Towards a Comprehensive Food Policy for Canada Championing

Towards a Comprehensive Food Policy for Canada Championing Public Health Nutrition Centre for Science in the Public Interest Dr. Carolyn Bennett, MP October 23, 2008

Food, Glorious Food

Comprehensive Food Policy for Canada Healthy Canadians…. Healthy Planet Good social policy = Good economic policy = Good environmental policy

National Food Policy n n n n Food security Food protection Ethical international development Sustainable agriculture, fishery Industry - strategy like tobacco won`t work Healthy choices Multicultural buffet

Across all departments n n n Agriculture Fisheries Industry Health Indian and Northern Affairs Environment International Trade International Development Finance Human Resources and Skill Development Transportation

Sir Michael Marmot Chair, WHO Commission on Social Determinants of Health “The worst thing for a physician is to help someone get well and then send them straight back into the situation that made them sick in the first place”

Canadian Institute for Advanced Research n n 25% health attributable to health care system 15% biology and genetics 10% physical environment 50% social and economic environments HEALTH VS HEALTH CARE

“Reorienting health systems” FROM a health CARE system TO a true system for HEALTH

Humbling reality n The health of our population cannot be the sole responsibility of the Ministry of Health and the health care sector.

Canadian legacy n n n Tommy Douglas… Father of Medicare Lalonde Report 1974 Ottawa Charter 1986 SARS, Naylor Report 2003 WHO Commission SDOH 2005 Health Goals for Canada 2005

Goal of Medicare… n Sharing risk n n getting people the health care they need when they need it Keeping people well not just patching them up once they get sick

The Tyranny of the Acute As long as citizens think of the sickness care system whenever they hear the word ‘health’ we are not going to be able to reorient health systems.

Fantasy

The Em PHA sis is on the wrong syl LAB le

Fleeing the Medical Model, Embracing the Medicine Wheel

Blame Hippocrates?

Affirm Hygeia HYGEIA: Goddess of Health

The solutions are complex For every complex human problem, there is a neat simple solution, it’s just that it’s wrong… HL Mencken

Complex doesn’t fit into a 7 second sound bite…. . or on a bumper sticker We must fiercely defend the complex solutions for the complex problems. . BUT……we need simpler messages

Citizens have to ‘get it’ n n n More health …less health care Service contract ? ? ? Or longer warranty ? ?

Putting the Public back into Public Health n Civic Literacy …. . individual n Civil Society…. Community Action

HOWEVER…… Public policy usually follows public opinion…. BECAUSE……. Doing the right thing is very difficult is the people aren’t onside… n “Father knows best” not great politics

Political Will to do the right thing n n Dramatically improves with an educated public…… health literacy Citizens pulling healthy public policy…. Civic efficacy

“What we have here is a failure to communicate” Cool Hand Luke 1967

Health Literacy Quiz n Empowerment Pulling Healthy Public Policy Putting the Public back into Public Health

Public Health 101

1. Do you think we should have a: A) strong fence at the top of the cliff B) state of the art fleet of ambulances and paramedics waiting at the bottom ?

2. Would you prefer: A) Clean air B) Enough puffers and respirators for all

3. Would you prefer that wait-times were reduced by: A) a falls program to reduce preventable hip fractures B) private orthopaedic hospitals and more surgeons

4. Should we invest in: A) early learning, child care, literacy, the early identification of learning disabilities and bullying programmes B) increase the budget for young offenders’ incarceration

5. Should we: A) assume that the 'grey tsunami' will bankrupt our health care system B) include our aging population in the planning of strategies to keep them well

6. Is the best approach to food security: A) food banks and vouchers B) Income security, affordable housing, community gardens and community kitchens and a national food policy

7. Pick the one that is NOT correct Pandemic Preparedness should focus on A) Tamiflu for all B) Working with the vets to keep avian flu a disease of birds C) Making sure people wash their hands especially the doctors and nurses D) Research on vaccines E) Community care plans for our most vulnerable

8. Governments should boast about: A) B) how much they spent on the sickness care system the health of their citizens, leaving no-one behind

Social Determinants of Health vs Choose Health (modifiable risks)

The Causes of the Causes Versus The Causes

Evolution of the Healthy Canadians Tree

Communiqué FMM September 2004 n “In addition, governments commit to accelerate work on a pan-Canadian Public Health Strategy. For the first time, governments will set goals and targets for improving the health status of Canadians through a collaborative process with experts.

Health Goals for Canada Overarching Goal As a nation, we aspire to a Canada in which every person is as healthy as they can be – physically, mentally, emotionally and spiritually.

Health Goals for Canada is a country where: Basic Needs (Social and Physical Environments) Our children reach their full potential, growing up happy, healthy, confident and secure. The air we breathe, the water we drink, the food we eat, and the places we live, work and play are safe and healthy - now and for generations to come.

Health Goals for Canada is a country where: Belonging and Engagement Each and every person has dignity, a sense of belonging, and contributes to supportive families, friendships and diverse communities.

Health Goals for Canada is a country where: Belonging and Engagement We keep learning throughout our lives through formal and informal education, relationships with others, and the land. We participate in and influence the decisions that affect our personal and collective health and well-being. We work to make the world a healthy place for all people, through leadership, collaboration and knowledge.

Health Goals for Canada is a country where: Healthy Living Every person receives the support and information they need to make healthy choices.

Health Goals for Canada is a country where: System for Health We work to prevent and are prepared to respond to threats to our health and safety through coordinated efforts across the country and around the world. A strong system for health and social wellbeing responds to disparities in health status and offers timely, appropriate care.

Health Goals n n n Choose indicators Include stakeholder in choosing meaningful and realistic but bold targets Develop real strategies…. n what, by when and how

French Paradox n Celebrating FOOD & DRINK…… thinner n North America n n Food = Guilt Obesity epidemic

Canada’s Food Guide ? ? Evidence ? ? Changing behaviour

Canada’s Food Rules - 1949

Canada’s Food Guide -1961

Canada’s Food Guide -1977

Canada’s Food Guide -1982

Canada's Food Guide to Healthy Eating -1992

Eating Well with Canada's Food Guide - 2007

Previous US Dept of Agriculture Pyramid

Walter Willett’s Healthy Eating Pyramid (from Eat, Drink and be Healthy)

New USDA Pyramid

What are Canadians to do ? n n n farmed salmon blueberries pomegranates red wine Carbs yes, carbs no No fats, good fats

Dr. Jay Wortman Alert Bay Project

National Food Policy n n n n Food security Food protection Ethical international development Sustainable agriculture, fishery Industry - strategy like tobacco won`t work Healthy choices Multicultural buffet

National Food Policy n n n n Food security Food protection Ethical international development Sustainable agriculture, fishery Industry - strategy like tobacco won`t work Healthy choices Multicultural buffet

Community Action n n Food Security Farmer`s Markets Community Gardens Community Kitchens Schools…. n n Enrichment Clusters Home Economics

horizontal – departments Structure Gridlock vertical - jurisdiction

Structure Silo- busting - Horizontality n Ministries or Ministers n Cabinet committees n Parliament n Officers of Parliament - Commissioners

Structure n Jurisdictional squabble n SARS …. Naylor report. . Collaboration n Cooperation n Communication n Clarity of who does, what, when n

Population Health: Keeping Canadians healthy…. n ‘Citizen centered’ federalism… n n bottom up Complexity n n Strong common purpose Local wisdom, local knowledge to get it done

Whole of government n `total cost accounting` n n Marilyn Waring …`Who’s counting ? ’ Annual Report of the Chief Public Health Officer for Canada

Process …. Health in all Policies n n Article 54 in PQ HIA…. All MC’s , budget, TB guidelines Citizen Engagement Parliament: The Use of Societal Outcomes for Parliamentarians, 2002.

Process – role of legislation n n n Vit D Folic Acid Seat belts Childhood immunization Exercise Diet Drinking and driving

Research n n Evidence-informed practice Practice-informed evidence n Courage to fund what works Courage to stop funding what doesn`t n Complex adaptive systems… n

Sir Michael Marmot “Evidence is not enough. There has to be the desire, the political will for change. Given that will - a big given but I am an optimist - the evidence of what works will be a great help. ”

No time for pessimists

Research Practice Policy

Research KT Practice Policy

Research KT Practice Policy Political will

Applied research Practice Research KT Policy Political will

ENGAGED CITIZENS Applied research Practice Research KT Policy Political will

What do we mean by food security? n Food and the Quality of Life n the social, cultural and local economics impacts of food production and consumption

What do we mean by food security? n Food, Health, Social Justice and Security in the Canadian ( & regional) context

What do we mean by food security? n Food Production and consumption in the global context & Canada’s responsibilty n global consequences of agricultural practices and food distribution systems on human well being and the environment

Towards a Comprehensive Food Policy for Canada n Symposium – n n n was supposed to be October 14 !!! 10 Working Groups Rural/Urban Collaboration – n Eluminate software

The Global forces of Food Security n n n Failed economic policies have privileged food as a commodity, not as a human right NAFTA & trade concerns Fair Trade-ethical international development

Ecological Threats to Food Security n n n Climate change and green house gases Water issues GMO’s

Pesticides & chemicals n n domestically SPP with U. S. Race to the bottom China !!

Biodiversity and Food Sovereignty n n n Aboriginal / traditional foods “put the culture back into agriculture” Multicultural

Redressing Food Security: New Approaches to Farming/Fishing n n n Sustainable agriculture Sustainable fisheries-fish farming/overfishing urban agriculture n n bee hives on top of Royal York Cuba

Food Security and Public Health n n n Education/Healthy schools Nutrition Tax Policy Labelling Marketing

Food Security and Food Safety Regulation Labelling Making informed choices n n n n n ethical, religious, health GMO’s nutraceuticals functional foods ingredients from elsewhere masking a poor food system with newly enhanced foods and vitamins is not the way to go. Address the root cause by growing healthy food from good soil that doesn’t have a huge carbon footprint in the first place

Food Security and Poverty n Pay the Rent or Feed the Kid? n n n Affordable housing Food banks Income security Community gardens Community kitchens

Food Security and Land Use n Ethanol-land water food or fuel?

Food Security and Local Economies n n Marketing regionally, not just national (federal support) institutional food procurement n n n federal government could adopt a 10 % purchasing policy of local foods like U. of T. ban all bottled water urban/rural culinary/agri-tourism local food markets

Addressing the public’s concerns through Practice & Policy Rationale for a Comprehensive Food Policy ``walking the talk`` n Jurisdictional Platformn n Root Causes of the Food Crisis intergovernmental regulations subsidies sliding regulatory system based on scale n n new meat regulations are ruining small producers like the lamb on Salt Spring Germany has addressed this issue very well)

ENGAGED CITIZENS Applied research Practice Research KT Policy Political will

“We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of our generation, so that stronger and more able generations may come after. ” Dr. Elizabeth Blackwell first woman physician

“A politician thinks of the next election, a statesman thinks of the next generation” James Freeman Clarke