and their children.

Cooking fun for families is a program that currently we're looking to get some funding behind so that it could actually be a staffed program. Currently it's being run out of schools with parents and is an opportunity for parents to work with their children on building cooking skills. I think it's looking like it's a need for people to develop cooking skills.

That's one of the skills that we're losing as we become more convenience-oriented in our fast-paced world. If you're not able to cook, then you're obviously going to be eating out, and then you're obviously going to be getting more low-nutrient, high-calorie foods. This is an area that I'm really excited that the recreation departments are interested in developing a partnership around.

It doesn't really matter what it looks like. We could do it with teens, or we could do it with families and preschoolers or whatever the case may be, whatever suits each of the rec centres. We can design it to fit their target audience. I think that's all I wanted to say.

L. Curtis: Some other programs in the region are teen programs, such as the teen fitness orientation, which encourages proper use of the weight room; teen fitness classes such as Pilates, awesome abs, yoga for teens; national life-saving program — this is how you become a lifeguard; bronze medallion, bronze cross — this is a prerequisite before you take your national life-saving program; AquaQuest for teaching swimming lessons.

There are five skateboard parks in the region. There are numerous drop-in sports programs: basketball, soccer, badminton, swimming, skating. There are outdoor programs such as mountain biking, rock climbing, kayaking. There's also the youth annual pass which is at a reduced rate. At the city of Victoria the youth annual pass is $189 a year. At Oak Bay it is $199 a year, and it is good for unlimited drop-in activities — all of this leading to lifelong physical activity.

We've just highlighted some of the things that we see as barriers to youth and physical activity and healthy eating. Some of them I'm sure you're probably already aware of and have heard people talk to you about — portion distortion, for example. There has been somewhere between a two- to five-time increase in our portion sizes, so that's really contributing to the fact that we're getting larger.

As I mentioned earlier, we're busy, and we tend to eat out more on the fast foods. More media mania, meaning we spend more time in front of the TV…. Also, parents are afraid to let their kids go outside, so they spend more time inside. There's less unscheduled play and more scheduled play, so kids have these jam-packed schedules.

Lack of positive role-modelling from parents. One of our key target areas is parents — teaching them about healthy eating and physical activity so they role-model to their children. That's how kids learn more effectively.

Another barrier might be cost of programs. I know that I have a few young, new moms who find it difficult to keep their physical activity up because they can't afford to pay for day care and also the cost of the programs. So just a few examples.

S. Clarke: Some of the things we're committing to doing to overcome some of the barriers. We're committed to educating parents on healthy activity from a very early childhood standpoint. We all have active-living guides and brochures. Some of the messaging that we're putting in and the additional information on how much activity children need and what kinds of healthy eating options there are is something we're trying to increase. We're trying to encourage parents to limit youth access to media to ten hours a week or to put some parameters around that.

We're trying to provide, as Carol has previously mentioned, healthy lunch and snack options to parents as they register for our programs and camps so that we can provide them with the tools they need to make wise choices for their children — encourage parents to bike/walk children instead of driving. Again, we can't specifically be doing that on a day-to-day basis, but when we have the opportunity to support initiatives such as the school ones, we're really happy to be doing that.

Finally, we try to encourage parents to enrol children in one physical activity on a regular basis to develop a lifestyle pattern of physical activity. That's really the mandate of the Canadian Tire programs when they fund programs. We think that's critical. If children start exercising regularly and get the benefits of regular exercise, it becomes something that they understand feeds their health and well-being. That pattern from the early days is critical to develop.

L. Curtis: Improving access to physical activity programs. This is where you folks can help us. All physical activity lessons/programs be eligible for a tax deduction. The federal government has recently announced a children's fitness tax credit for up to $500 in eligible fees for physical activity for children up to 16 years of age. We're really hoping that it includes the services that are offered at the local recreation centres as well as the annual passes to recreation facilities being eligible for tax deduction.

Active communities initiative. I'm sure all of you have heard about that, and we need to continue to educate the public that everyone is active every day. Continue to improve the infrastructure. More biking, more walking opportunities — e.g., the Galloping Goose. It has been very successful in attracting people for biking and walking opportunities.

The initiative we are going to launch in the fall — and we want you folks to be the first to hear about it — is called the Steps Out program. This is going to be a regional initiative. It's a walking program that combines physical activity with the use of computers. Now we're trying to link the two of them. You would be issued a pedometer, and we're hoping that people walk a minimum of 6,000 steps a day.

They will be able to log onto their computer. They'll have a log-in, and we're going to have a map going up the Island and back down. They'll be able to put in their 6,000 steps, and it will log how far they've gone that day. They can see their activity on the map every day. At certain points there will be prizes along the way. Anybody who logs in and participates in this program will be eligible for prizes.

We're hoping that we can get a sponsorship to include the youth, because our goal would be to issue every school child in the Greater Victoria area with a pedometer and get them on this program. It does not mean they necessarily have to walk. They can bike. They can do any other kind of activity, and there is a scale where they can convert the activity into walking steps. Again, kids love computers. They can go on their computer, and they can see their steps being logged.

R. Sultan (Chair): Thank you very much, and thank you for the pedometers. I presume these are gifts for the panel members. Or are you just lending them to us?

I'm curious. If I may ask one question, as the Chair's privilege, before the committee asks theirs: what does one of these little gadgets cost you?

R. Sultan (Chair): So $12 each. Wow. We'll have to report that to Mr. Oliver. Anyway, thank you for the gift.

D. Jarvis: For the most part I think children are lazy, so they don't necessarily sign up for the camps themselves. How do you get the children into those programs? Are they mostly low-income?

I'll ask a few short ones here. Are their parents pushing them in there just so they can have a little holiday — the parents, that is? How long is the camp for? Is it one week or two weeks? Is there any way to measure what percent of those kids may be obese or underweight or whatever the situation may be? Do you have any figures along that way?

Also, I think I did ask you earlier. Is it predominantly low-income that are going into those camps, in the summer programs?

S. Clarke: I'll try to answer that. The advertisement, or getting the information out to families and children, happens through our active-living guides and also brochures that are taken directly to the schools and given to the children. It's hard for me to assess whether it's a personal choice or a parent choice. I would guess it's a combination, particularly in the summer, because there is a need for day care as well.

I don't know that I can comment on the percentage of children who are obese that are coming to the programs. I think that's a good question, but I don't know that I could comment on it. As far as low income, that differs from municipality to municipality quite drastically.

In the city of Victoria most people will know that our percentage of families that live under the low-income cut-off level is high. It's about 23 percent of our population. We do have a lot of low-income families that participate — at the Crystal Pool, specifically. Again, that would differ from municipality to municipality.

C. Tickner: I would just suspect that the number of children at camp that are obese or overweight would be a reflection of what it is in the population for obese children, but I don't know.

J. Nuraney: I must say that it's really great to have the programs that you've put together. My compliments on that. I've got a few questions. What is the involvement of the aboriginal community in your programs?

C. Tickner: With HARA we have a nutritionist from the aboriginal programs that sits on our committee. Her role in the committee is to try and take our programs to the aboriginal community and to help us always consider the aboriginal community and how this program is going to work for them and how she's going to bring it to their community.

C. Tickner: I don't have the stats on that, although I know she's worked really hard to bring it to their community and had some success. A couple of groups were enthusiastic and did get involved, but I don't have the numbers. When we do our evaluation this June, we'll know better about that.

C. Tickner: Oh, when I was talking about an obesity treatment and assessment program? Is that what you mean?

C. Tickner: Well, right now we don't have a program that does that. I'm not really sure what that would look like, although there is a really good program from the States called Shapedown that has actually been running in Vancouver, which we're hoping to bring to Victoria. That is an assessment and treatment program.

The great thing about the Shapedown program is that it looks at the whole family. It's not like carting your overweight child off to the dietitian. It's involving the whole family because it's seen as a family problem, not just a child's problem.

Those cards are very cute — the sneakers and the tomatoes. What's the rate of redemption? How many do you get back?

C. Tickner: We're kind of in the process of figuring that out. The program runs for three months. We've just gone through our second month. In our first month there weren't very many; in our second month, more. We're expecting that our third month will be a lot higher.

We ran the program last year, and we didn't get a lot of redemptions. This year we've got really good sponsors: A-Channel, Frontrunners, Kool FM and News Group. We've had quite a lot of advertisement, and it has been running all three months. We are finding that we're much more successful in getting the cards back.

In terms of getting the school cards back, it's been really great. They're all interested in winning the $600 gift certificate from Sports Traders. That's been a great incentive.

J. Nuraney: Finally, you've got a typo in your brochure. The World Partnership Walk is May 28, not the 30th.

R. Sultan (Chair): Thank you, John. We like to give good feedback to our witnesses.

D. Hayer: It's a very good presentation. It's nice to see that you make it fun and entertaining for everybody.

The city of Surrey, the area I represent. You know, the population I represent is very diverse — from

South Asian descent, Canadians, Oriental descent to other parts. Over 400,000 in population, so the second-largest city….

Do you share your ideas with different municipalities and different cities to see how they're doing it and to learn from each other — provide input, success stories or challenges you have?

L. Curtis: We have provincial networking opportunities with other communities. In fact, the LIFE program that the Greater Victoria area implemented won a provincial award because we did share that with the rest of the province. It's much like what Carol was saying about the obesity program. We do look to other areas to bring in programs.

Our biggest sharing is within the region. We meet, and we share our success stories and what works here for us.

D. Hayer: One of the challenges we find is that different cities have a different population mix from different descents — trying to get people from all walks of life, all different descents and ancestry, to be involved in participating. It's really good to see getting the parents and grandparents involved with the kids and doing this exercise program together.

C. Tickner: Something we're also working on around the childhood obesity issue is to develop a network across the Island. We're looking for funding to be able to do that. In order to do it properly, we figure we need some staff members so that we can do a better job of sharing our successes and our learnings around various initiatives.

D. Hayer: It's good to see that you have many partnerships with different organizations. That's a really good story.

R. Sultan (Chair): We have two more questioners, and then I think we'll have to draw this section of the meeting to a close.

My questions fall into the area of trying to get balance and involvement across the entire community, involving ethnicity as well as economic affordability.

You've already mentioned that one of the possible barriers is the cost to programs. I would like to acknowledge from the get-go that throughout your presentation, you were recognizing that as being a possible barrier and were attempting to balance it off…. I'm sure your municipal government is watching the wallets and things of that nature.

With that type of background, it leads into my question. What type of evaluation do you have — whether it be increased participation rate, items of that nature — to judge the effectiveness of increasing your participation throughout the whole community, rather than being targeted to just those who can afford it and maybe those from my type of upbringing, who would relate to this type of presentation?

S. Clarke: Well, the LIFE program gives us a lot of statistics on how many people are participating and, on an annual basis, who comes back and continues to participate. Those are things we track — how many people come back, how many are new and what our total number is.

In the city of Victoria we have approximately 3,000 people in our LIFE program annually. In the first quarter of this year, 2006, we have 2,000 people registered already. I anticipate that we'll end up this year with about 4,000 people on that program.

I think the message is getting out to people that activity is available to you. If financial resources are a barrier — and there are other barriers that I know we have to address as well — that's certainly a program that is accessible to all. We do track it in that regard.

M. Sather: Two quick questions. It's great to see so many wonderful programs out there for the community. What is your source of funding for all these programs? That was my one question. The other one was…. For a change from bread, I was just curious why you would want people to eat some of these other things rather than bread.

C. Tickner: The idea behind that pamphlet was just to give parents some options, because often parents get a little bit stuck in coming up with new ideas for what to send their children for lunch. They're not always necessarily healthier choices than bread; they're just other alternatives. I don't know if you have kids of your own. It's difficult to get them to eat sometimes. So it's just an opportunity…. A good point, though. Maybe I'll have another look at it and make sure that they're healthy.

L. Curtis: Sources for funding. As I said earlier, some of the money is coming from things like Coast Capital Savings, Canadian Tire….

C. Tickner: We receive some of our funding for the Eat Well, Get Moving program from funding sources through VIHA.

R. Sultan (Chair): If I may ask one brief question. You referred to a confused target audience. What did you mean by that?

C. Tickner: I meant that sometimes they hear about this initiative and another initiative and another initia-

tive. They're all trying to get the target audience to do the same thing, but they're all with different names. I think that sometimes confuses our audience. Then maybe — and I don't have evidence of this — because they're confused, they may not choose to do anything. So we're hoping to amalgamate and be a little bit clearer to our audience.

R. Sultan (Chair): Well, you've given us a glimpse of another important dimension of solutions to the problem of childhood obesity. We'd like to thank you and the organizations — the city of Victoria, the city of Oak Bay and Vancouver Island Health Authority — for making you available to provide this important testimony.

R. Sultan (Chair): Good morning. I will call the meeting back to order. This is a continuation of the consultation of the Select Standing Committee on Health of the British Columbia Legislature. These are public meetings. Transcripts are available on the website and through audio on the World Wide Web.

We have as a next witness Janice Macdonald of the dietitians of British Columbia. Welcome.

R. Sultan (Chair): Perhaps you could lead off by explaining just exactly who you are and what the dietitians of British Columbia is, and then proceed into your presentation. We would like to allow you about 15 or 20 minutes for a presentation and a like period for some questions and answers if we may.

J. Macdonald: My name is Janice Macdonald. I'm a registered dietitian and the regional executive director for Dietitians of Canada for British Columbia region. I've worked in public health in several provinces across the country, and I've been the regional executive director for Dietitians of Canada since 1997.

I really appreciate the opportunity to speak with you this morning about the role of healthy eating in childhood obesity. I know you've just heard from one of my colleagues, Carol Tickner, speaking with you about a specific program here. I'll be giving more of a general overview of the role of healthy eating and its connection to childhood obesity. I also want to let you know that I am one of the founding members of the B.C. Healthy Living Alliance, which I think has been mentioned to you in previous presentations.

This is a fairly complex-looking slide, and I'm not going to go through it in great detail. But I want to bring to your attention that I'm going to be speaking today, or focusing almost entirely, on the role of healthy eating.

Healthy eating is only one part of the equation when it comes to the issue of obesity. Basically, obesity is an imbalance of food in and energy used up. For that reason, some of the initiatives across the country and in many other countries, as well, have focused on the individual — education, trying to get them to eat less, eat more healthfully or be more active. If it was so easy for us to be more active and to eat healthier foods, I think most people would be doing that. But it's not very easy, because there are many things influencing what we eat and how active we are within our communities.

What this slide points out is that there are international factors that play a role — national factors, community impacts and even the impacts from our home, work and school environment. I'll be focusing over the next 15 minutes or so on some of those factors and their relationship to childhood obesity.

As I said, if it was so easy for us to eat a healthy diet, I think most of us would be doing that, so obviously there's something creating these alarming statistics on childhood obesity in British Columbia. Right now, we have about one-quarter of our children in British Columbia who are either overweight or obese. That is a significant increase from the late 1970s, when we had about 15 percent of our youth overweight or obese.

The problem is worse in the aboriginal population. This is a Canadian stat: 41 percent of Canadian aboriginal children are overweight. The situation is worse for children who come from families with lower educational levels, with 31 percent of those children being overweight or obese.

The data on low-income and childhood obesity is a little unclear. We do know that adult women who are in low-income families tend to be more obese than those from middle- or higher-income families, so there's definitely a relationship of income to the risk of obesity in our population. Those are some of the stats, just to provide you with the basis for the discussion around healthy eating.

There are a number of trends, recognized in the literature, that are leading to this change in obesity in our childhood population. Some of these are well known to each of us. One that I think plays a significant role in childhood obesity and obesity in the adult population, as well, is that we've moved away from more traditional foods that are higher in complex carbohydrates and fibre to more energy-dense foods that are higher in fat and sugars and generally low in nutrients, like soft drinks and higher-fat fast foods. We've also seen an increase in soft drink and fruit juice consumption in the population and a decline in milk consumption. This is particularly noted among children.

A scary one is that with children, about 25 percent of their total energy intake is coming from foods that are not from any of the four food groups in Canada's Food Guide to Healthy Eating — potato chips, soft drinks, candy, chocolate, doughnuts and things like this. One-quarter — 25 percent — of their total energy intake is coming from those foods.

We also have seen a trend over the last 20 years with people eating out more, eating away from home.

The foods they tend to be purchasing are more energy-dense foods. We've seen a significant change in the portion sizes of foods that are served, particularly at eating establishments.

There is some literature to indicate that if children have soft drinks available in their school environment, they're more likely to drink them — which is not a huge surprise. There's some very interesting literature around playtime and unstructured time. This is U.S. information. There has been a decline in the amount of free time and unstructured playtime for children.

I think that's interesting. I won't be spending a lot of time on that particular trend, but I did find it interesting that children are more involved in structured play and structured sports, for example, than they were previously.

If you think back to the chart at the beginning, at the far left it talked about international factors that impact on childhood obesity or obesity generally. I want to note some of these that are particularly related to food and activity levels. Children who are engaged in excessive TV and video viewing have a higher risk of obesity. We know that children who watch more TV are more likely to request and consume foods that they see advertised on TV. Advertising has played a big role in the changing food that is available and eaten by children.

A very interesting statistic, which makes it really difficult for us in the nutritional world and in the public health world to compete with, is that the food industry spends about $11 billion on advertising. This is a 1998 statistic, so it's not even recent. It would be much more than that today. It's hard for us in the public health field to compete with those kinds of huge dollars with the small number of dollars that we generally have available to try to counter the advertising and the impact of the environment on our children.

The research is also pointing out what some of the trends and causes are. What are some of the issues that are leading to more obesity amongst children? There is some literature to indicate fairly clearly and consistently that there is a relationship between breast-feeding and childhood obesity, in that if a woman exclusively or partially breast-feeds her baby, there is a consistent reduction in the risk of childhood obesity.

There's recent literature to indicate that for every can of soda pop that a child drinks, it triples their likelihood of obesity. And that's just one can a day. There's also literature to indicate that when children eat more vegetables and fruits, they are less likely to be overweight or obese. This is because those foods replace energy-dense, low-nutrient foods in their diet.

There's also literature to indicate that mothers, in particular, exert a strong influence over the eating habits of their children and for the family generally. There's some very interesting literature that goes beyond the relationship of families eating together and having better diets, to families eating together and having not only better food intakes, but the children are better adjusted, have better school performance and better communication. So dietitians are big fans of families eating together, preparing food together and having some time together as a family to focus on eating and communication.

There's some information on the situation. We have some data on obesity. We have some of the literature that is suggesting why we have an increase in childhood obesity in our population. Our goal as dietitians is that we want healthy eating to be the norm. I don't think that healthy eating is the norm right now. I think it tends to be more the exception.

We believe that if eating healthy foods is to become the norm, our children are going to need to be surrounded every place they are by supportive environments that are encouraging them to eat healthy foods and that healthy foods will be available for them to eat, wherever they might be — whether it's at day care, preschool, school or, when they become adults, at work, at play, in their local recreation centre and so on. We think that this is particularly important, or we're not going to see a change in the trend of obesity. We would like to see the trend stop and be reversed.

The literature indicates that there are solutions. It's not simple. If it were a simple problem with a simple solution, then we would have been able to stop the trend of childhood obesity at this point in time. It's not simple, it's not easy, and no one program or education initiative is going to turn this situation around.

We believe that we need to apply the same approach that the marketing industry applies, and that's a social marketing approach, which is bigger than education. It's more than a health promotion campaign. It focuses on behaviour changes, targeting our messages to the audience, ensuring that we know why they behave the way they do and designing our programs and our initiatives to create a big behaviour change at the end of the day.

The literature is suggesting that there are some best practices and some promising initiatives that are available for us to take a look at and consider implementing. No one program is the answer, but rather a combination of a variety of programs and initiatives before we will see some changes in the childhood obesity rates.

One is policies. We need policies at every level of government to encourage us to eat healthy foods and to ensure that the food supply that is available is producing healthy foods. There is evidence to indicate that breast-feeding promotion programs that include education, peer support and policy changes like baby-friendly hospitals make a difference and do have a positive impact on the rate of breast-feeding.

There's an indication that bans on advertising would have an impact, particularly if they're directed to young children, because young children are easily influenced by the foods that are advertised on television. There's an indication that policies at the school level encourage and support children to eat more healthy foods, and there's evidence to indicate that if we apply comprehensive approaches in our school environment, that will have a positive impact on obe-

sity rates in children. We have some good literature from a study in the Annapolis Valley, Nova Scotia.

Where the evidence is unclear is around tax incentives and disincentives. There has been quite a bit of debate in the media and in the literature that maybe we should be taxing junk food. It's really unclear whether or not this would have a positive impact on foods consumed by our children and adults.

There's some literature to indicate that if, in enclosed environments, healthy foods are priced so that they are less expensive than the unhealthy foods, this certainly has an impact on the choices that children make from vending machines in a school environment, for example. But we do not have literature on the impact of a so-called junk food tax. It would be complex to even define what junk food is.

We also have very limited information on the impact of obesity intervention initiatives in the day care environment. We believe that this is an area where we need to pay more attention. We need to reach children before they get to school. Many of our initiatives are focused on the school environment, but many children today are in day care environments, and we believe that our initiatives need to focus on children before they reach school.

Based on this information, I have a number of recommendations that I would like to bring forward to you this morning for your consideration.

First of all, I believe that we need to work together across all levels of government, across ministries and with other agencies to ensure that all of our policies — not just health policies but agricultural polices, educational policies and so on — ensure that we all have access to safe and nutritious foods, no matter where we are, with particular attention on high-risk populations and populations in our province where it's difficult to access a variety of healthy foods.

We have seen a real, positive movement by this government, with ministries working more closely together to plan and initiate programs. We would like to see that trend continue and be strengthened. We would like the provincial governments to work cooperatively with the federal government to look at establishing restrictions on advertising directed to young children so that we can have an impact at the national and international level.

We would like there to be some social marketing campaigns that focus on supporting families to eat together. We would like continued support and promotion of breast-feeding in this province. We do have some initiatives that are in place, particularly focused at the high-risk populations, and we need these programs to continue and to be expanded to increase breast-feeding in our population.

Because there is very little in the literature on child care facilities, we would like there to be a further development in this area and a focus on funding to develop, implement and evaluate comprehensive programs that are focused at child care facilities, including facilities that serve the high-risk populations such as our low-income British Columbians.

We would like there to be a review of the child care facility regulations to ensure there are strong regulations that ensure that healthy foods are served within the child care environment. We've had quite a bit of focus in this province over the last few years on healthy eating and active living within the school environment. These are very positive steps forward with some good initial results from the programs that have been implemented, including Action Schools. This is a comprehensive school health promotion program which has a healthy eating component that is presently being piloted across the province.

We have school nutrition guidelines that have been developed and are waiting to be implemented across the province. We would like there to be support to implement those guidelines more quickly, so schools are not waiting till the eleventh hour, 2009, to implement these guidelines in their school environment.

We have a school fruit and vegetable program that is being piloted across the province, and we would like to see that program supported and expanded as quickly as it can be to ensure that children have healthy fruits and vegetables available to them on a regular basis. We know that children who eat more fruits and vegetables are less likely to be obese.

This next recommendation is focused more at the adult population around workplace policies to support healthy eating. We know that mothers, in particular, influence the intake of their children. We need healthy foods to be available for our adults, as well, and for it to be easier to eat healthy foods so that information will transfer to the family at home.

We would like there to be increased efforts with eating establishments and grocery stores to serve and promote healthy foods. There is some information to indicate that family intervention treatment programs have an impact on treating obesity. We can't ignore the 25 percent of our population of children who are already obese. We need to focus on taking care of them and providing them with tried-and-true programs that will help them deal with their overweight problem.

There is evidence to indicate that programs that involve the family, like Shapedown, which was mentioned in the presentation just prior to me, have an impact on minimizing the risk of obesity. These programs need to be available across the province and particularly to our high-risk populations, including our aboriginal children.

With all of these efforts in child care centres, in schools and in obesity prevention initiatives that are taking place across the province, we need more community nutrition support to support these programs. Our recreation centres, our schools and our day cares are calling on their community nutritionist, who is a registered dietitian working in a public health environment, for support — to present to them, to provide them with information, to do displays and to work with the community.

We do not have enough resources presently available to provide the kinds of services that British Columbians are asking for. I suspect it was offered in an

earlier presentation by John Millar from the Provincial Health Services Authority that we need to have continued surveillance. Right now we do not have a very good surveillance system of food intakes and weights of children in this province. So it's hard for us to know how serious our problem is and if we're having an impact and making a difference with our initiatives. There is no ongoing surveillance program in place that regularly monitors the food intake and weight of our children.

We do have some very recent data from 2004 on weights in children, and this is the first data that we've had available to us for a long, long time. We have some nutrition data, which will likely be released by the fall, on eating patterns. Again, this is the first data we've had on children since the early '70s.

We would like the provincial government to be advocating federally for an across-Canada system for ongoing surveillance for weight and food intake of children and adults.

That ends the recommendations and my presentation. I welcome questions from you and hope that I will be able to deal with those questions effectively.

R. Sultan (Chair): Thank you, Janice, for a most helpful and tightly organized presentation packed with information. We have many, many members who wish to ask you questions.

D. Jarvis: Just before you sat down, John Nuraney and I were discussing, and we were wondering if this committee wasn't just being superfluous, because everyone who comes seems to talk to us about recreation and dieting and all the rest of it.

My question to you was: if you had a wish list, what would you want us to do? You sort of answered that. It was probably one of the best presentations I've heard so far. I compliment you on it.

I guess I'd better just repeat what I thought before. I put my hand up, and then you answered all of my questions. Do you have any specific thing that you think we should be doing, or should this committee just keep going and putting the information out? It's going to take years before we ever overcome all of these problems, especially with our children.

J. Macdonald: I appreciate that question, but it's hard for me to recommend one thing, because as I said, it's a complex problem and I think we need to attack it from many angles.

I wish there was an easy solution — one easy solution that we could all get behind and fund and go: "This is it; this is the magic bullet." But it isn't that easy. We will have to attack it from all angles.

Where I'd like us to move, probably, is to a higher level, further upstream — so we can have an impact on advertising, for example. That would be one suggestion I would have: that we do some more work around ensuring that what our children are exposed to on television changes. That will definitely take some effort.

K. Whittred: Thank you, Janice. I want to say hurrah, hurrah, hurrah, because you've finally talked about…. Really, I ask this question every time, about the marketing and the labelling and all of that stuff. I think it's absolutely core.

It is a huge puzzle for anyone to try to buy juice, because the real juice is mixed together in the supermarket with all sorts of products that bear little resemblance to juice and are, for the most part, flavoured sugar.

I guess I wanted to ask you, sort of related to your theme of how we have to attack this from a social marketing perspective…. I guess what I would really like to see is some sort of really simple sticker that goes on stuff that says, you know, with a big happy face: "This is nutritious, and this is how much of it you should eat." You know, a half-cup of juice — real juice — is quite a healthy portion, and yet we often go into restaurants and you get a tumblerful that is probably in excess of eight ounces.

I guess my question is, first of all: has there been any progress in terms of working with…? I guess it's the federal government that actually controls that sort of thing. So that's one question.

The other question was, in terms of your advertising…. I agree with that, but I think in terms of television it has to go a step further. I think the modelling that is done around programs that children watch…. In every single program, soda seems to be the drink of choice. People in the program go to the fridge, they get a soda, and they open it. People are offered soda. Nobody appears to ever be offered water or tea or any other kind of drink.

I think it has to go further than just the advertising. Somehow we have to reach the people who are actually writing and producing the programming. So that's really two questions — one about the labelling and the other around how we capture that kind of TV marketing approach.

J. Macdonald: I think you've brought up a good point around some easy-to-understand label on food products. There are a couple of issues there. It is a federal issue. It is a federal regulation issue. We do have nutrition facts labels on all of our foods as of December '05. However, those are only on packaged foods. Many of our healthy food choices are not in packages, so we need to have some system of recognizing healthy food choices that are outside packages. We want our population to be eating fewer processed foods, which tend to be in a box or a container of some type.

As far as coming up with an easy, simple-to-understand sticker system or check system…. It's been done; it's been tried. We do have several food companies that have implemented their own kinds of labelling initiatives. We really believe the federal government needs to take a step here and try to come up with a consistent, standardized system. We have major food companies developing check systems and smart systems, using different criteria, which makes it even more confusing for the public.

I agree that we need one system, but the complication is: what's that symbol? What does it mean? How do we deal with unpackaged foods? It is a complex situation and does require some work with the federal government.

To deal with your question about television programming, I think that's a good point. It's probably easier for us to have an impact on regulating advertising than it is regulating television programming. You'll also notice that more celebrities are smoking on television as well. I think that will be more difficult for us to regulate — what people are eating and doing on television. But there are standards and systems in place around regulating advertising.

D. Hayer: A very good, very detailed presentation. I have a couple of questions. You talk about promoting breast-feeding. How long do you think they should breast-feed a child — for how many months or years?

J. Macdonald: Our recommendation is that you exclusively breast-feed for at least six months. That's the Canadian recommendation and the WHO recommendation.

D. Hayer: I know some families where they have breast-fed longer than that, and the kids are still having weight problems. I can tell you from experience. And I know some doctors. They were obese, and their kids were obese until later on.

I look at your recommendation. It talks about working together, which I think is much better, with all different organizations and the businesses, the places that serve food and also the groceries and the food in restaurants and everything else and also with the advertisements. You can have more success if you can try to educate them, bring them along, than just putting regulations in.

There's so much to do when you give the information. Because it seems like it's so difficult that people leave it out. If there are some baby steps people can take, then you can say: "Yes, this is how much we'd like to do." When they look at what you should be eating, then you say: "This might be impossible." But at the same time you can say: "This is something little you can start with." Many places I go to, very well-educated people, high-income people — their kids are obese too.

Also, when you talk about the pop, I go to a lot of people — well-educated, a lot of power positions they hold — and they also drink a lot of pop. It seems to be a habit that we get into — right? Maybe you can give us some suggestions on some of the baby steps, some of the minor things we can do and make a difference — and then a main thing, to work on the bigger things.

J. Macdonald: I think that's a good point. But the reason we drink soft drinks and we see everyone drinking soft drinks is because they're heavily advertised and marketed. So, you know, it's easy to say to someone: "Try not to drink soft drinks." But again, that's targeting the individual. They're drinking the soft drink because it's available to them, it's easy to get, and the other, healthier choice is not as accessible.

I still think a baby step is trying to make healthy foods more accessible, so policies in school environments is one step to ensure that we get the soft drinks out of our high schools, out of our elementary schools, and that they only have healthy choices available.

M. Sather: Janice, I agree virtually with everything you said in your presentation, so my question is not in any way to undermine anything you said. But I'd like to know what the facts are around these kinds of issues. With regard to obesity — in children, I suppose, or it could be in adults as well — do you have any information as to what the statistics are in terms of the role of genetics in obesity?

J. Macdonald: I don't want to quote you a percentage, but it's fairly low. It does play a role. I believe it's more in the area of 10 percent to 20 percent.

C. Wyse: Thank you, Janice. I'd like to ask you to elaborate a little further here for me. Clearly, your presentation has left me with the distinct impression that the less-educated, lower-income segment of our society is subject to obesity.

Often, the recommendations and choices that are put in front of us require an education and access to income in order to be able to implement recommendations to deal with this targeted group of our society. Do you mind, for me, just taking a very short period of time and giving me what you would recommend, the recommendations, to deal with the targeted group that you've identified, where obesity is predominant?

J. Macdonald: Okay. One thing that the literature indicates is that there are more fast-food establishments and convenience stores in low-income communities, for example. I believe that we need to ensure that our low-income communities — which include our aboriginal communities, in many cases — have access to healthier food choices.

Many of the stores that are available to the aboriginal community, for example, only have unhealthy food choices available. That's what they have to purchase; that's what they're going to purchase. We need to work with communities to help them appreciate it's those foods that are having an impact on their obesity levels and their diabetes incidence — for example, in the aboriginal population — and to have them make decisions about how they can bring more healthy foods into their community, as one example.

We also know that one of the reasons lower-income people choose those energy-dense, low-nutrient foods is because they're cheaper. That's just basically a fact. You get more calories by having a can of pop and some potato chips than you do from choosing a fruit or vegetable, for example. Money for calories — they actually usually make pretty smart decisions. They buy the

It's not a matter of education. It's really a matter of them having more money available to purchase those healthy foods.

R. Sultan (Chair): We have a question from John Nuraney, but before John begins — I can guess, perhaps, the train of his comments — I would like to commend you for introducing a new phrase into our vocabulary, or at least my vocabulary: energy-dense foods. I think that's perhaps a more suitable way to describe what many have called "junk foods."

J. Nuraney: I just remembered a dietitian's remark the other day, and I thought it was very appropriate. He said: "It's not the 9/11; it's the 7-Eleven that's killing more North Americans."

My question is around taxation of junk food. Have you ever lobbied this before with the federal government? What kind of response are you getting in terms of implementing that recommendation?

J. Macdonald: Oh, taxing. No, we have not done lobbying, because the literature is not very clear on that particular point. It's not one that dietitians have moved forward to recommend — taxing junk food. I only brought it up here because it's been a fairly popular item in the media, and it has been discussed in the literature — that maybe we should look at taxing junk foods. I don't honestly believe that it is the solution. I think it's very complex to figure out what we would define as junk food.

Some literature has indicated that the taxes from those foods would go into health promotion initiatives. I like the idea of there being more money available to support our population making healthy food choices, but I would prefer that we focus on making healthier foods available to our population rather than focusing on the unhealthy choices. That would be my suggestion. We need some more study around that area to see if it actually does have an impact.

The other issue is around taxing foods. If the so-called junk foods are taxed, those are actually the foods that our low-income populations are purchasing, and it has a bigger impact on them. They then have even less money available for food.

R. Sultan (Chair): If the Chair may be indulged in offering a question of his own. I walked through the supermarket the other day, and I had what I thought was sort of a blast from the past. I saw a whole rack of products on the shelves which I guess could be called dietary food supplements — things in cans and powders — and I can recall a family member getting a whole bunch of this stuff. You would get thin by drinking these various products and nothing else, as I recall. Obviously, these products are still being marketed.

J. Macdonald: Well, again, there is no quick solution for losing weight. We certainly don't recommend weight loss with growing children. If you're talking about adults, there's no product in a can, and there's no quick way to lose and maintain weight. Some of those products actually do work for losing weight, but they don't teach you new ways of eating. As soon as you stop the program or stop drinking the product — whatever it is — you usually regain the weight, so you've basically wasted your time and money. Often people regain weight. They gain more so that they're at a weight that's higher than where they were before.

Dietitians are not fans of these kinds of products. We prefer that our population focuses on eating more healthy foods all the time, not just when they're trying to lose weight.

R. Sultan (Chair): I would like to thank Janice Macdonald for a very erudite, dense and — one might even say — energy-dense presentation. Thank you very much for coming.

R. Sultan (Chair): Our next expert witness of the Select Standing Committee on Health on the childhood obesity file, to remind us all of our mission…. I would remind our expert witness that this is a public meeting, and every word will be transcribed and recorded for posterity — electronically and every other way.

I welcome Jennie Edgecombe, who is the chief executive officer of the YM/YMCA of Greater Victoria. We'll spend our remaining half-hour hearing her presentation and hopefully having time for a few questions and answers from committee members.

I would ask Jennie to lead off by just explaining a little bit about her background and what she does, and then proceed directly into her presentation. Welcome.

We probably should jump up and have a little fit break. A lot of Y events, as you probably know, start off with the YMCA song and everybody getting active.

I'm the chief executive officer of the Victoria YMCA/YWCA, and I've actually been in this position

for five months. I've been with the Y for 18 years and have previously held positions in Kamloops, in the interior, and before that in Ontario in Cambridge, London and Woodstock. I've probably done nearly every job there is in the Y — working directly in physical activity programs, membership marketing, day camps, working with children, etc. So I have a fairly broad background in program.

The YMCA in British Columbia has six sites. There are Ys in Chilliwack, Vancouver, Prince George, Kamloops, Kelowna and, of course, Victoria. The Y nationally is quite a large organization with over 50 YMCAs, 26 YWCAs and ten YMCA/YWCAs.

Victoria — we're one of those ten, where we are both a YMCA and a YWCA. They are two separate national organizations that we're affiliated with. We think that by being affiliated with both, we have the best of both worlds.

Worldwide the Y is in over 120 countries and so has a very broad base and provides many different programs in many different areas. The YMCA has been around in Canada for over 150 years, and the YWCA for almost as long.

Many, I think, will know the history of the Y, which really started in London, England, when many young men were leaving the countryside to come into cities to work in industry. The Y started by providing housing. They didn't want them out on the streets at night, so they started providing physical activity and gymnasiums. Basketball started at the Y. You probably know the story of the old peach basket and some balls. That's how basketball started. So the Y has a very long history in providing physical education.

Part of the Y's mission is to respond to the needs in the community, so programs have changed over the years. For example, in the '70s the Y became very actively involved in child care. Today the YMCA is the largest child care provider in Canada, and the YWCA is the second-largest child care provider in Canada. The Y also provides, in addition to health and wellness programs, recreation programs, aquatic programs, camping and outdoor education, child care, outreach programs — in particular we do a lot of work with youth at risk — and employment programs.

Each Y in each community is different. It responds to the needs of the community. I've got some pictures up there, just to show a little bit of the demographics we work with. We do work in child care, and we work in children's programs. The local Y has sites, as you may know, downtown. We have a site at Vic West, and we have a large camp out in Sooke-Metchosin — Camp Thunderbird.

We have youth programs. We're working with all ages. We often use the expression, between ourselves, of "working from cradle to grave." We have infants as young as six weeks old in our facilities and in programs, and we have individuals well into their 90s, and older in some cases, who are still exercising at the Y and swimming.

Locally we have a lot of work for youth-at-risk programs. We have housing for young moms and their children. We have a program for young women who are pregnant and at risk. We have a crystal meth program and youth counselling.

What the Y really likes to see is a continuum of service. We may have an individual, a client, in one of our youth-at-risk programs who would then access our facilities to also become part of a health or wellness program. We have a continuum of being able to link with children, so some of our young at-risk moms will get parenting programs from us, bring their children to child care and get involved in physical activity as well.

Of course, the one area the Y is always known for is its pool. Nearly everybody I know always says: "I learned to swim at the Y." There are a lot of Y pools right across the country.

That's a little background on the Y as a whole. Overall the Y in Canada in 2004, which is the latest statistics we have, served 1,000,669 individuals and had revenues of $446 million. In B.C. the Y in 2004 served over 123,000 individuals and had revenues of over $38 million. The Ys work very closely together. We're not only working independently to service our local community but also provincially and nationally.

Very good timing right now around childhood obesity is that the national YMCA will be developing a new strategic plan this year. Certainly, part of that is going to be some strategies around childhood obesity.

At a provincial level it's also been a discussion amongst the Ys in B.C. as to how we can do more to help and support childhood obesity. Many of our programs already include physical activity, so we have child care programs that include physical activity, recreation programs, programs for youth, etc. The challenge for us is the people who are not coming to our doors or people that we can't reach, and how we can help them and provide better programs.

The Y also works with many partnerships. Several Ys across the country have worked with doing research with universities. The Hamilton Y, a few years ago, did a program with McMaster University and got a lot of good research there.

Based on that, they actually started to take their programs further into the community so they could work on a continuum where they may go into an area — many of them are probably individuals who have a lower income, and there are many barriers to activity — and start to provide some basic walking programs and so on. They reached a point where they would send a bus so the kids from the community could come into the Y to go for a swim. They gradually involved that community into the Y in a broader space.

There are other partnerships such as…. Recently Canadian Tire started a JumpStart program, where they fund sports for children. They are working in partnerships with the Y, municipalities, Boys and Girls Clubs, and so on, right across the country. They raise funds, and they are funding children who couldn't afford the cost of sports to go into different sports.

It's a great program. It's growing rapidly, and there's certainly a commitment there to get more chil-

dren active. Through their foundation, they are also starting to spread the word and encourage more people to participate.

The Y operates very much as a partnership between volunteers and staff. In Canada we could not do what we do without over 300,000 volunteers. Locally in Victoria we have over 300 volunteers involved in our programs. They do everything from fundraising, special events, direct program delivery, assisting with sports leagues, children's programs, child care, fitness programs, etc. — also, of course, giving us guidance. Our board of directors is also all volunteers.

The Y's concept of health focuses very much on prevention and self-management and social support. The Y is often seen as the centre of a community. We work with a broad spectrum of individuals — so not only different ages but very many different backgrounds. It's a centre where people come together, and really once you're through the door, there's no difference.

The Y has a financial assistance program, and this is available right across the country as well as in B.C. and locally. Our philosophy is that we never turn anybody away through an inability to pay. So the Y does a lot of fundraising in order to financially assist families and individuals to access its programs and services.

Through that program, we see some huge growth in individuals — participants that would probably never have achieved success if they weren't part of this. One story that had a lot of meaning for me was a young man who was probably about 13 and had some challenges in school and challenges in the community. He was heading down a road that didn't look too promising in the future, but he loved to swim. So through the financial assistance program, he came to the Y and was swimming. He was a very good swimmer.

He was encouraged to start taking some life-saving courses, some of the advanced courses, bronze medallion and so on. In doing those programs, he met other young men and women. Because he was very good at what he did, he had a lot of self-esteem in this program. He was recognized by his peers, and he started to mix with them and socialize with them.

Eventually, listening to them and the goals they were setting to finish school and go to university, he did the same thing. He finished school, whereas he probably wouldn't have. He went to university, and he had a great part-time job at the Y as a lifeguard, which paid for his schooling. Great opportunities, I think, to see that balance of different individuals who come into the Y.

One of the challenges, too, with physical activity — you do see a balance there, and I'm not sure we have the perfect answer — is the many different ethnic cultures that we have in Canada, and the expectations and how to involve them in physical activity.

A colleague of mine a few years ago did some international work in Africa. He had taken some slides of activities at local Ys, and one of them was pictures of an aerobics class. The group he showed the picture to just collapsed laughing, because they couldn't fathom that in Canada we would get in our cars, drive to a facility and pay money to go and jump up and down, then get back in our cars and drive home again.

For many of them, to get to some of their workplaces and sites and what have you, they actually had to walk a considerable distance. This activity was just involved in their daily lives all the time. That's something that I think we have missed here — that we are not involving that activity in our daily lives. It's not a question of how we do it. We're putting it in a very different perspective. That really reflects down to our children and how our children perceive this.

In school I believe that we're starting to make some inroads. When I was with the Y in Kamloops, I was part of an action-for-healthy-communities committee, which was a partnership with the municipality, the university and the Y and which did a lot of great work around advocacy. We got a nutrition policy into the schools. The elementary schools were taking out their pop machines and offering healthy choices.

Also, we found funding so that each school had a kit of really basic equipment again — skipping ropes, fun stuff that could be picked up at any time. Also, kits for teachers — some quick games, quick physical activity exercises they could put together if they couldn't pull something off, off the top of their heads. Everybody had an opportunity in class to participate in some kind of activity, and that was really great.

The other thing I had an opportunity to do there…. It was very much a pilot program, and I think it has potential somewhere along the line. The Y and the university — some of their nursing students — did a little pilot program around looking at involving families in activity together. One of the challenges we face is that many children may get some activity through school, may get healthy eating choices through school, but if that isn't being reflected at home, then it's very difficult to follow through.

The pilot project identified, through some of the schools, six families. During the summer those families came to the Y. We just gave them access to the Y at no charge. They met every week — they became their own little group — to share resources and how they were doing and to give support. They had a log for physical activity. They had a log for nutrition. Again, it was that group support every week to take a look at how they were doing. Sometimes — and even as adults we find this really tough — it's tough to stay on track.

We found that by doing the group support, the family as a whole may come home in the evening and say: "Yes, we are going to take ten minutes to cut up some fruits and veggies, and we're not just going to dive into the chips right away. We're going to do this together. We're going to do some activity."

We gave all of the families a pedometer — again, to log how many steps they were taking per day. One of the challenges was that in the evening, when they met at home, they needed to see how many steps they had done. They set a goal, and if they hadn't met that, then everybody went out for a walk again.

We also introduced them, through the Y, to some different activities. It was quite interesting in that we had a couple of the parents who had some health problems and who really had thought that they couldn't participate in anything. We were able to find activities that made the parent healthier and also enabled them to participate with their children, which they didn't see being able to do before.

Although it was a very small sampling, and it was something that in the future would be a great program to look at developing further…. Out of those six families, there was one family where they all became more physically active and made healthier choices. There was another family who had a child who was obese, who definitely started to see a change in weight and in his physical shape.

It was a very interesting program to do, and we really felt that by involving the whole family and not just segregating sometimes into…. Right now a lot of our physical activity — and we see this quite often — is just either the adult coming in or the child coming in, and not always something together. It is a change in lifestyle that really makes that important.

R. Sultan (Chair): I hate to interrupt, but I was wondering if you would have some time for some questions and answers.

As the members are well aware, the bells start ringing, and all hell breaks loose at some point. But it's your presentation.

K. Whittred: Thank you, Jennie. I was going to ask you a question that relates back to our previous one. You mentioned the role that the Y plays in its child care programs, and I certainly know it enjoys an extremely good reputation. I was wondering if you could tell the committee what kinds of policies or practices the Y follows around snacks, and so on, in their child care programs.

J. Edgecombe: I will speak locally, because I can't speak for everybody around their policies, but I'm pretty sure they would be similar. There are policies around providing healthy snacks. There are also policies around education. The children bring their lunch with them. The Y is providing some education around healthy choices in the lunches they bring.

We're also doing more programs and looking at currently, locally, how we link some of the things we do. We actually have a nutritionist who works out of our downtown Y. We're looking at: can we link the nutritionist with some workshops for parents that will give tips on healthy snacks and things like that?

One of the Ys that I was at in Ontario, for example, had a nutritionist on site. She, on a regular basis, would have recipes and ideas for healthy snacks and would actually cook things up, which people love — when they can sample something and then take the recipe. This is a great snack to bring to school or what have you.

Also, in our facilities we're attempting in our downtown Y…. We were probably not the best. We did have a pop machine. That's now gone, and we just have a water machine. Sometimes being able to make those choices available for people is good too.

The committee has been apprised of the reality that childhood obesity is particularly acute among low-income and aboriginal groups. Is the Y successful in serving those two parts of our community in particular, and how do you reach them?

J. Edgecombe: I believe the Y is successful in working with low-income groups, mainly because of the financial assistance program which is open to everybody. It's well known right across the country that the Y does provide assistance.

In working with aboriginal groups, I think it depends on the community. I certainly know Ys that do a lot of work with aboriginal groups and others who probably do not do quite as much work. It may be just a question of location.

I'll speak to one of the other Ys that I was at. We did a lot of work through child care and parenting programs and also operated a shelter for women leaving abusive situations and worked with many aboriginals through that. That was, if you like, a first connection with the Y. Then from that, people often got involved with other programs beyond that.

Certainly, the children of parents we work with would become involved with the Y. The Y was always letting people know that we could help them, that we wouldn't turn anybody away.

Are there any other questions from the committee members? Hearing none, I would like to thank Jennie Edgecombe of the YM/YWCA for coming here and telling us about the activities of this famous institution — certainly very historical. I'm sure all of us in one way or another have come into contact with the YM/YWCA in the course of our lives.

It's a terribly important organization, and we appreciate you taking the time to come and present to the committee.

J. Edgecombe: Thank you for inviting me. I'd certainly be happy — as the Y continues its work on childhood obesity and the new strategic plan that's coming out — to share anything that may be useful to this committee.

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CONTENTS

		Page

Presentations		73
	S. Clarke
	L. Curtis
	C. Tickner
	J. Macdonald
	J. Edgecombe

Committee Staff:	Jonathan Fershau (Committee Research Analyst)

REPORT OF PROCEEDINGS (Hansard)

SELECT STANDING COMMITTEE ON HEALTH

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH