Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy
Canada’s health ministers will meet in Vancouver on January 20, 2016. It is good to know we have a federal government that will engage with the provinces on health care. Let’s hope they will engage on health, not just health care.
Forty years ago, the Trudeau government of the day produced the fabled Lalonde report. It became the first government in modern times to acknowledge that further improvements in the health of the population would not come primarily from more health care.
Instead, the report boldly stated: “There is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology.”
Initially, there was a strong focus on changing personal behaviour, forgetting that our choices are largely shaped and constrained by environmental, social, cultural, economic and commercial pressures, and that “lifestyle” is a collective noun.
But our experience with tobacco has shown clearly that a combination of legislation, taxation, environmental change, enforcement, social marketing and education can change the social norm and massively reshape individual and collective behaviour.
Today, perhaps the greatest threat to our collective health comes not from what we smoke, but what we eat. Obesity, it is said, is the new tobacco, while unhealthy food also contributes to heart disease, cancer, dental decay, diabetes and other ailments.
So while the ministers might want to talk a lot about the costs of health care, they need to recognize that the burden of disease — and the economic cost of treating these diseases — could be significantly reduced if they focused more on a healthy food policy for Canada.
A good place for the ministers to start is with the failed efforts to reduce salt levels in our diet, especially in processed and fast foods. An article published in CMAJ in 2012 noted: “The numbers of deaths averted by moderate reductions in population salt consumption would be at least as many as those achieved by plausible reductions in population smoking rates.”
Moreover, that same article reported that for a variety of fast-food products from six major companies in six western countries, “individual items marketed as the same product had very different levels of salt in different countries.”
Levels were generally highest in the U.S. and Canada and lowest in France and the U.K.
Regrettably, but consistent with its general preference to protect the health of corporations rather than the health of people, the Harper government did little. Its voluntary approach, as predicted, has largely failed. It didn’t work with tobacco, so why would it work for salt?
It’s time for a much stronger response, ministers. Time to take what we learned from fighting tobacco and turn it on eating, starting with salt.
But it’s more than salt. We also have to address levels of sugar and fat, and we also have to address the elephant in the room: portion size. The food industry’s unhealthy private policies are a major public-health problem that must be tackled forcefully.
A good place for positive action is healthy food for our children, because if we can establish healthy eating patterns early, we have some hope that they will remain healthy for life. Moreover, the benefits of healthy food for our children extend beyond better health to include learning and economic benefits.
The National Coalition for Healthy School Food, which includes the Heart and Stroke Foundation and several indigenous health organizations, among others, notes: “One-third of students in elementary schools and two-thirds of students in secondary schools do not eat a nutritious breakfast before school, leaving them at risk for learning, behavioural and health challenges at school.”
This also reduces their likelihood of graduating and harms their future job prospects and income potential.
The coalition is calling on the federal government to invest $1 billion over five years “in a cost-shared universal healthy school food program that will enable all students in Canada to have access to healthy meals at school every day.”
It’s time for a healthy food policy for Canada, one that promotes healthy eating and combats unhealthy food products.
This needs to be on the ministers’ Vancouver table.
Editor's note: This blog was originally published in the Times Colonist.