Health — Issue No. 8 — Tuesday, May 16, 2006 (HTML)

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

REPORT OF PROCEEDINGS
(Hansard)

SELECT STANDING COMMITTEE ON
HEALTH



CONTENTS

		Page

Presentations		89
	E. Dosdall B. Plecas E. Young

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. Emery Dosdall (Deputy Minister of Education) Dr. Chris Mackie (Ministry of Health) Bobbi Plecas (Ministry of Education) Dr. Eric Young (Ministry of Health)

R. Sultan (Chair): I'll call the meeting to order. Welcome to the Select Standing Committee on Health of the British Columbia Legislature.

Before we get to today's expert witnesses' introduction, I'd like to remind us all that today's meeting is a public meeting which will be recorded and transcribed by Hansard Services — our very competent staff in that little room behind us. A copy of this transcript, along with the minutes of the meeting, will be printed and made available on the committees website at www.leg.bc.ca/cmt.

In addition to the meeting transcript, a live audio webcast of this meeting is also produced and available on the committees website so that interested listeners can hear the proceedings as they occur. So we are live as we speak. Through the magic of the Internet we're being heard all around the world at this very moment by people who stayed up all night to hear what we have to say. An archived copy of the audio broadcast will also be retained on the committees website.

Carrying on with our fascinating portfolio of experts on this mandate from the Legislature for this committee, which is to examine and, in particular, recommend solutions to the growing public health crisis — and I think, based on the testimony this committee has heard so far, that is not an exaggerated word to use — involving childhood obesity.

Since our children spend so much of their day in school, it's very appropriate that our witnesses this morning are from the Ministry of Education. In particular, the deputy minister, Dr. Emery Dosdall, is here to give his testimony, accompanied by Ms. Bobbi Plecas, also of the ministry. We have scheduled about a 20-minute presentation followed by 15 or 20 minutes of questions.

We have one other witness this morning. At ten o'clock, as the deputy minister is well aware, the bells will ring, and your audience and everybody else will evaporate. So we're operating under a fairly tight deadline.

We would like you to begin, Dr. Dosdall, by introducing yourself in terms of your own background — and perhaps Bobbi could do that as well — and then proceed directly into your presentation.

E. Dosdall: Mr. Chairman, we are pleased to have the opportunity to present to the committee this morning. As you indicated, my role is deputy minister of the Ministry of Education, and the lead director from our initiatives department is Ms. Bobbi Plecas. Bobbi has been responsible for leading the initiatives we've been doing in the ministry as they relate to healthy schools, as well as the joint partnership that we have with our Ministry of Health. We are involved in a number of initiatives together.

With your permission, Chair, I'd like to start by talking, with the time that we have available, about a couple of things. As you talk about obesity, one of the things that has been identified in the throne speech is to try to find ways in which we can remove junk food — a lot of the fast foods, as they're sometimes called — from our B.C. schools.

We wanted, first of all, to have some baseline information that we could use in terms of marking our progress. So we went out in the spring of 2005 and prepared a survey that went across a large percentage of our schools across the province. We're using that in developing a baseline for data.

When we looked at the schools, you had to say: what foods would be in the schools? We're not looking at children's lunches per se. We're looking at what's available in vending machines. We're looking at what's available in cafeterias and in other kinds of sales that would be available to kids at the elementary, middle school and high school level.

We will do another comparison, a second survey, in '06-07 to see — with respect to the initiatives we've taken this last year — to what extent they've had some impact. Certainly we would be looking at doing further surveys so that we can monitor this on a longitudinal basis. As you know from the throne speech, it's our goal to have junk food eliminated from our schools by 2009.

When we talk about junk food, what is really junk food? What is not junk food? There's a lot of debate that goes on about what in fact is okay to eat and what is not okay to eat and in what quantities and what have you. Clearly, this is an area where there isn't even a lot of agreement between nutritionists and other dietitians and others that have established guides.

In partnership with our Ministry of Health, we've prepared a series of booklets called Guidelines for Food and Beverage Sales in B.C. Schools. These guidelines, as I said, were prepared by a team of nutritionists and dietitians, and they were led by the provincial nutritionist, Lisa Forster-Coull.

When you look at all of the foods that we have within the schools, we basically put them into four groups. The first group is food that we think you should choose the most, then foods that should be chosen sometimes. The third category would be foods that are chosen least, and the fourth one is foods that are just not recommended.

The point here is that you can identify some foods — like a pizza, for example — that you would think would be something you wouldn't necessarily recommend, but depending on the kind of pizza…. So we look at the content of the food; we don't just label the food. The specifics are that maybe a pizza that has only a small amount of cheeses, etc., would be something that, because of the content, should be chosen on an ongoing basis.

The other comment I would make here is that when we talk to a number of the students within our schools, one of the concerns we got is not only in terms of what they could choose and the variety but also that quite often we typecast. We only have certain kinds of foods, and we really don't cater to a number of the populations — to the cultural diversity within our schools — to provide those kinds of foods that would be more acceptable to some of our different nationalities or areas of the world.

When you look, as well, at the efforts that we've had with respect to physical activity and healthy eating, one of the big things that we do, obviously, through our ministry is establish the curriculum of what is going to be the basis that our teachers should be focused on. When you look here, we've revised our K-to-10 curriculum in career education. We put in a new physical education curriculum from 2006, so it's just going in. We put in a number of other resources that go right across the continuum.

As members will remember, in 2002 we did a major revision with respect to our curriculum and new grad program. There was a clear emphasis that we should have more emphasis on things like smart nutrition choices, greater emphasis on physical activity.

When I say physical activity, that is different from — if I can use the term — the traditional physical activity or physical exercises and those types of things that you would see in the schools. There was clear push from parents, as well as from our students, to have a bigger variety in the kinds of activity that they would be involved in.

One of the major initiatives, as it relates to physical activity, is Action Schools. The Ministry of Education has been responsible for Action Schools since 2005. To date, we've got something like a little over 900 schools that are now part of this particular program. We're working in cooperation with Legacies Now in developing this and working with schools. In many cases, it really is a major complement to the regular physical activity that the kids would get with respect to their courses.

The research we have that has been developed as a basis for Action Schools basically shows that increasing the kids' physical activity to about 150 minutes per week would have significant, long-term, positive impacts on their health. We also believed that there would be a significant correlation between that physical activity and the students' academic learning.

What we've found so far in the research is that there is not a negative impact, but we don't have a positive impact. In other words, more activity doesn't necessarily mean better learning. We think it supports, but on the basis of the research that we have to date…. It just shows that there is not any negative impact in terms of academic learning, but it does have a significant impact in terms of the long-term health of the student.

With respect to Action Schools, particularly the model that we're using in grades four to seven, we're also now trying to find ways in which we can expand that into our high schools and other places. We're preparing a guide that will go along with Action Schools and would support the nutrition component of the program.

To help us in terms of doing this on an ongoing basis, last March we provided an additional $1.3 million that has gone out to schools. That's to help them and encourage them to look at the physical activity equipment they have; to ensure that that equipment is upgraded; to create in them a consciousness of what they're doing and the kinds of activities that are available, so that there is a range of activities for the students in our schools — elementary schools, middle schools and high schools — so that they're not just focused on only one or two types of activities. There clearly is some variety built in, in order to keep the interest of our young people going.

The amounts we sent out were based on providing about $850 for each elementary school and $1,000 for each of the secondary schools. The bottom part was $50,000. I mention this only because sometimes we forget this component — that is, to help out with the costs of insurance.

In many cases the equipment is not up to snuff, or you haven't provided certain kinds of maintenance, or you haven't gone through and ensured that the equipment is in proper repair. There are costs associated with this, so many or most of our schools would have taken out insurance in order to cover those particular contingencies.

I guess a fourth component or area of work that we've been involved in for some time, really, is the work we're doing cross-ministry and in intergovernmental discussions that are taking place. We've had lots of discussions with our colleagues in the Ministry of Health. We've had discussions with the Ministry of Children and Family Development and in a number of different places.

What we're trying to do is involve networks of teams of schools that are interested in focusing on school health more broadly. In each of these schools, what we're saying is that we want to encourage them to focus on at least one aspect of healthy schools. In other words, they don't have to take on the whole thing in the first year, because quite often that becomes intimidating.

There are always so many demands that we have on our schools that sometimes teachers have some difficulty in terms of coping with those demands. What we're trying to say to them is: "Take one particular aspect. Start developing that particular aspect." Then it becomes pretty obvious, as they work through that, that from there they then start to build out into other components and start building out into other areas.

What we're trying to do is say: "Within the school, try to do it in terms of teams." We think that's really important — that there become teams of teachers, an administrator…. In some cases they also will bring in CUPE personnel. In other cases they bring in parents. It varies from school to school, but we try to insist as

much as we can that there's at least one administrator and one or more teachers on each of those teams.

As they get involved in the kind of activities there…. Part of it is to build that momentum, to build that morale, to build that esprit de corps, if you will, with the kids. "This is a positive thing to get involved in. This is something that you want to do. It's for you. It's going to last you your lifetime." Do it as a kind of team activity to build that kind of activity within the school.

With the Action Schools, we also make available about $1,000 for a school to set up and do this. Once a school has reached what we call a healthy designation, or it has a healthy designation for the school, then they would be awarded an additional $500. Part of that is incentive. Part of that is to then allow them to start to build some of the other resources that they think they would require in order to continue that momentum within their school.

As you can see from a number of things up on the slide, the member schools have a number of areas that they have to commit to. It is that team. That's the first thing. I think that's essential to them keeping it going. If it's only one person carrying the whole load in a school, it usually just doesn't work.

It's also piloting assessment tools to look at how the kids are doing. They're participating in our surveys — those types of things.

What we're also trying to say is that they should be consulting with their local health authorities and health promotion professionals in terms of making sure that what they are doing is based on good research: "Get involved in the activities. Get your students involved; get your parents involved. Get as many people involved as possible. But make sure that you're doing it in a reasonable way, that you're doing it on a research base and that it is something that then becomes sustainable and certainly becomes defensible."

Just the last part, if I might. I'll just talk a little bit about some of the cross-sector initiatives that we have in place. We do have a joint consortium for school health. As you can see, this does provide a structure where Canadian jurisdictions can promote health, as I have been talking about, in a very comprehensive and coordinated manner. As we have taken that forward to CMEC, which is the Council of Ministers of Education for Canada, clearly the lead for that has been the province of British Columbia. It's being developed now. I think all the provinces, with the exception of Alberta and Quebec, are part of that particular consortium, including the Northwest Territories and Nunavut.

We are also working across sectors in a way that I think is going to be really demonstrated in the next couple of weeks. On May 24, 25 and 26 at UBC we will be bringing together school, ministry, health and education experts right across Canada. This is an invitational conference that will be held at UBC. Part of it is to look at the activities that we're doing from province to province. Part of it is looking at ways in which we can build the kind of support that we require in each of the provinces in order to make sure that we meet next-steps.

The last part is that through these activities, we think it is really important, as we're suggesting at the school level, that there be a team — just as we're suggesting at the classroom level — but that everybody gets involved. We think it's clearly the case that it's an example that we should follow as well. As such, clearly, we're working very closely with our colleagues in Health on guidelines — as I said before — on Action Schools and on different types of activities. We're working across ministries.

Secondly, we're working across provinces. We believe this is a national agenda. This is the national agenda that we're proud to lead with our counterparts across Canada and with our Ministry of Health.

With that really high-level kind of overview of some of the activities of the Ministry of Education, Chairman, I would close by also offering that if there are particular questions, Bobbi and I would be pleased to attempt to answer those for you.

R. Sultan (Chair): Thank you, deputy minister, and my apologies for that little interruption. We have quite a list of people who would like to ask you some questions, beginning with MLA Dan Jarvis.

D. Jarvis: Thank you, Mr. Chair, and I guess the troops in Afghanistan will wonder who was calling them.

Thank you, Emery, for your report. It's very good. We've heard from quite a few people. Probably the most evident one that remains with me was that of Janice Macdonald, the director of the dietitians of British Columbia. Everyone seems to have an idea as to what is junk food and what is not junk food, in order to establish proper eating habits.

I think we can change our education system almost overnight on the academic end of it. Why is it going to take till 2009 — four years — to take off the not-recommended foods? Why would it take so long? Can't we just stop tomorrow? Is it money or politics?

E. Dosdall: It's a whole number of aspects, and Bobbi can comment more specifically. One of the things we've done over the course of the last little while is go and talk to the people that have the vending machines. We've gone to them and said: "Why is it that you can't take out the Coca-Cola, the Pepsi or whatever it is — you know, the sugar drinks that you have — and put in water or other kinds of things, etc.?"

They have agreements that they have negotiated, that they've signed, either with individual schools or with individual districts. They believe that they want to hold to those particular agreements. Frankly, we don't have sufficient quantity, if you will, within the whole province to make much of an impact in terms of

trying to ban these things in our province. Economically, it's not something that they're really rushing to do.

I think the other part is — and you saw in the press in the last few weeks with the Bill Clinton Foundation and the work they've been doing in the States, trying to put pressure there — that it's going to happen more as something that is going to catch on in one and then carry on to the next province, to the next country, and that will create the transformation and the changes that are going to take place. They are not going to change for a province. They are not going to change for Canada, frankly, in terms of the volumes.

B. Plecas: I would add that this is a very profitable business for our schools as well. A large secondary school in an urban area, even with a convenience store across the street, can bring in between $35,000 and $70,000 to their school from their vending machines.

There are districts — we have one here on the lower Island, Saanich — that have taken a lead, and they have eliminated pop from their schools. It's worked because they've done it in conjunction with the big education program with their kids. They have found, as they've eliminated junk food and pop from their schools, that milk and water have filled the gap.

The sense is that that's a change that's coming across the province, but that this is profitable business for schools and often, ironically enough, it's school sports teams that get the benefits of the vending machine profits. If you were to immediately change them over, particularly at secondary schools…. The overwhelming sense is that unless we can do that gradually with the kids, they'll cross the street, so that revenue that was going to the school will go to the corner grocery store across the street instead.

D. Jarvis: In essence though, those suppliers and some of those schools aren't very good corporate citizens in that sense, because we know that there's a danger out there.

B. Plecas: Coke and Pepsi — I met with both of them — understand what's coming, understand when it's coming and say: "We have agreements in place, and we will work as quickly as the schools will allow us to work with them to remove the not-recommended food from the vending machines." I'm hopeful it will be before 2009.

On a serious note, is there parental involvement in the activity aspect from K-to-seven? Unless the parents are involved, it does not become a lifestyle; it just is school curriculum. Is there any kind of initiative taken where parents are involved in those physical activities?

E. Dosdall: There are a number of aspects, particularly in the development of the Action Schools, and the whole concept of Action Schools is exactly that point. They want to make this something that doesn't just happen for a small period of time during the day when the child is in school. They try to set up a number of activities that go home. They also have activities that try to bring parents to the school so that they can support some of the things they're doing, but it's done in a way of: "This is an excellent way of supporting your school, supporting your child, supporting yourself. Get involved with your school, get involved with your child, and get involved with good health." So they have that kind of momentum, I think, which is a positive momentum.

They also have a number of activities they do that are school-wide, where they bring in numbers of parents, and they have races or other kinds of activities that they do on an ongoing kind of basis. It's very much looking for ways to get the parent involved.

They're successful in some areas. In some areas parents obviously can't be involved in terms of during the day but at least are aware of what's going on in the school and try to support it at home when they are home with their children. So, yes.

Regarding obese children being active, it's sometimes difficult for them. They may not be as good as other children at some activities — maybe not as quick at running. It can be a sort of psychological disincentive, if you will. Children may be even teased. Have you, in your programming, thought about the psychological barriers to activity for obese children, and do you have any strategies to address that?

E. Dosdall: I'll let Bobbi do a number of comments, but I'll just say the activities that are worked into Action Schools are not set up in terms of how they might have been in the past where it was a race and only one kid won kind of a thing. The thing that is celebrated is the participation. The thing that is celebrated is that all kids can participate, and you participate in different ways and in different activities. That in itself….

There's a little thing on TV where the announcer says that one of the proudest points was a little girl who was in a race and came in dead last, and she was given a participation ribbon, and that was the highlight of her life. Those are clearly the kind of stories that we hear from this. It's for every child, it's for every child's level of activity, and it's for every child to be able to be proud of what they can do.

The competitive kind of thing with most of these activities is not there. The competition is to get you involved. The involvement itself becomes a competition, not the winning, if we can use that kind of traditional term.

B. Plecas: Our new PE curriculum supports the things that Emery was saying in terms of looking at activities for kids that are less sports-oriented, although there are certainly some sports in the physical activity or PE curriculum. The notion is really to try and get kids more active.

In the Action Schools model that Emery talks about, there are these one-minute energy blasts. It's a video that you can stick in to your TV screen in the classroom, and kids stand up in their desks. They don't have to go to a gym; it doesn't require equipment; it doesn't require gym space. They can stand where they are and do one of the most important things for kids' health, which is to jump. Apparently, kids aren't jumping enough, and so their bone density isn't hard enough. Kids used to jump more, apparently.

Action Schools spend time having kids — and wouldn't it be great to be in a classroom below them — jumping up and down to hip hop music and doing some really funky basic dance moves. It isn't, "How fast can you run to the end of the room and back?" and: "How fast can you dribble the ball and back?" It is: "Let's do things that are fun that kids love, to music for instance, that they can do on the spot in their classroom."

If we wanted to do one, we could bring one in for the next meeting of the committee.

My understanding is that you have 1,662 public schools in total in British Columbia, and about 355 independent, and over 558,000 students. That's a lot of customers you serve.

D. Hayer: One thing with the students is…. When I was young, after you finished school you went home; you did a lot running around and exercising. Nowadays most of the kids go home and they watch TV or they sit in front of the computer and do Internet surfing or homework and all that. There is less activity involved.

As well, the food they are eating — there is a lot more junk food and not real stuff involved. There are chemicals and everything else. Is there a way that you are teaching the kids what is in the food? And working with the fast food chains to say maybe they should change some of the menus or something…. Many times they are right beside the high schools, especially in Surrey and some of the other cities. They can maybe adjust their menus, because a lot of their customers are these students.

E. Dosdall: One of the things that we've been saying in the Action Schools is that everything that is done with the kids is a shared responsibility with the parents and everybody else in the community. What we're trying to say is that the jumping activities that she talks about or other activities are also things that you can do at home that should be encouraged. We're trying to do that.

We're also trying to send home information and that to mom and dad to let them know more about things like what is healthy, or what we think is healthy, the kinds of things that would be recommended types of things that we would like to see you get involved in.

As you know, we have some pilots in some schools where the Ministry of Agriculture is piloting a number of our schools about providing fruits and vegetables to the kids, etc. We're trying to do that.

We have not had any specific discussions at this point in time with fast-food outlets or those stores that might be located across the streets from our high school campuses, etc. We haven't done that. We've been concentrating, first of all, in terms of the people who provide the vending.

The last part of my canon, just to go back to an earlier point in terms of the people who are providing vending machines and other kinds of things within our schools, is that there is a number of other vending companies — I don't want to leave you with the impression that it's only Coke and Pepsi — that have been very, very socially responsible — one here on the Island, particularly. They're doing their very best to try to accommodate the healthy needs and the things we're getting from our nutritionists in terms of what should be provided for kids. If I could go back and let you understand that there is a shared responsibility for this.

R. Sultan (Chair): We have a professional teacher on our committee: Katherine Whittred.

Yeah, a couple of questions, Emery. One of the things we've heard at this committee is that we don't have a lot of data. We've heard that largely around weight and measurement of children. You mentioned in your presentation 150 minutes of activity per week. That's two and a half hours. Do we have any data about what the average kid gets? I mean, most kids I know would have much more than that. Does that mean a whole bunch of kids are getting a whole lot less than that?

B. Plecas: Yes, it does mean that, in fact. We do a satisfaction survey. The Ministry of Education has done a satisfaction survey for five years now. It asks questions about a wide range of issues. This year, for the first time, we asked what we're calling the broccoli-and-sweat questions on our satisfaction surveys.

We're asking students how many servings of fruit and vegetables they have had in the last 24 hours. We're also asking them how many times they have exerted themselves physically such that their breathing increases and they sweat — hence the sweat-and-broccoli question — in the last seven days.

The preliminary results are just coming back. This is the first year we've done it. We know that about 50 percent of kids are having five servings of fruit and

vegetables or more and that about 45 percent of kids have been exercising 150 minutes a week.

We recognize it's just snapshot. We do it at grades four, seven, ten, 11 and 12. We have big, big numbers of kids, in the tens of thousands, who have answered these questions, but we recognize it's just a snapshot. We also recognize the data question you've asked, and we're beginning to try and grapple with how to ask those questions in a thoughtful and comprehensive way.

K. Whittred: That's quite shocking, actually, that that few children would have activity.

E. Dosdall: The key here is we're asking a question for the very first time this year, but it is to repeat that question year after year so that we have longitudinal data, which is the only way we're going to be able to assess how the activities we're involved in are either having an impact or not having an impact. If that number doesn't get higher in terms of activity and the kinds of things that they're eating, then we obviously have to go back and reassess what we're doing — how we can make better intrusion into that market, if you will, or better intrusion into those schools in order to change some attitudes.

It's a longitudinal survey, but we would agree that in terms of the initial responses, they are actually…. When they're made public, I think they're quite shocking for many communities, and we can break it down by community.

K. Whittred: Interesting. I would be very interested in seeing that in terms of regional breakdown.

A second question. You talked about esprit de corps, and I agree with you. I think that that kind of attitude is really important in terms of building this outcome we want in terms of activity. It's my observation that intramural sports have almost disappeared from high schools over the last 20 years. I would say that's largely because there are so many different organizations. Schools have gone to extended days, shorter lunch hours — a whole bunch of reasons.

I guess my question is: has there been any discussion at any sort of high level about that particular aspect of the extracurricular function of schools and encouraging the growth or the regrowth of extracurricular activities?

E. Dosdall: The minister was very concerned about the exact same things that you mentioned and this year has met with the provincial organization B.C. School Sports. She met with them, talked to them and encouraged them to continue with some of their work — made a grant available to them.

She also asked them to come to the Education Advisory Council, which they did about a month ago. At that particular committee there are representatives from all of the partner groups in education. There are about 20 to 25 of them at the table. They made a presentation about how they could work with each of those different associations to support intramural kinds of activities they're involved in.

It's a first step, but clearly, it's a step where the minister, as well, recognized that we have to — you know, we can't legislate it and what have you — find ways in which we can encourage it. We can find ways in which we can incent it wherever we can.

That is something we've worked on. I would agree with you that in terms of the numbers of things, they have in many cases gone from the volunteer kind of intramural to much more organized and competitive sports that are often organized outside of the school.

K. Whittred: Thank you, and if I could just conclude with a little bit of a success story. For many years in my community this last weekend has been what was called the Hose and Reel Festival. Anyway, it's gone by the wayside. A group of parents from three of our schools, the so called inner-city schools in my neighbourhood, reserved the park, and they had what they called a school fair on Saturday. I was invited, and I went, not knowing what to anticipate. I thought it would be rather small. This was a first attempt. Anyway, I arrived, and this was just the most magnificent success. These were the efforts of the PACs and the staff and everybody. They had organized this absolutely glorious day at Mahon Park, and I am assuming it's going to become an annual event.

R. Sultan (Chair): Our final questioner is the Deputy Chair of the Select Standing Committee on Health, David Cubberley.

D. Cubberley (Deputy Chair): A couple of observations. One of them I couldn't help thinking when I heard about the broccoli-and-sweat survey: was that being asked to children?

D. Cubberley (Deputy Chair): Two things jumped to my mind. One: why do we ask how many servings they've had, rather than how much they've had? "Servings" seems a technical term as opposed to…. Kids don't think about servings. If they think at all, they might remember: "I ate an apple. I had grapes."

B. Plecas: It was a friendlier way that we asked the grade fours and sevens. We said: "How many times have you had fruits and vegetables? Think about it as about the size of your fist as sort of once." So an apple or an orange or a….

D. Cubberley (Deputy Chair): The other observation on that one is: given that breaking a sweat is not necessary in order to achieve a health benefit from physical activity, why ask how many times someone broke a sweat?

B. Plecas: Again, I was being, probably inappropriately, cheeky when I called it the broccoli-and-sweat question. The question is actually phrased: "How many times have you physically exerted yourself?" Again, I think we have simpler language for the smaller kids, but the question boils down to: "How many times have you done activities such that you're breathing hard or you have broken a sweat?" We know from our colleagues with the Ministry of Health that getting their heart rate up is what we're really interested in having them do.

D. Cubberley (Deputy Chair): It's true, but taking a walk will get your heart rate up even if it's at a moderate pace, and you wouldn't necessarily even notice it. For a child to perceive it is really…. I just think it's an adult question being asked to a group of people who don't think in those terms. I would urge you to think about the way you ask a question to get the information you want.

Just thinking about the 150 minutes a week of, I assume, moderate physical activity, which is the Health Canada and CDC definition of when you begin to access the curve of fitness benefits, what you're looking at is 30 minutes a day, five days a week.

I couldn't help but think as I was listening to the types of activities you were talking about trying to promote through Action Schools that one of the very simplest ways a person, a child, could get a half-hour of exercise a day would be two 15-minute walks, which would be, more or less, the journey to and from school on a daily basis for the average household.

I noticed in the things you mentioned, while you mentioned activities like races and activities that could go home and activities that implied sports or participation in collective events, there wasn't any mention of the journey to and from school. I'm just interested to know whether that enjoys any place within the Action Schools idea. And if it does, why did that not come up as an area of interest for promotion?

B. Plecas: Action Schools is trying to complement our existing PE curriculum. What it's trying to indicate is that if teachers did 15 minutes of activity a day in their classrooms, that would complement the amount of time regularly scheduled in PE and would get them, in the schools, 150 minutes of physical activity. The Action Schools model doesn't specifically speak to walking to or from school, but it does speak broadly to a healthy lifestyle, as does our health and career education and our PE curriculum.

I know it's an N of one in a public school system of 1,600, but my children's own school has "walking" school bus days, where the kids can group together from safety points and walk in a group so that the issues of safety are addressed.

D. Cubberley (Deputy Chair): My question really is: why does the Action School model not include the journey to and from school, especially given the challenges of getting children to be active within the confinement of a school or within the confines of the dominant paradigms for physical activity, which are competition-based, team-based, at a prescribed time — that whole range of things that people have varying positive and negative responses to? Why limit yourself to what goes on within the school?

B. Plecas: Because we have control over what goes on in the school, so we can encourage parents….

D. Cubberley (Deputy Chair): You don't feel you have any ability to influence how people come to the schools?

B. Plecas: Oh, certainly. Sure, we have influence, and we can work with our schools to work with their parents on the way kids get to and from schools, but we have more control about what happens actually within the confines of the school. If we know we can get 150 minutes in the confines of the school, everything else outside will be supportive of that.

R. Sultan (Chair): I think we have run through our panel, and we have also run through the available time. I would like to thank Dr. Dosdall and Ms. Plecas for a very interesting presentation, and we will cogitate.

We will now take a two-minute break and get ready for our next witness, the deputy provincial health officer.

R. Sultan (Chair): This is a continuation of the hearings of the Select Standing Committee on Health of the British Columbia Legislature. Our next two witnesses are eminently qualified — in fact, mandated — to monitor and give advice concerning the health of all British Columbians. It's very appropriate that this committee — which is, of course, looking into the crisis of childhood obesity in British Columbia — hear from them this morning. We have about 37 minutes to hear the presentation and to have a few questions from and answers for the committee members.

Presenting today is Dr. Eric Young, who is the deputy provincial health officer. I'll ask him to explain what that exactly means. He's accompanied by Dr. Chris Mackie.

E. Young: Thank you very much, Mr. Chair. I'd like to thank you for the opportunity to come to speak to

you today on behalf of Dr. Perry Kendall, who is the provincial health officer. He, unfortunately, had to chair a meeting of the public health network in the east this week, so he's asked me to try and fill in for him. I will attempt to do my best.

The positions of the provincial health officer and the deputy provincial health officer, as you know, are within the office of the provincial health officer within the Ministry of Health of the province of British Columbia. It is our responsibility to report on an annual basis on the health of British Columbians and to make recommendations, where appropriate, on improvements to the health of British Columbians.

Today I have with me Dr. Chris Mackie, who's a third-year community medicine resident who's doing a rotation with us as part of the program at the University of Toronto to train specialists in public health or community medicine. Thank you very much for allowing Dr. Mackie to be with us today and to sit here.

I'd be happy to answer any questions at the end of the presentation. Right now we're trying to set up the CD so that we can run through this presentation, I think, in the 37 minutes that you've allowed. If you'd like, what we can do is start just with what's in front of you. I apologize for the fact that it's three slides per page, but I left room so you could make notes, if you like. Or would you like to wait until the presentation is up on the screen?

R. Sultan (Chair): I think we should carry on. We have the hard copies in front of us. Thank you.

E. Young: I think what we'd like to try and put in context here is the issue of child obesity, physical activity, overweight, nutrition, those kinds of things in relation to children, in the broader perspective of the major risks to health that this province faces.

As you can see from the first slide, cardiovascular disease is clearly one of the major risks, as is cancer, along with injuries, etc. Those diseases — like cardiovascular disease and cancer, as well as diabetes, hypertension and many other illnesses — are all tied in to some very basic risk factors.

In the third slide, if you look at the key risk factors that contribute to most of the disability and premature death in this province, you'll see that obesity is about 10 percent of the DALYs, or disability-adjusted life years. That's a measure that combines premature loss of life with living with disability. Physical activity, or lack thereof, contributes to another 10 percent. It's right up there with alcohol as one of the major contributing factors.

When you're addressing child obesity, nutrition, healthy eating and that kind of thing, you're not only going to impact that particular topic. What you'll do is impact many, many diseases in this province that occur later in life, and that's a really important thing to do. This is one piece of that puzzle in the continuum of life with respect to healthy eating and good physical activity.

On the next page I think you'll notice — and I'm sure you've had this mentioned to you before — that there's been quite an increase in the proportion of children who are overweight or obese in this country. In 2004, 26 percent of Canadian children were overweight or obese. That has increased in the last 25 years dramatically, with overweight going up at least 50 percent and obesity going up over 200 percent, almost 300 percent.

In the following slide, you'll see that back in the early or late '70s overweight was about 12 percent of the childhood population. That's increased to 18 percent, and obesity has gone up from about 3 percent to approximately 8 percent. That's quite a dramatic increase in a very few years, when you think about 25 years in a lifetime.

The problem, of course, with obesity, as you well know, is that it's linked to very many diseases. That's because the factors that contribute to obesity are linked to many of those diseases as well.

The next slide lists diseases such as type 2 diabetes, which not only do we see growing in our general population but growing at higher rates in our aboriginal population. We're also starting to see type 2 diabetes appear in adolescence, whereas before it was just mainly type 1 diabetes that we used to see in children. That type 2 diabetes in adolescence appears to be related directly to obesity or overweight. There's quite a significant increase in diabetes in persons who are overweight, unfortunately.

The other things are that overweight, as we know, also contributes to mental — I wouldn't say illnesses — things like emotional issues around low self-esteem, not feeling good about yourself, being very self-conscious and sometimes depression. Being overweight not only affects you, potentially, physically fairly soon in your life and in the long term with respect to your physical health. It also can affect your mental health, your emotional health and just your general state of well-being and enjoyment of life.

One of the things that was found in a very small study done in the lower mainland of 15-year-olds was that a significant proportion of children — up to 55 percent of them — if you actually do some blood tests and physical measurements on them, will have one or more risk factors for heart disease and chronic diseases that come from obesity, such as abnormal blood profiles of their lipids, blood pressures that are starting to go up, abnormal weights and just lack of physical fitness.

Basically, all this is not happening in isolation. What the next several slides show is the speedy increase, I think one could say, of overweight and obesity across this country. These demonstrate the trends in adults from about 25 years ago right through, for the next five slides, to 2003, 2004.

What you'll see is a steady progression of the proportion of people who are obese over that 20- or 25-year period. That's in adults. These children obviously don't live in isolation; they live in families. There is

quite a lot of research that demonstrates that children, especially when they're very young, will, of course, eat what their parents put in front of them. If you have parents who are gaining weight, eating high-fat foods, not getting enough exercise and basically taking in more calories than they're expending, they are likely to pass on those similar dietary habits to their children, because the children are eating the same thing at the table that the parents are.

The obesity rate in children, then, is not increasing in isolation. It's increasing parallel to the rate of obesity and to overweight in the general population at large. What you'll see in the following slide, which is the orange one…. That demonstrates the level of overweight and obesity across Canada, and you'll see that in British Columbia — if we had the slide up there, you'd see it better — it's about 26 percent. That's a significant proportion of the population.

The following slide shows the prevalence of overweight and obesity in Canadian children in a bar graph done by Dr. Tremblay. Again, the far right-hand column shows the 26 percent, which is about 18 percent overweight and about 8 percent obese. That's in this particular slide right here. I don't know if everyone's got to that page. It's at the bottom of page 5.

What you'll see is that there is a slightly higher rate in boys than in girls in 2004, but really, that's not all that relevant. What's relevant is the change from 1978, where the rate of overweight, in green, was about 12 percent, to its current 18 percent. The rate of obesity, in purple, went from 3 percent to about 8 percent.

There was a study done in Richmond a few years ago where they basically looked at the changes from 1999 to 2003. You'll notice that for boys, from the fall of '99 to the spring of 2003 there was an increase in both overweight and obesity which paralleled the Canadian rate of overweight and obesity increase. You'll also see that to a lesser extent there was an increase in girls as well.

The simple reason why this is happening is that there are more calories being consumed than burned through metabolism, food digestion and physical exertion. Most of the calories that you and I burn every day are burned through our metabolism and our digestion of food. Physical activity is a small portion of the total calories that we burn per day. For example, sitting here and talking to you, I'm not really doing anything very physical, although I am thinking, and that does burn some calories.

I'm probably burning, at my weight, which is about 80 kilograms, 1.2 kilocalories per minute. So I'm probably burning in the neighbourhood of 1,700 to 1,800 kilocalories per day just by sitting here, and you're doing the same. I would expect slightly…. About the same, I would imagine.

A lot of what we do, actually, in terms of our intake, is provide our body with the nutrition and the energy that it needs to think, for our hearts to beat, for our intestines to digest, for our livers and kidneys and muscles to function, etc. Children need more calories per kilogram than we do. Whereas we might be taking in an average of 30 kilocalories per kilogram per day, a child between the ages of two and six probably needs 70 or 80 or 90 kilocalories per kilogram per day.

They need more calories for their size because they're growing, so they're using a ton of energy. They're also running around and playing a heck of a lot more than we are, so they're burning off a lot of energy in physical exertion as well. But a lot of that is going to growth. As you get older and as you approach the age of 18 to 20, then your number of kilocalories per kilogram consumption required actually drops, and then you get down to roughly about 30 kilocalories per kilogram, which is what we're burning off in a general day.

I just wanted to point out that it's not just physical activity we're doing that burns calories. It's what we are doing all day long that burns calories, and most of that is just the body's functioning. The problem is that even a small difference between what you take in and what you burn off in a day makes a huge difference over a long period of time. I think one of the messages I want to leave is that it isn't necessary to go and make big differences all at once or big differences in any one field. All that's necessary is to make small differences over a long period of time in many, many areas.

I'm going to talk about, as a framework of an approach to dealing with childhood obesity, looking at a framework called an ecological model. The ecological model is used quite often in health promotion. The ecological model starts with the individual, looks at that individual within the context of the family and the influences of the family around that individual. That family is situated in a community which has its own cultural expression, its environment, its geography and its amenities. That community sits in a broader society, and that society could be within a provincial level, within a national level, but the cultural influences in that society make a big difference to what the community is doing, what the family is doing and what the individual is doing.

If you think of the connections of all those things, outward from the individual to the broader society, and then the influences of society, community, family on the individual, I think that is actually a really constructive way of dealing with something as complex as childhood obesity. Obesity, unfortunately, is not like dealing with something as straightforward as measles. We have a vaccine for measles. We give you the vaccine. We give you two doses as a child. You'll probably never get measles in your lifetime. All you have to do is convince the parent to bring the child for the shot to prevent measles, and that's it.

For that kind of approach in a public health sphere, we use a very simple model where we tell the parents what the risks of measles are. We have the vaccine available. We encourage the parent to come for the shot. The child gets the shot, and that's the end of the story. With physical activity, healthy lifestyle, healthy eating, the issues like obesity, cardiovascular disease and some types of cancer that are related to lack of physical activity and obesity, it's not that simple. You

have to use a very complex model, because behaviour is involved, the environment is involved, the person is involved, and there are different aspects of those three pieces of the puzzle.

There's an approach called social learning theory that actually looks at which pieces are affected in which ways and how to intervene in those areas. If one looks again at this ecological model, you can see that you can look at individual approaches, family approaches, community approaches and then societal approaches to dealing with this issue.

Since there's been such a change, it's clearly not because everybody's genes have changed. We do know that genetics has a significant role to play in obesity, how tall a person ends up being, how large a person ends up being, their bone mass and their body mass. There is a significant portion to genetics — a predisposition to being overweight, etc. — that is not easy to fix. But because of the speed of this change, we also have to look at what's been called the obesigenic environment, which is the community, the environment and the society we're living in where we're at more risk of becoming obese.

There are many, many issues that are related to that. I'm sure you've heard those along the way in your deliberations. One is that there are more convenience foods available than there ever used to be. People are in a real rush. Parents are in a hurry. Two parents have to work. It's not like when I was growing up where my mother stayed at home. We walked in the door at four o'clock or three o'clock in the afternoon, and there was fruit on the table. Then we ran out and played for two hours in the backyard, and mom could watch.

People are both working quite hard quite often nowadays. There are two-parent families where both parents are working. There are a lot of single-parent families now where the mothers are working. It's very difficult to cope. So there are convenient foods that are quick. Unfortunately, there are studies that show that the longer you have to take to prepare something, the less likely you are to prepare it.

We also have more high-calorie drinks than ever before. Portion sizes have changed dramatically in the last ten or 20 years. There's more snack food available. There are thousands and thousands of types of candies and snack foods out there now, where there didn't use to be. There used to be several choices, and now there are thousands of choices. So we have more choice; children have more choice.

The nutritious food usually ends up being more expensive than food that isn't so nutritious. Also, the low-calorie food is full of vitamins, etc., like an apple, which is only 44 calories, but it will still fill a child up after school. That's 44 calories. A child eating a bag of potato chips, which is still about the same price — a dollar — will get 300 calories. That's a huge difference of 250 calories that that child now has to burn off. If they're doing less exercise and have less physical activity and don't get out in the backyard to play or if they can't run up and down the street to play with other kids outside of school, then that's going to be hard for them to make up that difference.

As you can see, this is an example of the nine-pound hamburger, and somebody actually trying to eat a nine-pound hamburger. Fortunately, that isn't the norm. However, we do have a very high level of availability of high-fat foods, calorie-dense foods.

In one study done in the United States by the American Psychological Association Task Force on Advertising and Children, in their report, children are subjected to 40,000 advertisements per year per child in the U.S. of A. The most common advertisements relate to toys, cereals, candies and fast-food restaurants. It's well known that people advertise and spend hundreds of millions of dollars because it gets results.

We also have changing patterns of physical activity in society. The supremacy of the car, where everybody drives a car everywhere — to the bank…. You drive your child to school. They don't walk to school anymore.

When I was a child, I took a bicycle to school. It was a mile away. As soon as the weather was good enough in Hull, Quebec, I bicycled. My parents didn't worry about anything. They weren't worried about my safety. I'd bicycle with a couple of friends, or I'd go alone in the later years of grade school. No one batted an eye, whereas nowadays I think that there's quite a serious concern about safety.

Neighbourhood design is another issue. A lot of the neighbourhoods are not designed with parks that are easily accessible. It might be quite a distance to a park. There are studies that show that if you have accessible recreational facilities, children and adolescents will use them. If they're not accessible fairly easily, then you get reduction in use. It seems quite obvious, but….

There's another thing that's happening now, and that is increasing screen time. In the early days we used to talk, years ago, about maybe watching an hour of TV a day, and that was a privilege. In the days when colour TVs were just coming out, it seemed like an hour a day was quite something. Nowadays, actually, there are studies that show that children who are exposed to over four hours a day of TV or video games or time on the Internet will actually have higher rates of BMI than not.

R. Sultan (Chair): Dr. Young, I didn't mean to intrude, but I will. I think the committee is very interested in the solutions to the syndrome that you have very graphically described. We want to leave a few minutes for questions. So you could perhaps take that into the kilocalories you're burning up.

E. Young: Okay. Again, this idea of the walking bus is a really good idea, and that was mentioned earlier. If you look at the proportion of children who used to walk or bike to school in 1969 compared to 2001 — hugely different. The walking bus is a great idea for getting kids to school.

Looking at screen time. The proportion of overweight and obesity related to that, I think, is encourag-

ing parents to encourage children not to watch more than a couple of hours a day or to spend more than a couple of hours a day on a combination of television, Internet, etc., so that the rest of the time they can get outside and do exercise, play — that kind of thing. Play, especially unorganized play, has been shown to really significantly reduce your body mass index.

There is a link between socioeconomic status and obesity and overweight. This particular problem of obesity crosses all levels of socioeconomic strata. However, people who don't have enough money to put kids into sports, etc., or to get to a particular field or to provide good nutrition have a higher rate of children with obesity or overweight. The costs are huge, and I'm not going to go into those, but they're in the hundreds of millions of dollars a year. We need to look at individual issues, as I mentioned in that ecological model, and then also look at the societal, environmental and cultural aspects.

Again, going back, you don't need to do a lot to make a big difference, and it doesn't all have to be done at once or in a short time. One can of pop is about 125 calories. One can of pop a day or 125 calories a day — it doesn't matter how you get it — above daily energy requirements is 50 kilograms of weight in ten years, if all else was equal. That shows you that you don't really need to make big differences. You just need to do things consistently.

Dr. Kendall likes to use this slide. Healthy eating is on the bottom row. It looks at: are we doing enough in education? Is there enough access? Is there strategic planning going on? Is there social support available? Is there regulatory support available? Is there sustained support available for things like healthy eating, healthy living, etc.?

As you've heard from the Deputy Minister of Health and from many people who have come and talked to you, there are many new programs — ActNow B.C., Action Schools B.C. — that are going to be contributing to some of those columns that are listed there. But this is a very complex issue where we need to look at primary prevention and secondary prevention.

Primary prevention also includes education. We know that children with higher education do generally exercise more as adults. We need policy approaches and environmental approaches with respect to cities, walking trails and walking school buses, as I've mentioned, and school breakfast programs where children are provided with nutritious breakfasts. It's amazing how many kids get to school without breakfast these days. Community kitchens and gardens are some community things that people can do.

Healthy-eating cooking classes in the schools as a proximal contributor to helping people to change their way of dealing with the particular foods that they cook. Unfortunately, a lot of the fast food you can cook in the house is fried and easy to do. It doesn't require a lot of skill in cooking. People just throw stuff on and fry it, and you get a lot of calories from things that are fried, generally.

There are school prevention programs, which Action Schools B.C. has been talking about. Then there are the high-risk strategies where for that small percentage of children who are very obese or obese, you do need to start looking at what their cholesterol is, look at them for diabetes, check their blood pressure, etc., in a family practice setting.

You've heard about all of these programs — junk food–free schools, the B.C. Healthy Living Alliance, school healthy foods programs, the fruit and vegetable snack program. I'm not going to go into any of those, because I'm sure you've heard lots from the people who are doing those, but I think one of the things we want to do is make healthy choices, easy choices. Education is a real key to that. It's not only educating children in schools about what's good, because they will take that education and information back to parents, but it's also educating the community about what foods are good.

Families. Working with community groups, non-governmental organizations, etc., is really important and making sure that food security is an issue that's dealt with. We've talked about community interventions, with gardens, etc., and, also, having more research on what works and what doesn't. There are many studies on the different aspects of intervention in trying to reduce obesity. Some show positive effect, and some don't show much effect at all. There's clearly a lot more research that needs to be done.

Monitoring and regulating marketing approaches of the food industry is something that needs to be considered. Urban sprawl is significantly related to obesity. People use their cars. They don't walk. Therefore, the children are in the cars. They don't walk when mom goes to the store to pick up something. There's community design, adequate incomes, commitment to actions and goals, which I think is one of the things that you're working on: developing goals for this.

I think, though, one thing we have to be very cognizant of, and I'm sure you are, is primum non nocere, which means: "First, do no harm." I read an interesting article by O'Dea, who talked about the fact that with the best intentions, we can actually create more problems than we're solving. I think we have to be really careful about focusing on obesity and developing solutions around that. We've had this message about "control your weight" for the last 30 years in North America, and we've now got more people who are overweight and more people with eating disorders.

We don't want to equate health with weight. The state of health is the state of physical, mental, emotional and spiritual well-being if you look at the World Health Organization definition of health. It's not: "How much do you weigh?" Actually, there are studies that show that children who are overweight, if they're exercising physically, are in pretty good shape. It's the same with adults. You can make a big difference with your diabetes or anything else without losing weight by just doing exercise. Now, you can't lose weight just doing exercise. Most studies show that you actually need calorie reduction as well.

One of the risks of focusing on a solution to addressing obesity and focusing on that is that you may increase weight concerns. You may increase self-consciousness. Teenagers are notoriously self-conscious, especially when they get to around puberty. Adolescent girls and boys are very self-conscious when they hit puberty. You don't want to decrease self-esteem, and if you focus on something that they might see as wrong with them…. Actually, children who are normal weight often see themselves as overweight if you ask them. We don't want to increase dieting, quick fixes, fad diets, taking slimming pills or smoking and that kind of thing to reduce weight. We don't want to increase poor body image, and we don't want to stop them from wanting to exercise.

It's the same with prejudice, stigmatization, social marginalization, emotional distress, victim blaming, shame and guilt or medicalizing overweight. I think those are things we want to avoid. The take-home messages from us would be: to promote a healthy life, increase physical activity, increase healthy eating, look for gradual lifestyle changes and increase self-nurturing. All children need good nutrition. All adults need good nutrition, and all in society can benefit from appropriate physical activity. I think the goal should be healthy children, healthy families, healthy communities.

R. Sultan (Chair): Wow. Dr. Young, you have covered a lot of ground. I think we have time for two or three questions.

M. Sather: The question about children being at risk in walking to school comes up a lot. What are the stats? Do you know what the stats are around the risk of serious harm to children in walking or bicycling to school, particularly from adults but perhaps from older children? Has it changed over the decades? What is the reality around that?

E. Young: That's a really difficult question, because it's so difficult to measure that. We talk about increasing bullying, and there are programs for that. I think the key is to identify what those risks are and try and change those risks. Whether they're increasing or whether they're the same, they might still be unacceptably too high.

Safe roads and safe paths to get to school are extremely important. Is that what you're talking about?

M. Sather: I'm thinking particularly of risks from other human beings, being harmed by other humans, not car accidents.

E. Young: I don't actually know the answer to that, but I'm sure the police would. Certainly, there's a lot of media information on child abduction and this kind of thing. If something happens in some southern state in the United States, you'll hear about it. It's front-page news. It's on the news hour after hour after hour. Whether there's any increase in that now in B.C. as compared to 30 years ago, I don't really know.

Sorry. I can't answer that question, but it's a really important question. It may be just a question of perception rather than reality. I would suggest that if the police have that information, you might get it from them.

D. Cubberley (Deputy Chair): This is perhaps pushing a little bit beyond your presentation, but you identified the obesigenic environments, and you identified at some level the problems of urban sprawl and the need to look at community design. Do you see the need to retrofit existing environments to make them friendlier for physical activity? I want to go one step further. Who should be initiating the change?

E. Young: I think the objective should be to increase space for safe physical activity for children and spontaneous unorganized as well as organized physical activity. I think what needs to be done is that every community has to…. That's what municipalities are there for. That's why people elect governments. That is to provide a healthy, whole community for people to live in — an organized, safe community, etc. That's why it's so important that groups like…. The Union of B.C. Municipalities is getting some funding from the government now, as you know, to develop that whole healthy community concept.

It's up to communities, I think — neighbours — to look at what's available in their neighbourhood and up to community groups to get together to then go talk to the municipality. I think retrofitting, if it's needed, is a really good idea. I think every single community, municipality, neighbourhood needs to look at its own space and try and make sure that that space does the most it can for the most people.

That includes the elderly as well. As I say, this shouldn't just be seen in the context of childhood obesity. It's very important for the elderly to be out walking, to feel safe and to have a place to exercise. We know that the more physical activity you do over your lifetime, you get a reduction in osteoporosis, in fractures of the bones — all of those kinds of things that start appearing later in life, as well as cardiovascular disease and diabetes.

I think it's a really important thing to do — that every community looks at what's available and basically makes changes so that there is adequate recreational space for everyone.

R. Sultan (Chair): The bells have signalled imminent opening of today's legislative session, and many of us have to depart and go on duty in the House.

I would like to thank Dr. Eric Young, the deputy provincial health officer, and his colleague Dr. Chris Mackie from Toronto. It's nice to have you out here.

Anyway, it was sobering to hear your message, and it is very helpful to the work of the committee.

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.

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